Privatized employment services in Australia: addressing social, health, and equity impacts for health promotion

Employment status is an important social determinant of health. Employment services mediate unemployed people's outcomes and experiences, including their psychosocial and physical health and well-being, but have received little health promotion research attention. Over the past 30 years in Australia, employment service provision has been operating under a privatized model with five different policy iterations, yet there has been little consideration of the health impacts of this policy. Documentary methods examined these impacts, producing five key themes: (i) ideological underpinnings of privatization, (ii) the primacy of private interests, (iii) impacts on quality of service, (iv) negative social and health impacts, and (v) implications for equity. Perverse incentives, system gaming, and punitive forms of conditional welfare all lead to negative outcomes, including poverty and severe emotional distress, which unfairly affect people living in disadvantaged circumstances. There are growing calls for much greater direct government involvement in employment services to promote health and equity and public over private interests.