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Healthy Inside – Tackling Malnutrition in Prison

Healthy Inside – Tackling Malnutrition in Prison. Bethan Leach Dietitian for Offender Health Care UK Jonathan Tammam Programme Lead Nutrition University of Hertfordshire Catherine Wilson Catering Manager HMP Bullingdon. Buumba Njekwa Student Dietitian

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Healthy Inside – Tackling Malnutrition in Prison

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  1. Healthy Inside – Tackling Malnutrition in Prison • Bethan LeachDietitian for Offender HealthCare UK • Jonathan Tammam • Programme Lead Nutrition • University of Hertfordshire • Catherine Wilson • Catering Manager • HMP Bullingdon BuumbaNjekwa Student Dietitian University of Hertfordshire 2014 - 2017 ChrisitineChrisostomou Student Dietitian University of Hertfordshire 2015 – 2018

  2. Healthy Inside – Tackling Malnutrition in Prison Whilst we are waiting for everyone to arrive, why not take a look at the prison menu on your chair and decide if you were in this situation what you would like to eat.

  3. “I’m sooooooo hungry! They just don’t feed you enough here!” “They fill you up on so much stodge here… you just gain weight”

  4. Prison Rules and Prison Service Instructions (PSI)PSI 44/2010 Prisoners must be provided with 3 meals a day, these should be wholesome, nutritious, well prepared and served, reasonable varied and sufficient in quantity Prison Rules (1999) No.728, 24 (2): Food Neither Prison Rules nor PSI stipulate minimum daily nutrient targets for prison meals. Public Health England guidance gives average daily requirements but these are not currently calculated for prison meals.

  5. Finding out about the food in our prison What nutrients does this prison menu provide? How do these compare to the amount needed for health - UK dietary reference values (DRVs)? What choices do the men make within this menu? How do these compare to the amount needed for health - UK dietary reference values (DRVs)?

  6. Dietary Requirements The dietary recommendations used for comparison were Dietary Reference values (DRVs) - population recommendations for male adults given as an age range of 19 – 64 by Public Health England (PHE) (2016). DRV for energy (SACN ,2011) Minimum recommendation for fibre (SACN, 2015) Maximum recommendations for salt (SACN, 2003) Recommendations for total fat and saturated intake – all summarised by PHE (2016) as Dietary Reference Values (DRVs) for population

  7. Selected macronutrient content of food provision and choice.

  8. Selected micronutrient content of food provision and choice

  9. Menu adequacy • Everyone involved in prison food wants a menu to be adequate and to meet prisoners nutrient needs… the ‘wholesome and nutritious’ menu referred to in the original Prison Rule 24. • This work highlights a number of deficiencies in our menu, including energy • Menu analysis is one important tool in understanding whether a menu is nutritious. • Once nutritional provision is understood, changes can be made to ensure adequacy.

  10. A local plan for improving nutritional health • Some menu changes are quick, easy, and have already been implemented, others need more time to achieve. • Nutrition strategy being developed to address highlighted issues and ongoing work. • Focussing on lowering sodium through recipe changes, altered frequency of highly salty dishes and health promotion • Focus groups as part of nutrition strategy development strategy - common themes emerge. • Opportunities for ‘front of pack style’ labelling and nutrition education so informed choices can be made.

  11. Food Choice • Focus group work asked the men to talk about the reasons why they chose their particular meal choices. • If you take a look back at your menu choices, try to identify 3 reasons for them.

  12. Food Choice • More balanced menu options are not often chosen • Analysis of menu choice demonstrates a preference for high salt processed foods. • Highlighting a need for health promotion along side appropriate menu provision

  13. Why not take another look at the prison menu choices you made earlier… Looking also at the nutritional analysis for Friday lunch, would you change your choice?

  14. References • Bates, B., Cox, L., Nicholson, S., Page, P., Prentice, A., Steer, T., & Swan, G. (Eds) (2016). National Diet and Nutrition Survey Results from Years 5 and 6 (combined) of the Rolling Programme (2012/2013 – 2013/2014). London: Public Health England. • Department of Health. (1991). D reference values for food energy and nutrients for the United Kingdom. Report on Health and Social Subjects no. 41. HMSO, London. • De Viggiani N. unhealthy prisons: exploring structural determinants of prison health. Sociology of Health & Illness, 2007:29:115-135. • Ginn S. Prison environment and health. BMJ: British Medical Journal (Online). 2012 Sep 17;345 • HMIP (2016) Life in Prison: Food. Available from www.justice.gov.uk/about/hmi-prisons [4.9.18] • Ministry of Justice. 2010. Instruction PSI44/2010: catering – meals for prisoners. Available from< https://www.justice.gov.uk/offenders/psis/prison-service-instructions-2010.> [4.9.18] • Moller, L., Stover, H., Jurgens, R., Gatherer, A., and Nikogosian, H. (2007). Health in prisons: A WHO guide to the essentials in prison health. Geneva: World Health Organisation. • Public Health England. (2016). Government dietary recommendations. London: PHE.

  15. Thank you for listening bethan.leach@careuk.com j.tammam@herts.ac.uk

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