Back in March 2020, with the first COVID-19 lockdown in place, and reports appearing of the way the virus was affecting people of colour in the USA and UK, I started to look at the research in Australia and the data in the government data collecting agencies about people our bureaucracies currently label CALD – Cultural and Linguistic Diverse Australians.
Then all the evidence from the worst of our allies proved indicative – meat works, nursing homes, crowded towers of poor people of colour – we had them all. And still as the death tolls rose, borders were frozen and lockdowns were intensified, no one thought it might be helpful to discover how the disease was tracking in different cultural communities. And that partnering with those communities might ensure the messages of safety and survival were accurately delivered where they were needed most.
The most abysmal outbreak occurred at St Basil’s Greek Orthodox Nursing Home in Fawkner, in the north of Melbourne. On 19 July, Neos Kosmos reported that the then 32 cases among staff and residents had taken off in a few days. As of 12 September 2020, the ABC reported 183 cases and 44 deaths (the home had 150 residents). On current figures, 150 Greek elderly died in the second COVID-19 wave in Victoria.
The Commonwealth report on the St Basil’s disaster released in December 2020 identified six key factors that contributed to the dozens of deaths and ongoing injury. None of them included any reflection on the fact that the authorities had no data that could track infection and testing numbers across the Greek community. Perhaps it was just that no one thought about the data question, as they believed it was not important or useful.
Well, no. The NHMRC COVID advisory committee, chaired by Prof Michael Kidd, knew all about it from the outset, as did its politicians– from the ALP and the Liberals. Both medicos who had communicated their concerns back to their parties.
The committee was anxious to identify the vulnerable groups that would require close attention and support. Migrants and similar CALD people were at front of mind, but unlike any other priority groups, they remained an unknown quantity.
This “don’t mention the war” attitude was the direct result of Government push back, both within the public service hierarchy at the time, and in the offices of key ministers.
I went through my networks in the ALP and made the case that the Opposition should be pushing for recognition of cultural groups as dangerously marginalised by the government policy position. I was told the Party had no problem with me pushing on the issue, but they would not support the argument.
I went through my contacts in the Liberal Party in NSW and the national government – having just spent three years as a member of the Multicultural SW Advisory Board. I came across entrenched resistance to any data collection in NSW from those with policy responsibilities in both the public service and politicians’ offices. I also learnt from Victorian multicultural policy people that communication with state Health had disintegrated, with any attempt by them to advocate for better strategies and data collection effectively disregarded.
Then as the debate re-emerged in late 2020, following the shifting of Kidd to deputy Chief Medical Officer, the mood changed. The pressure from the Federation of Ethnic Communities Councils of Australia (FECCA) in a detailed paper on data failures, combined with the realisation in Prime Minister Scott Morrison’s office that tracking infections was different to rolling out vaccines, resulted in a complete new initiative. Minister Hunt’s office was also very positive this time around.
FECCA convinced the Commonwealth that there should be a CALD advisory group, as there was already for Aboriginal and Torres Strait Islander health, Disability issues and Sport. In parallel, the Commonwealth should ensure the National Notifiable Diseases Surveillance System (NNNDSS) to introduce the collection of culturally diverse data.
Two important and immediate transformations were implemented. Firstly, the formation of a CALD advisory group that includes, health care experts, cultural minorities, and peak multicultural bodies. The advisory group started working with commonwealth department of health on communications and the vaccine rollout.
Cultural groups have now moved into partnership roles where their expertise is integrated with the public health skills. Minister Hunt agreed that the vaccine roll-out will include everyone in Australia. For instance, that the 40-80,000 non-citizens, including non-permanent residents, refugees, as well as visitors, who were missed in the pandemic testing period, are now eligible for vaccine for free. The danger remains their vulnerability to arrest by Home Affairs if they surface and are detected.
The second initiative has been the decision to include culturally diverse data collection in the NNDSS, using country of birth and language spoken at home. A move that I had called for in June 2020. This agreement has to be incorporated into all the jurisdictions in Australia, a slow but nevertheless relentless process. The first stage of this – data collection in the Commonwealth funded GP respiratory clinics – unfurled about a fortnight ago.
But what about Fawkner? In my research I could find only one “guerrilla” data raid anywhere in Australia – in Fawkner. An emergency doctor from Royal Melbourne Hospital was charged early on in the Melbourne winter outbreak to establish a pop-up testing clinic. He was a data nerd, (as many of us are), who rapidly developed an app. A really snazzy one, now widely in use in Melbourne hospitals. The app asked language, country of birth, and whether the user had access to COVID19 safety data in their own language.
In the first week they covered over 30 percent of the Fawkner area population, 90 percent of whom used the app. There was no resistance reported to supplying the data. The process package included Redcap data collection, and an integrated health demography survey using ABS data definitions. This last was critical as it allowed everyone to be located by census area and produced a profile of which groups were and were not getting information and getting tested.
The report on this project went up the line – in so far as there is one in Victoria’s Department of Health and Human Services – and disappeared apparently without trace. Over a third of the respondents were those who spoke languages other than English (LOTE), who typically got their information from social media, or the Internet (far more than English speakers).
They were massively under-represented in testing, with Greek and Urdu speakers the most under-represented. This data was collected just as people began to die in St Basil’s and the network around it.
The two big outbreaks around Fawkner occurred among Greek and Urdu communities – and no one saw them coming. Except of course they did but nobody wanted to know. That’s why to see cultural diversity as a critical dimension of health is so important for the future well-being of multicultural Australia. Mr Hunt’s public commitment in this area for data funding in communication and support, added to the real changes in data collection, may mark a game-changing step forward towards a more reality-based multicultural Australia.
Andrew Jakubowicz is emeritus professor of sociology at the University of Technology Sydney, and a member of the COVID CALD advisory group mentioned in this opinion piece. For more work by Prof. Jakubowicz: https://andrewjakubowicz.com/author/m5stories/