cohealth’s submission to this review, undertaken by an independent panel and funded by philanthropists, looks at what worked well and what didn’t in Australia’s COVID-19 response. To better prepare for the next health crisis we recommend reducing health system fragmentation, having a clear focus on supporting communities that experience disadvantage and investing in community-led responses.
cohealth welcomes the opportunity to provide input into the Independent Review of Australia’s COVID Response. The pandemic has had, and continues to have, a significant impact on the physical, mental, economic and social health and wellbeing of the communities that cohealth works with.
cohealth is one of Australia’s largest community health organisations, delivering care from over 30 locations across the inner, north and west of Melbourne as well as statewide services across Victoria. cohealth provides integrated general practice, medical specialist, dental, allied health, mental health, alcohol and other drug, counselling, family violence, and social support services to more than 50,000 people each year.
People using cohealth services typically experience social disadvantage and are consequently marginalised from mainstream health services or require a higher level of care and support – such as people who are experiencing homelessness, mental illness, people who use alcohol and other drugs, Aboriginal and Torres Strait Islanders, refugees and asylum seekers, recently released prisoners, LGBTIQ communities and people with chronic and complex health conditions.
cohealth played – and continues to play – a major role on the front line of the COVID-19 response given our footprint in areas most impacted in Melbourne, providing testing, vaccination, health and social support and community engagement. During 2020 and 2021 cohealth provided assessment, health care and support to more than 10 percent of all COVID cases in Australia.
Throughout COVID we continued to provide our existing services, with some moving to telehealth provision, along with COVID safe outreach to clients’ homes to ensure they had food, medications, social contact and other essentials during this time.
This work gave us a unique and vital insight into how the pandemic impacted on individuals, families and communities.
Health burden – the communities of northern, western and inner Melbourne have experienced a significant health impact. Through 2020 and 2021 these areas, of relatively lower socio-economic status and where people had less ability to work from home and access sick leave, experienced higher COVID case numbers. Throughout the pandemic these communities also experienced higher rates of hospitalisations, ICU admissions and deaths of people from COVID.
COVID has impacted on the mental health of the community through isolation, loss of work and financial pressures. The hard lock downs of North Melbourne and Flemington public housing towers in July 2020, including highly visible policing, had a particularly significant impact on the mental health of residents.
The overall health status of communities is likely to have declined as a result of COVID infections; reduced access to health services; delayed check-ups and reduced monitoring of chronic diseases; the cancellation of elective surgery; and the significant increases in already long public dental wait times.
These impacts are likely to be felt long-term as all parts of the health system continue to be impacted by successive waves of COVID.
Economic burden – the loss of jobs and hours of work caused significant financial hardship particularly for people in casual jobs who experienced high unemployment. Additional costs such as for masks, sanitiser, digital devices for education and the like only exacerbated hardship.
Government financial support shielded many from the worst impacts and enabled them to isolate safely. However, some population groups were excluded from these payments – migrants, refugees and international students – and were left in dire circumstances, particularly in the first year of the pandemic. Charities, community organisations and social networks were left to provide vital support.
Social impact – increased isolation was experienced by many clients and community members, reducing their wellbeing. The long-term impacts of this are unclear. Increased reported incidents of racism, stigma and targeting reduced community cohesion.
Impact on services and workforce – enormous goodwill and innovation has been shown by services and workers to respond to community needs. At the same time the demands of long hours and extended crises has left many in the cohealth workforce feeling exhausted and burnt out at a time of high need amongst clients.
The initial economic and social supports provided by Federal and State governments to many affected by the public health restrictions and economic impacts of the pandemic – JobKeeper payment, Coronavirus supplement, accommodation for people experiencing homelessness, pandemic leave payments – were critical and protected many from the worst impacts of the pandemic. In addition to providing essential support, these provisions also demonstrated that major issues such as poverty and homelessness, and the impacts of casualised work, can be addressed when there is the political will to do so.
Services developed innovative responses to ensure the existing and emerging health and wellbeing needs of clients and communities were met. For some clients these new approaches, such as greater use of telehealth, improved access.
Governments of all levels adapted their standard, often lengthy, processes to enable new services to be rapidly established.
Although it was late in happening, government and health leaders listening to and engaging with diverse communities to ensure that culturally appropriate messaging and information reached all communities. This was most effective when communities were supported to drive their own responses, particularly through funding to employ community members, and when organisations were resourced to take services into communities. Some programs cohealth delivered demonstrating this approach include:
Inconsistent approaches and messaging from Federal and State governments, about the seriousness of the pandemic, public health measures and restrictions and vaccinations caused confusion and contributed to hesitancy to following measures.
The exclusion of some groups of people from eligibility for essential supports such as JobKeeper, Coronavirus supplement and concessional RATs, resulting in severe hardship for people from refugee and asylum seeker backgrounds, international students and migrants. Decisions were based on a person’s visa category rather than level of need.
Over-reliance, particularly early in the pandemic, on policing and enforcement approaches to compliance with public health orders. This approach failed to recognise the barriers many people faced to being able to isolate, particularly those ineligible for income support payments and working in casual jobs. Resulting fines had a disproportionate impact on communities already experiencing disadvantage.
The hard lock down of the public housing towers in Melbourne in 2020 was an extreme example of this, traumatising whole communities and eroding trust.
Late recognition that different approaches to public health messaging is required for diverse community groups, and that these are most successful when community led. This resulted in poor translation of materials, a lack of translated materials for smaller language groups and not using the most effective communication channels for particular groups. Once investment in community led health initiatives occurred, information and services were provided in community languages and in culturally appropriate ways, improving access and uptake.
Insufficient support for the community led initiatives that are most effective reaching diverse communities, including project funding that did not include salary component, preventing community members from being paid for their work. While there was a welcome increase in the employment of bi-cultural workers (BCWs), BCWs
and CALD community leaders have expressed frustration regarding organisations’ limited understanding of the complexity of BCWs roles, inadequate support systems, heavy casualisation, volunteerism and tokenism. Extremely short-term funding lengths (three months) provided no employment certainty and compounded the casualisation of the work.
Lack of the granular data to identify the most affected groups in the community and plan targeted responses. Vaccination data continues to be high level and does not identify cohorts by socio-economic status or cultural background.
Funding for COVID programs ending in June 2022 despite the high numbers of cases and the ongoing need for support – practical, medical/health care, housing, free/subsided RATs. This impacts particularly on already disadvantaged communities, reducing their ability to test and isolate.
National leadership is required to establish and embed cohesive national collaboration and consistency across governments, business and civil society.
Social structures and supports:
COVID highlighted the importance of the social determinants of health to our health outcomes, and the inequities that underpin them, such as having an adequate income, secure and appropriate housing, good employment conditions, health literacy and access to culturally appropriate health care. To reduce the risks from future health crises it is critical that governments address these issues, including by: raising the rate of JobSeeker payment; significantly increasing investment in social housing to start tackling the housing crisis; and reforming health care funding models to ensure equitable access to health care.
cohealth would welcome the opportunity to discuss this submission and our experiences in responding to COVID-19 in more detail. We would also welcome the opportunity to host a visit to our communities to meet those who were severely impacted by the pandemic as well as the health concierges and other staff who were at the front line of the response.
Please contact Jane Stanley, Advocacy and Policy Manager on email@example.com
 Acting Chief Health Officer Advice to Premier 1 July 2022 https://www.parliament.vic.gov.au/file_uploads/Report_to_Parliament_on_the_extention_of_the_pandemic_declaration__July_2022__D6HR8QrH.pdf
 See the report of the Victorian Ombudsman Investigation into the detention and treatment of public housing residents arising from a COVID-19 ‘hard lockdown’ in July 2020 https://www.ombudsman.vic.gov.au/our-impact/investigation-reports/investigation-into-the-detention-and-treatment-of-public-housing-residents-arising-from-a-covid-19-hard-lockdown-in-july-2020/
 Cohealth’s Bicultural Program 2021 2022 Evaluation Report https://www.cohealth.org.au/get-involved/bi-cultural-work-program/