Decreasing rates of full-time employment have led to a new class of working poor, whose struggles are borne out by the state of their dental health. By Samantha Trenoweth.

Seeing poverty in people’s teeth

“We think we live in a classless society but we don’t,” says Dr Estie Kruger, associate professor in the School of Anatomy, Physiology and Human Biology at the University of Western Australia. 

“Large parts of the Australian population are marginalised,” she explains. “I think poverty is not as visible here as it is in some other countries, but nonetheless it exists.” 

Kruger believes we can see poverty in people’s teeth. She sees it in the teeth of those who live in remote Indigenous communities, in the teeth of the elderly, and of those people who fall into “the gap between rich and poor”, between qualifying for some social security and earning a reasonable wage. These findings come out of research Kruger has been doing, with her colleagues Kate Dyson and Marc Tennant, into issues of access and equity in dental treatment.

“The situation remains,” she says, “that part of the population can afford to access dentistry because they have health insurance or they have incomes high enough that they can visit a private dentist. Then there are those who have healthcare cards and therefore access to public dental services. However, I think there is a large part of the population that falls somewhere in the middle – not quite rich enough for private insurance, not quite poor enough for public health – and they are the people who don’t have easy access to dentistry because it’s not covered by Medicare.”

Kruger’s evidence is, of course, largely anecdotal. Mine is, too. I know people, and I see people every day in the streets where I live, who are struggling to make ends meet, juggling multiple part-time jobs, or a freelance trade with inadequate pay and basic conditions, while paying substantially more than half their incomes to keep a roof over their heads. This is in Sydney, after all. 

It’s not easy to track these people – they’re not on benefits, they’re paying little or no tax, they slip below the radar. However, a 2014 report by the Australian Council of Social Service (ACOSS) found that a staggering 2.5 million Australians – that’s 13.9 per cent of us, and 17.7 per cent of our children – live below the internationally accepted poverty line, which is 50 per cent of median household income. And while the ACOSS report found that the risk of poverty was far greater among those who relied on social security payments, because many of these are insufficient to provide their recipients with an acceptable standard of living, it also found that one-third of people living in poverty were workers for whom some form of paid employment was their main source of income. 

Those people fit right into the gap Kruger identified between qualifying for public dentistry and being able to afford private practice, and there are other gaps they fall into, too. Certainly they’re the people least likely to be compensated if and when plans for rises in a tax such as the GST are revived.

“People in part-time jobs or low-income jobs would be hit the most,” says Ben Phillips, one of the authors of a report that the National Centre for Social and Economic Modelling (NATSEM) produced for ACOSS on the impacts of a rise in the GST. “Also, potentially, those people who rely upon super pensions or incomes from investments. These people are often old and not paying much if any personal income taxation.”

So they don’t pay enough tax to be compensated by a tax break, and they don’t receive any benefits that might be boosted to counteract the effects of GST-driven price rises. 

These people could also be hit hard by reductions in Medicare’s coverage of essential procedures such as Pap smears, blood and urine tests, MRIs, X-rays and ultrasounds – none of which are commonly undertaken on a whim, and all of which need to be undertaken in a timely fashion if they’re to save lives, not delayed by people experiencing financial hardship.

ACOSS found that more than half those employed people who were living below the poverty line were in part-time work, and that’s an issue that’s been growing slowly but steadily for decades. Sold to us as part of a new, bright, libertarian future, part-time and contract work has begun to erode what were once considered standard benchmarks in workers’ pay and conditions, and these private contracts are difficult to monitor.

1 . Financialisation takes hold

Australian Council of Trade Unions president Ged Kearney sees this as “a deliberate shift away from a full-time, secure employed workforce to one that is precarious and underemployed. It’s part of the process of financialisation: moving all the cost and responsibility for employment away from the employer and the state and onto the individual. So eventually you have a workforce that has no paid leave, no sick leave, quite possibly no workers’ compensation. Workers are insuring their own equipment, which they’ve bought. And many of these people are precariously employed, so they don’t have the benefit of knowing that they’re going to get an income week to week. It builds a very shaky house of cards.”

Kearney confesses that trade unions have been “a bit like frogs in boiling water” in terms of their reactions to these workplace changes. “They crept up on us slowly,” she says, “and I think we are now in danger of going down the path of America’s working poor.” 

The ACTU estimates 40 per cent of the Australian workforce is now “precariously employed”. Moreover, Kearney says, casual and contract work is becoming commonplace in industries where, only recently, secure, long-term employment was standard practice. 

“You expect to see casual work in hospitality, retail, agriculture, but now we’re seeing it all over the place – in our higher education workforce, for example.” According to the National Tertiary Education Union, casuals now make up 80 per cent of teaching-only positions in Australian universities. And, says Kearney, “it’s creeping into construction, nursing, the community sector. The community sector is funded in envelopes, so people are employed only for as long as the funding exists, and that might be three months or three years.”

Dennis Glover, author of An Economy Is Not a Society, published by a sister company of The Saturday Paper’s, believes casualisation has diminished incomes and quality of life for blue-collar workers, too.

“Thirty years ago, you could still expect to keep your job until you retired or were retrenched on a reasonable package. People laid down roots, they had dependable incomes, they made friends at their workplace, they built relationships with their employers.”

Those days have gone and he agrees that the union movement has not kept up. 

“The decentralisation of the workforce has made it more difficult to recruit and organise,” he says.

Kearney would like to see unions doing those things better and becoming more relevant to the working poor.

2 . Union relevance

One way to do that is by negotiating for workplace legislation that helps workers move from casual to permanent employment. She would like to see legislation that puts an end to the notion of the full-time casual position. “I mean, what’s a full-time casual?” she asks. “I’ve met people who have been casually employed, full-time, for five years, but they don’t get any paid leave and they can be sacked at eight hours’ notice.” 

She would also like to see legislation to ensure that “dodgy labour-hire firms” act within the law.

For those who still believe in the fantastic, flexible, freelance dream, the ACTU is investigating “portable entitlements”, which would allow workers to build up a bank of leave – sick leave, holiday leave, leave for education and training – that could travel with them from job to job.

Of course, this might all be too little and a decade or more too late. With union membership plunging from 40 per cent of the workforce two decades ago to well below 20 per cent today, the “financialisation” horse may have well and truly bolted.

And in all of this, will Kruger still see our standard of living reflected in our teeth? Interestingly, the Australian Dental Association is lobbying for a national dental health plan to be included in the next budget. It would provide a wider range of free dental care for children, the elderly, and ultimately other vulnerable sections of the community. It would be extraordinarily difficult for the assessment criteria to pick up a significant proportion of those who work and live in poverty, but Australians from low socio-economic backgrounds would be targeted. And if the targeting is good enough, it could give Kruger fewer teeth to worry about, at least.

This article was first published in the print edition of The Saturday Paper on Feb 27, 2016 as "Harmed to the teeth".

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Samantha Trenoweth is a writer and editor. Her most recent book was Bewitched and Bedevilled: Women Write the Gillard Years.

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