Gaps in monitoring global progress toward universal health coverage among disadvantaged populations: the case of people living in prison

The United Nations’ Sustainable Development Goals (SDGs) represent a sweeping initiative to create a sustainable and equitable global future. SDG 3 focuses on the health and wellbeing of the world. Expanding universal health coverage is a central component of SDG 3 and has been a focus area of the World Health Organization (WHO), which aims to expand universal health coverage to an additional 1 billion people by this year (2023). The WHO developed an index (indicator 3.8.1) intended to monitor coverage of essential health services across the globe. However, this indicator fails to incorporate health coverage for people in prisons. People incarcerated in prisons across the globe have high rates of physical health, mental health, and substance use conditions compared with the general population, and they are frequently excluded from policies and services available in the general population. For example, in some countries, like Australia and the United States, people in prison are legislatively excluded from the public health insurance programs available to the general population. Exclusion of prison health coverage from the WHO's universal health coverage indicator likely results in overestimation of health coverage in most countries and fails to identify gaps in care during and after periods of incarceration. We believe prison health coverage should be incorporated into the WHO's 3.8.1 indicator, which would more accurately capture a country's health coverage among its most disadvantaged populations. Monitoring of prison health coverage will require improved measurement of quality and service availability in prisons, which is sorely lacking in most countries.