Three decades of the health promoting prison: a critical reappraisal of policy and practice.

Abstract

Purpose: This paper aims to provide a critical appraisal of the Health Promoting Prison (HPP) thirty years after its introduction by the World Health Organisation. It examines the extent to which the original settings-based vision has been realised; identifies areas of progress and stagnation; and analyses how contemporary policy and structural conditions have shaped and inhibited the HPP's trajectory.

Design/methodology/approach: Using a critical review approach, this paper synthesises academic literature, policy documents and selected examples of prison health reform to explore the development of the HPP across three decades. The paper revisits earlier critiques of the HPP and integrates new evidence emerging over the last decade.

Findings: The analysis reveals a consistent gap between the rhetoric of the HPP and its real world implementation. While countries such as Scotland, the Netherlands and Portugal demonstrate structural reform aligned with HPP principles, progress elsewhere remains fragmented and predominantly behaviourist. The paper highlights how COVID 19 exposed deep systemic vulnerabilities to the HPP model and underscores the health and well-being of prison staff - critical to a whole prison approach - which remains marginalised in health policy and practice. Overall, the HPP remains conceptually compelling but operationally underdeveloped.

Practical implications: Findings indicate an urgent need for updated governance frameworks, strengthened whole prison approaches and renewed investment in environmental conditions.

Originality/value: This paper provides the only three decade assessment of the HPP model. It contributes new theoretical insight by applying institutional isomorphism to explain policy drift and highlights prison staff well-being as a critical, yet neglected, determinant of healthy prison systems.