key: cord-0764688-7wom9rxq
authors: Lins-Rocha, Matheus; Lins-Kusterer, Liliane; Menezes, José; Melo, Ailton
title: Mortality and Morbidity Among Persons Deprived of Liberty During the COVID-19 Pandemic in Brazil
date: 2021-08-19
journal: Health Equity
DOI: 10.1089/heq.2021.0057
sha: d66d8bb2e1ffdbd0b0565b06ea78c2bd52266c36
doc_id: 764688
cord_uid: 7wom9rxq

Dear Editor: In Brazil, persons deprived of liberty (PDL) have a high risk of COVID-19 infection due to the overcrowded and deficiently ventilated cells, restricted access to basic sanitation, and a lack of health units.1 Brazilian health services in prisons should be distributed according to the prison population and organized following the national primary care model, achieving the universality of the Unified Health System and guaranteeing the constitutional right to health for prisoners.2 Brazilian prisons present considerable challenges for the implementation of preventive health policies. A retrospective study analyzed data from the Brazilian Penitentiary statistical information system (INFOPEN),3 for the State of Bahia, Brazil, concerning periods before (second half of 2019) and at the beginning of (first half of 2020) the COVID-19 pandemic. Public Policies for PDL need to be effective in reducing the number of crimes or enabling the reintegration of prisoners into society.

Matheus Lins-Rocha, 1,2, * ,i Liliane Lins-Kusterer, 1,ii José Menezes, 2,iii and Ailton Melo 1,iv Dear Editor:

In Brazil, persons deprived of liberty (PDL) have a high risk of COVID-19 infection due to the overcrowded and deficiently ventilated cells, restricted access to basic sanitation, and a lack of health units. 1 Brazilian health services in prisons should be distributed according to the prison population and organized following the national primary care model, achieving the universality of the Unified Health System and guaranteeing the constitutional right to health for prisoners. 2 Brazilian prisons present considerable challenges for the implementation of preventive health policies. A recent ecological study evaluated the five Brazilian macro-regions, including the Federal District. Results showed 14 spatial risk clusters for COVID-19 among PDL, and the highest-risk cluster was in the Federal District. 1 The health of PDL is not an object of great concern by society. The provision of specialized health services has declined during the COVID-19 pandemic in Brazil. In this context, a similar or even worse situation is expected to occur concerning the health of Brazilian prisoners. We compared general morbidity and mortality of prisoners in the State of Bahia, Brazil, in the second half of 2019 and the first half of 2020.

A retrospective study analyzed data from the Brazilian Penitentiary statistical information system 3 for the State of Bahia, Brazil, concerning periods before (second half of 2019) and at the beginning of (first half of 2020) the COVID-19 pandemic. Prevalence of specific diseases and mortality rates for the two semesters were compared by using the Open-Epi tool (www.OpenEpi.com). 4 Comparing the two semesters, the prevalence of other causes of illness increased substantially among men (13.1 times) and women (5.98 times). A decrease (29%) in the prevalence of tuberculosis among men was also observed. Mortality by criminal causes and suicide increased 7.92 and 3.17 times among men, comparing semesters before and during the COVID-19 pandemic. Women accounted for 2.8% and 3.3% of the prisoners' total populations, in the first half of 2019 and 2020, respectively. There was only one case of death in the first half of 2020 (Table 1) .

A report issued by the Catholic Church in Brazil entitled The Pandemic of Torture in Prison, published by the Prison Ministry Office of the Bishops' Conference of Brazil, registered 90 complaints of ill treatment. The complaints included physical abuse, humiliating treatments, deprivations, and violations of the constitutional right to health care in PDL. 5, 6 Most of the complaints were ignored by judiciary authorities. Of the 90 reported complaints, only 8 were followed by an investigation. 

The advent of the COVID-19 pandemic was associated with changes in disease prevalence and mortality among PDL in the State of Bahia penitentiary system. We emphasize the increase of violent deaths, reflecting the stressful situation of the inmates. Public Policies for PDL need to be effective in reducing the number of crimes or enabling the reintegration of prisoners into society. They should also include health accessibility, and guarantee constitutional humans rights, preventing violence and torture. 

Impact and trend of COVID-19 in the Brazilian prison system: an ecological study

Establishes the National Policy for Comprehensive Health Care for Persons Deprived of Liberty in the Prison System (PNAISP) within the scope of the Unified Health System (SUS)

National Survey of Penitentiary Information-INFOPEN

On Academics: OpenEpi: A Web-Based Epidemiologic and Statistical Calculator for Public Health

Brazilian bishops decry conditions in prisons

Prison Pastoral Commission Report: The Pandemic of Torture in Prison

INFOPEN ¼ Brazilian Penitentiary statistical information system PDL ¼ persons deprived of liberty