Promoting health in prison.

In previous articles I have set out the challenges of providing healthcare in prisons and have examined the problems in British prisons of elderly prisoners, women prisoners, and prisoners with mental disorders. In this final article of the series I highlight how prison contributes to the treatment of people who are “hard to reach.” Many British prisoners come from the most economically deprived and socially disadvantaged groups within society. They share with these groups the experience of being raised in care, low educational attainment, unemployment, and homelessness (table 1⇓). Some minority ethnic groups are substantially over-represented (table 2⇓). Many prisoners have chaotic lifestyles and complex health and social problems. They may also have limited health aspirations and low expectations of health services, which may not have the flexibility to respond effectively to their needs. Prison can provide an opportunity for the orderly assessment and treatment of those whose lifestyle has previously prevented engagement. Prisoners can be encouraged to adopt healthier behaviours, and prison can be viewed as an opportunity to address health inequalities.However, prisons are not principally in the business of promoting health and some people argue that there is an inherent contradiction between the aims of care and control. Prisons have values, rules, and rituals that enable prisoners to be observed, contained, and disempowered ; these are at odds with any notion that prisoners can be encouraged to take charge of their health. In addition, any discussion about the health of prisoners cannot ignore the broader question of whether prison is the right place for many offenders. Health promotion in prison