Promoting health and well-being in prisons: an analysis of one year’s prison inspection reports

There is renewed optimism about the development of policy and practices related to promoting health in prison settings, driven by the epidemiological data which suggests that the health of people in prison remains very poor. In England and Wales, the focus of this paper, independent prison inspections, conducted by Her Majesty’s Inspectorate of Prisons for England and Wales (HMIP), form a critical element in how prisons are assessed. This includes efforts within prisons to promote health and well-being. This paper, using content and thematic analysis, analyses one year (2018) of inspection reports in 38 male prisons. Analysis demonstrates that a ‘whole-prison approach’ to promoting health and well-being is poorly understood, with only 41% of prisons showing characteristics of this approach. Of the male prisons inspected in 2018, there was good availability of disease prevention activities and screening programmes (88%) and smoking cessation support (94%). The provision of peer support mechanisms, access to condoms and access to health information was highly-variable across prisons. The paper makes several conclusions about the state of health promotion in prison and moreover the current criteria adopted by HMIP to assess health and well-being which seems to offer a very narrow biomedical perspective.