Never Let a Crisis Go to Waste: Opportunities to Reduce Social Disadvantage from COVID‐19

• Published date: 01 September 2021
• Author: Janeen Baxter,Deborah Cobb‐Clark,Alexander Cornish,Tiffany Ho,Guyonne Kalb,Lorraine Mazerolle,Cameron Parsell,Hal Pawson,Karen Thorpe,Lihini De Silva,Stephen R. Zubrick
• Date: 01 September 2021
• DOI: http://doi.org/10.1111/1467-8462.12428

The Australian Economic Review, vol. 54, no. 3, pp. 343–358 DOI: 10.1111/1467-8462.12428

Never Let a Crisis Go to Waste: Opportunities to Reduce Social

Disadvantage from COVID‐19

Janeen Baxter, Deborah Cobb‐Clark, Alexander Cornish, Tiffany Ho,

Guyonne Kalb, Lorraine Mazerolle, Cameron Parsell, Hal Pawson,

Karen Thorpe, Lihini De Silva and Stephen R. Zubrick*

Abstract

This article identifies and examines a range of

policy reform opportunities in Australia arising

from COVID‐19. The authors demonstrate how

COVID‐19 presents unique opportunities for

rethinking and redesigning long‐standing rules

and regulatio ns covering how people live an d

work in Australia, with some opportunities

arising coincidentally and others requiring

purposeful policy and institutional redesign.

They present a broad rangeof ideas to address

entrenched disadvantage in health, labour

markets, the tax and transfer system, gender

equality, education, housing and criminal

justice in Australia, in order to leverage the

COVID‐19 crisis to build a better society.

1. Introduction

The COVID‐19 pandemic has turned our

worlds upside down. Far more than a health

pandemic, the measures put in place by

government and health authorities to arrest

the spread of COVID‐19 have abruptly

changed many aspects of our lives, including

how we work, socialise, interact with family

and spend our spare time. Much has already

been written about the many negative health,

social and economic consequences of the

pandemic and it will be some time before

we can assess the full extent of these,

especially since the pandemic is likely to

continue for some time. At the same time, the

pandemic has led to a number of changes that

open previously unexpected opportunities for

potential positive outcomes. In this paper we

examine health, labour markets, tax and

transfer systems, gender equality, education,

housing and criminal justice, areas that we

believe are central in discussions of social

disadvantage. We argue that COVID‐19

provides unique opportunities for rethinking

and redesigning long‐standing, taken‐for‐

granted rules and regulations in each of these

areas. Some may arise coincidentally, and

others will require purposeful policy and

design.

As in some previous global crises, such as

the Second World War, which gave rise to the

United Nations, the COVID‐19 pandemic may

also be a moment for serious reflection and

* Baxter: Institute for Social Science Research, The

University of Queensland, Queensland 4072, Australia;

Cobb‐Clark, Cornish, Ho, De Silva: School of

Economics, The University of Sydney, New South

Wales 2050, Australia; Kalb: Melbourne Institute:

Applied Economic and Social Research, The University

of Melbourne, Victoria 3010, Australia; Mazerolle,

Parsell: School of Social Science, The University of

Queensland, Queensland 4072, Australia; Pawson: City

Futures Research Centre, The University of New South

Wales, New South Wales 2052, Australia; Thorpe:

Institute for Social Science Research, The University of

Queensland, Queensland 4072, Australia; Zubrick:

Telethon Kids Institute and Centre for Child Health

Research, The University of Western Australia, Western

Australia 6009, Australia. Corresponding author: Cobb‐

Clark, email <deborah.cobb-clark@sydney.edu.au>.

© 2021 The University of Melbourne, Melbourne Institute: Applied Economic & Social Research,

Faculty of Business and Economics

Published by John Wiley & Sons Australia, Ltd

reorientation of institutions and values at a

broad scale. The pandemic may engender a

willingness to look beyond our own short‐

term priorities to support measures that

emphasise societal goals over and above

individual needs and consider the greater

good, including provision for those who are

most adversely affected by the crisis through

no fault of their own. The principal idea

underlying ‘never waste a crisis’is that

changes previously not possible are now

feasible and the opportunity to realise them

should not be wasted.

We make no attempt here to develop the

detailed design elements needed for change,

or to rank areas for change in terms of

feasibility or government expenditure priori-

ties. These are beyond the scope and intent of

the paper and likely only possible when

additional data and evidence about the full

costs and outcomes of COVID‐19 are known.

Rather our aim is to provide an overview of

the possibilities for redesigning policies in a

forward‐looking counterpoint to what has

undoubtedly been a catastrophic global event.

2. Health

The constraints and restrictions on physical

proximity and movement during COVID‐19

provoked a marked shift in public policy and

health service provision via the extension of

Medicare coverage for telehealth services,

introduced in March 2020. Medicare provides

Australian citizens and permanent residents

with a range of health and hospital services at

no cost or reduced cost. Not all medical

consultations and procedures are covered by

Medicare. Online or phone consultations were

previously not covered by Medicare prior to

the COVID pandemic. Providing Medicare

coverage to telehealth consultations altered

two fundamental parameters that contribute to

unequal health outcomes—spatial barriers to

access and cost of health care.

First, it needs to be acknowledged that the

roll‐out of telehealth was fundamentally

reactive. The hazards of reactive, as opposed

to proactive, implementation have been well

outlined (Smith et al. 2020). There are also

barriers to overcome in coverage, reimburse-

ment, licensure, broadband access and ade-

quacy, and privacy and security (Myers 2019).

In short, telehealth implementation during the

pandemic is suboptimal to a more planned,

considered roll‐out.

COVID‐19 now provides opportunities for

large‐scale assessment, at population level, of

the impact of telehealth provision on health

access, use and outcomes using quantitative

methodologies. Until now, confidence in the

value of telehealth has been limited by the

predominance of descriptive studies and small

sample sizes (Caffery et al. 2017). The

pandemic is a rare ‘standout’evaluation

opportunity, provided by a natural experiment,

and for which comparative and counterfactual

evidence are available for both costs and access

differentiated by disadvantage. Longer‐term

health outcomes are most likely to be revealed

on onward use and rates of illness.

Previous reviews on the benefits of tele-

health have reported its potential to reduce the

inequities in access and health outcomes of

Australians in rural areas, and to address

chronic difficulties in recruiting and retaining

rural health workers (Moffatt and Ely 2010).

There are also documented benefits to pro-

viding telehealth in Australian Aboriginal

communities (St Clair et al. 2019). Benefits

include improved communication between

patients and health care providers, reduction

in trauma from travel, more inclusive decision

making from family members spread across

large areas, access to more specialist services,

and support of local staff in accurate assess-

ment and treatment plans.

Second, is the lesson from COVID‐19 is

that public health systems remain the ‘front

line’of prevention and response. If there is

any doubt about this, witness Australia's

current rates of laboratory confirmed seasonal

influenza (Figure 1). The pandemic has

confirmed the vital importance of preventative

health. In the absence of a vaccine, public

health has turned to well‐understood princi-

ples of infection control including behavioural

measures such as quarantine, social distan-

cing, restrictions to assembly, hand washing

and wearing masks. The public does not

344 The Australian Economic Review September 2021

© 2021 The University of Melbourne, Melbourne Institute: Applied Economic & Social Research,

Faculty of Business and Economics