Equality in health

The current health care needs of Indigenous Australians derive from their inadequate access to the primary determinants of health. As a matter of urgency, the report calls for the government to address the inadequacy of educational services for remote communities. To do so would progress the health outcomes of individuals, directly, through improvement of health-related knowledge and the ability to utilise that knowledge and, indirectly, through increasing employment prospects and income, thereby, facilitating access to health services.

In relation to persons in detention, both in prisons and immigration detention, the Special Rapporteur made the point that time spent in detention provides a unique opportunity for diagnosis and intervention, and should be better utilised for these purposes and to effect long-term behavioural change in those who are detained.

In brief, the standard of specialised health care in prisons is high, although delay and the capacity of services to manage chronic diseases are issues and preventative health services are inadequate.

The report endorses the view that Australian prisons have become “de facto mental institutions”. This assessment reflects the significant overrepresentation of individuals with mental illness within Australia’s prison system and the deficiency in the ability of current services to treat those prisoners. This service deficiency is the result of the failure to establish community-based treatment options at pace with population growth since the deinstitutionalisation of mental health care services.

Indigenous people are also overrepresented in Australian prisons and present with the coexistence of mental illness and substance abuse at a high rate. The Special Rapporteur strongly recommends that further steps be taken to reduce the rates and lengths of Indigenous incarceration through, for example, diversion programs, reconsideration of relevant criminal laws and assessment of sentencing policies.

The Department of Immigration and Citizenship (DIAC) aims “to ensure that the only change to an individual’s well-being as a result of being in [immigration] detention is to the restriction of freedom of movement”. Overall, the report found that the health services provided in immigration detention centres (IDCs) met the needs of the detainees, except to the extent of the prevalence of mental health issues among detainees and, particularly, those detained for lengthy periods.

Three other issues emerged for the provision of health services to detainees: the role of IDC security services in facilitating access to mental health and other health services; the availability of interpreters; and the utility of locating IDCs at excised offshore and remote places such as Christmas Island.

Security personnel facilitate access to services upon request by detainees, are responsible for identifying detainees at risk of suicide and self-harm (SASH) and can make decisions regarding the return of detainees to regular facilities once they have been placed in SASH rooms. The Special Rapporteur has called for more support and specialised training to enable security personnel to adequately fill these roles.

Health care service providers in IDCs face particular challenges in meeting the cultural needs of detainees, which are exacerbated by language barriers. Presently, telephone interpretation services are used for most translations. The Special Rapporteur identified the provision of on-site part-time interpreters for the main languages represented in IDCs as a not particularly onerous measure to improve access.

Although it ought to be acknowledged that Christmas Island is no more remote that certain parts of mainland Australia, its location poses significant challenges regarding service delivery. The report recommends that the government reconsider the appropriateness of detention facilities continuing on the island and assess the provision of mental health services to the population as a matter of priority.

Most recently, discussion about the state of health care in Australia and health reform has taken place in the context of political point scoring with the Australian electorate.

The Special Rapporteur’s report is a timely reminder that the enjoyment of the highest attainable standard of health is not appropriately conceived as an election promise. It is, in fact, a fundamental human right: one which Australia is obligated under international law (an obligation which we have freely and voluntarily undertaken) to ensure for all persons within the jurisdiction, whether they are a member of a minority population, disenfranchised, an asylum-seeker or an illegal immigrant.

The report draws together much of the available and valuable information in respect of the health status of Aboriginal and Torres Strait Islander people and persons in detention, and presents that information in the context of Australia’s human rights commitments.

In doing so, it is clear that the right to health is the equal entitlement of all persons but, in Australia, some persons enjoy the right more equally than others. This provides yet one more challenge for a newly sworn in Prime Minister, both in the short term of the lead up to this year’s election and, if she were to be re-elected, for the longer term.