1. Health as a human right: The treatment of persons in institutional care settings Presenter: Carol Berry Solicitor, Public Interest Advocacy Centre © PIAC 2007

2. What will this presentation cover? What is the right to health? The right to health in the Australian context The right to health in an institutional care settings context -Prisons -Immigration detention -Mental health facilities -Juvenile detention -Aged care facilities How can we promote the right to health, as well social, cultural and economic rights more broadly in Australia?

3. PIAC’s Health Project - some background Introductions Important: Let’s make this an interactive session! What is the Public Interest Advocacy Centre (PIAC)? PIAC’s Health Project - rights of people in institutional care settings PIAC’s dedicated Health Policy and Advocacy Solicitor position -Mental illness and the criminal justice system -Smoking regulations + influence of political donations -Medicines Working Group - US & Australia Free Trade Agreement -The Peaceful Pill Handbook -Elder law issues from a human rights perspective -The Federal Government’s proposed Access Card -National health policy ie. universal access, preventative health care

4. What is the right to health? The right to health has two basic components: 1. The right to healthy conditions; and 2. The right to access health services. ICESCR states: The State parties to the present Covenant recognise the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

5. What does the right to health include? The right to health includes the rights to: comprehensive primary health care Adequate, accessible, acceptable, affordable, appropriate and equitable health services Basic immunizations Adequate nutrition Adequate housing Freedom from violence Sexual and reproductive health information and services, including family planning Underlying preconditions to health, for example, the right to safe water and adequate sanitation, and in general the right to a clean and safe environment Information about health.

6. Consequences of a human rights approach to health Basic consequences of a human rights approach to health include: Increased accountability of governments Increased attention to the health needs of the vulnerable Participatory approaches to the provision of health services Governments must invest Governments honour minimum standards Governments must set goals

7. UN Special Rapporteur on the Right to Health UN Special Rapporteur - Professor Paul Hunt Key Issues: Alarmingly low health status of millions of people - a major obstacle to development NGOs are championing the right to health Access to quality health services, as well as underlying determinants of health Issues in developed nations Right to health has a role to play in the reduction, and elimination of poverty

8. The right to health in the Australian context Social justice - equitable access to services Health is central to quality of life - a shift toward a two-tiered system? Expand the enforceable rights we have in this country What services do our clients need to improve the quality of their lives? Can Community Legal Centres play a greater role in facilitating access to services in our communities?

9. Are we upholding the right to health in Australia? Internationally, the following groups have been recognised as having challenges accessing health care services in an equitable way: Women Children Adolescents Older persons Refugees Asylum seekers Minority groups suffering from discrimination Indigenous people People with disabilities People living in rural and remote areas People living in poverty

10. Right to health case study: Indigenous health Indigenous Australians live nearly 20 years less than other Australians (Women: 64.8, Men: 59.4) Higher rates of heart disease, cancer, kidney failure Poor housing, nutrition and education Government is clearly failing Indigenous people from a right to health perspective (right to healthy conditions, right to accessible services) Building Indigenous control and participation into the delivery of health and other services

11. The right to health in an institutional care context People within institutional care settings are some of the most vulnerable and disadvantaged within our community How can the right to health be explored in the context of the deprivation of liberty? Obligations on government - higher obligations given responsibilities of government in some contexts

12. Aged care facilities One in 8 people are aged 65 and over, by 2050, the figure will be one in 4 The ageing population - funding and quality of care issues Elderly people can be very vulnerable - reports of elder abuse Right to healthy conditions - how might we be failing in an aged care context? Are we doing enough to ensure that healthy conditions exist within aged care facilities? For those of us who have elderly clients, what are some of the issues that we are coming across?

13. Immigration detention Conditions in immigration detention facilities in Australia violate the right to health Conditions either exacerbate, or ignore the need for high quality mental health care Mental Health Council of Australia Commonwealth Ombudsman Parliamentary Human Rights Sub-Committee Visiting professionals are treated with suspicion

14. Mental health facilities Ability to access services has been a key issue in Australia in recent times Issues for our clients - ongoing problem of more vulnerable people getting the treatment they require Ongoing problem of arranging support for someone who has no insight into their condition As lawyers, how do we assist our clients when they need to access service and the appropriate service is not available (for eg. In rural and remote areas)?

15. Prisons Inmates report difficulties with accessing health services - probably some difference in terms of what institution you are in Security issues are prioritised over other issues Around 25,000 people are incarcerated in Australia National data on the health status of prisoners is unavailable Information available indicates that this substantial population group is mostly from a disadvantaged socio- economic background ‘It has been said that to understand society, one needs to look within its prisons. Within prison walls one can see up front and centre people who are afflicted by racism and poverty.’

16. Prisons In general, the prison population is characterised by poor physical and mental health status NSW Inmate Health Survey (2001): -More than half of all male and females prisoners surveyed reported a history of injecting drug use -40% males and 64% of females had Hepatitis C (+ higher rates of communicable disease (TB, HIV, Hep B) -NSW study on mental illness in prison found that 74% of males and 90% of females suffered some form of mental health disorder -Findings of the ACT Human Rights Commissioner Audit on the Operation of ACT Correctional Facilities under Corrections Legislation - supported the introduction of needle exchange programs - RACP has offered congratulations for the connection between this important human rights and health issue

17. Juvenile detention Criminalisation of vulnerability 2003 Health survey of young people in juvenile detention found that: -82% had not attended school in the six months prior to entering custody -43% had one or both parents in custody -62% had committed crime to get alcohol or drugs -Two thirds had experienced abuse or neglect in childhood -42% had experienced some form of physical abuse -22% of girls had experienced sexual abuse -Prevalence of bloode-borne and sexually transmissible infections was high, particularly for Hep B and Hep C How can we better tailor support services to young people at risk of committing offences? Are young offenders falling through the cracks in terms of accessing health services?

18. Monitoring and promoting the right to health Review the health information and services that are available Identify unmet health needs Relevance of public health messages

19. How can we promote the right to health in Australia? Indigenous health campaign is a good example of how a right to health framework can assist in achieving campaign objectives Facilitating a rights dialogue - placing a greater onus on Government Highlighting where we are falling down in terms of health provision to key vulnerable communities - placing their needs at the centre of the debate

20. Social, cultural and economic rights in Australia How can we best promote social, cultural and economic rights in Australia? Is this something we should be striving for? If so, what kinds of strategies should we be employing?

21. Conclusions and contacts Can we make the right to health a more applicable within the Australian context? Can place more pressure on Government in regard to social, cultural and economic rights? Can we facilitate a more effective dialogue around who is falling through the cracks? Carol Berry Solicitor Public Interest Advocacy Centre (02) 8898 6523 0418 968 810 carol@piac.asn.au