A person’s health is the result of a complex interplay of their genetics, lifestyle and environment. The World Health Organization defines health as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’ (WHO 1946). This recognises that health is multi-dimensional, and a person’s health is linked to their wellbeing.
Welfare refers to the wellbeing of individuals, families and the community. The terms welfare and wellbeing are often used interchangeably (see Understanding welfare and wellbeing).
Health is fundamental to an individual’s wellbeing. Both physical and mental health such as chronic pain and stress, are important aspects of health that affect wellbeing (see ’Chapter 2, Social determinants of wellbeing’ in Australia’s welfare 2021: data insights). A person’s health status plays a role in their ability to participate in work, education or training and engage with their community and social networks.
Health is both a protective and risk factor in that it can positively, or negatively, affect a person’s wellbeing. For example, a person may suffer isolation or loneliness because of poor health (see Social isolation and loneliness). On the other hand, good health may enable them to earn a sufficient income to support themselves and live independently, placing them at lower risk of poor outcomes such as poor housing conditions, overcrowding and homelessness (see Income and income support and Homelessness and homelessness services).
Conversely, the circumstances in which a person lives and works can affect their health. A number of social factors act together to strengthen or undermine health. These factors are also strongly related to wellbeing, as shown in Indicators of Australia’s welfare, Figure 1 and ’Chapter 2, Social determinants of wellbeing’ in Australia’s welfare 2021: data insights. Factors include education, employment, social networks (social disadvantage and lack of resources, opportunity, participation and skills) (McLachlan et al. 2013), the built environment and location (see the Australia’s welfare snapshots relating to housing, employment and income, and education).
Health inequalities
Health inequalities (avoidable differences in health outcomes and life expectancy across groups in society) arise because of the conditions in which a person lives and works (CSDH 2008).
Social inequalities and disadvantage are closely linked with health inequalities and the dramatic differences in health experienced across groups in society (CSDH 2008). It is estimated that closing the gap between the most and least socially disadvantaged groups would spare 0.5 million Australians from chronic illness, save $2.3 billion in annual hospital costs and reduce Pharmaceutical Benefit Scheme prescription numbers by 5.3 million annually (Brown et al. 2012).
One example of the link between social inequalities and disadvantage can be seen through health disparities in educational attainment. People with lower levels of education have higher rates of death due to cardiovascular disease. If all Australians aged 25–74 had the same cardiovascular disease death rate as people with a Bachelor degree or higher in 2011–12, the total cardiovascular disease death rate would have declined by 55%, and there would have been 7,800 fewer deaths (AIHW 2019b).
The health system is one part of a network of systems working to create positive wellbeing for all Australians. It plays a role in the prevention, early intervention and treatment of diseases and other ill health and injury to maintain health—not just treat illness. The health system helps people remain as healthy as possible for as long as possible.
The health system is linked with other sectors, especially welfare. An example of the relationship between health and welfare at the service level is the ‘no jab, no pay’ policy. This encourages parents to vaccinate children by requiring them to comply with immunisation requirements in order to receive Child Care and Family Tax payments (Department of Health 2020).
While health and welfare services are generally distinct but complementary, in some settings the boundaries are less clear, with services intersecting both health and welfare. For example:
- The aged care system aims to promote the wellbeing and independence of older people and their carers, as well as protect the health and wellbeing of care recipients (SCRGSP 2021; see Aged care). While aged care is generally regarded as a ‘welfare’ service, some aged care services may also provide ‘health’ services. For example, recipients of the Commonwealth Home Support Programme may be eligible for nursing care or allied health support services such as physiotherapy, speech pathology and nutritional advice (Department of Health 2020).
- People with permanent and significant disability may access disability support services. Support available for those eligible is wide ranging and includes some health-type supports, such as home modifications, allied health and the provision of aids and equipment (NDIA 2021; see Specialised support for people with disability).
Many issues involve both health and welfare services, requiring people to navigate multiple systems and providers. Family, domestic and sexual violence (FDSV) is one example of this. FDSV can have a serious impact on a victim’s health, but also on other aspects of their life that determine wellbeing. In 2016–17, 4,600 women and 1,700 men were hospitalised due to family and domestic violence (AIHW 2019a) and 119,200 people who sought homelessness services in 2019–20 had experienced family and domestic violence (AIHW 2020a). Services and initiatives across sectors work to support the wide reach of FDSV. For example, many people who have experienced violence from a current partner report having taken time off work as a result (ABS 2018). This can result in less income or loss of employment. Government initiatives introduced in the last few years include the introduction of paid domestic violence leave (SGV 2020).
The Coronavirus disease 2019 (COVID-19) is a major health threat, which has led to substantial disruption across almost all parts of society worldwide. Until the development of vaccines, the only practical way to contain its spread was by:
- travel bans
- strong physical distancing policies and practices
- personal hygiene
- closure of non-essential services
- face masks
- maintaining a minimum distance from others
- strict quarantine
- strict isolation of cases and close contacts
- establishing electronic check-in and QR codes to support contact tracing (Department of Health 2021).
The COVID-19 pandemic has direct effects on individuals who contract the virus, as well as many indirect effects on the broader community. These include changes to employment, income, living arrangements and ability to spend time with friends and family (see ’Chapter 3, The impact of COVID-19 on the wellbeing of Australians’ in Australia’s welfare 2021: data insights). For example:
- in April 2020, almost half (49%) of Australians reported that they had not met with anyone socially since the onset of the pandemic. This had reduced to 6.8% by November 2020, but was still higher than levels of social isolation reported pre-pandemic in February 2020 (2.0%) (see Social isolation and loneliness)
- between March and April 2020, the number of employed people aged 15 and over fell by 592,100. By May 2021, the number of employed people had recovered to above its March 2020 level, with an additional 130,400 employed people in May 2021 than in March 2020 (see Employment and unemployment).
In addition, many health and welfare services have been required to operate in different ways throughout the COVID-19 pandemic. In some cases, this has changed the way in which people access and use these services, while in other cases, new or additional services were made available to Australians through changes to service delivery models, policies and programs. Examples include:
- the JobKeeper Payment, which was introduced by the Australian Government in April 2020 as a fortnightly wage subsidy to help keep businesses trading and people employed during the COVID-19 pandemic. By July 2020, the number in receipt of the payment reached a peak of 3.7 million. From October 2020, after changes to the payment came into effect (referred to as JobKeeper Extension payment), the number of people receiving JobKeeper reduced from 1.6 million in October 2020 to 1.0 million by March 2021(see JobKeeper and employment services).
- family, domestic and sexual violence support services, which saw a 32% increase in contacts to the over the phone counselling service 1800RESPECT between March and August 2020 (see Family, domestic and sexual violence).
Health and welfare data are hugely valuable. Their strong evidence base enables better decision making and improved outcomes for Australians. People-centred data are needed to understand the experiences of the population and various cohorts within it across health, housing, education and skills, employment and income, social support, and justice and safety.
Data linkage (a process combining information from multiple databases, while preserving privacy) is increasingly being used to link across health and welfare data sets. Examples include the Australian Bureau of Statistics’ Multi-Agency Data Integration Project and the National Disability Data Asset, which is a large-scale data integration project, that brings together de-identified Commonwealth and state and territory government data to learn how to best share data between governments to gain a better understanding of people with disability’s life experiences– and National Integrated Health Services Information Analysis Asset – which brings together de-identified, hospital admissions, Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, aged care and mortality data. Linked people-centred data are beneficial for insight into an individual’s situation, support pathways, interactions and experiences with welfare services, interaction between health and welfare systems, and health and welfare outcomes.
From the start of the COVID-19 pandemic in Australia, data has been at the forefront of public discussion and understanding, and has been pivotal for decision makers. The pandemic transformed the way data is thought about and used, with strong demand for timely data. This has been shifting the way in which data are used and will, in turn, have a long lasting impact on the data system in Australia. See ‘Chapter 1 Welfare data in Australia’ in Australia’s welfare 2021: data insights.
For more information, see:
References
ABS (Australian Bureau of Statistics) 2018. Personal Safety, Australia, 2016. ABS cat. no. 4906.0. Canberra: ABS.
AIHW (Australian Institute of Health and Welfare) 2019a. Family, domestic and sexual violence in Australia: continuing the national story 2019. Cat. no. FDV 3. Canberra: AIHW.
AIHW 2019b. Indicators of socioeconomic inequalities in cardiovascular disease, diabetes and chronic kidney disease. Cat. no. CDK 12. Canberra: AIHW.
AIHW 2020a. Specialist homelessness services annual report 2019–20. Cat. no. HOU 299. Canberra: AIHW. Viewed 21 August 2019.
AIHW 2020b. Approved AIHW linkage projects. Canberra: AIHW. Viewed 6 April 2021.
Brown L, Thurecht L & Nepal B 2012. The cost of inaction on the social determinants of health. Report no. 2/2012: CHA-NATSEM second report on health inequalities. Canberra: National Centre for Social and Economic Modelling. Viewed 6 April 2021.
CSDH (Commission on Social Determinants of Health) 2008. Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization. Viewed 6 April 2021.
Department of Health 2020. About the Commonwealth Home Support Programme (CHSP). Viewed 6 April 2021.
Department of Health 2020. No Jab No Pay new requirements fact sheet. Canberra: Department of Health. Viewed 6 April 2021.
Department of Health 2021. Coronavirus (COVID-19) restrictions. Canberra: Department of Health. Viewed 6 May 2021.
McLachlan R, Gilfillan G & Gordon J 2013. Deep and persistent disadvantage in Australia. Canberra: Productivity Commission. Viewed 6 April 2021.
NDIA (National Disability Insurance Agency) 2021. Supports funded by the NDIS. Canberra: NDIA. Viewed 6 April 2021.
SCRGSP (Steering Committee for Review of Government Service Provision) 2021. Report on government services 2021. Canberra: Productivity Commission.
SGV (State Government of Victoria) 2020. Include an entitlement to paid family violence leave for employees. Melbourne: SGV. Viewed 6 April 2021.
WHO (World Health Organization) 1946. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June 1946. New York: WHO.