Health promotion and prison settings Lidia Santora, Geir Arild Espnes and Monica Lillefjell

Lidia Santora is a Researcher and Geir Arild Espnes is a Professor, both are based at Department of Social Work and Health Science, Norwegian University of Science and Technology NTNU, Trondheim, Norway. Dr Monica Lillefjell is an Associate Professor, based at Department of Health and Social Care, Sør-Trøndelag University College (HiST), Trondheim, Norway and Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway.

Abstract Purpose – The purpose of this paper is to examine the contribution of modern correctional service in health promotion exemplified by the case study of Norwegian health promotion policies in prison settings. Design/methodology/approach – This paper applies a two-fold methodology. First a narrative systematic literature review based on the Norwegian policy documents relevant for correctional settings is conducted. This is followed by a general review of the literature on the principles of humane service delivery in offender rehabilitation. Findings – Alongside the contribution of the Risk-Need-Responsivity Model in corrections and prevention of reoffending, the findings demonstrate an evident involvement of Norway in health promotion through authentic health promoting actions applied in prison settings. The actions are anchored in health policy’s overarching goals of equity and “health in all public policy” aiming to reduce social inequalities in population health. Originality/value – In order to achieve a potential success of promoting health in correctional settings, policy makers have much to gain from endorsing a dialogue that respects the unique contributions of correctional research and health promotion. Focussing on inter-agency partnership and interdisciplinary collaboration between humane services may result in promising outcomes for individual, community and public health gain. The organizational factors and community involvement may be a significant aspect in prisoner rehabilitation, reentry and reintegration. Keywords Health promotion, Prison, Reintegration, Throughcare Paper type Literature review

Introduction Intuitively, one may think that there is no better suited environment for health promotion than correctional settings. Indeed, one of the highest concentrations of poor physical, mental and social health often related to illicit substance abuse can be found in prisons (World Health Organization, 2007a; Fazel and Baillargeon, 2011). According to correctional research, the majority of prison populations also tend to have a myriad of personal, social and financial problems, often exacerbating throughout life (Visher et al., 2004). Besides having a history of social isolation and marginalization, many offenders are challenged by skills deficits that make it difficult for them to compete and succeed in the community (Social Exclusion Unit, 2002). Most individuals who enter prisons need assistance to improve their life and health conditions in addition to finding alternate prosocial thinking and behavioral styles in order to break the cycle of their criminal conduct. Quite right, prisoners’ clinical and/or social health problems, if left unaddressed while in custody and upon release, may in all probability have an adverse impact on the well-being of not only (ex)prisoners’ themselves but also the health and well-being of their families, the community they live in and public in general. In the absence of material, psychological and social support at the time of release, offenders may have a very difficult time breaking the cycle of release and rearrest (Griffiths et al., 2007). Recognizing prisoners’ health as an almost ever present globally distributed public health problem, in 1995, the World Health Organization (WHO) established Health in Prisons Programme (HIPP). Prison settings were thought to provide an opportunity for health promotion to address and improve all aspects of health in prisons (Gatherer et al., 2005). The HIPP advocates

DOI 10.1108/IJPH-08-2013-0036

VOL. 10 NO. 1 2014, pp. 27-37, C Emerald Group Publishing Limited, ISSN 1744-9200

j INTERNATIONAL JOURNAL OF PRISONER HEALTH j PAGE 27

promotion of the “whole-prison approach” in which health of inmates and staff as well as work and secure environment are crucial to assisting prisons to implement health promoting and reforming interventions. The Trencin statement on prisons and mental health underlines that “it is in the best interest of society that the prisoner’s health needs are met, that prisoner is adequately prepared for resettlement and that causes of re-offending are addressed” (World Health Organization, 2007b, p. 5). The “good health” and “well-being” are recognized as the key criteria to successful prisoner’s rehabilitation and reintegration (Hayton, 2007). In order to assist and enable the prisoner to successfully reintegrate into community, collaborative and appropriate service delivery is paramount (World Health Organization, 1998b). The impetus for a prison setting-based project deserves a brief attention. The project’s roots are attached to the WHO “Health for All” strategy (World Health Organization, 1985), which became solidified in 1986 through the statement of the Ottawa Charter that “health is created and lived by people within settings of everyday life” (World Health Organization, 2009a, b) and the 1991 Sundvoll statement on supportive and enabling environments for health (World Health Organization, 2009a, b). According to the Ottawa Charter, the principal goal of public health policy (also coined “healthy public policy”) would be reducing health inequalities and sustaining health and well-being in populations through a multidisciplinary and socio-ecologically “holistic approach” (World Health Organization, 1998a). The rationale of a holistic approach, in theoretical terms, is to relocate focus from a pathogenic deficit model of medicine in which health is understood as an absence of disease or psychopathology, to a salutogenic, resource model of health in which health is a positive concept related to a variety of personal, social and environmental health determinants, also called salutary factors (Antonovsky, 1996). In general, health promotion, contrary to disease prevention and health protection, “insists” that health is not restricted to specific populations (e.g. ill, diseased, poor or rich, men or women, prisoner or not) or environments. The role of the health sector may be included as a necessary health determinant but is not sufficient on its own condition for people’s lives and health. In community context, the role of other health determining human services such as corrections also needs consideration. Currently, there are 45 member nations joining the European network on the WHO’s Health in Prison Project. As of today the active commitment to the HIPP of each country is not well documented. Due to various barriers, the “prison-setting” has been described as the least popular context in which health can be promoted with success (Gatherer et al., 2005). Norway is one of the member nations participating in the network on the HIPP. Although no explicit document on health promotion in prisons as yet exists, the level of the country’s commitment to the project seems worth investigating since Norway’s attention to its population health is high on the political agenda. The political pursuit for fostering, developing and sustaining the highest achievable health as well as closing the gap in health distribution across the population is manifested in the explicit commitment of the government to Health in All Policy (HiAP) (Ministry of Health and Care Services (MHCS), 2012). In brief, the HiAP is part of an internationally designed public health policy (World Health Organization, Government of South Australia, 2010) with a key principle that health should always be essential in the formulation of any policy and action plan of all sectors based on partnership and collaboration in creating solutions and strategies to meet any health challenges. Exemplified by the case study of Norwegian health promotion policies in correctional settings, the purpose of this paper is to examine the contribution of modern correctional services that enable the prison to be health promoting. Two questions are raised: 1.

How do Norwegian health policies assist the correctional population in achieving “good health” and “well-being”?

2.

Besides the goals of crime prevention and crime reduction, what is the contribution of criminological research and practice to enable correctional settings to be health promoting?

In order to answer these questions, a two-fold methodology is used. First, the literature review based on the Norwegian policy documents relevant to prison settings is conducted. This is followed by the general review of the literature on the principles of humane service delivery in offender rehabilitation.

j

j

PAGE 28 INTERNATIONAL JOURNAL OF PRISONER HEALTH VOL. 10 NO. 1 2014

Methodology The literature review The data for the case study was obtained through search of the literature undertaken Fall, 2012. The search applied Norwegian combined key words such as “helse” (health), “helsefremming” (health promotion), “fengsel” (prison), “kriminalomsorgen” (corrections), “innsatte” (prisoners) and was restricted to the following governmental web sites of: the Ministry of Justice and Public Security, the Ministry of Health and Care Services, the Norwegian Directorate of Health, the Norwegian Directorate of Correctional Services and the Correctional Service of Norway Staff Academy. Additionally, a gray literature search was conducted through Google. The applied key words consisted of both Norwegian and English words (noted above), considering a high possibility of dissemination of information on Norwegian policies, practices or other to an international audience. Through this search, national reports, national and international conference papers and community-based reports of collaborating with corrections agencies were obtained. All material was scrutinized for information about health and corrections, and health promotion within correctional settings and the duplicates were excluded. Furthermore, the literature was once more reviewed and then its content was deductively analyzed (Patton, 2002) driven by the relevance to health promotion and correctional settings. The thematic analysis was conducted according to the followed criteria for data inclusion: target population, implication of health and welfare policy for health promotion in correctional setting and specific action plans and strategies at organizational level (structural health determinants) based on political documents and evidence-based research. The key sources selected for the presentation of the case study are information rich political documents, such as government white papers and reports. The back referencing from this material was additionally performed to search for relevant data. The general review The general review is predominantly based on a synthesis of the extensive scientific research on criminal behavior and the principles of effective offender rehabilitation presented in the seminal work by Andrews (1995) and Andrews and Bonta (2010) who have contributed to the currently worldwide applied principles of effective offender rehabilitation. In addition, the literature by Andrews and Bonta (2010) provides a comprehensive outline of existing research on the topic that is of high relevance to this paper. When relevant, additional references to other research literature were added.

Findings Searches of the literature for the case study yielded five governmental documents, three research reports, and one review paper. The material is identified through the overarching theme: “Norwegian public health and corrections.” Additionally, given that the focus of the paper is specific to correctional populations, we included information about the social and health profiles of Norwegian prisoners for comparative purposes should they be of interest to the international audience. Based on the overview of the key literature, the overarching theme of “humane service delivery in offender rehabilitation” with a sub-theme: “key principles of effective services in correctional settings” was extracted. 1. Norwegian public health and corrections: literature review The social and health profile of incarcerated population. Based on the 2010 national statistics, there were about 3,800 convicted inmates housed in one cell of 50 prisons across 43 Norwegian municipalities (Health Directorate, 2012a). Although the health and social profiles of prison inmates are found similar to those reported in the broad international literature, a brief presentation of Norwegian prison populations should be in order. Commissioned by the Ministry of Justice and Public Safety, the report on Living conditions of prison inmates (Friestad and Hansen, 2004) reveals that among the studied sample of 260 prisoners, adverse life conditions and various other problems have accumulated since childhood. At the time of imprisonment, 30 percent had a history of being in the custody of child

j

j

VOL. 10 NO. 1 2014 INTERNATIONAL JOURNAL OF PRISONER HEALTH PAGE 29

protective services and the same percentage had experienced having a close family member incarcerated. The 40 percent have not completed education above the secondary upper school, 70 percent were unemployed, 40 percent lived in poverty and 30 percent were homeless at the time of incarceration. The 50 percent suffered from ill health in terms of chronic disease(s) and 60 percent had alcohol and illicit drug abuse problems. In addition, it is recognized that debt is a common factor causing life problems, especially so called “black debt” linked to illicit drug related activities (Ministry of Justice and Public Security, 2008). It is reported that the period of transition from custody to community is particularly difficult for offenders (Hammerlin and Kristoffersen, 1998). This relates to the time of imprisonment itself during which some offenders may have acquired self-destructive habits and attitudes, may have lost their jobs, important personal relationships, other social networks or the ability to maintain housing. For example, the number of homeless individuals is doubled at the time of release as many have lost their home during their incarceration. In 2005 there were 5,500 homeless in Norway in which inmates consisted of the largest single group among them (Ministry of Justice and Public Security, 2008). Currently, the situation has improved, through close cooperation between corrections and Husbanken (a bank facilitating aid to the most disadvantaged in the housing market). Today, 90 percent of offenders have a place to live on release. Common public health policy and correctional settings. As noted earlier, in Norway, no explicit document on HIPP exists as of yet. This may be due to the fact that health promotion itself is considered essential and an integral part of the Norwegian government policy that applies to the whole population across settings and environments. The new legislation by the MHCS (2012), the Public Health Act, places focus on reducing health inequalities through evidence-based collaborative action on social determinants of health with particular focus on social and living-conditions in which individuals develop. The Public Health Act is based upon an action plan outlined in The challenge of gradient proposing upstream rather than downstream strategies in promoting public health in order to level up social gradients (Fosse, 2009; World Health Organization, 2009a, b). The central goal of such work is to reduce social inequalities in health through health promoting policies focussing on social inclusion and combating poverty. Consistent with principles of HiAP, the responsibility for enhancing population health is not restricted to health services, rather cross-sector partnership, equality, equity and social inclusion are the key principles for achieving meaningful health and social care for the whole population. In the wake of this new regulation, many innovative reforms created by intersectoral collaboration have taken place in Norway (MHCS, 2012). Within the correctional sector these are called the “Import Model,” “Individualized Plan” and “Reintegration Guarantee” (to be described below). The political platform for the current government crime policy is based on the Soria Moria Declaration that “with good welfare services for everyone, crime can be prevented and many of the initial incentives for a life of crime can be removed. Good psychiatric health and care services and an active labor market policy are important for comprehensive crime fighting. It is important that preventive welfare measures, good local communities and recreational activity programs for youth are also preserved as a part of the crime-fighting work” (Norwegian Labor Party, 2005, n.p.). The White Paper No. 37 (Ministry of Justice and Public Security, 2008) “Punishment that works – less crime – safer society” provides the basis for correctional work, where the principal aim is to prevent new crimes and reduce criminal victimization through successful reintegration of ex-prisoners into society. Correctional service. The most recently issued guide, Health care services to inmates in prison (Health Directorate, 2012b) is based on social and health profiles of incarcerated populations documented through the research study (Friestad and Hansen, 2004) presented above. Incarceration time for prisoners is seen as an especially good opportunity for health enhancement through addressing and implementing preventive, diagnostic and therapeutic measures. Treatment of diseases is a key aspect of rehabilitation, and successful reintegration into society depends on a comprehensive understanding of the inmate life situation. Although the guide refers to health situations from a pathogenic perspective (i.e. clinical health deficits and impairments), at the same time it stresses the prominence of social and environmental determinants of health (e.g. supportive prison environment) and the role and function of health services. The point is made that a prerequisite for good health and health care provided

j

j

PAGE 30 INTERNATIONAL JOURNAL OF PRISONER HEALTH VOL. 10 NO. 1 2014

to a prisoner depends on his/her access to qualified personnel with expertise in living conditions, quality of life and the person’s overall health (Health Directorate, 2012b). The Norwegian Medical Association in collaboration with other countries and international Human Rights have developed and recommended online courses for prison doctors to deal with current problems in prison medicine. The national strategy to reduce social inequalities in health aims at urgent improvement of prisoners’ living conditions as these are understood to be the probable cause and the consequence of crime and substance abuse (Health Directorate, 2012b). In order to achieve this goal, the main three measures of “Import Model,” “Individual Plan,” and “Reintegration Guarantee” were incorporated into the action plan. These measures are within national municipal tasks and are based on a close collaboration between the justice, social, health, educational and labor sector and other community-based agencies. This fact demonstrates that the policy makers do recognize health as an outcome of a wide range of factors, many of which lie outside the activities of the health sector and therefore require a shared responsibility and an integrated policy response. This neatly corresponds with the principles of HiAP consolidated within health promotion’s holistic approach to health. The process of social and psychosocial (re)habilitation involves provision of necessary assistance to a prisoner’s own efforts to achieve the best possible coping abilities, prosocial functioning and participation in society. Import Model. The “Import Model” is related to coordination reform that focusses on intersectoral collaboration with the overarching goal to enhance preventive and disease treatment interventions among patients and clients. Any services involved in collaboration are independent of and have free roles in relation to corrections. Following European directives (Council of Europe, 1989), prison health care services in Norway since 1989, have been fully integrated into the general health services in the local community (primary health care) and the larger health region (specialist and hospital services) where the prison is situated. Notably, Norway is one of the first three countries in the world in which health services in prison were made qualitatively equivalent to those provided to the rest of population. The services are an integral part of municipal sector. In the country, there are no forensic hospitals. Individual Plan. The “Individual Plan” is based on comprehensive, coordinated and individualized services in order to implement and secure the most effective welfare measures. Reintegration Guarantee. The “Reintegration Guarantee” aims to provide composite services according to inmate needs assessed at the early stage of sentencing and then on discharge planning. There are currently 25 assigned reintegration coordinators within central prisons who coordinate reintegration work, establish agreements, inform and lead service markets. The services are provided to prisoners in such a way that they can have a reasonable opportunity to make use of them. Correctional services, as far as possible, facilitate necessary information to the cooperating agencies (including volunteer organizations). Many prisons have firm contact with the Norwegian Labor and Welfare Service (NAV) via designated counselors (as of 2012, there were 47 such workers in total) who provide assistance in relation to housing, education, employment, help to dispose economy and so on (Norwegian Labor and Welfare Service, 2012). The NAV service is to be located inside all prisons. Offender assessment. In Norway, correctional services have begun to deploy a new structured offender assessment system BRIK (individual needs and resources assessment) with aims to provide comprehensive and effective interventions according to prisoner’s needs (Kriminalomsorgen, 2012). The instrument is based on “what works” knowledge in reducing reoffending, firmly anchored in research and practice on effective offender rehabilitation, the desistance theory (perspective that focusses on individual’s strength, abilities and competencies), and a restorative justice humanistic approach used in conflict resolution and counseling between the offender and the victim(s). The main objective of this approach includes holding the offender accountable in a meaningful way and repairing the harm caused to the victim or community. To a large extent, BRIK is founded in Risk-Need-Responsivity (RNR) Model with its principles recognized as core features in well-functioning offender assessment. The survey is voluntary and only conducted upon informed consent.

j

j

VOL. 10 NO. 1 2014 INTERNATIONAL JOURNAL OF PRISONER HEALTH PAGE 31

Offender assessment based on BRIK is currently subject to a pilot study in the newly open Halden prison facility and Halfway houses in Østfold. The purpose of this study is to examine the applicability of the instrument for a population sentenced to prison and community service. After completed evaluation of BRIK, the policy decision will be made regarding its applicability in corrections nationwide with its potential use for research purposes, hence evidence-based knowledge building. 2. Humane service delivery in offender rehabilitation: general review Key principles of effective services in correctional settings. In the 1980s, Canadian researchers developed the RNR Model proposing the key principles of effective humane services in correctional settings. The model is based on empirically defensible psychology of criminal conduct (PCC) that provides a base for the prediction and modification of criminal propensity as well as directions on effective crime prevention and offender rehabilitation (Andrews, 1995). The PCC includes potential situational, circumstantial, biological, personal, interpersonal and familial correlations of crime that may reflect broader social arrangements (e.g. structure, culture). The RNR Model has been extensively researched and used with increasing success to guide correctional interventions based on the assessment and rehabilitation of criminal offenders across the world (Andrews and Bonta, 2010). The model rests within the overarching principles of respect for the person and humane service provision in which help and assistance are provided in an ethical, legal, just, moral, humane and decent manner by correctional workers who possess high quality relationship and structuring skills (Andrews, 1995; Andrews and Bonta, 2010). For example, the principle of social support (Andrews, 1995) is anchored in the creation of settings within which working professionals are supported in active ways through training and consultations. Those professionals who adhere in a sensitive manner to the uniqueness of the person involved will yield stronger results of effective service (Andrews, 1995). This includes collaborative working relationships with the offenders and also collaborative practice between correctional, social, health or other community-based agencies and organizations that may facilitate and enable effective interventions (Andrews and Bonta, 2010). Since there are 18 principles of the RNR Model (Andrews et al., 2011), all of which will demand a rather lengthy description, highlighting the three key principles is hoped to be sufficient here. The risk principle. The risk principle states that in order to increase the effectiveness of offender rehabilitation, the level of service (i.e. program intensity, type and level of its structure) must be matched to the person’s risk level to reoffend. This requires theoretically and empirically sound, structured assessment of risk. The need principle. The need principle focusses on assessment of criminogenic needs. These are changeable characteristics of individuals and their circumstances that are related to criminal conduct. These are also called dynamic risk-need factors and predictors for criminal offending. The major and intermediate criminogenic needs comprise the “Central Eight” targets for interventions and effective correctional service. Based on research evidence from multiwave longitudinal studies these are: history of anti-social behavior, antisocial personality pattern, procriminal attitudes/antisocial cognition, social supports for crime/antisocial associates, family/marital circumstances, education/employment, leisure/recreation and, substance abuse. The most recent RNR multiwave study (Andrews et al., 2011) reveals that reword of desisting from crime leads to subsequent enhancement of success in various areas of life. In contrast, self-esteem (e.g. often addressed through mental health work on strengthening emotional resilience), personal distress (e.g. anxiety), major mental disorders (e.g. schizophrenia, manic-depression), physical health (e.g. physical disability, nutrient deficiency), intellectual deficits, victim of mental/physical abuse, spirituality, poor parental skills, poor housing, financial problems and physical activity belong to a group of non-criminogenic needs. These (and basic human needs) may be very important for some offenders and any problems faced by them are commonly dealt with for humanitarian and entitlement reasons through the services within a prison setting and/or health, social or other services, whether within prison or outside in the community. Indicated by research, non-criminogenic needs are not related to criminal conduct, at least not directly (Andrews et al., 2011). For example, working on increasing one’s self-esteem or improving living conditions without first addressing and targeting

j

j

PAGE 32 INTERNATIONAL JOURNAL OF PRISONER HEALTH VOL. 10 NO. 1 2014

change of procriminal attitudes, (especially in high-risk individuals), may result in confident and content offenders. Nevertheless, addressing personal or situational circumstances not only has a great potential to eliminate certain responsivity problems (e.g. readiness to positive change) but also may be important for the individual, immediate family, community or public gain (e.g. well-being), regardless of their impact for reoffending risk. (Andrews et al., 2004). As with risk, adherence to need principle requires an assessment of the person’s criminogenic needs and the identification of non-criminogenic needs. Responsivity principle. The responsivity principle focusses on maximizing the offender’s ability to learn from rehabilitative interventions that correspond with the individual needs, circumstances, learning styles, motivation, abilities and strengths in order to provide individually tailored services. Research document that the presence of human potentials, motives and capacities, also called strengths, is considered to have a potentially promoting effect in successful rehabilitation. They may contribute to the manner in which programs and services are designed and delivered for individual offenders (Andrews et al., 2004). The research suggests that female prisoners do require specific interventions that focus on strength rather than their problems and deficits. Women themselves view such an approach as most effective in their successful rehabilitation and behavioral functioning (i.e. desisting from crime) (Trotter et al., 2012).

Discussion The fact that the WHO advocates an important role of health promotion in prisons settings implies that prisoners’ health and criminal behavior should be of joint concern for both health promotion and crime prevention interventions. It has been said that “antisocial behavior is too serious an issue to be left in the hands of justice and correctional agencies” (Andrews and Bonta, 2010, p. 516) and “health is too important to leave to health staff alone” (Fraser et al., 2009, p. 412). The Norwegian health policy clearly documents that the topic of health promotion and the criminal justice system is now on the national health policy agenda. The governmental documents such as white papers (and based on them action plans), and reports demonstrate an obvious involvement in health promotion through authentic health promoting actions applied in correctional settings. These are anchored in health promotion’s overarching goals of equity and HiAP’s aims to reduce social inequalities in population health through efforts of closing the health gap, particularly for the disadvantaged people that the majority of prison population accounts for. The governmental health and welfare policies provide conditions for health and well-being through cross-sectorial collaborative activity that meets the needs of its whole population. Both health and welfare strategies relating to correctional settings are essentially the same kind of collective action strategies used to create the structural and organizational conditions for positive change in correctional population in order to manage and prevent potential health and societal problems arising as a consequence of criminal offending. Achieving good health in whole population is highly prioritized on the political agenda. Although not explicitly committed to HIPP in its documents, it is apparent that Norway pays specific attention to health promotion in correctional settings, in which most of its population are highly socially, economically and health wise disadvantaged individuals. Through the government’s social, health and criminal justice policies and practice an aid is provided to prisoners accordingly to their needs through sound structure of support and assistance from the prison institution to the community. Notably, among prisoners (Ministry of Justice and Public Security, 2008) there also exist resourceful individuals who do not suffer from poor (mental)health, drug problems or are not otherwise socio-economically disadvantaged. This fact deserves a comment that poor health or socio-economic position is not decisive for criminal propensity. Therefore, sentencing and offender management should preferably adhere to the RNR principles (recall Section 2) in order to avoid subjecting a prisoner to interventions upon “assumed” needs once an individual becomes a prison inmate.

j

j

VOL. 10 NO. 1 2014 INTERNATIONAL JOURNAL OF PRISONER HEALTH PAGE 33

Although a clear commitment to fostering and improving prisoners’ health is visible through the application of a number of strategies into correctional settings, the political emphases on health and welfare as a prerequisite for crime reduction suggests that health, well-being and prosperity prevent crime. There is a vast Norwegian (and international) research literature on mental health or psychopathology among forensic population. The link between deficits in mental health and crime is indicated, however, with mixed results (recall need principle). Notwithstanding the beneficial role of community involvement in prisoner rehabilitation, reentry and reintegration, the value of good health is seen as a significant factor in desisting from crime, as are social and structural determinants of health. Considering that interdisciplinary collaboration and inter-agency partnership are pivotal in health promotion, the new regulatory framework appears to allow for effective health promotion in prison settings. Some of the regulations are quite new and as yet no evaluative research on the effectiveness of specific interventions alone or in combination has been conducted. International literature indicates that well-coordinated services provided in and outside prison settings can significantly reduce recidivism (Petters and Bekman, 2007). It has been said that the “country’s economy is significant for the population’s health and welfare” (Forslin et al., 2012, p. 275). We would like to add that political willingness to promote health, general respect for human and human needs may also be helpful. This paper has also examined the role of criminal justice services as a determinant of and promoter of health based on the principles of humane service delivery to offender populations. The understanding of correlations of crime along with available evidence on the utility of RNR principles leads to an understanding that criminological research and practice can make a valuable contribution to the process of desistance from crime as well as health promotion. However, health promotion within a correctional context can only make a contribution so far as its activities align and support the evidence-based principles of effective correctional service delivery to offenders. The core principles of the RNR Model of offender rehabilitation, allow for a comprehensive service delivery to offenders through interventions planning. Although to different ends, the interventions may target criminogenic needs (related to criminal behavior), non-criminogenic needs (specific issues and challenges) and strengths (personal and community assets) with the potential to assist in the highest possible quality service. However, research suggests that focussing on positive health and well-being aspects without addressing the major criminogenic factors may potentially result in outcomes that can be harmful to society. According to correctional research, benefits in relation to health and well-being clearly include prosocial behavior. The analysis of the principles of effective offender services implies that in a correctional context, the question is not of whether health, educational or employment interventions work in crime prevention. Rather, the question will focus on the role or contribution the person’s health, education or employment can play in desisting from crime. Answering this question is essentially an interdisciplinary task between health science and criminology. Enhancing prisoners’ well-being, the pursuit for highest attainable health and a life as disease free as possible is very important and health (in all its dimension) should never be ignored. This is in line with ethical, professional, humane and decent practice and the principles of effective service to offender rehabilitation have this covered. This approach is not solely confined to a deficit model (offender assessment of problematic behavior) and links through additional focus on capacities and resources (strengths) of the holistic framework for health. Although omitted in this paper, we would like to note that various alternative models to effective correctional interventions have also been proposed (e.g. The Good Life Model). The presentation of these can be found in McNeill et al. (2010) “Offender supervision: New directions in theory, research and practice.”

Conclusion There are several implications of this analysis. First, there is a need for recognition of the role of the principles of modern correctional practices among health promotion policy makers. Second, public awareness is needed as to how correctional settings enable health within its overarching

j

j

PAGE 34 INTERNATIONAL JOURNAL OF PRISONER HEALTH VOL. 10 NO. 1 2014

goal of ensuring public safety through efforts of prevention and reduction of crime. This may support the case for recognizing criminal offending as a public health-safety issue, hence addressed in health promotion strategies. Third, individual and community benefits in relation to health and well-being include changing procriminal propensities and anti-social behavior through supportive environments. Therefore, the significance of contribution in reducing crime by changing criminal propensities and behavior should not be missed. Therefore, fostering the potential for health practitioners to learn from and support criminological findings, and the potential for correctional practitioners to learn from health promotion research may truly advance health promotion and the criminology discipline. The analysis also provides implications for research. The policies of modern corrections coupled with policies of health promotion present a window of opportunity for working explicitly with health within criminology and with crime within health promotion. The topic of health is close to the passions of many people and Norwegian politicians who engage in health promotion are clearly in favor of health-based policies within corrections. Taking this into consideration, explicit research on the role of health promotion on crime outcomes is needed. This area of research has not been explored yet. Considering another way forward, studies on HIPP may include the evaluative component of various health promoting interventions (i.e. according to salutogenic model) on its own, with or within the RNR Model on public health and/or public safety. These types of studies may provide benefits for planning and implementing appropriate interventions and methods based on knowledge gained from research evidence rather than ideology.

References Andrews, D. (1995), “The psychology of criminal conduct and effective treatment”, in McGuire, J. (Ed.), What Works: Reducing Reoffending (Chapter 2), John Wiely & Sons Ltd, Chichester, pp. 35-62. Andrews, D.A. and Bonta, J. (2010), The Psychology of Criminal Conduct, 5th ed., LexisNexis Matthew Bender, New Providence, NJ. Andrews, D.A., Bonta, J. and Wormith, J.S. (2004), The Level of Service/Case Management Inventory (LS/CMI): User’s Manual, Multi-Health Systems, Toronto. Andrews, D.A., Bonta, J. and Wormith, J.S. (2011), “The Risk-Need-Responsivity (RNR) model: does adding the good life model contribute to effective crime prevention?”, Criminal Justice and Behavior, Vol. 38 No. 7, pp. 735-55. Antonovsky, A. (1996), “The salutogenic model as a theory to guide health promotion”, Health Promotion International, Vol. 11 No. 1, pp. 11-8. Council of Europe (1989), Recommendation R (98) 7 of the Committee of Ministers to Member States Concerning the Ethical and Organizational Aspects of Health Care in Prison, Council of Europe Committee of Ministers, Stratsburg. Fazel, S. and Baillargeon, J. (2011), “The health of prisoners”, Lancet, Vol. 377 No. 9769, pp. 956-65. Forslin, B.M., Mo¨ller, H.E.R., Anderson, R.I., Sohlberg, E.M. and Tillgren, P.E. (2012), “The health-promotion perspective in public-health plans in a Swedish region over three decades”, Health Promotion International, Vol. 28, pp. 269-80, doi 10.1093/heapro/das009. Fosse, E. (2009), “Norwegian public health policy: revitalization of the social democratic welfare state?”, International Journal of Health Services, Vol. 39 No. 2, pp. 287-300. Fraser, A., Gatherer, A. and Hayton, P. (2009), “Mental health in prisons: great difficulties but are there opportunities?”, Public Health, Vol. 123 No. 6, pp. 410-4. Friestad, C. and Hansen, I.L.S. (2004), “The living conditions of prison inmates”, Report No.429, Research Foundation (FAFO), Oslo. Gatherer, A., Moller, L. and Hayton, P. (2005), “The World Health Organization European health in prison project after 10 years: persistent barriers and achievements”, American Journal of Public Health, Vol. 95 No. 10, pp. 1696-700. Griffiths, C.T., Dandurand, Y. and Murdoch, D. (2007), “The social reintegration of offenders and crime prevention”, Research Report No. 2007-2, National Crime Prevention Centre (NCPC), Public Safety Canada, Ottawa.

j

j

VOL. 10 NO. 1 2014 INTERNATIONAL JOURNAL OF PRISONER HEALTH PAGE 35

Hammerlin, Y. and Kristoffersen, R. (1998), Habilitering som livsmestringsprosess – startsted Hassel kretsfengsel?, Correctional Service of Norway Staff Academy (KRUS), Oslo. Hayton, P. (2007), “Protecting and promoting health in prisons: a settings approach”, in Møller, L., Sto¨ver, H., Ju¨rgens, R., Gatherer, A. and Nikogosian, H. (Eds), Health in Prisons: A WHO Guide to the Essentials in Prison Health, WHO Regional Office for Europe, Copenhagen, pp. 15-20. Health Directorate (2012a), “Health and care services to prison inmates”, presented at Conference at Correctional Service of Norway Staff Academy (KRUS), Oslo, June 7. Health Directorate (2012b), Guide on Health and Social Care Services to Inmates in Prison, (Publication No. 2012/IS- 1971), Health Directorate, Oslo. Kriminalomsorgen (2012), Manual for behovs- og ressurskartlegging av domfelte, BRIK, Kriminalomsorgen, Oslo. McNeill, F., Raynor, P. and Trotter, C. (2010), Offender supervision: New directions in theory, research and practice, Willan Publishing, Abingdon. Ministry of Health and Care Services (MHCS) (2012), New Norwegian Public Health Act, Ministry of Health and Care Services, Oslo. Ministry of Justice and Public Security (2008), “Punishment that works – less crime – safer society”, White Paper No. 37 (2007-2008), Oslo. Norwegian Labor and Welfare Service (2012), “NAV and corrections”, presented at Conference at Correctional Service of Norway Staff Academy (KRUS), Oslo, June 7. Norwegian Labor Party (2005), Crime Policy, Soria Moria Declaration 2005, Soria Moria, Oslo. Patton, M.Q. (2002), Qualitative Evaluation and Research Methods, Sage Publications, Thousand Oaks, CA. Petters, R.H. and Bekman, N.M. (2007), “Treatment and reentry approaches for offenders with co-occurring disorders”, in Greifinger, R.B. (Ed.), Public Health Behind Bars: From Prisons to Communities (Chapter 13), Springer New York, New York, NY, pp. 229-48. Social Exclusion Unit (2002), Reducing Re-Offending by Ex-Prisoners, Office of the Deputy Prime Minister, HMSO, London. Trotter, C., Mclovr, G. and Sheehan, R. (2012), “The effectiveness of support and rehabilitation services for women offenders”, Australian Social Work, Vol. 65 No. 1, pp. 6-20. Visher, C., LaVigne, N. and Travis, J. (2004), “Returning home: understanding the challenges of prisoner reentry”, Research Report No. CPR04 0122, Urban Institute, Justice Policy Center. World Health Organization (1985), Health for All by the Year 2000, World Health Organization, Geneva. World Health Organization (1998a), Health Promotion Glossary, World Health Organization, Geneva. World Health Organization (1998b), Mental Health Promotion in Prisons: Report on a WHO Meeting, World Health Organization, Regional Office for Europe, Copenhagen, The Hague. World Health Organization (2007a), Health in Prisons: A WHO Guide to the Essentials in Prison Health, World Health Organization, Regional Office for Europe, Copenhagen. World Health Organization (2007b), Trencin Statement on Prisons and Mental Health, World Health Organization, Regional Office for Europe, Copenhagen. World Health Organization (2009a), Milestones in Health Promotion: Statements from Global Conferences, World Health Organization, Geneva. World Health Organization (2009b), Setting the Political Agenda to Tackle Health Inequity in Norway: Studies on Social and Economic Determinants of Population Health, World Health Organization, Regional Office for Europe, Copenhagen. World Health Organization, Government of South Australia (2010), Adelaide Statement on Health in All Policies: Moving Towards a Shared Governance for Health and Well-Being, World Health Organization, Geneva, available at: www.who.int/social_determinants/hiap_statement_who_sa_final.pdf (accessed May 25, 2013).

j

j

PAGE 36 INTERNATIONAL JOURNAL OF PRISONER HEALTH VOL. 10 NO. 1 2014

About the authors Lidia Santora is a Researcher, Department of Social Work and Health Science, Faculty of Social Science and Technology Management, Norwegian University of Science and Technology, Norway. Lidia Santora is the corresponding author and can be contacted at: [email protected] Geir Arild Espnes is a Professor and the Director at the Research Center for Health Promotion and Resources. The Center I co-owned by Sør-Trøndelag University College and Norwegian University of Science and Technology, Trondheim, Norway. Dr Monica Lillefjell is an Associate Professor and an Assistant Director, Research Centre for Health Promotion and Resources, Sør-Trøndelag University College/Norwegian University of Science and The Technology, Trondheim, Norway.

To purchase reprints of this article please e-mail: [email protected] Or visit our web site for further details: www.emeraldinsight.com/reprints

j

j

VOL. 10 NO. 1 2014 INTERNATIONAL JOURNAL OF PRISONER HEALTH PAGE 37

Copyright of International Journal of Prisoner Health is the property of Emerald Group Publishing Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

Health promotion and prison settings.

The purpose of this paper is to examine the contribution of modern correctional service in health promotion exemplified by the case study of Norwegian...
130KB Sizes 3 Downloads 5 Views