Housing, Employment, Pandemic Planning, and the Social Determinants of Health

Rebecca Bentley, Adelle Mansour and Erika Martino on the public health power of mapping tools.

Today the NSW Premier declared a national emergency in Australia. The Delta strain of COVID is testing our capacity to contain the virus’ spread using the tools of contact tracing and staged lockdowns. In doing so, Berejiklian acknowledged that spread amongst the young, mobile population of Sydney’s south-west and western suburbs have challenged the effectiveness of lockdown measures.

It has become clear in both the Melbourne and Sydney outbreaks, and globally in cities such as New York (Glaeser et al., 2020), that a small area lockdown approach to virus containment is less effective when people cannot work from home and must work near others; particularly if their mobility is not considered in planning these measures. This vulnerability is amplified where there are also spatial concentrations of household crowding, insecure housing and homelessness.

During the pandemic, many people in precarious employment across the world have been deemed ‘essential’ or ‘permitted’ by local authorities, meaning that they have been required to physically attend workplaces despite policies that impose restrictions on movement, thus increasing mobility among these workers (Ramos et al., 2020).

When Melbourne was struggling with rising case numbers in locked down suburbs, we mapped the mobility and housing conditions of neighbourhoods across the city, aiming to identify where mobile people (i.e., the people keeping shops, petrol stations, food distribution and health care going) live. Many in this category are young and still not eligible for vaccinations.

In response, we developed the Neighbourhood Employment and Housing Precarity (NEHP) Index, a pilot tool constructed from a combination of six employment, housing and financial indicators that describe people’s ability to work from home, their proximity to others in the workplace and whether they have access to emergency funds, as well as precarious housing conditions that may also increase risk of exposure to the virus.

With the current situation evolving in Sydney, we have now mapped the Index for the Greater Sydney region. We find that the areas currently struggling with persistently high daily infections closely align with the NEHP index. This confirms that higher mobility among people in precarious employment places them at an unequally greater risk of exposure to the virus than other segments of the population (Shadmi et al., 2020).

There is a compelling case that cities should incorporate such mapping tools into their pandemic planning to support appropriate and equitable place-based approaches.

NEHP Index mapped over Greater Sydney.


Glaeser, E. L., Gorback, C., & Redding, S. J. (2020). JUE Insight: How much does COVID-19 increase with mobility? Evidence from New York and four other U.S. cities. Journal of Urban Economics. https://doi.org/10.1016/j.jue.2020.103292

Ramos, A. K., Lowe, A. E., Herstein, J. J., Schwedhelm, S., Dineen, K. K., & Lowe, J. J. (2020). Invisible no more: The impact of COVID-19 on essential food production workers. Journal of Agromedicine, 25(4), 378-382. https://doi.org/10.1080/1059924X.2020.1814925

Shadmi, E., Chen, Y., Dourado, I., Faran-Perach, I., Furler, J., Hangoma, P., Hanvoravongchai, P., Obando, C., Petrosyan, V., Rao, K. D., Ruano, A. L., Shi, L., de Souza, L. E., Spitzer-Shohat, S., Sturgiss, E., Suphanchaimat, R., Uribe, M. V., & Willems, S. (2020). Health equity and COVID-19: global perspectives. International Journal for Equity in Health, 19(1), 1-16. https://doi.org/10.1186/s12939-020-01218-z