Other public policys
Public health – worsening indicators
On two indicators – vaccination and road fatalities – progress has stalled or is reversing, but we’re doing much better than the USA.
The long-term public health story is one of success, and those successes, mainly in the decline in infectious disease, are largely unsung. Governments rarely get credit for their good work, because that would undermine the right-wing idea that governments are incompetent, wasteful, and insensitive to community needs.
But in Australia two public health indicators, after many years of improvement, have been moving in the wrong direction. These are child vaccination and road fatalities.
Child vaccination
Peter Breadon and Mia Jessrim of the Grattan Institute have published their findings on child vaccination in The Conversation: Child vaccination rates are falling fast, with some regions barely reaching 80%.
Until the Covid pandemic came we were making good progress, achieving and exceeding national targets. Since then we have slipped back. They find that as vaccination rates have fallen there has been a resurgence of whooping cough, one of the early indicators of failing rates of vaccination. For highly infectious diseases, such as measles, our vaccination rates could be falling below the rates adequate to provide herd immunity.
Their analysis is at a fine level of regional analysis: in addition to the Conversation contribution they have a chart pack with regional data. Vaccination rates are low in inland regions, and in outer suburban regions within our large cities, but because there is so much variability within regions they warn that “There is no single profile for communities with dangerously low vaccination. They are in cities and rural areas, in wealthy and poorer areas, and in every capital city.”
Road fatalities
Because road accidents always make for good media cover we can gain the impression that little progress has been made, but over the long term there has been huge progress. In 1970 there were almost 4 000 road fatalities. Over the last few years fatalities have been around 1 300 a year. That’s a reduction from 300 deaths per million population to about 50 per million. Our roads really were dangerous 50 years ago.
That reduction is shown in the chart below, compiled from the Commonwealth’s road safety database.
Of concern to policymakers is not only a flattening of the curve, but also a rise in the rate, from 43 in 2020 to 48 in 2025. At first this looked like normal random variation, and it was off the low base of 2020 when Covid immobilised us, but it could be on the way back up.
The common explanation for this flattening is the “low hanging fruit” metaphor – seat belts, speed detection cameras, booze laws, safer roads, crash survivability measures such as airbags, more forgiving vehicles. Finding reasons for the uptick is more difficult. Also deaths are only one indicator: it is evident that many accidents that would once have been fatal are now survivable, leaving people with horrendous injuries, but injury data has not been collected with the same clarity as death data.
Our fatality rate compared with other high-income countries is shown below. Differences in vehicle use and ownership, in vehicle sizes, in geography and in climate, probably account for most differences between countries, but it is notable that, as with vaccination, the USA is the outlier.
Gen Z heads to the bush
Gen Z (aged 18 to 29 years) are increasingly likely to leave large capital cities and move to other regions, attracted by lower cost of living.
The Regional Australia Institute has announced that Gen Z leads Great Urban Exodus: Australia’s future workforce is heading to the regions. That’s a little dramatic: it’s nothing like young people’s escape from the plague in Boccaccio’s Decameron.
But there is a population shift. Around half of Gen Z now living in capital cities say they are likely to move to non-capital regions within the next five years. A lower cost of living, including housing, is the strongest pull factor.
Unsurprisingly people living in Sydney are the most likely to move.
Already subdivided for Sydney refugees
Beyond these broad findings, the survey commissioned by the Institute does not tell us much, largely because it uses a binary classification where the word “region” refers to everything that isn’t part of a capital city, as if there are strong similarities that characterize Orange and Oodnadatta, or Coffs Harbour and Collarenebri.
Are these Gen Z exiles seeking a bucolic lifestyle, or are they simply seeking to move to smaller cities? Are they being attracted to single-industry settlements or to regions with fully developed economies? These are important question for governments planning infrastructure, and for businesses seeking to locate activities.
We get some hint of an answer from the survey data: attractors such as a “sense of space” and “close to nature” are less prominent than cost of living. That suggests people simply want to move to smaller cities rather than to seek some off-grid bucolic lifestyle. If that’s the case we should be concerned that urban planning issues are not confined to our big capitals. Is there land-use planning for water supply, renewable energy, rail and freeway easements, recreational land, and other physical infrastructure outside these growing cities?
For more than half a century policymakers have blinded themselves to spatial developments, by using that “capital city”/”regional” classification. It ignores important regional differences within our capitals, particularly as they take on multimodal distributions rather than the traditional CBD-suburban model. And it ignores the extraordinary heterogeneity of the other 99.5 percent of this country.
For a brief time in the 1970s the Commonwealth recognized the need for a revised approach to regional policy when they established the Department of Urban and Regional Development. But its life was not much longer than that of the Whitlam government. The Country Party could not bear the idea that their regional electoral base could be eroded by the growth of urban centres, with libraries, art museums, universities and other corrupting institutions, and that their seats could be invaded by growing populations of young and liberal-minded electors.