On being old, healthy, and in prison
or
Ageing Prisoners: Can we afford them?
Jim Hilborn
Baltic Institute for Crime Prevention
www.crimeless.eu
jimhilborn@gmail.com
Graying Prisoners
Exploring
the Quality of Life for Ageing Prisoners
With the support of the Nordic Council of Ministers, the Baltic Institute for Crime
Prevention initiated the study of the health and quality of life of ageing prisoners in
2010-2012 in Belorussia, Estonia, Finland, Hungary, Latvia, Lithuania and Russia.
…trying to better understand the prison experience
of aging prisoners
Who are these individuals, and what are their physical and mental health needs? How
do they experience prison? What is the quality of their life as an older person in
prison?
Losing Trio
2nd 1st 3rd
BAD - Mass Incarceration x Ageing Population =
Massive Increase in number of Ageing Prisoners
along with Collateral Damage to individuals, families
and communities
BADDER - Depopulation x Ageing Population = Fiscal
Crisis
BADDEST - Dependency on Mass Incarceration x
Depopulation x Ageing Population = Fiscal Crisis &
Public Health Crisis
Bad Situation – Penal Populism
2nd 1st
3rd
Mass Incarceration x Ageing Population=
Massive Increase in number of Ageing
Prisoners along with Collateral Damage to
families and communities
Presents a danger to rational penal policy
through the politicalization of criminal justice.
USA-Mass Incarceration
90 Years Sentence, 10 Done
Dying in Prison, Regretting Too Late, After Living Too Little
Hospice – Dying with Dignity
You Understand
Dying Alone
I Don’t Want to Die in Prison
Where are we going?
Angola, Louisiana
Pain
Listening
Coffin
With dignity
Badder Situation
POPULATION GROWTH 2005-2025
Top Twenty Growth Countries (in Purple) 1,047 million (73%)
EU27 3.4 million (0.24%)
Badder Situation
2nd 1st
Depopulation x Ageing Population =
Fiscal Crisis
by 2030 the EU can expect to have 14 percent fewer
workers and 7 percent fewer consumers than it does today
3rd
Badder Situation
‘The social institutions most likely to
experience strain from the twin trends of
ageing and depopulation are the pension and
health systems that comprise the crown
jewels of the postwar welfare state.’
Aging Europe – over 65
Growing Older in the 21st Century
Economic and Social Research Council’s (ESRC) Growing Older (GO)
Programme, UK
We already live in one of the oldest societies that has ever
existed, but it is going to get even older.
UK: The over 80s, who are the fastest rising segment of the
population, are expected to treble in the next 25 years.
Where in 1951 there were only 270 centenarians, there are
already over 6,000 today with projections suggesting there
could be 45,000 by 2030.
Growing Older in the 21st Century
One of the greatest achievements of the 20th century must be the 25
years added to life expectancy. Yet, future social historians will be
hit by a paradox. A society which was so successful in reducing the injuries
of biological ageing was pathetically weak in addressing the injuries
imposed by
social ageing.
Only one out of three men was in work at the end of the 1990s when they
reached the official retirement age. And this was only one of many fronts
where older people faced prejudice, discrimination and social exclusion.
The economic cost of the redundant over 50s is vast, ranging in estimates
up to £31 billion.
(Malcolm Dean, 2011)
Depopulation 2050
Japan-Aging Prisoners
Japan - Low rate of Incarceration, but ...
Aging Prisoner Population is growing
Baddest Situation
2nd 1st
3rd
Mass Incarceration x Depopulation x Ageing Population
=
Fiscal Crisis & Public Health Crisis
There is very little that can be done with the depopulation and ageing populaiton.
However the rate of incarceration and the use of alternatives to incarceration can
reduce the overall number of prisoners, especially the high costs of physical and
mental needs of the older prisoners. The US data suggests that the older prisoners
can cost 2 to 3 x the cost of the younger prisoner.
The Choice of Rate of Incarceration
EU Incarceration
Comparing different Prison Systems.
Rate of Inceration
Russia
529 per 100,000
Belarus
381 per 100,000
Latvia
314 per 100,000
Lithuania
276 per 100,000
Estonia
252 per 100,000
Hungary
163 per 100,000
England & Wales 154 per 100,000
Finland
59 per 100,000
Prison Population Occupancy Level
755,600
36,533
7,055
9,139
3,381
16,328
86, l131
3,189
91.6%
106.7 %
78.4 %
100%
97.2 %
132.4%
112.7 %
99.6%
What rate of incarceration is too low., just
right or too much?
A “ just right” rate seems to range from a low of 50 to a high of 150 per
100,000. Above 150 the potential for mass incarceration increases. David
Garland argues that mass incarceration has two components:
• One is sheer numbers.
• The other feature is systematic discrimination and the social concentration
of imprisonment’s effects.
Imprisonment becomes mass imprisonment when it ceases to be the
incarceration of individual offenders and becomes the systematic
imprisonment of whole groups of the population. It becomes collateral
damage for individuals, families and communities. Ernest20 Decker calls it
a plaque of prisons.
The Quality of Care and
the Quality of Prison Life
for the Aging Prisoner
Resilience
Health &
Well-being
Age,
Disease and
the Aging
Prisoner
Salutogenesis
Penal
Policy &
Practices
Healthy Prison
Age
Age: When is a Prisoner Old?
...the age at which a prisoner is defined as elderly or older is arbitrary and
varies between countries and studies. For example, in the United States
and Australia, prisoners above the age of 50 are generally considered as
elderly. In the United Kingdom those above 60 or 65 are considered to fall
within this category, according to different studies
The low threshold is said to be justified by the likelihood that prisoners
have an individual age 10 years in advance of their counterparts in the
community, due to chronic health problems, unhealthy lifestyles, alcohol
and substance abuse, as well as the stress and harmful effects of
imprisonment itself . (UNDOC, Handbook on Prisoners with special
needs)
Age: When is a Prisoner Old?
In the National Institute of Corrections program on Effective Managing
Aging and Geriatric Offenders, the NIC used a definition based on the
combination of two factors:
Prisoners identifed as needing assistance with daily living (ADL)
+
Prisoners who are 50 years plus
The NIC panel in the broadcast emphasized the importation thesis - that
many prisoners entered the prison with significant,chronic health
problems due to social determinants and lifestyle choices. The panel
emphasized the need for a proper assessment and staff training. Though
50 years was the agreed upon age criteria, it was noted that even younger
prisoners could have problems with daily living.
Coming Wave of Aging – 2009 data
It’s Not Age, It’s Agism
A Good Age (Dr. Alex Comfort, 1981)
Older people are, in fact, young people inhabiting old bodies and confronted
with the physical problems of reduced vigour, changing appearance and specific
disabilities affecting such things as sight and agility.
Agism is the notion that people cease to be people, cease to be the same people
or become people of a distinct and inferior kind, by virtue of having lived a
specified number of years. Sociogenic aging is the role society imposes on people
as they reach a certain chronological age when they can be condemned as
unemployable, unintelligent, crazy, and asexual.
As an 'old person' you will need four things-dignity, money, proper medical
services, and useful work. (These are the things you always needed.)
Health
Salutogenesis
Antonovsky: Rejecting the idea that health was the absence of
disease.
Salutogenesis
Pathogenesis
Health-ease – Dis-ease Continuum
Sense of Coherence (SOC) is a concept that includes the
measurable independent variables of meaningfulness,
manageability, and comprehensibility that Antonovsky
documented to be associated with better health.
Positive Deviance
(1) look at the data differently: instead of looking at those
who have succumbed to a problem to find out why, look at
those who are succeeding and try to find out why they are
doing well;
(2) persuade practitioners and researchers to ask about the
factors related to success, not just factors related to problems;
and finally
(3) stimulate the formation of unique hypotheses generated
to explain desired outcomes. Results from studies and
practices that promote and develop positive health outcomes
could then be the recommendations for promoting health.
Prison
Measure
the Quality
of Prison
Life
Quality of Prison Life
Harmony dimensions
Entry into custody
Respect/courtesy
Staff-Prisoner relationships
Humanity
Decency
Care for the vulnerable
Help and assistance
Professionalism dimensions
Staff professionalism
Bureaucratic legitimacy
Fairness
Organisation and consistency
Quality of Prison Life
Security dimensions
Policing and security
Prisoner safety
Prisoner adaptation
Drugs and exploitation
Conditions and Family Contact dimensions
Regime decency
Family contact
Wellbeing and Development dimensions
Personal development
Personal autonomy
Wellbeing
Distress
WHO Health In Prison Project
• http://www.euro.who.int/en/what-we-do/healthtopics/health-determinants/prisons-and-health/who-healthin-prisons-project-hipp
• Brenda van den Bergh
Technical Officer, Prisons Health
Phone: +45 3917 1401
Fax: +45 3917 1818
Email: bvb@euro.who.int
Some Key Conclusions of Graying Prisoners
There is good evidence that the majority of prisoners have
significant physical and mental health needs which they import
into the prison. Health care is a human right.
The prison should become a health promotion setting that
provides both high quality medical healthcare and also health
promotion. The Healthy Prison model developed in the UK is an
good operational tool and the MQPL/MHPHAP would help
maintain accountability.
If the physical and mental health needs are not properly dealt
with, the prison becomes a site for disease promotion. There is
evidence that a significant number of prisoners acquire new
health problems while incarcerated.
Some Key Conclusions of Graying Prisoners
It is clear that there is profound risk that Injecting Drug Use
leads to HIV/AIDS and the increased probability of TB. The
number of active TB cases and the level of MDR-TB in several
countries is already quite alarming. The increase in MDR-TB is
a warning .
There is a need for more co-ordinated action. A harm
reduction strategy would provide either bleach for needle
cleaning and/or needle exchange as well as the provision of
condoms. We need DOTS both in prison and also on followup.
Best Choice Policy Reform
•
•
•
•
•
•
Promote a Healthy Prison
Reduce Rate of Incarceration
Use Alternatives to Incarceration
Reduce Social Inequality
Social Reinvestment in Damaged Communities
Evidence-based Crime Prevention Strategies
(Early Intervention and Situational)
Next Steps
Make the present report available to anyone who is interested.
persons.
Baltic Crime Prevention Institution should have a Graying Prisoners blog
for interested parties the chance to discuss the issues, and to share
information.
There are issues of ageing prisoners that we did not examine in depth
such as traumatic brain injury, palliative care for the dying, as well as
issues of gender and sexual diversity. The work needs to continue.