2015 AMA report card on Indigenous health - closing the gap on Indigenous imprisonment rates

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 2015.3 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 9940, comprising 8938 males and 1002 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 30 June 2016. At the 2015 June quarter, Aboriginal and Torres Strait Islander people represented 28 per cent of all adult full-time prisoners4 despite being only three per cent of the population.5 They accounted for approximately two per cent of the total Aboriginal and Torres Strait Islander population. This Report Card treats the two gaps as connected. While acknowledging the complex drivers of imprisonment in any individual’s case, it considers the ‘imprisonment gap’ as symptomatic of the health gap. In particular, the AMA believes it is possible to isolate particular health issues (mental health conditions, alcohol and other drug use, substance abuse disorders, and cognitive disabilities are the focus of this report card) as among the most significant drivers of the imprisonment of Aboriginal and Torres Strait Islander peoples, and target them as health issues as a part of an integrated approach to also reduce imprisonment rates. Further, this 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. • The AMA Indigenous Health Report Card series commenced in 2002 with an overview of the health of Aboriginal and Torres Strait Islander peoples, which was aptly titled ‘No More Excuses’. In the ensuing years, the AMA Report Cards have covered important issues such as the Indigenous medical workforce, low birth weight babies, institutionalised inequity, childhood health, the health of Indigenous males, the inadequacy of funding, best practice in primary care, and getting the right start in life in the early years. The Report Cards have contributed to the broader debate around progress, or lack of it, in Indigenous health, and have been catalysts for informed further discussion. We like to think that they have all brought about some changes – in thinking, in action, in policy, and results. But we also know that some issues crawl along with little change, and maybe go backwards. In 2006, the AMA first cast its spotlight on the circumstances of Indigenous incarceration and the links to the lifetime health conditions of Aboriginal and Torres Strait Islander people who have spent time in prison. Aboriginal and Torres Strait Islander peoples’ imprisonment rates are rising dramatically. There was a 10 per cent increase from 8430 prisoners in 2013 to 9264 at 30 June 2014