Long before this place was an important university, it was the home of the Anewan People, who inhabited the lands and waters for millennia and passed their teachings down from generation to generation.
I pay my respects to the Anewan elders past, present and emerging.
Its time past time to match those words with deeds.
The sad fact is that we are not on track to close the gap in life expectancy or health outcomes, as we as a nation have promised to do.
We can and we must do better.
It is an enormous honour to have been asked to give the 2020 Earle Page Lecture.
I particularly want to thank the University for persevering. I was originally slated to be here earlier in the year, and weve had a few false starts for obvious reasons.
A particular hello to the people who would normally be here in person but are instead joining us online.
There are really three reasons Im honoured to be with you.
First, Im proud to join the list of distinguished Australians who have given this lecture which of course includes Malcolm Fraser, John Howard, Julia Gillard, Tony Abbott, Anthony Albanese and Penny Wong.
Second, tonight is a chance to celebrate the Earle Page College and the University of New England, and not just because both my wife and I are proud to have UNE degrees.
Strong regional economies are vital to a strong national economy and universities like UNE play an absolutely vital role in nurturing regional communities and innovation.
On a personal note, I also want to pay particular tribute to UNE for its ongoing commitment to teaching Indonesian.
When I decided to learn Indonesian several years ago, I turned to UNE.
More and more Australian universities have closed their Indonesian programs, in a massive backwards step for our understanding of our region.
We live in uncertain and unstable times.
A better understanding of and closer, less transactional relationships with countries in our region are vital.
And to my UNE Indonesian lecturers, it gives me a chance tonight to say:
Ibu Indra dan Pak Zi. Terima kasih atas mengajariky Bahasa Indonesia. Saya akan melakukan yang terbaik untuk terus belajar dan mendukung hubungan Australia dengan Indonesia.
Third, Im also pleased to honour Earle Page himself.
Its not obvious that the Labor Shadow Health Minister from Western Sydney should be invited to give a lecture honouring a former Country Party Prime Minister from New England.
But in these hyper-partisan times, we should recognise that people of good will and achievement have sat and continue to sit on both sides of Parliament.
When I wrote my book The Money Men, which focusses on Australias twelve most notable treasurers, I chose Page to be one of them.
Indeed I gave him mention as one of the upper rank of treasurers and said of him he was an anchor of stability in a long term Government and engineered long lasting reforms to Commonwealth-state financial relations
And Ill share a secret with you. I hope to emulate Earle Page and join him in a very small club.
You see, Page is one of two Australians to have served as both Treasurer and Minister for Health.
The other was Stanley Bruce. Two conservatives.
No-one in the Labor Party has held both offices. (The great Bill Hayden was Treasurer and also introduced Medibank, but he did so as Minister for Social Security).
Both Page and Bruce served as Treasurer first, then Health Minister - exactly the pattern of service I hope to emulate.
I want to do this because I understand that a healthier society and stronger economy go hand in hand.
A healthier society is a more productive one. A good economy is a good society.
This is really what I want to talk about tonight: using the jolt of COVID-19 to rebuild our economy and renew our society.
Tonight, I essentially want to offer three propositions.
First, that we must be better prepared for the next pandemic, and must tackle other health threats with the same urgency as COVID-19.
Second, that our health is shaped by our economy and our society, and that we must address the pandemic of insecurity.
The phenomenon of insecure work the gig economy has real implications for the health of individuals and our society as a whole, and we have to be honest about this.
And third, that all of this relies on good government, and that governments and alternative governments must learn the broader lessons of 2020.
More, that we take the misery and dislocation of COVID-19 and make it a hinge moment. We have to use the pandemic as a rare opportunity to reset our approach to governing.
COVID-19 and future pandemics
Unfortunately, pandemics arent black swan events.
In the last two decades alone, weve seen SARS, H1N1, MERS, Ebola and Zika.
And the most obvious lesson out of this pandemic is that we need to be better prepared for the next one.
The global world we live in, along with changing habitats and environments, makes pandemics a certainty into the future.
Theres no reason to think a future pandemic wont also present challenges even bigger than this one.
We have given bipartisan support to the Government, indeed to all governments state and federal, for the steps that have been necessary to tackle COVID-19.
But it is also incumbent on us to point out that we could have been better prepared.
We went into the pandemic with less than one mask for every Australian in our National Stockpile, an overreliance on global supply chains, and badly stretched aged and health care systems.
And the pandemic further exposed well known weaknesses in our health care infrastructure, like chronically under-funded and under-valued aged care.
As the President of the AMA put it recently, COVID-19 took the world by surprise, but its effects on the aged care system were entirely predictable.
Other health threats
But as important as pandemic preparedness is, we also need to have a broader conversation about the health of our nation.
We have to treat some of the other threats to our countrys health with the same sense of urgency.
Since January, weve spared no effort or expense in the fight against this virus.
But year after year, we fail to tackle other health threats that are killing Australians.
We spend a miniscule proportion of our nations health budgets on preventing chronic disease, despite the fact it afflicts one in two Australians, and contributes to 90 per cent of deaths in this country.
Every year, 1.3 million Australians skip primary care because they cant afford it, and another two million skip dental care.
In our public hospitals, one in three emergency patients are not seen on time.
And perhaps most damning of all, weve taken no real action on climate change, despite the World Health Organisation calling it the defining health issue of the 21st Century.
Ive already mentioned the impacts of these failures on First Nations peoples.
But theyre also on stark display in Armidale and other regional and rural areas.
Because its a tragic fact that life expectancy falls as remoteness increases.
Its 82 years in our cities, 80 in our regions, 76 in remote areas, and just 67 in very remote areas.
People in regional, rural and remote Australia die up to 15 years earlier on average.
According to the Commonwealth Fund, Equity and Access are the areas pulling us back from becoming the best health system in the world.
We have all the tools of an excellent health system but where you live and what you earn too often determine your ability to use those tools.
So we must be better prepared for the next pandemic. But we also need to treat other health threats with the same urgency as COVID-19.
Centre for Disease Control
Thats why last week, Anthony Albanese and I announced that a Labor Government would establish an Australian Centre for Disease Control.
Australia is the only OECD country without a CDC equivalent, and experts have been calling for one for over three decades.
Now, a CDC isnt a silver bullet. As weve seen tragically in the US, a CDC must be accompanied by strong political leadership.
But an Australian CDC would focus on pandemics all the time after COVID-19, and before the next one, making sure we are better prepared.
When outbreaks do occur, it would provide rapid and consistent advice to all governments Commonwealth, state and territory.
And as in other countries, an Australian CDC would have a broader public health role.
It would work to control all diseases be they infectious like COVID-19, or non-communicable like heart disease and diabetes.
Because as Ive said, other challenges threaten our health at least as much as COVID-19, and both deserve an ongoing focus.
Social determinants of health
When we talk about health, we tend to talk about health care.
As a country, we think less much less about why we stay healthy or get sick in the first place.
But the conditions in which we grow, live, work, and age and the political, social, and economic forces that shape them determine our health outcomes.
One of the most important health thought leaders in the world is Sir Michael Marmot, who incidentally trained at the University of Sydney and Royal Prince Alfred Hospital like Earle Page.
Marmot calls these forces the causes of the causes.
Not just whether we smoke, or carry too much weight, or eat badly the causes of ill-health.
But why we do those things.
More than a third of the health gap between First Nations and other Australians is due to the social determinants like differences in incomes, employment and schooling.
When you add health risk factors like smoking, you account for more than half the health gap between First Nations and other Australians.
Or to put it another way less than half the gap relates to access to health services.
So, to improve the health of First Nations peoples, and all Australians, we need to address not just access to health care.
Not just the direct causes of ill-health.
But the causes of the causes.
Socioeconomic position. Early life and education. Social exclusion. Employment and work. Housing and homelessness. The built environment.
All of these shape our health in powerful ways.
If we are going to make a real difference to the health of Australians, we are going to need to move closer to a Health in All Policies approach.
The World Health Organisation says health in all policies improves the accountability of policy makers for health impacts at all levels of policy making.
This approach recognises that policy decisions way beyond the health portfolio have health implications which must be considered when they are being made.
And tonight, I want to focus on one of the most fundamental determinants of health, and thats employment both its existence, and its nature.
The first economic responsibility of any government is to keep unemployment as low as practically possible.
This is particularly important as Australia suffers its first recession in three decades.
Thats why wage subsidies which Labor suggested and the Government resisted have been so important in 2020.
And its why it makes no sense to cut them while were still in the middle of a pandemic.
Because jobs good jobs are important for any number of reasons including that they shape our health.
Its well-established that unemployment is terrible for both mental and physical health.
And right now, thats particularly bad news for young people.
Between March and April, almost one in three workers aged 18 to 24 lost their jobs.
And while things have improved slightly as our economy has begun to reopen, the actual rate of employment for young Australians remains under 60 per cent.
Partly thats because young Australians make up more than half the workforce in the industries that have been hit hardest - hospitality, retail, culture and leisure.
And partly its because half of all young workers and 80 per cent of young workers in those particular industries are on casual contracts.
And Im concerned that as young people gradually return to employment, that figure of casualisation might actually grow even higher, as employers hire young people back.
Not only is unemployment bad for your health, so is insecure work.
If we are to adopt a health in all policies approach, we should be very concerned about the health impacts of increasing casualisation and insecurity.
More and more, when someone enters or re-enters the job market, they get an insecure job.
In fact, as the Melbourne Institute has recently highlighted, Australia has one of the highest rates of casualisation in the OECD.
One in four Australian workers is a casual. Half of those have no guaranteed hours.
Thats a problem for very many reasons, including what Marmot describes as the overwhelming evidence that job insecurity damages health.
Its not surprising that insecure workers face increased stress, anxiety, and other mental health challenges.
Studies show that the fear of losing your job is just as harmful as the actual experience of unemployment.
Not as obvious, but equally proven, is that this sort of work has physical implications too.
Taken together, 21 studies show a 34 per cent increased risk of heart disease for insecure workers.
And these health impacts are most prominent where job insecurity is thrust on people by circumstances beyond their control - in other words, exactly what we have seen this year.
Its critical we pay attention to this, the nature of work, in our shaping of Australia on the other side of COVID.
We live in the age of the gig economy, of omni-present Uber and other platforms to connect labour with people who need labour.
These have brought convenience and efficiency for everyone and thats pretty much all of us - who have used one or more of these new platforms.
And its true that some gig workers, like Uber drivers, welcome the flexibility and enjoy the social interaction that comes with the job.
Some, but by no means all.
These platforms have stretched the relevance of industrial conditions and protections to breaking point.
And that has real downsides for many of those who have no choice but to subject themselves to this working environment.
In her book Uberland, Alex Rosenblat argues that Uber and similar services have created a fundamental shift in what it means to be employed.
In particular, she argues that these services brand themselves as job creators, but have decoupled employment from employment rights.
And a recent survey of Australian rideshare and delivery drivers by the Transport Workers Union bears that out.
Three in four of these drivers wish the way they were engaged in work was different that they were employees, not independent contractors.
When you take into account all of the variable and fixed costs and income, these workers make an average $10.42 an hour.
$10.42 an hour. In Australia. One of the wealthiest countries in the world. In 2020.
Not even $100 for more than a full days work.
Thats consistent with broader evidence that 38 per cent of Australians who live below the poverty line are actually in work.
Its no wonder 71 per cent of these drivers are struggling just to pay the bills and buy groceries.
And even at the most basic level, the health implications of insecure casual work are there for all to see.
Sick leave is used for medical appointments and stops infectious people coming to work.
Gig workers without sick leave, reliant on every gig to make up a basic income, are likely to put off medical appointments leading to them being sicker.
And they are more likely to come to work when ill, putting their work colleagues and clients at risk of illness.
If COVID has taught us anything, it is that these precarious employment arrangements are an increasing risk to public health.
Pandemic leave has had to be introduced in the teeth of COVID-19, but we have hundreds of thousands of workers without access to sick leave every day in the non-pandemic environment and that is just as dangerous.
And if and when these workers do become seriously ill or injured, they dont enjoy nearly the same safety net.
Employees covered by NSW workers compensation laws are entitled to up to $110,000 in payments for medical costs, and ongoing weekly payments of up to $2,200.
But for Uber Eats drivers for example, medical payments are capped at $5,000, and weekly payments are half as much, and for only 30 days.
And its not just that.
Shift work has real health implications.
Plenty of studies show it. But I know it.
My Dad was a shift worker all through my childhood. For many years, he worked permanent midnight shift, catching up on sleep as well as he could during the day.
The health impacts are inescapable.
But at least my Dad and the thousands of other shift workers worked in a regulated environment, in which health impacts were considered in rostering and things like minimum breaks.
Insecure workers, catching as many shifts as they can with different platforms and at all hours receive no such consideration.
Of course, insecure work can look different in different places.
Rideshare and food delivery services are less common in regional and rural areas, which dont always have a critical mass of demand.
But as you know all too well, these areas have faced a different challenge in recent decades the flight of human capital to cities, and increasingly precarious work for those who remain.
And many young people who do leave the regions for the cities find they are thrown into precarious and insecure work on arrival.
Whatever its causes, when the nature of work creates conditions where people cannot meet their basic living requirements, then that is a problem for our health, our economy and our society.
So jobs good jobs are vital to Australias health.
Now Im no luddite. Im not suggesting we can or should wind back the clock to the era before we could tap our phones for an Uber or ask Airtasker to help us find someone to do some paving around the house.
But we must recognise the real and cancerous impacts of the growing workplace insecurity.
And governments must consider how our regulatory system needs to be updated to deal with it.
To me, this really comes down to a basic question.
What kind of society do we want?
A big part of Labors mission has been to avoid the development of an Australian under-class.
Our system of industrial arbitration and protections and our highly targeted social welfare system were both designed with this explicit objective.
Are we to now stand quietly by and say we are happy for such an under-class to develop because we think technology gives us no choice?
I say, no.
This is not impossible. Unions NSW and Airtasker showed a couple of years ago what is possible when they, to the credit of both parties, struck a deal around basic protections for service providers on Airtasker.
And as in so many areas, New Zealand is currently showing us a way forward.
Jacinda Ardern has invited one of her National Party predecessors as Prime Minister, Jim Bolger, to advise her Government on how better to regulate the labour market in this environment.
And Bolger has freely recognised that a laissez-faire approach like the one he once championed is not fit for purpose in this gig economy.
In Australia, we need a federal Government which doesnt use COVID to wind back industrial protections.
We need a Government that recognises those protections should be refreshed and updated to reflect these massive socio-economic changes.
Weve dealt with the COVID pandemic well so far.
We havent even started to tackle the pandemic of insecurity, with all the implications that it has for the health of individuals and the health of our society.
Some might argue that Im asking for a lot tonight.
Well, I plead guilty. Im ambitious for our nation.
And my third and final point is that COVID-19 has shown that governments can still do good things great things with force of will.
For a decade or so, Australian politics has been consumed by a series of toxic debates most spectacularly on climate change, but on other issues too.
Many Australians have come to believe that government is no longer interested in their lives, or able to improve them.
Thats one of the major drivers behind the political disengagement that is now well documented.
But COVID-19 gives us an opportunity to reset the political discussion and offer a new compact with the Australian people.
Because our response to the pandemic shows what is possible when governments actually apply force of will to seemingly intractable problems.
Lets take an international example.
In Britain, the Conservative Government had a target of reducing homelessness by 90 per cent in five years.
When the COVID crisis hit and Whitehall was concerned that rough sleepers would become a vector for the virus, this target was met in two days.
An ambitious government target, met in 48 hours.
It was a similar story in Australia.
Out of the estimated 8,200 rough sleepers here, an impressive 5,000 were temporarily sheltered in the early weeks of the pandemic.
And a final example. Australia entered this crisis with around 2,000 intensive care beds and ventilators.
That was less per head of population than Italy. The fear that ICUs would be overwhelmed here - as they were there - drove much of the effort to bend the curve in Australia.
To the credit of all involved, we now have around 7,000 intensive care beds. Thats a big achievement in a few months.
Martin Luther King talked of the fierce of urgency of now. We have all been living the fierce urgency of now this year.
When this approach is applied, when ideology is set aside, when prime ministers and premiers of good will work together to fix an urgent problem, a lot can be achieved.
But heres the caveat.
Our response to COVID-19 has been effective because we have focussed almost exclusively on the pandemic.
Too often, governments try to do too many things.
Thats a particular problem for Labor and other parties of the centre-left, who rightly see problems everywhere and want to fix them all.
But when we try to boil the ocean, we fail.
Thats one of the lessons of our time in Government, and particularly of the last election.
Im not arguing for less ambition.
But I am arguing for more focus, so that effort and investment can be concentrated on the greatest challenges.
And Ive nominated some starting points tonight.
Its often been said that you should never let a crisis go to waste.
Its often said, because its true.
The COVID crisis has taught us many things.
That we werent as ready for this crisis as we could have been.
That we need to be more ready for next time.
That investments in public health, including aged care, are just that: investments that pay back many times over when it counts.
That more and more of our fellow Australians are facing precarious, insecure employment and this has implications for their health, and the health of our country.
And that when governments turn their mind to something, focus on it and co-operate with other levels of government, seemingly intractable problems can be tackled and solved.
We should be less willing to accept that some problems are just too hard. We can make a real difference.
All this leads me to the conclusion that we can and must come through this crisis a stronger society. An even better country.
With stronger public health and more security in our working lives.
Its down to all of us to make it happen.
Long before this place was an important university, it was the home of the Anewan People, who inhabited the lands and waters for millennia and passed their teachings down from generation to generation.