Transcript Hepatitis C

Hepatitis C and prisons
Public Health Association of Australia
Michael Moore CEO
Ngunnawal people have always lived here. In this place we sang
and danced and laughed. Young men became wise men. The
sky and the earth gave us food and water. Then others came
The Public Health Association of
Australia
• Equity
 The prime driver
 Social determinants of health
• Prevention
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John Snow
1854 cholera
Clean water
Sanitation
Immunisation
Health promotion
Health Protection
Snow saw a problem and became an
advocate for governments to take action
No success until 1858 – the great stink
The Broad
Street Pump
Identify the problem + advocacy
• Hepatitis C - 2006 Estimates & Projections
• General Community
• The total number of people who have been exposed to hepatitis C in
Australia is 264,000
• It is estimated there are 197,000 people with chronic hepatitis C infection
• Up to 39,000 people may be unaware they have hepatitis
• 65% of those with hepatitis C are aged 20 to 39
years & 35% of total notifications are in women
• National rates of hepatitis C in prison entrants
is 34% for males and 50 to 70 percent for
females
Social Determinants of Health
• Sir Michael Marmott - WHO Report on Social Determinants of
Health - inequity is on a social gradient
Royal Commission into Aboriginal
Deaths in Custody
• There are an estimated 22,000 Aboriginal and Torres
Strait Islander people with hepatitis C
• In 1991, the Royal Commission into Aboriginal Deaths
in Custody
– Looked at such issues of organisation, culture and policy,
security issues, access to health care, domestic politics and
the system in the communities to which people return after
incarceration
– Now twenty years since the start of the Commission
– More aboriginal people in custody
– Health threats from hepatitis C and from HIV/AIDS
Royal Commission – a success?
• The Royal Commission
provided a road map – but
...
• Aboriginal and Torres Strait
Islander peoples now make
up 24% of the total prison
population
– an increase from 14% in
1992
• They make up only 2.5% of
the total Australian
population
Memorial for John Pat in front of the prison
walls of the decommissioned Fremantle Prison.
It was erected in September 1994 "in memory
of all Aboriginal people who have died in
custody in Australia"
Indigenous versus non-Indigenous
Incarceration in Australia*
3,000.0
2,500.0
Rate/100,000
2,000.0
1,500.0
1,000.0
500.0
0.0
NSW
Vic.
Qld
SA
Indigenous
WA
Tas.
NT
ACT
Non-Indigenous rate
Indigenous people are 13 times more likely to be incarcerated
than non-Indigenous people
A/Prof Ted Wilkes NDRI
Top 5 health concerns of prisoners
Aboriginal Non-Aboriginal
(%)
(%)
Drug use
40
41
Traumatic event
9
12
Sad 2+ weeks
16
11
Drinking
12
7
Nature/personality
7
5
Source: 2001 NSW Inmate Health survey
A/Prof Ted Wilkes NDRI
Substance misuse in prisons
•
Substance misuse
–
–
–
•
Alcohol: more than a third of women and half of
men drink in harmful range
Tobacco: 83% of women and 78% of men smoke
tobacco
Illicit drugs: 80% of total have used during lifetime
Chronic illness (e.g. diabetes, mental health,
cardiovascular)
–
•
95% women and 78% men have one or more
chronic health condition
64% of men and 40% of women have been
exposed to hepatitis C virus
–
Compared to 2% of in general community
PHAA: Justice Health Conference
Resolutions
• Advocacy and research
– Respect Australia’s local, international and human rights obligations to
prisoners
• Issues for Indigenous Australians
– Adopt an Indigenous holistic health focus particularly for Indigenous
prisoners
• Health services and planning
– Promote the concept of nationally binding targets for the states and
territories for reducing incarceration rates
– Recognise and respect the role and contribution of all staff throughout
the justice system
• Blood borne viruses, tobacco, other drugs and lifestyle diseases
– Adopt a national harm minimisation framework for prisons
• Mental health and co-morbidity issues
– Develop a National Prisoner Mental Health approach
Blood borne viruses, other drugs
and lifestyle diseases
• Adopt all harm minimisation strategies and programs
available in the community with demonstrated efficacy
• This includes:
– The use of opioid replacement therapies (including a pilot
study of a heroin trial)
– The adoption of needle and syringe programs (NSPs) in
prisons to initially be trialled in a small number of prisons
– National guidelines for bloodborne virus screening with
periodic follow up within the corrections system
– The ongoing national surveillance of BBV and STIs
including the National Prison Entrants Bloodborne Virus
Survey
– Ensuring national availability of condoms, dams, lubricants
in both adult and juvenile correctional facilities
Community – ‘prisoner health is
community health’
• Average length of time of incarceration
– 7 months
• Revolving door
• Indigenous impact
– The Indigenous population is relatively young, with a median age of 21
years compared with 37 years for the non-Indigenous population.
– This is largely the product of higher rates of fertility and deaths
occurring at younger ages among the Indigenous population (ABS
2004c).
– At 30 June 2006, people aged 65 years and over comprised just 3% of
the Indigenous population, compared with 13% of the non-Indigenous
population.
– In comparison, 37% of Indigenous people were under 15 years of age
compared with 19% of non-Indigenous people
• Ted Wilkes speaks of ‘normalisation of incarceration’
– as a ‘right of passage’
ABS and AIHW 2008
A/Prof Ted Wilkes NDRI
New Prison in ACT
Alexander Maconochie Centre
•
19th century prison reformer and
reforming Norfolk Island
commandant
•
Provides hope for the new prison
•
Ironically, forward thinking prisons
of today work by implementing
the Maconochie systems after
nearly two centuries
International
• The United Nations 1990 General Assembly Resolution on the
Basic Principles for the Treatment of Prisoners (Article 9)
states:
– “Prisoners shall have access to the health services available in the
country without discrimination on the grounds of their legal
situation”.
• World Health Organization view
– “All prisoners have the right to receive health care, including
preventive measures, equivalent to that available in the community
without discrimination” WHO 1993
• Being denied an international right is a denial to justice
International
Incarceration
Rates
Aboriginal
Australians
ACT Legislation
ACT Human Rights Act, 2004
Sections 19 (1)
– “Anyone deprived of liberty must be treated with
humanity and with respect for the inherent dignity of
the human person.”
• Human Rights Commissioner Dr Helen Watchirs
– Audit of Prisons ACT Correctional Facilities Aug 2007
• Over 100 recommendations including a Needle and Syringe
Program
• Being denied right under Human Rights Act
is a denial to justice
Countries with Prisons with NSPs (2006)
Switzerland
Germany
Spain
Moldova
Kyrgyz Rep.
Belarus
Luxembourg
Isl. Rep. of Iran
Armenia
Ukraine
UK (Scotland)
Portugal
1992
1996
1997
1999
2002
2003
2005
2005
2004
2007
2007
2007
7
1 (6 closed following political decision)
38
7
11
1 (as of 2004)
1
1 to 6
3
2 pilot projects due start September 2007
pilot study approved to start in 2007
implementation by 2008
SURELY IT IS POSSIBLE IN THE ACT
Wodak 2008
Who is stopping this access to justice
and to just health care?
• Prison officers – we need to engage
– Claim it is because of fear of needles as weapons
• This has been managed in Spain and Switzerland
– Truth
• It is moral issue for prison warders
• In some prisons they are part of the supply chain
• Politicians – we need to engage
– Either law and order themselves or concerned
about law and order campaigns
Ottawa Charter -Template for Action
• Health promotion
– puts health on the agenda of policy-makers
• Uses diverse but complementary approaches
– legislation
– fiscal measures, taxation
– organisational change
• Identification of obstacles to healthy policies
– Then ways of removing them
– The aim must be to make the healthier choice the easier
choice for
• Policy-makers
• People