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Introduction with description of health issue, needs and promotion:....................2


Description of the group and a rational for selecting this group:..........................4


Descriptions of goals:............................................................................... 6


Description of the model of health promotion and reasons ().......................8


The implications for health in the application of an innovative ()....................10

Conclusions.................................................................................................... 14
References:.................................................................................................... 15
Annexes......................................................................................................... 16
Personal Assignments...................................................................................... 19
Maria Malgorzata Wasylkowska (196816 PIV).....................................................20
Laura Garriga Plaza (220725 PIV).....................................................................22
Irina Elena Micu (220718 PIV) ..........................................................................25
Ciprian Marius Rotariu (220723 PIV)..................................................................26

A. Introduction with description of health issue, needs and promotion:

Jails and prisons have a profound influence on the health of communities,







individuals at high risk of violence, substance abuse, mental illness, and

infectious diseases; create incentives and penalties for health related behavior;
disrupt family life and push children into foster care; and have the potential to
link vulnerable population to needed health and social services. Correctional
institutions like prisons have direct and indirect effects on health. Indirectly they
influence family structure, economic opportunities, and political participation.
They can have a direct effect on the health of population by offering health care
and health promotion in jails, by linking inmates to community service after
release, and by assisting in the process of community reintegration.

Health Issue:

Regarding health and health promotion prisons pose special considerations due
to the nature of their unique environment. Possibilities and options are limited
for work alternatives and many inmates may have both medical and social
conditions that increase their risk of unhealthy lifestyle.
As prisons good health is very important to general public health, and as
prisons are not closed-off worlds, the health of prisoners is becoming a public
health priority of concern to society in general (Public Health, 2005)l; it seems

significant to improve health within those kinds of institutions. We fully agree

with the principles governing the WHO launched Health in Prisons Project`s
(HIPP) thinking on prisons health that all prisoners have the right to health care,
including promotion, without discrimination. Therefore the focus in our
assignment is on general health promotion and in particular on Healthy Food
(H.F.) and Physical Activities (P.A.) promotion.

Health need:
According to the WHO definition of the health need is the objectively determined
deficiencies in health that require health care, from promotion to palliation. 1
According to the professional view point is understood as health needs, the
need for health care, recognized by health professionals and the benefits of it
through counseling and the prevention, management, specific treatment;
By other way the scientific view understand too the biological, anthropometric or
psychological factors, expert opinion or the passage of time;
The perception of this needs could change between the personal perspective of
the own person's needs, and the professional point of view. For this reason is
important to work with the prisoners in that case, to know what they feel that
they need, and what the professionals of the health recommended to arrive to a
perfect intervention and with the best results.
Health Promotion:
As we know, health promotion is the process of enabling people to increase
control over and to improve, their health. To reach a state of complete physical,
mental and social well-being, a group must be able to identify and to realize
aspirations, to satisfy needs, and to change or cope with environment.

Expert Committee on Health Statistics. Fourteenth Report. Geneva, World Health

Organization, 1971 (WHO Technical Report Series No. 472, pp 21-22).

Health promotion focuses on achieving equity in health. Our target group

prisoners are human beings regardless of circumstances, and we believe that
they need equal opportunities to achieve their fullest health potential. This
includes a secure foundation in a supportive environment and opportunities for
making healthy choices.
In this regard, we propose a series of activities leading to the adoption of a
Healthy Lifestyle (H.L.) even though our target group has certain restrictions.

B. Description of the group and a rational for selecting this group:

The Prison and Probation Service

is an institution which is responsible for

prisons in Denmark. Its general objective is to contribute to reducing crime, a

goal it has in common with the police, prosecution and courts. Services main
task is to execute the sentences imposed by the courts, that is to say
imprisonment and other forms of sentences. Probation institutions reflect that
Denmark is a country, which wants to have alternative to incarceration.

The WHO European Health in Prisons Project after 10 years: Persistent Barriers and
Achievements; Am J. Public Health 2005 October, 95(10)

The Probation Service is on any given day of the year responsible for about
14ooo people, including approximately 4300 in prisons and jails and about 9700
in various forms of supervision. Convicted persons are normally placed in an
open prison. There occur, however, some cases where inmates are placed in a
closed prison. The Service has 36 custody places, 5 closed, 8 opened prisons
and Copenhagen Prisons, which is a common name for three prisons.
In 2013 The Prison Service had an average capacity of 4126 places, divided
between 909 in closed prisons, 1358 in opened prisons and 1859 people under
On a specific date, 10th December 2013, 95% of imprisoned were men,65% of
sentenced inmates were between 20 and 39 years old, 89%were serving
sentences of longer than 4 months, 82% of sentenced prisoners were Danish
citizens, 26% had no-Danish ethnic background.

11, 5%inmates have not completed any education or training at all and this
includes basic schooling. In this group most of prisoners are under 24 years old
it is them who have the poorest educational background; the figure for
inmates older than 35 is 8%. One out of four states that they have completed

vocational education or training, 2% of the inmates have finished a further

education of medium length and also 2% - university degree (bachelor or
master level). Some studies suggest that many prisoners who have formally
past 9 years of primary school, have had problematic learning period: have had
many absences, moved schools, etc. (Koudahl, 2007)3
In this assignment we will narrow our attention to the group which is placed in
opened and closed prisons and sentenced for more than 4 months as those
inmates are under individual activity plans provided for them by the Service
system. We mean that impact related to health promotion could be, inter alia, a
part of these individual plans. It signifies that our focus group constitutes of
(mostly) Danish men at the age between 18 and 39, sentenced for longer than 4
months, with poor educational background finished primary school and had
problematic learning period.

C. Descriptions of goals:
Our principal goal is to create new practical applications by using models as
the mainly empowerment and the educational model too. We are going to
explain this along the assignment.
Our goal through the empowerment model is give to the prisoners the tools to
learn how to live by their own and sustain themselves, developing their own
skills. But at the same time we hope that they develop to another skills like
socialize, work in groups, to be responsible, independent, optimistic and also to
learn how to cook all that is going to be use for the first goal about grow as a
About the Educational model we want to get with that a new form to give
information about what healthy means and how it affects to our life, but what is
more, how to have a healthy life in prison. We are going to develop that through

Koudahl, Peter (2007)Indsatte i danske fngsler. Uddannelse og

uddannelsesnsker2.reviderede udgave;Inmates in danish prisons. Education and training
request.2nd revised edition

the food and the P.A., learning how to take care of the body preventing obesity
and Sedentary.
We are making a link between how the food affects to the Physical Health but
we are thinking too in the mental health as an important issue relationed with
the food and P.A.
That kind of methods that we are planning involve the necessity of be healthy
and learn how to continue being healthy and having habits to develop outside
When we talk about have new habits in and outside of the prison we are making
a relation with the empowerment model because we need the people choosing
that live style as a choice not as an obligation to continue it.

We know that when one person is obligate to do something without understand

it or want it, that person is not going to continue this activity later.
Thats what we need the people to understand the impact of the healthy in our
life and how to have a healthy life.
Then our goal is to implement health promotion via the health prevention and in
this way influence the community around the prisoners outside the institution.
Our hope is that after getting out of prison the target group will extend the
development of health lifestyle.

D. Describe the model of health promotion and reasons why this

model is relevant:
The most relevant model of health promotion for our topic is the empowerment
The self-empowerment paradigm, with its emphasis upon self-awareness and
skills, resonates with what skill training and self-conditioning in order to help
individuals act upon their intentions to adopt health behaviors.
Self-empowerment is used in some cases to describe those approaches to
promoting health which are based on counselling and which use non-directive,
client-centred approaches aimed at increasing peoples control over their own
lives. For people to be empowered they need to recognize and understand their
powerlessness, feel strongly enough about their situation to want to change it
and feel capable of changing the situation by having information, support and
life skills.
Our target group has a sedentary lifestyle which can lead to obesity or the
occurrence of many diseases and our goal is to avoid that happens. The
methods that we use to implement the empowerment model are workshops
where we can suggest ideas about how they can produce H.F., meetings with
professionals, coaching.

The goal of this approach to health promotion is to empower individual people

to make healthy choices. Self-empowerment can be defined as the process by
which groups and individuals increase their control over their physical, social
and internal environments. In order to facilitate self-empowerment, participatory

learning techniques allow people to examine their own values and beliefs and
explore the extent to which factors such as past socialization as well as social
location affect the choices they make.
To reach a state of complete physical, mental and social well-being, a group in
our case- must be able to identify and to realize aspirations, to satisfy needs
and to change or cope with the environment prison, in our case.
The concept that we are using educational and self-empowerment.
Educational to provide information and create well informed people
Self-empowerment to empower choice and foster person growth.
The empowerment model is not the only one that we can use. Another one is
the educational model which can help us to teach prisoners to discover many
ways for training their body, their mind and their social skills. A good method for
giving them this information is using a teacher, a coach or a psychologist.
The examples are the best way to teach someone how to act. A person who
was in the same situation and succeeded to maintain a good health using H.F.,
making physical exercises is the most powerful motivation for making a change.
Health education is one of the instruments of social change. If the prisoners
adopt a H.L. in prisons they will also promote it outside, when they will get out.
We think that this will be a good thing for community, because a H.L. eliminates
the stress and the recidivism rate is lower. The prisoners also can be an
example for the peoples from outside, because the most often situation in
prisons including violence. Adopting a H.L. is a big step in changing the life of a
For all this to be possible is necessary to hold a good collaboration between
institutions The most important institutions which can help in producing a big
change in a prisoner life are The Church, the Municipality, the Hospital, the
School and the NGOs

E. The implications for health in the application of an innovative

approach to health promotion:

Our approach to the empowerment model of health promotion is based on the

traditional perspective4 ], though with some innovative elements regarding the
used methods. Our point of view is that the promotion of H.F. and P.A. can both
refer to prisons communities and can be included in the individual programs for
each prisoner. Our estimation is also that the promotion can be carried as a
planned activity (f.eg. written in the individual plans) and as a one-time action
(f.eg. an event).We will present below empowerment methods in two groups:
self-centered approaches and community developments, but we underline that





they cannot be considered separately as the community change cannot happen

without the individual change.
Individual empowerment:

Consultations with a social adviser about importance of healthy

eating, doing P.A. and consequences of NOT doing it during

Personal goals related to H.F. and P.A. written in the individual plan,
so a prisoner could consider it as a contract and by signing get a better
motivation and take responsibility for his/hers actions - f.eg. I will go for
a walk every day despite the weather or I will eat a fruit a day, etc.

Developing awareness/personal skills in workshops about significance of

H.F. and P.A. the workshops could be done either by the employees or
by professionals from outside. The final goal could be that the workshops
are run by the prisoners;

Access to a couch in the gym; the coach could make an individual

training plan for a person, give advices, etc.

For those, who take education: making assignments in the specific

subject (English, Danish classes) related to H.F. and P.A.

Give possibilities to relaxation/yoga classes to stress out and gain the

control over own body;

Rewards for those, who eat H.F. or do P.A. in form of f.eg. Longer
family visit time;

Empowerment of the group:

Promoting H.L. and H.F. by inviting a famous cook f.eg. From TV

program to make a presentation of making healthy meals;

Consulting/employing a nutritionist, who could set up a program for

every day meals. The meals could be cooked in the own prisons
kitchen, also by the prisoners;

Promoting H.F. in the prisons shop by competitive prices;

Making a vegetable garden by a prisons building, where there could

be planted some vegetables/fruit used in the cooking;


Creating a small farm with animals, which can give some product
hens (eggs), nanny goats (milk);

Making sport competitions of any kind, f.eg. Football, table tennis in

within one prison and between prisons

Making one day of the week day without sugar or fruit day and the
like promoting that idea by advertising on the walls, by loudspeakers,
serving on that day particular kind of food(without sugar or fruit salad,

The principal consequences that we are predicted and that we expect are give
to the prisoners better Health and Physical condition preventing the obesity and
the sedentary.
At the same time they are developing and working in their mental health,
improving social skills, all that through the develop of a better self-motivation to
do all these things.
And finally that kind of activities come to improve daily life, giving to the
prisoners a better life quality, both in the prison as outside because they are
getting and changing their habits / behaviors regarding healthy eating and
making P.A.
By that way it can help to increase their self-esteem, self-confidence; and we
hope that it will help them to continue this kind of lifestyle afterwards when they
are free, so it will prevent recidivism, lowering the number of recidivists and that
they will come back to the society as more aware and developed people.
After explain all our program and ours proposed activities we need to be clear
in that:
We are working with persons and sometime we dont get all what we want


The people is unpredictable but we have expectations and of course all the new
projects needs to be tested.
[1] Self-empowerment and empowerment of the groups

The main motto of our project is Prisoners are entitled to the same
level of medical care and social security as well as people from the
First of all, with our project we want to give the prisoners the tools to
learn how to live healthy by their own and sustain themselves, developing their
own skills. But at the same time we hope that they develop other skills like
socialize, work in groups, to be responsible, independent, optimistic and also to
learn how to cook all that is going to be use for the first goal about grow as a
Using the methods that we presented we want to get a new form to give
information about what healthy means and how it affects to our life, but what is
more, how to have a healthy life in prison.
The principal consequences that we are predicted and that we expect
are to give the prisoners better Health using healthy food and Physical condition
preventing the obesity and the sedentary.
And finally, that kind of activities will come to improve daily life, giving to
the prisoners a better life quality, both in the prison and outside because they
are getting and changing their habits / behaviors regarding healthy eating and
making physical activities.


Expert Committee on Health Statistics. Fourteenth Report. Geneva, World
Health Organization, 1971 (WHO Technical Report Series No. 472, pp 21-22).

2. The WHO European Health in Prisons Project after 10 years: Persistent

Barriers and Achievements; Am J. Public Health 2005 October, 95(10)


Koudahl, Peter (2007)Indsatte i danske fngsler. Uddannelse og

uddannelsesnsker2.reviderede udgave;Inmates in danish prisons. Education












Naldoo, Jennie; Wills, Jane (2009): Foundations for health promotionElsevier




Annex 1
Visit in Hobros custody
One of our group members (Maria) has visited a prison in Hobro, where
inmates are remanded in custody until their trial. We are fully aware of that this
place might be different from other, bigger prisons in the country and that the
prisons environment may differ from the conditions the detainees are under.
We believe though, that it gives anyhow the impression of Denmark`s inmates`
general situation. There is a short description of the visit:
On Thursday, 23rd Oct. 2014 I had the chance to visit Hobros custody, where I
participated in the Danish lessons and thus had possibility to see the place and
talk both to the personnel and the prisoners. I will present below my
observations related to the assignments subject.
Prisoners live mainly in 1 persons cells 5 square meter of size. They can visit
each other 1 by 1 from 16.00 to 21.00 in their cells.
Inmates get 1 hour walk and this is optional, i.e. they can choose self if they will
participate in it or not. Walking places are relatively small, surrounded by walls
and covered with a metal net. Prisoners can also use custodys well equipped
fitness center - 3 times a week 1 hour at a time.
Inmates prepare breakfast for themselves in their cells and get prepared meal 2
times a day. Food comes from outside in frozen boxes, a prisoner who is
responsible for making food unfreezes it, warms up and delivers to the others in
their cells. There is possibility to buy different products 2 times a week from a
local merchant who charges a lot more (that is what my interviewees told me)
than in his shop outside.










(Kriminalforsorgen Uddannelses Portal) and is highly protected, i.e. access to

many pages is blocked.
There are several people from outside who come and work with prisoners:

1. Teachers inmates are offered education, they can participate in Danish,

mathematics, English or social studies lessons;

Consultants those who need a treatment (alcohol, drug-addiction)

are offered sessions with a consultant; afterwards when they are
sentenced and placed in a prison, they can serve their punishments in a
treatment department there are several in the country;


Priest comes once a week to talk to the prisoners and celebrate



Social counselor/adviser comes after a person is arrested and talks

with them about their family/economical/personal situation;


Doctor comes 1 a week and deals with patients; there is also places,
where a nurse is employed full time;

Most of these people, in cooperation with prisons employees participate in

creating individual activity plans for inmates (each of them has got their own
section/part to describe). The employees underline that those plans are inmates
plans, which obliges them (detainees) to follow the assumptions and take
responsibility for their actions.


Personal Assignments


Maria Malgorzata Wasylkowska (196816 PIV)

Imprisonment is a specific state especially in the context of empowerment

understood as the process by which individuals/groups increase their control
over their environments. It is specific in the sense of considering the situation
where people who are under legal control are supposed to master their
conditions. Considering The Worlds Banks definition 5, health promotion by
empowerment seems relevant in relation to both each prisoner 6 and groups of
inmates7. In the following I will attempt to make a comparison of health
promotion (underlining H.F. and P.A.) in prisons in Denmark and Poland with
consciousness of the fact that the comprehensive analyze of the subject cant
be made in this assignment. Moreover, my description is based on observations
of single institutions, which cant be considered as representative.
My goal is not to evaluate any of the two, as the success of empowerment
strategies depends on adapting them to the local and cultural context. (WHO,







environment, health in general:

Individual activity plans(IAP) regarding IAP signed by a prisoner
different personal areas of a prisoner
Access to a doctor/nurse from outside GP employed by institution
Possibility to visit each other in their Only in opened prisons
1-2 persons in 1 cell, intimacy
Several persons in 1 cell
Social worker/adviser, psychologist, Those professionals employed by the
priest, therapeutic from outside


Empowerment as the process of increasing capacity of individuals or groups to

make choices and to transform those choices into desired actions and outcomes
(WHO, 2006:17)
with stress on developing personal skills
with stress on developing supportive environment


1 chosen person representing the This function exists only in legislation,

others in dialog with the system
not in practice
Treatment departments for prisoners Treatment
with alcohol-, drug- abuse problems



alcohol/drugs addicted

The food is delivered in frozen boxes Meals





and warmed up
nutritionist employed by institution
The food prices in the shop are high. In The prices in the prison shop are
principle all products also fresh high/limited assortment available
vegetables/fruit are available
Possibility of cooking for themselves in Possibility in opened prisons, selfopened



facilities provided equipment

Right to walk outside 1 hour/day
1 hour walk/day
Right to use a gym 1 hour 3 times a Gym only in opened prisons
My observation is that the Danish prisoners are given more possibilities to be
involved in decision-making processes regarding everyday situations, which is
essential for authentic participation in development of any kind.
WHO, February 2006: What is the evidence on the effectiveness of
empowerment to improve health? Health Evidence Network

Laura Garriga Plaza (220725 PIV)

Country: Spain

Starting to make a comparison between the situations in Spain (S.) and

Denmark's (D.) prisons and health applications of it, we need to know:
S. has about 150 prisoners per 100,000 inhabitants, while D. has about 60/70
prisoners per 100,000.
Furthermore D. spends about 1940 Kr per day per prisoner and S. the
equivalent of 416 Kr.
As members of the WHO since 1995 in the Health in Prisons Programme
(HIPP) S. and D. are committed to improving public health and health care in

main activity is to give technical advice to Member States on the

development of prison health systems and their links with public health systems
and on technical issues related to communicable diseases (especially
HIV/AIDS, hepatitis and tuberculosis), illicit drug use (including substitution
therapy and harm reduction) and mental health.
Enjoyment of the highest attainable standard of physical and mental health is a
fundamental human right. Prisoners should therefore have the same standard
of medical care as people living in the community. (Moscow Declaration, 2003)








recommendations for targeted interventions as measures, programs and

guidelines to prevent and control major communicable and mental health
diseases in prisons all that in the Health in Prisons Programs.
When we talk about agricultural work in D. in some prisons they make works of
creating and caring gardens. A concrete example of a prison that we can read

"The Contract Section has its own greenhouse Where They grow

vegetables in summer and their own little workshop Where They make candles
and repair bicycles"
While in S. we can see that there are some programs with orchards in the
prisons, like the new model has been launched in Lledoners (A Catalonia's
prison). Its being tested as a model of peaceful coexistence based prison and
responsibility, where inmates undertake to enter into a scheme of life without


drugs and violence, and the lifestyle is defined by three words: accountability,
participation and sharing.

This Model its relation on the experience of the Nordic countries and aims to
improve the social climate, the relationship between the internal and the officer
and prevent recidivism. The prisoner is committed to participating in a scheme
of life without drugs and violence and instead takes on a whole set of
responsibilities "normalize life in prison."

Although at present it is considered more as an utopia all about the farms in

prisons, and there is controversy over the danger of falling into the "slavery" or
"labor camps"; But there are another consideration as a hobby to develop social
skills, improve mental health while doing physical activity, not like to be
considered an obligation and a burden to make a trade and take advantage of it
or pay the "debt to society".

Agrupacin de los cuerpos de la Administracin de Instituciones Penitenciarias









World Health Organization: Regional Offiice for Europe (2014) . WHO Health in







QCEA: Quaker Council of European Affairs (2006). Country Report: Denmark.




Herraiz, Pepe (2014) La primera zafra del huerto teraputico del Centro Penitenciario
Las Palmas I. Las Palmas actualidad.

From http://laspalmasactualidad.com/la-


Irina Elena Micu (220718 PIV)


Country: Romania
Healthy lifestyle in Romanian prison... Every time when I talk about this
subject I feel a bit disappointed. From my experience with inmates and also,
when I visited the prisons I discovered a lot of problems like: poor housing
conditions, unhealthy food, the inmates are sedentary, they don't have their own
space, they are living with other 15 maybe 20 peoples in the same room.
After a long documentation, I observed a big difference between point of
view about health in Danish prisons and point of view about health in Romanian
Danish prisoners are getting more facilities which can give them the
chance to have a healthy life. I read about the possibility to use a fitness center.
Making a comparison, this is impossible in Romanian prisons and I think it is a
bad thing for inmates. They have a sedentary lifestyle which can lead to obesity
or the occurrence of many diseases and, to have a fitness center would be a
chance for many inmates to change something. If they learn in prison to have a
physical active program, they can also promote it outside.
Other things that caught my attention are the living and hygiene
conditions. In Denmark, prisoners live mainly in 1 persons cells 5 square meter
of size. In Romania, as I said before, the inmates share a room with other 20
peoples. They are allowed to take shower once per day and they have to use a
communal toilet. In my opinion, all this conditions can affect both the mental and
physical health.
There are also some commune things. The prison has a doctor for
inmates, there are also: a psychologist, a priest and more teachers who try to
help the prisoners.
In conclusion, I think that Danish prisons offer to inmates the opportunity
to have a healthy life, even if they are not in freedom with their families. On the
other side, the Romanian prisons don't give to the prisoners the chance to have
a normal life, with normal things which can determine a healthy life.


Ciprian Marius Rotariu (220723 PIV)

Country: Romania
It seems that contemporary society is more and more concerned about the
issues of crime and justice. Despite the different efforts and endeavors to
reduce or control crime, the phenomenon of crime has become a significant
Confronted with significant economic and social problems, Romania fight
for human rights principles. Romania prisons are overcrowded and the costs of
building and maintaining prisons are too high for a limited state budget. Prisons
have a profound influence on the health of urban communities, they collect and
concentrate individuals of high risk of violence, mental illness and infectious
disease. Physical conditions in Romania`s prisons reflect decades of neglect,
as well as the disastrous economic condition that currently exist throughout the
country. Prisons are old and mattresses, blankets and prisoner`s uniforms are
ragged and often dirty. Toilets and showers are primitive, though usually
functional. Prisons must be upgraded, laws and regulations must be enforced,
and mechanism must be built into the system to guarantee oversight of prisons
by non-government, as well as government, organizations. Prisons officials, the
Ministry of Justice, as well as independent organizations must take an active
role in guaranteeing that current laws are respected and that prison personnel
are held accountable for any failure to do so. The Ministry of Justice and the
Directorate of Prisons should issue new directives to all prison directors making
clear exactly what rules and regulations are currently in effect. Such a directive
should also specify that the failure to implement current rules and regulations
will result in punishment and possible termination of employment. This system
needs a new reform to combat corruption and human rights to be respected.
In Denmark, prisons are very different, therefore, they have a modern
system, and they treat very well the prisoners. The prisoners have the
opportunity to work with specialists from outside ,for example; those who need
a treatment(alcohol, drug-addiction) are offered sessions with a consultant,
when they are sentenced and placed in a prison, they can serve their
punishments in a treatment department, they can talk with a priest


celebrate mass ,he comes once a week; the adviser comes after a person is
arrested and talk with them about economical, personal situation; the doctor,
comes once a week and deals with patients ,there is also a nurse who is
employed full time; the prisoners can participate in Danish lessons,
mathematics, English or social studies lessons because teachers inmates are
offered education. The prisoners live mainly in one person`s cells five square
meter of size, they can visit each other one by one from 16:00 to 21:00 in their
cells, prisoners can also use custody`s well equipped fitness center.