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AS Australian governments introduce measures to slow the transmission of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the negative social and economic impacts will be felt most among people who are socially disadvantaged. This has profound implications for long term health inequities.
COVID-19 throws into sharp relief the need to address the social determinants of health inequities: the conditions into which we are born, grow, live, work and age and the opportunities that come with those, which are very unequally distributed.
No one is untouched by COVID-19. SARS-CoV-2 shows no respect for class, race or gender as it spreads among hundreds of thousands of people from all walks of life. However, its impact, and the impact of how our economic and social services systems respond, is very socially patterned.
It is not just the tragic loss of many lives that will affect the health and wellbeing of Australian society, but also the likely heart attacks and strokes resulting from the acute and chronic stress due to the unprecedented societal disruption.
The mental health aftermath of COVID-19 will be immense. People are scared. They fear for their loved ones, their livelihoods, their loss of their daily ways of life, and in many instances, their survival.
As we eventually unfurl from our reclusive state, people will struggle with the death of family members, friends and colleagues; the risk of being catapulted into poverty; and their uncertainty about the rules of society post-COVID-19. It is likely that thousands of Australians, particularly those who work in front-line services, will be suffering from post-traumatic stress disorder (here and here).
People who are already poor, have precarious employment, high levels of existing debt, are experiencing homelessness, have poorer access to quality health and social services, are living with disabilities, are socially marginalised, and have the least social capital will feel the devastating impacts of this pandemic most. Their physical and mental health will suffer now and for a long time into the future.
People who have savings, secure employment that can be done from home or is an essential service, comfortable and stable homes, and good social connections are much better placed to bunker down at home, practice physical distancing and stay safe and well.
COVID-19 will have significant impacts on health inequities in Australia through the economic and social fallout resulting from necessary pandemic mitigation measures compounding an already inequitable society. The images of desperation in queues outside Centrelink offices, and the inability of the MyGov website to cope with the surge in demand from people in need – some of whom had never had to do such a thing before – are two very real examples of the social determinants of health inequities in action – welfare policy and access to income, and infrastructure policy and access to information (here and here).
The existing embedded inequities in the social determinants of health will amplify the COVID-19 response effects, exposing socially disadvantaged groups even more. Fourteen per cent of Australians already live in poverty, and income inequities have widened. This reduces trust, self-worth, sympathy and a sense of community, which gives rise to feelings of social exclusion, insecurity and stress. The growth in precarious employment (such as temporary work, part-time work, informal work and piecework) has affected peoples’ income, job security and access to paid leave.
It is quite understandable, and absolutely necessary, that governments and communities are keenly focused on the health system responses to the virus. However, even in the midst of this pandemic, and when we begin to recover from it, if we are to prevent a massive widening in health inequities, we must prioritise people’s social, emotional, mental and physical health. That requires action on the social determinants of health and health inequities.
We need a host of multisectoral actions. Encouragingly, as part of its economic stimulus package, the Commonwealth boosted the JobSeeker Payment by $550 per fortnight for 6 months. We applaud this step but contend that support for people in need should be a mainstay of public policy, not a one-off emergency response.
The health sector has a vital role to play. An analysis of 266 health policies showed that while the rhetoric of the social determinants of health abounds in governments’ health policies, medical care and individualised behavioural change strategies continue to be privileged during implementation. These policies matter, of course, but they will not prevent massive health inequities. The health sector must engage in policy discussions about welfare, labour markets, housing and infrastructure, to name a few.
COVID-19 may end up being this generation’s Great Depression. The determinants of health, and how they are distributed, should be our guiding measure of a successful Australia as we rebuild from COVID-19.
Sharon Friel is Professor of Health Equity and Director of the Menzies Centre for Health Governance at the School of Regulation and Global Governance, Australian National University, and is the author of Climate Change and the People’s Health.
Dr Sandro Demaio is the CEO of VicHealth. He is a medical doctor and globally renowned public health expert and advocate, has published in many scientific journal articles and is the author of The Doctor’s Diet cookbook.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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I am now totally over the BS that surrounds this Covid 19 debacle.
Since lockdown came into effect I have confined myself to my house and have rarely gone out only to go to the supermarket. I suffer PTSD and now I am getting more and more depressed each day.
The final straw came yesterday when I went to the local post office and found the queue extending out of the po into the open spaces of the shopping centre.
The po does have markers on the floor to indicate where to stand and this was working.
However outside it was a bloody shambles with people not obeying social distancing and in almost every situation were in closer proximity of less than a metre of other people/
Thrown into the mix were two unsupervised kids skating inside the shopping centre while waiting for a parent in the queue and coming well within the 1.5 metre limit of persons who were waiting.
It has totally done me in, why the hell am I doing what we were told to do yet these bastards are blatantly disregarding the regulations.
In the meantime my levels of anxiety and depression are getting deeper especially after this incident and I am now left wondering who really cares? I no longer care and why should I, this incident has proven to be the final straw for me and as I say I will just be another statistic. What a joke this country has become,
I am concerned not only about the vulnerability of remote Aboriginal communities to the health impact of COVID-19 but also the social and economic impacts of the lockdown. Across the Kimberley Aboriginal communities are in lockdown and certain supplies are very scarce or unobtainable. I have dispatched ‘care packages’ to communities are elderly Aboriginal people in the townships with items they just couldn’t obtain due to stockpiling in the cities. Even packets of vegetable seeds are out of stock so it is hard for them to start growing their own supplies.
I already suffer from severe anxiety and depression. I can’t even afford to see a doctor let alone attend counselling. I’m a single parent and finally my kids started school this year and life started to look better – I started moving away from roller coaster emotions and thoughts of suicide.
Then the lockdown started. Suddenly I’m trapped he with my kids for an extra week after suffering abuse from strangers and supposed friends because I kept my kids in school as long as I could. The home based business I had been building has crashed and burned because “work from home” isn’t that simple if you are the only carer of your kids. Added to that my brother told my dad to bugger off when the virus hit – leaving me to pick up the balance of responsibilities – added to my already huge list that I have no choice in doing. If I go shopping I get harrasssed for taking my children – but I have no other choice but to take them.
I am over this overblown virus and extreme measures put in place that have been a knee jerk reaction to a virus – other diseases kill more people every day and we don’t hear about that!
No one is going to be there to pickup pieces or support me. Why? I live the country so state governments don’t care – this is clear because for years there has been an outcry here as our mental seduces got cut back despite a growing demand.
I watch as new govt recipients get extra $500 a fortnight – yet my parenting allowance is the same despite having to purchase more expensive groceries as greedy and stupid consumer panic buy abs continue. I can’t afford to keep up so now I’ve had to reduce my daily meals to one.
This stupid virus has shown what a self-centric society we live in and how the majority of people really don’t care about anything other than their own needs and Wellbeing.
Meantime I struggle through every damn day trying to do my best to get my family through it because if I crumble – who will care? No one but I bet criticism will be plenty.
Economic and psychological depression are a terrifying double jeopardy that will be ubiquitous for many lulled for decades now into a false sense of security that neoliberal globalisation will bring never-ending economic growth. Despite evidence of inequality, overconsumption and resource depletion and a climate crisis there has been an overriding faith in the techno-fix still reflected in the Prime Minister’s all too cheesy reference to ‘snap back’ to the status quo ex ante: the medical science techno-fix will address the health problem with a to-be-developed vaccine and a return to hyper-consumptive market capitalism will address the economic problem created in the immediate term by the government’s legally-enforced shutdown edict. Perhaps alongside ‘snap back’ from economic depression there will be calls for ‘snap out’ of deep psychological depression? I agree with the authors that coming out of COVID-19 we will need to structurally address the social determinants of healthy inequity/inequality, but surely as just one element of the need to address the politico-structural determinants of all inequality nationally and globally.