Health promotion co-existing in a high-security prison context : a documentary analysis

Purpose: There is interest in promoting health in prison from governmental levels, but, to date, understanding how best to do this is unclear. This paper argues that nuanced understanding of context is required in order to understand health promotion in prison and examines the potential for empowerment, a cornerstone of health promotion practice, in high-security prison establishments. Design/methodology/approach: 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. Documentary analysis was undertaken on all eight high-security prison reports using framework analysis. Findings: Analysis revealed elements of prison life which were disempowering and antithetical to health promotion. While security imperatives were paramount, there were examples where this was disproportionate and disempowered individuals. The data shows examples where, even in these high-security contexts, empowerment can be fostered. These were exemplified in relation to peer approaches designed to improve health and where prisoners felt part of democratic processes where they could influence change. Practical implications: Both in the UK and internationally, there is a growing rhetoric for delivering effective health promotion interventions in prison, but limited understanding about how to operationalise this. This paper gives insight into how this could be done in a high-security prison environment. Originality/value: This is the first paper which looks at the potential for health promotion to be embedded in high-security prisons. It demonstrates features of prison life which act to disempower and also support individuals to take greater control over their health.