The universal health goals of the World Health Organization (WHO) include financial risk protection, access to quality health services and affordable essential medicines. Countries are assigned a service coverage index score on a scale of 0 to 100 to assess how well they provide basic universal services. Australia is currently on 87, while Norway and Singapore are on 86, and Thailand and the United States are on 83.
But research shows that many countries, including Australia, can inflate their success by excluding people in prisons and youth detention centres. This means that every day 42,970 imprisoned adults and 800 children (aged 10-17) in juvenile detention do not receive quality, affordable care like other Australians.
“Universal health coverage, as defined by the WHO, means that all individuals and communities receive the health services they need without facing financial hardship,” says lead researcher Professor Kinner of Curtin University.
However, prisoners are excluded from Australia’s universal health care scheme, Medicare, while incarcerated. Responsibility for health care is instead transferred to state and territory government departments. This discontinuity of care is often associated with poorer health outcomes.
“Australia is rightly proud of its progress towards the UN’s 2030 Sustainable Development Goals, including working towards ‘universal health coverage’ (Target 3.8.1). But we may not be doing as well as it seems,” says Kinner. “We measure progress towards this goal using the WHO Service Coverage Index (SCI), and the SCI does not take into account health care in detention. By excluding prison health care from the SCI calculation, we are excluding some of the most vulnerable Australians and likely overestimating our progress. It’s just not good enough.
A report on inmate health from the Australian Institute of Health and Welfare found that 40% of people entering prison had a mental health condition, two-thirds of people entering prison were using a drug illicit in the previous year – 40% having used alcohol or drugs. abuse problem – and one in three participants suffered from a chronic physical health problem (diabetes, asthma, cancer). One in five prisoners had hepatitis C. These people are not included in the SCI scores of Australia and some other countries.
“Although Australia has a ‘universal’ health insurance scheme – Medicare – in reality it is not quite universal,” says Kinner. “It excludes some of the most marginalized and sickest people in our communities: people in prison and in youth detention. And this exclusion has a disproportionate impact on Aboriginal and Torres Strait Islander people, who are vastly overrepresented in prisons.
This current strategy of managing prison health care does not even make sense economically, with average health care costs among released inmates being double that of the public, based on much higher rates. emergency health services and hospital admissions.
“What is counted is done. It is time we started counting people in prisons, in our assessment of health care coverage, so that we can work towards greater equality in access to health care, both in Australia and in the world.
This research was published in Lancet Public Health.