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James Woodall’s 2026 critical review does not show that health promotion in prisons has been abandoned. Its central claim is narrower: the health-promoting prison (HPP) concept remains persuasive, but it has not been put into practice consistently. Implementation is fragmented, often aimed at individual behaviour, and gives too little attention to staff wellbeing and to the structural conditions of custody. The headline’s word “deprioritized” is a fair shorthand for that concern, but it goes further than the evidence supports if read as a claim that services have been cut or closed.
What the 2026 review claims, and what kind of paper it is
Woodall’s paper is a critical review. It synthesizes academic literature, policy documents and selected reforms, and it presents its conclusions as the author’s assessment rather than as a quantified causal finding. The published abstract, released by Emerald Publishing on 21 August 2026, puts the core judgement this way: “Overall, the HPP remains conceptually compelling but operationally underdeveloped.”
Three problems sit behind that judgement:
- Inconsistent translation. The principles of the HPP model have not carried through reliably into day-to-day prison practice.
- Individual focus. Initiatives often target what individuals eat, how much they exercise or whether they stop smoking, rather than the environment that shapes those choices.
- Missing dimensions. Staff wellbeing and wider structural conditions, such as regime design and staffing pressures, receive comparatively little attention.
Read the review as a diagnosis of how the idea is applied, not as proof that the idea has been dropped. The abstract summarises the paper’s position; it does not provide a country-by-country account of funding or service closures, and this article does not claim one.
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What a health-promoting prison means
A health-promoting prison applies a whole-settings approach. Health is shaped by the institution’s physical environment, conditions, organisation, relationships and services, as well as by individual behaviour and clinical care. WHO guidance treats prison health as a shared responsibility of people and organisations across the whole prison, not only of the healthcare team.
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That shared-responsibility idea is the part most often lost in practice. If health promotion sits inside a healthcare department, it can be run as a set of clinic-based programmes. If it is treated as a whole-prison matter, it has to be built into how the regime runs: when people eat, move between wings, work, learn and see visitors.
Why “deprioritized” is the wrong frame for most of the evidence
The most recent England policy report, updated on 30 March 2026 by the Ministry of Justice and the Department of Health and Social Care, does not describe health promotion as abandoned. It says: “There are positive examples of health-promoting interventions and activities across the prison estate but they vary widely and are often initiated and monitored by either healthcare providers or justice services, rather than a co-ordinated approach between both.”
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That distinction matters. The problem described by both Woodall and the government is uneven, unco-ordinated delivery. A prison can run good activity while no one owns the outcome across departments, and a national picture can contain strong local examples alongside weak or unmonitored ones. Calling this “deprioritized” captures the risk that health promotion depends on local enthusiasm; it does not establish that it has been withdrawn.
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The concept carries a built-in tension. Prisons are institutions of confinement and security, and the control, choice and routine that health promotion depends on are restricted by the regime. An earlier qualitative study by Woodall, based on interviews with 36 male prisoners and 19 staff in three English category-C prisons, found that prisoners both gave up control and exercised agency and choice, but that this agency was limited by prison norms and structures.
The findings describe those three prisons. They are not a measure of prisons generally, but they show why community health-promotion models do not transfer neatly. A programme that assumes people can choose when to exercise or cook may fail where movement, timetables and security checks decide those things first.
The government report makes the same point in practical terms. Exercise and health-promoting activity have to fit into a structured regime, and they compete with paid work, education, socialising and other scheduled activity. Where a prison counts a gym session and a workshop slot as equivalent demands on the same afternoon, health promotion usually loses.
Current England evidence
The England report draws on the following figures. Each is reported as stated in the Ministry of Justice and Department of Health and Social Care report of 30 March 2026 and applies to England only.
| Measure | Figure reported | Scope and qualification |
|---|---|---|
| Approved health research projects | 203 | Involving people in prison or on probation in England, 2015–2024 |
| Projects on mental health | 106 (described as 52%) | Share of the 203 projects in the period above |
| Projects on generic health | 66 (described as 33%) | Share of the 203 projects in the period above |
| Projects on cancer | Less than 2% | Same period and population |
| Projects on cardiovascular topics | Less than 2% | Same period and population |
| Imprisonment rate, most deprived vs least deprived areas | Around ten times higher in the most deprived areas | Reported for England; the report describes it as a high-need population |
The pattern is clear enough. Evidence on health in prison is concentrated in mental health, and research on the chronic diseases that affect many people in custody is thin. That gap is relevant to deprioritization arguments: where the evidence base is narrow, services are harder to justify, plan and measure.
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What England policy recommends
The March 2026 report sets out a set of practical recommendations. Each one answers a specific implementation gap:
- Record health-promotion activity consistently. Without shared data, healthcare and justice teams cannot see what the other is delivering.
- Trial and evaluate staff and peer training. The report calls for trials of training for staff and for peer health champions, with evaluation built in.
- Provide a stop-smoking service in every prison. The report recommends this as a standard service rather than an occasional local offer.
- Update guidance and reporting for physical-health checks. Current checks need refreshed guidance and clearer reporting.
- Coordinate delivery across healthcare and justice. The report recommends better coordination and evaluation so that activity is not started and monitored separately.
How to assess whether a prison system is health-promoting
No standard numerical score exists for comparing prison systems on health promotion. The four questions below draw on Woodall’s review and the England recommendations, and they give a practical way to test any programme or policy claim:
Quick Recap
- Is health integrated across the institution? Look for shared ownership between healthcare and justice teams, rather than activity that sits only within the clinic.
- Does the programme change conditions or only behaviour? Programmes that alter the environment, timetable or staffing are more than individual advice.
- Can people participate with genuine choice inside the regime? Check whether activities compete with work, education or family contact, and whether attendance is realistic.
- Is staff wellbeing part of the system? A healthy-prison approach that ignores the health of the people who run the prison is incomplete.
Limits of the evidence
- The 2026 review is known here through its published abstract. The country-level evidence in the full paper is not summarised in this article, so its conclusions should be read as the author’s judgement.
- The England figures and recommendations apply to England. They should not be extended to Wales, Scotland, Northern Ireland or other countries.
- The qualitative study covers three category-C prisons and interviews with male prisoners and staff. It illustrates mechanisms; it does not describe all prisons or all groups.
- NICE’s evidence review notes that health promotion may not be a priority for prison healthcare staff, and it found no evidence for a needs-assessment tool. It called for more research. That is a documented gap in evidence, not proof that no health-promotion services exist.
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