The Impact of Macroeconomic Austerity on Prisoner Health and Wellbeing in England

Lead Research Organisation: University of the West of England
Department Name: Faculty of Environment and Technology

Abstract

Prisoner health has not significantly improved over the last two centuries. English prisons are currently facing a sustainability crisis that dovetails with the government's austerity measures, represented by a £900 million (24%) prison spending reduction at the end of the last Parliament (National Offender Management Service 2015). This research will investigate the variegated, deepening impact of austerity on prisoner health and wellbeing. Specifically, it will focus on the Healthy Prisons Agenda (World Health Organization (WHO), 2007), which promotes reduction of prison health risks; preservation of human rights while maintaining a security regime; equivalence of prison health provisions compared to community health services; and promotion of the whole-system approach in prisons. This research aligns with the ESRC Delivery Plan 2016-2020, which calls for greater understanding of the macroeconomic impact on governmental policies.
The research proposes four interdisciplinary work programmes that will collectively explore the current disconnect between policy and practice.
Programme 1 (International Level) will situate the current austerity measures towards prisoner health and wellbeing against the international obligations on prison health, focusing on the following research questions:
1) How has the UK Government articulated a compelling state interest in consolidating fiscal measures that impact the delivery of the Healthy Prisons Agenda?
2) How has the state balanced austerity with its international obligations that seek to protect prisoners' health entitlement?
3) How has the state demonstrated that it has exhausted alternative measures regarding prisoners' enjoyment of health?
Findings will bridge the gap between international policy and the political constructs that legitimise the notion of austerity, which potentially impact prisoner health.
Programme 2 will explore how austerity measures align with recent developments in prison health, including the prison reform agenda and prison diversion scheme at the macro-level, and focus on the following research questions:
1) How do decision-makers maintain prison standards under an austerity mandate?
2) How does austerity fit with the Prison Safety and Reform Agenda 2016 and the calls for justice reinvestments in diverting people from prisons for rehabilitation purposes?
Potential contributions include advancement of knowledge in policy formation, policy initiation, and institutional interactions at the macro-level during times of uncertainty.
In response to the gap in contextualising the austerity phenomenon at the operational level of prisons, Programme 3 will investigate the influence of austerity on prison governors and staff, and voluntary organisations, examining the following research questions:
1) In what ways has austerity impacted the delivery of services by prison governors and staff?
2) How do voluntary organisations adapt to the service demands and funding changes that create gaps in state provision in this time of austerity?
3) How do voluntary organisations deal with the confluence of forces such as market efficiency, competition, and altruism that can result from austerity?
This programme will develop empirical knowledge about how prison governors, prison staff, and voluntary organisations negotiate the impact of austerity upon prisoners, whilst simultaneously advancing improvements in working practices in English prisons.
Programme 4 will explore how austerity, at the micro-level, suppresses prisoner health:
1) What are the expectations of prisoners regarding support for their health?
2) How do prisoners make sense of austerity?
3) How do the politics of austerity impact prisoners regarding the availability, accessibility, acceptability, and quality of health services?
This programme will seek to build knowledge on the impact of macro-level policy on austerity upon prisoners at the micro-level.

Studentship Projects

Project Reference Relationship Related To Start End Student Name
ES/P000630/1 01/10/2017 30/09/2027
1938015 Studentship ES/P000630/1 01/10/2017 31/03/2021 Nasrul Ariff Ismail
 
Description This research is currently ongoing until September 2020. The preliminary findings of this research can be summarised as follows:

1. Austerity has established a regressive political system that shapes the societal attitude towards social issues, which has exacerbated prisoners' poor health.

2. Austerity has undermined social collectivism, imposing a culture of acceptance among prison officials and the general community.

3. Along with the imposition of long working hours and the high levels of absenteeism among prison staff, austerity has aggravated the devastating impacts of prison instability, as evidenced by the increasing levels of suicide, violence, radicalisation, and prison gangs among prisoners.

4. Reducing the prison population, using international obligations as minimum standards to protect prisoners' right to health, and providing greater resources would create a more positive and inclusive system, in line with England's international and domestic commitments to the humane treatment of all people.
Exploitation Route Although my research is still underway, available results which have been published via peer-reviewed publications can be used to promote ceasing the implementation of austerity measures not only in prisons, but also across other public sector services in the United Kingdom.

My research outcomes can be used by politicians and governmental officials to enhance political and policy understanding of the austerity phenomena, as well as to support discussions of the detrimental impact of austerity on the prison health governance, prison workforce, and prisoners themselves.

Furthermore, the non-governmental organisations (NGOs), think-tanks, and scrutiny organisations can leverage the outcomes of this project as part of their advocacy, research and monitoring programmes to initiate a paradigm change with regard to austerity and how it could be reversed to improve the prison health policy and governance.

My results are also transferable to other areas and can be meaningfully used to determine the impact of austerity on other areas of public services, particularly in terms of the end-users and the workforce, as well as be extended to other countries that had adopted austerity measures, such as Portugal, Ireland, Iceland, Germany, and Spain.
Sectors Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice

URL https://doi.org/10.1186/s12889-019-7396-7
 
Description The results of my results have been leveraged to influence policy discussion, formulation, and implementation on the European and national levels. Research results were disseminated to the following political and policy networks: • House of Commons Select Committee • House of Commons Justice Committee • Ministry of Justice (including the Justice and Prison Ministers), as well as the Shadow Minister of Justice • UN Subcommittee on Prevention of Torture (SPT) • Council for Penological Co-operation (PC-CP) of the Council of Europe • International Committee of the Red Cross, the National Preventive Mechanism • UK Independent Advisory Panel on Deaths in Custody • National Audit Office • The Prison Officers' Association • The United Nations' Special Rapporteur on Extreme Poverty and Human Rights My results have informed the House of Commons Justice Committee hearing on Prison Governance in 2019, advised the National Audit Office as part of their investigation into improving the prison estate, contributed towards various European and national policy discussions on the impact of fiscal reduction on prisons, and enabled the Prison Officers' Association to secure a legally binding protocol with the Ministry of Justice on health and safety at work. My research findings were also discussed at the Congress of Lisbon on Health in Prisons in October 2019. Furthermore, the outcomes of my research also generated a considerable media interest: some of my findings were featured in the news by Scram News, a UK independent media outlet in shaping public debates and enhancing public understanding of austerity and its impact on the prison health governance and prisoners. Reporters from The Independent (UK), The Canary (UK), and DLF Media (Germany) also expressed their interests in developing news coverage of my publications. To raise public awareness about the impact of austerity on prison health, in December 2017, I created corresponding accounts on social media platforms such as Facebook (https://en-gb.facebook.com/prisonsunderausterity/) and Twitter (https://twitter.com/prisonausterity?lang=en-gb). To date, these accounts have attracted over 15,000 followers. Thus far, the regular and timely updates I have posted regarding various news items, publications, conferences, symposia, and seminars have garnered several millions of feedback impressions (retweets, likes, shared links, profile clicks, replies, and hashtag clicks), all of which highlight professional and public interest in my research. I also expect that the momentum of usage of my research findings will increase during the postdoctoral research phase in 2021, during which a dissemination plan will be incorporated into my research workplan.
First Year Of Impact 2017
Sector Healthcare,Government, Democracy and Justice
Impact Types Societal,Policy & public services

 
Description Provided the evidence to the NHS Long-Term Plan consultation, October 2019
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description A joint publication with the World Health Organization (WHO) Health in Prisons Programme and Public Health England on the UN Sustainable Development Goals 2030 
Organisation Public Health England
Country United Kingdom 
Sector Public 
PI Contribution I was invited to lead a joint publication, in collaboration with the World Health Organization (WHO) Health in Prisons Programme and Public Health England (PHE), on the contribution of prison health towards meeting the UN Sustainable Development Goals 2030.
Collaborator Contribution This publication was greatly reinforced by the input provided by the WHO and PHE. The WHO and PHE also provided dissemination platforms via the WHO & Public Health England's Prison Health Conference 2020 and online via the Worldwide Prison Health Research & Engagement Network (WEPHREN) website.
Impact The publication is expected to be published in the Summer 2020.
Start Year 2019
 
Description A joint publication with the World Health Organization (WHO) Health in Prisons Programme and Public Health England on the UN Sustainable Development Goals 2030 
Organisation World Health Organization (WHO)
Department Regional Office for Europe (WHO/Europe)
Country Global 
Sector Public 
PI Contribution I was invited to lead a joint publication, in collaboration with the World Health Organization (WHO) Health in Prisons Programme and Public Health England (PHE), on the contribution of prison health towards meeting the UN Sustainable Development Goals 2030.
Collaborator Contribution This publication was greatly reinforced by the input provided by the WHO and PHE. The WHO and PHE also provided dissemination platforms via the WHO & Public Health England's Prison Health Conference 2020 and online via the Worldwide Prison Health Research & Engagement Network (WEPHREN) website.
Impact The publication is expected to be published in the Summer 2020.
Start Year 2019
 
Description A partnership building initiative with the Ludwig Boltzmann Institute of Human Rights, Austria 
Organisation Ludwig Boltzmann Society
Country Austria 
Sector Academic/University 
PI Contribution I am building a partnership with the Ludwig Boltzmann Institute of Human Rights, Austria. At present, we discuss how the organisation could use the input from this project as part of its research and advocacy campaigns to improve detention conditions across Europe.
Collaborator Contribution It is anticipated that the partner will provide policy and advocacy input into the process, and disseminate our results via its communication channels.
Impact To be confirmed
Start Year 2019
 
Description Collaboration with the Association for the Prevention of Torture, Switzerland 
Organisation Association for the Prevention of Torture (APT)
Country Switzerland 
Sector Charity/Non Profit 
PI Contribution I am planning to collaborate with the Association for the Prevention of Torture, Switzerland. The Association could use my research findings to enhance political and policy understanding of the austerity phenomena via the Association's advocacy campaigns.
Collaborator Contribution The Association could use my research findings as part of its advocacy campaigns.
Impact To be confirmed
Start Year 2019
 
Description Criminal justice health and wellbeing annual review 
Organisation Centre for Crime and Justice Studies
Country United Kingdom 
Sector Private 
PI Contribution In cooperation with the UK Centre for Crime and Justice Studies, I am currently discussing a potential project entitled "Criminal justice health and wellbeing annual review". While the discussion is still in progress, the envisaged project is anticipated to lead towards development, adoption, and monitoring of new indicators of health and wellbeing across the criminal justice pathways.
Collaborator Contribution The partner will provide strategic steer, link the core project group members with the existing stakeholder network, and disseminate the outputs via its communication channels.
Impact To be confirmed.
Start Year 2020
 
Description Discussion with the European Centre for Social Welfare Policy and Research, Austria on research collaboration and dissemination related to the criminal justice projects across Europe 
Organisation European Centre for Social Welfare Policy and Research
Country Austria 
Sector Charity/Non Profit 
PI Contribution Another partnership currently under discussion is with the European Centre for Social Welfare Policy and Research, Austria. The focus of this negotiation is on how the organisation could use my planned project output to inform its future research initiatives related to the criminal justice projects across Europe. The details of the projects remain confidential at this stage, although it is anticipated that they will be made public in Autumn 2020.
Collaborator Contribution It is anticipated that the partner will provide policy input into the process and use our joint project results in its research projects and publications.
Impact To be confirmed
Start Year 2019
 
Description Circulation of policy briefings to the political and policy stakeholders in prison health 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Based on my two peer-reviewed publications in BMC Public Health and Journal of Public Health in 2019, I produced and circulated two-page policy briefings. These policy briefings attracted the following political and policy engagement:

• I received positive feedback from the members of the House of Commons Select Committee and House of Commons Justice Committee. In particular, my publications were discussed by the House of Commons Justice Committee as part of its Prison Governance Inquiry in 2019. The results of my research also informed political debate on the detrimental impact of the reduction in fiscal resources on the running of prisons and signalled prisons in crisis.

• These publications were also considered by the UN Subcommittee on Prevention of Torture (SPT) as part of their first visit to the United Kingdom in September 2019. In addition, there were also reviewed by the European Committee for the Prevention of Torture following their second visit to the United Kingdom in May 2019, the Council for Penological Co-operation (PC-CP) of the Council of Europe, and the International Committee of the Red Cross.

• These publications were also considered by independent monitoring bodies on detention in the UK, such as the National Preventive Mechanism and the Independent Advisory Panel on Deaths in Custody.

• The results of my research were included as part of the evidence by the National Audit Office to inform their investigation into improving the prison estate.

• The Prison Officers' Association used the evidence reported in these two publications-particularly, on the increasing level of sickness absence of prison officers as compared to the general public sector services in general-as part of their legal action against the Ministry of Justice on the dangerous working practices. My results enabled the Prison Officers' Association to secure a legally binding protocol on health and safety at work with the Ministry.

• These publications were considered by Sir Philip Alston, the United Nations' Special Rapporteur on Extreme Poverty and Human Rights, and his team on the level of poverty in the United Kingdom and its impact on prisoners' pre- and post-incarceration living conditions.
Year(s) Of Engagement Activity 2019,2020
 
Description Discussion at the Congress of Lisbon on Health in Prisons 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The peer-reviewed publications were also discussed at the Congress of Lisbon on Health in Prisons, from human rights in prisons perspectives, on 21st October 2019.
Year(s) Of Engagement Activity 2019
 
Description Press coverage 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact The results of my peer-reviewed publications were featured in the news by Scram News (United Kingdom), an independent media outlet in shaping public debates and understanding around austerity and its impact on the prison health governance and prisoners. I was also approached by reporters from The Independent, The Canary (United Kingdom), and DLF Media (Germany), who now plan to develop news coverage based on these publications.
Year(s) Of Engagement Activity 2019,2020
 
Description Public engagement via social media platforms 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact As part of public engagement of this project, in December 2017, I created corresponding pages/accounts on social media platforms such as Facebook (https://www.facebook.com/prisonsunderausterity/) and Twitter (https://twitter.com/prisonausterity?lang=en-gb). To date, these accounts have attracted over 14,000 followers. Thus far, the regular and timely updates I have posted regarding various news items, publications, conferences, symposia, and seminars have garnered several millions of feedback impressions (retweets, likes, shared links, profile clicks, replies, and hashtag clicks), all of which highlight professional and public interest in my research.
Year(s) Of Engagement Activity 2017,2018,2019,2020