There is a lot of rhetoric around about the need for whole-of-government approaches to improving the population’s health. It would be interesting to know if health bureaucrats have had any input into plans by Jenny Macklin and her department to extend the reach of income management – or if they’ve had any input since the plans became public.
As previously canvassed at Croakey, many public health and health equity experts are worried about the move. Concerns have been raised about the lack of evidence for such “tough love” policies, the likely impact on people with mental health problems, and the inequity and inconsistencies of such policies.
Now the eminent public health physician Professor Ian Webster AO, who has long experience in working with the homeless and other disenfranchised people, explains why he believes the policy is taking exactly the wrong approach. He writes:
“Talk-back on ABC’s Fora, December 1st, was about a new income management scheme for the Northern Territory. The words from the listeners, Minister Macklin and the discussants, including ACOSS’s CEO Clare Martin, swirled around “alcoholism”, “substance abuse”, “passive welfare”, “humbugging”, gambling and the protection of children.
The scheme is to be implemented beyond the remote Indigenous communities so far involved to other regions and will target ‘at risk’ individuals. If it works the scheme will be applied across Australia. This approach to income management is described as a “welfare conditionality reform” and embeds the Howard Government’s mutual obligation with sanctions into the once rights-based social security system.
One thing societies can do too well is to judge strangers and those we don’t know. It is assumed that others, poor people, are incapable of making decisions in their own interests or in the interests of their children.
Any physician or social worker who has tried to understand the predicaments of marginalised people – those with mental illness, those infirm and disabled, those in pain, those who may be dependent on alcohol or drugs and those whose lives are otherwise impoverished, will know that the decisions they make – given their deprivations and powerlessness – are remarkably rational and sensible. Decisions which are more rational than the middle-class observer could make in the same circumstances.
State intrusion into individual freedom is dangerous territory. When the state takes away autonomy for serious criminal acts or under mental health or guardianship legislation, there are elaborate checks and balances to protect the rights of the individual.
But comparable remedies are not available to those on social security. These people are already humiliated by the treatment they receive from social institutions – attitudes, assumptions, speech and tone of voice – and now there is to be a further loss of control, this time over the use of their income entitlements.
The problems which the Government wishes to address by income management are more basic and demand government responses well beyond the ‘quick fix’ of garnisheed income payments.
European countries, Britain and even the US, are able to create positive incentives for income management by disadvantaged families, for example, by investment in a worker’s education and training in anticipation of frequent job changes and during periods of unemployment, the provision of more flexible income support during periods of sickness and incapacity and in some instances, in the US, additional payments and in-kind benefits for families when children attend school. Why can’t we do that?
One-time Minister for Social Security and Deputy PM, Brian Howe, has advocated in his book “Weighing up Australian Values” an anticipatory and capability approach to income maintenance.
In my experience as a physician, the categorical and punishing approach we have at present does a great deal of harm to already damaged people and should be replaced by a facilitative, responsive and supportive approach.”
• Ian Webster is Emeritus Professor of Public Health and Community Medicine of the University of NSW