Content area
Full Text
Introduction
Compared to community populations, prisoner populations have a high burden of disease. In particular there are high rates of illicit drug dependence, mental ill-health and blood-borne viruses ([4] Champion et al. , 2004; [14] Hammett et al. , 2002; [27] Singleton et al. , 1998). Mortality is higher amongst ex-prisoner populations ([24] Rosen et al. , 2008; [2] Binswanger et al. , 2007). Within prison, suicide rates amongst prisoners are five times higher than community populations ([10] Fazel et al. , 2005). Following release from prison, there is an increased risk of death from illicit drug overdose, largely due to prisoners losing tolerance to illicit drugs whilst in prison which places them at risk when they start using again in the community ([9] Farrell and Marsden, 2008).
Prisoners also have a high rate of co-morbidity. A UK based cross-sectional survey exploring health morbidity amongst prisoners showed over 70 per cent have two or more co-morbid health problems ([27] Singleton et al. , 1998). However despite such high morbidity and mortality the standard of healthcare has traditionally not been equivalent to that offered in the community. Prison populations have been highlighted as a hard-to-reach group presenting a challenge to the provision of flexible, responsive healthcare provision ([30] Wright et al. , 2010). Developments in healthcare provision in recent decades have placed an increasing emphasis upon health education and health promotion paradigms to empower patients to effect positive behaviour change for the improvement of their own health. "Health Education" has been defined quite simply as "educating people about health" ([18] McKenzie et al. , 2009). In the World Health Organization's 1986 Ottawa Charter, the definition of "health promotion" goes beyond "health education" and has been defined as "the process of enabling people to increase control over and improve their health ... to identify and to realise aspirations, to satisfy needs, and to change or cope with the environment. Health is seen therefore as a resource for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capabilities" ([29] World Health Organization, 1986). The Charter also outlines the following principles for effective health promotion:
- to empower and strengthen community action;
- create supportive environments;
-...