Critical Race Studies and Intersectionality Responses to COVID-19

My book chapter, Critical Race Studies and Intersectionality Responses to COVID-19, is available to purchase now online as an individual chapter, or you can purchase the hardback book.

This chapter is published as part of the book, Overlapping Inequalities in the Welfare State. It’s edited by Dr Başak Akkan, Dr Julia Hahmann, Dr Christine Hunner-Kreisel, and Dr Melanie Kuhn, and published by Springer.

My chapter shows how race is a pervasive system that categorises and stratifies people in ways that maintain institutional and systemic inequality. Race has impacted the evolving management of public health responses to the Coronavirus (COVID-19) pandemic around the world. In Australia, state governments imposed harsh policing of migrant and refugee working class people that were not applied to white middle class people. The Government failed to meaningfully engage Aboriginal and Torres Strait Islander people in early public health planning, leaving communities who were at high risk from the virus to autonomously coordinate action without substantial state support. My chapter presents a case study of the webseries, Race in Society, co-hosted with Professor Alana Lentin. The series featured Aboriginal and Torres Strait Islander scholars and practitioners, and other people of colour researchers from Australia who examined public discourses of race and the pandemic. My chapter uses the concept of intersectionality to illustrate how the welfare state exercises multiple domains of power to maintain racial inequality, even during the public health crisis of COVID-19. My chapter provides guidance for educators and researchers on how to apply critical race perspectives into their own scholarship, teaching, and activism.

Race at Work Within Social Policy

My chapter ‘Race at Work Within Social Policy,’ is published in the book, Critical Racial and Decolonial Literacies: Breaking the Silence, edited by Dr Debbie Bargallie and Dr Nilmini Fernando. The short video below provides an overview.

My chapter demonstrates how poor racial literacy impacts social policy documentation, including policies attempting to implement anti-racism principles. Three case studies illustrate how white supremacy prevails: in a state strategy aimed at advancing Indigenous data sovereignty, policy meant to enhance service delivery for First Nations people, and an action plan seeking to increase disability inclusion in the public service. I explore how lack of racial literacy maintains what I term hegemonic diversity. That is, focusing on individualistic approaches to policy and practice, such as ‘celebrating’ individual differences, without dismantling racism and other structural inequities. I show how a racial literacy framework can enhance social policy.

You can purchase the book at 50% discount off the RRP when ordering via NewSouth Books. Email your order request to: renee.l.collins@newsouthbooks.com.au. Alternatively, you can purchase the eBook from Bristol University Press with 50% discount using code CNF24. It is also available on Kindle.

The book was launched on 20 September 2024, at Western Sydney University, on the lands of the Burramattagal People of the Darug Nation. Events in Brisbane and Melbourne to follow in October 2024.

The issue of gender equity is a structural problem, and it is therefore broader than the trade sector. Our research evaluates 22 empirical studies on women apprentices and trainees and makes recommendations about how to begin addressing change.

We find that four key issues affect women’s training and employment in male-dominated trades. First, family, teachers, careers advisors and other influential people don’t understand the potential value of trade careers for women, especially because they perceive trades are ‘not for girls’ and university is seen as the key pathway to success. Second, gender bias is not proactively addressed in workplaces and training institutions, including safety, sexual harassment, work practices, and social support. Third, employers favour recruitment strategies that disadvantage women, such as a focus on hiring through their existing social networks. Finally, influential people discourage girls from exploring apprenticeships and traineeships at school, because they lack awareness of opportunities for girls.

Our research is intended for decision-makers, employers and industry groups, providing tips on how to start tackling gender myths, bias, and discrimination.

Read the Women in Trades Promising Practice Review. This research is conducted by the Behavioural Insights Unit, in partnership with Training Services NSW, of the Department of Education.

Date: Mon, 12 September 2022, 8:00PM-9:30PM AEST (11:00AM – 12:30PM BST)

Register: online.

About this event: (from the organisers)

In this event, we challenge the positive framing of REF and impact to examine the conditions in which this labour is undertaken, given what we know about cultures of digital hate. We understand academia as a sector with visibility built in, that can both be understood through frameworks relevant to public facing fields like celebrity and politics, and offer insights for understanding the harms of forced online visibility more generally. Therefore, insights can inform fields beyond ‘academia studies’, and be applied to digital hate more broadly. This event will ask how the politics of visibility and its unequally distributed risks shape our ability to contribute to public debate through online participation.

Speakers include:

• Dr Claire Sedgewick, Impact Officer at the University of Derby
• keisha bruce, PhD candidate at the University of Nottingham
• Jess Wren Butler, PhD candidate at Lancaster University
• Dr Gayle Brewer, Lecturer in Psychology, University of Liverpool
• Dr Xine Yao, Lecturer in American Literature to 1900, University College London
• Dr Zuleyka Zevallos, applied sociologist and senior policy researcher, living on Gadigal land (Sydney)

Hosted by Dr Hannah Yelin, Oxford Brookes University and Dr Laura Clancy, Lancaster University.

Cyber safety

Our game gives people an opportunity to practice training on how to accurately report phishing emails. Phishing refers to malicious emails that try to trick people into clicking on links or otherwise give away sensitive information. Many workplaces provide some cyber security training on phishing and other attacks, however, much of it follows a traditional model. That is, people are presented with education about cyber safety, and they are then asked to answer questions about the training. This model measures immediate comprehension, but does not tell us much about whether people’s behaviour has changed as a result of the training.

Cyber attacks are on the rise globally, and have increased since COVID-19 pushed many businesses to work from home or go online. Cyber attackers prey on our behavioural biases. Unfortunately, most training does little to address this pattern. For example:

• Training is hard to remember and the perception of risk fades over time. You might do cyber training in January. By June, when you receive a phishing email, you may have forgotten what to look for and fall prey to a cyber attacker (availability bias)
• People lack time and mental bandwidth to respond to phishing. The average worker receives over 100 emails a day. We are busy and respond quickly. We may therefore overlook clues in a phishing email (scarcity)
• There are too many unfamiliar rules. Cyber security training introduces many ideas that most people are not used to thinking about, such as how to spot illegitimate domain addresses. Training therefore tends to overwhelm novices who are less engaged with technology (information overload)
• People don’t know how to report and therefore take no action when they see a suspicious email. Reporting functions also vary across each email platform. The button to report on Outlook that you use at work may be different than your personal email client, such as Gmail (the latter emphasises spam, not phishing). When people see an email they mistrust they are more likely to ignore it or delete it. This means that other people in your organisation may fall for the phishing, because it was not reported by others who received the email earlier (default bias)
• People don’t know what happens when they report a suspected phishing email. Do you recall the last time you reported a suspected phishing email? It is often an anti-climax. The email usually disappears into the ether and you get no reinforcement for your good deed. Nor do you receive feedback as to whether you were right to report it. Our research shows that people prefer not to report because they fear they may get it wrong, or that it’s not worth the hassle. People prefer to avoid what is unfamiliar (ambiguity bias)
• People don’t see reporting as their primary responsibility. We are used to seeing our computers and software automatically update. We are often prompted to change our passwords periodically by machines. Generally speaking, unless they work on cyber security, most individuals don’t think that cyber security is part of their remit. They trust that other experts, or their latest software, offer enough protection (motivation)

For these reasons and more, phishing reporting is not at the top of people’s minds.

Our game

We used the principle of gamification to build our cyber security training game. Gamification uses game design principles to solve problems. The goal of gamification is to break down complex and unfamiliar rules into a fun activity. The process involves building behavioural science prompts into an immersive learning environment. People are drawn into an interesting story or quest, where they are given positive reinforcement to learn. This might be points or other rewards when they apply learning correctly. The narrative challenges people to apply learning in an interactive way. Most importantly, gamification gives people an opportunity to practice what they learn in a timely way, rather than simply expecting them to remember facts.

As we’ve seen, many people find the topic of cyber security daunting or overly technical, and often switch off. Gamification has been shown to increase the likelihood that users will distinguish cyber safe emails from illegitimate emails. Most phishing training games provide people with positive motivation to apply training. Gamification has been shown to enhance self-efficacy, making individuals more confident about cyber security.

Our game has players taking the role of a cyclist playing for their team in a competition, Tour de Phish (based on what else – the Tour de France!). Through the game, we give players opportunities to exercise their phish-spotting skills in various scenarios. This includes messages resembling phishing emails, other riders making nefarious phishing offers along the route, and other obstacles in the course. Critically, learners also have to respond correctly to genuine requests, just as they would at work. The game has timed levels, so users practice phishing tips under pressure, to distinguish legitimate and illegitimate information requests.

Players receive tips and feedback. There are various rewards and penalties throughout the game. Players see a real-time podium where their score is compared to others in the organisation and their points count towards their team. This is all designed to tap into personal motivations to improve, as well as a social desire to help their team win.

Gamification makes learning more salient. Rather than simply being quizzed at the end of an online module (standard fodder in most training), people are sent a link to our training game, where there is an interactive story that prompts them to apply their training. Behavioural research shows that people are more likely to act when information is presented in a novel way. Our user testing shows that 89 percent of people who played our game prefer to learn via an online game compared to an online course or a face-to-face workshop. Additionally, 92 percent of people enjoyed playing our game, and 100 per cent of people felt more confident in identifying phishing emails after completing Tour de Phish.

The game was built in close consultation with people with disability to make it accessible to people who are blind or have low vision. I also designed the characters to represent diversity. I am grateful to the graphic design team, game developers, and our team who overcame many hurdles in building an inclusive game.

Read more about the behavioural science on our website.

References

Gokul, C. J., Pandit, S., Vaddepalli, S., Tupsamudre, H., Banahatti, V., & Lodha, S. (2018). Phishy – A serious game to train enterprise users on phishing awareness. CHI PLAY 2018 – Proceedings of the 2018 Annual Symposium on Computer-Human Interaction in Play Companion Extended Abstracts, 169–181. https://doi.org/10.1145/3270316.3273042

INTERPOL. (2020, August 4). INTERPOL report shows alarming rate of cyberattacks during COVID-19. https://www.interpol.int/en/News-and-Events/News/2020/INTERPOL-report-shows-alarming-rate-of-cyberattacks-during-COVID-19

Tchakounté, F., Wabo, L. K., & Atemkeng, M. (2020). A Review of Gamification Applied to Phishing. Preprints. https://doi.org/10.20944/PREPRINTS202003.0139.V1

Weanquoi, P., Johnson, J., & Zhang, J. (2017). Using a game to teach about phishing. SIGITE 2017 – Proceedings of the 18th Annual Conference on Information Technology Education, 75. https://doi.org/10.1145/3125659.3125669

In late 2020, many people were confused about how to correctly self-isolate after getting a COVID-19 test. Our team worked to stop people leaving self-isolation before getting a negative result. We tested a behavioural intervention using

• A multilingual handout, and
• ‘Teach-back’ instructions about self-isolation.

Teach-back is an effective way to improve health comprehension. Clinicians follow a script. They then ask people to repeat key instructions. They also allow time for questions and explanation.

Our intervention and survey were given in four languages (English, Chinese, Arabic and Korean). Our study included 76,000 people in Western Sydney. We analysed 8,000 valid survey responses.

The Northern Beaches outbreak happened during our trial. Our intervention shows how hard clinicians work. They have a strong commitment to trying new solutions.

We reduced self-isolation breaches by 29%. Our research has now been scaled across NSW. Scaling is when a successful intervention is expanded to a broader population.

As part of our scaling, I co-wrote the script for our training video. It explains how clinicians should deliver teach-back. It was interesting to be involved in the filming. I was there to ensure the science was portrayed correctly. Turning research into a visual format is an example of  visual sociology. In our case, we used behavioural science to design our handout and video.

Our project shows how

• Applied sociology adds value to multidisciplinary teams, and
• Diverse scientists make a real difference to public health.

My co-leads are a psychologist and economist. We are all from non-English speaking migrant backgrounds. Our multilingual focus is due to our team reflecting on how we can increase equity and diversity in our research. Using multiple languages in our study was very satisfying.

Enjoy reading our work.

The challenge

During 2020 and 2021, self-isolation after COVID testing was an essential part of the public health strategy to prevent further community outbreaks of COVID. However, self-isolation behaviour confused some people. Despite good intentions, maintaining self-isolation could be challenging. People getting COVID tests may not have considered practical issues like picking up children from school, attending work, grocery shopping or visiting family. Additionally, some people who do not have severe symptoms get tested for peace of mind, or to satisfy work and childcare requirements. They may perceive lower likelihood that they are COVID-19 positive. They are subsequently caught off guard when they’re told they need to self-isolate until they get a negative test result.

What we did

We conducted fieldwork in Western Sydney to understand the behavioural barriers impacting on correct self-isolation behaviour. We found that:

• Different information materials were being used in different testing clinics. Some clinics gave customers numerous leaflets with dense information, while others may not specifically provide written instructions on self-isolation.
• Verbal briefing of self-isolation varied, with some clinics spending around five minutes to explain the importance of self-isolation in detail, while others presume familiarity and place less emphasis on self-isolation.
• There was inconsistent explanation of self-isolation behaviours. The relevant Public Health Order at the time required that people go straight home after a test, until they receive a negative test result. However, some customers would stop off along the way, or continue with their activities for the day.

Our trial began with a one-week benchmarking period (12 November to 22 November 2020), where customers were sent an English language survey prior to the intervention, to gauge a baseline of compliance.

We then delivered the intervention over six weeks, from 24 November 2020 to 3 January 2021. Everyone who was tested in nine clinics in Western Sydney Local Health District was randomly assigned to either the treatment or control group.

1. Treatment: this group received a new handout and an enhanced briefing process (‘teach-back’), which were designed using behavioural insights principles.
2. Control: this group received a standard NSW Health leaflet for customers with the pre-existing briefing process delivered (no teach-back).

The nine trial sites alternated between treatment and control from one week to the next, for the six-week period. The figure below provides an illustration of this process. 

In addition, a further four clinics served as benchmarking sites. They were not placed into Treatment or Control. Rather, they were used to monitor the impact of testing volumes and to provide a benchmark of customer experience.

Customers who received a negative test result were invited to complete our survey about their customer service experience, as well as report on their self-isolation behaviours.

People with positive results were not surveyed for ethical reasons. People who are COVID-19 positive are under stress and already receive additional monitoring from NSW Health that reinforces self-isolation.

Almost 76,000 customers with negative COVID-19 results were sent a link to our survey via SMS. The survey could be completed in English or one of the other three biggest languages in Western Sydney, which have the lowest level of English-language proficiency: Chinese, Arabic and Korean. We received almost 8,000 valid responses to our survey across the 13 clinics. In this analysis we focus solely on responses from the 9 clinics (n=3,289), including 1,649 customers in Treatment and 1,640 in Control.

We relied on self-reported measures, including how many times customers left home while waiting for their test results. To limit social desirability bias (responding to questions in the best positive light) customers were surveyed online after they received a negative result and their required self-isolation was over, and the survey was completely anonymous. We also reduced perceived stigma by asking about a range of reasons that people may need to break self-isolation, including permissible reasons under the Public Health Order, such as seeking medical assistance.

Behaviourally informed written advice to customers

The behaviourally informed handout provided simple, but targeted, written information at the point of testing: a clear call to action, practical steps to overcome barriers to self-isolation, assurance about the 24-hour time waiting for results, and multilingual instructions.

The behavioural science techniques embedded in our handout include:

• Simplification: Breaking down complex and unfamiliar tasks into easy steps increases compliance. The handout told people the two things they need to do immediately after leaving the testing clinic: 1) Go straight home. Don’t stop off along the way. 2) Self-isolate. The instructions were provided in Easy English.
• Salience: People are more likely to pay attention to details that stimulate their senses (such as attractive colours), and which focus attention on important details. Our handout reminded people they’ll get results within 24 hours, and they should stay home even if they don’t feel sick. Graphics of the key messages aid understanding.
• Scarcity mindset: People who are busy or overwhelmed have limited ability to take in new information and make optimal choices. We can help busy people who feel unprepared for self-isolation by offering suggestions to major behavioural barriers. 
• Timeliness: People are more likely to take action if they receive clear directions at an optimum time. Rather than overwhelming customers with detail, we focused on essential information they need at time of testing: how to best self-isolate at home. Additional information about testing and self-isolation from the business-as-usual leaflets were accessible via a QR code. Each language had its own QR code, that led customers to a translated webpage.
• Make it easy: Asking for translated materials is sometimes a barrier. Our double-sided multilingual handout included four languages in one place. This meant customers weren’t forced to request additional help, and staff didn’t spend time trying to find the right materials for those who need it most.

A sample of our behavioural handout is included below.

‘Teach-back’ is an effective way for health professionals to check whether customers are confident in following directions when they leave a healthcare setting. We provided clinic staff with standardised script on self-isolation that mirrors the messages in the handout. Customers were then asked to repeat back what they need to do to correctly self-isolate. Clinic staff also had a checklist, to ensure they listen for key information.

Teach-back ensures clinic staff don’t assume customers’ understanding and ability to action directions (that is, their health literacy), and provides opportunity to ask questions and clarify self-isolation issues.  

The teach-back script draws on the following behavioural principles:

• Simplification: Clarifying messages strengthens compliance. The script clarifies the meaning of self-isolation and reinforces the call to action from the behavioural handout.
• Temporal discounting: People tend to discount future benefits and consequences. The script emphasises that 24 hours is a short wait for peace of mind on test results.
• Error management: People are more likely to make mistakes in stressful working conditions. Checklists present complex information clearly and concisely, ensuring important details are not missed. Our checklist ensures clinic staff can double check the customer has understood the key messages on self-isolation.

What we found

Our handout and teach-back intervention led to increased compliance. People who received our intervention were less likely to break isolation (92.5% said they never left home) compared to people who received business-as-usual service (89.5%). The difference was statistically significant.

The intervention could decrease the number of people leaving home before getting their test results by 300 people each day, or 2,100 each week for every 10,000 tests conducted. This equates to 29% fewer people breaching self-isolation weekly.

Customer satisfaction with COVID-19 clinics

The enhanced process was stress-tested during the Northern Beaches outbreak. Throughout the six-week trial period, customers gave COVID-19 testing clinics a high satisfaction rating, with an average 9.4 out of 10. Even with a significant increase in testing volume, the handout and teach-back did not impact high customer satisfaction (see the graph below).

Willingness to be re-tested

Additionally, our trial found that only 3 out of 5 customers reported they would get re-tested in less than 24 hours if they had symptoms again. This suggests continued communications could improve responses to public calls for testing.

Multilingual survey options increase response rates

We found that more people completed our survey when they received a SMS text that offered multilingual options. During benchmarking week, an average of 10.8% of people completed our survey, however, during the trial, when people had the option to complete in English, Chinese, Arabic or Korean, an average of 16.4% of people completed our survey.

Nevertheless, most people completed the survey in English. Possibly because the survey in English was simple enough for people to understand.

Our results suggest that multilingual materials boost compliance and reciprocity. Providing COVID-19 materials in multiple languages, and surveying in multiple languages, demonstrates the NSW Government is listening to multilingual communities.

Managing additional information by using a QR code

Only 11% of people used the QR code to access more information on self-isolation on the NSW Health webpages. Most people visited the English page, but spent little time reading these resources (there was a 70% bounce rate, meaning people left within seconds of opening the page).

Our results suggest that QR codes may be useful for instrumental purposes (e.g. COVID Safe check in), but less impactful in delivering health education. Further testing is required on the efficacy of QR codes for delivering complex health information. It seems likely that the public requires less information and responds well to simplified directions that clarify what they need to know on the spot.

What’s next

After reviewing the research findings, in 2021 NSW Health has:

1. Redesigned the written information provided to customers at public COVID testing clinics

• The new information provides easy-to-follow instructions, which addresses common behavioural barriers that lead to people breaking self-isolation
• The new information includes practical tips on how to plan ahead, such as asking friends to drop off groceries or for family to pick up children from school
• A personalised QR code allows customers to register for their test results following a small number of simple steps
• Translated information is available to maximise community reach.

2. Provided new training resources to all clinic staff across NSW, including a training video produced by the Health Education and Training Institute. In the first three months of use, over 1500 NSW Health staff had completed the training.

Additionally, private clinics around NSW have adopted advice on behavioural communications into their practices (see the example from Histopath below). In the first three months of implementation, there were 1,000 unique views of the webpage for private clinics containing the teach-back training.

Note

This research was first published by the NSW Behavioural Insights Unit on 25 January 2022.

The challenge

Disability is more common than most people may think. One in five Australians have a disability (18%). It’s likely that we work with someone who has a disability, even if we don’t know it.

The NSW Premier’s Priority to create a ‘world class public service’, includes ensuring that 5.6% of government sector roles are held by people with a disability by 2025. In 2019, 2.5% of public servants were people with disability. To meet the Premier’s target, the NSW public service sector is supporting a broad range of activities to improve recruitment and workplace culture.

What we did

We did fieldwork to understand how we could support the Premier’s Priority with a behavioural intervention.

We interviewed 50 NSW public servants:

• 22 one-on-one interviews with staff with a range of physical, sensory, and cognitive/ mental health disabilities. Most of these staff members had more than one disability. Two of the participants were Aboriginal, and five were ethnic minorities from non-English-speaking backgrounds (two are Auslan speakers, one of whom is an ethnic minority).
• Six focus groups with 28 senior managers and HR experts (‘managers’).
• Participants were roughly balanced by gender and age (14 were over 41 years, the rest under 40 years).

We also consulted with experts from the Department of Customer Service to better understand data collection on people with disability, to identify potential improvements to the recruitment and promotion of people with disability.

The result

Support managers to improve recruitment and promotion

Managers told us that there are many hurdles, as well as hidden costs, to recruitment (friction costs). For example:

• Navigating extensive information for recruitment panels, with dense guidelines and too many forms.
• Lack of focus on disability inclusion; for example, not knowing how to check for interview adjustments.
• Little flexibility to modify role descriptions.
• No awareness about Rule 26, which allows recruiters to vary recruitment and selection process, to improve outcomes for non-Executive candidates with disability (e.g. advertising requirements, recruitment assessments, modifying bulk recruitment processes).
• Difficult to understand how workplace adjustments work once a candidate is hired, especially in fast paced environments experiencing budget cuts.

Reduce unnecessary administrative burden from recruitment (‘sludge’)

Provide hiring panels with a brief checklist that includes tips on disability inclusion, such as offering all candidates adjustments during the selection process, discussing job share and flexible work options as part of the job interview, and considerations on whether Rule 26 might apply.

Create a feedback loop

In our interviews, staff report that they are looking to better understand how to act on promotion opportunities. Individuals improve their results when they are provided timely feedback data they can reflect and use to change their behaviour (‘feedback loop’). Examples discussed in our interviews include:

• Constructive feedback on how to improve their capabilities.
• Opportunities to learn new skills on-the-job.
• Collaborating with a manager to come up with a list of specific skills and goals to prepare staff for a higher-level position.
• Executive Roundtables create an opportunity for leaders and managers hear directly from staff with disability on what they need to ensure their career progression.
• Specialist programs, such as Stepping Into, provided staff with more dedicated support to navigate career planning. Public servants can tap into these established networks to recruit and retain talent.

Make it easier to implement workplace adjustments

In our interviews, staff report many challenges and delays to get reasonable workplace adjustments properly implemented (e.g. multiple assessments).

• Simplify implementation of adjustments. People are more likely to act when forms are easy to follow, and unnecessary steps are removed (simplification). The Department of Customer Service has rolled out a ‘Workplace Adjustment Passport,’ that eliminates the need to re-apply for, and chase up, their adjustments each time an employee applies for a new role. The Passport states the employee’s approved adjustments, without specifying disability or other personal details. This simple administrative action could be efficiently used across the public service.

Managers told us it is confusing to navigate information about how to pay for and implement adjustments for their staff. Other research has also identified that lack of awareness and perceived cost about adjustments hampers recruitment of those who might need them.

• Establish central funding as the default. Individuals prefer to go with the pre-set option (default bias). Therefore, making a new or unfamiliar decision the automatic choice encourages positive behaviour change. The Department of Customer Service has recently introduced central funding for adjustments, taking financial pressure off individual teams and hiring managers. As part of the recruitment processes, hiring managers can be prompted with a reminder about central funding, and encouraged to proactively promote workplace adjustments in job ads.

Improve data collection to inform recruitment and promotion decisions

Our fieldwork included a review of data and systems. We found that there are many systems where potential candidates can choose to disclose their disability. This includes on their job application, during onboarding, and on the human resources portal. However, these systems aren’t connected. If they are comfortable disclosing, staff should only have to ‘tell us once’ about their disability status, and have full control to update this easily.

• Prompt staff to update their disability status. Behavioural research shows that individuals are more likely to change preferences if they are given a reminder at an optimal time. Behavioural reminders could regularly encourage staff to update their records by highlighting the benefits and outcomes of diversity initiatives. For example, if staff opt-in, they could be confidentially offered relevant training or targeted career opportunities.

Support for managers

Managers told us they need improved resources and training on disability inclusion. 

• Send personalised invitations to relevant training. Managers told us that they want dedicated training on how to support staff with disability, including on mental health issues. Managers have access to hundreds of courses online, but it’s hard to know which course is most relevant (information overload). Behavioural insights suggest that personalisation can improve uptake of relevant training. This could be emailing personalised invitations to managers with a direct link to relevant training, with clear links to the specific skills gained from the course.
• Provide peer support. Managers told us that they seek advice and mentorship from senior colleagues with first-hand experience of supervising staff with disability. Research shows that volunteer networks who provide practical support improve workplace culture (reciprocity). One way to achieve this is to establish a peer mentoring network to help managers upskill their management techniques, and receive support from influential peers.

Create more training opportunities for people with disability

In our fieldwork, staff with disability said they want accessible training to support their career progression. 

• Make training easier to access. Staff with disability find it difficult to find relevant courses that are accessible, and how to negotiate time, funding, and approval to attend. Training can be made easier by removing complex approvals, and other unnecessary administrative burdens (friction costs). All courses should make electronic materials available ahead of time. 

What’s next?

Using these insights, our team ran a randomised control trial in 2020, to improve disability awareness and training.

How can you use this in your work?

Behavioural insights from our project have wide application for other diversity initiatives:

• Make training more attractive: Make training more accessible and send personalised invitations to managers. Promote training and resources at optimal times with reminders of how team members and customers benefit from inclusion.
• Make it easy to implement change: set up centralised funding for diversity initiatives as the default option. Use a checklist to prompt hiring managers to ask about inclusion (e.g. adjustments, flexible work). Use a simple, once-off approval process to facilitate voluntary disclosure of diversity (e.g. Workplace Adjustment Passport). Prompt staff to voluntarily opt-in to disclose by showing the benefits and practical outcomes of diversity programs.

Notes

This research was first published by the NSW Behavioural Insights Unit.

We received ethics approval prior to fieldwork. Interviewees were provided with their stated adjustments: most staff with disability opted for online or phone interviews (rather than face to face), and two interviews were conducted with Auslan interpreters.

* This analysis reflects the person-first language preferred by people with disability who work in the public sector.

Quechua and Aimara are both official national languages of the Republic of Peru, alongside Castellano (Español, or Spanish spoken in South America). Quechua has an ongoing influence on the evolution of Castellano in Peru. This includes every day words, grammar, conventions used for the third person, and regional variations of speech.¹

Indigenous languages are the original mode of verbal communication in Peru. The events in Congress reflect the pervasive impact of race on politics and all other aspects of society.

To explore the functions of race in Peru, I begin with an examination of Bellido’s speech as a case study of race. I’ll then explore the history of race and language in Peru, before discussing why racial inequality persists despite the development of Constitutional right to language and ethnic (cultural) autonomy. I then deep dive into a racial profile of Quechuan people, using data from the most recent Census.

Plain language summary

• Discrimination. The case study of Prime Minister Bellido is an example of racial discrimination. Quechua was once used as a common language to help with trade. People who used Quechua could keep their own language and culture. The Spanish invasion in 1532 removed this social order. It relied on violence to establish dominance. It also used Castellano to increase power. The Spanish punished Indigenous people who refused to assimilate
• Stratification. The Spanish introduced new racial categories. This helped white people and Castellano speakers stay at the top. They justified inequality by stigmatising Indigenous people and other groups. These racial categories are still used today
• Policies. The Spanish were unable to master Quechua. They banned Quechua and established schools that only teach Castellano. This legacy still impacts Indigenous people. They don’t have the same education and opportunities as others
• Cooperation. We are taught to accept racial inequality. Mestizo people are “mixed” from Indigenous and white people, but they are seen as inferior to white people. Mestizos still helped the colonisers to oppress Indigenous people. Peru maintained racial discrimination, even though Indigenous people were central to winning Independence
• Slippery system. Elites allow racial categories to change so they can maintain control. The Spanish could not reduce the significance of Indigenous languages. The ruling class eventually started using Quechua to claim a link to the Incas. This made it easier to justify land theft. Indigenous people are still disadvantaged in their own regions
• Adaption. Following independence, Peruvian elites continued to use race, under the guise of nationalism. Indigenous people are told they must speak Castellano, even when they get into government
• Resistance. From the 1970s, Peruvian governments began changing language rights. Little progress was made, due to bad planning and poor investment. New laws do not guarantee racial equality. This only happens with broader social change
• Language: The Census counted 31 million people in Peru. The biggest languages are Castellano (87%), Quechuan (14%), and Aimara (1.7%)
• Literacy: One in four Quechuan people in rural areas can’t read or write (24%). Castellanos have lower rates of illiteracy (12.5%). They are doing better than Indigenous people in rural areas
• Education: Indigenous people face discrimination in education. In some regions, 22% of Aimara have not gone to primary school, compared to 3% of Castellanos. Castellanos are three times more likely to go to university than Indigenous people
• Race: Mestizos are the biggest racial group in Peru. They make up over 60% of the population. Quechuan people are the second biggest race (22%).  Blancos are the third biggest race (6%)
• Racial inequality: Quechuan people have high rates of illiteracy. They are three times less likely to go to primary school than mestizos. Indigenous women are almost three times less likely to go to school than mestizas and blancas
• Change: The Census shows why it’s important that Bellido spoke about racial discrimination in Congress, and that he did it in Quechua and Aimara. We need to understand how race and language impact inequality.

Constitutional right to bilingualism

In the clip below, Prime Minister Bellido speaks in Quechua and Aimara, addressing the Congress President and Vice President, the Head of Congress, and Members, calling them his sisters and brothers. He then addresses the current celebrations of the bicentennial of the Peruvian Republic. He notes that social policy is exclusionary, as it’s solely delivered in Spanish. He notes that he embodies the fight for rights for the Indigenous people, who have expressly elected him to represent their voice. And so, he speaks in Quechuan:

“Brothers across all districts, communities, regions and every corner of Peru. Today, after 200 years of bicentennial life in the Republic, we [Quechuans] are still here. For 500 years we have suffered” [this is a reference to Spanish colonisation in 1531]. We [Quechuans] are progressing slowly, through the hills and mountains. We have arrived in Congress with the purpose of having our voices heard from this place” [My emphasis]

– Guido Bellido

Bellido then addresses the social and political struggles of Indigenous people in Peru, who are forced to interact in Spanish, rather than their first language. He notes the struggle of bilingualism is bound with disadvantage, as it means Indigenous people cannot access adequate political representation, or engage in civic life fully, because politicians fail to learn Quechuan.

The President of Congress interrupts Bellido, saying that he’s a national representative, and from now on he must speak Castellano. Bellido repeats the key points of his speech in Castellano, but the heckling continues.

“…I’ve come here in the name of our community, who struggles to speak in only one language. With our own brothers and sisters, we speak beautifully; we don’t need to argue or fight. We [Quechuans] also speak in Spanish. Sisters and Brothers, in Article 48 of the Constitution, it says ‘We can speak in both Quechua and Spanish.'” [My emphasis]

– Guido Bellido

Later, Jorge Montoya, Member of Congress, speaks to journalists, saying: “The official language of Peru is Castellano, Spanish. There’s a Quechuan translator. He [Bellido] should have spoken in Spanish and had it translated. He did it the wrong way round.”

This racist logic illustrates how institutional racism functions to concentrate power for dominant groups. Bellido is elected to Congress to represent Cusco, and he spoke in the language of his constituents. The President of Congress argued that he is a “representative of the people” and should therefore have spoken in Castellano. This reinforces non-Indigenous Peruvians as the core citizens, thereby placing Quechuans and other Indigenous Peruvians as second class. “The people” do not understand Quechua, and so people who speak Quechua should be forced to speak Castellano. This serves Bellido’s original point, that Quechuans do not have the same political rights.

Montoya similarly argues that Castellano should be the primary language used in Congress. In this view, a Quechuan speaker (Bellido), who has been elected to represent Quechuan interests, should speak in a language foreign to his people, and instead have his words translated back to his region.

Bellido’s speech appealed to Quechuans’ constitutional right to speak their language – he did this in Castellano. Still, his fellow politicians shouted him down.

As we will soon see, this is not the first time Congress has exploded after an Indigenous politician addressed racial inequality in Quechuan.

Race, language and racism

Race is a social system of oppression. It creates social categoriesthat position some groups as superior over others, conferring greater rights, resources and access to dominant groups.² Politics and other social institutions keep racial categories in place through laws, systems, and other processes. As the case study of Bellido shows, language translation is positioned as a tool to be controlled by the state. In a moment, we’ll see how the discourse used in Congress replicates historical patterns where the law has limited the use of Quechua.

Politicians would prefer to hear a Quechuan person address language inequality in Castellano, where they have the advantage of linguistic mastery. If they can hear a Quechuan person assert language rights in Castellano, they can refute their claims in Castellano. An elected official addressing his political equals in Quechuan—a language that the state has fought actively to eradicate—is met with howls because it inverts the racial power structure.

Bellido uses a conciliatory appeal: he addresses Congress as “my sisters and brothers” and he also speaks about Quechuan people in the same way. Here, he appeals to their shared nationhood, putting their humanity on equal footing (we are all Peruvian), before pointing out that Quechuans’ journey to Congress has been paved by inequity. Despite Bellido’s familial approach, the members of Congress react with dissent. Even as Bellido translates his words, and physically holds up the Constitution, he is explosively told that his political participation is conditional on him speaking Castellano. Congress refuses to acknowledge his words because he spoke to them first in Quechua. This is, in fact, unconstitutional. The fact that Congress denies Bellido basic language rights enshrined in law—legislation that Congress is set up to uphold—is an indictment of the state of race relations in Peru.

This political interaction illustrates how language is used to maintain a racial hierarchy, and echoes many instances of historical resistance, where Quechuan people have refused to engage their oppressors in Castellano.

History of language and racial domination

Peru has always been a multilingual, multi-ethnic nation, even before Spanish colonisation.^3(p185) Inca spirituality says that the first Incans descend from Manco Cápac (Manqu Qhapaq in Quechua, or “the royal founder”).

Textbox 1: Creation of the Incan Empire

Archaeological evidence shows complex agricultural settlement in the Andes began as early as 400 BCE. Two Andean civilisations pre-date the Incan Empire. First, the Tiwanaku Polity (300–1100 BCE) was based along Lake Titicaca, which stretches across the Southeast border of Peru and Bolivia. Second, the Wari Empire (also known as Huari, 600–1100 BCE), and was based near the city of Ayacucho, in the central South of Peru. Pre-Incan state formation expanded from 1000-1400 BCE, with the dominance of the Ayarmaca, Pinagua, and Mohina groups (a time when the Aimara were politically dominant in the region).^4(p811) Incan imperial expansion began in 1438 BCE, under the Emperor Manco Cápac.

Manco Cápac was a real person, born in Cusco in the 12th Century. In one Incan myth, Manco Cápac was the son of the creator of all life, Viracocha (Wiracocha). Manco Cápac, his sister and wife Mama Ocllo, and his six other siblings emerged from windows in a cave in a sacred hill, and they travelled across the Cusco valley, uniting Andean tribes.^5(pp39-47) In another myth, Manco Cápac was the son of the sun god, Inti (son of Viracocha), and moon goddess, Mama Killa.^6(p267) Inti sent his son and daughter (Mama Ocllo) to earth, emerging from the sacred lake Titicaca, and they walked to Cusco.^{4(p811),7(pp3-6)}

Under Manco Cápac’s leadership, the Incan Empire expanded through conquest and strategic intermarriage alliances between groups.^8(p331) People retained distinct ethnicities, related to their ayllu, a kinship system based on groups of unrelated families who lived on the same block of land.^8(p334) Ayllu function as a local council; making collective decisions, participating in spiritual worship, sharing education, and resolving disputes. Many groups also held multiple ethnic identities, related to kinship ties to other groups, region, or language.^8(pp328-329) Neutral territories were used for rituals and to exchange goods and services.^8(pp329-330) High migration meant that the Incan Empire was already adept at managing a highly ethnically diverse population before colonisation.^8(p332)

1400-1531: Multilingualism and the Incan Empire

From 1400-1531 BCE, Quechua was established as the runa simi (“lengua de gente,” or the language of the people), or the “general language” / “lingua franca” during the Incan Empire to bridge multilingual cooperation across groups.^{3(p173),9(p166),10(p14)} However, multiple variations of Quechua evolved over time, and it was treated as one of many languages that flourished across the Incan Empire.

1532-1780: Colonisation by Spain

In 1532 CE, Spanish conquistadors invaded Peru. One year later, they killed off the last Incan Emperor, Atahualpa. In 1533, the Spanish forcibly established Castellano as the new official state language.^3(p173) Along with violent dispossession, Castellano was one of the ways in which the racial order was imposed and maintained, with Spanish colonisers at the top, and Indigenous people at the bottom.

Language as a political tool was used to justify genocide. Antonio de Nebrija, who wrote Gramatica de la Lengua Castellana, the first book to document the grammatical rules of Castellano, wrote that:

The Spanish murdered at least two-thirds of the Indigenous population in central and southern Peru. There were 280,000 Incans before Spanish invasion, and this declined 93,331 Indigenous people in 1683.^14(p45) Other estimates say Indigenous population declined at a rate of 58:1.^14(p42)

Policy decisions since invasion, and into the present day, actively oppress Quechuan and other Indigenous languages.  

Race and social control

Spanish colonisers imposed race as a system of stratification. That is, a way to distinguish different groups who are forced to serve the ruling class, and to justify unequal distribution of goods and services. The Spanish ignored existing ethnic groupings, including the functions of the ayllu and the authority of the Incan Emperor. Race is premised on the idea that one group is morally superior to all others. This justifies genocide and land dispossession. Census and government records show that conquistadors used phenotype (biological markers) to categorise populations, including skin colour and the unscientific classification of blood quantums.^8(p334)

Official records by the Spanish Royal representative Visitor-General Jose Antonio de Areche (1784), the Lima Census (1790), the Viceroyalty Census (1795) and other historical documents show that the Spanish classified people into 21 racial categories.^8(p339) Broadly, these can be re-categorised into six major racial groups that are familiar today. This is summarised in the table below. For a history, see Appendix 1.

Table 1: Summary of racial categories in Peru

Race and language

The Spanish colonisers strategically allowed Quechua to continue after invasion, because Indigenous people were used as slave labour. Through rape and forced intermarriage, Mestizo (“mixed”) people rose above Indigenous people, and acted as translators between Indigenous and Spanish invaders.^13(p294).

From the 1570s, religious elite feared losing control of doctrine. Spain ordered priests to learn Quechua, to convert Indigenous people to Christianity. To make this easier, they enforced one dialect (Inca Koine) and further simplified this language.^13(p295) Race underpins this decision: the Spanish colonisers erroneously believed that language unifies people. This is a flawed idea that we see to the present day in Peru, Australia, and elsewhere. Regardless, that is not the original purpose of Quechuan language; the Incas introduced Quechua as a common way to facilitate trade and collaboration, not to homogenise cultural groups.

Paradoxically, language facilitates cultural memory.^13(p297) Quechuan people speaking Quechuan meant they continued to remember their life before colonialism, and their traditions. The Spanish came to believe that Quechua impeded religious expansion. Specifically, because they saw the language was too simplistic to convey Catholic beliefs. This is another example of race, which positions a complex, ancient language as being inferior, when, in fact, the Spanish failed to effectively translate ideas into the local language.

1781-1971 Language ban

In the 17^th Century, a new ruling class (Criollo) began to claim Incan heritage, and adopted Quechuan titles, dress, and language. Again, race rears its head: to further exploit the forced labour of Indigenous people, the colonisers establish authority, by laying “authentic” claim to land, people and resources. Elites created poetry and other writing in Quechua, Latin and Castellano, to stage a Renaissance.^13(p299) Here is another example of race: to erase violent dispossession, colonisers use language and the arts to romanticise colonisation.

At the same time, Quechuan plays and literature were also used to covertly flame the fire of revolution.

From 1730 to 1780, Quechuan people led 37 rebellions. This eventuated in the 1781 political ban of Quechuan language from theatre and literature.^13(p300)

In 1792, the Bourbon administration in Spain adopted eradication policies, managed through the establishment of local schools., and penalties for those who don’t attend.^13(p300) Education was a means to establish Castellano dominance, and dilute Quechuan influence. Formal education operates through race: to eradicate cultural traditions. Local landowners did not support this move. Castellano was the way they legitimised land theft. Spanish scribes documented land “sales” in Castellano, and land “auctions” were held in Castellano so that Indigenous people could not understand and voice objection.^13(p301) Jesuit priests taught Castellano, which allowed some Indigenous people to contest their rights in writing.

Even in 1821, following the Peruvian independence from Spain, Castellano retained its dominance into the early 1970s.

By setting up social institutions exclusively in Castellano, economic and political participation depend on “integration into the national society”^13(p292) The language of colonisation masks genocide and dispossession through a discourse “civilisation” (through the institution of religion), and in modern times, through a discourse of “assimilation” and “development” (through the institution of politics).^{c.f. 13(p303)}

Following the official language ban, Quechuan speakers were forbidden to speak their own languages, especially at schools. Quechuan people continued to resist and maintain their language at home, and they protested these laws.

See below for the diversity of Quechuan culture in the early 1900s, captured by renowned Quechuan photographer, Martín Chambi.

1972-1992: Bilingualism and constitutional reform

In 1972, under the military presidency of General Juan Velasco Alvarado (President 1968–1975), the ban was officially lifted.

In 1975, Quechua was officially recognised as a national language. At the tail end of his dictatorship, President Alvarado issued a decree that recognised:

1. Quechua and Spanish are the official languages of the Republic
2. From 1976, the Quechuan language was to be compulsory at all educational levels  
3. From 1977, court cases and legal proceedings would be held in Quechuan if this is the primary language of parties involved
4. The Ministry of Education and other agencies would need to prepare dictionaries and other official documents in Quechuan
5. Any legal provisions that conflict with the new laws were revoked.^3(pp182-183)

Despite this decree, government planning failed to implement these laws effectively. The decree was poorly coordinated, dictionaries lacked key words, local experts were not consulted, and teaching staff lacked proper training.^3(p184) Subsequent government breakdown meant the plan was not enforced.

In 1979, the next government, led by President Alan Garcia, implemented a new Constitution. Article 83 recognised Quechua and Aimara as languages “of official use in the zones and according to the law,” and Article 35 declared a right to bilingual education for Quechuan communities.^9(p167) Unfortunately, poor planning continued to weaken progress.

1993-2006: Language rights

The 1992 self-coup staged by President Alberto Fujimori led to the establishment of the 1993 Constitution.¹⁵ Three articles established language rights:

1. Article 2.19: the right to an ethnic and cultural identity, the State’s duty in protecting this diversity, and the right to use one’s own mother tongue and an interpreter when interacting with any public authority
2. Article 48: Quechua, Aimara, and other Indigenous languages are recognised as official languages alongside Castellano, in regions where these communities are predominant
3. Article 17: the state should promote bilingual and intercultural education.^9(p168)

The way in which race functions is that even when civic rights are progressing, this does not guarantee racial justice. Legislative and Constitutional changes are meant to protect racial equality, but as we see in Peru and other places, equality under the law does not mean laws are enforced as fairly.

2007-present: Individual rights

From 2001 to 2006, four Indigenous politicians were elected to Congress, which continued to spark language right debates. In 2006, Hilaria Supa and María Sumire both chose to take their inauguration oath in Quechua. The President of Congress asked Sumire three times to repeat her statement in. In the video below, politicians shout that she hasn’t taken her oath because she only did it in Quechua (“Peru first!”) She is called back to take the oath, and she speaks again in Quechua:

“I’m going to work for my people, which is Cusco, and for all the lands, and for Túpac Amaru.” [Túpac Amaru was the last Incan monarch who was executed by the Spanish following a great battle in 1572]

– María Sumire

As the representative for Cusco, Sumire argued this was an act of aggression against her rights as a Quechua-speaker.^9(p171)

When Supa was elected President of the Congress Education Commission, another politician resigned from her role in the Commission in protest. Additionally, a national newspaper called Supa an “ignorant peasant woman” (“peasant” in this case is a racist slur), and the paper published Supa’s handwritten Castellano notes, pointing out grammatical errors.^9(p172) Sumira is highly educated; she was a lawyer before being elected to Congress.

Even though this happened 26 years after the official recognition of Quechua as an official, and 13 years after Constitutional reform, it’s clear how language is used to maintain the racial order, even for elected officials who are Quechuan. We see echoes of the same racist pushback happening again in 2021 with Bellido.

In 2007, Sumire led new legislation to implement Article 48 from the Constitution: Law 29735 introduces individual rights on the use, preservation, growth, recuperation, and diffusion of Indigenous languages.^9(p173) A public information campaign promoted the new laws (“Speak your language, it’s your right). The law facilitates regulated access to an interpreter when accessing social services, new public service hiring laws, and targeted bilingual education policies.

Cusco, Ayacucho, and other Indigenous regions funded not-for-profits to improve language services, schools were mandated to teach Quechua and other local Indigenous languages, and courts and other public services also incorporated bilingual processes.^9(p174)

In Cusco, Quechua is an official regional language, meaning that public servants must speak at least basic Quechua. It has one of the largest budgets and governance structures, due to high revenue from tourism, allowing the region to invest in Quechuan language autonomy.^9(p176)

Despite this regional progress, racial inequality and conflict persist nationally.

In 2009, 33 Indigenous activists were killed by police during protests in Bagua, which led to renewed non-Indigenous public interest in language rights.^9(p16)

Speaking “proper” Castellano continues to be a marker of race, ethnicity and class.^9(p167) Conversely, social stigmatisation of Indigenous people continues.

Census data show how race and language are used to disadvantage Quechuan people.

Quechuan speakers today

In the most recent national Census from 2017, 5.2 million people are Quechuan (22.3%).^16(p219)

Cuzo is Peru’s seventh most populated region. Over 1.2 million people live in Cusco (4.1% national population). Cusco’s population today is 2.5 times the size since the first Census in 1940.^16(p21) While Quechuan people make up 9.7% of urban dwellers nationally, they represent 30.3% of regional Peru.^16(p199)

More than half of people in Cusco have grown up speaking Quechuan since infancy (55.2%).^{16(pp202-204)} Given its sacred place amongst Quechuan people, and as Peru’s primary tourism region, political representation of Quechuan locals is vital.

Language, literacy, and education

Peru has a national illiteracy rate of 5.8% (1.3 million people). However, while only 3.5% of Castellano speakers are illiterate, 16.5% of Quechuans cannot read or write. Illiteracy rates are also high among Aimara (16.5%), other Indigenous language speakers (12.3%). Illiteracy rates are astronomical among people who are deaf and not verbal (79.5%) and Peruvian sign language speakers (61.8%). In comparison, only 0.8% of migrants are illiterate.

Illiteracy is further compounded by class: 17% of rural Peruvians are illiterate, compared with 3.2% of urban Peruvians. The rate of illiteracy is twice as high for rural Quechuan speakers (24.4%) than Castellano population (12.5%).^16(p207)

When Bellido evokes the language struggles of his sisters and brothers in the hills and mountains, he is referencing the racial, linguistic and class divide between rural Quechuans and predominantly urban-dwelling Castellano speakers.

Across Peru, women are far less likely to be educated beyond primary school. Educational disadvantage is even more pronounced for Indigenous people. One in 5 people who speak Ashaninka have no level of formal education (22.3% or 10,039 people), followed by 14.6% of Quechuan speakers (475,664 people), 13.4% other Indigenous languages (11,194 people – primarily Shipibo-Konibo people who live in the Ucayali River in the Amazon, and Aimara speakers). In comparison, 3.1% of Castellano speakers have no formal education.^16(p209)

Nationally, Castellano speakers are almost three times more likely to complete post-school qualifications (38.3%) compared to people who speak other languages (14.6%).^16(p211) In Cusco, 15.4% of people who speak another language complete post-school qualifications; this is 40.6 percentage points lower than Castellano speakers (56%).

In a region highly stratified by race and class, Castellano speakers are therefore faring far better in Cusco than the national average. Quechuans don’t have the same advantage, even though they are the biggest group in the region.

Race and ethnicity

Peru is stratified across race and class. The Peruvian Census asks about ethnicity, not race; however, the ethnic categories of Peru are a mixture of race and culture. For example, 60.2% of people describe themselves as mestizo (“mixed race”). This is a racial category.^16(p214) They primarily speak Castellano and make up two-thirds of all Peruvians living in urban regions (63.9%).^{16(pp215-216)} At the same time, regions with the highest proportion of mestizo people (75% to 80%) are closer to the Andes and Amazon (San Martin, Cajamarca, Loreto, Piura, La Libertad, and Ucayali).^16(p218)

The next largest cohort are Quechua people (22.3%), who predominantly live in rural regions.^{16(pp215-216)} The biggest concentration of Quechuan people (75% to 84%) are in Apurímac, Ayacucho, Huancavelica, and Cusco.^16(p219) They are marginalised, along with other Indigenous Peruvians.

The third largest racial group are Blanco (white) (5.9%). This is a racial category. Blanco people make up no more than 10% of any single region. The biggest concentrations are in La Libertad (10.5%), Tumbes (9%) and Lambayeque (9.0%).^16(p220) White people are numerically a minority, but at the national level, they hold power in key institutions, including politics, education, and media.

A significant minority of Peruvians self-identify as Afrodescendiente (“Afro descendants” or Afro-Peruvians); they make up 3.6% of the population. This is a racial category. Afrodescendiente make up no more than 11% of any region. The highest concentration live in Tumbes (11.5%), Piura (8.9%) and Lambayeque (8.4%).^16(p221) They are socially disenfranchised, and lack access to political and economic power.

Other racial groups are represented in the table below.

Table 1: Ethnicity in the 2017 Peruvian Census

Race, literacy, and education

Nationally, Quechuan people have one third the rate of illiteracy than Mestizo people (3.9% vs 10.9%).^16(p224) White people are slightly worse off (4.2%), but they have higher rates than Afrodescendiente people (6%). Yet illiteracy rates are twice as pronounced in rural regions: Mestizo (13.8%), Blanco (14.8%) and Afrodescendiente (16.7%) have similar rates of illiteracy, while Quechuan people have almost twice the rate of illiteracy as Mestizo people (21.4%).

Looking at people who have no formal education, Mestizos (3.4%), Blancos (3.5) and Afrodescendiente people (4.9%) have similar rates that are lower than the national average (5%).^16(p226) However, Quechua people have three times the rate of no education as Mestizo people (9.5%). Aimara people also fare poorly (8.4%).

Quechuan women (14.4%) and Aimara women (13%) are much worse off than Metizas and Blancas (4.8% each) when it comes to no education.^16(p226)

One in five people in Peru have a university qualification (19.7%). More than one-fifth of Blanco people (22.8%) and Mestizo people (21.9%) are university-educated, while Quechuan people (14.8%) and Aimara (13.8%) are less likely to be university-educated.^16(p226) Conversely, more than half of all Nikkei (48%) and Tusan people (52.6%) are university-educated.^16(p227)

Language, work, and health

Castellano speakers make up 81.1% of people of working age, and Quechuan speakers make up the second largest proportion, at 1.9%.^16(p270)

Quechuan speakers have higher than average health insurance (75% compared to 72.8% for Castellano speakers), and much higher than Aimara 60.5%, but lower than for Shawi/Chayahuita 90.8% and other Indigenous speakers.^16(p211)

In terms of ethnicity, Aimara people have the lowest health cover (60.3%) and Nikkei have the highest (80.1%). Indigenous Amazonian people, Shipibo/ Konibo, Ashaninka and other Indigenous groups have the highest rate of health insurance (over 75%), followed by Tusan (74.5%), Mestizo (73.6%), Blanco (73.5%), Quechua (72.8%) and Afrodescendientes (72.8%).^16(p229)

Access to health cover is important, however, the COVID-19 pandemic has shown that access to healthcare was not enough when infrastructure is lacking. Only 60% of Indigenous communities in Peru have access to basic sanitation at home.^17(p17) While the Peruvian Government does not publish race or ethnicity data on COVID-19 infections, 51 Indigenous communities collectively suffered 15,017 infections by October 2020, with a mortality rate much higher than the general population (2.6% vs 1.5%).^18(p94)

Summary

Race is used by the ruling class to create social stratification and maintain power. The ruling class divides people into groups, so they are placed at the top of the hierarchy, and others are at the bottom. At the time of colonisation, it was the Spanish nobility and Christian elites who ruled. The state gave them authority to enforce laws decreed by Spanish royalty, they stole Indigenous land, and they ran businesses that profited from slave labour. Criollos (“mixed” landowners) also had power that came with land ownership. Migrants were called on to supply labour when slavery was abolished, but they faced discrimination. Mestizos were inferior, as they were working class. Afrodescendientes and Indigenous people were placed at the bottom of the social hierarchy.

Today, mestizos and blancos in urban areas are doing better most other groups in Peru. Nevertheless, mestizos in regional Peru are significantly disadvantaged than their urban counterparts. The country faces ongoing economic and social turbulence as a direct consequence of colonisation. Additionally, there are serious environmental challenges that are correlated to the exploitation of Indigenous land. Even still, race logic prevails, so Indigenous knowledge is denigrated, even though it can improve national outcomes. In the most famous uprisings that led to the Peruvian independence, it was Indigenous people who galvanised mestizos and Afrodescedientes to revolt against their shared oppression. Race and class divisions today continue to undermine similar progress against neo-colonial systems.

Race categories are legitimised and maintained through language policies. Like the history of colonisation, the case study of Minister Bellido illustrates how Castellano is used to maintain the status quo. Bellido is one of only a small number of Indigenous politicians to be elected to Congress. This is emblematic of the ongoing national divide on race and language diversity.

Invasion, genocide, slavery, and other forms of political oppression have been justified by language policies. While the Incan Empire used Quechua as a common language to facilitate political and economic cooperation, the Spanish conquistadors used Quechua to control the Indigenous population. At first, the Spanish ruling class and Christian churches attempted to learn Quechua to monitor their imposed religion. Later, Castellano education was mandated to eradicate language, to stop rebellion and increase religious conversion.

Race perpetuates oppression through social cooperation. Race creates the promise of social mobility, even when the benefit will be minimal. A case in point is the creation of the mestizo category. In a sense, Peruvians have always been “mixed” because the Incan Empire was expansive and consolidated many groups, who maintained their ethnic and linguistic autonomy. Under the Spanish, the mestizo category was elevated above Indigenous and Afrodescendiente people, but they were inferior to criollos (“mixed” landowners) and the blancos in power (the Spanish ruling class). Spanish colonisers initially relied on mestizo translators to profit from Indigenous slavery but continued to place them in subordinate roles. Rather than reject the racial system, mestizos accepted this because it meant that they were slightly less worse off.

Race is a slippery system that imposes mutable requirements. Race is a social construct created to exert political power, and because it is invented, the content of racial categories is always changing with the times. Dominant groups (the Spanish colonisers) dictate who is undesirable, but they will shift definitions to maintain control. The Spanish could not master Quechua and other Indigenous languages, so they initially mobilised priests to learn the local languages. Indigenous people continued to defy subjugation and resisted religious conversion. The racial system then attempted to nullify the ongoing significance of Indigenous languages. The coloniser nobility used Quechua to claim rightful lineage to Incan authority, so they could justify land theft. They took a language they believed was inferior and absorbed it to reinforce Spanish superiority. Later, as rebellion continued, they banned Quechua. The language that the Spanish ruling class now claimed gave them rightful claim to Incan resources was too powerful to incorporate into the racial system, so they sought to extinguish it. The Spanish saw that language kept cultural pride alive, and this incited political revolt. Indigenous languages were seen as an impediment to the aim of colonisation: cultural erasure, to facilitate exploitation and profit from Indigenous lands.

Race adapts to new conditions. Once free from Spanish colonisation in 1821, the racial system continued to dictate life following the Peruvian independence. The ruling classes who benefited under Spanish rule created a new discourse of nationalism. Castellano remained dominant, and racial and class divisions created in 1532 have been fixed for another 200 years. The role of language in racial domination is clear, when terms that did not exist prior to colonisation (blanco, mestizo, Afrodescendiente) are so firmly entrenched that they are not only measured in the Census, but they are also correlated with socioeconomic status. Peruvian nationalism is racialised: we hear it in the outrage of politicians who yell “Peru first” and “you represent the people” when Quechua politicians speak in language in Congress.

Race is resistant to material change. Even as laws change, and some overt signs of racism become unpalatable, the racial system reproduces itself, in a new guise of “progress.” This is because racial categories are embedded in multiple social institutions. Since the 1970s, various Peruvian governments have changed the Constitution to address language rights. Until recently, little material investment was made to implement progress. It is not enough to mandate bilingualism to eradicate linguistic and racial discrimination; the education system must be properly funded, what is taught in schools must change, teachers’ attitudes and training must change, school policies need to be audited, and so on.

Cusco and other Indigenous majority regions have made the greatest strides. By implementing new laws alongside other institutional changes, Indigenous people in some regions can access social services in their own languages. Nevertheless, Indigenous people still have the poorest outcomes in these regions where they are concentrated, because the rest of Peru refuses to give up the racial system which permeates all aspects of social life.

Legal rights are important, but without enforcement and investment, they do little to change the economic conditions and political power of racial minorities. This is spectacularly demonstrated when Congress shouts down a solitary Quechuan over a two-minute speech on racial equality.

Nevertheless, Quechuan and other Indigenous leaders, educators and activists persevere with instigating change, as they have done every day, for over 489 years.

Appendix 1: A simplified list of racial categories in Peru

• Españoles (Spanish): white elites. Isabella of Portugal and the Holy Roman Emperor Charles V were in power when Spain invaded Peru in 1532. The Spanish conquistador Francisco Pizarro led the invasion and executed the reigning Sapa Inca (Incan Emperor) Atahualpa. Conquistadors were initially established as Governors of stolen Peruvian territories. In 1542, the Viceroyalty of Peru took over as political administrators who served Spain. Peru-born Españoles retained power after Independence. Today, their descendants are known as blancos (“whites”). They are the third biggest group, and make up less than 6% of the Peruvian population.^16(p214) Despite being numerically a minority, as a group, they retain socio-political power
• Criollo (“creole”): mixed race landowners. They were Castellano-speaking people who had mixed Spanish and Indigenous or Afrodescendiente ancestry, but who typically occupied a higher social status. While criollo was used synonymously to refer to “mixed” and “Spanish” people, their race was closer to white.^8(pp342-343) After Independence, they rose to prominent policy roles.^13(p294) They owned property, had key roles in commerce, and could be conferred Spanish royal titles.^13(p298) Criollos often exploited their knowledge of Castellano to trick Indigenous people during land “sales.”^13(p301) However some Criollos used their wealth to support Indigenous arts.^13(p299) Some Criollos participated in rebellions that led to Independence. Today, this term is not used as a racial category and is not counted in the Census, however, the term still refers to Limeño culture (derived from Lima, the capital city of Peru). Criollo influence is still seen in national culture, especially in cuisine, dance and music
• Mestizo (“mixed race”): working class. This category includes people who are the children of Spanish and Indigenous people.^8(p339) They had little political, social, linguistic, or cultural connection to Indigenous cultures. They spoke Castellano and wore Spanish clothing.^8(p335) They were often poor and worked on farms.^{8(pp337, 345)} Today, they are the biggest group in Peru, comprising 60% of the population.^16(p214) They are overwhelmingly middle-class and hold positions of power in Government and other institutions
• Migrants: working class. The Spanish government categorised “Chinese” people from the late 1780s. The abolishment of slavery in Peru in 1821 left the Spanish with a labour shortage. Chinese (now known as “Tusan”), Japanese (“Nikkei”), and Italian migrants were attracted to migrate to Peru to work on sugar and cotton plantations and in mining.^19(p242) They were free but faced discrimination. These groups had a strong impact on national culture, especially cuisine, economy, and politics. Today, Tusan and Nikkei each comprise 0.1% of the Peruvian population.^16(p214) After many generations, they retain distinct cultural ties to their ancestral homelands, while also having strong Peruvian identities. Asian-Peruvians generally have high rates of education and more upwardly mobile than other groups, but many still face racism. New groups of migrants include Venezuelans, who also face discrimination
• Afrodescendiente (Afro-descendants): lower class. They are the descendants of slaves forcefully brought to Peru in the 16^th Century, from the Caribbean and Brazil. The Viceroyalty census classified them as Black. They made distinctions between enslaved and freed Afrodescendientes, while other government records also made distinctions between Afrodescendienties who were mixed with other groups.^8(p340) These racial categories are now considered racist and not used in official records. Afrodecendientes led many rebellions against the Spanish. They have an enduring influence on national culture, especially cuisine and music. Today, they are the fourth biggest group in Peru, and make up 3.6% of the population. Afro-Peruvians experience racial discrimination, and hold few positions of power.²⁰
• Indigenous, lower class. Indigenous people were murdered, dispossessed, and were enslaved when the Spanish invaded Peru. The Viceroyalty classified those who survived as “Indians,” a term that is now seen as racist, but is still used perojatively.^8(p345) The Spanish ignored existing ethnic identities, and instead made racial distinctions based on blood quantum, a classification imported from Spain. They also classified originales (originals) versus forastero (outsiders).^8(p366) The children of Indigenous and mestizo people were classified as “peasants” and under other derogatory racial categories.^8(p338) Indigenous people who were allowed to own land still had to pay land taxes.^8(pp366-367) Indigenous people mounted many rebellions. They also formally petitioned the Spanish for their land rights as early as the 1700s.^8(p330) Today, there are 51 Indigenous groups in Peru. Quechuans make up almost one quarter of the national population (22.3%), and they are the third-biggest group in Peru. Aimara are the fifth biggest group in Peru (2.4%).^16(p214)

References

1.         Sessarego S, Andrade Ciudad L. Introduccion: Una mirada contemporanea a las variedades del castellano peruano. In: Andrade Ciudad L, Sessarego S, eds. Los Castellanos Del Perú: Historia, Variación y Contacto Lingüístico. London: Routledge; 2020:1-7.

2.         Zevallos Z. Sociology of race. The Other Sociologist. https://othersociologist.com/sociology-of-race. Published June 9, 2017. Accessed July 3, 2021.

3.         Chang-Rodriguez E. Problems for language planning in Peru. 1982;33:1-2. doi:10.1080/00437956.1982.11435731

4.         Covey RA. The Inca Empire. Handb South Am Archaeol. 2008:809-830. doi:10.1007/978-0-387-74907-5_40

5.         de Gamboa PS [1907]. History of the Incas. (Markham CR, ed.). Cambridge: In parentheses Publications; 2000. https://www.yorku.ca/inpar/sarmiento_markham.pdf. Accessed September 18, 2021.

6.         Steele PR, Allen CJ. Handbook of Inca Mythology. Santa Barbara: ABC CLIO; 2004.

7.         de la Vega G. El Reino de Los Incas Del Peru. (Bardin J, ed.). Boston: Allyn and Bacon; 1918. http://books.google.com. Accessed September 18, 2021.

8.         Cahill D. Colour by Numbers: Racial and Ethnic Categories in the Viceroyalty of Peru, 1532-1824. J Lat Am Stud. 1994;26(2):325-346. https://www.jstor.org/stable/157946. Accessed September 19, 2021.

9.         Rousseau S, Dargent E. The Construction of Indigenous Language Rights in Peru: A Language Regime Approach: https://doi.org/101177/1866802X19866527. 2019;11(2):161-180. doi:10.1177/1866802X19866527

10.       Adelaar WFH, Malvestitti M DP. La historia lingüística andina: una visión de consenso en transformación. III Encuentro Lenguas Indígenas Am Libr Actas. April 2014:13-22. https://hdl.handle.net/1887/45460. Accessed September 18, 2021.

11.       Torero A. Los dialectos quechuas. An Científicos la Univ Agrar. 1964;2:446-478.

12.       Parker G. La clasificación genética de los dialectos quechuas. Rev del Mus Nac. 1963;XXXII:241-25.

13.       Mannheim B. Una nación acorralada: Southern Peruvian Quechua language planning and politics in historical perspective*. Lang Soc. 1984;13(3):291-309. doi:10.1017/S0047404500010514

14.       Newson L. Indian population patterns in colonial Spanish America. Lat Am Res Rev. 1985;20(3):41-74. doi:10.2307/2503469

15.       Congreso de la República del Perú. Peru: Constitucion Politica de 1993 Con Refomas Hasta 2005. Lima: Congreso de la República del Perú; 2005. https://pdba.georgetown.edu/Constitutions/Peru/per93reforms05.html. Accessed September 17, 2021.

16.       Instituto Nacional de Estadistica e Informatica. Peru: Perfil Sociodemografico. Informe Nacional. Censos Nacionales 20217: XXII de Poblacion, VII de Vivienda y II de Comunidades Indigenas. Lima; 2020. https://www.inei.gob.pe/media/MenuRecursivo/publicaciones_digitales/Est/Lib1539/libro.pdf.

17.       Economic Commission for Latin America and the Caribbean and others. The Impact of COVID-19 on Indigenous Peoples in Latin America (Abya Yala): Between Invisibility and Collective Resistance. Santiago; 2021. http://www.cepal.org/apps. Accessed September 18, 2021.

18.       Ravins A. Infection Rates and Indigenous Rights: The Effects of the COVID-19 Outbreak in the Amazon – NYU JILP. J Int Law Polit. 2021;2021:88-96. https://redamazonica.org/wp-content/uploads/Mapa-22-COVID19-. Accessed September 18, 2021.

19.       OECD. Latin American Economic Outlook 2010. Paris: OECD; 2009. doi:10.1787/LEO-2010-EN

20.       Minority Rights Group. Afro-Peruvians. World Directory of Minorities and Indigenous Peoples. https://minorityrights.org/minorities/afro-peruvians/?utm_campaign=shareaholic&utm_medium=printfriendly&utm_source=tool. Accessed September 19, 2021.

Summary of findings

• Wait times for bookings at the Sydney mass vaccination site are up to two months for non-priority groups
• Despite holding pre-scheduled appointments, on the day, the public lines up outdoors for up to two-hours. This makes for a physically uncomfortable and de-motivating experience
• Behavioural barriers during the mass vaccination experience may impact people’s willingness to return for their second dose in a timely way. For example:
  • the line-up system is confusing
  • it’s hard to hear staff directions
  • inadequate accessibility
  • lack of social distancing outdoors
  • few signs and instructions
  • lacking cultural safety for Aboriginal and Torres Strait Islander people
  • poorly promoted multilingual services for migrants
  • insufficient communication about extended wait times mean people may not be properly prepared to stand in line for so long  
• Behavioural science evidence could be used to improve the customer service experience, by:
  • improving physical cues, to encourage COVID-19 safe behaviours, and
  • using behavioural messages to motivate customers to return for their second vaccination dose on time.

COVID-19 vaccination in New South Wales

Vaccination, effective self-isolation, and adequate socioeconomic support are key public health measures that are proven to reduce the impact of COVID-19. Vaccination is safe,¹  and scientifically shown to reduce death, hospitalisation, and severe health issues arising from COVID-19. Vaccination is currently available to everyone in Australia aged over 16; from 13 September 2021, it will be extended to 12 to 15 year olds. I’m very lucky, and thankful, to be fully vaccinated. Vaccination itself was quick, easy, and painless. Health staff delivered excellent service. In particular, the clinicians who carried out the vaccine were compassionate, warm, patient, and good humoured. I urge everyone who is medically able to get vaccinated as soon as possible.

Vaccination efforts have been radically advanced in the state of New South Wales (NSW), due to the current Delta outbreak. As of today, 4 September 2021, vaccination doses have already reached 7.3 million in NSW alone.² Mass vaccination sites are producing extraordinary results given current constraints, including a strict lockdown in Southwestern Sydney.³

Nevertheless, there is a pressing need to rapidly increase vaccination. To date,⁴ 62.1% of people over 16 years have received one vaccine dose in Australia, and only 37.8% are fully vaccinated. Health inequities undermine vaccine efforts. I’ve previously detailed that policing patterns are unfairly targeting racial minorities in working class suburbs, illustrating how race and class impact the management of vaccination.⁵ As I show below, there has been a lack of vaccine supply and outreach to priority groups at high-risk of COVID-19, including Aboriginal and Torres Strait Islander communities, people living in aged care and disability group homes, and rural and remote regions.

Many countries are struggling to entice people to return for their second vaccination. For example, in early April 2021, five million Americans⁶ had not gotten their second dose. By early August Britain is lagging behind France on second doses.⁷

Policy context

The rollout and management of the vaccination program in Australia has been lacking. With the aim to vaccinate four million Australians by April 2021, the federal Government quickly fell behind schedule.¹¹ Poor leadership,¹² ongoing mismanagement of vaccine supply¹³ and lack of access for Aboriginal people,¹⁴ people living in aged care homes,¹⁵ and disabled people in group homes¹⁶ has contributed to vaccine hesitancy.

This has forced states and territories to take over vaccination in rapid timeframes.

On 21 August 2021,¹⁷ New South Wales (NSW) exceeded the highest number of COVID-19 within a 24-hour period, for any Australian state or territory (with 825 cases).  Numbers continued to climb. Five days later,¹⁸ we exceeded 1,000 daily cases; a trend which has continued daily. Today, on the 04 September, we reached 1,533 daily cases,² with increasing number of deaths. The number of people being hospitalised due to COVID-19 is up to 15%, with the intensive care capacity at 80% capacity in NSW.¹⁹ In this context of alarmingly high Delta variant cases, getting COVID-19 cases down, and vaccination up, is paramount to slowing the spread of infection.

As of today,²⁰ 72% of people over 16 years in New South Wales have received one vaccine dose, and 39% are fully vaccinated. However, vaccine availability and access vary.

Vaccination is especially needed in rural and remote regions in NSW, particularly in Western Sydney, which is currently battling a concerning rise in COVID-19 cases. For example, Wilcannia is in crisis²¹ due to government failure. The small town, which has a population that is 69% Aboriginal, is battling 97 COVID-19 cases (13% of the town is infected to date),²² a lack of food and medical services, and inadequate access to vaccination.²³ While two-thirds of the town has now received its first vaccine dose, this only happened in the past two weeks, after cases made national headlines.

Aboriginal communities were identified as a priority vaccination group by the federal Government in February 2021, but less than 20% are vaccinated across the country. In nine local health districts in NSW,²⁴ the vaccination rate of Aboriginal and Torres Strait Islander people is at least half that of non-Indigenous people.

Multicultural suburbs across Southwestern Sydney and Western Sydney are experiencing especially tough conditions,²⁵ with harsh curfews, stricter restrictions, and the additional expectation that these locals should get vaccinated as soon as possible. As these suburbs comprise up to 80% of authorised workers (people who cannot work from home),²⁶ they represent the biggest groups who are mandated to be vaccinated by their industry (including aged care, health, construction, and education).²⁷

Health professionals are doing an exemplary job of delivering vital care and services under such challenging circumstances. What follows is not a comment on healthcare workers, or the healthcare system, but rather an analysis of how behavioural science could enhance mass vaccination, given the current constraints.

Systemic support could improve vaccination, especially through federal funding to support people who are unemployed or precariously employed, so they are not forced to keep struggling until they are fully vaccinated. Alongside institutional responses, small physical and behavioural tweaks could improve the public experience at mass vaccination sites.

Research methods

My analysis of a Sydney vaccination centre draws on two ethnographic methods: participant observation and visual sociology.

Participant observation involves watching people, objects, a physical environment, and texts in their natural setting (that is, outside of a lab).^8(pp109-120) Researchers can assume various roles to carry out this analysis, from a complete participant who joins in, and records, all activities, to complete observer (someone who watches, but does not join).⁹ Since I reflect on my own vaccination here, I am closer to the complete participant end of the spectrum. I documented my impressions of the environment, and the procedures used to organise the public through their vaccination.

I also used visual sociology; a methodology for collecting visual data to analyse social phenomena.¹⁰ In this case, I took photos and short videos of my experience in line while I waited to be vaccinated, but I did not directly film other people or staff. I did not record audio, personal data, or any other material that would be identifying.

The focus of my discussion is solely on the physical environment and behavioural messages at the mass vaccination site.

This analysis does not typify all vaccine contexts, and it captures sociological and behavioural observations at one site at a particular point in time. I do not deal with the lack of vaccine doses, and confusion about eligibility, or other issues, such as vaccine hesitancy. For my research methods and ethics, see the end of this post. For broader issues on vaccination, see my other research;²⁸ and for structural dynamics and inequality of COVID-19, please see my recent writing.^5,29,30

The steps to vaccination

1. Pre-registering and booking

I pre-registered my interest to be vaccinated as soon as this was possible in New South Wales, in early June 2021. At this time, only one vaccine type was available to my age group.

As I am not in a priority group, the earliest booking I could make meant waiting two months.

Thankfully, now, in Sydney, anyone over 18 years³¹ can now receive AstraZeneca (AKA Vaxzervria) from pharmacists, their medical practitioner and walk-in clinics without any wait time.³² It’s safe for almost everyone, including people who are breastfeeding,³³ and pregnant.³⁴ Pfizer will now be available to all Australians over the age of 16 years.³⁵ Soon, vaccination will open up to 12 to 15 year olds.^36,37 Either way, people should not wait; everyone should take whichever vaccine is available as soon as possible.³⁸

The booking form takes five minutes. The questions ask about pre-existing health conditions, disability, pregnancy and allergies. You can put in your Medicare details, but it’s not required. Vaccines are free for everyone in Australia, including undocumented people. You are shown vaccine availability dates and times; the system does not allow you to book the second dose any sooner than three weeks after the first dose.

2. Getting vaccinated

I was vaccinated at a mass vaccination site in Greater Sydney, in a metropolitan location. My first dose was in late July 2021, and my second dose in mid-August 2021.

I received a reminder SMS the day before each of my appointments. The content was perfunctory (time, date, and link to a PDF with extra information – see below).

This text misses an opportunity to use behavioural messaging to increase commitment to show up for the appointment, especially the second dose. For example, the SMS reminders could say:

For my first appointment, I arrived 25 minutes early, at 4.20pm. I was vaccinated at 6.47pm, and I left after 7.00pm. It had been quicker for me to walk to the vaccination site, rather than take multiple buses and trains. However, not knowing I would be standing for two hours, this aggravated my knee injury and led me to seek physiotherapy. My physiotherapist noted I was the fourth person they’d treated because of long wait times at mass vaccination sites. I tried to call the mass vaccination site ahead of my second appointment to see what help was available, but after a 30-minute wait, I gave up. The link to my booking and the information link sent in my reminder text had no other way for me to contact the site other than via phone.

For my second appointment, I arrived on time, at 9.30am. I was vaccinated at 10.15am and I left at 10.35am. Following the advice of my physiotherapist, I spoke to clinic staff about my injury, and I had a note from my physio stating that I should not stand for longer than 15 minutes at a time. There was a little confusion, but I was then given a coloured sticker and I was able to go straight in. There was still some lining up once indoors (around 15 minutes, plus a 30-minute wait while seated). Once inside, but before entering the building, a nurse asked me questions about my injury, pain and whether I was on medication. I was told that due to my injury, I could have gone straight in through another entrance, but there was no way for me to know, as no staff I asked outside mentioned this.

Both times, the lines went around the block both ways. Throughout the hours I was there, there were at least two to three hundred people at any given time, but it seemed slightly less crowded in the morning.

Inside the building, check in kiosks were swift and efficient, printing out a QR code and customer vaccination number.

You’re directed into different seated waiting areas (e.g. general public, and people with special requirements). Both times, I waited 30 minutes while seated. Monitors show people’s QR code number when their vaccine is ready. You get a text message when it’s your turn to be vaccinated.

The vaccination took less than two minutes each time, including reviewing the health questionnaire I filled in at time of booking. Each person was seated with a nurse at a desk. The nurse checks that the information and your contact details are up to date. The needle is painless, and it takes two seconds to receive the vaccine. You’re given a sticker with the time of your vaccination, so staff can let you know when it’s safe to leave (15 minutes later). The staff were kind, engaged and provided an opportunity to ask questions.

After you receive each dose, you’re taken to an observation area that was well-staffed. You wait for 15 minutes, in case you have an adverse reaction. Staff responded quickly and with compassion when a customer said they felt unwell (e.g. faint). When your time is up, staff ask if you feel okay, and if you do, you hand in your stickers and leave.

There are monitors in the observation section. This visual real estate could be used effectively to leverage reciprocity and pro-social messaging (see Textbox 2).

During my first visit, I received two flyers in the observation area. There was too much text (information overload), and no call to action to motivate people to come back for their second dose. Behavioural insights best practice shows that people are more likely to change their behaviour, or comply with a message, if they understand in plain language exactly what they must do and when.³⁹

On my second visit, we received no health literature.

The flyer (and lack thereof) are missed opportunities to use behavioural messages, and boost commitment to return, as well as promote vaccination to friends and family.

For both doses, there were no verbal instructions about maintaining COVID-19 safe behaviours post-vaccination. The flyer includes a list of ways to ‘stay COVID safe;’ however, it doesn’t explain why it matters. It takes two-to-three weeks after the second dose for the vaccine to be fully effective. In a forthcoming study, we found that simple and salient instructions, repeated visually and verbally, increases compliance with COVID-safe behaviours. Given the NSW Public Health Order currently restricts travel and mandates mask-use, it may seem okay not to explain how the vaccine works. However, behavioural research suggests risk compensation could lead to people becoming lax in observing social distancing and other rules.⁴⁰ This is especially a problem in between the first and second dose, where protection from the vaccine is lower.

To improve outcomes, behavioural message could say:

3. Post-vaccination

I did not have painful side effects, other than a mildly sore arm after the first dose, and a little redness and itching after the second dose. Both times, these symptoms were gone after a couple of days.

Side effects are normal.⁴⁹ Most people who experience side effects only have mild symptoms. Over 99% of people who get a COVID-19 vaccine do not experience any major side effects. Only rarely (1% of cases), will people who are at-risk of developing a rare blood clot (thrombocytopenia syndrome, or TTS) will be affected if they take AstraZeneca. Everyone else, including others at-risk of blood clots, are safe to receive AstraZeneca and should not delay vaccination.⁵⁰ All other major vaccines available in Australia do not carry this risk which affects a minority of people.

I received two post-vaccination surveys. The first was about immediate side effects after the vaccination. The second was about lingering side effects a week after the second dose. Both surveys were exclusively focused on physical reactions. There were no questions about mental health, COVID-19 safe behaviours (e.g. did you maintain self-isolation?), and the customer service experience.

My vaccination certificate was not available two weeks after my second dose. I followed the instructions on the flyer I had previously received and logged onto the MyGov website. This showed my general immunisation record, with my second vaccination dose only, but not a separate COVID-19 certificate. I downloaded the Medicare app, as the flyer alternatively suggested. This was a bureaucratic pain, as I would otherwise prefer not to use this app. Still, it did not have the certificate. I contacted Services Australia publicly on Twitter, and the next day received an email saying my certificate was ready.

This process should be easier. Individuals should receive an automated alert when the certificate is ready. The delay did not impact me, but timely delivery is especially important for workers who have a requirement to be vaccinated. Soon, it will be necessary for the broader public, given that NSW is exploring options to provide additional freedoms to people who are fully vaccinated, once the state reaches the 70% and 80% double dose targets.

Behavioural barriers

The following physical barriers led to a protracted waiting process and may impact people’s prompt return for their second dose.

Reduce friction costs for families

Friction costs—the direct and indirect hurdles to healthcare and other assistance—put off some people from accessing services. The booking reminder email says you shouldn’t bring children.⁵¹ This is a barrier to people with primary care responsibilities (especially single parents), Aboriginal and Torres Strait Islander people, and migrants. This is even tougher when people are being actively encouraged not to use childcare services (100 centres are closed in NSW alone),⁵² and the Public Health Order rules prevent having family members from outside the household babysit.

On the days I was vaccinated, a couple of people brought kids or elderly family members and they were forced to wait across the road or in cars. There was nowhere for them to sit.

Reducing the hassle for parents and other carers would increase vaccination take-up.

Simplifying the lining up system

There were no signs on where to line up. There is no way to understand how lines correspond to appointment times. There was only a small sign at the entrance, which is hard to see from around the corner. Coordination of lines is confusing – lines go both ways around the park.

Making the lines easier to follow with better signs and physical cues would reduce this otherwise disorienting experience.

Signs to boost COVID-19 compliance

Adverse choice architecture opens potential for transmission. Choice architecture describes how the organisation of information, including a physical environment, impacts our decisions.⁵³ Because there are no physical cues, people line up as they would normally, without applying the 1.5 metre social distancing rule. Due to poor signs, new arrivals must ask other people in line what to do. Because we’re in masks, everyone leans into one another to hear. Even with masks, this creates potential for the spread of infection, as we cannot maintain social distancing (customers may be infectious even if they are asymptomatic and unaware they’re sick).

Signs and other environmental cues would help social distancing compliance.

Remove ambiguity for AstraZeneca patients

Occasionally, staff will call for people who have “AZ” at the end of their booking confirmation. It’s not clear that this is for AstraZeneca, and why this is being done, and so people were confused. Staff rarely stopped to explain. It’s hard to hear these calls.

Make it clear before arrival that AstraZeneca patients are prioritised in line.

Eliminate vaccination inequity

At the time of booking, patients can tick if they have accessibility requirements. However, some people may not feel comfortable, especially if they are used to be being denied opportunities. Disabled people can enter through another door, but you may not know if you didn’t pre-book. People who are hard of hearing would be unable to hear staff shouting directions outside, especially from long distances. Deaf people who use hearing aids cannot hear shouting, no matter how loud someone thinks their voice is; they require hearing loops.

The inside waiting area has large screens showing which customer numbers are ready to be vaccinated; however, the numbers are tiny and vision impaired people would find this difficult to read. People with mobile phones receive a SMS but some older people may not be checking their phones.

Accessibility should be built into every step of the customer journey.

Provide culturally safe services

Aboriginal people experience racism in healthcare. Lack of access to vaccination is in itself a sign of institutional racism. It is unsurprising that First Nations people currently have low vaccination rates. At the mass vaccination site, there was an Acknowledgement of Country sign at the entrance, and an Acknowledgement of Country occasionally flashed on screen inside. These signs are the bare minimum given we are on First Nations’ land, and do not go far enough to create a welcoming environment.

Provide a culturally safe service for Aboriginal and Torres Strait Islander people.

Provide multilingual services

At the time of booking, you can tick a box if you need a translator, but it’s easy to miss. On the day, staff have stickers they can give customers who ask for interpreters, but there’s no way to know this unless you find a staff member to ask. Generally, people with low English proficiency are reticent to ask for help unless they see someone who they think speaks their language.

I saw a man speaking Mandarin ask several staff for assistance and various staff asked one another if they knew anyone who could help. They were evidently eager to help, but there was no easy process to request a translator on the ground.

Before entering the mass vaccination building, a multilingual sign at the entrance says “Welcome” in many languages. There are no other multilingual signs, even though the mass vaccination site and surrounding suburbs are 78% overseas-born, predominantly from non-English speaking countries.

Many migrants have lost family members to COVID-19. Many of us are cut off from family and friends due to lockdown in a way that impacts us differently than other Australians (e.g. due to cultural and religious obligations). Getting vaccinated is an emotional rollercoaster as a result. The need to have culturally and linguistically relevant services is paramount.

Increasing multilingual services on the ground would help migrants feel welcome.

Reduce negativity bias

Negativity bias measures how, in Western cultures, negative memories often outweigh positive ones.⁵⁴ The mass vaccination site is currently vaccinating over 10,000 people daily. They are under-staffed. Staff work long hours and are on their feet all day. Understandably the few staff on site stand together near the entrances and exits. While some staff float around, and occasionally yell instructions, they cannot cover the full length of the massive lines. As a result, new arrivals invariably walking to the entrance, only to be told to line up elsewhere. A poor customer experience may disincentivise the public from coming back promptly for their second dose.

Creating a better customer service experience outdoors will ensure people aren’t put off from returning.

Enhance timeliness

The notion of time is culturally mediated; societies value time differently, and this has material consequences for some workers over others.⁵⁵ The “choice” to be vaccinated is not as simple as making vaccines available. Research shows that when people in Western cultures weigh up two options, they will prefer to reap immediate rewards.⁵⁶ They will delay investing in costs today, even if it means foregoing a bigger benefit in the future. A long wait time now still means being fully protected sooner. This is especially pertinent with Delta cases rising daily. After all, it takes two-to-three weeks from the second dose for the vaccine to be effective. The longer you put off getting vaccinated, the greater the risk of contracting COVID-19.

Yet with a two-hour wait time in line, it’s understandable that people would delay the second dose, because you must set aside so much time to get vaccinated, even with an appointment. Some people may delay vaccination, in order to wait for crowds to thin out, and get speedier service when there is less demand. Others might be afraid to lose so much time off from work: four hours to a casual or precariously employed worker can impact whether or not you can pay your rent. While the NSW Government gives public servants and council workers paid time to be vaccinated,⁵⁷ other workers are not currently eligible, not even disability residential care workers who work with a priority group at-higher-risk of COVID-19 (noting they are federal Government employees).⁵⁸ Even though there are appointments in evenings and weekends, waiting hours in line (especially for workers who are on their feet all day) is not an enticing experience.

Speeding up the wait times and making the experience more pleasant would ensure people don’t put off their second dose.

Promote effective planning

Anchoring is a cognitive bias, where people are heavily influenced by the first piece of information they receive, impacting our future decisions.⁵⁹ By anchoring patients to an appointment time, there’s inadequate planning. Many people arrive early and end up standing for hours. There’s nowhere to sit. I was vaccinated in Autumn; it gets pitch black at 5.30pm. It was very cold and uncomfortable outdoors. The people in front of me left at the one-hour mark. Having arrived in the afternoon, and not realising the wait would be so long, I missed dinner. There was nowhere to purchase food nearby (plus I would have lost my spot on the line).

Anchoring could be better managed by telling people what to expect before they arrive, and giving people updated wait times on arrival.

Behavioural solutions

Easy instructions with timely reminders

1. Make it easier to get there. Increase trains and buses. Introduce shuttle buses from community centres. Reduce traffic congestion with better directions for people arriving by car.
2. Help people plan. Vaccine hesitancy partly stems from people not knowing what to expect on the day. Make clear in the booking reminder email/ SMS that AstraZeneca bookings go in a different line and provide a clear map of the entrances, to show them where to go. Telling the public about the excellent customer service they can expect before they arrive would be highly motivating. (“Speak to our staff if you have questions on the day.”)
3. Manage expectations. Tell people to come on time, and that early arrivals will only be seen at their allocated time. Give people indication that wait times can be up to two hours. Tell people to dress accordingly, and to bring water and snacks.

Improve the customer experience outside

1. Boost customer service. Roster more staff and spread them out along the line to provide clear instructions and answer customer questions.
2. Improve accessibility. Introduce hearing loops and provide microphones for staff giving instructions.
3. Employ Aboriginal and Torres Strait Islander liaison officers. E.g. with a badge saying their role.
   1. Employing more Aboriginal and Torres Strait Islander health practitioners and staff, and following cultural safety protocols, could make customer experience more welcoming to Aboriginal and Torres Strait Islander people.⁶⁰
   2. There could be specific days that are dedicated to First Nations people’s vaccination, just as there has been to essential workers, construction workers, and Year 12 students from the 12 multicultural “suburbs of concern.” Organise community buses to pick up families. Collaborate and fund Aboriginal community-controlled health organisations (ACCHOs) to promote to communities.
4. Employ staff from multilingual backgrounds. E.g. badges saying they speak a specific language. More multilingual signs and bilingual staff could make the vaccination process easier.
5. Enhance comfort and safety.

5. Provide seated waiting area for vulnerable community members. E.g. Staff to be on the lookout for older people, disabled people, and pregnant people.
6. Use social distancing markers on the ground. There are stickers inside, but not for the long queues outdoors
7. Lights along the street from 5.30pm. Set up portable street heaters for night-time 
8. Make it social. At least half of customers came alone. Promoting sign up of households would help to alleviate the prolonged line up experience

Improve signage

1. Place reciprocity messages outdoors, to keep customers in good spirits, and stay motivated to wait in line. Include messages in different languages. E.g. “Thank you for getting vaccinated. You’re helping to protect your loved ones and your community.”
2. Visible instructions for lines around both directions. E.g. arrows and signs “4.30pm follow this sign.” Use different colour signs and stickers for different times.
3. Directions for AstraZeneca appointments. Use coloured signs/ stickers so these customers can speed ahead. Separate line/ entrance for AZ customers to speed up process.
4. Automate wait time indications. E.g. On arrival, tell people what they’re in for, such as “Your wait time is 1 hour.” Moving check-in to outdoors while in line would facilitate this.
5. Provide outdoor check in to speed up lines, give people a clear indication of how long the wait time is, and allow people to seek shelter instead of standing in line for hours.
6. Once checked in, send customers a SMS telling them their wait time, and when to start lining up (so customers can find a place to sit while waiting).

Maximise commitment once inside

1. Improve accessibility. Introduce hearing loops inside, and audibly announce customer vaccination numbers. Show customer vaccination numbers larger on screen.
2. Provide a simplified flyer to urge people to return for their second dose.
3. Reinforce importance of second dose in observation area. Monitors can include behavioural messages using reciprocity and pro-social messaging to motivate people to return for second dose.

Summary

The table below summarises the behavioural barriers and solutions.

Infographic: COVID-19 mass vaccination behavioural process

Methods

I attended my vaccination as an ordinary citizen, not as a researcher intending to carry out analysis. However, upon arrival, the layout and coordination of the vaccination site soon piked my sociological imagination. I have been conducting visual sociology since 2009, including on this blog and on my social media. I often take notes, photographs, and videos of my everyday life. Like most sociologists, I walk through the world as a sociologist, meaning that I do not ever switch off from critical reflection. Even as I documented my experience, I did not originally expect to publish this analysis. I was motivated to write this post after my second vaccination, seeing that the process had not improved.

I am trained as a qualitative researcher. My professional expertise is in improving outcomes on social policy issues. In recent years, I have worked on public health (including COVID-19), education, equity, and justice, with a focus on disadvantaged groups. I am generally interested in making services more accessible for the public, particularly marginalised people.

My analysis of the mass vaccination centre was opportunistic. Once I arrived at the vaccination site, I quickly assessed that the process could be enhanced with behavioural insights.

Participant observation

I took observational notes on my mobile phone, noting:

• the physical surroundings, such as posters and signs, and physical cues (such as social distancing stickers)
• the times when we were moved from one area to another
• length of waiting periods
• behavioural barriers (e.g. examples where it was difficult to follow instructions, or where coordination led to adverse behaviours, such as when strangers were forced to ask for help because there were no other signs)
• behavioural enablers (e.g. examples of good practice, such as stickers for people needing translators)
• ideas of how the environment and process could be improved

I did not take notes or collect other data about specific staff or the public, nor did I record or analyse conversations of staff or others around me. I did not collect data, or otherwise evaluate, the job performance of staff. I did not collect, nor did I have access to, any medical records other than my own.

Visual sociology

I also took photographs and short videos of the environment, and my reflections on my progress through the line. I only captured images of objects in my path, but did not record notes, visuals, voice or other data about other people. I followed staff directions and did not go out of my way to photograph or film other people, rooms, or events outside of my immediate view, nor did I walk into unauthorised areas.

Visual data I collected included:

• Images of text message and emails related to my appointment
• Signs and posters at the vaccination centre
• Flyers provided to me during vaccination
• Stickers and other markers on the ground

Ethics

There are no research participants involved in this analysis, and so this work does not require ethical review. However, I would still like to reflect on the ethics of my participant observation methods.

The National Statement on Ethical Conduct in Human Research is organised around the four sets of values outlined below. My analysis falls under ‘negligible risk research,’ as there is no foreseeable risk of harm or discomfort to others.⁶¹

1. Research merit and integrity: I share my reflections to demonstrate the value of using behavioural insights to improve the coordination of mass vaccination. The perceived benefits of this analysis is to demonstrate to other practitioners how vaccination efforts might be bolstered with simple behavioural cues and messages.
2. Justice: there were no participants recruited. By publishing my observations on my blog, I hope my analysis is available to the public, in a timely way. The COVID-19 pandemic is dynamic, and the Public Health Order changes constantly. As such, opportunities to improve the vaccination process, or public understanding of vaccination issues, has potentially strong value.
3. Beneficence (do no harm): human research must justify any risks to participants, as well as the benefits to participants or the wider community, or to both. Again, there are no direct participants included in my analysis, outside of myself. The topic of vaccination is potentially fraught, due to ongoing public debate about misinformation, mandated vaccination of some workers, lack of access to vaccines by groups at-higher-risk of COVID-19, and other issues. My analysis has not collected data on these, or other, sensitive topics.
4. Respect: research must address the rights and dignity of participants, including their privacy, confidentiality, and cultural sensitivities. I did not elicit participation of other people in research, nor do I incorporate any private information, or other data about other individuals.

My recommendations on how to improve mass vaccination are drawn from observations of a public space. My presence did not impact staff, nor other members of the public. As this is an unobtrusive observation of a public place, and I draw on non-identifiable reflections, my analysis is unlikely to cause harm.

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Without warning, on 30 July 2020, the Victorian Government placed 3,000 people living in nine social housing towers into a police-enforced lockdown. They aimed to contain the spread of COVID-19 infection by targeting disadvantaged migrants who were in a dependent relationship with the state (social housing tenants live in buildings owned by the Government). Ultimately, this racial targeting did not work. The entire state of Victoria was still placed into lockdown, which lasted almost four months.

The Melbourne example shows police-enforced segregation of multicultural communities is an ineffective public health model. This pattern is currently being repeated in Sydney almost exactly one year later.

Announced suddenly on 03 July 2021, police and the military have been deployed into eight multicultural suburbs in South West and Western Sydney, to enforce lockdown through door-to-door visits. Military personnel are not mandated to be vaccinated. This show of state force was not used in previous outbreaks involving white, middle class people in the Northern Beaches, or at the start of the present lockdown, in Bondi.

Heavily policing public health in places where Aboriginal people, migrants and other working class people live sends a damaging message to those communities. There are potential health risks with this plan, including to mental health and safety.

Ableism is the discrimination of disabled people, based on the belief that able-bodied people (people without disability) are superior, and the taken-for-granted assumptions that able-bodied experiences are “natural,” “normal” and universal. Racist ableism describes how ableism intersects with racial discrimination (unfair treatment and lack of opportunities, due to ascribed racial markers such as skin colour or other perceived physical features, ancestry, national or ethnic origin, or immigrant status). Learn more in: “Lockdown, Healthcare and Racist Ableism”

Lessons from Victoria, July 2020

The Victorian Parliament Inquiry found that policing of COVID matters increased existing inequity in Melbourne. A critical race theory approach shows these patterns are racialised.

The Victorian Parliament Inquiry into the Victorian Government’s Response to the COVID-19 Pandemic found that, rather than sending in police, “a health-based approach during the lockdown would have been more appropriate” (p. 189). Healthcare workers and service providers noted that police “impeded” and “obstructed” their ability to deliver food, medicine and healthcare (p. 189). As a result of police, nine towers residents were left feeling “scared, powerless and criminalised” (p.190). More generally, multicultural communities reported that health responses throughout the pandemic were inadequate (p.44).

Similarly, an investigation by the Victorian Ombudsman found the policed approach to lockdown in the nine towers was a violation of human rights.

The Inquiry heard that, from the establishment of COVID penalties on 17 September 2020, to 16 December 2020, almost 40,000 COVID-19 fines had been issued n Victoria. Fines increased when COVID-19 infections and restrictions were highest, and dropped when cases and restrictions were lowest (pp. 262-263).

Additionally, twice as many fines were handed out in local government areas with the greatest socioeconomic disadvantage. The highest proportion of total fines were issued in Greater Dandenong (1,837 fines, or 5.62% of total fines) and Brimbank (1,503 fines, or 4.59%) (pp. 264-266). Not coincidentally, these areas have high migrant populations. Greater Dandenong has a population 64% overseas-born, mostly from Vietnam, India, and Cambodia. Brimbank has a population 55% overseas-born, primarily from Vietnam, India, and the Philippines. Brimbank was one of the five local councils with the most COVID-19 cases by 1 December 2020, and is of the 10 most disadvantaged councils in Victoria. It also had a higher percentage of insecure work (p.130).

Non-English speaking migrants are among the most disadvantaged groups. They are disproportionately employed in “essential services,” including aged care and healthcare, and so they have no choice but to go to work during the pandemic. They are already overpoliced. As a result, they receive the highest COVID fines.

By increasing policing in Sydney, and not heeding the lessons from Victoria, we are set to reproduce the same racial and health inequalities.

Health inequality in Sydney, July 2021

Seemingly overnight, at the request of Police Commissioner Mick Fuller, 300 military personnel have been deployed to enforce the COVID-19 lockdown in metropolitan Sydney. It came with the same swift, harsh and punitive timing as the Melbourne lockdown.

The Sydney operation is focused on eight multicultural suburbs, who are already under “hard lockdown.” I’ve previously shown that the first five suburbs put on elevated restrictions have 50% to 69% migrant populations from non-English-speaking origin. Of the three new suburbs put on hard lockdown, two have higher than average migrant populations (Parramatta and Georges River). Campbelltown has a higher than average Aboriginal and Torres Strait Islander population. The table below shows selected characteristics of the eight Sydney local areas in hard lockdown, in comparison to Bondi and the rest of New South Wales (NSW).

Three of these local areas have lower than average median incomes (Fairfield, Canterbury-Bankstown, and Liverpool), though this does not capture the impact of precarious employment. Six of the eight suburbs in hard lock down have a higher than average disabled population (exceptions are Georges River and Parramatta). Disabled people are a priority group vulnerable to COVID risk. Two of these regions have higher than average rate of “essential workers” (Canterbury-Bankstown and Campbelltown). These vulnerable groups need culturally appropriate healthcare, not guns and fines.

Given that officials continue to emphasise that workplaces are the primary place of infection, and that these local areas supply a big group of essential workers, policing individuals is unlikely to address unsafe working conditions.

All eight suburbs under hard lockdown have above average COVID-19 test rates, with Canterbury-Bankstown and Liverpool twice the state average, and Fairfield 3.5 times the average. While this partly reflects mandatory testing for essential workers who need to leave their local area for work (“surveillance testing”), it still shows these multicultural communities are complying with the Public Health Order. This is not the message we hear daily from police and officials, who emphasise exceptional cases of deviance among multicultural communities.

In comparison, Bondi (where the first case in this outbreak originates), did not get military and police doorknocks, even at the peak of infection when cases were higher than other outbreaks. Bondi currently has a substantially lower number of COVID-positive cases now, but that wasn’t the case early on. Bondi has a high overseas-born population (55%), who are predominantly English-speaking (8% of Bondi residents were born in England; this is more than twice the rate of the next biggest overseas birthplaces, Brazil and South Africa). Bondi has 2.5 times fewer disabled residents than the rest of NSW. Residents have a weekly income that is $689 higher than the median, and a lower rate of essential workers. Race and socioeconomics has protected Bondi residents from a military onslaught.

Bondi and the other eight suburbs have a lower than average number of people aged over 70 years (a COVID priority group).

Table 1: Local Government Areas with high locally acquired cases since Bondi cluster began

Criminalising COVID

Racial minorities are already subject to over-policing in Sydney, and have been disproportionately penalised during the pandemic.

For example, legal researcher, Vicki Sentas and colleagues, find that, from 15 March to 15 to June 2020, 9% of people stopped for COVID-related matters in New South Wales (NSW) were Aboriginal people (even though they make up 2.9% of the population in NSW). Aboriginal people also made up 10% of people searched, and 15% of arrests for COVID matters. These patterns, as well as those from the nine towers in Melbourne, suggests that using police and military to liaise with community is in opposition to positive public health outcomes.

Learn more: Listen to Vicki Sentas discuss her other research on stop and search patterns and the pandemic in our Race in Society episode, “Policing the Quarantine.”

Criminalising healthcare

The police response targeting non-English speaking migrants and Aboriginal communities tells these groups that the state perceives them to be inherently criminal. The reality is that the eight communities under hard lockdown supply a large portion of essential workers who cannot work from home. The state has acknowledged that the economy relies on these workers. So, while we cannot afford to have these workers stop supplying labour, we still put them in workplace environments that carry increased risk of COVID infection. When individuals cannot avoid infection under these impossible circumstances, their sickness is punished.

Racist ableism leads to elevated fear of healthcare, to the point where four infected people in New South Wales have died at home without medical help. In one recent case, a 60 year-old migrant man was scared to call for an ambulance, for fear getting in trouble after learning he was COVID-19 positive. He died at home. His entire family was infected, but they had also avoided medical care until his death.

On the one hand, public officials say: “Our government… is not like the government that you have lived under overseas. We are here to support you.” But, on the other hand, we fine poor people severely, we put non-English speaking migrants into hard lockdown, demonise them in the media for not following the rules (even as other suburbs are flagrantly flouting lockdown), and then send the military to their homes.

Racial discrimination coupled with ableist approaches to the pandemic (keep going to work, but we will punish you if you get sick) are compounding disadvantage amongst the most vulnerable.

Vaccination

In June 2021, the Federal Government announced that the military had been put in charge of the vaccination rollout, even though this is the responsibility of the Prime Minister’s office. On 30 July 2021, the NSW Police Commissioner announced military personnel will accompany local police on door knocks to ensure people who have tested positive to infection are self-isolating at home. Upon questioning by journalists, the Commissioner admits military are not mandated to be vaccinated (police doing the door knocks are mandated to be vaccinated). Using unvaccinated military personnel during home visits increases health risks to vulnerable communities.

This approach sets up a racist double standard on vaccination, where state forces who are not vaccinated are being used to enforce the Public Health Order, even when they are not following vaccination advice. Defence Forces are, after all, a priority group who were given early access to vaccination.

The military and police were not used to door knock in affluent, Anglo-Australian majority suburbs during the Northern Beaches outbreak in December 2020, nor at the beginning of the current outbreak in Bondi.

More broadly, low vaccination leaves vulnerable communities at risk. The vaccination program, which is led by the Federal Government, is not going as planned.

By the end of July 2021, Australia has the second lowest vaccination rate among OECD nations (in 37th place), with only 15% of Australians fully vaccinated (and almost 18% only one dose). In New South Wales, only 39% of people over 70 years are vaccinated, 30% of disabled people in group homes, and 20% of Aboriginal people have received one vaccine dose (only 7% fully vaccinated).

Learn more: Prime Minister Scott Morrison initially announced a target of having 20 million adults fully vaccinated by October 2021. In January 2021, priority groups were frontline healthcare, quarantine, aged care and disability workers, as well as residential aged care and disability residents (1A). Other priority groups were elderly adults over 70 years, Aboriginal and Torres Strait Islander people over 55 years, younger people with underlying health conditions including disability, and emergency workers (including Defence and police) (1B). These targets have not been met. The Prime Minister did not prioritise negotiation of vaccines. The states were forced to help with the rollout in March, but are still beholden to the federal government to deliver supply. The new national targets are: 1) 70% of eligible Australians vaccinated to introduce selective lockdowns; 2) 80% to end lockdowns and allow international travel.

The pandemic has already had a negative impact on Aboriginal people, leading to greater barriers in accessing healthcare. Exposing vulnerable community members to unvaccinated (albeit masked) military members is an unnecessary risk. Moreover, it may negatively impact willingness to get:

1. COVID-19 tested; and
2. Vaccinated.

Take action: 1) Get vaccinated! I have; it’s safe and painless. It helps protect our loved ones and vulnerable people who cannot get vaccinated for medical reasons. If you live in New South Wales, any adult over 18 years can now get AstraZeneca from mass vaccination hubs without delay, and from 4 August, you can also get it from your pharmacist. 2) Sign the petition Vaccines and COVID protection for disabled people now.

Mental health

The current approach may lead to further mental health risks. This is especially the case for Aboriginal and Torres Strait Islander people. They are already disproportionately jailed and are more likely to die in custody. Historical and ongoing patterns show that police interactions lead to adverse, and lethal, outcomes. Police cannot be trusted to treat Aboriginal people with the same care as they do non-Indigenous people. Aboriginal people have justifiable fear of police and Government officials coming to their homes, and removing their children at four times the rate of non-Indigenous people. First Nations people already experience intergenerational trauma due to ongoing colonisation. The military was used to impose numerous harmful restrictions during the 2007 Northern Territory, leading to long-term health damage.

On top of this, Jill Gallagher (Chief Executive Officer of the Victorian Aboriginal Community Controlled Health Organisation) tells us in Race in Society that COVID-19 has increased mental health risks for Aboriginal people.

Refugees and asylum seekers have experienced human rights violations and they continue to experience elevated psychological issues after resettling in Australia, including post-traumatic stress and depression.

Ultimately, 1.5 years into the pandemic, racist ableism prevails. The state and federal governments seek to ramp up voluntary vaccination among the general population, while struggling to provide impactful public health outreach to migrant and First Nations communities. Nevertheless, it is clear that the state is more concerned with enforcing the racial hierarchy, than providing culturally safe public health.

A culturally safe approach

Cultural safety can improve public health responses to the pandemic. Insights from our Race in Society episode, “Lockdown, Healthcare and Racist Ableism,” could be applied in the current Sydney outbreak, through:

• Ethical engagement with Aboriginal and Torres Strait Islander people living with disability
• Practical help, including groceries and improved services, to rural and remote Aboriginal communities
• Application of cultural safety principles when dealing with First Nations people and migrants. This includes learning to recognise and redress racism in healthcare through better training of staff, and deeper consultation with communities about their needs throughout the pandemic
• Improving data collection on race, language and socioeconomics, to measure the impact of policy responses on different communities
• Enhanced accountability of pandemic policies.

Notes

Table 1 sources:

• a) Local Government Area under hard lockdown of 1 August 2021
• b) in past 4 weeks to 31 July. Source: https://www.health.nsw.gov.au/Infectious/covid-19/Pages/stats-local.aspx
• c) 2016 Census QuickStats (see reference list for each LGA)
• d) reported in the Census needing help in their day-to-day lives due to disability. NB. Limited definition of disability, not a social definition of disability (i.e. does not capture others who self-identify as disabled but don’t need help day-to-day)
• e) https://profile.id.com.au/fairfield/assistance
• f) https://profile.id.com.au/canterbury-bankstown/assistance
• g) https://profile.id.com.au/liverpool/assistance
• h) Parramatta Ward: https://profile.id.com.au/parramatta/assistance
• i) https://profile.id.com.au/campbelltown/assistance
• j) https://profile.id.com.au/georges-river/assistance
• k) Data for Bondi Ward. https://profile.id.com.au/waverley/assistance
• l) https://profile.id.com.au/australia/assistance
• m) Data for Waverly LGA (Bondi not disaggregated)
• n) China excludes SARs and Taiwan
• o) Industry of employment, top responses only: working in hospitals, aged care, building cleaning, supermarkets and groceries, cafes/ restaurants, road/ freight/ transport. (NB. Undercounts people who work in these industries, but are not in top for this LGA)

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Policy context

Three states in Australia are presently under a strict COVID-19 lockdown: New South Wales, Victoria, and South Australia. New South Wales is experiencing a major Delta variant outbreak, which is highly contagious. It has spread to the other states through working-class people, who do not have the luxury of working from home. Similarly to what happened in the Melbourne lockdown in 2020, residents in migrant communities have been placed into a tougher lockdown relative to others, even as they are required to continue working, and submit to COVID testing every three days (“surveillance testing”).

Public discourse about the COVID-19 outbreaks continues to be racially coded in media articles and in press conferences. This contributes to a moral panic about racialised people. Blame is placed on multicultural communities for not listening to public health messages, even though the majority of cases originate in ‘essential’ workplaces that are not required to shut down. As some communities remain confused about public health messages, state responses have been heavily criticised for not promoting culturally-appropriate public communication campaigns, while targeting migrants with a heavy police presence.

In early-July 2021, 200 police were sent to South Western Sydney, where at least half the population are migrants. Since then, reports on infringement notices feature in the daily press conferences. This did not happen at the beginning of this latest outbreak, when infection was exclusively spreading in Bondi, an affluent suburb where the majority of residents are white, Anglo-Australians.

On the morning of 24 July 2021, the New South Wales Deputy Police Commissioner announced 246 people had received infringement notices in the past 24 hours, highlighting the case of a grieving family gathering to mourn, implying they were from a non-English speaking background. The Minister for Health spoke heavily about ‘multicultural’ communities not following the rules by visiting family members who don’t live in the same house. By the afternoon, 3,500 anti-lockdown protesters marched through central Sydney without masks, being violent, and yet only 90 people initially received infringement notices, and 57 people were arrested. The race of the protesters—who were overwhelmingly white—has not been a focus of media reports.

Delta outbreak

The origins of the current national emergency began on 16 June 2021, with two initial cases in Bondi. A private driver who works with international flight crew became infected., followed by his wife. The driver was reprimanded by media and officials for not wearing a mask and for not being vaccinated (quarantine workers, including drivers, are mandated to be vaccinated). However, his employers were not subject to this scrutiny, and the broader ongoing problem with quarantine system, which is a federal government responsibility, was not given the same attention. Rightfully, the Bondi driver’s race, language and ethnicity was not the leading story.

The virus spread across Bondi over the following four weeks. Experts agreed from inception that the Bondi outbreak was serious, and very different to previous outbreaks, because it was the Delta variant. The community was encouraged to stay home and get tested; however, Bondi was not placed into a tough lockdown. There wasn’t a focus on handing out fines, or otherwise policing Bondi residents, even as they continued to go out in droves. Bondi is a white, Anglo-Australian majority suburb. The whiteness of the community was not villainised.

By 18 June 2021, the rest of metropolitan Sydney was placed on elevated restrictions due to the Bondi outbreak. Throughout this time, Bondi residents continued to move around, without adhering to social distancing rules. However, when ethnic minorities broke the rules – even momentarily – their names and images are published by the media, in a way that did not happen in Bondi.

On 8 July 2021, three removalists from Sydney travelled from Victoria into New South Wales and South Australia while knowingly infectious. In mid-July, another two Sydney removalists travelled into regional New South Wales after testing positive for COVID-19. The media has heavily focused on the latter two removalists’ Arabic background. Critiques of ‘multicultural communities’ followed. The two removalists are brothers. Their family say that they did not understand the phone call from New South Wales Health informing them about their positive COVID-19 test, due to low English language proficiency, and they requested NSW Health contact their boss. The brothers’ names have been made public, despite the fact that their mother died of COVID-19 after the case was made public, their father has also since tested positive.

The same is not true of the three removalists who travelled into state. They have been charged and face court proceedings, however, their ethnicity, and their community by extension, are not under trial by media.

The Australian media has been relentless in naming and shaming index cases, including the driver who was the first person infected in the Bondi outbreak. This is reprehensible. Yet the media and police go one step further, by relishing the opportunity to punish migrants.

Racialised lockdown

On 9 July 2021, metropolitan Sydney was placed into an even stricter lockdown. All office workers were ordered to work from home. On 17 July, three suburbs from South Western Sydney were given stronger restrictions, with only essential workers allowed to leave their local area, but only if they submit to COVID testing every three days. The majority of currently infected people live in South Western Sydney and Western Sydney suburbs. These suburbs have a predominantly non-English speaking population. For example, 69% of Liverpool residents were born overseas, with the biggest groups from Iraq, India, and Fiji. Similarly, 60% of Fairfield residents were born overseas, primarily in Vietnam, Iraq, and Cambodia, and 50% of Canterbury-Bankstown residents were born overseas, primarily in Lebanon, Vietnam, and China. While the Government recognises that these residents are ‘essential workers’ who are keeping the economy running, a strong police presence was announced for South Western Sydney.

Since then, infringement notice reports feature daily at news conferences.

Tougher lockdowns, surveillance testing of essential workers, and penalties were not a daily feature of press conferences and media coverage when the majority of COVID cases were in Bondi. Even now, with the entire metropolitan Sydney population under lockdown (and South Western Sydney under even stricter limits), affluent white-majority suburbs flout lockdown rules (see Coogee below).

Unlike other states, New South Wales has resisted defining ‘essential workers’ throughout the pandemic. The first list was provided on 17 July, only to be expanded two days later, after ‘consultation with businesses.’

Further lockdowns were imposed on three regional towns on 21 July (Blayney, Cabonne and Orange), but, unsurprisingly as they are white-majority areas, the announcement came without the threat of extra policing. Just three days later, on 24 July, Cumberland (58% overseas born) and Blacktown (44% overseas-born and a sizeable Aboriginal population), have been placed on the same restrictions as the three other South Western Sydney suburbs.

Working class burden

People in precarious jobs cannot simply work from home. Health officials continue to report that workplaces are the key ‘seeding’ events (where infections originate), and that infected workers then transmit the disease across the community via their households. The pandemic continues to illustrate how race and class inequality function: there is a general lack of protection of working-class workers (class), and most working-class ‘essential workers’ are racial minorities (race).

When white people are caught doing the wrong thing, their race is never mentioned by the media. However, when racial minorities are involved, their communities are implicated. South Western Sydney mayors say that this is a ‘double standard.’

Lebanese Muslim Association president Samir Dandan says the police response is ‘disproportionate’: ‘This is highly problematic and reinforces the experience of this community being over-policed and continues to create heightened sensitivities around the over-scrutinisation of these communities.’

The South Australian outbreak started on 18 July, when a man arrived in Australia from Argentina, and was isolated into a New South Wales quarantine hotel (due to the pandemic, the majority of international arrivals come via Sydney International Airport). After becoming injured in quarantine, he was taken to a New South Wales hospital, and subsequently tested positive for COVID-19.

The spread of infection is exacerbated by the lack of protection for working-class people, especially racial minorities, in quarantine jobs, aged care, healthcare, and other essential services. Quarantine safety and vaccination are both the responsibility of the federal Government.

Media and officials continue to blame racial minorities in a way that does not feature for white-majority communities. For a deeper look at how this plays out, revisit our Race in Society series, which delves into this head on, in Media Representations of Race and the Pandemic.

References

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