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Income management will punish rather than help: senior public health physician

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

Comments 3

  1. Trevor Kerr says:

    croakeyblog tweeted “Which begs the question – where is fed health on income mgt, and what about whole-of-govt approaches to health?”

    Wasn’t there some talk about “one-stop-shops” for centralising all aspects of children’s health care? Maybe I’m fantasising, but you’d think a WoG approach would have Income Management and Superclinics on the same page of policy, in relation to seeking the best outcomes for our children.

    There was a newspaper article this week about an infant who died while in a vehicle being driven by its parents over a long distance. There’s the usual hue and cry, but the fact is that once a child-at-risk is in a moving vehicle, that’s it. No chance of intervention to protect. And the reason for the journey? Maybe to run away from something?

    I’d like an authority on child protection, like Chris Goddard, and experts on behaviour and the psychology of crisis, to discuss the likelihood that marginalised parents will present their urgent problems to any service centre built by the WoG initiative.

  2. Jon Hunt says:

    Well, goodness me. You don’t have to be a professor or an AO to know that there is no aspect of the intervention which is going to improve the situation. This has been the problem with government policy all along; the indigenous doctor’s association has stated that you can’t cure disposession, disempowerment, marginalisation and so on with the same (funnily enough). This is quite a simple concept yet for reasons one would need to surmise no-one seems to realise that the only solution to these problems is to address these. It is actually quite simple. Frustrating.

  3. sixonesixfour says:

    I’m a middle class. middle aged woman, born in the UK. My family emigrated when I was 12 and since then I have had little to do with any Aboriginal people. Mostly I’ve lived in affluent areas with a similar, English speaking population. My family’s moderate affluence and my own lack of education about Australian history and the challenge that history imposed upon the existing Indigenius population led me to be unaware and unaffected by the challenges they face.

    But no longer!

    A friend forwarded a link to an article about the intervention, she said to me “Do you realise what our government has been doing since it said “sorry?”. I started reading and as the articles unfolded so too did my anger. Like many Australians I applauded the Rudd Government apology and thought it meant a new period of justice for the Aboriginal people of this country. Like many Australians I was shocked by the report of widespread child abuse in the Northern Territory and trusted our governemnt to take what it described as essential measures such as health checks for every child and education programs. I even agreed with news reports that said income quarantining would help solve the problems because it would mean money was spent on food and education rather than alcohol.

    After only 1 day of reading article after article exposing the reverse side of the coin I am disgusted with our government and ashamed of myself for placidly accepting the lies that allowed this action of intervention to take place.

    I ask myself: How would I feel if I had to pass a “prescribed area” sign each time I entered my suburb? A sign that branded myself and my community as alcoholic porn addicts? How would I feel if the person or authority that controlled my source of income took most of it and decided what was best for me, without consultation? What would I do if that system failed and I and my children went hungry until it was fixed? I think I would feel insulted, completely disempowered and extremely vulnerable.

    I think If I already felt disempowered and vulnerable surely these actions made by those with power over me would only increase these feelings. Surely the effect of this would be anger, despair or apathy leading to an exacerbation of the manifestation of all these problems. If I drink to forget then maybe I would just drink more. If I suffer depression and lack of motivation caused by that depression then removal of any hope must lead to deeper feelings of worthlessness. So, I ask myself, how is reducing self-determination and making a group of people MORE reliant of government handouts (and goodwill) going to improve their situation? Nowhere in the literature I read today do I see positive stories about increased services, increased quality of life and increased self esteem.

    I have battled my own demons of alcoholism and depression but I was fortunate not to have to suffer the stigma that some Aboriginal people do. I and many of my friends can cover our addictions because we have resources to draw upon and so we often go unnoticed. If we did not have such material resources I can not confidently say we would not be treated in the same way except somehow the colour of our skin would probably make us less likely to suffer discrimination and judgmentalism from our suburban neighbours and those in power.

    I am ashamed of our government but even more so ashamed of myself for being so ignorant. I have now resolved to be more aware and do what I can to fight this injustice.

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Pregnancy and childbirth
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Acknowledgement
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PIJ Commissions 2021
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Health in All Policies
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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
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Population Health Congress 2015
2016 conferences
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#cphce2016
#CPHCEforum16
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