There is a pressing need to address the poor health and justice outcomes experienced by Indigenous Australians, who are over-represented in adult prisons by an age-standardised factor of 13 and in youth detention by a factor of 24.1,2 Numerous government reports emphasise the need to Close the Gap,3 and special provisions have been made to address Indigenous health inequity, including an exemption under section 19(2) of the Health Insurance Act 1973 (Cwlth) to permit Aboriginal Community Controlled Health Services (ACCHS) access to Commonwealth funding, even if they are funded by state governments.4 This policy seems sensible given the poor health outcomes experienced by many Indigenous people, and the evidence that Indigenous-specific services can play a role in ameliorating these outcomes in custodial settings.5 Unfortunately, the thousands of Indigenous Australians who cycle through custodial facilities each year — arguably those most in need of health services — are excluded from Commonwealth-subsidised health care under section 19(2), limiting the services available to them.4 Adult and youth custodial facilities are crucial sites for identifying and treating chronic diseases prevalent in Indigenous Australians, yet the current system excludes incarcerated people from Commonwealth-subsidised health care and requires an awkward, and often unsuccessful, transition between custodial and community health services.5 The predictable results are poor continuity of care and poor health outcomes.5 Although some ACCHS provide limited in-reach (in-custody) services, under section 19(2), they are prevented from claiming Commonwealth subsidies for this service.4,5 Consequently, such services are typically limited and ad hoc.
- 1. Australian Bureau of Statistics. Prisoners in Australia, 2015. Canberra: ABS, 2015. http://www.abs.gov.au/ausstats/abs@.nsf/mf/4517.0 (accessed May 2016).
- 2. Australian Institute of Health and Welfare. Youth justice in Australia 2014–15. Canberra: AIHW, 2016. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129554930 (accessed May 2016).
- 3. Department of the Prime Minister and Cabinet. Closing the Gap: Prime Minister’s report 2016. Canberra: Australian Government, 2016. http://closingthegap.dpmc.gov.au/assets/pdfs/closing_the_gap_report_2016.pdf (accessed May 2016).
- 4. Plueckhahn TM, Kinner SA, Sutherland G, Butler TG. Are some more equal than others? Challenging the basis for prisoners’ exclusion from Medicare. Med J Aust 2015; 203: 359-361. <MJA full text>
- 5. Lloyd JE, Delany-Thiele D, Abbott P, et al. The role of primary health care services to better meet the needs of Aboriginal Australians transitioning from prison to the community. BMC Fam Pract 2015; 16: 86.
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