Universal health coverage and incarceration

Universal health coverage and incarceration: People in prisons left behind in drive to reach universal healthcare goals: An international study of global progress in reaching World Health Organisation (WHO) goals in the provision of universal healthcare coverage has found that many countries, including Australia, may be inflating their success by not counting people in prisons and youth detention in their data.

The review, led in Australia by Curtin University and The University of Melbourne, and published in The Lancet Public Health, analysed the way WHO collects global data about coverage of essential healthcare.  The researchers found that incarcerated people are currently excluded from these global data, despite the enormous concentration of health needs in custody settings.

Lead Australian researcher Professor Stuart Kinner, from Curtin’s School of Population Health, said that particularly in countries with high incarceration rates, failure to include custodial settings in healthcare coverage calculations might not only result in overestimation of progress, but also mask important health inequalities.

“Universal health coverage, as defined by WHO, means that all individuals and communities receive the health services they need without facing financial hardship,” said Professor Kinner. “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. 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 overestimating our progress. It’s simply not good enough.”

“While Australia does have a ‘universal’ health insurance scheme – Medicare – in reality it’s not quite universal. 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.” Professor Kinner said the paper calls on WHO to include people in custody in their assessment of healthcare coverage.

“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.”

The paper was an international collaboration led by Associate Professor Tyler Winkelman from Hennepin Healthcare (Minnesota, Minneapolis) and is available online here. Professor Stuart Kinner is Professor of Health Equity, School of Population Health, Curtin University; Head, Justice Health Unit, University of Melbourne; Head, Justice Health Group, Murdoch Children’s Research Institute; and Adjunct Professor, Griffith Criminology Institute, Griffith University.