Reforming penitentiary health. The transition from ‘cure’ to ‘care’ in Italian prisons

Background: Until today, inadequate attention has been paid to the distinguishing attributes of healthcare provision in prisons. It has been conceived either as ancillary or as a core component of imprisonment. While the former idea prevailed in the past, leading to a bio-medical approach to care in prisons, the latter is currently arising. Method: This paper discusses the change in the approach to care in Italian penal institutions, examining their inertia. The design of the research consisted of a mixed approach: at the beginning, a desk study of law documents was realized; then, a semi-structured 48-item questionnaire was addressed to the health managers operating in the penal institutions of a southern Italian region. Results: The study suggests that penitentiary health areas are prone to change and they are willing to establish inter-organizational relationships with healthcare organizations operating within the National Health Service. Notwithstanding, they have to cope with the institutional inertia of penal institutions, that favour organizational monism. The legislative efforts are not sufficient to foster a process of change in prisons; healthcare professionals usually act as catalysts of change, championing it and encouraging the reorganization of penitentiary healthcare. Conclusions: This study paves the way to both further theoretical developments and to practical implications. On the one hand, it suggests a reconceptualization of healthcare provision within penal institutions, claiming the belonging of penitentiary health to public health. On the other hand, penal institutions are unwilling to change, due to their nature of total institutions: the involvement of healthcare professional in fostering the reorganization of healthcare provision is thus crucial to legitimate the process of change.