Hon Tariana Turia

Associate Minister of Health

8 June 2012 Speech

Inside and Out Improving primary health care for current and former inmates and their whānau

Nordmeyer Theatre, University of Otago Wellington

I want to acknowledge Te Rōpū Rangahau Hauora a Eru Pōmare, and Regional Public Health for your initiative in holding this hui today and in particular to mihi to Bridget Robson, as Associate Dean, Māori and Director for your commitment to the kaupapa of primary health care and Peter Gush, Regional Public Health.

I want to also acknowledge the vision behind today, which I understand was inspired by the work of two people: the prisoner reintegration project led by Sione Feki, and the work on continuity of care pioneered by Dr Paula King, a public health registrar. Tēnā kōrua.

I also want to mihi to a long time advocate, Kim Workman, for his commitment to this issue.

The unique set of challenges that emerge from the interface between the Corrections system and the healthcare system have challenged many of us for many years – and it is a sign of progress that today marks a new milestone in this regard.

As I look around this room at old friends, respected colleagues, people who have pushed the boundaries in so many ways, it seems a remarkable coming together; this is the day that Justice meets Health – and Health meets Justice.

This is indeed our own Transit of Venus – that unique celestial pattern in which the planet Venus crosses the sun.

We’ve all learnt a bit more about this phenomenon this week. One fact that intrigued me was that at the first sighting in 1639 it apparently prompted a remarkable global initiative between nine nations and 120 observers; all coming together with one goal in sight - to establish the Earth’s distance from the Sun.

So if we take a leap of faith into 8 June 2012 – the challenge for us here today, is what we will do with this moment; with our own Transit of Venus opportunity.

The purpose of this symposium is already set – to raise awareness of health issues for current and former inmates and their whānau.

But what will be our global initiative? What will be the shared goal that we commit to?

It is great to see Corrections staff; Regional Public Health staff; health promoters; justice activists; academics, analysts, advisors; social services; and groups like PILLARS; PHOs, emergency department staff coming together in one place, with one focus. To see such a range of community based prison support organisations and health providers focusing on health outcomes is in itself a very positive development.

It enables us an ideal opportunity to look at the bigger picture – about continuity of care – and how we can work closely with those in prison and those outside to enhance healthy lives.

So I come back to the question – what will be our shared goal from today?

Well, if you had to ask- I truly believe that that the single-most important thing we can do in addressing primary health care for current and former inmates, is to focus on the outcomes for their whānau.

The reason is clear – whānau is an all-embracing, all inclusive arrangement by which we can collectively mobilise our efforts for the greater good.

Let me share a simple truth - No-one is born an inmate.

But every one born has the relationship and genealogy that helps them to identify as a member of a family; a whānau member. So why wouldn’t we opt for the solutions or strategies that will have the greatest impact?

When I came here today I read the whakatauki (page 3) E kore koe e ngaro, he kākano nō Rangiātea – you shall never be lost for you are a sacred seed sown in the heavens. They are sacred seeds that are locked away for whatever reason from their families.

Of course, rigorous scrutiny must be applied to the quality of healthcare in prisons – as it should be to any healthcare provider regardless of where they are practising. We expect nothing less. At the very least we would expect the quality of care to be equivalent to the care provided in the community.

I come to this symposium today, knowing that the Ombudsman Review in 2010 found that generally prisoners have rapid access to primary health and in fact that there are relatively short waits for secondary care.

We must not ignore some of the areas of concern identified in that Review, including inadequate resources to provide effective dental services; poor management of mentally unwell prisoners or inmates being denied prescribed medication. Hardly equates to quality primary health care.

I welcome, however, the recent developments for health centres in prisons to achieve accreditation certificates.

I was of course pleased that it was Whanganui Prison in February this year, that was the first prison to meet the Cornerstone General Practice Accreditation standards.

But where we often fall down is on ensuring that there is continuity of health care on entering and leaving prison. High health needs of inmates are therefore not met – and this has flow-on effects to whānau and communities. And we all too often fail to appreciate the difficulties that whānau have, in accessing primary health care, if they have moved to be near to their prison where their family member is placed.

The National Health Committee in the Health in Justice report, brought the wellbeing of whānau into sharp focus telling us:

Imprisonment affects communities as well as families… [T]he most vulnerable communities are more susceptible to the cycle of imprisonment. High imprisonment rates can erode the stability and cohesion of the whole community.

The large proportion of Māori in New Zealand prisons means the impacts of imprisonment fall disproportionately on Māori whānau and communities, and result in many living on the verge of crisis (p. 112).

None of this is breaking news -we all know the awful statistics – too many people are in prison – and too many of these are of Māori descent.

But it is useful to remember that when we think of ‘vulnerable communities’ what we actually mean is those who are the most disadvantaged, often described as ‘hard to reach’. They are poor, dispossessed, disenfranchised, and can be said as a result of institutional racism.

Just in terms of health alone – being ‘hard to reach’ is demonstrated by the fact that a third of all people sent to prison do not have a previous relationship with a primary health care provider. In other words, for many inmates, prison might well be the first time they have received care for their health needs.

And for many of them – those needs are extreme.

• many have chronic diseases such as diabetes, untreated injuries, neglected teeth, communicable diseases, and other health risks relating to living in poverty;

• 90% will have a history of alcohol or other drug abuse;

• one third of prisoners will require full hearing loss screening;

• 64% of people entering prison, including 74% of Māori men have had at least one head injury

•

• there is a consistent history of depression, post-traumatic stress disorder, and a higher risk of suicide.

• women in particular have higher health needs than the general population and are at risk for a broad range of mental and physical health problems due to high rates of exposure to trauma and abuse.

On top of that the evidence shows that imprisonment itself contributes significantly to poor health outcomes – the more time an individual spends in prison, the greater this contribution.

As a Minister – this last statement defies belief.

How can it be that New Zealanders accommodated within an institution of the state end up leaving that institution with poorer health than when they entered?

What responsibility does Government bear towards addressing such an obvious failing of our justice system, our health system?

It is a question I hope this symposium goes some way towards answering.

We must be vigilant to ensure that the equivalence of care principle operates in all our prisons. When a person enters prison they are stripped of the right to their liberty – they should not be punished again, by being denied access to health care. As one prisoner told the Ombudsman, “I know we are in prison but we are still people”.

As I said earlier, a key driver in calling this hui is to address the continuity of care conundrum. We have to make sure that when a prisoner enters prison, their medical notes are immediately available to the health staff of the prison.

And when they leave, their medical records should be transferred to their GP – and if they aren’t enrolled anywhere, then there should be systems put in place to help that happen.

But we must do more than just caring for the inmate on release. We must ensure that we provide support to their whānau as well.

And we mustn’t forget that these families will have many of the same high health needs that their family member in prison has.

So what we need to see, is the concept of integration and healthcare continuity adopted by all the various agencies that are somehow involved with an inmate and their family.

It would seem to me a relatively simple, technical procedure for records to be transferred from the GP to prison and vice versa – and I would hope that any pre-release planning would take into account an expectation that enrolment in a healthcare practice would be part of the reintegration programme.

We have to get a lot better at improving the interface between prison and private health providers – to make the connections explicit.

And I want to say, that the recent initiative of the Director General of Health meeting with the Chief Executive of the Department of Corrections every three months is a great start.

But there is one more message I want to raise today.

And that is to remind us of another group associated with prisoners whom society remains blind to – and that is of course their tamariki.

I am pleased to see Verna McFelin will be speaking at this forum later this morning about their report, Invisible Children. Pillars has brought out the finding that Government agencies virtually never respond knowledgably or effectively to the needs of these children.

And yet it is estimated that at any one time about 20,000 New Zealand children will have at least one parent in prison; and as a result, they face increased risk of poor health. This is a tragic statistic.

The effects span across physical, emotional and behavioural health: anger, anxiety, allergies and skin problems; bedwetting; physical sickness; conduct disorder; eczema, asthma – the list goes on.

Children of imprisoned parents have an increased risk of poor long-term health and are at particular risk for mental health problems. Worse yet, a child’s health problems become progressively worse following the incarceration of a parent. I wonder if we even look at the children and see their potential, their beauty or their ability to shine. When we look at them we often see their problems rather than what is good with them.

Despite the fact that 80% of children with at least one parent in prison suffer health problems; health agencies are described as ‘surprisingly absent’. Or as one stakeholder told Te Puni Kokiri the problem is not hard to reach people, but hard to reach services.” This is another issue that demands explanation – why are these children being left behind?

Finally I return to the single focus that I have promoted in these opening remarks – and that is to place whānau on all of our agendas.

The quality and intensity of health services in prison must reflect the high health needs of imprisoned persons.

But so too, the continuity of care between prison and community health services must be our collective priority in order to improve the health and wellbeing of inmates and their whānau.

The right to the highest attainable standard of health for all obliges us to take action to improve access to high quality health care for those who are missing out.

We must never stop believing that all of our whānau deserve to be healthy or are entitled to every opportunity to be the best that they can be.

There is no more important task ahead of us than this.

ENDS

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