A natural experiment in social security as public health measure: Experiences of international students as temporary migrant workers during two Covid-19 lockdowns.

What is the impact of social security on public health? And what mechanisms does it operate through? To answer these questions, we take advantage of the unique circumstances of temporary migrant workers two Covid-19 lockdowns in Australia - one in which they were provided with social security, and one in which they were not. We undertook 47 qualitative interviews with South Asian international students who had lost their jobs in two lockdowns in 2020-2021. In Australia, international students represent the largest group of a growing temporary migration program, with many working in low-skilled occupations, in conditions below legal minimum standards. We compare our findings to two models of social security: the self-insurance model and state-insurance model. In first lockdown, without social security, participants struggled to comply with public health orders because of the need to work for income, lack of housing suitable for isolation, and lack of medical leave. Participants tended to avoid testing, and to work while potentially contagious. Participants reported high levels of anxiety, depression and emotional distress caused by job loss and exclusion from an implicit social contract with the rest of Australian society. In contrast, during the second lockdown, where temporary migrants were provided social security payments, participants reported avoiding risky work, undertook Covid-19 testing many times, and self-isolated successfully. There was little evidence of emotional distress. Participants felt like a valued part of Australian society. These results suggest a self-insurance model of social security does not protect the physical and psychological health of vulnerable populations and can exacerbate the spread of communicable diseases. In contrast, state-insurance and social welfare payments to marginalised communities, particularly unemployment benefits and medical leave, are crucial public health policy levers for both protecting vulnerable populations and tackling outbreaks of communicable diseases such as Covid-19.