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PUBLIC HEALTH AND THE PRISONER Is there a Problem? Peter Sims UPNG Peter Sims UPNG Teaching and Learning Tasks Learning Objective To understand the composition of the Prison population in terms of its epidemiology Peter Sims UPNG Performance Objectives To appreciate 1.The variation in the use of prison worldwide 2.The changing size and composition of the prison population 3.Diseases common in prison and among prisoners 4.The success and failure of prison 5.The problems of prison and imprisonmentindividual and societal 6.Possible solutions Peter Sims UPNG “Write the vision, and make it plain upon tables, that he may run that readeth it” Habbakkuk ch.2 v.2 • Peter Sims • Professor of Public Health Medicine • The School of Medicine • University of Papua New Guinea • <[email protected]> Peter Sims UPNG WHY PRISON? • The Public Health and Private Good • Who is in Prison? • What for? • What is it like? • Does Prison work? • What else can we do? Peter Sims UPNG WHAT ARE PRISONS FOR? • To protect society from the activities of evil doers • Prison,as Punishment will be an effective deterrent, both for the ex-convict and the person tempted into criminal activity • In Prison the criminal will have opportunity to repent, reform and be rehabilitated Peter Sims UPNG WHO GOES TO PRISON? The Mad, the Bad and the Sad Young Men<35 Low IQ Ethnic minority The Mad Psychopaths Personality disorders The sad Depressed The Bad Criminal cultures Anxious Inadequate Evil fanatics Peter Sims UPNG A Crime committed-the Law broken • The Process of Law The Court Process Crime committed Investigation Arrest Remand Peter Sims UPNG Verdict Judgement Punishment The Men and Women in Prison • In the UK at any time there are 60,000+ people in prison • 20,000 are on remand,awaiting trial • Less than 4,000 are women • The average time in prison is 18 months • In 1 year 150,000 people pass through Prison Peter Sims UPNG Types of Institution • • • • • High-Medium-Low security Prisons Men-Women Prisons ,Juvenile Offenders Special Prisons for - Criminally insane -Military -Political Prisons are built in remote places to make escape difficult,the buildings are comfortless fortresses, the ambience is gray, cold, stone and is designed to depress and crush the human spirit Peter Sims UPNG Hierarchies,currencies,abuse • Prison Hierarchies The Screws The Bosses The Blokes Drugs,Tobacco Bullying,abuse Peter Sims UPNG Sex offenders Risks to Health-the diseases of Prison • • • • • • • Tuberculosis Diarrhoeal disease Infections-typhus HIV and STD’s Trauma Mental illness Suicide Peter Sims UPNG Health risks Drug addiction and HIV disease • • • • • • Drug abuse -drugs are easily available -people are bored and unhappy -there is a culture of drug taking -drugs are the currency -shared, dirty needles spread HIV -there will be opportunity for voluntary/involuntary homosexual sex Peter Sims UPNG Prison Health Care • Preventive Services • Eyes, teeth, ears,and skin care • Spectacles, dentures Hearing aids etc • VD treatment • Drug addiction • Alcohol addiction • Treatment services • High consultation rates/sickness • Trivial problems • No self therapy • No trust of doctor • No continuity of care • Poor compliance Peter Sims UPNG Does Prison Work?-No • The re-offending rate remains stubbornly high worldwide at 70% and little affected by • The Prison-High /Low secure • The Prisoner-offence, age, sex • The regime-tough,punitive or rewarding of effort and educative • The length of sentence, remission, parole Peter Sims UPNG A Future Vision Prison as a therapeutic community Prison as a Healthy Setting • • • • • • • • Imaginative sentences Tailored to individual Family links Paid work Education New skills Probation/follow up Parole,furlough Peter Sims UPNG After Prison-what? • Financial security • Real work provided on discharge,properly paid and reflecting new skills • Family support-health,relationships housing, • Restitution and responsibility • A real alternative to criminal culture Peter Sims UPNG “Society can be measured by the way its Prisoners are treated” Winston Churchill Peter Sims UPNG
