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.