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

在过去的两个世纪里，囚犯的健康状况并没有显著改善。英国监狱目前正面临一场可持续性危机，这与政府的紧缩措施相吻合，即在上一届议会结束时削减了9亿GB(24%)的监狱开支(国家罪犯管理署，2015)。这项研究将调查紧缩对囚犯健康和福祉的不同、深入的影响。具体地说，它将侧重于《健康监狱议程》(世界卫生组织(世卫组织)，2007年)，该议程促进减少监狱健康风险；在维持安全制度的同时保护人权；监狱保健规定与社区保健服务的等价性；以及在监狱推广全系统办法。这项研究与ESRC 2016-2020年实施计划相一致，该计划呼吁更好地了解宏观经济对政府政策的影响。研究提出了四个跨学科工作方案，将共同探讨当前政策与实践之间的脱节。方案1(国际一级)将把目前针对囚犯健康和福祉的紧缩措施与监狱健康方面的国际义务相比较，重点关注以下研究问题：1)英国政府如何在巩固影响《健康监狱议程》实施的财政措施方面表达了令人信服的国家利益？2)国家如何在寻求保护囚犯健康权利的国际义务之间取得平衡？3)国家如何证明它已经用尽了关于囚犯享有健康的替代措施？调查结果将弥合国际政策和使紧缩概念合法化的政治结构之间的差距，这可能会影响囚犯的健康。方案2将探讨紧缩措施如何与监狱健康的最新发展相一致，包括监狱改革议程和宏观一级的监狱分流计划，并侧重于以下研究问题：1)决策者如何在紧缩任务下维持监狱标准？2)紧缩如何与《2016年监狱安全和改革议程》和呼吁司法公正的呼声相适应？潜在的贡献包括在不确定时期的政策制定、政策启动和宏观层面的机构互动方面的知识进步。针对监狱运营层面的紧缩现象背景方面的差距，方案3将调查紧缩对监狱管理者和工作人员以及志愿组织的影响，考察以下研究问题：1)紧缩对监狱长和工作人员提供的服务有何影响？2)志愿组织如何适应在当前紧缩时期造成国家供应缺口的服务需求和资金变化？3)志愿组织如何应对紧缩可能导致的诸如市场效率、竞争和利他主义等力量的汇合？本计划将发展关于监狱长、监狱工作人员和志愿组织如何协商紧缩对囚犯的影响的经验知识，同时促进英国监狱工作实践的改进。方案4将探索紧缩如何在微观层面上，抑制囚犯的健康：1)囚犯对其健康的支持期望是什么？2)囚犯如何理解紧缩的意义？3)紧缩的政治如何影响囚犯对医疗服务的可获得性、可及性、可接受性和质量？本方案将寻求建立关于宏观层面的紧缩政策对囚犯在微观层面的影响的知识。

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.