Introduction by Croakey: The Australian Medical Association has called on the NSW Government to implement a lockdown that it is “more Victorian style”, saying it is “absolutely ridiculous” that upmarket stores remain open.
With NSW recording 97 new locally acquired COVID cases in the 24 hours to 8pm last night, AMA president Dr Omar Khorshid said the current lockdown was not working, and so something needs to be done differently. “We can’t just keep doing the same thing and expect a different outcome,” he told journalists.
As international media have reported, the NSW Premier Gladys Berejiklian’s Government has repeatedly declined to specify what businesses and personal movements count as essential when asking the community to stay at home, saying people should use “common sense”.
Professor Brendan Crabbe, CEO of the Burnett Institute, today issued a long Twitter thread citing modelling by the Institute and arguing for NSW “going to Stage 4-like restrictions immediately”. He tweeted: “As painful as it is, there is greater certainty of returning to an open society soon if this is done.”
Victoria, meanwhile, may not be able to emerge safely from its snap lockdown after five days, according to modelling cited by researchers from Melbourne and China at The Conversation. They stress the importance of increasing vaccination rates as quickly as possible.
Political and policy leaders have also been urged to do much more to integrate action on the social determinants of health into the pandemic response.
In the article below, Professor Rebecca Ivers, Head of the School of Population Health at UNSW, suggests that governments have much to learn from the pandemic response of Aboriginal and Torres Strait Islander community controlled health services.
Rebecca Ivers writes:
Living in inner city Sydney, watching COVID cases and exposure sites rapidly spreading around me, I feel increasingly agitated about the lack of coordination in our state and indeed national responses.
There is no doubt that NSW Health has incredible leadership and has appropriately and rapidly tailored the state response to the virus as new data and research emerge. It is evident that the approach taken by our health agencies here in NSW, including our local health districts, is multifaceted and flexible.
However, the strong public health response our agencies would like to deliver is being increasingly challenged through politicisation by politicians and the media, including increasingly parochial state-based commentary and public criticism by thousands of armchair epidemiologists and commentators, in addition to increasingly nasty and unpleasant commentary.
Of course a public health response must take into account the epidemiology, the science of vaccination, the science behind mask wearing and aerosol transmission. It is about effective communication and social marketing, and how you mobilise change at a population level.
But public health is also about addressing the social determinants of health: the socioeconomic factors that drive people’s behaviour, the consideration of income, including casual employment without sick leave. It’s about active consideration of culture and behaviour, and understanding the diversity of people’s lives, and tailoring the responses appropriately.
A systems approach is needed
Public health takes a systems approach – whereby we create a system that does not put the primary focus on individual behaviour change but creates a system that enables healthy decisions.
We know from decades of public health and communications research that people do not change their behaviour and make healthy decisions on the basis of information only. We know very well that creating and enforcing sensible policy works very well to change behaviour – think of the incredible gains in road safety, in tobacco control.
But we also know for this approach to be effective, we must create an environment where people can readily make healthy decisions, and we must support change with targeted education that speaks to the diversity of the population.
So what does this mean for our public health response here in NSW now?
There is no doubt that in order to halt the rapid spread of COVID we need lockdown with public health orders that restrict our movement, and clear and equitably applied penalties for breaching these.
But it also means that we must work with community leaders to co-design visible and clear communication campaigns and outreach that supports these orders.
This means working with agencies on the ground in communities, it means designing and distributing information that is tailored to the many diverse communities we have. It means tackling vaccine hesitancy with clear and consistent communication.
It means we make it easy for people to be locked down. That means we provide timely and flexible income support to those who need it, we provide judgement free support and outreach services to vulnerable members of the community, including those experiencing family and domestic violence, those with insecure accommodation, those without access to Medicare and work visas. It means giving sick leave to casual workers, income support to those whose businesses are failing.
It also means we make it easy for people to get vaccinated, particularly those in most need. That means opening up vaccination centres in every community, and making it easy for people to book in for appointments.
We have an incredible network of community pharmacists and nurses who could be used to staff vaccination centres around the state. Centres need to be accessible and supportive environments for everyone, particularly the vulnerable and marginalised who may not be comfortable attending general practice.
It means understanding that our health system is more than just doctors and hospitals, and demedicalising our response by ensuring the full gamut of available and appropriately trained health professionals are involved in the roll out of vaccination campaigns.
It means ensuring that people who are most vulnerable to COVID – the health workers, those working in quarantine, in aged care, people in prisons, asylum seekers, and people with chronic conditions and disabilities – are actively targeted for vaccination first.
All of these are happening to some degree, but it is hard to see the plan behind this. There is a lot of demonising of individuals and focus on people doing the wrong thing.
Ignoring lessons
NSW also appears to have ignored lessons from Victoria in terms of the need to provide appropriate targeted support and communication for essential and casual workers, instead taking an unfairly punitive geographically and racially targeted approach to enforcement of lockdown laws.
This is not in line with an equitable and well thought out coordinated approach – the one we deserve. We do have a great example of how to do it.
A timely and effective public health response to COVID has already been delivered in Australia – not by the mainstream, but by Aboriginal and Torres Strait Islander community-controlled health services, who have led COVID efforts nationwide for their communities with timely, targeted, communication in addition to delivery of accessible, culturally safe, services (as reported recently by Croakey).
This response has eclipsed any State or Australian government response and has meant there has been very limited impact by COVID for Aboriginal and Torres Strait Islander people. We need to learn from this.
When we train people in public health we teach them about all of this. In addition to learning about epidemiology and biostatistics, our students learn about the intersection of health and politics, about health economics, about value based care. They learn about health equity and the social and commercial determinants of health, and how public health responses address these. They learn about the importance of a multisectoral, coordinated decolonised public health approach.
It feels like our leaders might need a lesson. We’ve made a start, but it’s time to stop the state-based snarkiness and work on together on a national coordinated plan that will get us through this together.
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