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Learn from the experience of disadvantaged people to build back better

Introduction by Croakey: The COVID-19 pandemic has affected virtually every Australian but for many vulnerable and disadvantaged people its health, social and economic impacts – and other crises like bushfires – have exacerbated existing, underlying need.

For people who are unemployed or in insecure employment, homeless or in overcrowded housing, or unsafe in their own homes, life could get even tougher in the next few months.

Federal Treasurer Josh Frydenberg this week ruled out extending the JobKeeper payment past 28 March as the number of unemployed continues to rise to more than 900,000 people.

In the middle of Western Australia’s five-day COVID-19 lockdown, Shelter WA, the peak organisation for homeless people, has called for urgent assistance for the estimated 9,000 people who are homeless each day in that state and have no home to go to during mandatory lockdowns.

And the bushfires now raging east of Perth add to these concerns, with homeless people known to be at increased risk from bushfire smoke.

In this Longread below, Tessa Boyd-Caine, CEO of Health Justice Australia, calls for greater collaboration between health and legal services to respond to the new problems that have arisen for disadvantaged people from recent crises.


Tessa Boyd-Caine writes:

Following hot on the heels of the horrendous bushfires of 2019-2020, the COVID-19 pandemic disrupted everything we took for granted in our work and lives.

But for some people, the health, social and economic impacts of each crisis were exacerbated by existing, underlying need.

For people who were disadvantaged by insecure or overcrowded housing, by precarious employment, by exposure to stigma and discrimination, or who were unsafe in their own homes, these successive crises demonstrated acutely how existing health, legal and social problems in people’s lives are exacerbated and new problems emerge in times of crisis and its aftermath.

That experience comes through loud and clear in Collaboration through the Covid19 crisis. This new Health Justice Australia report examines the multiple, intersecting health and legal needs that emerged during the successive crises of bushfires and pandemic in 2020; and the role played by health and legal assistance services responding to those needs. In particular, it points to the value of collaborative relationships across otherwise siloed service settings to support people who were most vulnerable to indirect but serious health and social impacts.

Collaborative service model

The report shares stories from health and legal assistance practitioners involved in health justice partnership, a collaborative service model that embeds legal help into healthcare teams and settings, providing examples of how health and legal assistance services were able to work differently around some of their most vulnerable patients and clients throughout 2020.

In areas like family violence, this role was vital. As family violence services saw a drop in the number of women seeking help during COVID-19 shutdowns, services created important pathways for women to seek help, even when they were locked down with their perpetrators at home. When one service converted its contact number from a landline to a mobile, it saw an immediate increase in women seeking help. When another service brought forward its planned technology upgrade, it started receiving requests for help and information via its webchat function late into the night, giving women a much-needed avenue to seek help outside of standard office hours when their perpetrators were not around.

Enabling ways for women to seek help in relation to family violence during the pandemic has been particularly important for health settings, which are often people’s first port of call for help. Even low-tech solutions came into their own. When COVID-19 shutdowns meant that legal partners in a health justice partnership could no longer attend the health service in-person, one practitioner reported: “We are ringing the hospital every day and if a woman is needing assistance [she] will be put on the phone by the social worker.”

Struggling to keep pace

While Collaboration through the Covid19 crisis explores how services were able to respond to rapidly changing need among the communities they support, it also shows where this capability lagged in government. Even when governments’ ability to work at scale was critical to sharing the lessons of what was working on the ground, service responses were undermined by a lack of capacity within government to keep pace with the rapidly changing context.

One service supporting mental health and addiction faced an immediate challenge when the COVID-19 lockdown meant that clients could not safely access their methadone treatment within the existing policy framework. The service identified options to address this but could not get a response from government, despite repeated efforts. A senior executive of the service said the problem was the inability of the government to respond in policy terms in real time. “There was no notification that they were working on this; nor any indication of a timeframe within which we could anticipate a decision.”

There was also a lack of capability within government to implement public health-led decisions to support health and wellbeing alongside security and compliance. Another healthcare service encountered great difficulty following up COVID-19 positive tests within the community they served. Normally, a healthcare provider would ask for a test and get the results back directly. But in the rush to set up COVID-19 testing, there was no ‘clinical commissioner’ authorised to receive the test results. Against a backdrop of privacy provisions, this meant that healthcare professionals could not access the information they needed to identify and provide care to patients who were COVID-positive in the community.

Lessons for the future

Individual examples of policy lag and inconsistent decision-making are understandable in the chaos of crisis and rapid response, but we need to learn from them to inform better ways to operate in future.

One of the clearest lessons here is the importance of community infrastructure for crisis response and its aftermath.

Responding to crisis and recovering from it relies heavily on trusted relationships between communities, the services that support them and the authorising (including policy and funding) environment in which those services operate. Rather than struggling for sanction of new responses to rapidly changing need, services need to be able to access effective mechanisms to communicate to their policy, regulatory and funding decision-makers about problems as they emerge and solutions as they are found.

Effective mechanisms that enable advice and decision-making will support health, legal assistance and social services to meet the needs of the communities they serve. The absence of such mechanisms can undermine those same services and community outcomes.

Some of the medical infrastructure that Australia has relied upon in our response to COVID-19 has been built up over decades. So too, we need to build and maintain the community infrastructure that enables rapid response to the health, social and economic impacts of crises, whether pandemic, environmental, or otherwise. While these impacts might be secondary or indirect consequences of a crisis, their effect in people’s lives and communities can be as dire as the crisis itself.

Through the shock and chaos of 2020, one of the most promising ideas to emerge was the call to build back better. To do that, we need to learn the lessons of what worked, what didn’t and what needs to change among communities, the services they rely on and the government and other funders that enable them.

Dr Tessa Boyd-Caine is the CEO of Health Justice Australia, the national centre of excellence for health justice partnership. A discussion of some of these ideas can be heard in this webinar recently published by the Menzies Centre for Health Governance.


Further reading

The BMJ has published a collection of articles on the pandemic, global health and equity, with a focus on the political economy of the response, the role of international institutions, overwhelmed health systems, the role of social determinants, the value of indices of preparedness, and the need for all countries to act together to reduce inequality, protect health, and organise a more effective response to climate change.

See this Twitter thread by Croakey’s Melissa Sweet giving an overview of the articles, and a related post.

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Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
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
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017