Health in justice or health injustice? Indigenous Māori experiences of primary care following release from New Zealand prisons: a national record study

Abstract

Background

Indigenous Māori experience mass imprisonment in New Zealand secondary to colonisation, coloniality and racism. In addition to high risks of morbidity and mortality, community re-entry from prison presents multiple challenges to accessing healthcare and other critical services. In New Zealand's publicly funded health and disability system, primary care acts as the entry point and gatekeeper to secondary services, facilitating linkages to other supports. Guided by lived experience and using deidentified linked national administrative data, we examined the primary care experiences of Māori over the 12-months post-release from prison.

Results

A total of 7398 Māori were released from prisons between June 1, 2021 and May 31, 2022. Over half experienced reimprisonment during the 12-months post-release. Only 76 % were enrolled with a primary health organisation meaning 24 % did not have access to subsidised primary care. Over 12-months, 47 % had accessed primary care consults, 63 % received medication, and 23 % had a community laboratory test. In the 12-months post-release, 26 % presented to an emergency department and 5 % were admitted for ambulatory sensitive hospitalisations.

Conclusions

Whilst our findings indicate that Māori released from prisons access primary care, there are financial barriers to access. We also found (across a range of access and quality measures) that primary care services are not meeting their high health needs, demonstrating governmental breach of Indigenous rights to health. High-quality primary care is critical to successful community re-entry and to preventing adverse outcomes. There is an urgent requirement for evidence-informed culturally safe strategies that guarantee equitable access to high-quality primary care, developed and designed in ways that privilege the views of Māori with lived experience of imprisonment, those of their families, and communities.