Haves and have-nots: What the suburbs that suffer most in a pandemic have in common

It’s official: COVID-19 does discriminate and we’re not all in the same boat.

Anyone who says otherwise probably isn’t thinking about how social inequality makes some people more susceptible to a deadly pandemic than others.

Blue-collar heartland: Fairfield and other parts of south-west Sydney were under stricter lockdowns than other LGAs during last year’s mid-year lockdown.Credit: Dean Sewell

Stories about the uneven impacts of coronavirus are not hard to find. The most obvious example globally is the failure to vaccinate the poorest countries, while in Australia the user-pays approach to rapid antigen tests (RATs) has emphasised the divide between the haves and have-nots.

In case there’s any doubt, researchers at the Australian Catholic University, commissioned by Catholic Health Australia, have crunched the numbers to quantify the impact of inequality on the pandemic in Australia.

Tom Barnes, an economic sociologist and senior research fellow at the university’s Institute for Humanities and Social Sciences, based his analysis mostly on the Delta outbreak in 2021 but also drew in figures from outbreaks in 2020.

He concluded that the proportion of blue-collar workers in a local government area (LGA) was the biggest determinant of the spread and impact of COVID-19.

“You had a direct cause and effect between the proportion of blue-collar workers and case numbers,” says Barnes. “That’s reflecting the fact that these workplaces were not able to operate remotely and there was higher occupational exposure.”

For example, the City of Fairfield – one of the 12 LGAs in Sydney designated a COVID-19 hotspot during the Delta outbreak – has more than 40 per cent of the workforce in blue-collar occupations. That’s seven times higher than Woollahra in the eastern suburbs.

Similarly in Melbourne, blue-collar workers account for 40.5 per cent of the workforce in Brimbank in the western suburbs of Melbourne, four times higher than Stonnington in Melbourne’s inner southeast.

Barnes found each percentage point increase in the proportion of blue-collar workers in an LGA led to one additional coronavirus case for every 183 people living in the area.

In Sydney, this translated to an additional 848 cases for every percentage-point increase in blue-collar workers, based on the average population of an LGA. In Melbourne, it led to an additional 895 cases per percentage point.

This trend has continued - NSW Health figures show areas designated as LGAs of concern in the Delta wave are still bearing the brunt in January 2022.

Like many in the community, Debe Thomas, in her home in Busby, has struggled to find rapid tests and believes they should be provided free or at cost. Credit: Flavio Brancaleone

It’s a reality that Debe Thomas knows only too well living in the Liverpool LGA, in the blue-collar suburb of Busby. Liverpool was one of the official hotspots in the Delta outbreak and in January 2022, the LGA is still experiencing the third-highest number of COVID-19 infections per capita in Sydney.

Thomas, 61, spent the first two years of the pandemic providing full-time palliative care for her husband as well as caring for another friend with post-polio syndrome.

This meant taking extreme precautions including showering and washing her hair every time she returned to the house from an outing, stretching the household budget to have groceries delivered, and managing the risk of healthcare and support workers coming to the home.

Without access to convenient and affordable testing, people are more likely to mingle with others while infectious, or stay home and miss out on work or social opportunities.

When her husband died in December, Thomas finally caught COVID-19, though she didn’t realise it until she was on holiday in Newcastle with friends.

“I guess I dropped my guard when my husband died and the ambulance and police needed to come,” Thomas says. “I’m doing a lot better but still have a nagging cough. I’m just glad that I didn’t give it to my husband - that would have been horrible.”

Like many in the community, Thomas struggled to find rapid tests and believes they should be provided free or at cost.

The Australian Catholic University study found areas with a high proportion of “culturally and linguistically diverse” (CALD) residents were also hard hit by the pandemic - but the correlation is weaker than for blue-collar workers.

The model found a one percentage-point increase in the percentage of culturally and linguistically diverse workers led to one additional coronavirus case for every 255 people in an LGA.

In Sydney, this translated to an additional 609 cases for every one-point increase in diversity, and in Melbourne an additional 642 cases.

Melbourne LGAs with the highest proportions of CALD residents overlap extensively with LGAs with high numbers of blue-collar workers, such as Brimbank in the west or Hume and Whittlesea in the north.

Sydney LGAs with the highest proportions of CALD residents are located in the western suburbs or in other multicultural localities such as Strathfield in the inner west or Ryde in the northern suburbs.

Associate Professor Maria O’Sullivan, the deputy director of the Castan Centre for Human Rights Law at Monash University, says there is a right to health, but this can be undermined by structural inequality. RATs are a prime example because of availability as well as cost, despite making it free for people with health care cards.

Liverpool was one of the official hotspots in the Delta outbreak and, in January 2022, the LGA has the third highest number of COVID-19 infections in Sydney, per capita.Credit: Dean Sewell

“I drove around for hours last week trying to find a RAT, so it’s not just the cost of it,” she says. “The ability of people who work two shifts a day to be able to do that [is limited] and an assumption that your work is going to give it to you is just not a reality for a lot of people.”

Price gouging has been rampant but even the regular price of $10 to $15 per test is too much for many households to test all members on a regular basis. Logic dictates if someone doesn’t have access to convenient and affordable testing, they are more likely to either mingle with other people while infectious, or stay home unnecessarily and miss out on work or social opportunities.

Barnes says social inequality could also hamper the rollout of vaccine booster shots for adults and first doses for children aged five to 12, since in 2021 wealthy areas consistently showed higher levels of vaccination.

In Melbourne, less-advantaged LGAs lagged in the vaccine rollout, Barnes says. Hume, the LGA with the highest case numbers in Melbourne, had the third lowest full vaccination rate in the city by late October (48.4 per cent). Whittlesea, with the second highest case numbers, had the fourth lowest full vaccination rate (49.9 per cent).

Meanwhile, NSW had a strong push on vaccination in western Sydney that helped bridge the gap with wealthier areas but some of that was driven by economic and social coercion, with people getting vaccinated to get out of lockdown.

Given those restrictions are no longer in place, that could spell a lower appetite for booster shots and children’s vaccines.

Besides unequal health impacts, disadvantaged areas also took the hardest economic knocks. Barnes’ found the “miraculously low” unemployment numbers during the Delta outbreak masked dramatic declines in workforce participation, especially in the most disadvantaged areas.

In Sydney, the labour force fell from 3 million in May 2021 to 2.75 million in September, a decline of 8.3 per cent. This was even worse for women, with a decline of 9.2 per cent.

“That’s a huge decline in the number of people who have simply given up looking for work because there’s no point because the whole city is locked down,” Barnes says.

Again, the impact was uneven. Barnes says the size of the labour force in south-west Sydney declined by a remarkable 14 per cent in August 2021. This decline overlaps with this region’s high proportion of blue-collar workers and CALD groups.

In Melbourne, labour force decline also overlapped with more exposed or vulnerable populations, for example in south-eastern areas like Casey and Frankston and northern areas like Hume.

Two of the hardest hit employment sectors were retail and construction, with those jobs disproportionately concentrated in LGAs of concern.

Medical historian Peter Hobbins, the head of knowledge at the Australian Maritime Museum, says the link between inequality and the spread of a pandemic has been a feature of Australian society since the early days of colonisation.

Then, as now, people of low-socioeconomic status, living in crowded conditions, and unable to afford medical care or time off work, were more susceptible to catching disease and spreading it within their community.

“With the influenza pandemic in 1919, there were people who had to go out to make a living, get bread on the table, and couldn’t afford, or they didn’t feel they could afford, to take time off work,” Hobbins says.

“That had two consequences. One was they were more likely to spread the disease … but also that they tended to work for longer than they ought to and they had a much higher than expected death rate because they carried on in the face of the sickness.”

Nor is the blame game new. A century or two ago the prevailing rhetoric was about slums being full of the undeserving poor, Hobbins says, and when disease struck people said “they brought it on themselves” or “they brought it into our midst” or “they’re the ones perpetuating it”.

Hobbins says until the 1920s, health was largely considered a private responsibility but throughout the 20th century, the state took on more responsibility for public health, with hospital care, large-scale vaccination and other preventative programs.

After heavy reliance on state and federal governments to manage the public health and economic response to COVID-19 in the first two years of the pandemic, politicians are now placing higher emphasis on “personal responsibility”.

While emergency fiscal measures in 2020, such as JobKeeper and the Coronavirus Supplement, were effective in saving jobs and mitigating the worst effects of the crisis in 2020, Barnes says the policy response in 2021 and 2022 is much less comprehensive.

The strain on the states’ test-and-trace systems and the reluctance to provide free rapid tests for everyone is another example, Hobbins says.

“We’ve seen people giving up on the testing clinics and people accepting that they probably will get COVID,” he says. “These are in some ways to me a return to an earlier way of thinking.”

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