Intended for healthcare professionals

Rapid response to:

Analysis Healthcare in Prisons

Prison environment and health

BMJ 2012; 345 doi: (Published 17 September 2012) Cite this as: BMJ 2012;345:e5921

Rapid Response:

Re: Prison environment and health

Ginn has highlighted some important points relating to prisoner health. An additional factor that should not be overlooked is diet. Inmates rely on two sources of food to meet their nutritional requirements. Main meals are provided by the prison and additional items may be purchased from the shop (known as ‘canteen’ by inmates and staff). The prison canteen is the penal equivalent of the local convenience store; it allows prisoners to exercise some freedom in their food choices and to supplement their diet. Money permitting, items can be pre-ordered, from an approved list, on a weekly basis and are subsequently delivered to prisoners for ad libitum consumption.

While the prison provides meals that meet nutritional guidelines, the quality of the prisoners’ diet is also greatly affected by the choices they make from the shop. Access to ‘tuck-shop’ style items such as sweets, chocolates, pot-noodles, biscuits, cakes and carbonated drinks can contribute to the high fat and energy intake found among prisoners (1).

A proportion of the prison population is adolescents and young adults in Young Offender Institutes (YOI). These populations, when given free choice, are likely to consume much of what is palatable and little of what they dislike. Thus the availability and consumption of snack products from the shop can have important implications for their health. Excessive daily consumption of confectionary in children may be a predictor of criminal violence and convictions in adulthood (2). Furthermore, reduced consumption of snack foods is associated with fewer incidents of offending and self-harm in prison (3). Thus, despite the relationship being poorly understood, nutrition should be considered an important factor in mental health as well as in physical health.

We carried out a content analysis of macronutrients, energy and sodium in the types of food (categorised into 10 logical groups for the purpose of analysis – see table) available to young adult male prisoners during 2009-2010 by surveying a canteen list from a representative YOI in North West England. The energy content, macronutrient contribution to energy and sodium (as % Reference Nutrient Intake; RNI) of the food items available in the prison shop are shown in the table. Average sizes represent those typically consumed in a single sitting. The canteen foods predominantly provide high levels of fats and sugars. Other than from fruit, all sugars provided are non-milk extrinsic sugars (NMES). Chocolates, snacks, sweets, drinks, biscuits and bakery items provide sources of fats and sugars. The greatest contribution to energy of sugars comes from sweets and soft drinks. Snacks and chocolates make the largest contribution to fats. The sodium content of a number of products is relatively high and contributes to a large proportion of RNI. Moreover, some of these products may contain hydrogenated fats, which have well-established implications for cardiac health. Some products available do provide nutritional value beyond macronutrients and sodium, however, anecdotal evidence from prison officers suggests that their uptake is low.

It is common practice for prisoners to supplement their regular meals with shop-bought goods (4). A Tasmanian report on prison food suggested that the food available to purchase from the canteen is considered to be ‘junk food’ (5). Foods containing a large proportion of calories in the form of NMES tend to be low in vitamins, minerals and fibre. Their consumption can displace more nutritious foods and lead to micronutrient deficiencies and a concomitant decrease in nutritional status. Additionally, greater consumption of sugar sweetened carbonated soft drinks is associated with violent behavior in adolescents (6). Furthermore, an unrestricted supply of products high in sugar may lead to excessive consumption which can disrupt metabolic and neurophysiological processes. If little of the sugar consumed is routed through the non-oxidative glucose metabolic pathway, this may be a predictor for violent impulsive behavior (7) and is, therefore, a very important consideration in the context of a prison environment.

HM Prison Service has a duty of care to ensure the health of its residents. The availability of the high fat, high sugar products in the prison shop may run contrary to this. However, removing such items may encounter resistance, as prisoners perceive canteen food as luxury, tradable items that also act as a link with the outside world (8). Regardless, a change in policy to allow for a slow incremental alteration of the list, alongside a strategy to introduce and promote the uptake of alternative healthier items, may provide future benefits to the health of prisoners.

Jonathan Tammam, Research Scientist, University of Oxford
Louise Gillam, Former Research Assistant, University of Oxford
Bernard Gesch, Senior Research Scientist, University of Oxford
John Stein, Professor of Neuroscience, University of Oxford

1. Eves A, Gesch B. Food provision and the nutritional implications of food choices made by young adult males, in a young offenders' institution. Journal of Human Nutrition and Dietetics. 2003 Jun;16(3):167-79.
2. Moore SC, Carter LM, van Goozen SHM. Confectionery consumption in childhood and adult violence. Brit J Psychiat. 2009 Oct;195(4):366-7.
3. Schoenthaler SJ. The Northern California diet-behavior program: An empirical examination of 3,000 incarcerated juveniles in Stanislaus County Juvenile Hall. International Journal of Biosocial Research. 1983;5(2):99-106.
4. Condon L, Hek G, Harris F. Choosing health in prison: Prisoners' views on making healthy choices in English prisons. Health Education Journal. 2008 September 1, 2008;67(3):155-66.
5. Heckenberg D, Cody D. Food Matters - Issues surrounding food in prisons. Occasional Paper 3. Technical Report. [Technical Report]. 2006.
6. Solnick SJ, Hemenway D. The 'Twinkie Defense': the relationship between carbonated non-diet soft drinks and violence perpetration among Boston high school students. Injury Prevention. 2011 October 24, 2011.
7. Virkkunen M, Rissanen A, Franssila-Kallunki A, Tiihonen J. Low non-oxidative glucose metabolism and violent offending: An 8-year prospective follow-up study. Psychiatry Research. 2009;168(1):26-31.
8. Valentine G, Longstaff B. Doing Porridge. Journal of Material Culture. 1998 July 1, 1998;3(2):131-52.

Competing interests: No competing interests

04 October 2012
Jonathan D Tammam
Research Scientist
Louise Gillam, Bernard Gesch, John Stein
University of Oxford
Department of Physiology, Anatomy and Genetics University of Oxford South Parks Rd Oxford OX1 3PT