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

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Extant scholarship has demonstrated that macroeconomic austerity disproportionately harms marginalised end-users. Its impact on the governance and delivery of health provisions on such individuals, however, has received less attention. Drawing on interviews with 27 policy elites involved with England's prison health policy, interviewees perceive that austerity policies have shaped and constrained the prison health system through the politics of deterioration, drift, distraction, and denial. The deterioration of the prison workforce size has been linked to diminished prisoner access to healthcare, attendant with an increased number of riots, assaults, acts of self-harm, and suicides. Concurrently, the microeconomic structure of organised crime is filling the void in prison governance, thus conducing to heightened abuse of psychoactive substances, as well as a surge in associated medical emergencies and violence. Successful prosecution of prior sexual offences, continued incarceration of those imprisoned for indeterminate sentences, and harsh sentencing practices have created policy drift, unremitting overcrowding, and reinforced excessive dependency on prison healthcare resources. The rapid turnover of justice ministers and intensified push for prison privatisation have enabled widespread distraction. Moreover, despite well-documented crises besetting English prisons, politicians seemingly remain in a state of denial. Preventive imprisonment, recurrent spending, and enhanced financial and political accountability measures are necessary to mitigate the effects of austerity and germane policies fomenting inimical impacts on England's prison health system.

Original languageEnglish
Pages (from-to)1368-1378
Number of pages11
JournalHealth Policy
Issue number12
Early online date21 Sep 2020
Publication statusPublished - 1 Dec 2020

Bibliographical note

Funding Information:
This research was supported by an Economic and Social Research Council (ESRC) Research Studentship Award (ESRC Grant: ES/P000630/1 ). The funder played no role in the analysis or preparation of this manuscript.

Publisher Copyright:
© 2020 The Author(s)

Copyright 2020 Elsevier B.V., All rights reserved.

Structured keywords

  • SPS Centre for Research in Health and Social Care


  • Austerity
  • England
  • Incarceration
  • Neoliberalism
  • Prison
  • Prison health

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