While the body itself is not the primary target of the penal system, it could be argued that the body of the prisoner is frequently still a devalued body, with consequences for health – both morbidity and, in extreme cases, mortality. While these are unintentional, a secondary result of imprisonment, they may impact the health of the prisoner through a number of mechanisms. These may include residual informal violence in prisoners, from fellow prisoners or from staff (the latter usually idiosyncratic although its encouragement or discouragement may vary considerably from system to system and unit to unit); harms from the environment, particularly in facilities with old construction, overcrowding and poor ventilation and sanitary systems; self-harm on the part of inmates, such as injecting drugs, tattooing, sexual behavior and use of cell-brewed liquor; and organizational
harm as a function of poor prison social and moral climates which view the devalued inmate body as unworthy of appropriate health care (Sim, 1990). Nevertheless, it would be a mistake to blame the health issues of inmates in the correctional system solely on the system itself: the inmate typically comes from an underclass with poor health and access to health care. There is thus a tension between the importation of poor health and its production (or reduction) in any penal system. Relevant here is the impact of imprisonment itself on the inmate body. Inmates may engage in potentially or actually health-debilitating behaviors (such as drug use and other risk behaviors) to self-medicate or to dull the pains of imprisonment, or because such risky behaviors are an integral part of the inmate prison culture. Whether an inmate leaves in better or worse health is a function of a balance of multiple levels of factors ranging from the population through the system and individual level. However, it would be a mistake to assume that because the spectacle of the body as object of punishment has disappeared, the body as subject to the impact of imprisonment has also disappeared. The body as object of rehabilitation is beginning to emerge, and a health education and literacy approach to health rehabilitation is the subject of this chapter.