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Issue #1713      December 2, 2015

Editorial

A proactive plan

In 2002 the Australian Medical Association (AMA) initiated an Aboriginal and Torres Strait Islander Report Card Series with the aim of increasing awareness among the general public and politicians about the appalling state of Aboriginal and Torres Strait Islander health, and to make practical recommendations about what needs to be done to address it.

Each year, a Report Card brings together the most up to date and relevant evidence and information on a selected topic or special area of urgency in Indigenous people’s health.

Among the divides between Aboriginal and Torres Strait Islander peoples and non-Indigenous people in Australia, the health and life expectancy gap and the stark difference in the rates of imprisonment are among the most well-known.

It is estimated that, on average, an Indigenous male born in 2010-2012 will live just over 10 years less than their non-Indigenous peers (69.1 and 79.7 years respectively) and an Indigenous female just under 10 years less than her non-Indigenous peers (73.7 and 83.1 years respectively).

Life expectancy is a proxy indicator for overall health and wellbeing. Each year, the Prime Minister reports against “Closing the Gap” targets that include one to close the life expectancy gap by 2030.

The age standardised imprisonment rate for Aboriginal and Torres Strait Islander peoples was 13 times greater than for their non-Indigenous peers in 2015.

The year 2016 marks a grim milestone in the numbers of Aboriginal and Torres Strait Islander peoples being held in custody. At the end of the 2015 June quarter, the average daily number of Aboriginal and Torres Strait Islander adult prisoners was 9,940, comprising 8,938 males and 1,002 females.

Under current projections, for the first time over 10,000 Indigenous people could be in custody on the night of the annual prison census on June 30, 2016. At the 2015 June quarter, Aboriginal and Torres Strait Islander people represented 28 percent of all adult full-time prisoners despite being only three percent of the population.

They accounted for approximately two percent of the total Aboriginal and Torres Strait Islander population.

The Report Card examines how the situation is compounded by a health system and prison health system that, despite significant improvements over past decades, remains – in many critical areas – unable to respond appropriately to the needs of Aboriginal and Torres Strait Islander prisoners.

Because Aboriginal and Torres Strait Islander peoples tend to come into contact with the criminal justice system at younger ages than their non-Indigenous peers, a major focus of this integrated approach is on the health, wellbeing, and diversion from the criminal justice system of Aboriginal and Torres Strait Islander children and adolescents. Culturally-based approaches have been identified as effective in working with this cohort in areas like suicide prevention.

The high rates of health problems among, and the imprisonment of, Aboriginal and Torres Strait Islander peoples should be a priority social justice and human rights issue in this context.

1. Set a national target for closing the gap in the rates of Aboriginal and Torres Strait Islander imprisonment.

2. Adopt a justice reinvestment approach to fund services that will divert Aboriginal and Torres Strait Islander people from prison.

3. Develop service models to support the expansion of Aboriginal Community Controlled Health Organisations (ACCHOs) and other services as part of an integrated approach to improving the health of Aboriginal and Torres Strait Islander peoples in the community (including responding to mental health conditions, substance use disorders and cognitive disabilities based on need) and as a preventative measure to reduce imprisonment rates.

4. In partnership with ACCHOs, prison health services, and other services as appropriate, develop a model of health care that integrates ACCHOs, prison health services, and other services to deliver an integrated approach to service provision that aims to improve health and reduce imprisonment rates at the same time.

5. Employ Aboriginal Health Workers and Indigenous health professionals in prison health services to support them to deliver a culturally competent health service.

Next article – Perth – Climate Action Rally

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