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This article was first published on Wednesday, September 7, 2022
Introduction by Croakey: The Federal Government’s failure to lift the JobSeeker payment to a livable income at a time of increasing cost-of-living pressures is condemning many people to poor health, suggests an investigation for Croakey.
Touted as a “much-needed boost” by the Minister for Social Services, Amanda Rishworth, the JobSeeker payment is set to rise $1.80 per day on 20 September due to indexation. The daily rate will go from $46 to $47.80 – $17,378 per year – still well below the Melbourne Institute’s poverty line of approximately $28,600 per year.
“It does not deliver a real increase – an increase above inflation – and that is what people on JobSeeker and other payments need to keep a roof over their head and put food on the table,” Australian Council of Social Service CEO Edwina MacDonald said in a statement.
Amid ongoing cost pressures, the Reserve Bank has again lifted interest rates, setting the cash rate at 2.35 percent – a move that will spark more price rises across the economy.
With the Labor Government’s plan to continue with the legislated Stage 3 tax cuts – commencing in mid-2024 – and reluctance to increase the JobSeeker rate in October’s Federal Budget, there’s concern about the Government’s commitment to address the structural drivers of inequality, which impact health, healthcare costs and community wellbeing.
For the report below, freelance health and science journalist Felicity Nelson spoke to health professionals across Australia about how poverty caused by the low JobSeeker rate is impacting people’s health in diverse and adverse ways.
Healthcare often comes last when people cannot afford to eat – the JobSeeker rate almost guarantees that Australia’s priority populations will suffer poverty-related health problems, according to Nelson.
Felicity Nelson writes:
When general practitioner Dr Nada Andric gets to work, a waiting room full of patients is the last thing she sees.
At the front gates of the Exodus Foundation in Ashfield, Sydney, there is usually a crowd of clients with a rough look, wearing slightly worn-out clothing, using walking aids, or clutching shopping trolleys full of bags. As you walk into the church hall, there’s a flurry of activity in the dining room area.
Sometimes entire families are perched at the tables, enjoying a warm, free meal they otherwise probably wouldn’t be able to afford.
The demographic largely reflects that of Ashfield, with many people of a Chinese and Asian background accessing the soup kitchen for lunch and breakfast each day.
As you walk on, there’s a large room with couches where AA meetings are run. There, clients can relax and watch TV out of the rain. Under the awning outside, a few clients might be playing cards or having a chat.
Only then do you reach the medical clinic at the back, where the GPs, dentist, nurse, and social workers operate.
When people don’t know where their next meal is coming from or are worried about having nowhere to sleep for the night, their medical care is usually the last thing on their mind.
“People have very different priorities when it’s almost a full-time job to find somewhere safe to sleep,” Andric said.
So, at the Exodus Foundation, before patients even reach the GP clinic, they are offered food and somewhere safe to rest.
A friendly nurse is often seen chatting to potential patients in the food hall, spotting wounds that need dressing, listening to people’s health concerns and encouraging them to consider dealing with health issues they may have been putting off.
Patients living in poverty are dealing with a lot. They often present with complex trauma, chronic illness, mental health issues and drug or alcohol issues.
The stress of being unable to pay for essentials like food and housing can contribute to respiratory infections and skin infections. Many homeless people develop nasty foot disease due to the damp, cold and exposure.
In response to these substantial hardships, JobSeeker provides just $46 per day which will increase to $47.80 with an indexation increase on 20 September.
“You can’t really pay for rent, let alone paying for food, and medications. And then, actually getting yourself together and getting ready to find work,” Andric said.
“I find the expectations that our society has of people who are marginalised really unrealistic when it comes to knowing how expensive things are. I think any increase in any payments for JobSeeker would be really welcome.”
Diseases of poverty
In 2008, a landmark World Health Organization report on the ‘social determinants of health’ popularised a concept that has long been recognised by doctors. They refer to this as ‘diseases of poverty’.
Shelter, food, employment, education, healthcare, and transport are all essential for a long, happy, and healthy life. Poverty, on the other hand, causes health problems.
When these basics are absent, the effects on human health are devastating. The rate of infectious disease, chronic illness, disability, mental health issues, and drug and alcohol use disorders are all higher among populations living in poverty.
“A girl born today can expect to live for more than 80 years if she is born in some countries – but less than 45 years if she is born in others,” the WHO report states.
The average age of death in Australia’s homeless population is 48.
Around 4.5 million Australians currently live in poverty, including 1.2 million children.
Despite this, the current JobSeeker payment available to unemployed Australians is substantially below the poverty line, and around 41 percent of the minimum wage.
Australia’s JobSeeker rates are the second lowest among 37 member countries of the OECD.
“JobSeeker does not fulfill its core function of providing a minimum, adequate income for those suffering unemployment,” said Joey Moloney, a senior associate of economic policy at the Grattan Institute.
“It’s woefully inadequate. The Government needs to increase the rate of JobSeeker by at least $100 a week for singles.”
The Australian Council of Social Service (ACOSS), which represents around 4,000 community sector groups across the country, is calling for JobSeeker to be lifted to at least $70 a day.
“That has to be a bare minimum to ensure that everyone receiving that payment can cover basic costs,” Charmaine Crowe, the program director for social security at ACOSS, said.
“JobSeeker and other payments were totally inadequate before we saw these huge increases in the cost of living. People are in an even more desperate situation now.”
The low JobSeeker rate has a direct effect on your health because you can’t afford basic healthcare or medicines or fresh fruit and vegetables, according to Crowe.
“And, of course, just the sheer stress of not having enough money day-to-day really grinds people down and their mental health suffers as a result,” she said.
A study by The University of Melbourne published in June found that the temporary Coronavirus Supplement payment, which bumped Australians on welfare above the poverty line, protected mental health by lowering financial stress.
A review of 21 studies of wealthy countries, published last year, found that policies that improved social security benefits were associated with improvements in mental health, while policies that were less generous harmed mental health.
Diseases of poor nutrition
Karl Briscoe, the CEO of the National Association for Aboriginal and Torres Strait Islander Health Workers and Health Practitioners (NAATSIHWP), said the low JobSeeker rates affect food security and housing among Indigenous communities.
“Access to adequate nutrition, fresh fruit and veg, is probably one of the biggest issues that people are faced with,” he said. This particularly affects people living in remote areas where the price of food is higher.
Briscoe is a Kuku Yalanji man from Mossman (the Daintree area of Far North Queensland). Before becoming the Canberra-based CEO of NAATSIHWP, he was an Aboriginal health worker in Queensland.
When people cannot access vitamins and minerals due to poverty, they can be more susceptible to a range of diseases, including skin infections and diabetes, according to Briscoe.
Overcrowding is another major issue, he said. In Aboriginal communities, it can contribute to the spread of scabies, a skin infection caused by mites that burrow into the skin, which is linked to chronic kidney disease.
Too many people living in the same house can also increase the spread of Strep A infections, which can cause rheumatic fever and rheumatic heart disease, an autoimmune condition where the heart valve tissue becomes swollen and scarred, disrupting blood flow.
While increasing the JobSeeker rate is a clear necessity, what is really needed to improve conditions in Aboriginal and Torres Strait Islander communities is capital investment, such as infrastructure projects that bring jobs, according to Briscoe.
Poverty is an outcome of colonisation for many Aboriginal and Torres Strait Islander people.
“We don’t have a long line of inheritance that’s been passed down generation to generation,” Briscoe said.
Choosing between food and medication
Dr Liz Sturgiss, a GP based in Canberra, and primary care researcher at Monash University, explained that people living in extreme poverty have health conditions you just don’t see in the general population.
“The number of clients I have who are severely and chronically constipated or have really severe vitamin mineral deficiencies because they can’t afford food, it’s really quite sad,” she said.
“Working with this community, it’s the first time I’ve ever seen folate deficiency,” Sturgiss said. This condition is non-existent in the general population because of the widespread access to fortified cereals and breads.
Sturgiss’ works for a clinic that provides holistic care to people with substance dependency or enduring, severe mental illnesses, such as bipolar disorder or schizophrenia. Many of her patients are on JobSeeker or disability entitlements.
People living in extreme poverty often cannot climb out of it, according to Sturgiss.
“I see some of my long-term patient’s going for a job interview, but they haven’t got money to get clothes for the interview to make a good impression. They don’t have the money to get a proper haircut,” she said.
“It’s even hard to get transport to get to the interview, and to start the job,” Sturgiss said.
“Before you get your first pay packet, trying to make it all work, not having any financial means to kind of take those steps forward. It just keeps you down in the hole of poverty.
“When you don’t have money, and you’re stressed about money, there’s no part of your life that doesn’t touch. It’s a constant weight on your mind.
“If you think about it, if you don’t have any money, then you don’t have any options.”
People living off JobSeeker often have to choose between food and medications, according to Sturgiss.
“I’ve seen my patients having to choose between things that are very essential to their everyday wellbeing,” she said.
“If you have a healthcare card, medications are still $6 a go,” she said. “So, if you’re on four or five different medications that can really add up.”
Methadone isn’t covered by the PBS so it’s very expensive for patients to use it to treat drug addiction (Note from Croakey on 13 Sept: see a correction and clarification to this statement in the comments section and here).
“And now, even petrol prices are really high in Canberra,” Sturgiss said. “I’ve seen more people asking for a telehealth appointment because they can’t afford petrol.”
Public transport is non-existent in some parts of Canberra, particularly the newer suburbs where a lot of community housing has recently been relocated, according to Sturgiss.
The price of electricity is another big issue. “In Canberra this morning, the ground was thick with frost, it was absolutely freezing,” Sturgiss said. “A lot of my patients can’t afford to heat their homes properly, so they end up jumping into bed early and putting on heaps of blankets, but that’s not good for staying social with people or staying physically active.”
Sturgiss’ clinic has access to taxi vouchers, and funding for medications and women’s dignity packs with sanitary products, which can help overcome some of the basic barriers to care.
During the early stage of the pandemic, the Coronavirus Supplement payment helped her patients afford better food but it “feels like so long ago now”, she said. “I think people have forgotten what it was like with that bit of extra money coming in.”
Sturgiss said that one of the biggest impacts to her patient’s overall wellbeing happens when they finally qualify for a disability pension after wading through all the checks and balances, paperwork, and interviews.
“For people who have chronic and severe illness, just getting through those hoops and processes is incredibly challenging,” she said. “But when they then qualify and their rate of payment goes up to disability amount, they can afford better food. They’re not really stressed about how they’re going to pay for their medications. It makes a huge difference.”
Poverty is expensive
Dr Andrew Davies, a GP and the medical director and founder of Homeless Healthcare in Mt Lawley, Perth, said there’s a ‘chicken and the egg’ problem with trying to separate the healthcare from social work.
Davies first got interested in homeless healthcare when he worked as a ‘street doctor’ in Perth. He found the complexity of the underlying social problems fascinating but quickly became frustrated by the inability of the system to address the root causes of healthcare issues.
He decided to start his own organisation, Homeless Healthcare, and work three days a week trying to make a real difference.
Of course, within three months, he was working full-time. And now the organisation has around 65 staff working across 16 sites in nursing, general practice, mobile clinics and services related to securing community housing.
The organisation has 12 doctors working shifts, which is around 3.5 full-time equivalent doctors. Davies does clinical work three days a week.
They also run a respite centre for people who are too sick to stay on the streets but aren’t sick enough to go to hospital.
“There’s nothing like this service anywhere else in Australia,” Davies said.
“GPs can’t bulk bill Medicare for consults in the street so we have nurses…We are trying to stop the cycle of people who are homeless going in and out of hospital.”
“They don’t come separately. The fact that they are homeless is what makes them sick,” he said.
“On the streets, they get beaten up all the time. Poor health stops them being able to maintain housing. It’s not easy to organise yourself to get into a rental and maintain it if you have serious mental health issues.”
People living on the streets usually have a poor diet with high carbohydrates and low protein. “People who are homeless might be overweight, but they don’t have much muscle mass,” Davies said.
Smoking rates are very high. Alcohol and drugs use disorders are common.
People who are homeless put off healthcare because it isn’t a priority.
“If you’ve got no food and you are worried about where you are going to sleep, you can’t look after your health,” Davies said. “Your priorities are different. Health is often ignored until you collapse in the street. Something catastrophic happens and you end up in hospital.”
People who are homeless and have depression often lack the motivation to see a doctor.
If they have anxiety, that can be a barrier too.
In Perth, the areas with GP clinics don’t tend to overlap with the areas where people who are homeless are living.
On the streets, personal possessions get stolen. “Antibiotics get stolen, and they can’t get new antibiotics and deteriorate,” Davies said.
People who are homeless often go in and out of hospital, costing up to $70,000 per year for those admitted most frequently, according to research conducted by Homeless Healthcare in 2017.
A more recent case study by the organisation revealed one homeless man cost the public health system $185,000.
When Davies showed his patient this tally, his reaction was “Why the f**k didn’t they just get me a house?!”
A recent study showed that 234 patients collectively cost the public health system $4 million over three years before they became patients at Homeless Healthcare. “They cost half that now,” Davies said.
The Coronavirus Supplement that provided a basic living wage for just a few months was transformational for Davies’ patients. “It was fantastic,” he said.
One patient used this extra funding to get himself into transitional housing, which is the first step towards permanent public housing.
The patient wouldn’t apply for this service before he got the Coronavirus Supplement because this kind of housing swallowed 80 percent of his income and he was a smoker who couldn’t give up cigarettes at that point, explained Davies.
This patient has now secured a full-time job as a truck driver and managed to maintain his housing even after the Coronavirus Supplement was scrapped.
This patient had a history of untreatable depression and anxiety, but this small influx of cash gave him a precious opportunity to establish some stability and his mental health is now “miles ahead”, Davies said.
“He has self-esteem. His physical health issues aren’t going away but they aren’t progressing as fast. We’ve treated Hepatitis C. There’s a huge difference to his health. He’s quit smoking in the last month. It’s amazing what stability can do.”
Unfortunately, that success story isn’t common. For most people living rough on the streets, the sudden bump in income followed by a complete withdrawal of that support was a gut punch.
“People who had been in housing were back on the street, getting beaten up and not know where they can go to the toilet,” Davies said.
The average life expectancy in Australia is 81.2 years for men and 85.3 years for women. Among Davies’ patients, the average age of death is 48.
Raising the rate of JobKeeper to above the poverty line is “a bit of a no brainer”, Davies said.
Prison cycle
Associate Professor Penny Abbott, a GP who works with people in prison in Western Sydney, said “almost everyone” she sees in her practice is unable to prioritise their health because of their difficult financial situation.
One patient came to mind when discussing the health impacts of the low JobSeeker rate: A young woman in her 30s who was leaving prison and was determined to ‘stay straight’, see a psychologist and not relapse into drug use again.
“She had actually done some pre-release work and had accommodation planned,” Abbott said. “But, when she got out, she found that she really couldn’t afford the cost of the transport from her accommodation to the methadone unit. She was required to travel there daily to pick up a methadone dose. She was sometimes jumping onto the train, and then she got caught.
“Her parole was revoked, and she was back in contact with the legal system. It just seemed to me such a tragic outcome that a woman who was actually trying to do the right thing, just simply didn’t have enough money to get to her medical appointments.”
Abbott works inside prisons, but her patients often cycle between prison and the community. While people are in prison, they might gain access to health services, but then they struggle to pay for specialist appointments and medications when they leave.
“While you’ve been in prison, the unit that you were renting is let go, and all of your property that was in it is disposed of,” Abbott said.
“When you leave prison, you have to re-establish yourself,” she said. “You have to buy all your new clothes and household goods, as well as try and address your transport needs and your medical needs. It is extremely hard.”
People in prison often lack family support. Their social ties have broken down. When they leave prison, they don’t have a job, and are relying on the measly JobSeeker payments to make ends meet.
Prisons sometimes arrange pre-release jobs, but that all stopped during the pandemic and hasn’t restarted yet, according to Abbott. The pandemic also made it very difficult for prisoners to access specialist services reliably as services were so disrupted and prisons went into strict lockdowns.
Missing data
Internationally, the research demonstrating a strong causal connection between poverty and poor health outcomes is substantial, going back several decades now.
Unfortunately, Australia still does not track the social determinants of health, according to a study led by Professor Fran Baum AO, a public health social scientist at The Stretton Institute at The University of Adelaide.
Australia should start using best practice methods to collect data on income, wealth, housing, education, employment, disability, and the size and distribution of minority groups, Baum said in the paper.
“Data alone will not force the hand of government to action, but as long as the causes remain invisible, action is much less likely to happen,” she said.
While more data and advocacy work might be needed to twist the government’s arm, it’s hard to resist pointing out the obvious – that providing a weekly income that covers the basic costs of living is just common sense.
Felicity Nelson is a freelance health and science journalist based in Sydney.
Croakey thanks and acknowledges donors to our public interest journalism funding pool who have helped support this article.
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