As we watch anxiously the growing rates of Covid19 infection in Australia, we gain further insight into what this new normal looks like. From bushfires to pandemic, 2020 has provided the starkest examples of how inequity exacerbates the impact of crises in people’s lives. But how do we continue to advocate for the structural reforms that are so necessary to address this inequity, in a time of crisis? In this article, Health Justice Australia’s CEO Dr Tessa Boyd-Caine shares what she has learned from Covid19 about advocating for systemic change during a crisis.
Since the first signs of lockdown earlier this year, Health Justice Australia has been in response mode: identifying emerging need and supporting our network of health and legal assistance services to address it. The impact of structural inequity has become glaringly evident in who is impacted first and worst by that need. As a result, advocacy has played an increasingly important role in our work; and in our shift from response to prevention, tackling these inequities of impact in what is likely to be our new normal.
We are an organisation that works with complexity.
We identify the multiple, intersecting problems in people’s lives that create or further their experience of disadvantage; and we tackle the complexity of the service systems that have been set up to respond to people’s needs. We support collaborative practice across the otherwise siloed services of the health and legal assistance systems, to improve how those services respond to complexity in the lives of the people they are here to help.
As the impacts of Covid19 were first becoming clear in Australia, we recognised that there was likely to be complex legal need emerging as a result of this health crisis at two ends of the spectrum. At one end was the problem of volume. Almost overnight, there was a massive increase in the population of people likely to be eligible for publicly funded legal assistance, due to their loss of paid work.
At the other end of the spectrum was the problem of acute need. This was likely to be most dire among particular cohorts of people who are:
- Vulnerable to the risk of abuse in the home, including through family violence and elder abuse
- Living with poor mental health, for whom personal contact is critical to maintaining connectedness with services and socially
- Living in unhealthy housing, for instance where mould drives respiratory problems or over-crowding increases the spread of infection
- Living with disability and who are dependent on others to meet their basic needs.
In March, Health Justice Australia published a statement on the risks of social and legal (ie indirect) impacts of Covid19 and recommendations to address these risks among people for whom vulnerability to these impacts could be as dire as the virus itself. That became a cornerstone of our response to Covid19, both in our advocacy and in our engagement with services and decision-makers directly. And our concerns have been borne out in the need emerging across the country.
A birds-eye view
As a centre of excellence and not a frontline service, Health Justice Australia has the opportunity to develop a birds-eye view of what’s happening on the ground by working closely with our diverse network of health and legal assistance services across the country. From the early days of Covid19 we were taking the pulse of what they were seeing in the communities they support. We were well prepared to do this through the pandemic because we had been doing so since the bushfires.
One of the things that both crises have taught us is the great need for rapid coordination. Yet many services in our network were themselves scrambling to move to working remotely while maintaining access to help for clients and patients. They were not well-placed to coordinate sector-wide responses to Covid19. If we wanted to work collaboratively, we needed to enable that ourselves.
Our work
We drew on existing relationships to establish the Covid19 Legal Assistance Working Group, comprised of the national peak bodies for community legal centres; Aboriginal and Torres Strait Islander legal services; family violence prevention legal services (also an Aboriginal community controlled network); and the two largest legal aids, NSW and Vic. This grouping was important because, while it represented the breadth of the legal assistance sector, it was not constrained by the siloed structures through which legal assistance policy, service design and funding usually flow.
Our first challenge was to identify shared priorities and what we could do about them. Meeting over several months, the Working Group developed a shared analysis of the legal needs that were emerging, who was most vulnerable to them, and the experience of services responding to that need.
Contributing our own capacity and capability was important to this effort. Beyond convening the Working Group, Health Justice Australia developed a survey tool through which we could hear directly from our network of services and we shared that with legal assistance sector peaks to use with their members. We convened meetings between health and legal assistance practitioners to test emerging assumptions and develop holistic responses. We engaged with social media platforms like @wepublichealth and contributed to health sector publications.
We briefed other organisations playing a central role in the response such as the Australian Healthcare and Hospitals Association and the Australian Council of Social Service. We engaged with influencers including members of the Prime Minister’s Covid19 Coordination Commission.
We worked across state as well as federal government, ensuring that bureaucrats were briefed as part of our advocacy.
Working through the Covid19 Legal Assistance Working Group enabled us to test emerging insights across broader sectors, strengthening the legitimacy of our advocacy. This played an important role in the eventual commitment of Covid19 funding for legal assistance services, when the Prime Minister announced an additional $63.3 million for the legal assistance sector.
Our convening and advocacy had an impact and funding was committed. But were we any closer to securing the outcomes that Health Justice Australia is here to achieve? What ground had we laid for our system-wide agenda of improving health and justice in people’s lives?
We have learned two key lessons from our Covid19 advocacy so far.
Firstly, this crisis lays bare the tension between responding to immediate, pressing needs, on the one hand; and driving systemic change for improved outcomes into the future, on the other hand.
While the sentiment that ‘we’re all in this together’ is heart-warming, it’s not accurate. Our work has revealed acutely different experiences of the pandemic. Those differences are determined as much by structural factors as they are by how well people wash their hands. These structural factors include the adequacy of people’s income; the security of our housing; our social connectedness; and how safe we are, whether from institutional discrimination like racism and ageism, or from violence particularly against women and children.
In the first phase of the global pandemic, we watched this play out most prominently internationally. Many of these differences were also present in Australia, but the last two weeks have shone the brightest light on them, with the quarantining of public housing tenants in Melbourne.
Whether responding to crisis or in business as usual, any organisation working for systemic change should be setting the foundations for ‘better’. In the context of Covid19, this has been captured in the language of resilience and recovery; and in the calls to ‘build back better’. We should be focussing our advocacy on what we can learn from this crisis to improve outcomes and drive the systemic change needed to secure them. But to date, we have had to focus on critical and immediate needs. The challenge for us now is to plot the path to advance systemic gains beyond the immediate; and to do so in the knowledge that crisis – whether environmental or viral – might be our new normal.
But how do we advance this agenda when there is so little appetite or capacity within governments to change from how we did things to how we should do them differently?
New ways to make progress
The second key lesson from our advocacy so far is that, while the existing challenges to make policy gains and systemic change have been exacerbated, we have to find new ways to make progress even through crisis.
That has been particularly evident in the difficulty asserting equity as a core principle in how Covid19 assistance is distributed. If the problem you are responding to is complex, like lack of access to services or health and social inequity, how you spend is as important as what you spend it on.
We used the ‘win’ on legal assistance Covid19 funding to develop core principles about how that funding should be allocated, based on:
- Improving access for those most in need
- Learning what we can about what works in a time of crisis, recognising that this is already a major deficit due to underinvestment in outcomes measurement across legal assistance services for decades
- Supporting collaborative approaches where possible, to maximise value and impact
This approach allowed us to shift from response to prevention, laying the foundations for longer-term outcomes in our Covid19 response. To do that, we have worked differently in a number of ways.
- We have asserted positions independently. We developed a set of recommended principles to drive the allocation of legal assistance funding from which we do not benefit directly.
- We have worked through quieter advocacy. We have been engaging with state and territory governments directly, including operating behind the scenes where others have stronger relationships.
- We have worked to influence philanthropy as well as government. Every opportunity to brief a foundation is an opportunity to influence what and how they contribute to the response and to show the way in collaborative, lasting impact.
We will advance these principles in our ongoing work towards systemic change. Through our engagement with the raft of current inquiries currently underway into mental health, disability, domestic and sexual violence and the campaign to increase the rate of social security payments, we will be bringing these principles into that work. In doing so, we will continue to connect the dots between the legal, health and social problems that drive disadvantage; and how best we can collaborate for the systemic change needed to reduce it.
