Time for a Living Wage floor in public health

By Julie Douglas and Heather Came, Auckland University of Technology

The Public Health Association is committed to the improvement of health outcomes, particularly for Māori and Pasifika peoples in Aotearoa. They argue that paying a Living Wage to all workers employed and contracted by health services is an important part of any strategy to alleviate poor health outcomes.

It has been clearly established by the UN that everyone has a right to health, and also that income is a key modifiable determinant of health. A World Health Organization survey found people in the poorest socio-economic status quintile were twice as likely to experience poor health than those in the wealthiest.

Therefore eliminating poverty, through initiatives such as implementing a Living Wage policy, remains an important and obvious strategy to address health inequities. As Treasury has identified, a minimum wage has never been seen as a way to reduce poverty and is only part of a range of strategies needed. The use of a Living Wage strategy affords a level of autonomy and dignity that minimum wages and state supplements cannot foster.

Good incomes lead to better health as they allow for the improvement in outcomes of housing, education, nutrition, and health services engagement. Therefore, we argue that it is counter intuitive for health services to pay inadequate wages given their responsibility for good health outcomes of their populations.

Data from official information requests to health services found that only two of the 20 now superseded District Health Boards (DHBs) were considering paying a Living Wage. The other 18 stated a position of following any government directive. This passive position appears to contradict their own Employment Relations Strategy 2019-2024 document which states the DHBs are committed to “lifting the pay of the low-paid workforce” and importantly “reducing poverty and inequalities by leveraging our employment footprint”.

Health services are in a unique position as they are often very significant large employers in regional New Zealand. This affords them the power to influence wage setting in these smaller communities. Ultimately, this could contribute to their goal of poverty elimination.

While there may not be large numbers of employees in health services paid under the Living Wage level, this does not diminish the urgent need to focus on wages in this area. These staff tend to be in non-medical occupations but still part of the team delivering quality health care services. It must not be overlooked that every worker paid less than a Living Wage is at risk of in-work poverty and all the diminished socio-economic outcomes this creates for the individual and their dependents. Indeed, there may be a positive financial outcome in the long run as improved health outcomes reduce cost to the public health services.

There have been decades of inaction on health equity in Aotearoa and despite targeted legislative and policy imperatives there has been limited improvement in Māori health outcomes. Māori are over-represented in the lowest wage brackets so we argue that paying a Living Wage would disproportionately lift Māori households out of poverty. This is unequivocally a logical response to in-work poverty and poor health, particularly in the health sector.

The Public Health Association is clear – we need to stop talking about the determinants of health and take some real action that creates change in the lives of those that need it most.
There is a great opportunity with the newhealth entities in the sector restructure to prioritise this employment goal. To this end, the lobbying and education work of the Public Health Association continues to push for fair and decent wages in the health sector. This is key if we are to achieve Decent Work and decent health, particularly for Māori, in New Zealand.