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).
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
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.
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.
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.
Our South Australia community health centres achieved so much with so little and could now be helping so much with local responses to COVID-19.
Recommendations for addressing inequities
Dr Connie Musolino, Research Fellow, Southgate Institute for Health, Society and Equity, Flinders University
The SA Heaps Unfair report has 37 recommendations to SA and Federal Government for how different sectors can address inequities, covering health, housing, employment, social security, economy, community, NGO sectors and others.
It is critical to SA’s future to withstand economic and health crises such as the coronavirus that the South Australian Government creates a long-term plan for the social & economic development of the state which will work towards ecological sustainability wellbeing and equity.
SA Health’s monitoring of coronavirus to treat and prevent transmission has been admirable. But we recommend the SA Government establish a program of comprehensive primary health care centres in SA which build community capacity through community care.
Primary health care centres would play a crucial role in responding to health crisis, monitor population health, and be in the best position to respond to their local communities health and wellbeing needs.
The coronavirus crisis has also shone a light on the divide between poor and wealthy within the education system and the importance of public schools to the education, health and wellbeing of children living in vulnerable circumstances.
We are calling for an increase to support for public education, particularly schools in areas of disadvantage, reduced subsidies to the private school sector and to target areas of underperformance.
Targeting early education and children through public school system is key to addressing health inequities.
The report also recommends the South Australian Government, led by Wellbeing SA, develop a state-wide health equity monitoring system and policy to reverse current trends and reduce inequities.
Privatisation of services has been under spotlight during the coronavirus with SA Pathology. The report notes that “privatisations are often undertaken as a temporary relief of state funding, without a willingness to increase state tax revenue.”
The ability of a government to respond to a crisis depends on the quality of its public service. The report recommends SA Government restore and protect the apolitical and independent role of the SA public service to ensure it can provide evidence-based advice on complex issues.
The Australian Unemployed Workers have documented people choosing to go without medicine or food.
Health inequities and COVID-19 are gendered. Health, education, care workforce and carers are more likely to be women.These groups are more risk of contracting COVID-19, are lower and unpaid. Changes to social security and& employment must recognise this into account.
My mother is in her 60s and still working in childcare. The centre is risk of closing as children are taken out, government funding decreases. What happens to the health workers with small children who need care?
My hope is that coronavirus reminds us of the importance of collectivism, social justice and community values as individuals and families reach out to help each other and the less able through this crisis and that this experience forms a social movement to pressure local and global governments into action to stop inequities.
How can we address inequities?
Ross Womersley, CEO, South Australian Council of Social Service
As we’ve already been saying the report shows us once again, that funding is critical to ensuring equal health access, and consequently equal health outcomes for ALL South Australians. Anything less, is #SAHeapsUnfair.
Also watch this presentation outlining the report’s recommendations:
The Twitter Festival coincided with yet more news of newsrooms closing and journalism job losses, with the pandemic further weakening an already fragile public interest journalism sector. #PIJmatters
Dr Tess Ryan
This report has made some crucial points about health inequity, including privatisation, casualisation, education, housing shortage and workforce changes in SA.
I wonder if after all this global crisis winds down, if the country can have a conversation about what hasn’t worked in a neoliberal society? Because I feel this is really showing us the failures in humanity and the house of cards that can be capital gain right now.
A long term plan by SA (and other) governments after COVID19 is drastically needed regarding social and economic development.
We need a clean whiteboard to write a new discussion the changes the way we do life – away from simply a neoliberal mindset and capital economic gain towards something where those that have for too long been left behind are given genuine assistance in which to survive.
If this crisis has taught us anything it is that we simply do not know what is ahead of us – surely we should build a strong foundation for our society in order for us to continue?
More funding is needed for further engagement with health consumers, especially after COVID19.
Professor Fran Baum
Watch this video thanks from Professor Fran Baum.
The hashtag was used by 268 Twitter accounts, with 1,620 tweets sent, creating 11.7 million Twitter impressions between 24-30 March, according to Symplur analytics.
The Twitter transcript is here.
The article above was compiled by Marie McInerney and Melissa Sweet for the Croakey Conference News Service.
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