Degree Name

Doctor of Philosophy


School of Health and Society


Background Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), or COVID-19, was first identified in China in December 2019. Due to the severity and swiftness of the spread of the outbreak, the World Health Organization (WHO) declared COVID-19 a Public Health Emergency of International Concern on 30 January 2020. Subsequent public health mitigation strategies, such as lockdowns, border restrictions and social distancing, were implemented globally to combat the widespread transmission of COVID-19. The flow-on effect of the paused social and economic activity of the nationwide Australian lockdowns caused some population groups to experience unemployment, loss of income, housing instability and food insecurity. However, the impact of the public health mitigation strategies on Australians is dependent on the state of their pre-pandemic social determinants of health. ‘Social determinants of health’ was first coined as a term in the 1970s and refers to the conditions in an individual’s environment wherein they are born, grow, live, learn, work and age. These conditions are shaped by the distribution of power, money and resources, influencing health both directly and indirectly. Furthermore, it has been established that social determinants of health can impinge on an individual’s wellbeing. Wellbeing, as used in this thesis, is a multidimensional paradigm encompassing physical, psychological, financial, spiritual, occupational, social, intellectual and environmental elements that interconnect to facilitate positive wellbeing. With the emergence of a new infectious disease, and with many Australians already experiencing the negative effects of the social determinants of health, this PhD thesis explores the relationship between wellbeing and the social determinants of health among Australian adults during the COVID-19 pandemic.

Methods An explanatory sequential mixed methods study design underpinned by the WHO Commission on Social Determinants of Health conceptual framework was used. The study was undertaken in two distinct phases: quantitative and qualitative. Phase 1—quantitative—used an online cross-sectional study design undertaken between August 2020 – October 2020 and recruited a diverse sample of 1,211 participants from across Australia. Data were analysed using descriptive and inferential statistics using Statistical Package for the Social Sciences (SPSS) version 25. All data in phase 1 were analysed prior to conducting phase 2 of the research. Phase 2—qualitative—used a descriptive qualitative study design informed by the results of phase 1. Purposeful sampling was used to identify and recruit participants from the online cross-sectional study (phase 1) who agreed to participate in an interview. Data were collected using semi-structured interviews between March 2021 – August 2021, with the interviews audio-recorded and transcribed verbatim. Data were analysed using inductive thematic analysis supported by NVivo version 12.

Results Fundamental to a mixed methods study design, the results of each of the phases was integrated using a connection model as described by Creswell. Three key findings emerged from this thesis.

1. Food and housing insecurity impact wellbeing: The most significant finding of this thesis is that food and housing insecurity during the COVID-19 pandemic were high among Australians and were associated with diminished wellbeing. Difficulty accessing food was more prevalent among Australians living in lower socioeconomic areas and was amplified by reduced financial capacity and loss of employment as a result of the pandemic. Similarly, housing insecurity was predominantly associated with Australians living in lower socioeconomic areas and almost exclusively among women. Economic vulnerability through loss of employment and income, especially among Australians in a low socioeconomic areas experiencing food- and housing-related stress, influenced their overall wellbeing.

2. Social capital influences the ability to cope during the pandemic: It was determined that those with strong social support had significantly higher wellbeing scores compared to Australians with moderate and poor social support. Additionally, social support was found to be a predictor of wellbeing; those with strong social support had better wellbeing. Australians’ lived experiences of social capital during the pandemic demonstrated that ‘no person is an island’, with most participants voicing concerns regarding a loss of social connection. The results showed that Australians with high social capital prior to the pandemic were able to remain socially connected during the lockdown periods, resulting in a greater capacity to cope mentally during the pandemic. Australians with low social capital and social support during the pandemic resorted to drug and alcohol use as a way to cope with the loneliness and isolation of the lockdowns. 3. Employment and income loss are associated with low socioeconomic status: Economic wellbeing was influenced by employment and income loss among Australians during the pandemic. There was an association between economic wellbeing and Australians who resided in low socioeconomic areas, with those living in low socioeconomic areas having significantly higher odds of experiencing employment loss during the pandemic. Loss of employment and income during the pandemic resulted in housing and food insecurities, as explained by participants in the qualitative study. This was particularly true for female Australians who resided in low socioeconomic areas. Those who experienced employment and income loss felt that their wellbeing substantially worsened as they were not only dealing with the uncertainties of the pandemic but were also trying to cope with challenges such as lack of finances, inability to pay bills and loss of employment.

Conclusion This thesis provides new evidence for the relationship between Australians’ wellbeing and social determinants of health during the COVID-19 pandemic. The findings demonstrate that Australians, particularly those residing in low socioeconomic areas, experienced significant food and housing insecurity, had low social capital, and were more likely to have income and employment loss that influenced their overall wellbeing during the COVID-19 pandemic. This thesis shines a light on the social determinants of health and reveals that there are social and health inequalities within Australian society that need addressing. Recommendations for public health in addressing the social determinants of health include lobbying governments to incorporate the social determinants of health in all policies, implementing strategies to address food security, and implementing public health interventions to address low social capital. Policy recommendations involve addressing housing affordability, renewing action on the United Nations Sustainable Development Goals and implementing policies to address employment and income security.

FoR codes (2008)




Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.