Article

Populations at Special Health Risk: Incarcerated

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Abstract

The level of disease and illness among prison populations worldwide tends to be much higher than in the general population. In particular, the resurgence of communicable diseases poses enormous challenges for prison systems internationally. Reducing disease transmission in prisons is an integral part of reducing the spread of diseases in the community. States have an obligation to implement policies consistent with good public health and human rights practice and to ensure that prisoners are provided with a standard of health care equivalent to that in the broader society. Based on empirical evidence, this article examines key medical and penal policy issues raised by the transmission of infectious diseases in prisons. It analyzes the policy directions and alliances that are effective in improving the health of prisoners in light of their practical applications.

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Background Until today, inadequate attention has been paid to the distinguishing attributes of healthcare provision in prisons. It has been conceived either as ancillary or as a core component of imprisonment. While the former idea prevailed in the past, leading to a bio-medical approach to care in prisons, the latter is currently arising. Method This paper discusses the change in the approach to care in Italian penal institutions, examining their inertia. The design of the research consisted of a mixed approach: at the beginning, a desk study of law documents was realized; then, a semi-structured 48-item questionnaire was addressed to the health managers operating in the penal institutions of a southern Italian region. Results The study suggests that penitentiary health areas are prone to change and they are willing to establish inter-organizational relationships with healthcare organizations operating within the National Health Service. Notwithstanding, they have to cope with the institutional inertia of penal institutions, that favour organizational monism. The legislative efforts are not sufficient to foster a process of change in prisons; healthcare professionals usually act as catalysts of change, championing it and encouraging the reorganization of penitentiary healthcare. Conclusions This study paves the way to both further theoretical developments and to practical implications. On the one hand, it suggests a reconceptualization of healthcare provision within penal institutions, claiming the belonging of penitentiary health to public health. On the other hand, penal institutions are unwilling to change, due to their nature of total institutions: the involvement of healthcare professional in fostering the reorganization of healthcare provision is thus crucial to legitimate the process of change.
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