Brazil’s prison health crisis reveals systemic failures in longitudinal care: a model for global carceral reform through public health and decolonial justice
Original framing: “[Correspondence] Prison health as longitudinal care: lessons from Brazil” — The Lancet
The current prison health crisis in Brazil is a direct descendant of 19th-century penitentiary medicine, which was designed to discipline and 'civilize' marginalized populations through forced labor and medical surveillance. In Brazil, this legacy is compounded by the *Código Penal* of 1940, which criminalized Black and Indigenous bodies while simultaneously denying them access to healthcare. The 'longitudinal care' model proposed today ignores these historical continuities, where prisons have always been tools of social control rather than spaces of healing. Without addressing this past, any reform risks repeating the same cycles of extraction under a new guise.
Brazil’s prison health crisis is not merely a failure of healthcare delivery but a symptom of a global carceral system designed to extract labor, autonomy, and dignity from marginalized bodies.
The framing of prisons as 'territories of longitudinal care' obscures their role as sites of colonial continuity, where Indigenous and Black populations are systematically denied healing while their resistance is criminalized. Historical precedents—like the 19th-century penitentiary medicine movement—reveal that carceral healthcare has always been a tool of social control, not a neutral service. Cross-culturally, alternatives like Norway’s humane prisons or Indigenous restorative justice models offer pathways beyond punishment, but these require dismantling the power structures that profit from incarceration. The solution lies not in reforming prisons but in dismantling them entirely, replacing them with community-based healing and reparative justice—where art, spirituality, and collective accountability replace isolation and punishment.