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Twitter Festival launches new report showing health gaps increasing

A “perfect storm” of global, national and state factors has produced a dramatic rise in health inequities in South Australia that risk halting or reversing life expectancy trends in the state, according to the SA: The Heaps Unfair State report being launched today.

The report warns that unless the South Australian and Federal Governments change the way they respond to these pressures, health inequity will continue to worsen and “improvements to life expectancy may halt or even go backwards in South Australia, as has been witnessed in the United States and in parts of the United Kingdom”.

The #SAHeapsUnfair report has been produced by the Southgate Institute for Health, Society and Equity at Flinders University and the South Australian Council of Social Service (SACOSS). 

It is being launched via a Croakey #TwitterFest, with the discussions captured in rolling posts below.

The impact of the neoliberal trends highlighted in the report is relevant and timely for other states and territories and the Federal Government, with many of the same issues affecting health equity elsewhere and weakening our capacity to respond collectively to the devastating health, social and economic impacts of the coronavirus pandemic.

“Inequities are shining out in this epidemic,” Southgate Institute’s Professor Fran Baum said in this preview of the report.

Baum and Ross Womersley, SACOSS CEO, say the report was sparked by their alarm at data showing that while life expectancy continues to increase in South Australia, “the gradient in health is getting steeper and the health of the least well-off is worsening”.

That includes a rate of premature deaths in the most socioeconomically disadvantaged areas of the state that is now over twice the rate of premature mortality in its most socioeconomically advantaged areas, they said.

South Australia is also “faring particularly poorly” compared to other states and territories.

The report finds a range of contributors including:

  • The impact of de-industrialisation on the South Australian economy and manufacturing industries, and trends in employment and income (including social security income).
  • Privatisation in education, health, public infrastructure and housing sectors.
  • Decrease in public housing stock and quality, and increase in housing and living costs.
  • The politicisation and hollowing out of the state and federal public sector’s capacity and expertise to respond to economic and social challenges.
  • The erosion of democratic social justice values and disinvestment in community-based approaches to health and education.

It makes 36 recommendations across the social determinants of health, from self-determination for Aboriginal and Torres Strait Islander people, to raising income support, investing in public housing and ensuring digital inclusion (see more detail in this Twitter thread).


Introductions

Dr Tess Ryan

To introduce myself, I’m a Biripai woman, academic and freelance consultant. I’ve a vested interest in social justice, representation and equity in health. I myself have a chronic condition and face regular issues regarding inequity and the intersections of race and health.

I speak regularly of my lived experience as an Aboriginal woman with chronic conditions.

Prior to academia I was on a Disability pension in public housing trying to survive day to day. Things such as finances, housing, race and navigating services all impact on health further.

This virus does not discriminate but it is shining a light on who we are as a society – we need to think not just of ourselves but of those that can’t self-isolate or those that don’t have stable living environments. We need humanity (not economics) deeply embedded in health.

I’d also like to say something about the current global health crisis, acknowledging first those worldwide that have passed and those frontline workers that are doing all they can to flatten the curve.

Those frontline workers aren’t just the medical fraternity or research scientists. They clean our transport, they are also our retail workers and food service workers. Many of these people are casuals and themselves face inequities which could impact on health.


Health inequities in SA on the rise and COVID-19

Dr Toby Freeman, Deputy Director, Southgate Institute for Health, Society and Equity, Flinders University

My name is Toby Freeman, I work at the Southgate Institute for Health, Society, and Equity on Kaurna land in Adelaide. I would like to pay my respects to elders past and present, and acknowledge the health inequities that have arisen from ongoing colonisation.

I am tweeting this today from self-isolation (due to entering SA after the borders closed). As you’ve said, I will tweet particularly about our findings on the growing health inequities in South Australia. #SAHeapsUnfair

Full report at https://flinders.edu.au/content/dam/documents/research/southgate-institute/sa-heaps-unfair-state.pdf

Analyses were all done by my colleague Dr Joanne Flavel. Data was from PHIDU Social Health Atlas – you can look at the inequality graphs for SA, other states, and Australia here: http://phidu.torrens.edu.au/social-health-atlases/graphs/monitoring-inequality-in-australia/inequality-graphs-time-series 

It shows that premature deaths have decreased in SA from 1987-91 to 2011-15, which is great! But these gains have disproportionately gone to the most advantaged in our society.

Those in the most disadvantaged quintile did not see the same extent of decrease in premature deaths, and are now dying early at over twice the rate of the most advantaged quintile.

People being over twice as likely to die early because of their socio-economic status is clearly unfair and avoidable.

SA ranks second worst in terms of greatest raw increase in inequality ratio between 1997-2001 and 2011-2015.

Yes, unfortunately, SA’s health inequities are getting worse at a faster rate than most other states and territories 

Some of the risk factors for severe illness from COVID 19 are chronic lung disease, heart disease, and asthma https://cdc.gov/coronavirus/2019-ncov/specific-groups/people-at-higher-risk.html All of these conditions follow a social gradient, and this gradient has been getting worse.

Really important issues! Inequities in access to care are going to be highlighted during COVID.

These existing health inequities are just one reason COVID-19 is going to increase health inequities in SA and beyond. They show the urgency of addressing health inequities at every step, especially in times of crisis.


Why health inequities have increased in SA

Professor Fran Baum, Director, Southgate Institute for Health, Society and Equity, Flinders University

Our report highlights why health inequities have increased in SA; much is due to the run down of the state through public sector cuts and privatisation. COVID-19 is shining a light on the problem these trends have created.

I will take you through five themes from the findings about what has increased health inequity: deindustrialisation; gig work; privatisation; public housing cuts; rising living costs; hollowing out of the public service; and erosion of democratic social justice values.

First theme: Deindustrialisation and changes to work – the loss of manufacturing jobs, eg in car industry, casualisation of work, stagnation of incomes, freezing of Newstart, gig jobs – all things amplified by COVID19, all increase inequity.

Right now people are losing their jobs.  Lots of grieving for our work families now. Gig jobs, casual jobs are not good for health or equity.

Second theme:

Third theme: The decrease in amount of public housing and an increase in housing and living costs including energy.

The SA Housing Trust was great; provided good homes to many. Cuts backs have seen it decimated. In the post COVID-19 recovery, let’s build lots of public housing.

Fourth theme:  The politicisation and hollowing out of the state and federal public sectors capacity and expertise to respond to economic and social challenges. There have been cut backs and outsourcings so public sector is weaker than it was and less able to develop good policy.

Fifth theme