Discussion
In 2020 there has been an enormous impact on social and health systems from COVID–19. The effect is worldwide with social and health ramifications into the future. What is emerging is a new inequity and the focus is on new political processes that deal with UHC under these extreme conditions. 16
Estimates of the impacts on employment in Australia and hence incomes suggest that at least 3.6 million people will be out of work, with those from hospitality, retail and entertainment industries most hard hit. These are the low paid workers on casual employment with few savings behind them to support them through the pandemic. This includes close to 94,000 casual academics. Casual workers are not eligible for government benefits. 17-19
Older people especially with chronic conditions are at greater risk if contracting coronavirus. Pre-existing conditions can also create greater risks of severe virus outcomes. 20. In some countries migrating workers and their poor living conditions have created a greater danger of infection. 21 Government measures to curb the spread of the virus are leaving many of these same people exposed to greater risks to their physical and mental health. These risks stem from increased exposure to the virus and from increased economic and social hardship during the lockdown.22
Inequitable opportunities as the result of economic downturn, after major recessions in the US long term unemployment have been shown to have far reaching effects for future productivity as well as employability. This is especially so for younger people who in slumps are “scarred” 23 having lower wages and fewer employment opportunities in their early careers. In Australia the impact on younger people can be seen from the withdrawals from superannuation (pension schemes). Over 450,00 withdrawals have been made by people <30 who have amassed the least savings. 24Physical capital has not been destroyed, but the risk of human capital damage is large, through the scarring of significant numbers of unemployed for long periods of time. 25
The coronavirus pandemic demonstrates the inadequacy of current health systems, particularly with regard to preventive care where Australia spends relatively less. 26 Restoring health affected by COVID–19 is a long-term prospect which will entail dealing with greater inequities. Delays in education and further studies will affect many and will lead to longer term inequality. However, COVID-19 offers an opportunity to conduct far-reaching reform. Webster27 points out in the UK The Independent Scientific Group for Emergencies (SAGE) identified that centralised control was an impediment and undermined local integration of health and social systems, where primary care is the backbone of the system..
Similarly, Sturmberg and Martin 1 argue that the integration of UHC and PHC requires political leadership which involves local communities and resourcing, this ignores the influences of lobby groups in the health sector on policies and government spending in health, often towards greater medical intervention. As was the case with the UK Government the ideological positions of political leaders may preclude communities participating. 27
Australian PHC is an ever-evolving system driven by changes in power relations, most notably between funders and health professionals, health professional bodies, lobbyists and within the professions.28, 29 Whether it can be deemed a system, which suggests some stability is questionable. 30 The term “navigating the health system” is in common parlance for good reason. Interestingly, in a call for a national minimum data set in primary care, the Deeble Institute 31 points out that there is little understanding of how and why patients access Australian PHC.