Practical Steps to Reduce Health Inequalities in Prisons: A Public Health Approach

Increasing health inequality has been a long-standing issue across the UK, and one of the key places where this is becoming increasingly stark and contrasting to the general public is within UK prisons. According to Public Health England, mortality rate for individuals in prison is 50% higher than the rest of the population, while 42% of males and females in custody and 17.3% on probation experienced depression, compared to around 10% of the rest of the population.

In order to narrow this gap, your prison must start by consider the 8 key ‘P’s to reducing health inequality in prisons before they take action on a strategy to end health inequality between the prison population and the general public. These include

• Person-centred language
• PHE & WHO roles
• Principles for prison health
• Public health needs & health inequalities
• Public health approach to prison health
• Partnerships
• Programmes of work
• Parliamentary and other scrutiny

The above form the ‘bread and butter’ of reducing health inequalities so below delves deeper into the practical aspects which should and can be used within prisons to help ameliorate the issue:

Taking a Public Health Approach to Prison Health

• It’s important that prison staff understand individual’s needs in prison. This can be achieved by collating and utilising data and published evidence resources to define health & social care needs of people in prison.
• Staff must recognise that many of the determinants of ill-health and social need happen prior to and following imprisonment, therefore it is important to look at the bigger picture through a whole care pathway by taking account of the prior to, during and post-imprisonment circumstances of individuals.
• It is always a good idea to use, design and implement evidence-based interventions informed by principles of equivalence of health outcomes and after implementing these it is important to evaluate, review, refine and redesign these. This will help your staff know what is successful and what works less well.
• Working collaboratively across sectors to overcome health inequalities. For instance, prison staff can learn a lot from the health sector and from charities and vice versa, therefore regular partnership working through termly meetings or other forms of collaboration is encouraged.

There are many tangible benefits to following a Public Health Approach to reducing health inequality in prisons which lead to community dividend.

By improving the health of people in prison, the cost to the NHS is reduced and the incidence of reoffending reduces which reduces the cost to law enforcement.  Furthermore, lower crime rates will lead to more community safety while supporting rehabilitation will increase levels of productivity and social cohesion.

Therefore, it is crucial that prison officers and the organisations working within and across the criminal justice system.

The above suggestions have been developed by Public Health England in order to deliver improvements in reducing health inequality among the general public and prison population.