Recent developments in prison health care promise enhanced health benefits for prisoners and the promotion of health has become a central feature of prison health care policy. This article presents the background to these changes and considers what they are likely to mean in practice. It provides a description of the emergence of health promotion within the prison setting, locating prison-based initiatives within the context of the wider political drive towards health promotion in society at large. Finally, it raises questions about the fundamental philosophies underpinning current models of prison health care where the benevolent aims of health promotion may become extremely punitive.