If Socrates was to suggest how minimal and better directed funding could be best used to improve the health and welfare of the community members, perhaps this story by Melissa Sweet about Miller, a suburb of South West Sydney, and its people is the best example.
For a relatively small amount of funding local communities could be empowered to improve their own health and welfare services without the interference of those who may not have such a proven record of doing this, or who may not have the same vested involvement in a community healing itself.
Understanding Miller “Locational disadvantage” has an enormous impact on the lives of residents in many Australian suburbs. But an experiment in Sydney’s 2168 postcode area is yielding results, writes Melissa Sweet
28 March 2011
Connecting with The Hub as a volunteer was a turning point for Stephen Williams (above, talking to Synthia Clark from neighbouring Green Valley), who became one of the dozens of local residents contributing to the Miller Street Art Gallery.
Photo: Mitchell Ward
THE sun is intense as I drive back to Miller, a suburb of some repute in Sydney’s sprawling southwest. I’ve been visiting for a year or more, but my picture of the area is still full of contradictions and unanswered questions. This time, I hope, I’ll finally see the place in a clear light.
On this Friday morning, the carpark outside the rundown shopping centre is packed. People are hanging around the entrance to the Green Valley Hotel. Nearby, the pawnbroker’s doors are open, and a sign on the window lists the “ten top wanted goods.” (At the top of the list are PlayStations, Xboxes and mobile phones.) I make my way past the two-dollar shops and across the road to Miller Square, where a few people are sitting on a brick wall by the library, drinking. They seem out of place, sitting in front of the metres and metres of murals and mosaics that brighten the walls and distract from the faded brick flats nearby. Beyond is the patchwork of public housing that dominates the area.
The artwork seems to be saying – in a voice that’s not entirely convincing, perhaps because it knows you can never entirely escape your past – that this is a friendly place where anyone is welcome. The bright paintwork on the exterior of the community health centre spells it out more explicitly: “Welcome to The Hub.” And as I push open the door another sign gives a different message, warning that offensive or aggressive behaviour will not be tolerated.
Perhaps it’s not surprising that visits to Miller usually leave me confused; it is a place of such mixed messages, of hope and pride as well as despair, frustration and anger. But the story of this suburb is worth trying to understand because it says much about the connections between where people live and their prospects, their wellbeing and their health. It also says something about how government policies and programs can both help both to create and to ameliorate the problems of people living in suburbs like Miller.
In the jargon, this area of “locational disadvantage” matches all the usual indicators: low education levels, unemployment, poverty, family dysfunction, and mental health and drug and alcohol problems. But this is also a place where an unusual project has brought together local residents with government and community agencies to work for change.
The Community 2168 project – a reference to the local postcode – began in 1999 with three agencies, the Liverpool City Council, the state Department of Housing and the local health service, pitching in $30,000 each. Described as a “major community renewal and capacity building partnership,” it began in response to a crisis in public safety alongside the closure of the bank, the police station and other local services, which left residents feeling abandoned.
Community 2168 has set up forums for residents and local service providers – including local NGOs, police, the council, and housing, health and community services – to come together to identify problems and devise ways of dealing with them. In the early years, the focus was on tackling crime, through policing and prevention measures, and increasing the range of services in the area. A smart new Police and Community Youth Club was set up, for example, and parks and other public areas were upgraded.
As the community’s priorities shifted, the project focused more on developing the skills and capacity of locals through initiatives such as art and cultural activities, volunteer programs, an annual employment and education expo, grants for local groups, and the creation of community gardens. Community 2168 has often acted as an incubator, helping to establish a new program or service and then passing it on to other agencies.
Anita Hanna, a social worker who ran the project for four years and continues to be involved through her new position as coordinator of community development for Liverpool City Council, is full of enthusiasm for its achievements to date and potential for the future. “I really like working in the 2168 area,” she says. “The people are wonderful, enthusiastic, always putting in hard work to get things happening.”
Ms Hanna says the project is moving towards a social enterprise focus, and its next major venture will be establishing a “people’s shed” later this year, which will provide a hub for diverse activities, including a men’s shed, artisan and trades projects, and a food market. In the longer term, she would like to see the project’s approach rolled out more widely. “What I like about 2168 and what I think it’s done more than anything is develop a model that works in locationally disadvantaged areas,” she says.
Given the unending cycle of policy shifts and restructuring that bedevil public and private sector agencies, it seems a minor miracle that the project has lasted so long, and with so many of the original players still involved or at least in contact. Many other programs in the area have come and gone during that time.
It is also unusual, at a time when disadvantaged communities are often subject to top-down, punitive “welfare reforms,” as are apparently mooted for the forthcoming federal budget, to see a genuine attempt to engage communities themselves in creating the changes they want. This philosophy wasn’t evident back in the 1970s, when top-down state government policies brought high concentrations of public housing to an area lacking in services and infrastructure. Many local residents and agencies blame those policies for the area’s current problems.
The 2168 project also stands out as a rare effort to tackle the social and economic factors that shape the health of individuals and communities. The “social determinants of health” receive plenty of rhetorical attention, but there is far less investment in action to tackle them. We prefer to spend billions on acute healthcare services, which are often ill-equipped to pick up the pieces of social disadvantage, when intervening in the root causes of so much poor health is clearly a more effective approach.
Perhaps one of the reasons that funding priorities are so often askew is the difficulty of telling the stories of places like Miller. These are often complex, lack simple take-home messages, and are ill-suited to the short attention spans of political debate and much of the mainstream media. In fact, many of the locals remain as resentful of the media as when a young filmmaker called Peter Weir came to the area in 1973 to make a spoof documentary about how media coverage stereotyped the locals as losers.
Apart from its lessons for the national social policy agenda, some think that the 2168 experience offers lessons for the federal government’s controversial health reform process. It is notable that the social factors underlying ill health do not rate even a mention in the government’s recently released guidelines for the new primary healthcare organisations to be known as Medicare Locals.
According to Peter Sainsbury, a public health specialist with a distant involvement in Community 2168, the project exemplifies many of the qualities of real primary healthcare. Although primary healthcare is often conflated with the work of GPs, its proponents see it as encompassing much more than healthcare services. In its fullest sense, it is based on principles such as community participation, multidisciplinary and intersectoral action, political advocacy and health promotion.
The 2168 project is special, says Professor Sainsbury, because of the deep level of engagement by both professionals and local residents, as well as the effective collaboration of local agencies. “The difference in Miller,” he says, “is that the professionals know the patch; they know the people, they know the other service providers. They do work together to provide something approaching comprehensive primary healthcare.”
BACK inside The Hub, I find Stephen Williams, with shaggy grey beard, thick black eyebrows and Aboriginal colours on his T-shirt, sitting at a table with paintbrush in hand. He is making posters to advertise the Miller Walkabout, a walking group that is one of many activities run from the centre with the help of volunteers.
He shows off a large tabletop nearby, which he has decorated with a snake and other motifs of bright colours – lime green, pinks and oranges, as well as red, black and yellow. “And these are the South Sydney colours,” he points out with a smile. Mr Williams has lived in the area on and off for much of his life – ever since his mother moved her children here from a blacks’ camp near Cowra, to where she and her family had been relocated from their homelands.
He pauses to wave off a group heading out on a cycling expedition, before explaining that he moved back here several years ago to nurse his mother, Dorothy Williams, for the last four years of her life. “When she passed away I just fell in a heap,” he says. “She was my main person, she was trying to be a father and a mother. I just didn’t feel like doing anything. I lost the will to work.”
Connecting with The Hub as a volunteer has been something of a turning point for Mr Williams, who became one of the dozens of local residents who contributed to the Miller Street Art Gallery. The artwork has made a big difference to the neighbourhood, he says, but he’s still not at all happy about the behaviour of some “no-hopers.”
Outside, as he shows me around block after block of murals, Mr Williams tidies the street, pausing to put an empty beer bottle in the bin and shift an abandoned shopping trolley. The streets have more than their share of debris, but are much improved over the bad old days when this area was known as “the Miller drive-through” – drugs were sold openly to people in passing cars, residents were afraid to leave their homes and kept awake by unrest, and the community health centre was firebombed and emblazoned with graffiti warning “no go zone.” It was, as one community worker remembers, “this haunt for all the dead beats, the druggos.” It was not a place where service providers wanted to be.
As Mr Williams shares the bare bones of his own story, it becomes clear how his life has been shaped by racism: the slurs, even more hurtful when they came from young children, the fights, the long journey to understand how his own story is part of a much bigger one. “Growing up with so much racism, it really brought me down,” he says. “I’ve come out the other side of that and I’ve survived that.”
Stigma and discrimination are a problem for 2168 residents at many levels. There are tensions between the old-time residents, who remember when there were still farms in the area, and the newest arrivals, many of whom speak Arabic, Vietnamese, Hindi or Spanish at home. When researchers associated with the 2168 project employed local residents last year to conduct a door-to-door survey, the team spoke twenty-one languages among them.
The Liverpool area is one of the most multicultural in Sydney, with around 44 per cent of residents born overseas, and it is expanding rapidly. But infrastructure and services already struggle to cope. The latest state government projections suggest that by 2036 the area will be almost as large as Canberra is now, with a population of about 325,000 people, an increase of more than 75 per cent on the current figure.
Not all locals like the concept of multiculturalism. Elizabeth Harris, of the University of New South Wales’s Centre for Health Equity Training, Research and Evaluation, which is based at Liverpool, has been involved in evaluating the 2168 project since its inception. Known for being a straight-talker, she says, “There is a strong feeling that there is too much diversity now. They feel they’re losing things. It’s not as if it’s a multiculturalism that’s bringing in lots of restaurants and fabulous shops; it’s just bringing in kids who don’t speak English into the schools.”
John Leech, a community services worker who grew up locally, says many people in the area have low levels of acceptance of the other tribes, whether these are the police, Aborigines, single mothers or welfare recipients. “There’s an assumption that anybody who speaks Arabic must be Muslim, and ‘Muslims are no good because they’re all terrorists,’” he says. “It’s just so wrong but I can walk out into the square and talk to two or three people and that’s what they will say to my face.”
Indeed, one man who has lived in the area for almost fifty years, an upright citizen who maintains a spotless house and garden and who works hard for the community, has no compunction in telling me that most of the area’s problems are due to “the towel heads.”
This sort of language is not at all foreign to Wendy Waller, the mayor of Liverpool City Council, who works in an overstretched not-for-profit agency providing counselling and other services to families in crisis. Every day she sees the impact of intergenerational dysfunction on people’s lives and their capacity to make sensible choices for themselves and their families. She says racial tensions in the area are at least partly a reflection of its having many traumatised people with low levels of education.
“Liverpool has 150 cultures now,” she says. “I will quote my Arabic-speaking worker who said a lot of people who come in are traumatised, they often don’t have an education, they are poor… Because a lot of people are coming here as refugees or in very sad situations, they’re coming with belief systems that are often quite distorted.
“You’ve got to understand that the people who are feeling threatened are seeing this whole change happening around them. They’re powerless and they’re losing their identity, their place is disappearing. I’m not saying it’s right or wrong but that’s what’s happening. Plus a lot of people are housed here with drug and alcohol and mental health problems, so their way of thinking isn’t as clear as yours or mine.”
Many residents feel stigmatised by their address, and complain that they and their children miss out because of where they live. For Colleen Boler, who has lived here for more than forty years, it seems like “the only people who live in Sydney are in the eastern suburbs.” She raised her family here, and is involved in the Community 2168 management committee and the local residents’ action group, which organised a recent health and family fun day.
“Many of us are getting old and there’s only a handful of us involved, and we’d really like to have more younger people from different cultural backgrounds come to our meetings,” she says. “The more people we could involve, the more pull you’ve got when dealing with the council and the services.”
Like many long-termers, she looks back to when her neighbours were working families who helped each other in times of need. These days her backyard is overshadowed by a block of bedsits, with many of the male residents having been in and out of prison or mental health care. “A handful of elderly men have lived in there for years, and they’re wonderful, but they’ve got to put up with the other people in there who cause trouble,” says Colleen. “We don’t have control over our environment.”
Sarah Stapleton, a thoughtful and personable nineteen-year-old I met when she was handing out material for the local Labor candidate at Miller High School on federal election day last August, believes she has had difficulty finding a job because her address says Miller. At the time, she was unemployed but had thought about becoming a police officer, a nurse or a welfare worker. She said that a recent job interview at Red Rooster had ended badly when the manager saw that she had attended Miller High. “People bag this place out,” she says, “but there are people here who want to do well.” (Soon after we met, Sarah found a job with a local law firm.)
Her father, Michael, explains that he moved to the area about twenty years ago for its cheap housing, and that he likes living here because the people are honest and unpretentious. He gets irate when he sees how the area is often portrayed in the media. “It’s galling,” he says. “No one likes to have the area they live in have the shit kicked out of it by people who don’t know it.”
IN THE early 1970s, Peter Weir was tossing up whether to film a documentary in the housing estates of Mount Druitt or Green Valley, two outer suburbs of Sydney. In his proposal to the Commonwealth Film Unit, he explained that he settled upon the Valley after a colleague called it “Dodge City” because it was home to debt dodgers and said that many if not all of its residents were in the criminal class. This reaction was typical, Weir wrote at the time. “The media has created an image of Green Valley that is entirely distorted.”
As part of the Whatever Happened to Green Valley? project, Weir also made a mockumentary about the media, and helped local residents tell their own stories. Years later, a reviewer in the Sydney Morning Herald wrote, “The results are simple but very telling: the struggle to create a better life for the children, financial worries despite the relief of increased space, feeling abandoned without sufficient facilities once they had moved in.”
“Green Valley” no longer refers to the broad area but is now one of the better-off suburbs in the 2168 postcode area, which also takes in Ashcroft, Busby, Cartwright, Heckenberg, Sadleir and Hinchinbrook. But it is Miller – named after an Irish immigrant, Peter Miller, who came here as a baby and grew into a prosperous farmer – that tends to attract the bad headlines.
While the demographics have changed hugely since Weir’s time, many locals remain upset about how the media portrays the area they call home. It’s okay for them to call Miller a “hell hole” or worse, but woe betide any outsiders using such language. When I ran a pro bono media advocacy workshop for residents last year, some were still upset about a Daily Telegraph headline, “Adding Colour to their Grey Lives,” that had run months earlier above an article about Miller’s street art. Perhaps it would not have been so hurtful if there had not been such a long history of negative coverage.
Yet damning headlines have played a part in directing political attention and funding to the area. This is a catch-22 for places like Miller: adverse publicity can generate funding but it can also reinforce harmful stereotypes. As a recent article in the Medical Journal of Australia points out in another context, the research suggests that negative publicity about the state of Aboriginal health discourages Aboriginal people from engaging with health services.
“When we recognise a distinct and disadvantaged group within the general population, we inadvertently and unavoidably label that population as inherently disadvantaged, even in the act of trying to address this disadvantage,” write researchers Emma Kowal and Yin Paradies from the University of Melbourne. “The publication of Indigenous health statistics draws attention to health problems and attracts resources to deal with them. However, for Indigenous Australians, it also creates a sense that an Indigenous identity is tied to inevitable ill health, homogenising the varied health and wellbeing of individual Indigenous people.”
Generalisations are always fraught; even within Miller there is enormous variation in people’s circumstances, capacities and expectations. To misquote Tolstoy, happy places are all alike; every unhappy place is unhappy in its own way.
Simon Fox, a social worker and manager of community planning at Liverpool City Council with a long involvement in the 2168 project, says that the resilience of the people of Miller in the face of historical neglect is impressive. “One of the key messages that needs to get out there is that the problems being faced by an area like 2168 are not the fault of the people who live there,” he says. “This is a systemic problem that’s been created by a society that chooses to create places like Miller, place people in the housing there, say ‘this is where you are going to live,’ then not provide the support.
“People outside tend to blame the victim. They say, ‘they’re hopeless there, aren’t they?’ But put anybody in that situation, and they’re going to struggle. This is a problem we as a society have to deal with. We allowed it to be created. We have a responsibility now to do whatever we can to try to improve the situation.”
IF YOU ask the people of 2168 about their health, as researchers have, around 90 per cent nominate personal habits, lifestyle and access to health services as the key influences. Less than 60 per cent of them nominate their financial circumstances. Findings like these come as no surprise to the Canadian health policy expert Dennis Raphael, who has been trying for many years to focus the media’s spotlight on the social determinants of health. Raphael, professor of health policy and management at York University in Toronto, blames a dearth of media coverage for the wider community’s poor understanding of their importance.
“I teach over 600 undergraduate students a year who are genuinely surprised to learn that there are factors beyond ‘healthy lifestyle choices’ that influence health,” he wrote recently in the journal Health Promotion International, in an article titled “Mainstream Media and the Social Determinants of Health: Is It Time to Call It a Day?” “I receive a similar response when I present to the general public. It seems reasonable to hypothesise that this lack of public awareness about the social determinants of health has been abetted by the mainstream media’s neglect of this key issue.”
Professor Raphael cites a study of Canadian health reporters who say the barriers to reporting on these issues include the difficulty of putting them into the immediate and concrete “storytelling” that typically comprises news reporting, and the perception that “living conditions affect our health” is not news.
Indeed. One of the struggles of writing about Community 2168 has been trying to construct a narrative around its work. Endless meetings, committees, newsletters, email lists, the building of relationships between service providers and residents over years, youth and cultural events, community BBQs, and measures to improve street lighting or reduce vandalism – these are not the makings of dramatic scenes that tend to engage the media’s audiences.
But the online world is offering new opportunities for telling stories about places like Miller. “Beating the Odds,” a recent ABC online investigation focusing on Mt Druitt, includes documentary material contributed by a fourteen-year-old who’d been in trouble at school and was given a camera for a week to record his life. Notable was the constructive discussion on the site from readers, with many sharing their own experiences. “While individual stories can be very inspiring,” wrote one, “I think when trying to understand complex situations it is far more useful to look at overall trends, not individual stories. Personally I feel lucky to have got out of disadvantage, yes I worked hard, but I had support and a lot of luck too. I refuse to knock or preach to others because I know it could be very easily me in their position.”
Worlds away, another innovative online initiative was recently launched in Boston to help people see the connection between their postcode and health. Billboards around the city encourage people to visit the website, whatsyourhealthcode.com, which gives information about the health of various suburbs, and encourages people to lobby for a better deal for their communities. One link, for instance, says: “South Boston has one of the highest rates of substance abuse mortality in Boston. Things that put young people at risk of substance abuse include easy availability of drugs and a high concentration of places to buy alcohol. In fact, South Boston has the highest density of alcohol beverage outlets and the most liquor licences per resident in the city… Living in a healthy environment isn’t only about having access to clean air and water, it also is about protecting young people from misleading messages and easy access to products that can result in serious health problems.”
In a statement launching the campaign, which was years in the making, Mayor Thomas Menino said, “Geographic location is one of the most significant factors determining an individual’s health. This campaign will help Boston residents identify the contributing factors in their own communities and learn more about what they can do to improve their health and the health of their families and neighbours.” Presumably, though, any evaluation of this campaign would have to consider its effect on the stigmatisation of disadvantaged areas.
ONE of the things that marks out the 2168 project has been an ongoing process of evaluating its performance, with the results fed back to the community via the Liverpool City Council’s website and community meetings. The results show that there have been ups and downs – some early gains diminished during a period of instability several years ago when the project officer position was vacant. But overall, the trend is towards improvement in many areas, with concerns about racism being one of the few indicators to have worsened. Overall, residents have reported improvements in the neighbourhood and say that the project has also provided opportunities for learning, employment and capacity development, improved access to services and helped build social cohesion.
Given the poor relations with police before the project began, it is significant that four out of five residents now say they would turn to police if they needed help. Where once drug dealing and public safety were major issues, residents now nominate as their biggest concerns litter, vandalism, the poor state of the shopping centre and a lack of safe places for children. In 1999, 51 per cent of people felt the area had become worse over the previous few years; by 2010, this had fallen to about 30 per cent. The latest survey of Miller residents, conducted last May, found that 78 per cent were quite or very satisfied with their lives.
Although perceptions of community safety have lifted, there is room for more improvement. In 2010, 21 per cent of people who responded to the survey reported that they, or a member of their household, had been a victim of crime in the year prior to the survey; 27 per cent did not feel safe in their homes at night and 74 per cent did not feel safe walking down their street after dark. Almost two-thirds felt that Miller does not have a reputation as a safe place.
Elizabeth Harris, who has been one of the driving forces behind the 2168 project and its evaluation, began her career as a social worker in one of Sydney’s old psychiatric institutions, Callan Park, and has worked in diverse settings, including Papua New Guinea, Vanuatu, Malaysia and the western NSW town of Bourke. She has been involved in various projects in Sydney’s disadvantaged suburbs for years.
One of the things she has learnt along the way is the “importance of culture and how people see things in completely different ways than you do.” She says, “There’s such a gulf between what people who live in a situation understand to be an issue and what people who are looking down on it from a long way away understand.” The 2168 evaluations support this observation, repeatedly showing that while service providers tend to nominate big-picture issues like unemployment and housing as the key issues, local residents are more focused on immediate concerns, like vandalism and potholes.
Ms Harris says that one of the project’s more important outcomes has been a change of attitude among service providers, who increasingly recognise the importance of giving local people a greater say. “There’s always been residents’ action groups but my perception is now people take their views more seriously than they might have ten years ago,” she says.
Her centre plans to establish a research and training hub to train local workers and residents in working with disadvantaged communities, with the aim of institutionalising some of the lessons from 2168. “There’s a growing number of residents who can see a bigger picture, who can see a bigger role for themselves, and we hope to develop that, so that they don’t have to be the passive recipients,” says Ms Harris.
Simply increasing services to places like Miller will not have the optimal impact, she adds, unless the locals are genuinely involved in setting priorities. This is one of the reasons she is so concerned about moves to expand the reach of income management for welfare recipients, which she believes has the potential to exacerbate rather than ameliorate disadvantage. She says very few politicians these days really understand what it is like to live in places like Miller.
“It’s very hard for people not to feel worn down by always being portrayed as not pulling their weight, not caring for their kids, not having drive, not having resilience,” she says. “What is really distressing is that nobody is actually saying you’ve neglected your child, it’s just that you happen to live in this postcode or suburb and therefore, unless you can prove otherwise, you are going to have your income quarantined.”
ONE of the lessons from Miller is that there are alternatives to the big-bang, top-down policies like income management. And yet, despite all the hard work and the impressive commitment of many of those involved in Community 2168, is it really just tinkering at the edges? How can a community development project that runs on the smell of an oily rag deal with the huge structural problems confronting such places?
These are questions that have dogged my visits to the area, clouding my attempts to understand 2168. They are also questions that Ms Harris often asks herself.
“Everything is tinkering at the edges really,” she says. “If you think there is a magic bullet to solve health inequality, then you don’t understand the multiple causes of health inequality. What Miller has demonstrated is that groups like housing, health, police and council can work together on something over a long period of time and invest in it in a way that can have outcomes. Those outcomes are not profound but they are important to the people who live there.
“That saying, ‘from little things big things grow,’ is quite an important way of thinking about this stuff. I don’t think that what I do is going to change the world overnight but I think it’s helping incrementally to change some things for some people. I always take the view that whatever I do, I’m looking at a ten-year timeline because I’ve never seen anything change substantially in less than that. Somehow politicians have got to start thinking on a ten-year timeline.”
As well as that long-term vision, places like Miller need help from people and agencies willing to understand multiple perspectives, work with complexity in all its challenging messiness, and recognise the importance of both local detail and the over-arching big picture. It’s no small ask in this age of the quick fix and the sound bite. •
Melissa Sweet is a health journalist and editor of the health policy blog Croakey. She has honorary appointments in the School of Public Health at the University of Sydney and the School of Medicine at Notre Dame University (Sydney campus).
22nd Apr 2011
1:08am