the health and wellbeing of aboriginal people in prison: findings from the nsw inmate health survey...
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The health and wellbeing of Aboriginal people in prison: findings
from The NSW Inmate Health Survey
Indigenous Allied Health Australia National Conference
November 2012
Jude Page
Project Manager, Aboriginal Health
Acknowledgements
• 2009 Inmate Health Survey (IHS), Investigators: Devon Indig, Libby Topp, Elizabeth McEntyre, Bronwen Ross, Peter Kemp, Denise Monkley, Martin McNamara, Robyn Rosina, Stephen Allnut, David Greenberg, and Edouard Tursan D’Espaignet.
• IHS Aboriginal Health Report, Authors: Devon Indig, Elizabeth McEntyre, Jude Page and Bronwen Ross.
• Funding: NSW Health: (Mental Health and Drug and Alcohol Office, Centre for Epidemiology and Research, Centre for Health Protection) and Justice Health
Overview
• Background – to imprisonment – to the survey
• Methodology
• Results- Social Determinants- Risk Behaviours- Chronic diseases- Infectious Diseases
• Conclusions
International Incarceration Rates, 2008
33
58
89
116
119
129
153
185
257
326
335
531
629
756
0 100 200 300 400 500 600 700 800
India
Indonesia
Germany
Canada
China
Australia
United Kingdom
New Zealand
Thailand
Israel
South Africa
Cuba
Russia
United States
Rate per 100,000 population
Source: World Prison Population List (eight edition), December 2008. Kings College London. Note: Australia is cited in this report using ABS figures as 129 per 100,000 for 30/6/2008; however ABS reports Australia as having 168 per 100,000 at 30/6/2008 in its Prisoners in Australia publication (cat 4517.0), 2009. Note: This data may include both adults and juveniles in some countries.
Adult Incarceration Rate by State 2009
Source: ABS Prisoners in Australia, 2009. ABS Cat no 4517.0.
75
104
140
155
168
204
261
658
175
0 100 200 300 400 500 600 700
ACT
VIC
TAS
SA
QLD
NSW
WA
NT
Australia
Rate per 100,000 population
Adult Incarceration Rate by State and Indigenous Status, 2009
Source: ABS Prisoners in Australia, 2009. ABS Cat no 4517.0
966
1159
578
2597
1733
2591
4075
2104
2310
66
99
126
121
125
156
159
161
131
0 500 1000 1500 2000 2500 3000 3500 4000 4500
ACT
VIC
TAS
SA
QLD
NSW
WA
NT
Australia
Rate per 100,000 populationIndigenous Non-Indigenous
Background to imprisonment
Individual factors• Effects of colonization• Social determinants of
health (housing ,education, employment, poverty etc)
• Mental health, disabilities• Other risk factors
Structural factors• Laws and policies• Policing• Sentencing• Bail laws & conditions • Access to health & support
services• Availability of diversion
options
Change in Aboriginal Custodial Population, NSW 1998-2012
1998 2009 2012 SOURCE
Custodial Population 7824 11160 9624
CS NSW Inmate Census
Male (%) 94 92 93.5Female (%) 6.2 7.7 6.5Aboriginal Male (%) 13.5 21 22Aboriginal Female (%) 20 28 30
Source: NSW Inmate Census 2009, CSNSW 2012, Offender population report, CSNSW 30 September 2012. Totals include full-time inmates and period detainees.
Nationally 71% increase in Indigenous imprisonment between 2001 and 2009, compared to 25% increase for non Indigenous prisoners (ABS, 2009)
Risk factors for Aboriginal prosecution & imprisonmentMajor risk
High risk alcohol consumption
Illicit drug use (Weatherburn, et. al 2006, NATSIS)
Increase risk
Not completing year 12, unemployment, overcrowded housing, homelessness, being removed from family as child (incl. stolen generations)
Breach of bail conditions
Violent offences (assault, robbery)
Copyright ©2003 BMJ Publishing Group Ltd.
Cunningham, C. et al. BMJ 2003;327:403-404
Impact of colonisation on Aboriginal health today. Modified from Mathews5
Research Methods
• The Aboriginal Health Report is the first report of the health of Aboriginal adults in NSW prisons.
• A snapshot of Aboriginal people within a larger study of Inmates in NSW Prisons
• Acknowledged as one of the world’s most comprehensive assessments of prisoners’ health
Research Methods
• Random sample of 996 people (over-sample of women and Aboriginal people)• 31% identified as Aboriginal (312 people) • Average age 35 years
• Exclusion criteria: non-English speaking, acute mental illness, profound intellectual disability
• Computer-assisted telephone interviews• Average interview length 73 minutes• Response rate: 85%
Survey content
• Physical health tests – physical measurements, blood pressure, blood sample (blood borne viruses, blood sugar, etc), urine sample (STIs, etc)
• Physical health – prison history, demographics, health status, disability, medications, asthma, diabetes, exercise, injury, SF-12, diet, etc
• Access to healthcare – in prison and community
• Mental health & risk behaviours– psychiatric history, suicide, self-harm, smoking, alcohol, drugs, tattoos, sexual health
Healthcare access in community (ever), Inmate Health Survey 2009
Aboriginal Men (N=259)
Non-Aboriginal Men (N=538)
Aboriginal Women (N=53)
Non-Aboriginal Women (N=146)
No health services 27% 12% 6% 4%
Hospital 45% 59% 62% 68%
GP 40% 69% 60% 87%
Medical centre 39% 41% 70% 58%
Community health centre
25% 21% 36% 39%
Home nursing 5% 3% 23% 4%
Other 16% 7% 32% 19%
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women0
20
40
60
80
66
4750
48
70
46
58
43
73
43
60
39
No school certificate by Aboriginality and sex, Inmate Health Survey 1996, 2001 and 2009
1996 2001 2009
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women0
5
10
15
20
10
6
15
8
10 10
16
10
14
10
12
10
Unsettled accommodation/sleeping rough in 6 months prior to prison by Aboriginality and sex, Inmate Health Survey 1996, 2001 and 2009
1996 2001 2009
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women
0
20
40
60
80
100
61
51
92
71
54
41
77
6164
43
87
60
Not working in 6 months prior to incarceration by Aboriginality and sex, Inmate Health Survey 1996, 2001 and 2009
1996 2001 2009
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women
0
20
40
60
80
100
40 39
68
6161
45
72 70
77
57
94
72
On pension or benefit 6 months prior to imprisonmentby Aboriginality and sex, Inmate Health Survey 1996, 2001 and 2009
1996 2001 2009
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women0
20
40
60
34
15
40
20
46
22
45
27
Ever placed in care as a child by Aboriginality and sex, Inmate Health Survey 2001 and 2009
2001 2009
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women0
10
20
30
40
27
11
29
13
31
12
36
10
Parents ever in prison (if known) by Aboriginality and sex, Inmate Health Survey 2001 and 2009
2001 2009
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women0
20
40
60
80
42
25
35
20
58
33
52
21
61
33 34
17
Ever been in juvenile detention by Aboriginality and sex, Inmate Health Survey 1996, 2001 and 2009
1996 2001 2009
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women
0
20
40
60
80
100
80
60
74
60
72
57
65
53
81
56 58
41
Ever previously been in prison by Aboriginality and sex, Inmate Health Survey 1996, 2001 and 2009
1996 2001 2009
Summary – Social determinants Aboriginal inmates had worse social determinants of health
than non-Aboriginal inmates:
Nearly twice as likely to not complete Year 10
More likely to be unemployed (often long-term) prior to prison
Nearly three times as likely to have had a parent in prison
Twice as likely to have been placed in care as child
Twice as likely to have ever been in juvenile detention
More likely to have been in prison previously
Risk Behaviours
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women
0
20
40
60
80
100
78
68
7773
8176
92
8183
71
88
76
Current smoker by Aboriginality and sex, Inmate Health Survey 1996, 2001 and 2009
1996 2001 2009
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women0
20
40
60
80
100
7478
81
7478
75
57
72
90 88
80
71
Like to quit smoking (among smokers) by Aboriginality and sex, Inmate Health Survey 1996, 2001 and 2009
1996 2001 2009
Smoking characteristics
Average Aboriginal inmates smoked at approximately double the rate of Aboriginal people in the community (85% vs 45%)
A third of participants smoked by the time they were aged 12.
Aboriginal inmates smoked less cigarettes per day (approximately 20% of Aboriginal inmates smoked 21+ per day compared to about 30% of non-Aboriginal inmates)
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women0
20
40
60
80
63
4442
37
58
40
48
22
73
56
49
34
Risky drinker by Aboriginality and sex, Inmate Health Survey 1996, 2001 and 2009
1996 2001 2009
Drinking characteristics Over a third (35%) of Aboriginal women did not drink any
alcohol in the year before prison, compared to 31% non-Aboriginal women.
Nearly half (44%) of Aboriginal men scored 20 or more on the AUDIT, indicating alcohol dependence
58% of Aboriginal men reported usually drinking 10 or more drinks on a typical day (compared to 41% non-Aboriginal men)
40% of Aboriginal men reported they had 6 or more drinks on a daily basis in the year before prison (compared to 27% non-Aboriginal men)
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women0
20
40
60
80
100
73
67
92
79
89
76
96
81
8884
88
74
Ever use illegal drugs by Aboriginality and sex, Inmate Health Survey 1996, 2001 and 2009
1996 2001 2009
Benzodiazepines
Others methadone/bup
Your methadone/bup
LSD/acid
Ecstasy
Cocaine
Ice
Amphetamines
Other opiates
Heroin
Cannabis
0 10 20 30 40 50 60 70 80 90
32
17
24
29
27
40
11
51
18
53
75
25
16
23
28
44
45
42
57
19
41
81
Type of drugs used, Inmate Health Survey 2001 and 2009
20092001
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women0
20
40
60
80
3941
68
63
52
47
79
62
46
37
4751
Ever inject drugs by Aboriginality and sex, Inmate Health Survey 1996, 2001 and 2009
1996 2001 2009
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women0
20
40
60
80
51 51
4541
55
47
34
46
52
57
66
55
Overweight or obesity (BMI 25+) by Aboriginality and sex, Inmate Health Survey 1996, 2001 and 2009
1996 2001 2009
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women
0
20
40
60
80
1917
3741
26
18
60
41
26 26
62
32
Ever been told by a doctor that you have asthmaby Aboriginality and sex, Inmate Health Survey 1996, 2001 and 2009
1996 2001 2009
Summary – Chronic Diseases
Aboriginal inmates had high rates of chronic diseases than non-Aboriginal inmates:
Twice as likely to have diabetes
Twice as likely to have ever had asthma (Aboriginal women)
Aboriginal inmates had higher rates of infectious diseases than non-Aboriginal inmates:
Chronic diseases characteristics
Nearly all (91%) Aboriginal women were currently taking medications, compared to 84% non-Aboriginal women and two-thirds of both Aboriginal and non-Aboriginal men
Over half of women (59% Aboriginal women and 54% non-Aboriginal women) self-reported having 3 or more health conditions compared to about 40% of both Aboriginal and non-Aboriginal men
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women
0
20
40
60
80
100
3035
72
64
4239
76
61
36
24
54
42
Infectious Diseases - Hepatitis C antibodyby Aboriginality and sex, Inmate Health Survey 1996, 2001 and 2009
1996 2001 2009
Aboriginal men Non-Aboriginal men Aboriginal women Non-Aboriginal women
0
20
40
60
80
52
24
58
42
31
26
45
28
36
17
3533
Hepatitis B core antibodyby Aboriginality and sex, Inmate Health Survey 1996, 2001 and 2009
1996 2001 2009
Summary – Infectious Diseases
More likely to be Hepatitis C antibody positive
But decreasing
Twice as likely to be Hepatitis B core antibody positive (Aboriginal men)
But decreasing
A third of Aboriginal men (32%) reported ever being diagnosed with a sexually transmissible infection (30%) and Aboriginal women (26%). NOTE: usually no symptoms
Not decreasing
Infectious diseases characteristics
One inmate tested positive to HIV antibody
Aboriginal men - higher rates of testing for a blood borne virus in prison (61% vs 47%) compared to non-Aboriginal men.
Aboriginal women - best knowledge of risk factors for Hepatitis C transmission (54% correctly answered 3 risk factors).
Conclusions
Over representation of Aboriginal people in prisons
Social determinants of health (poor educational attainment, family displacement, unsettled accommodation) impact on health
Higher prevalence of risk factors for chronic diseases such as smoking, risky drinking and illicit drug use
Aboriginal inmates are more likely to have chronic and infectious diseases, which start at a younger age – mostly preventable
Where to from here?
Utilising the evidence to inform policy and program development and to seek enhanced funding and services
Need for government to work more closely with Aboriginal people to break the cycle of crime, disadvantage and poor health
Prison presents an opportunity to screen for chronic and infectious diseases, provide treatment, health education and strengthen self management
Improving culturally responsive services to Aboriginal people in custody and access to health care on return to community
What is our role?
Reduce risk factors for poor health
Treat effects of trauma
Improve access to appropriate health care, support & follow up
Make the health care experience relevant and positive
Include health promotion and understanding in each health interaction (where appropriate)
Model of health: patient centred, holistic
Support healing & healthy communities
Education, inclusion, opportunities
Tools http://sydney.edu.au/medicine/addiction/indigenous/resources
Future research
Aboriginal Men in Custody Study• Focus on experience of criminal justice system, resilience,
racism and mental health – using Inmate Health Survey cohort
• Study of experiences of 125 men is being finalised
