People in prison are being left out of universal healthcare goals

The universal healthcare goals of the World Health Organisation (WHO) include financial risk protection, access to quality healthcare services, and affordable essential medicines. Countries are given a Service Coverage Index score on a scale of 0-100 as to how well they are providing basic universal services. Australia is currently on 87, while Norway and Singapore are on 86, and Thailand and the USA are on 83.

But research shows that many countries, including Australia, may be inflating their success by excluding people in prisons and youth detention centres. This means that on any given day, 42,970 imprisoned adults, and 800 children (aged 10-17) in juvenile detention, are not receiving quality and affordable care like other Australians.

“Universal health coverage, as defined by WHO, means that all individuals and communities receive the health services they need without facing financial hardship,” says lead researcher Professor Kinner from Curtin University.

However, prisoners are excluded from Australia’s universal healthcare scheme, Medicare, while incarcerated. The responsibility of healthcare is instead transferred to the state and territory government departments. This discontinuity of care is often associated with worse health outcomes.

“Australia has been justifiably 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 target using the WHO Service Coverage Index (SCI), and the SCI doesn’t consider healthcare in custody. By excluding prison healthcare from calculation of the SCI, we’re excluding some of the most vulnerable Australians, and probably over-estimating our progress. It’s simply not good enough.”

A report on prisoner health by the Australian Institute of Health and Welfare found that 40% of prison entrants had a mental health condition, two-thirds of prison entrants were using an illicit drug in the previous year – with 40% having an alcohol or drug abuse problem – and one in three entrants had a chronic physical health condition (diabetes, asthma, cancer). One in five prisoners had hepatitis C. These people are not being taken into account in Australia’s and some other countries’ SCI scores.

“While Australia does have a ‘universal’ health insurance scheme – Medicare – in reality it’s not quite universal,” says Kinner. “It excludes some of the most marginalised and unwell people in our communities: people in prisons and youth detention. And this exclusion disproportionately impacts Aboriginal and Torres Strait Islander people, who are drastically over-represented in custodial settings.”

This current strategy of prison healthcare management doesn’t even make economic sense, with average healthcare costs among released prisoners being double compared to the public, based on much higher rates of emergency health services and hospital admissions.

“What gets counted gets done. It’s time we started counting people in prisons, in our assessment of healthcare coverage, so we can work towards greater equality in access to healthcare, both in Australia and globally.”

This research has been published in The Lancet Public Health.

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