Health promotion and prison settings
Lidia Santora, Geir Arild Espnes and Monica Lillefjell
Lidia Santora is a Researcher
and Geir Arild Espnes is a
Professor, both are based at
Department of Social Work and
Health Science, Norwegian
University of Science and
Technology NTNU, Trondheim,
Norway.
Dr Monica Lillefjell is an
Associate Professor, based at
Department of Health and
Social Care, Sør-Trøndelag
University College (HiST),
Trondheim, Norway and
Department of Social Work and
Health Science, Norwegian
University of Science and
Technology, Trondheim,
Norway.
DOI 10.1108/IJPH-08-2013-0036
Abstract
Purpose – The purpose of this paper is to examine the contribution of modern correctional service in health
promotion exemplified by the case study of Norwegian health promotion policies in prison settings.
Design/methodology/approach – This paper applies a two-fold methodology. First a narrative systematic
literature review based on the Norwegian policy documents relevant for correctional settings is conducted.
This is followed by a general review of the literature on the principles of humane service delivery in offender
rehabilitation.
Findings – Alongside the contribution of the Risk-Need-Responsivity Model in corrections and prevention
of reoffending, the findings demonstrate an evident involvement of Norway in health promotion through
authentic health promoting actions applied in prison settings. The actions are anchored in health policy’s
overarching goals of equity and “health in all public policy” aiming to reduce social inequalities in
population health.
Originality/value – In order to achieve a potential success of promoting health in correctional settings,
policy makers have much to gain from endorsing a dialogue that respects the unique contributions of
correctional research and health promotion. Focussing on inter-agency partnership and interdisciplinary
collaboration between humane services may result in promising outcomes for individual, community and
public health gain. The organizational factors and community involvement may be a significant aspect in
prisoner rehabilitation, reentry and reintegration.
Keywords Health promotion, Prison, Reintegration, Throughcare
Paper type Literature review
Introduction
Intuitively, one may think that there is no better suited environment for health promotion than
correctional settings. Indeed, one of the highest concentrations of poor physical, mental and
social health often related to illicit substance abuse can be found in prisons (World Health
Organization, 2007a; Fazel and Baillargeon, 2011). According to correctional research, the
majority of prison populations also tend to have a myriad of personal, social and financial
problems, often exacerbating throughout life (Visher et al., 2004). Besides having a history of
social isolation and marginalization, many offenders are challenged by skills deficits that make it
difficult for them to compete and succeed in the community (Social Exclusion Unit, 2002). Most
individuals who enter prisons need assistance to improve their life and health conditions in
addition to finding alternate prosocial thinking and behavioral styles in order to break the cycle of
their criminal conduct. Quite right, prisoners’ clinical and/or social health problems, if left
unaddressed while in custody and upon release, may in all probability have an adverse impact
on the well-being of not only (ex)prisoners’ themselves but also the health and well-being of
their families, the community they live in and public in general. In the absence of material,
psychological and social support at the time of release, offenders may have a very difficult time
breaking the cycle of release and rearrest (Griffiths et al., 2007).
Recognizing prisoners’ health as an almost ever present globally distributed public health
problem, in 1995, the World Health Organization (WHO) established Health in Prisons Programme
(HIPP). Prison settings were thought to provide an opportunity for health promotion to address
and improve all aspects of health in prisons (Gatherer et al., 2005). The HIPP advocates
VOL. 10 NO. 1 2014, pp. 27-37, C Emerald Group Publishing Limited, ISSN 1744-9200 j INTERNATIONAL JOURNAL OF PRISONER HEALTH j PAGE 27
 promotion of the “whole-prison approach” in which health of inmates and staff as well as work and
secure environment are crucial to assisting prisons to implement health promoting and reforming
interventions. The Trencin statement on prisons and mental health underlines that “it is in the best
interest of society that the prisoner’s health needs are met, that prisoner is adequately prepared
for resettlement and that causes of re-offending are addressed” (World Health Organization,
2007b, p. 5). The “good health” and “well-being” are recognized as the key criteria to successful
prisoner’s rehabilitation and reintegration (Hayton, 2007). In order to assist and enable the
prisoner to successfully reintegrate into community, collaborative and appropriate service
delivery is paramount (World Health Organization, 1998b).
The impetus for a prison setting-based project deserves a brief attention. The project’s roots are
attached to the WHO “Health for All” strategy (World Health Organization, 1985), which became
solidified in 1986 through the statement of the Ottawa Charter that “health is created and
lived by people within settings of everyday life” (World Health Organization, 2009a, b) and the
1991 Sundvoll statement on supportive and enabling environments for health (World Health
Organization, 2009a, b). According to the Ottawa Charter, the principal goal of public
health policy (also coined “healthy public policy”) would be reducing health inequalities and
sustaining health and well-being in populations through a multidisciplinary and socio-ecologically
“holistic approach” (World Health Organization, 1998a). The rationale of a holistic approach,
in theoretical terms, is to relocate focus from a pathogenic deficit model of medicine in which
health is understood as an absence of disease or psychopathology, to a salutogenic, resource
model of health in which health is a positive concept related to a variety of personal, social
and environmental health determinants, also called salutary factors (Antonovsky, 1996).
In general, health promotion, contrary to disease prevention and health protection, “insists” that
health is not restricted to specific populations (e.g. ill, diseased, poor or rich, men or women,
prisoner or not) or environments. The role of the health sector may be included as a necessary
health determinant but is not sufficient on its own condition for people’s lives and health.
In community context, the role of other health determining human services such as corrections
also needs consideration.
Currently, there are 45 member nations joining the European network on the WHO’s Health in
Prison Project. As of today the active commitment to the HIPP of each country is not well
documented. Due to various barriers, the “prison-setting” has been described as the least
popular context in which health can be promoted with success (Gatherer et al., 2005). Norway is
one of the member nations participating in the network on the HIPP. Although no explicit
document on health promotion in prisons as yet exists, the level of the country’s commitment to
the project seems worth investigating since Norway’s attention to its population health is high on
the political agenda. The political pursuit for fostering, developing and sustaining the highest
achievable health as well as closing the gap in health distribution across the population is
manifested in the explicit commitment of the government to Health in All Policy (HiAP) (Ministry of
Health and Care Services (MHCS), 2012). In brief, the HiAP is part of an internationally designed
public health policy (World Health Organization, Government of South Australia, 2010) with a key
principle that health should always be essential in the formulation of any policy and action plan of
all sectors based on partnership and collaboration in creating solutions and strategies to meet
any health challenges.
Exemplified by the case study of Norwegian health promotion policies in correctional settings,
the purpose of this paper is to examine the contribution of modern correctional services that
enable the prison to be health promoting. Two questions are raised:

1. How do Norwegian health policies assist the correctional population in achieving “good
health” and “well-being”?
2. Besides the goals of crime prevention and crime reduction, what is the contribution of
criminological research and practice to enable correctional settings to be health promoting?
In order to answer these questions, a two-fold methodology is used. First, the literature review
based on the Norwegian policy documents relevant to prison settings is conducted. This is
followed by the general review of the literature on the principles of humane service delivery in
offender rehabilitation.

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Methodology
The literature review
The data for the case study was obtained through search of the literature undertaken Fall, 2012.
The search applied Norwegian combined key words such as “helse” (health), “helsefremming”
(health promotion), “fengsel” (prison), “kriminalomsorgen” (corrections), “innsatte” (prisoners)
and was restricted to the following governmental web sites of: the Ministry of Justice and Public
Security, the Ministry of Health and Care Services, the Norwegian Directorate of Health, the
Norwegian Directorate of Correctional Services and the Correctional Service of Norway Staff
Academy. Additionally, a gray literature search was conducted through Google. The applied
key words consisted of both Norwegian and English words (noted above), considering a
high possibility of dissemination of information on Norwegian policies, practices or other to an
international audience. Through this search, national reports, national and international
conference papers and community-based reports of collaborating with corrections agencies
were obtained. All material was scrutinized for information about health and corrections, and
health promotion within correctional settings and the duplicates were excluded. Furthermore,
the literature was once more reviewed and then its content was deductively analyzed
(Patton, 2002) driven by the relevance to health promotion and correctional settings.
The thematic analysis was conducted according to the followed criteria for data inclusion: target
population, implication of health and welfare policy for health promotion in correctional setting
and specific action plans and strategies at organizational level (structural health determinants)
based on political documents and evidence-based research. The key sources selected
for the presentation of the case study are information rich political documents, such as
government white papers and reports. The back referencing from this material was additionally
performed to search for relevant data.

The general review

The general review is predominantly based on a synthesis of the extensive scientific research
on criminal behavior and the principles of effective offender rehabilitation presented in the
seminal work by Andrews (1995) and Andrews and Bonta (2010) who have contributed to
the currently worldwide applied principles of effective offender rehabilitation. In addition, the
literature by Andrews and Bonta (2010) provides a comprehensive outline of existing research on
the topic that is of high relevance to this paper. When relevant, additional references to other
research literature were added.

Findings
Searches of the literature for the case study yielded five governmental documents, three
research reports, and one review paper. The material is identified through the overarching
theme: “Norwegian public health and corrections.” Additionally, given that the focus of the
paper is specific to correctional populations, we included information about the social and health
profiles of Norwegian prisoners for comparative purposes should they be of interest to the
international audience. Based on the overview of the key literature, the overarching theme of
“humane service delivery in offender rehabilitation” with a sub-theme: “key principles of effective
services in correctional settings” was extracted.

1. Norwegian public health and corrections: literature review

The social and health profile of incarcerated population. Based on the 2010 national statistics,
there were about 3,800 convicted inmates housed in one cell of 50 prisons across 43 Norwegian
municipalities (Health Directorate, 2012a). Although the health and social profiles of prison
inmates are found similar to those reported in the broad international literature, a brief presentation
of Norwegian prison populations should be in order.
Commissioned by the Ministry of Justice and Public Safety, the report on Living conditions
of prison inmates (Friestad and Hansen, 2004) reveals that among the studied sample of
260 prisoners, adverse life conditions and various other problems have accumulated since
childhood. At the time of imprisonment, 30 percent had a history of being in the custody of child

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 protective services and the same percentage had experienced having a close family member
incarcerated. The 40 percent have not completed education above the secondary upper school,
70 percent were unemployed, 40 percent lived in poverty and 30 percent were homeless at
the time of incarceration. The 50 percent suffered from ill health in terms of chronic disease(s)
and 60 percent had alcohol and illicit drug abuse problems. In addition, it is recognized that
debt is a common factor causing life problems, especially so called “black debt” linked to illicit
drug related activities (Ministry of Justice and Public Security, 2008). It is reported that the period
of transition from custody to community is particularly difficult for offenders (Hammerlin and
Kristoffersen, 1998). This relates to the time of imprisonment itself during which some offenders
may have acquired self-destructive habits and attitudes, may have lost their jobs, important
personal relationships, other social networks or the ability to maintain housing. For example,
the number of homeless individuals is doubled at the time of release as many have lost their
home during their incarceration. In 2005 there were 5,500 homeless in Norway in which inmates
consisted of the largest single group among them (Ministry of Justice and Public Security, 2008).
Currently, the situation has improved, through close cooperation between corrections and
Husbanken (a bank facilitating aid to the most disadvantaged in the housing market). Today,
90 percent of offenders have a place to live on release.

Common public health policy and correctional settings. As noted earlier, in Norway, no explicit
document on HIPP exists as of yet. This may be due to the fact that health promotion itself is
considered essential and an integral part of the Norwegian government policy that applies to the
whole population across settings and environments. The new legislation by the MHCS (2012),
the Public Health Act, places focus on reducing health inequalities through evidence-based
collaborative action on social determinants of health with particular focus on social and
living-conditions in which individuals develop. The Public Health Act is based upon an action
plan outlined in The challenge of gradient proposing upstream rather than downstream strategies in
promoting public health in order to level up social gradients (Fosse, 2009; World Health
Organization, 2009a, b). The central goal of such work is to reduce social inequalities in health
through health promoting policies focussing on social inclusion and combating poverty. Consistent
with principles of HiAP, the responsibility for enhancing population health is not restricted to health
services, rather cross-sector partnership, equality, equity and social inclusion are the key
principles for achieving meaningful health and social care for the whole population. In the wake of
this new regulation, many innovative reforms created by intersectoral collaboration have taken
place in Norway (MHCS, 2012). Within the correctional sector these are called the “Import Model,”
“Individualized Plan” and “Reintegration Guarantee” (to be described below).
The political platform for the current government crime policy is based on the Soria Moria
Declaration that “with good welfare services for everyone, crime can be prevented and many of
the initial incentives for a life of crime can be removed. Good psychiatric health and care services
and an active labor market policy are important for comprehensive crime fighting. It is important
that preventive welfare measures, good local communities and recreational activity programs for
youth are also preserved as a part of the crime-fighting work” (Norwegian Labor Party, 2005,
n.p.). The White Paper No. 37 (Ministry of Justice and Public Security, 2008) “Punishment that
works – less crime – safer society” provides the basis for correctional work, where the principal
aim is to prevent new crimes and reduce criminal victimization through successful reintegration
of ex-prisoners into society.

Correctional service. The most recently issued guide, Health care services to inmates in
prison (Health Directorate, 2012b) is based on social and health profiles of incarcerated
populations documented through the research study (Friestad and Hansen, 2004) presented
above. Incarceration time for prisoners is seen as an especially good opportunity for health
enhancement through addressing and implementing preventive, diagnostic and therapeutic
measures. Treatment of diseases is a key aspect of rehabilitation, and successful reintegration
into society depends on a comprehensive understanding of the inmate life situation. Although
the guide refers to health situations from a pathogenic perspective (i.e. clinical health deficits and
impairments), at the same time it stresses the prominence of social and environmental
determinants of health (e.g. supportive prison environment) and the role and function of health
services. The point is made that a prerequisite for good health and health care provided

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to a prisoner depends on his/her access to qualified personnel with expertise in living conditions,
quality of life and the person’s overall health (Health Directorate, 2012b). The Norwegian Medical
Association in collaboration with other countries and international Human Rights have
developed and recommended online courses for prison doctors to deal with current problems in
prison medicine.

The national strategy to reduce social inequalities in health aims at urgent improvement
of prisoners’ living conditions as these are understood to be the probable cause and
the consequence of crime and substance abuse (Health Directorate, 2012b). In order
to achieve this goal, the main three measures of “Import Model,” “Individual Plan,” and
“Reintegration Guarantee” were incorporated into the action plan. These measures are within
national municipal tasks and are based on a close collaboration between the justice, social,
health, educational and labor sector and other community-based agencies. This fact
demonstrates that the policy makers do recognize health as an outcome of a wide range of
factors, many of which lie outside the activities of the health sector and therefore require
a shared responsibility and an integrated policy response. This neatly corresponds with
the principles of HiAP consolidated within health promotion’s holistic approach to health.
The process of social and psychosocial (re)habilitation involves provision of necessary
assistance to a prisoner’s own efforts to achieve the best possible coping abilities, prosocial
functioning and participation in society.
Import Model. The “Import Model” is related to coordination reform that focusses on
intersectoral collaboration with the overarching goal to enhance preventive and disease
treatment interventions among patients and clients. Any services involved in collaboration are
independent of and have free roles in relation to corrections. Following European directives
(Council of Europe, 1989), prison health care services in Norway since 1989, have been fully
integrated into the general health services in the local community (primary health care) and
the larger health region (specialist and hospital services) where the prison is situated. Notably,
Norway is one of the first three countries in the world in which health services in prison were
made qualitatively equivalent to those provided to the rest of population. The services are an
integral part of municipal sector. In the country, there are no forensic hospitals.

Individual Plan. The “Individual Plan” is based on comprehensive, coordinated and individualized
services in order to implement and secure the most effective welfare measures.

Reintegration Guarantee. The “Reintegration Guarantee” aims to provide composite services

according to inmate needs assessed at the early stage of sentencing and then on discharge
planning. There are currently 25 assigned reintegration coordinators within central prisons
who coordinate reintegration work, establish agreements, inform and lead service markets.
The services are provided to prisoners in such a way that they can have a reasonable
opportunity to make use of them. Correctional services, as far as possible, facilitate necessary
information to the cooperating agencies (including volunteer organizations). Many prisons have
firm contact with the Norwegian Labor and Welfare Service (NAV) via designated counselors
(as of 2012, there were 47 such workers in total) who provide assistance in relation to housing,
education, employment, help to dispose economy and so on (Norwegian Labor and Welfare
Service, 2012). The NAV service is to be located inside all prisons.

Offender assessment. In Norway, correctional services have begun to deploy a new

structured offender assessment system BRIK (individual needs and resources assessment)
with aims to provide comprehensive and effective interventions according to prisoner’s needs
(Kriminalomsorgen, 2012). The instrument is based on “what works” knowledge in reducing
reoffending, firmly anchored in research and practice on effective offender rehabilitation,
the desistance theory (perspective that focusses on individual’s strength, abilities and
competencies), and a restorative justice humanistic approach used in conflict resolution
and counseling between the offender and the victim(s). The main objective of this approach
includes holding the offender accountable in a meaningful way and repairing the harm caused
to the victim or community. To a large extent, BRIK is founded in Risk-Need-Responsivity
(RNR) Model with its principles recognized as core features in well-functioning offender
assessment. The survey is voluntary and only conducted upon informed consent.

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 Offender assessment based on BRIK is currently subject to a pilot study in the newly open
Halden prison facility and Halfway houses in Østfold. The purpose of this study is to examine the
applicability of the instrument for a population sentenced to prison and community service.
After completed evaluation of BRIK, the policy decision will be made regarding its applicability in
corrections nationwide with its potential use for research purposes, hence evidence-based
knowledge building.

2. Humane service delivery in offender rehabilitation: general review

Key principles of effective services in correctional settings. In the 1980s, Canadian researchers
developed the RNR Model proposing the key principles of effective humane services in
correctional settings. The model is based on empirically defensible psychology of criminal
conduct (PCC) that provides a base for the prediction and modification of criminal propensity as
well as directions on effective crime prevention and offender rehabilitation (Andrews, 1995).
The PCC includes potential situational, circumstantial, biological, personal, interpersonal and
familial correlations of crime that may reflect broader social arrangements (e.g. structure,
culture). The RNR Model has been extensively researched and used with increasing success to
guide correctional interventions based on the assessment and rehabilitation of criminal
offenders across the world (Andrews and Bonta, 2010). The model rests within the overarching
principles of respect for the person and humane service provision in which help and assistance
are provided in an ethical, legal, just, moral, humane and decent manner by correctional
workers who possess high quality relationship and structuring skills (Andrews, 1995; Andrews
and Bonta, 2010). For example, the principle of social support (Andrews, 1995) is anchored in
the creation of settings within which working professionals are supported in active ways through
training and consultations. Those professionals who adhere in a sensitive manner to the
uniqueness of the person involved will yield stronger results of effective service (Andrews, 1995).
This includes collaborative working relationships with the offenders and also collaborative
practice between correctional, social, health or other community-based agencies and
organizations that may facilitate and enable effective interventions (Andrews and Bonta, 2010).
Since there are 18 principles of the RNR Model (Andrews et al., 2011), all of which will demand
a rather lengthy description, highlighting the three key principles is hoped to be sufficient here.
The risk principle. The risk principle states that in order to increase the effectiveness of offender
rehabilitation, the level of service (i.e. program intensity, type and level of its structure) must be
matched to the person’s risk level to reoffend. This requires theoretically and empirically sound,
structured assessment of risk.
The need principle. The need principle focusses on assessment of criminogenic needs. These
are changeable characteristics of individuals and their circumstances that are related to criminal
conduct. These are also called dynamic risk-need factors and predictors for criminal offending.
The major and intermediate criminogenic needs comprise the “Central Eight” targets for
interventions and effective correctional service. Based on research evidence from multiwave
longitudinal studies these are: history of anti-social behavior, antisocial personality pattern,
procriminal attitudes/antisocial cognition, social supports for crime/antisocial associates,
family/marital circumstances, education/employment, leisure/recreation and, substance abuse.
The most recent RNR multiwave study (Andrews et al., 2011) reveals that reword of desisting
from crime leads to subsequent enhancement of success in various areas of life.
In contrast, self-esteem (e.g. often addressed through mental health work on strengthening
emotional resilience), personal distress (e.g. anxiety), major mental disorders (e.g.
schizophrenia, manic-depression), physical health (e.g. physical disability, nutrient deficiency),
intellectual deficits, victim of mental/physical abuse, spirituality, poor parental skills, poor
housing, financial problems and physical activity belong to a group of non-criminogenic needs.
These (and basic human needs) may be very important for some offenders and any problems
faced by them are commonly dealt with for humanitarian and entitlement reasons through
the services within a prison setting and/or health, social or other services, whether within prison
or outside in the community. Indicated by research, non-criminogenic needs are not related
to criminal conduct, at least not directly (Andrews et al., 2011). For example, working on
increasing one’s self-esteem or improving living conditions without first addressing and targeting

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change of procriminal attitudes, (especially in high-risk individuals), may result in confident
and content offenders.
Nevertheless, addressing personal or situational circumstances not only has a great potential
to eliminate certain responsivity problems (e.g. readiness to positive change) but also may be
important for the individual, immediate family, community or public gain (e.g. well-being),
regardless of their impact for reoffending risk. (Andrews et al., 2004). As with risk, adherence to
need principle requires an assessment of the person’s criminogenic needs and the identification
of non-criminogenic needs.

Responsivity principle. The responsivity principle focusses on maximizing the offender’s ability
to learn from rehabilitative interventions that correspond with the individual needs,
circumstances, learning styles, motivation, abilities and strengths in order to provide
individually tailored services. Research document that the presence of human potentials,
motives and capacities, also called strengths, is considered to have a potentially promoting
effect in successful rehabilitation. They may contribute to the manner in which programs
and services are designed and delivered for individual offenders (Andrews et al., 2004).
The research suggests that female prisoners do require specific interventions that focus on
strength rather than their problems and deficits. Women themselves view such an approach
as most effective in their successful rehabilitation and behavioral functioning (i.e. desisting
from crime) (Trotter et al., 2012).

Discussion
The fact that the WHO advocates an important role of health promotion in prisons settings
implies that prisoners’ health and criminal behavior should be of joint concern for both health
promotion and crime prevention interventions. It has been said that “antisocial behavior is too
serious an issue to be left in the hands of justice and correctional agencies” (Andrews and
Bonta, 2010, p. 516) and “health is too important to leave to health staff alone” (Fraser et al.,
2009, p. 412).
The Norwegian health policy clearly documents that the topic of health promotion and
the criminal justice system is now on the national health policy agenda. The governmental
documents such as white papers (and based on them action plans), and reports demonstrate
an obvious involvement in health promotion through authentic health promoting actions
applied in correctional settings. These are anchored in health promotion’s overarching goals of
equity and HiAP’s aims to reduce social inequalities in population health through efforts of
closing the health gap, particularly for the disadvantaged people that the majority of prison
population accounts for. The governmental health and welfare policies provide conditions for
health and well-being through cross-sectorial collaborative activity that meets the needs
of its whole population. Both health and welfare strategies relating to correctional settings
are essentially the same kind of collective action strategies used to create the structural and
organizational conditions for positive change in correctional population in order to manage
and prevent potential health and societal problems arising as a consequence of
criminal offending.
Achieving good health in whole population is highly prioritized on the political agenda. Although
not explicitly committed to HIPP in its documents, it is apparent that Norway pays specific
attention to health promotion in correctional settings, in which most of its population are highly
socially, economically and health wise disadvantaged individuals. Through the government’s
social, health and criminal justice policies and practice an aid is provided to prisoners
accordingly to their needs through sound structure of support and assistance from the prison
institution to the community. Notably, among prisoners (Ministry of Justice and Public Security,
2008) there also exist resourceful individuals who do not suffer from poor (mental)health,
drug problems or are not otherwise socio-economically disadvantaged. This fact deserves
a comment that poor health or socio-economic position is not decisive for criminal propensity.
Therefore, sentencing and offender management should preferably adhere to the RNR
principles (recall Section 2) in order to avoid subjecting a prisoner to interventions upon
“assumed” needs once an individual becomes a prison inmate.

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 Although a clear commitment to fostering and improving prisoners’ health is visible through
the application of a number of strategies into correctional settings, the political emphases on
health and welfare as a prerequisite for crime reduction suggests that health, well-being and
prosperity prevent crime. There is a vast Norwegian (and international) research literature
on mental health or psychopathology among forensic population. The link between deficits in
mental health and crime is indicated, however, with mixed results (recall need principle).
Notwithstanding the beneficial role of community involvement in prisoner rehabilitation, reentry
and reintegration, the value of good health is seen as a significant factor in desisting from
crime, as are social and structural determinants of health. Considering that interdisciplinary
collaboration and inter-agency partnership are pivotal in health promotion, the new regulatory
framework appears to allow for effective health promotion in prison settings. Some of the
regulations are quite new and as yet no evaluative research on the effectiveness of specific
interventions alone or in combination has been conducted. International literature indicates that
well-coordinated services provided in and outside prison settings can significantly reduce
recidivism (Petters and Bekman, 2007).
It has been said that the “country’s economy is significant for the population’s health and
welfare” (Forslin et al., 2012, p. 275). We would like to add that political willingness to promote
health, general respect for human and human needs may also be helpful.
This paper has also examined the role of criminal justice services as a determinant of and
promoter of health based on the principles of humane service delivery to offender populations.
The understanding of correlations of crime along with available evidence on the utility of RNR
principles leads to an understanding that criminological research and practice can make a
valuable contribution to the process of desistance from crime as well as health promotion.
However, health promotion within a correctional context can only make a contribution so far as
its activities align and support the evidence-based principles of effective correctional service
delivery to offenders. The core principles of the RNR Model of offender rehabilitation, allow for
a comprehensive service delivery to offenders through interventions planning. Although to
different ends, the interventions may target criminogenic needs (related to criminal behavior),
non-criminogenic needs (specific issues and challenges) and strengths (personal and
community assets) with the potential to assist in the highest possible quality service.
However, research suggests that focussing on positive health and well-being aspects
without addressing the major criminogenic factors may potentially result in outcomes that can
be harmful to society. According to correctional research, benefits in relation to health and
well-being clearly include prosocial behavior.
The analysis of the principles of effective offender services implies that in a correctional context,
the question is not of whether health, educational or employment interventions work in crime
prevention. Rather, the question will focus on the role or contribution the person’s health,
education or employment can play in desisting from crime. Answering this question is essentially
an interdisciplinary task between health science and criminology. Enhancing prisoners’
well-being, the pursuit for highest attainable health and a life as disease free as possible is very
important and health (in all its dimension) should never be ignored. This is in line with ethical,
professional, humane and decent practice and the principles of effective service to offender
rehabilitation have this covered. This approach is not solely confined to a deficit model (offender
assessment of problematic behavior) and links through additional focus on capacities and
resources (strengths) of the holistic framework for health.
Although omitted in this paper, we would like to note that various alternative models to
effective correctional interventions have also been proposed (e.g. The Good Life Model).
The presentation of these can be found in McNeill et al. (2010) “Offender supervision: New
directions in theory, research and practice.”

Conclusion
There are several implications of this analysis. First, there is a need for recognition of the role of
the principles of modern correctional practices among health promotion policy makers. Second,
public awareness is needed as to how correctional settings enable health within its overarching

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goal of ensuring public safety through efforts of prevention and reduction of crime. This may
support the case for recognizing criminal offending as a public health-safety issue, hence
addressed in health promotion strategies. Third, individual and community benefits in relation to
health and well-being include changing procriminal propensities and anti-social behavior
through supportive environments. Therefore, the significance of contribution in reducing crime
by changing criminal propensities and behavior should not be missed. Therefore, fostering
the potential for health practitioners to learn from and support criminological findings, and the
potential for correctional practitioners to learn from health promotion research may truly advance
health promotion and the criminology discipline.
The analysis also provides implications for research. The policies of modern corrections coupled
with policies of health promotion present a window of opportunity for working explicitly with health
within criminology and with crime within health promotion. The topic of health is close to the
passions of many people and Norwegian politicians who engage in health promotion are clearly
in favor of health-based policies within corrections. Taking this into consideration, explicit research
on the role of health promotion on crime outcomes is needed. This area of research has not
been explored yet. Considering another way forward, studies on HIPP may include the evaluative
component of various health promoting interventions (i.e. according to salutogenic model) on
its own, with or within the RNR Model on public health and/or public safety. These types of
studies may provide benefits for planning and implementing appropriate interventions and
methods based on knowledge gained from research evidence rather than ideology.

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About the authors
Lidia Santora is a Researcher, Department of Social Work and Health Science, Faculty of Social
Science and Technology Management, Norwegian University of Science and Technology,
Norway. Lidia Santora is the corresponding author and can be contacted at:
lidia.santora@svt.ntnu.no

Geir Arild Espnes is a Professor and the Director at the Research Center for Health Promotion
and Resources. The Center I co-owned by Sør-Trøndelag University College and Norwegian
University of Science and Technology, Trondheim, Norway.

Dr Monica Lillefjell is an Associate Professor and an Assistant Director, Research Centre for
Health Promotion and Resources, Sør-Trøndelag University College/Norwegian University of
Science and The Technology, Trondheim, Norway.

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