Rolling back the prison estate: the pervasive impact of macroeconomic austerity on prisoner health in England

Abstract

Prisons offer policymakers an opportunity to address the pre-existing high prevalence of physical and mental health issues among prisoners. This notion has been widely integrated into international and national prison health policies, including the Healthy Prisons Agenda, which calls for governments to address the health needs of prisoners and safeguard their health entitlement during imprisonment, and the Sustainable Development Goals 2030 concerning reducing inequality among disadvantaged populations. However, the implementation of the austerity policy in the United Kingdom since the re-emergence of the global financial crisis in 2008 has impeded this aspiration. This interdisciplinary paper critically evaluates the impact of austerity on prison health. The aforementioned policy has obstructed prisoners’ access to healthcare, exacerbated the degradation of their living conditions, impeded their purposeful activities and subjected them to an increasing level of violence. This paper calls for alternatives to imprisonment, initiating a more informed economic recovery policy, and relying on transnational and national organizations to scrutinize prisoners’ entitlement to health. These systemic solutions could act as a springboard for political and policy discussions at national and international forums with regard to improving prisoners’ health and simultaneously meeting the aspirations of the Healthy Prisons Agenda and the Sustainable Development Goals.

Deterioration, drift, distraction, and denial: How the politics of austerity challenges the resilience of prison health governance and delivery in England

“…Consistent with prior work [ [30] , [31] , [32] ], this study’s participants identified a rapid deterioration of the existing poor standards of health and decency under austerity. Given the longstanding overcrowding problem within prisons, reducing the number of officers within institutions diminishes interactions between prisoners and staff.…”

“…Compatible with prior research [ 31 , 37 , 55 ], this study drew on the expertise of 27 of an invited 73 (38 %) national health experts with experience devising and implementing prison health policies across England, whether through the government or for non-governmental organisations. As such, they reflected a broad composition of England’s prison health terrain, political and policy elites in an ideal position to understand the impact of austerity measures.…”

“…Moreover, only one in 10 were allowed to move freely for at least 10 h a day [ 30 ]. The lack of resources has also been linked to a threefold increase in the number of self-inflicted deaths, a rate that has now reached 86 per 1000 prisoners [ 31 , 32 ]. Furthermore, decreasing staff numbers and attendant supervision likely influenced the unprecedented 57 % increase in both self-harm and assaults among prisoners between March 2010 and March 2019 [ 32 ].…”

Secondary care clinicians and staff have a key role in delivering equivalence of care for prisoners: A qualitative study of prisoners’ experiences

“…Achieving equivalence of care for prisoners requires investment of a higher level of resource than for community patients, to create prison-focussed solutions and pathways that exceed, rather than fail, community standards of care [ 30 ]. These investments will transfer out into the community, improving the health of society overall [ 31 ]. Prison healthcare remains an evolving landscape, and hospital care is one of many areas requiring further research with respect to equivalence.…”

The politics of austerity, imprisonment and ignorance: A case study of English prisons

“…However, since austerity measures imperil prisoners’ health, the level of punishment has arguably increased beyond the loss of liberty. 22 Due to the lack of prison staff, prisoners missed 15% of medical appointments on average. 8 Furthermore, two-thirds of prisoners waited longer than 14 days to be seen by acute mental-health professionals, while some waited more than 12 months to be transferred to a secure mental-health hospital.…”