Prisoners’ Health and Health Services in Prisons

The article discusses the problems of health service in prisons in relation to health of prisoners. It refers the results of conducted empirical studies which assumed that the ailments of the imprisoned, specific to their age, actual health service needs, expectations and needs related to health service of prisoners, are indicators of their health. A conception of prisoners’ social service by penitentiary administration without pressure on corrective influence formulated by Henryk Machel was the theoretical basis of the study. The study aimed to answer what was health of the prisoners examined, defined by their general health, needs and expectations concerning health service and to what degree they are answered by the health service in prison. The study was conducted in prisons under District Inspectorate of Prison Service in Poznań, i.e. remand institution in Poznań and prison institutions in Rawicz and in Wronki. All three institutions are of a closed type. The study was conducted between January 2011 and November 2012. It included analysis and explanation of acts of law concerning health service in prisons and questionnaires and interviews with prisoners and prison staff . 279 of them were suitable for further study. Structuralized interviews included 30 doctors and 30 prison carers. The results were analysed statistically. They show opinions of the respondents on the problem of health service in prisons. Young and middle age adults were the majority of the respondents (67,03%). There was a statistically significant relation between general health declared by the respondents and their age. The younger a prisoner was, the better his own general health declared, and vice versa p> 0,001, x2 = 23,245). The data show that half of prisoners declared that imprisonment contributed to deterioration of their health. This is in contrast with a relatively low number of diseases found by doctors after imprisonment. Among various ailments declared by prisoners, psoriasis and sleep deprivation were the most frequent ones. The most detrimental factor to health was prison stress. Its role was indicated by as much as 17 doctors (62,97% of all doctors in the study). Every fourth doctor indicated bad living and sanitary conditions in prison (25,93%). The same number concerned other factor, i.e. nicotinism among prisoners. This shows that many prisoners assume detrimental health habits in prison conditions. Results of the research show that, in practice, response to the need of health protection in penal institutions was very diverse. Health protection was a secondary issue and it was a part of various modules of prisoner treatment. They were characterized by various intensity of health service. It was established that the modules were as follows: control and security (63,36% indications in general). In practice, in penal institutions included in the study, this module occurred in two forms: social and health (providing security and order, prisoners’ control under prison rules, social service and above-standard health care), social (providing security and order, prisoners’ control under prison rules, social service and standard health care), security and rehabilitation (66,67% indications, providing security and order, providing a minimum level of social service and basic health care, rehabilitation). Only the first of the above forms allows to fit the problem of health care fully into penitentiary actions. The study allows for a conclusion that, in the face of the crisis of penitentiary rehabilitation, the role of health care of prisoners will increase – as a consequence of “non-rehabilitationˮ modules of prisoner treatment being more and more frequent. Health care, along with ensuring suitable living conditions and social service, may thus become a part of good penitentiary practice. Health care, and to be exact, medical cal care and medical services for the imprisoned must fit their actual needs. In general, the research has shown that the objective health condition of the imprisoned included in the study is better than their declarations. However, their health varied from a person to another, most of all related to age. The greatest health needs were declared by seniors and their expectations concerning health care and medical assistance ensured by the prison were greatest too. A practical model of prisoners' medical treatment must take this into account. I was established that penitentiary practice employs, most often, modules with basic medical treatment. This is due to the relatively modest prison infrastructure but also to limited budget. Thus, a security - control - pro-health treatment module seems to be a good penitentiary practice. It includes ensuring security to the prison and the imprisoned, order maintenance, above standard health care and social care according to European Prison Rules. Thus, a good practice must be of an eclectic character. Health care and health protection have an important place in such practice. From this point of view, the research shows a diversified picture of penitentiary reality. On the whole, it is relatively positive