The federal government last week passed legislation to expand the trial of the cashless welfare card to other areas of Australia. The controversial policy quarantines 80% of welfare payments to Indigenous Australians living in the Ceduna and East Kimberley regions of Western Australia and cannot be used on gambling, alcohol or to withdraw cash.
The passing of the legislation comes as an inquest into 13 Aboriginal youth suicides in the Kimberley region is hearing about the welfare card’s impact. It’s also a few weeks after mining billionaire Andrew Forrest’s philanthropic organisation, the Minderoo Foundation, together with regional councils and outgoing WA Police Commissioner, Karl O'Callaghan, were conveyed to Canberra to advocate for the card’s expansion.
The lobbying came in a video designed to shock with emotive descriptions of child abuse and footage of children lifted by their hair and stomped on. It implied a strong link between violence against children and income management. Forrest and his supporters were strategic in promoting income management and showing their video before appealing their case to the Prime Minister.
While we can’t necessarily attribute the trial’s expansion to the success of the campaign, it shows evidence-based approaches, which speak against continuing the policy, have been ignored. This is another case that adds to growing concern among researchers that evidence-based policy formulation is being threatened by easily-digestible, emotive campaigns.
Does income management work?
The Minderoo Foundation and some community members promote the cashless debit card as it cannot be used to buy alcohol, gambling products or to withdraw cash. While not a panacea, they believe it will be a potential circuit breaker as it “… gives community services a chance, that gives health workers a chance, that gives the police a chance”.
The government has long been using income management as a child protection tool. Yet there is little evidence to suggest income management policies improve children’s well-being.
An evaluation of income management in the NT in 2014 found people subjected to child protection income management made up a small proportion (0.5%) of the overall income management population. So evaluating whether the policies worked was difficult. Instead researchers relied on interviews with child protection staff which were varied.
Meanwhile, the Royal Commission into the Protection and Detention of Children in the NT has heard that child protection notifications, substantiations of these, as well as out-of-home placements had all more than doubled since 2007.
If the card’s aim is to reduce alcohol-fuelled violence in general, the evidence is again unconvincing. The NT evaluation above revealed no statistically significant changes in the level of reported problems for either those on compulsory or voluntary income management. But it did show the direction of change was towards a relative worsening of problems due to drinking.
Dr Elise Klein, who is researching the cashless welfare card, told the inquest into the suicide of Indigenous youths it is an “oppressive scheme” representing neocolonialism and government overreach.
Indeed, the government has a long history of restricting an individual’s choices supposedly in their best interest. One example is the Aborigines Act 1902, which resulted in a Chief Protector who was “the legal guardian of every aboriginal and half-caste child to the age of 16 years”.
Colonisation’s damaging effects across generations is an issue shared globally by most Indigenous people. The suggested reparation work is the first step in tackling the social determinants of health which are many including education, employment and income, with education being the most potent.
The next step is to tackle the causes of the causes, which will only occur if there is support from the highest political levels. In the absence of this, lifestyle driftthrives whereby policy initiatives to tackle inequalities in health that begin with a broad social determinants approach drift down in favour of blaming individuals for becoming sick as a result of their poor lifestyle choices.
It is easier for governments to support healthy lifestyle promotion programs despite the risk that sometimes these approaches are ineffective and even counterproductive. In addition they can increase inequality.
A spray-on solution
With the perception that truly addressing the social determinants of health is too hard, it is understandable why the cashless welfare card is attractive. It is easier to spray-on a solution rather taking responsibility for tackling underlying public health and social policy issues. However, taking the easier option is a health risk.
The principle of “let the data do the talking” to influence government polices is failing. Data can be hard to access requiring subscriptions or payment, whereas news of the Forrest campaign was readily accessible. The message was also straightforward, while researchers don’t have a well resourced foundation to assist with conveying complex concepts.
Researchers are rarely as high profile with political influence and are vulnerable to having their research buried. This experience reveals the need for academics and scientists to better understand the policy process, to step up and be more political and actively involved in advocacy. Forrest et al have provided a lesson on how to do it.
Michael Bret Hart is affiliated with the Social Determinants of Health Alliance as chair and is an Independent Board Director of Puntukurnu Aboriginal Medical Service and deputy chair of the Board of Wellbeing in Schools Australia.
Authors: Michael Bret Hart, Adjunct Clinical Associate Professor Curtin Medical School Public Health Physician, Curtin University