Rationale and Mandate for Health Promotion in Correctional Facilities

To assist correctional health programs to shift from the current focus on acute care for those in custody to health promotion for populations entering and leaving correctional facilities, it will be necessary to provide a compelling rationale and some external mandate for health promotion. Such arguments can help correctional health staff already interested in this approach to convince their superiors to support such efforts and may persuade policy makers to consider a shift to a health promotion perspective.

Here we review four different approaches to defining standards and models for correctional health care:

1. American Public Health Association's (APHA) Standards for Health Services in Correctional Facilities (2003)

2. National Commission on Correctional Health Care's (NCCHC) Clinical Guidelines (2001, 2003)

3. Re-Entry Policy Council Policy Statements on Physical Health Care (2005)

4. from Europe, the Health in Prisons Project (HIPP), sponsored by the World Health Organization (WHO) (Gatherer, Moiler, & Hayton, 2005; Whitehead, 2006; WHO, 2006)

The APHA guidelines were developed in 1976 and revised in 2003 by correctional health professionals to encourage appropriate health care in correctional facilities that is respectful of patients' rights. The intended audience included medical and nonmedical corrections staff and community-based public health professionals (APHA, 2003).

The NCCHC developed a set of clinical guidelines (2001) to assist health care workers with management of illness in correctional settings and improve incarcerated patient outcomes. The NCCHC also developed a document (2003) that specifically addressed health education within correctional facilities.

The Report of the Re-Entry Policy Council (2005) included policy statements drafted from meetings of 100 professionals in workforce, health, housing, public safety, family, community, and victim services. The statement on physical health care addressed prevention, management, and treatment of chronic and infectious disease.

Finally, the Health in Prisons Project (HIPP) was started in Europe in 1995 by the WHO with the goal of improving health in prisons in order to improve public health (Gatherer et al., 2005). Member countries (there are currently 28) have pledged the resources necessary to build a public health infrastructure in prisons and participate actively in the collaboration (Whitehead, 2006).

Together, these documents demonstrate that a wide variety of correctional health and criminal justice professionals and organizations support the inclusion of a health promotion perspective within CHS. In our review of these guidelines, we identified seven program activities that can provide an operational definition of health promotion within correctional facilities. These were counseling, health education, chronic disease management, community follow-up, collaboration, meeting other social needs, and policy advocacy. These activities are not mutually exclusive, e.g., chronic disease management can include counseling, health education, and community follow-up, but each activity has distinct characteristics, as defined in Box 13.1. Table 13.1 summarizes how each of the four standards or guidelines describes these activities. Note that not every standard addresses all seven activities. For example, only HIPP includes policy advocacy as a core activity and the focus on reentry is a more recent development, highlighted by the Re-Entry Policy Council.

In summary, we have so far presented two different approaches to describing health promotion within jails and prisons. The first, using the "key activities" for health promotion developed by WHO, provides a broad framework for an alternative paradigm for the mission of CHS. The second, derived from existing standards for CHS, delineates specific health promotion activities that are described in existing guidelines for CHS. In a later section, we summarize evidence from the literature on existing health promotion interventions in correctional facilities and in the community after release, using the WHO "key activities" as the organizing rubric. First, however, we review contextual and organizational factors that influence health promotion in the correctional system.

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