Covid-19 presents us with an opportunity. A more equal society, more resilient to the challenges ahead, or a society ruled by power imbalances, struggling to cope with both natural and man-made disasters.
Pre-Covid
Thirty years ago it was demonstrated that in an environment where access to health care was equitable, health outcomes were determined by one’s position in the social hierarchy. Power over one’s life determined the age of one’s demise (Marmot). Eleven years ago it was demonstrated that in wealthy countries like Australia health and social outcomes correlated strongly with relative income, a gradient of power against health (Wilkinson and Pickett, The Spirit Level Slide 7).
The Royal Commission into Aged Care Quality and Safety has released its Interim Report, pointedly and appropriately titled Neglect. It states,
“Many of the cases of deficiencies or outright failings in aged care were known to both the providers concerned and the regulators before coming to public attention. Why has so little been done to address these deficiencies?”
The Royal Commission into Victoria’s Mental Health System has released its Interim Report. It states,
“Poor mental health has become a pressing yet ignored health crisis. Mental health services continue to fail to provide treatment, care and support to people living with mental illness, their families and carers”
The powerless suffer. The powerful carry on.
According to the Australian Newspaper (June19, 2020) the Australian Building and Construction Commission’s audit of labour hire firms found that eighty percent were “not complying with workplace laws by not paying workers correctly, not keeping proper records and not giving their workers pay slips.” Profitable companies using such firms pretend they don’t know how their business world works.
Underpayment of low paid workers is regularly and repeatedly exposed thanks mainly to unions, the ABC, and Fairfax media. Once again, the regulators are asleep, lacking resources, or in the pockets of the powerful.
The powerless suffer. The powerful carry on.
Fortunately for the powerless, we do have a welfare system. It was the most highly targeted system in the OECD in 2011. Targeting has increased, including through the now ceased failed ‘Robo-debt’. Even before that, applying for welfare and complying with requirements was a huge challenge for many, whether because of mental health issues, physical illness, language and cultural issues, or lack of access to or knowledge of computers. It is disempowering, demeaning, and demoralising.
The underlying principles guiding welfare for several decades have been targeting, mutual obligation, a poverty level income to encourage work engagement, and minimising costs. The Federal Government is now adopting an ‘investment approach’ to welfare which would see targeting resources to those most likely to benefit in the short term. But there is no talk of the long term adequacy of the payments and little heed of the complexities which citizens must negotiate. Under the ‘investment approach’ the powerless remain so unless they belong to a group which can be shown to respond rapidly to some targeted resources.
Enter Covid
Into this power and income imbalance charges Covid-19. As one might expect, it hits the powerless hardest, the aged in residential aged care, the poor in crowded, labour hire firm arranged accommodation or workplaces where it is almost impossible to physically distance, and the poor in inadequately serviced, crowded housing commission accommodation. But the virus has no respect for class, power, or income. So we see a response from the powerful, an immediate appreciation that if one gives an unemployed person an adequate small income, the money will all return to the economy immediately. It is a government stimulus as recession hits. Finally, some minimal consideration has been given to those desperate people wanting to feed their family and themselves whilst supposedly self isolating or getting tested. The realities of relatively powerless people’s lives are belatedly being partly recognised.
Blame for the unfolding Covid-19 pandemic in Australia has been everywhere. Minimally trained and supported security guards were employed in quarantine hotels, employed in a poorly regulated industry where the firm was chosen without tender by the Victorian Government. But blame is productive only where it helps policy makers look at the system failures which lead to problems. Hospitals have understood this for years. They avoid blame when a medical disaster occurs. The question asked is not “Who is to blame?,” but rather “what kind of a system with appropriate checks and balances should we have in place to prevent a disaster, knowing that individuals make mistakes, and that individuals who already feel powerless may make more mistakes?”
Health has rightly been the major focus. But the economy is also crucial. The Federal Government has made a series of extraordinary decisions. With the full knowledge that those most impacted financially were women and young people, it decided to reduce childcare support, and plan a reduction to job keeper and job seeker payments. It appointed a team primarily of corporate directors to lead the job creation advice in secret. There remains minimal representation from those involved in providing public services. It is keen to further deregulate private industry whilst ignoring the fact that poorly regulated private industry is part of the problem. It has introduced a financial incentive to those with enough money to already have plans for home building, to pursue their dreams. It is considering bringing forward the legislated tax cuts which will see those earning between $22,000 and $30,000 a year getting $55 extra a year and those earning more than $100,000 getting $2560 a year. Higher income earners invest in their own future whether it is more shares or another negatively geared property. They have no need to spend it in the productive economy, the one that will drag us up from the recession. The decisions ignore the reality that those on low income spend every cent every week.
The Covid Opportunity
The opportunity is present now to spend. If we can even consider tax cuts for those who don’t need them, we can definitely afford to spend now on residential aged care with increased mandatory staffing level. We can easily afford increased spending on public mental health care. We don’t need to wait for recommendations from Royal Commissions to initiate such spending. We can resource much more vigorous regulation of labour hire firms and employers in general to minimise underpayments. Such measures create jobs and target the powerless. Their health improves. They are then more likely to become employed. Adequate income support to those on lower incomes will mean that those most affected by the recession are the ones much more likely to benefit. Every cent will be spent rebuilding the economy immediately.
This is an opportunity to look at the power imbalances in the structure of our society. It is a health issue. Politicians are the ones charged with the responsibility for all of the problems outlined previously. They have clearly been captive to powerful industry interests and/or their own interests as they have let this situation evolve. Many mean well but the structures of which they are a part limit any well meaning resolve such that, despite these issues being discussed for years, the power imbalance remains and the effects on people’s lives are shocking. Neglect describes it well. Where are the leaders?
Tim Woodruff is a specialist physician working in private practice. He is President of the Doctors Reform Society and Chair of the Australian Health Care Reform Alliance.
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