Journal articles on the topic 'Workers' compensation Victoria'

BackgroundOccupational contact dermatitis is one of the most common occupational diseases, but there is a lack of reliable information on incidence. Despite acknowledged limitations, workers’ compensation statistics may provide insights into contact dermatitis patterns.ObjectiveThe objective of the study was to characterise historical patterns of workers’ compensation claims for occupational contact dermatitis.MethodsThis was a retrospective analysis of workers’ compensation claims for occupational contact dermatitis from 1996–2015 (n=3,348) accepted by WorkSafe Victoria in Victoria, Australia. Accepted claims per 1 00 000 person-years stratified by sex, age and industry were calculated. Denominators for the population at risk were obtained from the Australian Bureau of Statistics using Victorian Labour Force Survey data.ResultsThe compensation claims rate of occupational contact dermatitis was 6.72 per 1 00 000 person-years for the overall twenty-year period. There was a significant reduction in claims from 11.84 in 1996 to 1.78 in 2015. Males had a higher overall claims rate of 7.97 compared to the rate for females of 5.18. Over the twenty-year period the rate for males decreased from 14.46 to 1.7 compared to a reduction from 8.4 to 1.8 for females. This decrease was still observed when the data were standardised for underlying changes in the age structure of the population. There was an overall decline across all high-risk occupational groupsConclusionsThere was a fivefold decrease in accepted claims for occupational contact dermatitis for the twenty-year period from January 1996 to December 2015 for the state of Victoria in Australia. These results need to be regarded with caution as the declining rate of accepted occupational contact dermatitis claims may indicate changes in workplace dermal exposures or improvements in workplace skin protection practices over time, or they may be driven by underlying changes to the workers’ compensation system or changes to claims behaviour amongst workers.

When the Victorian Labor government created the WorkCare system in 1985, it believed that the government takeover of the workers compensation system from private insurers would permit the creation of a system that could provide more generous and compassionate benefits for injured workers. while first containing and then reducing costs to employers. The WorkCare system never succeeded in reconciling these goals. Instead, it became enmeshed in financial difficulties and failed to acquire either stability or political legitimacy throughout its seven years of existence. This failure made it possible for the incoming Coalition government to bring down the curtain on the WorkCare system at the end of 1992, and to replace it with a scheme based on harsh and ungenerous treatment of injured workers. Coalition policy is that this new 'WorkCover' scheme will be privatized once its financial position is stabilized. However. there is considerable uncertainty about whether privatization ultimately will occur.

BACKGROUND: Migrant workers have been identified in Europe, North America, Asia and Australia as a particularly vulnerable working population with a higher risk of work-related injury and mortality compared to non-migrant workers. Lack of English language proficiency is associated with an increased risk of work-related injury. Whether lack of English proficiency influences post-injury recovery or return to work outcomes remains unknown. OBJECTIVE: Using administrative data from a population based workers’ compensation dataset in the state of Victoria, Australia, we aimed to examine work-related injury rates, worker characteristics and compensation outcomes in workers who were not proficient in English. We hypothesized that the use of an interpreter service would be associated with a poorer post-injury recovery profile and worse return to work outcomes. METHODS: WorkSafe Victoria accepted non-fatal claims for injuries and illnesses reported between January 1, 2003, and December 31, 2012 by workers aged 15 to 74 (n = 402, 828 claims) were analysed. Consistent with prior research, we selected “use of an interpreter service” as the indicator of English language proficiency. The total and categorical compensable cost of recovery was used as recovery outcomes. RESULTS: Of these claims, 16,286 (4%) involved the use of an interpreter service (LOTE workers). Our analysis revealed that Victorian injured LOTE workers have significantly different demographic, occupational and injury characteristics compared to non-LOTE injured workers. Furthermore, we present novel evidence that LOTE status was associated with poorer long-term injury outcomes, observed as a greater healthcare utilisation and larger paid income benefits, after controlling for occupation, employment status and injury type compared to non-LOTE injured workers. CONCLUSIONS: These data suggest that English language proficiency is associated not only with the risk of work-related injury but also to the long-term recovery outcomes. We conclude that despite access to language interpreter services, injured LOTE workers experience English language proficiency dependent, and injury severity independent, recovery barriers which need to be overcome to improve long term recovery outcomes.

IntroductionRTC burden is commonly measured using fatality or hospitalisation statistics. However, non-fatal and less severe injuries contribute substantial economic and human costs, including work absence. In Victoria, Australia, two major compensation systems provide income support to employed people injured in RTCs; workers’ compensation (if RTC occurred during work) and an RTC-specific compensation system. This study aimed to describe the number and rate of episodes of work absence due to compensable RTC and determine factors associated with work-related RTC resulting in work absence.MethodsAdministrative data for working-age people (15–65 years) with accepted compensation claims between 1 July 2003 and 30 June 2013 were extracted from Victoria’s Compensation Research Database and analysed. Injured people receiving at least one day of income support were retained. Rate calculations used Victoria’s labour force as the denominator and negative binomial regression determined any time-based trend changes. Multivariable logistic regression was used to determine odds of the RTC being work-related.ResultsThere were 40 677 claims made by workers with an RTC injury that consequently missed work, averaging 4068 claims per year at a rate of 12.9 per 100 000 working population. Work-related cases contributed 17.4% (N=7061). Males, older adults and RTCs involving heavy vehicles, buses, trains and trams had higher odds of a work-related RTC resulting in work absence. More severe injuries tended not to be work-related.ConclusionsWork absence due to RTC injury constitutes a substantial burden, and this measure could provide a valuable addition to conventional RTC statistics.

Time taken to first return to work (RTW) is often a primary endpoint for studies among injured workers. However, studies using administrative workers’ compensation claims data have documented that a substantial proportion (approximately one half) of claimants will incur a subsequent period of wage replacement. Unfortunately, workers’ compensation data is limited in the information collected to better understand which claimants are more likely to have a subsequent absence from work. The objective of this study is to address this gap using a cohort of workers’ compensation claimants in the Australian state of Victoria.The sample for this study is drawn from a longitudinal cohort of workers’ compensation claimants (n=869). For the purpose of this analysis we focused on those claimants who had returned to work (self-reported) at the baseline interview, which was conducted approximately 4 months after the injury had occurred (n=372). Independent variables examined included if the respondent was working on full or partial duties, currently receiving health care for their injury, type of injury (musculoskeletal versus psychological), co-worker responses when they returned to work (measured using nine questions), and work limitations, measured using an abbreviated form of the work limitations questionnaire.A total of 205 respondents (55% of the sample) reported a subsequent absence from work when interviewed 6 months later. All independent variables, with the exception of injury type, were associated with subsequent absences from work. In a multivariable model, only working modified duties and greater limitations remained statistically significant.The results of the current study help inform our understanding of trajectories in RTW and factors, measured after the first RTW, which may be associated with a subsequent absence from work. These findings can be integrated into RTW programs to help more workers achieve sustainable RTW following a work injury.

ObjectiveTo measure the effect of legislated increases to workers’ compensation benefits on claiming behaviour.MethodsInterrupted time series of workers’ compensation claims in Victoria, Australia (2008–2012), assessing 1) the overall effect of the legislation and 2) raising the wage replacement cap on higher earners, by condition type, in reference to a comparator of other Australian workers’ compensation jurisdictions.ResultsOverall claiming increased 11.7%, driven largely by musculoskeletal condition claims. There was no detectable effect on disability duration overall, though back/neck conditions were up 26.9%. Among higher earners, there was mixed evidence of an increase in claiming, though disability durations were up 32.9%, which was also driven by back/neck conditions. There was mixed evidence of an effect on mental health claims, suggesting either no response or a negative response to benefit generosity.ConclusionsFindings mainly align with existing evidence: more generous benefits increase claiming and disability durations, primarily driven by back/neck musculoskeletal conditions. However, some mixed findings by injury group and among higher earners raise questions about confounders such as co-occurring events.

Abstract This article discusses uses of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) in Australia and New Zealand. In addition to its use in the United States, the AMA Guides also is used in Australia, New Zealand, Canada, and some European countries such as Ireland, the Netherlands, and Norway. Use of the AMA Guides varies from country to country, depending on local workers’ compensation or personal injury legislation. In Australia, the AMA Guides is used in various state systems, but the editions used or recommended may differ. Often, cases in which the impairment predates December 1988 (when the current Commonwealth Workers’ Compensation Act became effective) are assessed in terms of the AMA Guides, Fourth Edition. Although many physicians use the Fourth Edition, others refer to the Table of Disabilities (Div 4/S66 of the New South Wales Workers’ Compensation Act) and Victoria prefers the AMA Guides, Second Edition. At the federal level, Australia has adopted the Guide to the Assessment of the Degree of Permanent Impairment (1989 but under revision at the time of writing). In New Zealand, the Accident Compensation Commission officially adopted use of the AMA Guides, Fourth Edition, in 1997.

BackgroundThe burden of road traffic crashes (RTC) is commonly reported using fatalities and hospital admissions. Disruption to regular activities, such as work, is rarely reported, yet known to have significant economic and human costs. In the state of Victoria, Australia, people injured and unable to work due to RTC may have treatment and income support provided either through the RTC compensation system or through workers’ compensation. By examining data from both systems, this study sought to determine the rate (per 1 00 000 working population) of RTC injury resulting in work absence, and to quantify the amount of working time lost to RTC injury.MethodsData from each compensation system were harmonised. Analysis included claims from RTCs that occurred between July 1 2003 and June 30 2013 by 15–65 year olds who received at least one day of income support. Fatalities and rejected claims were excluded. Time lost was calculated as the total weeks of income support. Non-parametric tests were performed to determine differences between exposure variables (e.g. male versus female).ResultsThere were 36 640 workers meeting inclusion criteria (average 305 cases per month; mean rate per month of 11.6 per 1 00 000 working population). A total of 1,121,863 lost working weeks were compensated, with a median of 10 weeks. Thirty-two percent of cases did not have a record of attending hospital. The lowest median duration of time loss was among those involved in a train or tram crash (2.9 weeks) and the highest among those with quadriplegia (142.2 weeks). Duration of income support was significantly different within age, sex, injury type, severity, crash type, and compensation system groups.ConclusionsResults showed that RTC injuries of all severities caused considerable work absence. Measures of work absence can complement existing measures of RTC burden.

PurposeWorkers’ compensation claims for older workers and workers who have suffered psychological injury are increasing as a proportion of total claims in many jurisdictions. In the Australian state of Victoria, claims from both these groups are associated with higher than average wage replacement and healthcare expenditures. This cohort profile describes a longitudinal study which aims to investigate differences in the return to work (RTW) process for older workers compared with younger workers and claimants with musculoskeletal injuries compared with those with psychological injuries.ParticipantsThis prospective cohort study involved interviewing workers’ compensation claimants at three time points. The cohort was restricted to psychological and musculoskeletal claims. Only claimants aged 18 and over were recruited, with no upper age limit. A total of 869 claimants completed the baseline interview, representing 36% of the eligible claimant population. Ninety-one per cent of participants agreed at baseline to have their survey responses linked to administrative workers’ compensation data. Of the 869 claimants who participated at baseline, 632 (73%) took part in the 6-month follow-up interview, and 572 (66%) participated in the 12-month follow-up interview.Findings to dateInformation on different aspects of the RTW process and important factors that may impact the RTW process was collected at the three survey periods. At baseline, participants and non-participants did not differ by injury type or age group, but were more likely to be female and from the healthcare and social assistance industry. The probability of non-participation at follow-up interviews showed younger age was a statistically significant predictor of non-participation.Future plansAnalysis of the longitudinal cohort will identify important factors in the RTW process and explore differences across age and injury type groups. Ongoing linkage to administrative workers’ compensation data will provide information on wage replacement and healthcare service use into the future.

ObjectivesSerious mental illness is common among those who have experienced a physical workplace injury, yet little is known about mental health service use in this population. This study aims to estimate the proportion of the workplace musculoskeletal injury population experiencing a mental illness, the proportion who access mental health services through the workers’ compensation system and the factors associated with likelihood of accessing services.MethodsA longitudinal cohort study was conducted with a random sample of 615 workers’ compensation claimants followed over three survey waves between June 2014 and July 2015. The primary outcome was receiving any type of mental health service use during this period, as determined by linking survey responses to administrative compensation system records for the 18 months after initial interview.ResultsOf 181 (29.4%) participants who met the case definition for a serious mental illness at one or more of the three interviews, 75 (41.4%) accessed a mental health service during the 18-month observation period. Older age (OR=0.96, 95% CI 0.93 to 0.99) and achieving sustained return to work (OR=0.27, 95% CI 0.11 to 0.69) were associated with reduced odds of mental health service use. Although not significant, being born in Australia was associated with an increased odds of service use (OR=2.23, 95% CI 0.97 to 5.10).ConclusionsThe proportion of injured workers with musculoskeletal conditions experiencing mental illness is high, yet the proportion receiving mental health services is low. More work is needed to explore factors associated with mental health service use in this population, including the effect of returning to work.

Precarious employment has been associated with adverse occupational health and safety (OHS) outcomes across a range of studies. Temporary agency workers are particularly vulnerable, with studies showing they experience a higher incidence of workplace injury, and a greater likelihood of more severe injuries than all other employment types. Explanations for agency workers’ higher risk of injury have, to date, been impeded by data limitations associated with researching temporary employment. This article seeks to begin filling this gap through analyzing the experience of agency workers based upon two data sources. The first is a unique qualitative and quantitative data set developed from investigated temporary agency and directly hired workers’ compensation files; the second is focus groups of agency workers conducted in the State of Victoria, Australia. Quinlan and Bohle’s (2004) Pressures, Disorganization and Regulatory Failure (PDR) model, developed to explain the greater OHS vulnerability of precarious workers, provides the framework for analyzing the data. After explaining the key concepts in the PDR Model, the article analyses the data to test for evidence of economic pressures, disorganization at the workplace, and regulatory failure impacting upon temporary agency workers’ health and safety. The analysis supports the relevance of the PDR model, and provides an understanding of additional and unique risk factors which contribute to agency workers’ higher risk of injury. Temporary agency workers experience economic pressures in common with other types of precarious workers. However, these appear more acute amongst agency workers. They also confront disorganization risks, extending to mismatched placements; lack of familiarity with host workplaces; and more complex fractured communication. These contribute to workplace risks and create barriers to improving their experience. Many of these outcomes are a result of, or contribute to regulatory failure. The analysis finds strong support for the explanatory value of the PDR model as a tool for understanding how precariousness contributes to temporary agency workers’ adverse health and safety outcomes. It also suggests the complexities of the triangular employment relationship create additional economic insecurities and disorganization problems beyond those experienced by other types of workers, which the regulatory environment has yet to address.

PurposeTo identify patterns of health care use in truck drivers with work-related injury or illness and to identify demographic, occupation, injury/condition, claim and geographic factors associated with patterns of care.Method13 371 accepted workers compensation claims from truck drivers lodged between 2004 and 2013 in the state of Victoria were included. Episodes of health care were categorised according to practitioner type as General Practitioner (GP), Specialist Physician, Mental Health, Surgery, Return to Work, or Physical Therapy. Latent class analysis was used to identify and characterise the distinct profiles of users with different patterns of health service use. Multinomial logistic regression was used to examine the associations between latent class and predictors including demographic, claim and injury-related factors.ResultsFour profiles of heath service use were identified: (1) Low Service Users (55% of the sample) were more likely to be younger, have an injury that did not result in time off work and have conditions other than a musculoskeletal injury; (2) High Service Users (10%) tended to be those who were aged between 45 and 64 years, lived in major cities and had musculoskeletal conditions that resulted in time off work; (3) Physical Therapy Users (25%) were more likely to be aged between 45 and 64 years, live in major cities and have non-traumatic injuries that resulted in time off work; and (4) GP/Mental Health Users (10%) were more likely to be over 24 years of age, from the lowest socio-economic band, be employed by smaller organisations and be claiming benefits for a mental health condition.ConclusionsIt is possible to identify distinct patterns of health care use following work-related injury and disease using workers’ compensation claims data. Nature of injury/disease, sociodemographic characteristics and geographic proximity to health services affect patterns of care.

Abstract This article updates one published in The Guides Newsletter in January/February 1998 and reflects changing legislation in the workers’ compensation area and also in motor accident compensation. In the various Australian state and federal jurisdictions, impairment rating has become an important component of independent medical examinations, and in many areas, impairment guides have been adopted as a mandatory tool for assessing permanent impairment. For example, in the mid-1990s the state of Victoria established use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, as the sole tool for evaluating impairment and continues to use this edition to the present time. Despite the publication of the AMA Guides, Fifth Edition, in 2000, the Motor Accidents Authority in New South Wales (NSW) continues to use the fourth edition, supplemented with the NSW Motor Accidents Authority Guidelines. In November 2001, Tasmania adopted the same guidelines that were being used by the NSW Motor Accidents Authority. Despite publication of the AMA Guides, Sixth Edition, in 2007, there has remained a general reticence in Australia to progress to use of this latest edition either as stand-alone impairment rating tools or an underpinning of the purpose-developed impairment guidelines already in place. A large number of Australian medical assessors have become used to the model based on the NSW WorkCover Guides for the Evaluation of Permanent Impairment, which interprets the AMA Guides, Fifth Edition.

Purpose – Many migrants coming to Australia end up in poor quality jobs that can lead to injury or illness. The purpose of this paper is to examine work-related resources available to migrants in Australia to determine whether these contain information on employment standards (ES), occupational health and safety (OHS) and workers’ compensation (WC). Design/methodology/approach – National and state-based websites of government, unions, WC boards and community organizations were searched for relevant materials. Resources were analysed and categorized according to location, content, resource type, audience and language. Findings – We found 175 work-related resources that targeted migrants, or those working with them. The greatest numbers of resources were found in New South Wales, Victoria, and at a national level. There was a lack of comprehensive resources, with most resources containing only general work-related information. Those that had information on ES, OHS and WC generally covered only one topic in depth. Few resources were directed at temporary foreign workers. Although there are many resources to help newcomers find employment, these often do not include comprehensive information about rights at work, injury prevention and WC. Practical implications – Improving the comprehensiveness and accessibility of work-related resources could assist migrant workers in understanding ES, OHS and WC in Australia. Originality/value – This study, a first of its kind in Australia, examines work-related resources aimed at recent immigrants and whether these contain information related to health and safety, employment rights and responsibilities or what to do in the event of an injury. The analysis suggests that there is a paucity of comprehensive resources that address these topics. This is significant because recent immigrants, compared to native-born workers are more likely to work in jobs that expose them to hazards and increase their risk of injury. Resources preparing newcomers for work in Australia should include work and health-related information.

Objective The aim of this study was to present the views of four stakeholder groups, namely general practitioners (GP), employers (EMP), injured workers (IW) and compensation agents (CA), about the content and usability of the draft of the new Victorian sickness certificate. Methods A cross-sectional mixed-methods qualitative study was conducted in GP clinics and community settings in Melbourne, Australia. Interviews were conducted with GPs, EMPs and IWs and one focus group discussion was completed with CAs (n = 29). Data were collected between October and December 2013. Thematic analysis was performed. Results All stakeholders viewed the new draft certificate as an improvement on the old one. GPs saw the certificate as a form of communication, whereas EMPs and CAs saw it as a therapeutic device. GPs continued to certify based on incapacity and provided little information about what IWs could do on return to work. All groups said that assessments for mental health needed more clarity and specificity. GPs, EMPs and CAs also said that the new certificates must be electronically available and integrated into existing medical software to streamline uptake. Conclusions To ensure appropriate use of the new certificate, stakeholders must share a common understanding about its purpose and the certificate must be incorporated into existing medical software. Content on mental health assessment, an area of continued difficulty, needs additional refinement. The new certificate replaced the old certificate in March 2015; after it has been established in clinical practice, an impact evaluation should be completed to determine whether GPs are certifying capacity and earlier return to work. What is known about the topic? When it comes to sickness certification, GPs tend to focus on what injured patients cannot do, rather than what they can do. The new sickness certificate aims to change GP behaviour by focusing the certificate more on capacity (i.e. what the injured patient can do). What does this paper add? Four stakeholder groups agreed that the content and usability of the new certificate has improved. However, they agreed that the assessment of mental health capacity needs further specificity. Dissonances also remain between the stakeholders on the purpose of the certificate. What are the implications for practitioners? Appropriate use of the new certificate requires a common understanding about the purpose of the certificate, training on its appropriate use, incorporation into existing medical software and clarity on mental health assessment.

Objective Health and social care workers have a significantly higher rate of work-related injury and illness than workers in other industries. The objective of this study was to examine the rate and distribution of work-related injury and illness in the Victorian health and social care sector by demographic, occupation and injury characteristics. Methods A retrospective cohort analysis was conducted of population-level workers’ compensation claim records, including 43910 claims from the Victorian health and social care over a 10-year period from 2006 to 2015. Negative binomial regression was used to compare claim rates between occupation categories. Results The 55–64 year age group had the highest injury rate compared with the 15–24 year age group (rate ratio 2.26; 95% confidence interval 1.91–2.68). Ambulance officers had the highest overall injury claim rates and had a fluctuating trend of musculoskeletal, psychological and neurological injury claims during the study period. Social workers had the second highest rate of psychological injury and up to threefold the risk of psychological injury compared with nurse professionals. Conclusions Although the greatest volume of claims was observed in nurses, ambulance officers and paramedics were at higher risk for injury, followed by social workers. The differential patterns of injury and illness among occupation groups suggests a need for primary and secondary prevention responses tailored by occupation. What is known about the topic? The health and social care industry is a large and diverse industry. Health and social care workers encounter unique occupational health risks, with exposure varying by occupation. What does this paper add? This study provides evidence of a high rate of work-related injury and illness among health and social care workers, with ambulance officers and social workers at highest risk. Notably, there are also high rates of psychological injury claims among these two occupations. What are the implications for policy makers? This study compares rates of compensable injury and illness in the Victorian health and social care sector by occupation. The study provides guidance on which occupations and which health conditions require greatest attention.

In this 2019 electoral year, a federal Morrison Liberal Government was returned to power with little in the way of an industrial agenda. It failed to implement its key legislation, which mainly included reform to union governance and changes to religious freedom in the workplace. Meanwhile, the state governments, particularly the Victorian Andrews Labor Government, reviewed a swathe of labour law, including wage theft, industrial manslaughter, owner–driver legislation and workers' compensation laws and implemented a host of progressive changes. This year has also seen the continuation of a key policy trend, observable at both state and federal levels of government, towards regulation of aspects of industrial relations by the state that were once exclusively the province of employers and trade unions through a twentieth-century system of conciliation and arbitration.

Background: Despite the reliance on administrative data in epidemiological studies, there is little information on the completeness of co-morbidities in administrative data coded from medical records. Objective: The aim of this study was to quantify the agreement between the International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) administrative coding of mental health, drug and alcohol co-morbidities and medical records in a severely injured patient population. Method: A random sample of patients ( n = 500) captured by the Victorian State Trauma Registry and definitively managed at the state’s adult major trauma services was selected for the study. Retrospective medical record review was conducted to collect data about documented co-morbidities. The agreement between ICD-10-AM data generated from routine hospital coding and medical record–based co-morbidities was determined using Cohen’s κ and prevalence-adjusted bias-adjusted kappa (PABAK) statistics. Results: The percentage of agreement between the medical record and ICD-10-AM coding for mental health, drug and alcohol co-morbidities was 72.8%, and the PABAK showed moderate agreement (PABAK = 0.46; 95% confidence interval (CI): 0.37, 0.54). There was no difference in agreement between unintentional injury patients (PABAK = 0.52; 95% CI: 0.42, 0.62) compared with intentional injury patients (PABAK = 0.36, 95% CI: 0.23, 0.49), and no change in agreement for patients admitted before (PABAK = 0.40; 95% CI: 0.30, 0.50) and after the introduction of mandatory co-morbidity coding (PABAK = 0.46; 95% CI: 0.37, 0.54). Conclusion: Despite documentation in the medical record, a large proportion of mental health, drug and alcohol conditions were not coded in ICD-10-AM. Acknowledgement of these limitations is needed when using ICD-10-AM coded co-morbidities in research studies and health policy development. Implications: This work has implications for researchers of drug and alcohol abuse; mental health; accidents and injuries; workers' compensation; health workforce; health services; and policy decisions for healthcare, emergency services, insurance industry, national productivity and welfare costings reliant on those research outcomes.

Background: General Practitioners (GPs) play an important role in worker's treatment and return-to-work (RTW).Objectives: To establish what factors potentially predict the type of medical certification that GPs provide to injured workers following work-related injury.Methods: A logistic regression analysis was performed to assess the impact of a number of factors on the likelihood that an injured worker would receive an alternate (ALT) vs. Unfit for work (UFW) duties certificate from their GP. Compensation Research Database, containing claims and medical certification data of Victorian injured workers was accessed for the research purposes.Results: A total of 119,900 claims were included into this study. The majority of the injured workers were males, mostly age of 45–54 years. Nearly half of the workers with UFW and 36.9% with ALT certificates had musculoskeletal injuries. The regression analysis revealed that older males were less likely to receive ALT as opposed to the younger females (25–34 years old) in most occupations. Living in rural areas was associated with smaller odds of receiving ALT. We also found that seeing a GP who is more experienced with workers’ compensation increased the odds of ALT certificates. However, suffering from mental health issues decreased the odds of receiving the ALT in all workers.Discussion: To our knowledge this is the first study to describe factors predicting GP medical certification of injured workers. The results clearly indicate that workers with physical injuries, female workers, and workers visiting GPs with a higher injured worker case load in metropolitan area are more likely to receive an ALT certificate.Conclusions: The findings of this study help to identify groups of injured workers that are less likely to be recommended ALT certificates. It also suggests that certain health service providers and policy makers might require more education on the health benefits of RTW.

AbstractPurposes Timely delivery of treatment and rehabilitation is generally acknowledged to support injury recovery. This study aimed to describe the timing of health service use by injured truck drivers with work-related injury and to explore the association between demographic and injury factors and the duration of health service use. Methods Retrospective cohort study of injured truck drivers with accepted workers’ compensation claims in the state of Victoria, Australia. Descriptive analyses examined the percentage of injured truck drivers using health services by service type. Logistic regression model examined predictors of any service use versus no service use, and predictors of extended service use (≥ 52 weeks) versus short-term use. Results The timing of health service use by injured truck drivers with accepted workers’ compensation claims varies substantially by service type. General practitioner, specialist physician, and physical therapy service use peaks within the 14 weeks after compensation claim lodgement, whilst the majority of mental health services were accessed in the persistent phase beyond 14 weeks after claim lodgement. Older age, being employed by small companies, and claiming compensation for mental health conditions were associated with greater duration of health service use. Conclusions Injured truck drivers access a wide range of health services during the recovery and return to work process. Delivery of mental health services is delayed, including for those making mental health compensation claims. Health service planning should take into account worker and employer characteristics in addition to injury type.

ABSTRACTObjectiveComorbidity is known to affect length of hospital stay and mortality after trauma but less is known about its impact on recovery beyond the acute care period. A main challenge to study the impact of pre-existing conditions is that information on these conditions is not collected systematically and comprehensively. The aim of this study was to investigate the role of pre-existing health conditions in recovery from workplace injury using linked data. ApproachIn Victoria, Australia, approximately 85% of the labour force is covered by the state workers compensation scheme regulated by WorkSafe Victoria. The scheme provides financial compensation for healthcare and income support to eligible injured workers. . One year of WorkSafe claims for injuries that occurred between 1/07/2008 and 31/06/2009 (N = 49,171) were linked to eight years of pre-injury hospital admission admissions and emergency department presentations, received from the state Department of Health and Human Services. Main outcomes of the study included the total and categorical cost of recovery (e.g. hospital, medical, allied health) measured over short (2-6 months), medium (1-2 years) and long-term (5 years) periods. All models controlled for characteristics of the worker, workplace and injury.ResultsThe preliminary results show that the cost of recovery from workplace injury is significantly associated with history of pre-injury admissions: Workers with pre-injury admissions have higher cost of recovery including longer periods of time off work as well as further cost of health service use during recovery. As this is an ongoing project, further detailed results will be presented at the conference such as the impact of admission under each category of pre-existing conditions according to ICD codes on a wide range of outcomes after workplace injury.Conclusion Our findings are expected to help government injury compensation regulators to better understand the drivers of compensation costs and other key system outcomes such as return to work. The findings will support better allocation of financial resources, better internal management of claims and efficient allocation of physical and human resources and therefore greater client satisfaction leading to ensuring faster recovery, return to work and more effective as well as efficient service provision.

Australia, like the USA, has state-based workers’ compensation (WC) systems that provide income support, healthcare and rehabilitation for injured and ill workers. The eleven major Australian WC systems provide coverage for over 90% of the labor force and accept approximately one quarter of a million new claims per annum. Governments commonly use changes in scheme design (most often enacted through legislative amendment) to influence WC system performance including rates of claiming, costs and return to work (RTW) outcomes. Using a national, longitudinal, case level dataset of WC insurance claims data, we evaluated the impact of multiple, state level legislative amendments. The impact of legislative amendments in the states of South Australia (year of 2009), Tasmania (2010), Victoria (2010) and New South Wales (2012) were evaluated using interrupted time series analysis. Outcomes included volume and incidence of accepted WC claims, employer and insurer claim processing timeframes, and duration of work disability. Major findings include (1) the Tasmanian amendments designed to improve RTW outcomes failed; (2) the South Australian amendments designed to encourage early employer claim lodgment were partially effective; (3) the New South Wales amendments designed to ensure the financial viability of the WC scheme reduced access to benefits and disproportionately affected workers with occupational disease and mental health conditions; (4) the Victorian amendments designed to increase benefit generosity led to an increase in claims and longer duration of disability. Study findings demonstrate both intended and unintended consequences of WC system reform, and provide an evidence base for future reform.

AbstractPurpose This study sought to determine patterns of opioid use among workers with a compensated lower limb injury, factors associated with opioid use, and how opioid use is associated with time loss duration. Methods Claims and medication data were provided by the workers’ compensation regulator of Victoria, Australia, for claims lodged 2008–2018 from workers aged 15+ years with a lower limb injury. Descriptive statistics showed the number and prevalence of each opioid type (weak/strong) by demographic, claim and injury predictors. Binary and multinomial logistic regression determined the likelihood of any opioid use, and use of strong, weak or a combination of strong and weak opioids by predictors. Cox regression determined the effect of each opioid type on duration of time loss, controlling for predictors. Results There were 51,334 claims and of these 23.6% were dispensed opioids (9.2% for strong opioids only, 6.6% for weak opioids only and 7.8% for a combination). Weak opioids, on average, were dispensed 15 days earlier than strong opioids. Time loss claims and workers with fractures or hip injuries were most likely to be dispensed opioids. All opioids were associated with increased duration of time loss, with those dispensed both weak and strong opioids having the longest duration of time loss. Conclusions Any opioid use was associated with longer time loss duration, with increasing opioid strength having a greater effect. Review of pain management methods should be undertaken to reduce opioid use, which may have a positive impact on duration of time loss and long-term function.

Pre-hearing compulsory Appropriate Dispute Resolution processes (ADR) is increasingly popular in the Australian judicial system, with expectations of achieving fair, quick and efficient resolution of disputes and a reduction in the number of lengthy expensive court based proceedings. While new jurisdictions are enthusiastically incorporating compulsory pre-hearing ADR there is little research on longstanding institutions. The private nature of these court annexed ADR processes can be an inherent weakness; allowing less rigorous use of ADR processes to go unchecked and potentially lessening achievement of substantive justice for individual appellants. In Victoria the Accident Compensation Conciliation Service (ACCS) conciliates all disputes between WorkCover insurers and workers as a compulsory step before proceedings can be taken in court. This paper seeks indicators of how well the ACCS is currently achieving the Workplace Injury Rehabilitation and Compensation Act 2013 (the Act)’s Objectives compared to historical outcomes by examining trends in new applications and resolution rates, and levels of human resources. These statistical trends are derived from 10 consecutive Annual Reports. Key areas explored include power imbalances, work intensification, fairness and selection of assessment criteria. This analysis found resolution rates are slowly declining and workloads are intensifying. Questions remain about how these trends will impact on public confidence in these justice processes and what is meant by ‘reasonable efforts to bring the parties to agreement’. Developing assessment criteria for conciliation processes is identified as a future industry wide project essential for the credibility of mandatory statutory ADR.

Background: Delivering quality health services in a cost effective manner is becoming an increasingly critical issue for insurance companies and government agencies. The Clinical Framework used as part of peer review has been proposed as an alternative for institutions to control costs and maintain optimal clinical care.Objectives: To develop a concise set of principles for use by clinicians and regulators to determine the need for treatment within in a compensable setting.Method: The Clinical Framework was first implemented in 2003 at the Victorian WorkCover Authority as part of peer review of physiotherapy management of injured workers. It consists of five principles that clinicians and institutions use to determine the ongoing need for intervention. The Framework allows clinicians to exercise judgment in selecting treatment with due consideration to the evidence and patient's individual needs. Results: Following its introduction in 2003, it broadened to apply to chiropractic, osteopathy, psychology, and occupational therapy. In 2012 it was endorsed across Australia for motor accident and worker's compensation bodies by the representative bodies of the above disciplines. In 2013 Federal Minister Shorten released a review of the SRC Act which recommended amendments including “medical treatment must meet objective standards such as those in the Clinical Framework.”Discussion: This paper will discuss some of the issues that have been addressed in implementing the Clinical Framework on over 20,000 files over the past ten years.Conclusions: The Clinical Framework is a document that has won broad acceptance across the Australian compensable system in allied health as part of sustaining quality care while reducing unnecessary costs.

The Palagua swamp in the Middle Magdalena region of Colombia is a territory governed by nearly a century of petro-development and armed conflict. This toxic reality, along with the disappointment of temporary legal victories and demands for environmental compensation, have left deep marks on individuals’ psyche, eroding the self-confidence and spirit of communities. Drawing on archival research, secondary regional sources, and 13 semi-structured interviews with former oil workers, fishers, farmers, and women activists, we delve into the meaning, implications, and transformation of petro-development and internal colonialism. We suggest that the decolonization of being in a petrolized environment implies challenging imposed imaginaries of development and perceiving forces of internal colonialism. This should be recognized as a long-term process, a painful incubation of possibilities, marked by persistent and transformative day-to-day actions.

Background: In 2007, the Health and Disability Strategy Group (HDSG) of the TAC and Victorian WorkCover Authority recognised an opportunity to improve scheme outcomes by working more closely with health disciplines. To investigate whether this was feasible, a pilot program was proposed with a select group of physiotherapists. Objectives: To determine whether a network of physiotherapists who were provided with training, monitoring and support could achieve improved outcome in return to work and health outcomes.Method: In 2008, 92 physiotherapists undertook a select tender process and then completed training in return to work, the HDSG's Clinical Framework and familiarisation of the compensation system for work related and motor accident injuries. The outcomes of this network physiotherapist program were evaluated internally and by three independent research organisations to determine 1) impact on return to work, 2) impact on health outcomes, 3) patient satisfaction and 4) satisfaction of the physiotherapist providing the service. Results: When compared to non-network physiotherapist, the network physiotherapists demonstrated improved return to work for clients, better health outcomes, and greater patient satisfaction. Therapist satisfaction was also higher within the network physiotherapists.Discussion: This body of work conducted on a pilot group of physiotherapists demonstrates improved outcomes in a number of important domains for the management of worker's and motor accident injuries. It indicates that there is a benefit for schemes in supporting clinical programs. Current evidence suggests that compensable patients have worse health outcomes than their non-compensable counterparts. There is a need to promote programs that are beneficial to patients, compensable schemes and providers. Further investigation is required to demonstrate this benefit on a larger scale.Conclusions: This study indicates that there may be opportunities to improve health outcomes by investment from compensable bodies in training, support and monitoring of specific health disciplines.

Introduction: Bubbles and Sport The ephemeral materiality of bubbles – beautiful, spectacular, and distracting but ultimately fragile – when applied to protect or conserve in the interests of sport-media profit, creates conditions that exacerbate existing inequalities in sport and society. Bubbles are usually something to watch, admire, and chase after in their brief yet shiny lives. There is supposed to be, technically, nothing inside them other than one or more gasses, and yet we constantly refer to people and objects being inside bubbles. The metaphor of the bubble has been used to describe the life of celebrities, politicians in purpose-built capital cities like Canberra, and even leftist, environmentally activist urban dwellers. The metaphorical and material qualities of bubbles are aligned—they cannot be easily captured and are liable to change at any time. In this article we address the metaphorical sporting bubble, which is often evoked in describing life in professional sport. This is a vernacular term used to capture and condemn the conditions of life of elite sportspeople (usually men), most commonly after there has been a sport-related scandal, especially of a sexual nature (Rowe). It is frequently paired with connotatively loaded adjectives like pampered and indulged. The sporting bubble is rarely interrogated in academic literature, the concept largely being left to the media and moral entrepreneurs. It is represented as involving a highly privileged but also pressurised life for those who live inside it. A sporting bubble is a world constructed for its most prized inhabitants that enables them to be protected from insurgents and to set the terms of their encounters with others, especially sport fans and disciplinary agents of the state. The Covid-19 pandemic both reinforced and reconfigured the operational concept of the bubble, re-arranging tensions between safety (protecting athletes) and fragility (short careers, risks of injury, etc.) for those within, while safeguarding those without from bubble contagion. Privilege and Precarity Bubble-induced social isolation, critics argue, encourages a loss of perspective among those under its protection, an entitled disconnection from the usual rules and responsibilities of everyday life. For this reason, the denizens of the sporting bubble are seen as being at risk to themselves and, more troublingly, to those allowed temporarily to penetrate it, especially young women who are first exploited by and then ejected from it (Benedict). There are many well-documented cases of professional male athletes “behaving badly” and trying to rely on institutional status and various versions of the sporting bubble for shelter (Flood and Dyson; Reel and Crouch; Wade). In the age of mobile and social media, it is increasingly difficult to keep misbehaviour in-house, resulting in a slew of media stories about, for example, drunkenness and sexual misconduct, such as when then-Sydney Roosters co-captain Mitchell Pearce was suspended and fined in 2016 after being filmed trying to force an unwanted kiss on a woman and then simulating a lewd act with her dog while drunk. There is contestation between those who condemn such behaviour as aberrant and those who regard it as the conventional expression of youthful masculinity as part of the familiar “boys will be boys” dictum. The latter naturalise an inequitable gender order, frequently treating sportsmen as victims of predatory women, and ignoring asymmetries of power between men and women, especially in homosocial environments (Toffoletti). For those in the sporting bubble (predominantly elite sportsmen and highly paid executives, also mostly men, with an array of service staff of both sexes moving in and out of it), life is reflected for those being protected via an array of screens (small screens in homes and indoor places of entertainment, and even smaller screens on theirs and others’ phones, as well as huge screens at sport events). These male sport stars are paid handsomely to use their skill and strength to perform for the sporting codes, their every facial expression and bodily action watched by the media and relayed to audiences. This is often a precarious existence, the usually brief career of an athlete worker being dependent on health, luck, age, successful competition with rivals, networks, and club and coach preferences. There is a large, aspirational reserve army of athletes vying to play at the elite level, despite risks of injury and invasive, life-changing medical interventions. Responsibility for avoiding performance and image enhancing drugs (PIEDs) also weighs heavily on their shoulders (Connor). Professional sportspeople, in their more reflective moments, know that their time in the limelight will soon be up, meaning that getting a ticket to the sporting bubble, even for a short time, can make all the difference to their post-sport lives and those of their families. The most vulnerable of the small minority of participants in sport who make a good, short-term living from it are those for whom, in the absence of quality education and prior social status, it is their sole likely means of upward social mobility (Spaaij). Elite sport performers are surrounded by minders, doctors, fitness instructors, therapists, coaches, advisors and other service personnel, all supporting athletes to stay focussed on and maximise performance quality to satisfy co-present crowds, broadcasters, sponsors, sports bodies and mass media audiences. The shield offered by the sporting bubble supports the teleological win-at-all-costs mentality of professional sport. The stakes are high, with athlete and executive salaries, sponsorships and broadcasting deals entangled in a complex web of investments in keeping the “talent” pivotal to the “attention economy” (Davenport and Beck)—the players that provide the content for sale—in top form. Yet, the bubble cannot be entirely secured and poor behaviour or performance can have devastating effects, including permanent injury or disability, mental illness and loss of reputation (Rowe, “Scandals and Sport”). Given this fragile materiality of the sporting bubble, it is striking that, in response to the sudden shutdown following the economic and health crisis caused by the 2020 global pandemic, the leaders of professional sport decided to create more of them and seek to seal the metaphorical and material space with unprecedented efficiency. The outcome was a multi-sided tale of mobility, confinement, capital, labour, and the gendering of sport and society. The Covid-19 Gilded Cage Sociologists such as Zygmunt Bauman and John Urry have analysed the socio-politics of mobilities, whereby some people in the world, such as tourists, can traverse the globe at their leisure, while others remain fixed in geographical space because they lack the means to be mobile or, in contrast, are involuntarily displaced by war, so-called “ethnic cleansing”, famine, poverty or environmental degradation. The Covid-19 global pandemic re-framed these matters of mobilities (Rowe, “Subjecting Pandemic Sport”), with conventional moving around—between houses, businesses, cities, regions and countries—suddenly subjected to the imperative to be static and, in perniciously unreflective technocratic discourse, “socially distanced” (when what was actually meant was to be “physically distanced”). The late-twentieth century analysis of the “risk society” by Ulrich Beck, in which the mysterious consequences of humans’ predation on their environment are visited upon them with terrifying force, was dramatically realised with the coming of Covid-19. In another iteration of the metaphor, it burst the bubble of twenty-first century global sport. What we today call sport was formed through the process of sportisation (Maguire), whereby hyper-local, folk physical play was reconfigured as multi-spatial industrialised sport in modernity, becoming increasingly reliant on individual athletes and teams travelling across the landscape and well over the horizon. Co-present crowds were, in turn, overshadowed in the sport economy when sport events were taken to much larger, dispersed audiences via the media, especially in broadcast mode (Nicholson, Kerr, and Sherwood). This lucrative mediation of professional sport, though, came with an unforgiving obligation to generate an uninterrupted supply of spectacular live sport content. The pandemic closed down most sports events and those that did take place lacked the crucial participation of the co-present crowd to provide the requisite event atmosphere demanded by those viewers accustomed to a sense of occasion. Instead, they received a strange spectacle of sport performers operating in empty “cathedrals”, often with a “faked” crowd presence. The mediated sport spectacle under the pandemic involved cardboard cut-out and sex doll spectators, Zoom images of fans on large screens, and sampled sounds of the crowd recycled from sport video games. Confected co-presence produced simulacra of the “real” as Baudrillardian visions came to life. The sporting bubble had become even more remote. For elite sportspeople routinely isolated from the “common people”, the live sport encounter offered some sensory experience of the social – the sounds, sights and even smells of the crowd. Now the sporting bubble closed in on an already insulated and insular existence. It exposed the irony of the bubble as a sign of both privileged mobility and incarcerated athlete work, both refuge and prison. Its logic of contagion also turned a structure intended to protect those inside from those outside into, as already observed, a mechanism to manage the threat of insiders to outsiders. In Australia, as in many other countries, the populace was enjoined by governments and health authorities to help prevent the spread of Covid-19 through isolation and immobility. There were various exceptions, principally those classified as essential workers, a heterogeneous cohort ranging from supermarket shelf stackers to pharmacists. People in the cultural, leisure and sports industries, including musicians, actors, and athletes, were not counted among this crucial labour force. Indeed, the performing arts (including dance, theatre and music) were put on ice with quite devastating effects on the livelihoods and wellbeing of those involved. So, with all major sports shut down (the exception being horse racing, which received the benefit both of government subsidies and expanding online gambling revenue), sport organisations began to represent themselves as essential services that could help sustain collective mental and even spiritual wellbeing. This case was made most aggressively by Australian Rugby League Commission Chairman, Peter V’landys, in contending that “an Australia without rugby league is not Australia”. In similar vein, prominent sport and media figure Phil Gould insisted, when describing rugby league fans in Western Sydney’s Penrith, “they’re lost, because the football’s not on … . It holds their families together. People don’t understand that … . Their life begins in the second week of March, and it ends in October”. Despite misgivings about public safety and equality before the pandemic regime, sporting bubbles were allowed to form, re-form and circulate. The indefinite shutdown of the National Rugby League (NRL) on 23 March 2020 was followed after negotiation between multiple entities by its reopening on 28 May 2020. The competition included a team from another nation-state (the Warriors from Aotearoa/New Zealand) in creating an international sporting bubble on the Central Coast of New South Wales, separating them from their families and friends across the Tasman Sea. Appeals to the mental health of fans and the importance of the NRL to myths of “Australianness” notwithstanding, the league had not prudently maintained a financial reserve and so could not afford to shut down for long. Significant gambling revenue for leagues like the NRL and Australian Football League (AFL) also influenced the push to return to sport business as usual. Sport contests were needed in order to exploit the gambling opportunities – especially online and mobile – stimulated by home “confinement”. During the coronavirus lockdowns, Australians’ weekly spending on gambling went up by 142 per cent, and the NRL earned significantly more than usual from gambling revenue—potentially $10 million above forecasts for 2020. Despite the clear financial imperative at play, including heavy reliance on gambling, sporting bubble-making involved special licence. The state of Queensland, which had pursued a hard-line approach by closing its borders for most of those wishing to cross them for biographical landmark events like family funerals and even for medical treatment in border communities, became “the nation's sporting hub”. Queensland became the home of most teams of the men’s AFL (notably the women’s AFLW season having been cancelled) following a large Covid-19 second wave in Melbourne. The women’s National Netball League was based exclusively in Queensland. This state, which for the first time hosted the AFL Grand Final, deployed sport as a tool in both national sports tourism marketing and internal pre-election politics, sponsoring a documentary, The Sporting Bubble 2020, via its Tourism and Events arm. While Queensland became the larger bubble incorporating many other sporting bubbles, both the AFL and the NRL had versions of the “fly in, fly out” labour rhythms conventionally associated with the mining industry in remote and regional areas. In this instance, though, the bubble experience did not involve long stays in miners’ camps or even the one-night hotel stopovers familiar to the popular music and sport industries. Here, the bubble moved, usually by plane, to fulfil the requirements of a live sport “gig”, whereupon it was immediately returned to its more solid bubble hub or to domestic self-isolation. In the space created between disciplined expectation and deplored non-compliance, the sporting bubble inevitably became the scrutinised object and subject of scandal. Sporting Bubble Scandals While people with a very low risk of spreading Covid-19 (coming from areas with no active cases) were denied entry to Queensland for even the most serious of reasons (for example, the death of a child), images of AFL players and their families socialising and enjoying swimming at the Royal Pines Resort sporting bubble crossed our screens. Yet, despite their (players’, officials’ and families’) relative privilege and freedom of movement under the AFL Covid-Safe Plan, some players and others inside the bubble were involved in “scandals”. Most notable was the case of a drunken brawl outside a Gold Coast strip club which led to two Richmond players being “banished”, suspended for 10 matches, and the club fined $100,000. But it was not only players who breached Covid-19 bubble protocols: Collingwood coaches Nathan Buckley and Brenton Sanderson paid the $50,000 fine imposed on the club for playing tennis in Perth outside their bubble, while Richmond was fined $45,000 after Brooke Cotchin, wife of team captain Trent, posted an image to Instagram of a Gold Coast day spa that she had visited outside the “hub” (the institutionally preferred term for bubble). She was subsequently distressed after being trolled. Also of concern was the lack of physical distancing, and the range of people allowed into the sporting bubble, including babysitters, grandparents, and swimming coaches (for children). There were other cases of players being caught leaving the bubble to attend parties and sharing videos of their “antics” on social media. Biosecurity breaches of bubbles by players occurred relatively frequently, with stern words from both the AFL and NRL leaders (and their clubs) and fines accumulating in the thousands of dollars. Some people were also caught sneaking into bubbles, with Lekahni Pearce, the girlfriend of Swans player Elijah Taylor, stating that it was easy in Perth, “no security, I didn’t see a security guard” (in Barron, Stevens, and Zaczek) (a month later, outside the bubble, they had broken up and he pled guilty to unlawfully assaulting her; Ramsey). Flouting the rules, despite stern threats from government, did not lead to any bubble being popped. The sport-media machine powering sporting bubbles continued to run, the attendant emotional or health risks accepted in the name of national cultural therapy, while sponsorship, advertising and gambling revenue continued to accumulate mostly for the benefit of men. Gendering Sporting Bubbles Designed as biosecurity structures to maintain the supply of media-sport content, keep players and other vital cogs of the machine running smoothly, and to exclude Covid-19, sporting bubbles were, in their most advanced form, exclusive luxury camps that illuminated the elevated socio-cultural status of sportsmen. The ongoing inequalities between men’s and women’s sport in Australia and around the world were clearly in evidence, as well as the politics of gender whereby women are obliged to “care” and men are enabled to be “careless” – or at least to manage carefully their “duty of care”. In Australia, the only sport for women that continued during the height of the Covid-19 lockdown was netball, which operated in a bubble that was one of sacrifice rather than privilege. With minimum salaries of only $30,000 – significantly less than the lowest-paid “rookies” in the AFL – and some being mothers of small children and/or with professional jobs juggled alongside their netball careers, these elite sportswomen wanted to continue to play despite the personal inconvenience or cost (Pavlidis). Not one breach of the netballers out of the bubble was reported, indicating that they took their responsibilities with appropriate seriousness and, perhaps, were subjected to less scrutiny than the sportsmen accustomed to attracting front-page headlines. National Netball League (also known after its Queensland-based naming rights sponsor as Suncorp Super Netball) players could be regarded as fortunate to have the opportunity to be in a bubble and to participate in their competition. The NRL Women’s (NRLW) Premiership season was also completed, but only involved four teams subject to fly in, fly out and bubble arrangements, and being played in so-called curtain-raiser games for the NRL. As noted earlier, the AFLW season was truncated, despite all the prior training and sacrifice required of its players. Similarly, because of their resource advantages, the UK men’s and boy’s top six tiers of association football were allowed to continue during lockdown, compared to only two for women and girls. In the United States, inequalities between men’s and women’s sports were clearly demonstrated by the conditions afforded to those elite sportswomen inside the Women’s National Basketball Association (WNBA) sport bubble in the IMG Academy in Florida. Players shared photos of rodent traps in their rooms, insect traps under their mattresses, inedible food and blocked plumbing in their bubble accommodation. These conditions were a far cry from the luxury usually afforded elite sportsmen, including in Florida’s Walt Disney World for the men’s NBA, and is just one of the many instances of how gendered inequality was both reproduced and exacerbated by Covid-19. Bursting the Bubble As we have seen, governments and corporate leaders in sport were able to create material and metaphorical bubbles during the Covid-19 lockdown in order to transmit stadium sport contests into home spaces. The rationale was the importance of sport to national identity, belonging and the routines and rhythms of life. But for whom? Many women, who still carry the major responsibilities of “care”, found that Covid-19 intensified the affective relations and gendered inequities of “home” as a leisure site (Fullagar and Pavlidis). Rates of domestic violence surged, and many women experienced significant anxiety and depression related to the stress of home confinement and home schooling. During the pandemic, women were also more likely to experience the stress and trauma of being first responders, witnessing virus-related sickness and death as the majority of nurses and care workers. They also bore the brunt of much of the economic and employment loss during this time. Also, as noted above, livelihoods in the arts and cultural sector did not receive the benefits of the “bubble”, despite having a comparable claim to sport in contributing significantly to societal wellbeing. This sector’s workforce is substantially female, although men dominate its senior roles. Despite these inequalities, after the late March to May hiatus, many elite male sportsmen – and some sportswomen - operated in a bubble. Moving in and out of them was not easy. Life inside could be mentally stressful (especially in long stays of up to 150 days in sports like cricket), and tabloid and social media troll punishment awaited those who were caught going “over the fence”. But, life in the sporting bubble was generally preferable to the daily realities of those afflicted by the trauma arising from forced home confinement, and for whom watching moving sports images was scant compensation for compulsory immobility. The ethical foundation of the sparkly, ephemeral fantasy of the sporting bubble is questionable when it is placed in the service of a voracious “media sports cultural complex” (Rowe, Global Media Sport) that consumes sport labour power and rolls back progress in gender relations as a default response to a global pandemic. Covid-19 dramatically highlighted social inequalities in many areas of life, including medical care, work, and sport. For the small minority of people involved in sport who are elite professionals, the only thing worse than being in a sporting bubble during the pandemic was not being in one, as being outside precluded their participation. Being inside the bubble was a privilege, albeit a dubious one. But, as in wider society, not all sporting bubbles are created equal. Some are more opulent than others, and the experiences of the supporting and the supported can be very different. The surface of the sporting bubble may be impermanent, but when its interior is opened up to scrutiny, it reveals some very durable structures of inequality. Bubbles are made to burst. They are, by nature, temporary, translucent structures created as spectacles. As a form of luminosity, bubbles “allow a thing or object to exist only as a flash, sparkle or shimmer” (Deleuze, 52). In echoing Deleuze, Angela McRobbie (54) argues that luminosity “softens and disguises the regulative dynamics of neoliberal society”. The sporting bubble was designed to discharge that function for those millions rendered immobile by home confinement legislation in Australia and around the world, who were having to deal with the associated trauma, risk and disadvantage. 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Introduction The highly contagious COVID-19 virus has presented particularly difficult public policy challenges. The relatively late emergence of an effective treatments and vaccines, the structural stresses on health care systems, the lockdowns and the economic dislocations, the evident structural inequalities in effected societies, as well as the difficulty of prevention have tested social and political cohesion. Moreover, the intrusive nature of many prophylactic measures have led to individual liberty and human rights concerns. As noted by the Victorian (Australia) Ombudsman Report on the COVID-19 lockdown in Melbourne, we may be tempted, during a crisis, to view human rights as expendable in the pursuit of saving human lives. This thinking can lead to dangerous territory. It is not unlawful to curtail fundamental rights and freedoms when there are compelling reasons for doing so; human rights are inherently and inseparably a consideration of human lives. (5) These difficulties have raised issues about the importance of social or community capital in fighting the pandemic. This article discusses the impacts of social and community capital and other factors on the governmental efforts to combat the spread of infectious disease through the maintenance of social distancing and household ‘bubbles’. It argues that the beneficial effects of social and community capital towards fighting the pandemic, such as mutual respect and empathy, which underpins such public health measures as social distancing, the use of personal protective equipment, and lockdowns in the USA, have been undermined as preventive measures because they have been transmogrified to become a salient aspect of the “culture wars” (Peters). In contrast, states that have relatively lower social capital such a China have been able to more effectively arrest transmission of the disease because the government was been able to generate and personify a nationalist response to the virus and thus generate a more robust social consensus regarding the efforts to combat the disease. Social Capital and Culture Wars The response to COVID-19 required individuals, families, communities, and other types of groups to refrain from extensive interaction – to stay in their bubble. In these situations, especially given the asymptomatic nature of many COVID-19 infections and the serious imposition lockdowns and social distancing and isolation, the temptation for individuals to breach public health rules in high. From the perspective of policymakers, the response to fighting COVID-19 is a collective action problem. In studying collective action problems, scholars have paid much attention on the role of social and community capital (Ostrom and Ahn 17-35). Ostrom and Ahn comment that social capital “provides a synthesizing approach to how cultural, social, and institutional aspects of communities of various sizes jointly affect their capacity of dealing with collective-action problems” (24). Social capital is regarded as an evolving social type of cultural trait (Fukuyama; Guiso et al.). Adger argues that social capital “captures the nature of social relations” and “provides an explanation for how individuals use their relationships to other actors in societies for their own and for the collective good” (387). The most frequently used definition of social capital is the one proffered by Putnam who regards it as “features of social organization, such as networks, norms and social trust that facilitate coordination and cooperation for mutual benefit” (Putnam, “Bowling Alone” 65). All these studies suggest that social and community capital has at least two elements: “objective associations” and subjective ties among individuals. Objective associations, or social networks, refer to both formal and informal associations that are formed and engaged in on a voluntary basis by individuals and social groups. Subjective ties or norms, on the other hand, primarily stand for trust and reciprocity (Paxton). High levels of social capital have generally been associated with democratic politics and civil societies whose institutional performance benefits from the coordinated actions and civic culture that has been facilitated by high levels of social capital (Putnam, Democracy 167-9). Alternatively, a “good and fair” state and impartial institutions are important factors in generating and preserving high levels of social capital (Offe 42-87). Yet social capital is not limited to democratic civil societies and research is mixed on whether rising social capital manifests itself in a more vigorous civil society that in turn leads to democratising impulses. Castillo argues that various trust levels for institutions that reinforce submission, hierarchy, and cultural conservatism can be high in authoritarian governments, indicating that high levels of social capital do not necessarily lead to democratic civic societies (Castillo et al.). Roßteutscher concludes after a survey of social capita indicators in authoritarian states that social capital has little effect of democratisation and may in fact reinforce authoritarian rule: in nondemocratic contexts, however, it appears to throw a spanner in the works of democratization. Trust increases the stability of nondemocratic leaderships by generating popular support, by suppressing regime threatening forms of protest activity, and by nourishing undemocratic ideals concerning governance (752). In China, there has been ongoing debate concerning the presence of civil society and the level of social capital found across Chinese society. If one defines civil society as an intermediate associational realm between the state and the family, populated by autonomous organisations which are separate from the state that are formed voluntarily by members of society to protect or extend their interests or values, it is arguable that the PRC had a significant civil society or social capital in the first few decades after its establishment (White). However, most scholars agree that nascent civil society as well as a more salient social and community capital has emerged in China’s reform era. This was evident after the 2008 Sichuan earthquake, where the government welcomed community organising and community-driven donation campaigns for a limited period of time, giving the NGO sector and bottom-up social activism a boost, as evidenced in various policy areas such as disaster relief and rural community development (F. Wu 126; Xu 9). Nevertheless, the CCP and the Chinese state have been effective in maintaining significant control over civil society and autonomous groups without attempting to completely eliminate their autonomy or existence. The dramatic economic and social changes that have occurred since the 1978 Opening have unsurprisingly engendered numerous conflicts across the society. In response, the CCP and State have adjusted political economic policies to meet the changing demands of workers, migrants, the unemployed, minorities, farmers, local artisans, entrepreneurs, and the growing middle class. Often the demands arising from these groups have resulted in policy changes, including compensation. In other circumstances, where these groups remain dissatisfied, the government will tolerate them (ignore them but allow them to continue in the advocacy), or, when the need arises, supress the disaffected groups (F. Wu 2). At the same time, social organisations and other groups in civil society have often “refrained from open and broad contestation against the regime”, thereby gaining the space and autonomy to achieve the objectives (F. Wu 2). Studies of Chinese social or community capital suggest that a form of modern social capital has gradually emerged as Chinese society has become increasingly modernised and liberalised (despite being non-democratic), and that this social capital has begun to play an important role in shaping social and economic lives at the local level. However, this more modern form of social capital, arising from developmental and social changes, competes with traditional social values and social capital, which stresses parochial and particularistic feelings among known individuals while modern social capital emphasises general trust and reciprocal feelings among both known and unknown individuals. The objective element of these traditional values are those government-sanctioned, formal mass organisations such as Communist Youth and the All-China Federation of Women's Associations, where members are obliged to obey the organisation leadership. The predominant subjective values are parochial and particularistic feelings among individuals who know one another, such as guanxi and zongzu (Chen and Lu, 426). The concept of social capital emphasises that the underlying cooperative values found in individuals and groups within a culture are an important factor in solving collective problems. In contrast, the notion of “culture war” focusses on those values and differences that divide social and cultural groups. Barry defines culture wars as increases in volatility, expansion of polarisation, and conflict between those who are passionate about religiously motivated politics, traditional morality, and anti-intellectualism, and…those who embrace progressive politics, cultural openness, and scientific and modernist orientations. (90) The contemporary culture wars across the world manifest opposition by various groups in society who hold divergent worldviews and ideological positions. Proponents of culture war understand various issues as part of a broader set of religious, political, and moral/normative positions invoked in opposition to “elite”, “liberal”, or “left” ideologies. Within this Manichean universe opposition to such issues as climate change, Black Lives Matter, same sex rights, prison reform, gun control, and immigration becomes framed in binary terms, and infused with a moral sensibility (Chapman 8-10). In many disputes, the culture war often devolves into an epistemological dispute about the efficacy of scientific knowledge and authority, or a dispute between “practical” and theoretical knowledge. In this environment, even facts can become partisan narratives. For these “cultural” disputes are often how electoral prospects (generally right-wing) are advanced; “not through policies or promises of a better life, but by fostering a sense of threat, a fantasy that something profoundly pure … is constantly at risk of extinction” (Malik). This “zero-sum” social and policy environment that makes it difficult to compromise and has serious consequences for social stability or government policy, especially in a liberal democratic society. Of course, from the perspective of cultural materialism such a reductionist approach to culture and political and social values is not unexpected. “Culture” is one of the many arenas in which dominant social groups seek to express and reproduce their interests and preferences. “Culture” from this sense is “material” and is ultimately connected to the distribution of power, wealth, and resources in society. As such, the various policy areas that are understood as part of the “culture wars” are another domain where various dominant and subordinate groups and interests engaged in conflict express their values and goals. Yet it is unexpected that despite the pervasiveness of information available to individuals the pool of information consumed by individuals who view the “culture wars” as a touchstone for political behaviour and a narrative to categorise events and facts is relatively closed. This lack of balance has been magnified by social media algorithms, conspiracy-laced talk radio, and a media ecosystem that frames and discusses issues in a manner that elides into an easily understood “culture war” narrative. From this perspective, the groups (generally right-wing or traditionalist) exist within an information bubble that reinforces political, social, and cultural predilections. American and Chinese Reponses to COVID-19 The COVID-19 pandemic first broke out in Wuhan in December 2019. Initially unprepared and unwilling to accept the seriousness of the infection, the Chinese government regrouped from early mistakes and essentially controlled transmission in about three months. This positive outcome has been messaged as an exposition of the superiority of the Chinese governmental system and society both domestically and internationally; a positive, even heroic performance that evidences the populist credentials of the Chinese political leadership and demonstrates national excellence. The recently published White Paper entitled “Fighting COVID-19: China in Action” also summarises China’s “strategic achievement” in the simple language of numbers: in a month, the rising spread was contained; in two months, the daily case increase fell to single digits; and in three months, a “decisive victory” was secured in Wuhan City and Hubei Province (Xinhua). This clear articulation of the positive results has rallied political support. Indeed, a recent survey shows that 89 percent of citizens are satisfied with the government’s information dissemination during the pandemic (C Wu). As part of the effort, the government extensively promoted the provision of “political goods”, such as law and order, national unity and pride, and shared values. For example, severe publishments were introduced for violence against medical professionals and police, producing and selling counterfeit medications, raising commodity prices, spreading ‘rumours’, and being uncooperative with quarantine measures (Xu). Additionally, as an extension the popular anti-corruption campaign, many local political leaders were disciplined or received criminal charges for inappropriate behaviour, abuse of power, and corruption during the pandemic (People.cn, 2 Feb. 2020). Chinese state media also described fighting the virus as a global “competition”. In this competition a nation’s “material power” as well as “mental strength”, that calls for the highest level of nation unity and patriotism, is put to the test. This discourse recalled the global competition in light of the national mythology related to the formation of Chinese nation, the historical “hardship”, and the “heroic Chinese people” (People.cn, 7 Apr. 2020). Moreover, as the threat of infection receded, it was emphasised that China “won this competition” and the Chinese people have demonstrated the “great spirit of China” to the world: a result built upon the “heroism of the whole Party, Army, and Chinese people from all ethnic groups” (People.cn, 7 Apr. 2020). In contrast to the Chinese approach of emphasising national public goods as a justification for fighting the virus, the U.S. Trump Administration used nationalism, deflection, and “culture war” discourse to undermine health responses — an unprecedented response in American public health policy. The seriousness of the disease as well as the statistical evidence of its course through the American population was disputed. The President and various supporters raged against the COVID-19 “hoax”, social distancing, and lockdowns, disparaged public health institutions and advice, and encouraged protesters to “liberate” locked-down states (Russonello). “Our federal overlords say ‘no singing’ and ‘no shouting’ on Thanksgiving”, Representative Paul Gosar, a Republican of Arizona, wrote as he retweeted a Centers for Disease Control list of Thanksgiving safety tips (Weiner). People were encouraged, by way of the White House and Republican leadership, to ignore health regulations and not to comply with social distancing measures and the wearing of masks (Tracy). This encouragement led to threats against proponents of face masks such as Dr Anthony Fauci, one of the nation’s foremost experts on infectious diseases, who required bodyguards because of the many threats on his life. Fauci’s critics — including President Trump — countered Fauci’s promotion of mask wearing by stating accusingly that he once said mask-wearing was not necessary for ordinary people (Kelly). Conspiracy theories as to the safety of vaccinations also grew across the course of the year. As the 2020 election approached, the Administration ramped up efforts to downplay the serious of the virus by identifying it with “the media” and illegitimate “partisan” efforts to undermine the Trump presidency. It also ramped up its criticism of China as the source of the infection. This political self-centeredness undermined state and federal efforts to slow transmission (Shear et al.). At the same time, Trump chided health officials for moving too slowly on vaccine approvals, repeated charges that high infection rates were due to increased testing, and argued that COVID-19 deaths were exaggerated by medical providers for political and financial reasons. These claims were amplified by various conservative media personalities such as Rush Limbaugh, and Sean Hannity and Laura Ingraham of Fox News. The result of this “COVID-19 Denialism” and the alternative narrative of COVID-19 policy told through the lens of culture war has resulted in the United States having the highest number of COVID-19 cases, and the highest number of COVID-19 deaths. At the same time, the underlying social consensus and social capital that have historically assisted in generating positive public health outcomes has been significantly eroded. According to the Pew Research Center, the share of U.S. adults who say public health officials such as those at the Centers for Disease Control and Prevention are doing an excellent or good job responding to the outbreak decreased from 79% in March to 63% in August, with an especially sharp decrease among Republicans (Pew Research Center 2020). Social Capital and COVID-19 From the perspective of social or community capital, it could be expected that the American response to the Pandemic would be more effective than the Chinese response. Historically, the United States has had high levels of social capital, a highly developed public health system, and strong governmental capacity. In contrast, China has a relatively high level of governmental and public health capacity, but the level of social capital has been lower and there is a significant presence of traditional values which emphasise parochial and particularistic values. Moreover, the antecedent institutions of social capital, such as weak and inefficient formal institutions (Batjargal et al.), environmental turbulence and resource scarcity along with the transactional nature of guanxi (gift-giving and information exchange and relationship dependence) militate against finding a more effective social and community response to the public health emergency. Yet China’s response has been significantly more successful than the Unites States’. Paradoxically, the American response under the Trump Administration and the Chinese response both relied on an externalisation of the both the threat and the justifications for their particular response. In the American case, President Trump, while downplaying the seriousness of the virus, consistently called it the “China virus” in an effort to deflect responsibly as well as a means to avert attention away from the public health impacts. As recently as 3 January 2021, Trump tweeted that the number of “China Virus” cases and deaths in the U.S. were “far exaggerated”, while critically citing the Centers for Disease Control and Prevention's methodology: “When in doubt, call it COVID-19. Fake News!” (Bacon). The Chinese Government, meanwhile, has pursued a more aggressive foreign policy across the South China Sea, on the frontier in the Indian sub-continent, and against states such as Australia who have criticised the initial Chinese response to COVID-19. To this international criticism, the government reiterated its sovereign rights and emphasised its “victimhood” in the face of “anti-China” foreign forces. Chinese state media also highlighted China as “victim” of the coronavirus, but also as a target of Western “political manoeuvres” when investigating the beginning stages of the pandemic. The major difference, however, is that public health policy in the United States was superimposed on other more fundamental political and cultural cleavages, and part of this externalisation process included the assignation of “otherness” and demonisation of internal political opponents or characterising political opponents as bent on destroying the United States. This assignation of “otherness” to various internal groups is a crucial element in the culture wars. While this may have been inevitable given the increasingly frayed nature of American society post-2008, such a characterisation has been activity pushed by local, state, and national leadership in the Republican Party and the Trump Administration (Vogel et al.). In such circumstances, minimising health risks and highlighting civil rights concerns due to public health measures, along with assigning blame to the democratic opposition and foreign states such as China, can have a major impact of public health responses. The result has been that social trust beyond the bubble of one’s immediate circle or those who share similar beliefs is seriously compromised — and the collective action problem presented by COVID-19 remains unsolved. Daniel Aldrich’s study of disasters in Japan, India, and US demonstrates that pre-existing high levels of social capital would lead to stronger resilience and better recovery (Aldrich). Social capital helps coordinate resources and facilitate the reconstruction collectively and therefore would lead to better recovery (Alesch et al.). Yet there has not been much research on how the pool of social capital first came about and how a disaster may affect the creation and store of social capital. Rebecca Solnit has examined five major disasters and describes that after these events, survivors would reach out and work together to confront the challenges they face, therefore increasing the social capital in the community (Solnit). However, there are studies that have concluded that major disasters can damage the social fabric in local communities (Peacock et al.). The COVID-19 epidemic does not have the intensity and suddenness of other disasters but has had significant knock-on effects in increasing or decreasing social capital, depending on the institutional and social responses to the pandemic. In China, it appears that the positive social capital effects have been partially subsumed into a more generalised patriotic or nationalist affirmation of the government’s policy response. Unlike civil society responses to earlier crises, such as the 2008 Sichuan earthquake, there is less evidence of widespread community organisation and response to combat the epidemic at its initial stages. This suggests better institutional responses to the crisis by the government, but also a high degree of porosity between civil society and a national “imagined community” represented by the national state. The result has been an increased legitimacy for the Chinese government. Alternatively, in the United States the transformation of COVID-19 public health policy into a culture war issue has seriously impeded efforts to combat the epidemic in the short term by undermining the social consensus and social capital necessary to fight such a pandemic. Trust in American institutions is historically low, and President Trump’s untrue contention that President Biden’s election was due to “fraud” has further undermined the legitimacy of the American government, as evidenced by the attacks directed at Congress in the U.S. capital on 6 January 2021. As such, the lingering effects the pandemic will have on social, economic, and political institutions will likely reinforce the deep cultural and political cleavages and weaken interpersonal networks in American society. Conclusion The COVID-19 pandemic has devastated global public health and impacted deeply on the world economy. Unsurprisingly, given the serious economic, social, and political consequences, different government responses have been highly politicised. Various quarantine and infection case tracking methods have caused concern over state power intruding into private spheres. The usage of face masks, social distancing rules, and intra-state travel restrictions have aroused passionate debate over public health restrictions, individual liberty, and human rights. Yet underlying public health responses grounded in higher levels of social capital enhance the effectiveness of public health measures. In China, a country that has generally been associated with lower social capital, it is likely that the relatively strong policy response to COVID-19 will both enhance feelings of nationalism and Chinese exceptionalism and help create and increase the store of social capital. 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