Alcohol consumption during COVID-19 significantly impacts vulnerable communities: The case study of Miller

by Andrew Reid

A national YouGov poll commissioned by The Foundation for Alcohol Research and Education (FARE) found one in five (20 percent) Australian households buying more alcohol than usual since the COVID-19 outbreak in Australia. Within these households, 70 percent are drinking more, with 34 percent drinking now daily. This is  likely to be a result of job loss, financial stress, family pressures, social isolation, declining mental health and a loss of structure and routine during the pandemic.

While we are waiting on further research and study results to uncover the full extent of the impact caused by alcohol consumption during COVID-19, it is highly likely those Australians who are already poor, unemployed or underemployed, with high levels of existing debt, suffering homelessness, or facing existing difficulties with access to health and social services, will be most affected. This is supported by available evidence that suggests disadvantaged communities have more significant alcohol-attributable harms compared with individuals from advantaged areas for given levels of alcohol consumption, even after accounting for different drinking patterns, obesity, and smoking status at the individual level.

Community profile of Miller

Miller is a suburb within the Liverpool Local Government Area (LGA). In 2016, Miller had a population of 3,237 people, an unemployment rate of 15.5% more than double that of NSW (6.3%), 3.9% of the population were Aboriginal and/or Torres Strait Islander, 43.4% of Miller residents were in social housing, many with multiple and complex needs. Miller remains one of the most socio-economically disadvantaged suburbs in the state with the SEIFA Index of Relative Social Disadvantage (IRSD) score of 701 in 2016.

Alcohol Related Assault

Figure 1: Incidents of Alcohol Related Assault, July 2018 – June 2020, Miller

(Source: New South Wales Bureau of Crime and Research Statistics (BOCSAR), 2020)

The latest figures for incidents of alcohol-related assault from New South Wales (NSW) Bureau of Crime and Research Statistics (BOCSAR) show incidents of alcohol-related assault in Miller in May 2020 increased to 58.5 compared to 13 for NSW (see Figure 1). 

A breakdown of the data reveals incidents of alcohol-related assault (non-domestic assault) in Miller in May 2020 also increased to 58.5 compared to 4 for NSW. Compared to this time last year (May 2019), incidents of alcohol-related assault (non-domestic assault) in Miller was 0 compared to 8.5 for NSW

Incidents of Assault (Domestic Assault)

BOSCAR data for the same period (May 2020) showed incidents of assault (domestic assault) in Miller increased to 117 compared to 30.3 for NSW. While this may be due to several factors, existing evidence has found this could be linked to alcohol consumption. In 2010, research revealed alcohol was “present” in 41% of domestic assaults in NSW. Other studies since have found alcohol was involved in up to half of partner violence in Australia and 73% of partner physical assaults. The same studies also pointed out that alcohol features prominently in police data, although not all jurisdictions keep consistent records.    

Significant factor – access and availability of alcohol

There currently are 2 packaged liquor outlets and 1 hotel in Miller.

While the NSW Government COVID-19 restrictions forced the pubs and clubs to close between March 23, 2020 and 1 June 2020, Miller residents were still able to purchase alcohol from packaged liquor stores. The normal trading hours for one of these outlets in the area includes Monday to Saturday, 8:00am to 9:00pm and Sunday, 10:00am to 8:00pm. These alcohol outlets in Miller are in a Statistical Areas Level 1 (SA1) quadrant of approximately 280 households belonging to the lowest 1 percent of the most disadvantaged quantile in NSW.

In addition to this, Miller residents also had the option of buying alcohol online. In April 2020, Retail Drinks Australia reported one national retailer’s deliveries were up 300% from December 2019 to March 2020, while the size of the average order had increased by 50%. Around the same time, the Commonwealth Bank data showed a 34 percent increase in spending on alcohol over a week from March 27, 2020, compared to the same week in the previous year.

Despite no locally available data, Miller residents may be subject to the unsavoury and illegal delivery practices of some of the most popular online alcohol retailers in Australia. A study in January 2020, found 69 percent of these retailers advertised that they were willing to leave alcohol unattended at an address without verifying the purchaser’s age.

Conclusion

Alcohol consumption during the COVID-19 pandemic has the potential to impact all Australians. However, it can potentially further affect vulnerable communities. More research is needed to understand the full extent of the impact on these communities. In the case of Miller, preliminary data shows alcohol has contributed to an increase in incidents of assaults (non-domestic) and, most likely, incidents of assault (domestic assault). Access and availability of alcohol is a major contributing factor. Therefore, there needs to be more action taken around managing the economic and physical availability of alcohol, as well as provision of support for disadvantaged communities. We must remember this is an avoidable burden on our communities.  Let’s act now before it is too late!

Adequacy of the NSW LiveData site for evidence-based liquor licence decisions

By Andrew Reid, Dr Alison Ziller and Dr John Crozier

This commentary examines the adequacy of the NSW Liquor and Gaming LiveData website in providing evidence to assist decision making about liquor licences and trading hours.

Introduction

On 4 May 2020, Liquor and Gaming NSW [L&GNSW] invited feedback on the draft Liquor Amendment (24-hour Economy) Bill. The aim of the Bill, once COVID-19 restrictions are eased, is to ‘create a vibrant and safe 24-hour economy with risk-based liquor laws that support business’. Among the proposed changes is ‘a refined evidence-based approach to help manage the density of licensed premises, and associated risks of alcohol-related violence and anti-social behaviour, in areas of high venue concentration’. The draft Bill says that the Authority may prepared an ‘evidence-based’ cumulative impact assessment.

In December 2019, L&GNSW introduced a trial version of its LiveData site, which ‘is an online tool that allows you to search the latest liquor licence information alongside demographic, alcohol-related crime and health data for every suburb and Local Government Area in NSW’. There are, however, a number of significant flaws in the LiveData tool. We showcase several of these here with reference to the NSW suburb of Miller.

The Live Data evidence profile and the Miller suburb
The community of Miller

Miller suburb is located in Liverpool LGA. In 2016, Miller had a population of 3,237 people, an unemployment rate of 15.5% more than double that of NSW (6.3%), 3.9% of the population were Aboriginal and/or Torres Strait Islander, 43.4% of Miller residents were in social housing, many with multiple and complex needs. Miller remains one of the most socio-economically disadvantaged suburbs in the state with the SEIFA Index of Relative Social Disadvantage [IRSD] score of 701 in 2016.

The LiveData profile

The LiveData site does not provide the SEIFA IRSD score, preferring instead the SEIFA Index of Relative Advantage and Disadvantage.  It notes that Miller is in the bottom 1% of NSW households but Liverpool LGA is in the top 38% . Presenting this information suggests that the LGA is not too badly off and the suburb score is unusual. However, Miller is one of a cluster of highly disadvantaged suburbs in the relatively large Liverpool LGA.

Alcohol outlet density in Miller

The suburb of Miller has 2 packaged liquor outlets and 1 hotel. These are located in Miller town centre in a Statistical Areas Level 1 (SA1) quadrant of approximately 280 households belonging to the lowest 1 percent of the most disadvantaged quintile in NSW.

The LiveData profile

Alcohol outlet density is described on the LiveData site as outlet saturation and outlet clustering. Overall alcohol outlet saturation (number of outlets per 100,000 residents) is reported as lower in Miller suburb (61.8) compared to NSW as a whole (201.9) and Major Cities of Australia (NSW) (176.8) averages. However, the overall rate conceals the fact that for each of the years shown the alcohol outlet saturation rate for the licence types actually present in Miller presents a quite different profile. For example, in 2019 the saturation rate for hotels in Miller, major cities and NSW as a whole was 30.9, 19.1 and 28.5 respectively . The saturation rates for outlets authorised to sell packaged liquor was virtually the same for Miller 61.8 as for major cities (62.3) and significantly higher than the rate for Liverpool as a whole (34).

Public health profile in Miller

Since 1999, hazardous drinking in public spaces in Miller has been a significant concern. The last Miller Household Survey (2010) found 70.6 percent of the 301 people surveyed felt that drug and alcohol problems divided people in their neighbourhood a bit or a lot.  While most of the respondents reported good health overall, average scores on standardised physical and mental health assessments showed the sample was well below other Australian norms (CHETRE, 2010).

This issue has taken on a new urgency with the arrival of COVID-19 and the reporting of differential incidence of the virus, with residents of low-income areas at greater risk. There is concern that lockdown restrictions are associated with increased drinking, gambling and domestic violence.

LiveData health profile

The LiveData site reports alcohol attributable deaths in Liverpool LGA for the two years to 2015/16 and alcohol attributable hospitalisations to the two years to 2017/18. While alcohol attributable deaths declined in the reported period, alcohol attributable hospitalisations rose. The two charts (9 and 10) on the LiveData site have a similar format and would be easy to misread as being on the same scale (vertical axis) whereas the number of deaths is on a scale of 17.5 – 21.0 per annum while the number of hospitalisations is on a scale of 350 – 600 p.a.. Alcohol-attributable hospitalisations are increasing in Liverpool as well as NSW as a whole.

Risk of gambling related harm in Miller

Environmental factors, such as locational disadvantage, significantly influence gambling outcomes. In one US study, neighbourhood disadvantage was linked to a 69% increased odds of exhibiting a gambling problem and eight additional gambling occasions. Australian research has found gambling increased with risky alcohol consumption for all gamblers during a single visit to a gambling venue. That is, gambling is part of the health profile of hotels.

The LiveData gambling profile

LiveData does not provide information about gambling. However, gambling is a significant source of profit for hotels in NSW and the late trading hotel in Miller has its full complement of 30 gaming machines. There are 345 gaming machines in venues in Liverpool LGA. Data available to Liquor and Gaming NSW and provided in part on another L&GNSW site (reveals that in 2019, each machine was making an average $227,127 profit per annum. On this basis, the hotel in Miller would have made [$227,127 x 30 =] $6,813,820 in gaming profit in 2019. A particularly significant loss for the local community.

Assault and violence in Miller

The non-domestic assault rate in Miller for the year to December 2019 was 1462.0 per 100 000 population. NSW as a whole had a rate of 403.2.  The domestic assault rate in Miller for the year to December 2019 was 877.2, while the NSW rate was 390.4. All three alcohol establishments in Miller are located within a ‘hotspot’ for these incidents of assault which has persisted for many years.

The assault and violence LiveData profile

The LiveData site has charts (5 & 6) for alcohol-related domestic and non-domestic assault for Miller, Liverpool LGA, major cities and NSW as a whole . Both charts show significant declines in these crimes in Miller in the last two years while the rates for the LGA, major cities and the State show small changes. These charts do not present the significantly adverse data available on the BOCSAR website and summarised above. This is because, the charts use only those assaults recorded by police as alcohol-related. BOCSAR notes these rates cannot be relied on. The net effect of using these unreliable data is to present a misleading picture of these crimes in a suburb where their incidence is significant.

Discussion

LiveData is presented as a useful source of information for liquor licence applicants and members of local communities alike. However, these are unlikely bedfellows. The information on the site appears more favourable to licence applicants than to local residents, as shown above for the suburb of Miller, namely:

  • The community profile fails to report the most relevant measure of social disadvantage – a measure known to correlate with alcohol-related harm.
  • Outlet saturation is presented in aggregate concealing concerning rates of density for the licence types actually in the suburb.
  • Crime data is treated selectively, minimising the number of domestic and non-domestic assaults in the suburb by reporting only those assaults recorded as alcohol related — notwithstanding the known limitations to the data presented and the high rates of assault actually occurring.
  • Data on gaming machine losses in the local hotel is omitted entirely.
  • Health data for the LGA is presented in visually similar charts with such different scales as to render them non-comparable.

Conclusion

There is growing evidence to suggest the adverse impact of increasing liquor licenses and extended trading hours in disadvantaged communities. It is of significant concern that the LiveData site being trialled by Liquor and Gaming NSW fails to signal these risks. A data source that cannot signal risk in the case of a community as disadvantaged as Miller, cannot be relied on.

Authors’ information

Andrew Reid is a Research Officer at The Centre for Health Equity Training Research and Evaluation (CHETRE). Andrew is also the Chair of the Liverpool Community Drug Action Team (CDAT).

Dr Alison Ziller is a Lecturer in the Department of Geography and Planning, Macquarie University.

Dr John Crozier is a vascular and endovascular surgeon. He is appointed as Visiting Medical Officer to Liverpool Hospital. Dr John Crozier is the current Chair of the Royal Australasian College of Surgeons’ national trauma committee.

References

Centre for Health Equity Training, Research and Evaluation. (2010). Miller Household Survey (pp. 1-72). Liverpool, NSW: CHETRE

Alcohol Harm Reduction in South Western Sydney – Webinar 3: Working Together (Wed 16 Sept 1.00 -2.30)

Wed 16 Sept  1.00 -2.30

Register for Webinar 3: https://www.eventbrite.com/e/alcohol-harm-reduction-in-south-western-sydney-webinar-series-tickets-116168397805

Program includes:

– Social Policy Research Centre UNSW on alcohol promotion and consumption during COVID-19

– walk through the range of programs and support provided by the  Alcohol and Drug Foundation (ADF)

– discussion of a culturally responsive approach to reducing alcohol harms among CALD communities from the Drug and Alcohol Multicultural Centre

– Matilda Centre for Research in Mental Health and Substance Use on two evidence-based programs for young people: Climate Schools and Strong and Deadly Futures

Use of natural experiment for gambling related harm?

The issue

The cessation of gambling during the early stages of the COVID-19 response provides a potential avenue for understanding the impact of gambling on the region. Research suggests ‘natural experiments’ are a useful way to understand the impact of policy decisions and actions that occur in real time. However, there is little  understanding relating to the conduct and usefulness of applying a natural experiment design to evaluating and measuring complex issues like gambling-related harm. The challenge for natural experiments is adequately capturing the complex pathways between an ‘intervention’ (policy decision or action) and the various elements that might influence what this means for health, wellbeing, and equity.

 Context

Research has shown harms related to gambling reflect social and health inequalities, negative effects unequally distributed among economically and socially disadvantaged groups, and are commonly associated with a range of mental and physical health issues. Furthermore, evidence shows this group is more vulnerable to harmful gambling when experiencing financial distress or hardship, which is more prevalent during the pandemic. In 2017-18, total gambling turnover (i.e., the total amount wagered) in Australia was $218.9 billion.  During the first wave of COVID-19, Australians saved approximately $1.5 billion, which would otherwise have gone into pokie machines, due to the closure of pubs and clubs across the nation. The New South Wales (NSW) Government allowed clubs and pubs to reopen their gambling rooms on June 1, 2020. 

The project

The project involves conducting a rapid review of the literature to assess the appropriateness and usefulness of using natural experiment methodology to evaluate or measure gambling-related harm on health, wellbeing and health equity. The output of the project may be (a) a report; (b) a peer reviewed publication.

Contact

Patrick Harris or Andrew Reid

Community STaR – Screening for Gambling Harm: A pilot project – 10:30-11:30 17 Sept 2020

Community STaR (outreach service of the Centre for Health Equity Training, Research and Evaluation) presents:

Speaker:  Nick McGhie,

Project Manager – Gambling

South Western Sydney Primary Health Network

Topic: Screening for gambling harm: A pilot project

This project has focused on the creation of a gambling harm screening and referral model to:

•    Assist GPs, health professionals and community workers assess and refer patients needing gambling support more effectively.

•    Ensure people affected by gambling harm receive the right support quickly and efficiently.

All interested health, welfare, and community workers are welcome.

 When: Thursday, September 17, 2020 

Time: 10:30am – 11:30am 

Where: Online – MS TEAMS 

If you need any further information, please contact Andrew Reid:andrew.reid@health.nsw.gov.au  

Alcohol Harm Reduction in South Western Sydney – Webinar Series (Sept 2020)

SWSLHD Population Health and Drug Health Services invite you to attend any, or all, of 3 free webinars to explore strategies to reduce alcohol-related harm.  All interested health, welfare and community workers are invited.  Discussion will focus on issues for communities in South Western Sydney.

Please note: you will need to register separately for each webinar via the specific links provided.

Alcohol Harm Reduction in South Western Sydney

Webinar 1:   Setting the Scene 

Wed 2 Sept  1.00 – 2.30

Register for Webinar 1: https://www.eventbrite.com/e/alcohol-harm-reduction-in-south-western-sydney-webinar-series-tickets-116071963367

Keynote presentations:

 Effective Prevention of Alcohol Harms –   Emeritus Professor Ian Webster AO

– FARE fight? Opposing Woolworths, Australia’s Alcohol Giant – Di Martin, Public Interest Manager, Foundation for Alcohol Research and Education (FARE)

This session will include a discussion led by SWSLHD A/Director Population Health and General Manager Drug Health Services about alcohol issues in south western Sydney and services to reduce alcohol-related harms. Plus a personal story from someone who has dealt with significant alcohol issues in her life.

Alcohol Harm Reduction in South Western Sydney

Webinar 2:   Making a Difference

Wed 9 Sept  1.00 -2.30

Register for Webinar 2: https://www.eventbrite.com/e/alcohol-harm-reduction-in-south-western-sydney-webinar-series-tickets-115947190167

Program includes:

– SWSLHD Aboriginal Health Directorate

– implications and opportunities arising from the state’s 24Hour Economy Legislation and liquor licensing regulations

– Ministry of Health initiatives to support local action around liquor licensing applications and alcohol harm reduction

– a successful campaign in a local community to stop an unwelcome liquor licensing development 

– an exciting pilot program Planet Youth being implemented in the Blue Mountains and Marrickville

Alcohol Harm Reduction in South Western Sydney

Webinar 3:   Working Together

Wed 16 Sept  1.00 -2.30

Register for Webinar 3: https://www.eventbrite.com/e/alcohol-harm-reduction-in-south-western-sydney-webinar-series-tickets-116168397805

Program includes:

– Social Policy Research Centre UNSW on alcohol promotion and consumption during COVID-19

– walk through the range of programs and support provided by the  Alcohol and Drug Foundation (ADF)

– discussion of a culturally responsive approach to reducing alcohol harms among CALD communities from the Drug and Alcohol Multicultural Centre

– Matilda Centre for Research in Mental Health and Substance Use on two evidence-based programs for young people: Climate Schools and Strong and Deadly Futures

The SWSLHD Equity Framework and COVID-19

Presented by Evelyne de Leeuw (2 June 2020)

Presentation for the plenary of the Division of Population Health of the South Western Sydney Local Health District about the (health and social) equity dimensions of the COVID-19 pandemic and its consequences – including changed use and access to emergency departments, income and employment, and social isolation.

SWSLHD Equity Framework to 2025

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Link to the map on unemployment and poverty due to COVID-19 in Australia :

https://www.newcastle.edu.au/newsroom/featured/researchers-map-emerging-disadvantage-in-australia-due-to-covid-19-job-loss

Further challenges for new migrants and humanitarian entrants in COVID-19

By Andrew Reid

There is a concern that COVID-19 may exacerbate inequality towards vulnerable groups, including migrants and refugees. Here, I highlight a few from past experiences between 2006 – 2011 as a Non-Government Organisation (NGO) project and casework officer. My role included assisting and supporting Australian permanent residents within the first five years of arrival. This group included humanitarian entrants, family stream migrants with low English proficiency; and other selected visa subclasses. This group was located in Outer and Inner Western Sydney, under the Settlement Grants Program (SPG), now known as Settlement Engagement and Transition Support (SETS), funded by the Federal Department of Home Affairs.

Information and service access issues

SETS workers from 78 providers across Australia, funded under SETS – Client Services for the period 1 January 2019 to 30 June 2022, during this COVID-19 period, will necessarily be delivering services ‘from home.’ As a consequence, the SETS target group, including 20,102 humanitarian entrants that are settled in all states/territories between 1 January 2019 to 31 December 2019 (see figure 1 below), are likely to receive less face-to-face casework, interaction, and access to services at a time of even greater need to address their current settlement issues and concerns.Permanent Settlers (All Streams) in all States/Territories with a Date of Settlement* between 01 January 2019 and 31 December 2019

Figure 1: Permanent Settlers (All Streams) in all States/Territories with a Date of Settlement* between 01 January 2019 and 31 December 2019

There are a number of translation and interpreting services in Australia,
such as the Federal Government Translating and Interpreting Service (TIS) operating 24/7 and the NSW Multicultural Health Communication Service, that cover a very large number of languages. The Federal Government on 11/3/2020 announced a $30 million public information campaign. However, with increased demand many new migrants and refugees may find it more difficult than usual to get the necessary information, assistance, and support when needed. There are more than 21% of the population who speak languages other than English at home, and 6% that either speak little English or none at all. It is likely that there will be longer wait times from increasing demand in this COVID-19 period for such essential services.

A significant number of new migrants and humanitarian entrants that have resettled in Australia, particularly in the past 5 years, struggle with accessing information and services on their own. COVID-19 has forced a large number of Australians to ‘self-isolate’ or ‘stay at home.’ This has made it much harder for this population group. One contributing factor to this is the considerably diverse educational backgrounds of recently arrived humanitarian migrants. Some have relatively few years of education. Research, in 2017, found that 15% had no formal education and a further 18% had six or fewer years of schooling). Another contributing factor is digital exclusion. Research in 2019 has shown recently-arrived Culturally and Linguistically Diverse (CALD) migrants who had arrived under the humanitarian immigration program recorded a lower level of digital inclusion than the national average, primarily due to very low levels of affordability.

Older people in this population group are particularly at risk of not understanding and adhering to the required course of action needed to keep people safe and reduce the spread of COVID-19. As Associate Professor Robyn Woodward-Kron, at Melbourne University, explains, “some of the older migrants in Australia have had very little schooling, so they need reliable information that they can understand.”

It is particularly important that there is a ‘coordinated and creative’ approach involving a diverse range of stakeholders including community leaders, different multicultural organisations and community groups to develop the required information and disseminate it in appropriate and effective ways.

Health impacts
Increased Survivor’s Guilt

Research in 2019 found humanitarian migrant populations remain at high risk for mental illness over the first 3 years of resettlement in Australia. One contributing factor to this is survivor’s guilt. This is a sense of deep guilt a person may experience because they have survived a life-threatening situation (i.e., wars, natural disasters, and other traumas), when others have not. COVID-19 may be likely to increase survivor’s guilt among newly arrived migrants and refugees to Australia. This could be exacerbated by numerous domestic and overseas news reports of the alarming speed and spread of COVID-19 across the globe as well as fears of the unknown and for the welfare of friends and family left behind in home countries and refugee camps. Survivor’s guilt is a symptom of Post-Traumatic Stress Disorder (PTSD). Thus COVID-19 could potentially raise the positive screening of PTSD above the 52.4%, shown in a 2019 study, among the humanitarian migrant populations in Australia.

Further stigma

Stigma is already identified as one of the critical barriers to help-seeking for mental health or other health advice, particularly amongst refugee men in Australia. History and international experiences suggest COVID-19, like other pandemics (i.e., Spanish Flu and Ebola), could very well increase this stigma in the recently-arrived CALD migrant population who entered the country under the humanitarian program. This could mean less COVID-19 testing, social rejection, denial of services, and reduced treatment opportunities for Australian new migrants and refugees. Moreover, it can also lead to elevated depressive symptoms, stress, and substance use within this population group. Therefore, COVID-19 can effectively cause further stigma, which can result in mental and physical harm. This could include increasing the present prevalence estimates for depression and anxiety above the current 20% for migrants and 40% for refugees.

A final note, although COVID-19 is having significant impacts on the Australian community, newly arrived migrants and humanitarian entrants are at risk of experiencing increasing challenges as a result of this pandemic.

 

The social gradient of COVID-19

by Andrew Reid and Siggi Zapart

While COVID-19 does not discriminate, the impacts of the virus will not be equitably distributed. Vulnerable populations living in low socioeconomic disadvantaged communities will feel its health and educational impacts far more strongly than those living in more affluent areas.

 Health impacts
 Reduced access to essential healthcare

Some health experts suggest the COVID-19 pandemic could infect up to 70% of Australians. Based on estimates of current infection, more than 45,000 Australians will have COVID-19 by 10 April, 2020. At least 2,254 people would require ICU beds, (more than the current Australian capacity of 2,229). People in lower socioeconomic disadvantaged communities generally have poorer health and higher rates of heart and respiratory disease, and chronic illnesses. This means they could make up a large proportion of people likely to need ICU beds, and/or find it a lot harder to receive critical healthcare for their other illnesses in their local hospitals.

Furthermore, the Australian Government’s plan to implement a ‘whole-of-population telehealth’ approach will disadvantage vulnerable populations who do not have access to smartphones or computer technology due to lower income or education levels. The ‘whole-of-population telehealth’ includes phone and video mental health, allied health, and primary health consultations. Moreover, even those with internet access will be disadvantaged due to inferior NBN service types(see graph below). Research conducted in 2016 showed only 29% the most disadvantaged areas across Australia (SEIFA decile of 1) had fibre-to-the-premise (FTTP) – considered the best broadband technology solution available – or fibre-to-the-node (FTTN) connections. In the least disadvantaged(SEIFA decile of 10), 93 % had FTTP or FTTN. This is clear evidence that optimal NBN service increases as the SEIFA decile increases. Hence, even though telehealth is covered by Medicare, people living in disadvantaged suburbs are likely to miss out on the much needed essential services.

Impact on mental health

The continuing upward trend in the number of confirmed COVID-19 cases across Australia is causing increased anxiety and stress among disadvantaged communities. This is due to multiple and simultaneously occurring factors including, risk and uncertainty associated with the virus; feeling of powerlessness in the current situation; inconsistent messaging and confusion about social distancing measures; separation from loved ones due to quarantine or self-isolation; loss of freedom, and increased boredom; low income reducing to no income; and the type and condition of housing many people in these areas reside in. Most residents in these communities live in low-cost private rentals, social housing, and for some (many with disability, health or mental health issues, victims of domestic violence, people recently released from prison etc.) and social housing bedsits. The pandemic can potentially raise the Australian adult rates of poor mental health(currently 20%) and high or very high psychological distress (13%).

Educational impact

Across Australia, some states have closed schools, commencing school holidays early. Others like NSW have kept them open but encouraged parents to keep children at home. All schools are preparing for online learning, though at this stage, options for school attendance will be available for those that need it in some states.  However, given the low attendance rates (20-30% last week), it seems many parents think it safer to keep their children at home. For students in vulnerable communities, online learning could lead to increased barriers to education. Not all will have access to computers, the internet, or quality technology, such as wireless networks at home or quality NBN service. Many students might have mobile phones, but these may not be enough to engage with the curriculum or complete required tasks. Shools could send home lessons and resources for parents to use, but many parents in these communities would struggle, or not feel confident to teach their children at home.

In addition, the Federal Government’s closure of public libraries and community centres will hurt the educational outcomes of children in disadvantaged communities as these facilities provide a safe environment to facilitate lifelong learning. Public libraries offer free or affordable access to the internet, computers, printers, photocopiers, and a wide range of educational resources. Several community centres host Learning Clubs, i.e., after school programs designed to provide extra assistance to primary and secondary students in developing academic skills, such as homework, numeracy, and literacy. Not having access to these facilities and programs will prevent a large number of children in these disadvantaged communities from participating in learning, completing online school assignments, and having the right to a high-quality education experience.

So, a final note, although COVID-19 is impacting the entire population, those doing it tough already are and will continue to experience even more severe consequences as a result of the pandemic.

Community STaR event with Joan Silk (10:30-11:30 22 Nov, 2019)

Community STaR presents…

Doing more with less:
Observations about community development in Cuba

Can lessons learned from the Cuban experience
improve health disparities in Australia?

Speaker : Joan Silk

Cuba is the largest island in the Caribbean Sea. Despite limited funding and supplies, Cuba’s adult and youth literacy rate stands at 100%, and it has consistently managed to keep its population of 11 million people healthy into old age with a health system recognized worldwide for its excellence and its efficiency.

Joan Silk visited Cuba in 1997 and again this year. Her presentation will draw on those experiences and reflect on what we can learn from the Cuba experience.

Joan Silk is a health worker with a special interest in the relationship between inequality and health, both on a community and an international level. She has worked in the printing, retail, hospitality and creative industries, as a secondary school teacher, a research assistant, and for the last 20 years as a health equity worker in various communities. She has a BA Honours in Economic History and Politics and a Diploma of Education.

  • When : Friday, November 22, 2019
  • Time : 10:30am – 11:30am
  • Where : Miller Community Centre,
    18A Woodward Crescent, Miller, NSW 2168
  • RSVP by 18 November
  • Register here via Eventbrite
  • For more information, contact: E: Andrew.Reid@health.nsw.gov.au  or T: 02 87389310
  • See flyer