Right to Health in Prison

There are over 10 million prisoners worldwide. The majority come from the poorest and most vulnerable groups in society. Their health is much worse health than that the general population and it deteriorates further after incarceration. With an estimated prison population of 607,731, Brazil has one of the highest rates of imprisonment at 301 per 100,000 population. Although Brazil is a signatory of the UN Universal Declaration of Human Rights (UDHR), which includes basic principles for the treatment of prisoners including access to healthcare, there is evidence of widespread prisoner neglect and maltreatment. In 2016 alone there were 379 deaths in Brazilian prisons due to violence and neglect. The majority of prisoners have an African background, belong to the poorest communities and are a highly stigmatised group. This contributes to an apparent widespread social indifference in Brazilian society.
In Scotland, the prison population is considerably smaller than in Brazil; however, at 7692 the rate of imprisonment of 143 per 100,000 population, it is still amongst the highest in Northern Europe. Only England, Estonia, Latvia and Lithuania have higher rates of imprisonment. The prison population is overwhelmingly young, male and from the most deprived and vulnerable groups; but in contrast to Brazil, the majority are indigenous Scots, with only a small minority from ethnic minorities. In 2012, responsibility for healthcare provision was transferred from the Scottish Prison Service (SPS) to NHS Scotland because of concerns about the quality of provision. However, five years after the transfer there is no evidence a reduction in health inequalities or an improvement in addressing the health care needs of prisoners, whose health status remains considerably worse than that of the general population,
We have brought together a diverse team of researchers from Scotland and Brazil working in the fields of public health, law, human rights, media and communications and social sciences, who will work together to create a realistic plan for improving access to healthcare in prisons. We will work together both face to face in interactive workshops and through the world-wide-web on three Work Packages. In the first, we will explore the views of government, members of the legal profession, the prison and health services and prison and health care workers about the role of prisons in Brazilian society and prisoners' human rights. We will also analyse how prisoners and prisons are portrayed in selected media and public relations materials from government agencies. In work package 2 we will review human rights law and examine how it is applied in practice in Brazil. This will involve engagement with members of the legal profession as well human rights organisations. In Work Package 3 we will explore male and female prisoners' experiences of accessing healthcare in prison. Special emphasis will be placed on empowering prisoners and breaking silence by obtaining their testimony and witnessing of prison life, access to healthcare, and strategies for change. In addition to interviews and focus groups with prisoners, we will also collect examples of art work and creative writing produced as part of creative arts projects operating within the selected prisons. This will allow prisoners to tell their stories in their own voices.
We will share our work locally, nationally and internationally through: a web-portal specially designed for the project; academic papers; research and policy briefings; and through a public event designed to engage both professionals and members of the public. Through a consultation process we will work with researchers and stakeholders to produce a draft action plan to improve prisoners' access to health together. We will then develop a programme of research priorities to support the action plan and apply for funding for the research.

Short term impacts (0 to 6 months)
In the short term, the project will have an immediate impact on members of the partnership. First there will be an exchange of information on prisons and access to health, which will increase understanding about the different country contexts and the barriers and facilitators in both countries. Second, since participation in the project will be based on the acceptance of principles of co-production and trans-disciplinary working. As this is not necessarily common practice in the everyday practice of the partners there will be a rapid increase in understanding of the different constructs and approaches used by the different disciplines. However, it could also lead to the dismissal or rejection of some approaches. In this first period it will be important to acknowledge the challenges of this way of working and to focus on developing ways of integrating different approaches across the project. The short term impact ultimately will be an integrated and coordinated approach to working on the project.
Medium term impacts (7-18 months)
In the medium term, there will be an increase in awareness of the project and the issues that are being addressed in terms of attitudes towards prisoners, inequalities in access to healthcare and access to health as a basic human right. Initially the impact will be greater on participants and stakeholders involved in the project but through discussion fora and blogs on the public web-portal and media coverage of the project, we anticipate an increase in awareness and debate among members of the general public. There is also the risk of increasing negative attitudes to prisoners and the provision of healthcare. We will put in place a strategy to rapidly counter erroneous statements that emerge in the media by having available expert commentators and commentary to respond to the issues raised. Through the process of working on the Work Packages, partners will develop skills in co-production and trans-disciplinary working and thee approaches will be included in other research they are involved in. For some there will be a complete paradigm shift.
Longer term impacts (> 18 months)
The longer term impacts of the project will be determined by the quality of the outputs from the project and how they are disseminated. The web-portal and the broader communications and media strategy are central to the extent of reach of the project into the research, political, policy and practice communities as well as the general public. A high profile presence on the international academic stage (conferences and publications) is also essential. Following the second workshop and public event there will be a rapid increase in awareness of the project across all audiences identified above. However, to achieve sustained impact and change an attitudinal shift is required at all levels in society, which results in the recognition that access to healthcare in prison is a basic human right. This project is only the start of that process. Through the consultation process involving a range of stakeholders involving an option appraisal process, a realistic strategic plan to improve access to healthcare will be developed together with a research strategy to support the plan. The systems approach that we will adopt will help ensure that there will be some understanding of the impact of each element of the strategic plan on different parts of the system. If implemented this will improve access to healthcare in prisons, improve physical and mental health and reduce mortality among prisoners, and potentially improve their life chances on release from prison.
Finally, the establishment of a sustainable research hub with global participation will extend the reach of the project and its' outputs, provide a model to address access to health in other countries, and stimulate new research and evaluation projects both in Brazil, the UK and elsewhere.