Introduction by Croakey: While so much of the discussion about Australia’s response to COVID-19 has focused on the health, disability and aged care systems, a new report suggests we should be talking much more about the health impacts of wider policy responses.
The report from the Menzies Centre for Health Governance at the Australian National University investigates the likely impacts on health equity of 156 specific policy measures introduced by Federal and State/Territory Governments.
The findings highlight an urgent need to focus on improving policies across key social determinants of health equity, including employment, income, cost of living, education, housing and infrastructure.
“Governing going forward requires a new social compact, supported by a national, whole-of-government health equity strategy,” the report’s lead author, Professor Sharon Friel, writes below.
The report will be officially released tomorrow, Thursday, 27 August, and discussed at a webinar (Thursday, 27 August, from 12.30-1.30pm AEST), where Melissa Sweet will live-tweet the discussions for the Croakey Conference News Service. Follow #Govern4Health and this Twitter list of participants.
Sharon Friel writes:
COVID-19 will likely widen the already widening health inequities in Australia. People experiencing poverty, precarious employment, high levels of existing debt, homelessness, and poor access to quality health and social services are already socially marginalised, financially stressed and experiencing little sense of control over their lives.
These populations will disproportionately feel the impacts of this pandemic on their physical and mental health now and into the future without appropriate government intervention.
COVID-19 highlights the critical need to address the social determinants of health inequities – the conditions in which we are born, grow, live, work, and age, and which are shaped by structural drivers of power, money, and resources. These factors are very much influenced by public policy well beyond the health sector.
The Australian Government, like many governments worldwide, introduced multiple policies aimed at reducing the spread of COVID-19, and economic stabilisation and recovery.
During the period 12 March to 16 June 2020, 156 policy measures were introduced by the Federal and State/Territory Governments. Most responses focus on economic stability through matters of employment, income and cost of living, but the spread of policies includes education, housing, infrastructure, and community services.
If we are to prevent a massive widening in health inequities going forward, it is vital to pay attention to the health and social equity implications of such policies.
In the Menzies Centre for Health Governance report, titled Australian COVID-19 policy responses: Good for health equity or a missed opportunity?, we examined Australian Federal and State/Territory Government policy responses to the 2020 COVID-19 pandemic.
The report will be discussed at a webinar tomorrow (Thursday, 27 August, from 12.30-1.30pm AEST) featuring presentations by Professor Sharon Friel, Director of the Menzies Centre for Health Governance, RegNet ANU, Dr Sandro Demaio (VicHealth) and Professor Emily Lancsar (Research School of Population Health, ANU).
Below is a summary of the report highlights.
Income and employment
When based on principles of decent work and living standards, labour market and social protection mechanisms provide financial security, social status, identity and self-worth, and social connections. These are all vital for good health.
When COVID-19 hit, the necessary public health lockdown measures shook the Australian economy.
Many businesses are on the brink of closure. Nearly 600,000 people lost their jobs in April alone, and thousands more were furloughed. This is on top of already high levels of poverty (14%), income inequality in Australia, and a labour market with high levels of precariousness (temporary work, part-time work, zero-hours contracts) that have adversely affected income and job security.
The major and very positive social protection policy response from the Federal Government was the provision of additional money to people on income support schemes. Since the end of April, the Federal Government has provided an additional $550 per fortnight to people on income support schemes including JobSeeker. This was a critically important policy response, especially to some of the most disadvantaged Australians.
Keeping in place the positive changes to income support schemes will go a long way to protecting people from poverty and prevent a widening of health inequities.
Generous universal social protection systems are associated with much better health outcomes, including lower mortality levels among socially disadvantaged groups. Reducing health inequities requires social protection systems that allow a healthy standard of living below which nobody should fall.
Another centrepiece of the Federal Government response is the JobKeeper wage subsidy, which was introduced to increase cashflow for businesses that have had their revenues significantly affected by COVID-19. This is an excellent intervention, providing employment and financial security to more than 3 million people, many of whom are low paid workers.
It would be good to ensure the conditions of the policy do not incur any unintended widening of social and health inequities. Analysis has shown nearly one million casual workers are ineligible, many in accommodation and food services, retail trade and health care and social assistance.
JobKeeper-related amendments to the Fair Work Act enables employers to temporarily vary work arrangements. Job insecurity and precariousness, which are enabled by the amendments to the Fair Work Act, are not good for health, and are more common in low paid, and youth and female dominated sectors, including retail and hospitality.
Going forward, the longer term systemic issues of poor employment arrangements and working conditions must be addressed if employment-related health inequities are to be reduced.
Early child development and education
Healthy development during the early years provides essential building blocks in social, emotional, cognitive, and physical well-being. Childcare is therefore an important setting for children’s health, and provides a mechanism by which to reduce social and health inequities across the life course.
When COVID-19 hit, the Early Childhood Education & Care Relief Package was introduced, providing childcare services a weekly subsidy to continue to deliver early childhood education and care, and families were able to access childcare for free during this period. This was incredibly positive, and particularly helpful for low income households.
Stopping the subsidy will disadvantage already disadvantaged households and children. The evidence shows that once a child starts from behind, the prospect of catching up to their peers, in schooling and in life, is much diminished.
Many health problems among adults have their roots in disadvantage in the early years of life, including obesity, heart disease, and mental health problems.
There has been little policy response to help students, parents and schools deal with the COVID-19 impact, despite the universally recognised importance of primary and secondary education.
Even before COVID-19, around 44 percent of socially disadvantaged children were assessed to be developmentally vulnerable on entering school at age five. According to a report from the Grattan Institute “….most students did not learn as much while at home as they would have in their classroom – and disadvantaged students were hardest hit”.
Formal education remains the major route out of disadvantage. This is a very real issue in light of the pandemic impact on schooling.
The physical environment
Communities and neighbourhoods that ensure access to basic goods and shelter, that are socially cohesive, that are designed to promote good physical and psychological well-being, and that are protective of the natural environment are essential for health equity.
Housing is one of the areas that received government intervention following COVID-19. The Federal Government HomeBuilder Program offers eligible owner occupiers a $25,000 grant to build a new home or renovate their existing home.
However, the beneficiaries of this are people who can already afford major renovations. At the State/Territory level, a number of subsidies and grants were provided to tenants who lost their jobs, plus support for property owners to enable them to drop rents. Measures were also introduced for social housing.
While the State/Territory interventions go some way to address acute housing stress for people experiencing financial insecurity brought on by COVID-19, they are insufficient.
Australia struggles with the availability of, and access to, affordable quality housing. Home ownership has been declining in Australia in the past two decades. For those who do own their home, many have large mortgages that put them in financially vulnerable positions. There is a shortage of affordable private rental housing, especially for low income households, and there has been inadequate investment in public housing. For some low income households, precarious housing circumstances can result in homelessness.
There are important calls from the social sector and industry to reorient the HomeBuilder Program and stimulate the economy with jobs in energy efficient and solar, low-income housing installation through a National Low Income Energy Productivity Program.
This would create the necessary jobs, cut energy bills for people on low incomes, and reduce carbon emissions. This would all be good for health equity. Similarly, investment in social (public and community) housing – could help bridge the gap in housing investment, job creation and income growth and at the same time reduce homelessness.
Four policy initiatives focused on infrastructure – shovel-ready projects; road safety works; local road and community infrastructure; and earlier than planned provision of grants to assist local councils.
These important interventions offer hope for health – there is a wealth of evidence showing that infrastructure matters for health and health equity.
Safe green places encourage people to be outdoors and are good for mental health. Accessible quality pathways and roads encourage cycling and walking. Transport infrastructure impacts upon walking behaviours, trafﬁc injuries, noise and air quality, and attractive public buildings encourage a sense of community cohesion.
Unfortunately, the policy responses missed the opportunity to invest in social housing as key infrastructure.
Community and social services
Community services play an important role in relation to health inequities. They help mediate and redress the health impacts of risks and harms that people experience through their daily living conditions. They can also engender a sense of belonging and wellbeing.
In response to COVID-19, the Federal Government made four major interventions in community and social services.
Although the focus was primarily on keeping people in work, the policy response supports three sectors that are fundamental to health equity – aged care, disability, and domestic violence, and a fourth sector – the Arts, which helps create community wellbeing.
These policy measures to support aged care, disability services, the arts and family violence are very helpful in the short term.
However, COVID-19 shines a light on the need for sustained and adequate funding to these sectors which provide critical social and legal support, particularly going forward when it is clear that these organisations will play a vital role in helping to rebuild communities
Many of the very welcome responses to COVID-19 only scratch the surface of what is needed to redress and prevent a massive widening of health inequities going forward.
None of the policies challenge the status quo. The inequities in power, money and resources that sit behind the conditions of everyday life will not change as a result of these policy responses.
There is no attention to structural change in policies related to the social inequities that drive health inequities.
There is silence when it comes to issues of taxation, especially of multinational corporations; financial regulation; trade and investment, and racism – each of which drive the conditions in which we live, and are important for addressing social and health inequities.
COVID-19 has initiated an incredible intergenerational transfer of debt. The health consequences will be felt for decades, possibly generations, to come. But austerity cannot be the policy response going forward. Investment and action is vital across the conditions of daily living. Action on the structural drivers of health inequity is essential.
The silence on climate change in Australian policy is deafening. Unless something significant changes, climate change will continue to exacerbate existing health inequities.
The green COVID-19 recovery that various commentators are talking about has many co-benefits for health equity. Fundamentally, action must focus on the consumptagenic system – the institutions, policies, processes, and ideas that embed, facilitate, and normalise the dominance of a system addicted to growth and profits irrespective of the environmental, social, and health costs.
Have we stopped a tsunami of health inequities in Australia as a consequence of COVID-19? Not yet.
‘Bouncing back better’ from COVID-19 could see a healthier, more equitable and sustainable Australia but only if political leaders choose to use this unfortunate event to drive positive societal change.
Governing going forward requires a new social compact, supported by a national, whole-of-government health equity strategy.
• Read here for a full analysis of the Australian policy response to COVID-19 and the implications for health equity. The report’s authors are Sharon Friel, Sharni Goldman, Belinda Townsend and Ashley Schram. Register for the webinar here.
Follow on Twitter: @SharonFrielOz