Incarceration Equals Desperation For Indigenous Australians

A special welcome to Dr Mark Wenitong, the President of the Australian Indigenous Doctors' Association, Mr Henry Councillor, the Chairman of the National Aboriginal Community Controlled Health Service Organisation and our hosts, the Victorian Aboriginal Health Service - along with their board and Chairman, Kevin Coombs.

I'd like to thank the traditional owners for allowing us to hold this function on their land, and pay respects to the elders and their ancestors.

Today I have the honour of launching the latest AMA Report Card on Indigenous Health - the fifth in the series.

I'd like to say 'successful' series, but success is not a word that should be associated with the state of Indigenous Health in Australia in the 21^st century.

Let's call it an honest series that exposes a great Australian tragedy of neglect, disadvantage and inequality.

The major subject of this year's report is the health of Indigenous Australians in prison.

This report - like its predecessors - is a horror story.

The bleak health condition of prisoners - in both body and mind - is universally grim.

But this is particularly true for Indigenous Australians, who suffer unique cultural, spiritual and tribal consequences of imprisonment.

Indigenous Australians make up 2.4 per cent of the population of Australia, but 22 per cent of its prison population.

An Aboriginal or Torres Strait Islander young person is 19 times more likely than a non-Aboriginal young person to be detained at a juvenile facility.

The health status of Aboriginal and Torres Strait Island people in prison is horrifying - the statistics bear this out.

In 2002, there were 14 reported Aboriginal deaths in custody.

The rates of smoking, alcohol abuse, illicit drug use, violence and abuse for Indigenous prisoners are much higher than national rates, and way over rates for the Indigenous community in general.

Infectious diseases, chronic diseases and mental illness all strike Indigenous prisoners much more severely than their non-Indigenous counterparts.

By publishing this Report Card, we at the AMA hope to draw attention to some of the injustices visited upon the Indigenous Australians in this nation's jails.

We hope also that governments listen to the changes we're suggesting to help right some of the wrongs.

Two key changes need to occur.

Firstly, we need to keep out of prison those who should never have been put there in the first place.

I'm talking particularly about people with mental health and substance abuse problems.

We're calling on Federal, State and Territory Governments to make sure imprisonment is the last resort for Indigenous citizens with mental health or substance abuse problems.

Governments should set annual targets for reducing national incarceration rates for individuals with these problems.

And prisoners should be screened by a mental health team within 48 hours of being remanded or sentenced.

Those with mental health problems should, where possible, be treated for those problems rather than imprisoned.

Those with alcohol and other substance abuse problems should be offered treatment - including residential treatment - as an alternative to putting them in jail.

In the Good News section of this year's Report Card, we've highlighted some excellent treatment programs that are working.

One place getting results is Benelong's Haven Family Drug and Alcohol Rehabilitation Centre on the NSW North Coast.

A soon-to-be-published study has found that Aboriginal and Torres Strait Islander people referred to Benelong's Haven from the criminal justice system show improvements in a range of psychological and physiological markers.

Then there's Milliya Rumurra Alcohol and Drug Rehabilitation Centre, in Broome, Western Australia.

All but one of the 22 people diverted to the program from the justice system over the past year have stayed out of trouble with the law.

Of course, these and the new treatment and support programs I'm talking about need to be properly funded by Governments to ensure their success.

The second key change is that Australia needs to ensure that health service provision in prisons is the best it can be.

That means making sure that Indigenous and other prisoners have the same access to health and medical services that we enjoy as free citizens.

While it's obvious that Indigenous prisoners have special needs, most research and statistics about inmates apply to the whole prison community.

Currently a mixed bag of corrective services departments, private providers, human services and health departments are charged with looking after the health of prisoners.

The United Nations' 1990 General Assembly Resolution on the Basic Principles for the Treatment of Prisoners, states:

"Prisoners shall have access to the health services available in the country, without discrimination on the grounds of their legal situation".

If Australia is to uphold that resolution, we need to change our approach to prisoner healthcare.

The Federal Government needs to give inmates the same access to Medicare and the Pharmaceutical Benefits Scheme as other citizens - and the Health Minister, Tony Abbott, can do that at the stroke of a pen.

Federal, State and Territory Governments also need to implement the UN resolution.

To do this they must give responsibility for prisoners' health care to Departments of Health - not to Departments of Corrective Services, not to Departments of Human Services - but to the same departments which have responsibility for the health services enjoyed by you and I.

In addition, Governments must ensure that Indigenous prisoners are able to access Aboriginal Medical Service inreach services.

Until these basic changes are made, we can expect to see a continuing inequality between the health status of prisoners - especially Indigenous prisoners - and that of most of the population, excepting the Indigenous population, of course.

Furthermore, we can expect to see a continuing disparity between the health status of Indigenous prisoners and non-Indigenous prisoners.

You'll find in this year's Report Card that we have touched on some of the issues covered in previous years; namely, the Aboriginal and Torres Strait Islander medical workforce; and spending on Aboriginal and Torres Strait Islander Health Services.

The AMA called two years ago for a Government commitment to ensuring that at least 2.4 per cent of health professionals are Indigenous Australians.

It's been great to see that, since then, some medical schools have made an effort to attract more Indigenous students.

If all university medical schools followed the good examples set by the University of Newcastle and James Cook University, Australia would be close to meeting the target of having 2.4 per cent of doctors from an Indigenous background by 2014.

My colleague Dr Mark Wenitong, the President of the Australian Indigenous Doctors' Association, will be able to tell you more about that later.

As far as Indigenous Health Service funding is concerned, the Federal Government has made a substantial commitment to improving access to health care for Aboriginal and Torres Strait Islander people.

Next financial year, the Government is expected to spend around $350 million on Indigenous health - about double its 2001/02 spending of $184 million.

But there's still much, much more to be done.

The AMA estimates that the gap between spending and need just keeps getting bigger.

In our Budget submission this year we called for an extra $400 million this year and every year.

Access Economics has updated that figure to $460 million a year if we are even to get to start to do the job properly.

The Federal Government needs to set standards for the provision of primary health care services - in consultation with the National Aboriginal Community Controlled Health Organisation and other Indigenous representatives.

And it needs to fully fund those services.

I know this list of asks seems long and expensive. It is. But it's also necessary. It is also fair.

What we're really calling on the Government to do is to ensure that Indigenous Australians - both in and out of prison - are afforded the same basic healthcare access, the same basic health rights, as other Australians.

In April Treasurer Peter Costello declared this country "debt free".

Last week he splurged the Budget surplus on tax cuts for all, especially higher income earners.

But he didn't extend his Budget surplus largesse to Indigenous health. No votes in that!

But Indigenous health and living standards should not be about votes - it is simply about doing the right thing by the people who need it the most.

The Report Card we are launching today is another short - but far from sweet - summary of injustice and unfairness in what is supposed to be a sophisticated and caring society.

We can do a lot better.

Let's end the undue punishment of Indigenous Australians in our jails.

And let's do our best to improve the health and life expectancy of all Aboriginal people and Torres Strait Islanders.

Thank you.