It’s time to fix social and health inequities
by Sharon Friel
With COVID-19 exposing and deepening health inequities across Australia, whoever is elected the next Australian Government must go above and beyond in implementing a strategy to tackle them.
The global pandemic has shone a spotlight on pre-existing social fault lines in countries across the globe, including Australia. Indigenous peoples, people living in poverty, those in precarious employment or with high levels of existing debt, those experiencing homelessness or housing stress, and anyone without access to quality health and social services were already financially stressed, socially marginalised, and experiencing little sense of control over the policy decision-making processes that affect their lives. COVID-19 only made things worse.
Crucially, each of these factors affected their physical and mental health. COVID-19 has widened, and is likely to continue widening, health inequities in Australia and globally unless action is taken to address them and focus on the social determinants of health.
Last year, the Menzies Centre for Health Governance produced a Health Equity Report Card of Australian government responses to the pandemic up until 1 October 2021, focusing specifically on employment, income support, and housing.
These issues received much attention throughout the pandemic and are key drivers of health inequity. They affect peoples’ financial security, sense of dignity and control over their lives.
The Report Card revealed mostly mediocre performances from the federal government in regard to the likely effect of their COVID-19 policy responses on health inequities.
While policies designed to protect jobs, raise unemployment benefits, and provide enhanced tenancy protections were all very welcome, the positive impacts for health equity have been moderate and very short lived. The policies focused on being ‘temporary and targeted’, largely failing to address deeper structural issues.
Post-election, Australia must do better. The pandemic has presented an opportunity for change.
The mainstream focus upon resilience and pandemic preparedness represent largely further technocratic fixes. They are insufficient.
With vaccination now protecting so much of the community, the government has the chance to stimulate policy and action in ways that promote health and health equity, address the inequitable distribution of resources that creates negative health outcomes, and address climate change.
Achieving these transformative goals requires a ‘social vaccine’. This would mean a shift in the orientation of the health sector away from dominant discussions of biomedical solutions towards a focus underlying social factors that cause disease and suffering.
This would comprise policies that aim to keep people well and mitigate the structural drivers of inequities in daily living conditions which make people and communities vulnerable to disease and trauma. After all, the oldest saying in medicine is ‘prevention is better than cure’.
Importantly, the social vaccine would not only help people with the worst access to a healthy life, it but would aim to bring everyone in the system closer together. More equal societies produce better outcomes for everyone on a range of wellbeing measures.
The targets of a social vaccine would be the conditions that underpin four basic requirements for health and equity to flourish: a life with security, opportunities that are fair, a planet that is habitable and supports biodiversity, and governance that is just.
A key part of a social vaccine would be a National Health Equity Strategy, acting as a central framework for guiding the actions of all Australian Government departments.
An initial focus on income, employment, and housing innovations would be tremendous, and such a strategy would demand policies that tackle the structural causes of health inequities.
Australia urgently needs policies that ensure secure, safe, and decent working conditions for all workers in Australia. It must acknowledge that transitioning those in casual and insecure employment who want to work full-time into secure employment with decent working conditions is not just desirable for economic reasons, but for health reasons too.
This is why the next government must introduce a national employment strategy that provides that security to workers, and encompasses a just transition for those working in industries affected by climate action via re-training and income support.
More broadly, income support must be a pillar of Australia’s health equity system. The next government must reform social policy on principles of social justice and dignity, with all income support schemes designed to ensure a living income well above the poverty line – not cynically designed to starve people into getting ‘back to work’.
Australians also need access to secure and good quality housing, as its role as a major election focus shows. The next government must curtail tax relief for housing investors and must invest in and build adequate, accessible, and sustainable social housing across the country.
Building forward fairer from the COVID-19 pandemic requires a social vaccine that tackles the structural causes of health inequities and flattens the social gradient in health.
Implementing this will require political vision and courage, but the health inequities highlighted in Australia by COVID-19 will remain unless a social vaccine of this kind is developed and applied. Australia needs decisive action on the root causes of health inequity if it is to prevent a further tsunami of disease burden and suffering in the years to come.
_This piece is based on the Health Equity Report Card produced by the Menzies Centre for Health Governance based at ANU School of Regulation and Global Governance, and published as part of Policy Forum’s new feature section – In Focus: Australia’s policy future – which brings you policy analysis and ideas that go beyond the sound bites.
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