Prison contexts often have profound implications for the health of the people who live and work within them. Despite these settings often housing people from extremely disadvantaged and deprived communities (Houchin 2005), many with multiple and complex health needs (Senior and Shaw 2007), health research is generally neglected within both criminology and medical sociology. This neglect is significant given that multiple studies have illustrated not just that there is a direct relationship between health and offending (Social Inclusion Unit 2002) but that people who have served custodial sentences have higher mortality rates from all causes compared to those with no custodial experience (Binswanger et al. 2007, 2013; Farrell and Marsden 2008; Graham et al. 2015; Paanila et al. 1999; Phillips et al. 2017; Spittal et al. 2014; Verger et al. 2003; Zlodre and Fazel 2012). Moreover, there has been a marked increase in the population of older people in prison (Baidawi et al. 2011; Ginn 2012; Williams and Abraldes 2007), partly driven by longer average sentence lengths (Millie et al. 2003). In England and Wales, we now have as many people aged 50 and over in prison (16% of the prison population) as we have young adults aged under 25, and the percentage of over 50s in custody is even greater in Scotland, at 22% (Sturge 2019).
The authors agree that prison health is a key public health concern with research being fundamental to inform policy and practice in addressing the significant health and social issues faced by this group. The concept of ‘prison health’ has, in the main, been clearly aligned to a biomedical perspective (Sim 1990). Morris and Morris (1963, p.193), in their study of Pentonville prison, encapsulated the predominant discourse which surrounded prison health:
For the prison, health is essentially a negative concept; if men are not ill, de facto they are healthy. While most modern thinking in the field of social medicine has attempted to go further than this, for the prison medical staff it is not an unreasonable operational definition.
Such a view has notable implications, as health is defined by the absence of disease and not the attainment of positive health and well-being. The authors adopt a far broader view of prison health, which is reflected throughout the chapters in the book. Indeed, our stance on ‘prison health’ is embedded in a social model that moves away from a reductionist, biomedical focus to a viewpoint whereby health is influenced by a range of factors that can be structural and environmental in nature. Our position is supported more widely by an international systematic review (which included studies from Australasia, Europe, USA and Africa) conducted by Herbert et al. (2012) which concluded that prison health services fail to fully exploit public health and ‘upstream’ health promotion work. This has been echoed in England and Wales where critical reviews of prison health services described a reactive and inefficient service, underpinned by a medical model that was largely blind to the social determinants of health and thus failed to exploit public health opportunities (HMIP 1996).
This book constitutes the first publication to utilise a range of social science methodologies to illuminate diverse and new aspects of health research in prison settings. Through the fourteen chapters of this book, a range of issues emerge that the authors of each contribution reflect upon. The ethical concerns that emerge as a consequence of undertaking prison health research are not ignored, indeed these lie at the heart of this book and resonate across all the chapters. Foregrounding these issues necessarily forms a significant focus of this introductory chapter.
Alongside explicitly considering emerging ethical issues, our contributing authors also have considered diverse aspects of innovation in research methodologies within the context of prison health research. Innovative research practice is challenging in this setting, given the myriad of practical issues that prison researchers face. Many of the chapters are innovative through the methodologies that were used, often adapting and utilising research methods rarely used within prison settings. By incorporating a range of perspectives on methodological and ethical issues, innovations in health-focused social science research before, during and after a period in custody, this book constitutes an opportunity to explore continuities and disconnections in people’s health and well-being as they move through (and in and out of) the prison system. Chapters from a wide range of disciplines and engagements with the prison systems of England, Northern Ireland, Scotland and Wales are incorporated within this book, including people with lived experience of prison, and those who work in custodial settings. It is hoped that the book will provide a starting place for on-going discussion around health research within prison settings in the UK, but also beyond. The book brings together chapters from students, scholars, practitioners and service users from a range of disciplines (including medical sociology, medical anthropology, criminology, psychology and public health).
The Initial Symposium in Glasgow in May 2016
The starting place for this book was a symposium held in Glasgow in May 2016, from which some of the researchers who are featured in this book began to discuss challenges and opportunities for innovation within prison health research. The initial symposium, which considered the methodological and ethical dimensions of conducting health-focused social science research through and beyond prison settings, was supported by funding from the Foundation for the Sociology of Health and Illness, Royal Holloway University of London, and the Social and Public Health Sciences Unit at the University of Glasgow. It was held over two days, one at the Social and Public Health Sciences Unit, University of Glasgow, and secondly at HMP Barlinnie, Glasgow. The second day was of particular significance as this allowed symposium participants to get an insight into Scotland’s largest prison. Additionally, this setting enabled prison staff and people serving custodial sentences to participate in the symposium and contribute to what was at that point an emerging discussion. The contribution of people in custody was particularly insightful, through critiquing a number of the presentations at the symposium from a reflective perspective grounded in the lived experiences of custody. This points to a wider limitation with prison research and what it can and can’t tell us about life in prison (Drake et al. 2015), and the emergence of convict criminology within this space (Earle 2016; Ross and Richards 2003).
The symposium included 24 presentations and keynote addresses, including research from a wide range of international jurisdictions (including, Poland, Denmark and the USA). However, given the richness of the studies included in this chapter, it was decided to focus on the UK prison context in this book, in order to provide a consistent context for comparison and contrast between diverse studies. We are hopeful that this book reflects the dynamism and critical engagement of the initial symposium and more widely represents a number of new connections and collaborations between a previously disparate body of scholarship.
The Unique Contribution to the Field of Prison Health Research
Prison health research remains in its relative infancy, although there are a number of pre-existing contributions on prison health that are relevant for the focus of this book (Anonymous 2013; Cinar et al. 2017; Elger et al. 2017; Hammersley 1990; Hatton and Fisher 2011; Holligan 2016; Malloch 1999; Meek 2014; Paton et al. 2002; Phillips et al. 2017; Pope et al. 2007; Pratt 2016; Read and Mccrae 2016; Ross 2013; Scott 2014). Of these, Emerging Issues in Prison Health, edited by Elger et al. (2017), has particular resonance. This book consists of 16 chapters examining a wide range of health issues in prison (e.g., older prisoners, diet and drugs in prison). This in many ways reports findings from a range of health studies conducted in prisons and with former prisoners. We see our publication as having a different orientation, taking an explicitly eclectic (reflecting the growing diversity of prison health research) and reflective approach in which the methodological and ethical aspects of conducting health research in prison are foregrounded. This book does not only entail the reporting of study findings, but goes further to reflect on some of the opportunities and challenges of conducting health research in prisons—this we feel is sometimes not explicit in the writing of those researching prison settings. Furthermore, this book incorporates a wider range of perspectives on health research in prison, including chapters from people with lived experience of prison and those working within prison systems. Additionally, Health and Health Promotion in Prison by Ross (2013) bears some initial similarities. However, this is a historically orientated book considering the policy and legal context of health in prisons. Throughout there is a focus on UK and US prison populations and the practical application of the UN Health in Prisons model. The distinctiveness of this book over the Ross (2013) book is that the latter does not consider some of the more practical issues associated with conducting health research in prison, so there is little focus on methods or the ethics of conducting health research in prisons. Furthermore, innovative approaches to health research, focusing on particular groups of prisoners (such as male prisoners, pregnant prisoners, etc.) are not considered. Ultimately, we suggest that our text is more process and less policy focused and therefore ultimately contributes to quite a different and distinct perspective on prison health research. We hope that this first book to explicitly focus on issues and innovations associated with prison health research also contributes to a small but important literature on ethics in prison research (Arboleda-Flórez 2005; Brewer-Smyth 2008; Crighton 2006; Fine and Torre 2006; Freudenberg 2007; Gostin 2007; Hornblum 1997; Moser et al. 2004; Overholser 1987; Pope et al. 2007; Shaw et al. 2014; Ward and Bailey 2012). Ethical issues are at the forefront of any research study, but arguably require more careful consideration in a prison context where ...