The Health-Justice Nexus: Crime and Justice as Social Determinants of Health in Scotland

Principle Investigator (lead Institution) – Professor Katherine Smith (University of Strathclyde)

Collaborating institutions – Edinburgh Napier University, University of Glasgow

Funding amount – £998,123

Lay Summary

The Scottish Government says it wants the justice system (including police, prison officers and social workers) to pay more attention to people’s health. This is because evidence shows that people who are taken into custody, or subject to supervision or post-release licences, often have high health needs which are not always met by current health and care systems. This means that they may not get the support they need. We know, for example, that it can be hard to register with a GP without a fixed address (which is often the case for people leaving prison).

We also know that it is not only a lack of access to healthcare that impacts on health for those in contact with the justice system. People living in Scotland’s poorest communities tend to have more health problems, are more likely to be sent to prison, and often die earlier than those living in wealthier communities. The Scottish Government agrees that these differences are unfair and is committed to reducing them. However, new data suggest some health gaps are getting worse, with increases (from 2014 onwards) in avoidable deaths for men and women living in the five most deprived areas in Scotland.

We want to help improve the health of Scotland’s most disadvantaged communities by examining how the justice system impacts on health (negatively and positively). Researchers working to understand health inequalities and those studying crime and justice often work separately so evidence about the impacts of justice on health sit apart from evidence about health inequalities (despite the fact that poverty, discrimination and stigma play an important role in both). This programme brings these bodies of expertise together to identify actions to reduce the negative impacts of justice on health and increase opportunities to improve health and wellbeing in Scotland’s disadvantaged communities.

Working alongside people who live and work in these communities, including people who have had contact with the justice system, we will: use existing research to find promising approaches for health improvement; explore how new digital and phone-based technologies might improve health and care access, including in prisons; examine how Police Scotland are changing the ways they work to improve community wellbeing; consider how people’s experiences of living in high crime areas impacts on wellbeing and what happens to people’s health when they leave prison.

We will also ask what changes people want to see in their communities, and in Scotland’s health and justice systems, to help improve health and wellbeing in marginalised communities. We will speak to people who work in the police, prisons, public health and government to understand how they are all trying to improve people’s health, what changes they believe would have the most positive health impacts and why. We will use all this information to pursue positive changes for people living in Scotland, including by working to make sure that the views of people who have experienced poverty and/or being in custody, prison, or otherwise involved with justice social work, are heard in Scottish health policy.