Stronger links must be developed between the public health and social services sectors in order to advocate for fair, health-promoting welfare reforms, according to Gemma Carey, Research Officer with the St Vincent de Paul Society, National Council of Australia and Research Associate, Centre of Excellence in Intervention & Prevention Science.
Gemma Carey writes:
Under the new Coalition Government, Tony Abbott has signalled the return of ‘Work for the Dole’ and the expansion of controversial ‘welfare quarantining’ policies to all people on welfare payments across the nation.
The re-introduction of so-called ‘active employment policies’ presents a significant threat to public health, and a major challenge to the public health community to stop their reintroduction. ‘Work for the dole’ was a key pillar in the Howard Government’s approach to social support.
However, the OECD found that such schemes do not improve economic participation and are expensive for governments, particularly in a slowing economy such as the one faced by the new Coalition Government. Work for the dole schemes were widely condemned as short-term, with no focus on skilling people or preparing them for sustainable employment. Even Howard’s own commission – the McClure Report – recommended a major overhaul.
Welfare quarantining (or ‘Compulsory Income Management’) was first introduced by the Howard Government as Part of the Northern Territory Intervention. Under Labor, it was expanded to postcodes of concentrated disadvantage across the country.
So far, welfare quarantining trials have shown little evidence of being effective. While this has been the subject of much debate, a comprehensive review by the Federal Parliamentary Library described positive outcomes of the trials as “uneven and fragile”.
Research on the social determinants of health indicates that these policies will have a detrimental effect on the health of individuals and health inequalities. Work by Michael Marmot has demonstrated that health is intrinsically linked to individual control. The more control we have over our lives, the more likely we are to have better health.
Existing active employment policies are fundamentally disempowering – they remove people’s control over their own lives. Under income management, a percentage of welfare payments are ‘quarantined’ for spending on certain items, such as food and clothing. Other items, such as alcohol and tobacco, are outright banned. Work for the dole schemes stigmatise participants, making the transition off welfare and into employment even harder.
By further entrenching disadvantage, both of these policies will widen social and health inequalities.
Active welfare policies are also extremely expensive, requiring considerable administrative resources to implement. Over ten years, income quarantining has been projected to cost the government $1 billion in trial sites alone. If expanded to everyone on government welfare, these costs will skyrocket.
The opportunity costs are also high. These funds could instead be directly invested in the health, training and education of disadvantaged and unemployment people.
Proponents argue that the effectiveness of income quarantining can only be measured over the long term. But there is simply not enough evidence to justify their expansion. The precautionary principle (that if a action has a risk of harm, it should not be take) coupled with everything we know about the social determinants of health, demands that these policies should be dropped.
In a recent Croakey article, Associate Professor Marilyn Wise from the Centre of Primary Care and Equity highlighted the need to change social institutions that do not reduce people’s exposure to unhealthy stressful living and working conditions.
Yet, our largest social institution – government – is set to pursue policies that increase stress, decrease control and prohibit the transition into work.
What can we do?
The public health community needs to engage with debates about welfare reform. There is now an expansive body of evidence on the social determinants of health that can provide direction in this area.
At the 2013 Public Health Association Conference, Professor Mike Daube, Director of the Public Health Advocacy Unit at Curtin University, revealed his top tips for public health advocacy, including a call for public health to work in coalitions.
When it comes to advocating for welfare reform, these coalitions need to be across sectors. Stronger links must to be built between the social services sector and public health. Working together, they can achieve far more than either can on their own.
The new Social Determinants of Health Alliance, established by Catholic Social Health, provides the ideal platform to begin engaging across sectors over social determinants of health issues.
As the new government prepares to sit in Canberra, the first order of business for both sectors must be to challenge Prime Minister Abbott on his welfare reform policies.
• Gemma Carey Research Officer, St Vincent de Paul Society, National Council of Australia & Research Associate, Centre of Excellence in Intervention & Prevention Science
• In Anti-Poverty Week (13-19 Oct), The St Vincent de Paul Society will release its ‘Two Australias Report’. The report provides a plan for addressing disadvantage and unemployment that will not widen social and health inequalities and is more cost-effective