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Surgery won’t fix my chronic back pain, so what will?

<p><em><a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a></em></p> <p>This week’s ABC Four Corners episode <a href="https://www.abc.net.au/news/2024-04-08/pain-factory/103683180">Pain Factory</a> highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain.</p> <p>The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain.</p> <p><a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">One in five</a> Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated <a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">A$139 billion a year</a>, including $12 billion in direct health-care costs.</p> <p>The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work?</p> <h2>Opioids and invasive procedures</h2> <p>Treatments offered to people with chronic pain include strong pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/30561481/">opioids</a> and invasive procedures such as <a href="https://pubmed.ncbi.nlm.nih.gov/36878313/">spinal cord stimulators</a> or <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.14120">spinal fusion surgery</a>. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm.</p> <p><a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06900-8">Spinal fusion surgery</a> and <a href="https://privatehealthcareaustralia.org.au/consumers-urged-to-be-cautious-about-spinal-cord-stimulators-for-pain/#:%7E:text=Australian%20health%20insurance%20data%20shows,of%20the%20procedure%20is%20%2458%2C377.">spinal cord stimulators</a> are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual.</p> <h2>Addressing the contributors to pain</h2> <p>Recommendations from the latest <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/low-back-pain-clinical-care-standard">Australian</a> and <a href="https://www.who.int/publications/i/item/9789240081789">World Health Organization</a> clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as:</p> <ul> <li>education</li> <li>advice</li> <li>structured exercise programs</li> <li>physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.</li> </ul> <p>Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain.</p> <p>The interventions have minimal side effects and are cost-effective.</p> <p>In the <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">RESOLVE</a> trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move.</p> <p>In the <a href="https://pubmed.ncbi.nlm.nih.gov/37146623/">RESTORE</a> trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it.</p> <h2>Why isn’t everyone with chronic pain getting this care?</h2> <p>While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session <a href="https://www.sira.nsw.gov.au/__data/assets/pdf_file/0005/1122674/Physiotherapy-chiropractic-and-osteopathy-fees-practice-requirements-effective-1-February-2023.pdf">can cost</a> $90–$150.</p> <p>In contrast, <a href="https://www.servicesaustralia.gov.au/chronic-disease-individual-allied-health-services-medicare-items">Medicare</a> provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions.</p> <p>Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs.</p> <p>Access to trained clinicians is another barrier. This problem is particularly evident in <a href="https://www.ruralhealth.org.au/15nrhc/sites/default/files/B2-1_Bennett.pdf">regional and rural Australia</a>, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited.</p> <p>Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/data-file-57-opioid-medicines-dispensing-2016-17-third-atlas-healthcare-variation-2018">rate of opioid use</a>, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas.</p> <h2>So what can we do about it?</h2> <p>We need to reform Australia’s health system, private and <a href="https://www.health.gov.au/sites/default/files/documents/2020/12/taskforce-final-report-pain-management-mbs-items-final-report-on-the-review-of-pain-management-mbs-items.docx">public</a>, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments.</p> <p>Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian <a href="https://pubmed.ncbi.nlm.nih.gov/38461844/">trial</a>, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain.</p> <p>Advocacy and <a href="https://pubmed.ncbi.nlm.nih.gov/37918470/">improving the public’s understanding</a> of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/227450/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/christine-lin-346821"><em>Christine Lin</em></a><em>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, Professor, Sydney School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, Professor of Psychology, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/surgery-wont-fix-my-chronic-back-pain-so-what-will-227450">original article</a>.</em></p>

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Drugs like Ozempic won’t ‘cure’ obesity but they might make us more fat-phobic

<p><em><a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p>Many have <a href="https://www.economist.com/leaders/2023/03/02/new-drugs-could-spell-an-end-to-the-worlds-obesity-epidemic">declared</a> drugs like Ozempic could “end obesity” by reducing the appetite and waistlines of millions of people around the world.</p> <p>When we look past the hype, this isn’t just untrue – it can also be harmful. The focus on weight, as opposed to health, is a feature of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277539521001217">diet culture</a>. This frames the pursuit of thinness as more important than other aspects of physical and cultural wellbeing.</p> <p>The Ozempic buzz isn’t just rooted in health and medicine but plays into ideas of <a href="https://butterfly.org.au/weight-bias-fatphobia-diet-culture/#:%7E:text=Weight%20bias%2C%20sometimes%20also%20called,or%20being%20around%20fat%20people.">fat stigma and fat phobia</a>. This can perpetuate fears of fatness and fat people, and the behaviours that <a href="https://link.springer.com/article/10.1186/S12916-018-1116-5">harm people who live in larger bodies</a>.</p> <h2>Not the first ‘miracle’ weight-loss drug</h2> <p>This isn’t the first time we have heard that weight-loss drugs will change the world. Ozempic and <a href="https://www.ncbi.nlm.nih.gov/books/NBK551568/">its family</a> of GLP-1-mimicking drugs are the <a href="https://theconversation.com/ozempic-is-in-the-spotlight-but-its-just-the-latest-in-a-long-and-strange-history-of-weight-loss-drugs-209324">latest in a long line of weight loss drugs</a>. Each looked promising at the time. But none have lived up to the hype in the long term. Some have even been withdrawn from sale due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126837/">severe side effects</a>.</p> <p>Science does improve <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30028-8/fulltext">incrementally</a>, but diet culture also keeps us on a cycle of hope for the next <a href="https://sahrc.org/2022/04/diet-culture-a-brief-history/">miracle cure</a>. So drugs like Ozempic might not deliver the results individuals expect, continuing the cycle of hope and shame.</p> <h2>Ozempic doesn’t work the same for everyone</h2> <p>When we talk about the results of studies using Ozempic, we often <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719041/">focus on the average</a> (also known as the mean) results or the maximum (or peak) results. So, studies might <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">show</a> those using the drug lost an average of 10.9% of their body weight, but some lost more than 20% and others less than 5%</p> <p>What we don’t talk about as much is that responses are variable. Some people are “<a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769">non-responders</a>”. This means not everyone loses as much weight as the average, and some don’t lose weight at all. For some people, the side-effects will outweigh the benefits.</p> <p>When people are on drugs like Ozempic, their blood sugar is better controlled by enhancing the release of insulin and reducing the levels of another hormone called glucagon.</p> <p>But there is greater variability in the amount of <a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769#bib88">weight lost</a> than the variability in blood sugar control. It isn’t clear why, but is likely due to differences in genetics and lifestyles, and weight being more complex to regulate.</p> <h2>Treatment needs to be ongoing. What will this mean?</h2> <p>When weight-loss drugs do work, they are only effective while they’re being taken. This means that to keep the weight off people need to keep taking them long term. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542252/">One study found</a> an average weight loss of more than 17% after a year on Ozempic became an average net weight loss of 5.6% more than two years after stopping treatment.</p> <p>Short-term side effects of drugs like Ozempic include dizziness, nausea, vomiting and other gastrointestinal upsets. But because these are new drugs, we simply don’t have data to tell us if side effects will increase as people take them for longer periods.</p> <p>Nor do we know if <a href="https://www.medicalnewstoday.com/articles/why-weight-loss-drugs-stop-working-how-to-break-past-ozempic-plateau#:%7E:text=A%20lifetime%20commitment%20to%20Ozempic&amp;text=By%20these%20standards%2C%20such%20drugs,long%2Dterm%20risk%20is%20unknown.">effectiveness will be reduced</a> in the long term. This is called <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/drug-tolerance#:%7E:text=A%20condition%20that%20occurs%20when,or%20different%20medicine%20is%20needed.">drug tolerance</a> and is documented for other long-term treatments such as antidepressants and chemotherapies.</p> <h2>Biology is only part of the story</h2> <p>For some people, using GLP-1-mimicking drugs like Ozempic will be validating and empowering. They will feel like their biology has been “normalised” in the same way that blood pressure or cholesterol medication can return people to the “normal” range of measures.</p> <p>But biologically, obesity <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202176/#:%7E:text=Obesity%20behaves%20as%20complex%20polygenic,about%2080%25%20(3).">isn’t solely about GLP-1 activity</a> with <a href="https://www.worldobesity.org/what-we-do/our-policy-priorities/the-roots-of-obesity">many other</a> hormones, physical activity, and even our gut microbes involved.</p> <p>Overall, <a href="https://www.ncbi.nlm.nih.gov/books/NBK278977/">obesity is complex and multifaceted</a>. Obesity isn’t just driven by personal biology and choice; it has social, cultural, political, environmental and economic determinants.</p> <h2>A weight-centred approach misses the rest of the story</h2> <p>The weight-centred approach <a href="https://butterfly.org.au/body-image/health-not-weight/#:%7E:text=Health%20and%20wellbeing%20are%20multi,on%20their%20size%20or%20appearance.">suggests that leading with thinness means health will follow</a>. But changing appetite is only part of the story when it comes to health.</p> <p>Obesity often <a href="https://www.sciencedirect.com/science/article/pii/S2667368123000335#:%7E:text=Obesity%20related%20malnutrition%20can%20also,%5D%2C%20%5B7%5D%5D.">co-exists with malnutrition</a>. We try to separate the effects in research using statistics, but focusing on the benefits of weight-loss drugs without addressing the underlying malnutrition means we aren’t likely to see the <a href="https://www.wsj.com/articles/ozempic-diet-exercise-healthy-43eee86c">improved health outcomes in everyone who loses weight</a>.</p> <h2>Obesity isn’t an issue detached from people</h2> <p>Even when it is well-intentioned, the rhetoric around the joy of “ending the obesity epidemic” can <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">harm people</a>. Obesity doesn’t occur in isolation. It is people who are obese. And the celebration and hype of these weight-loss drugs can reinforce harmful fat stigma.</p> <p>The framing of these drugs as a “cure” exacerbates the binary view of thin versus fat, and healthy versus unhealthy. These are not binary outcomes that are good or bad. Weight and health exist on a spectrum.</p> <p>Ironically, while fat people are told they need to lose weight for their health, they are also <a href="https://www.dailytelegraph.com.au/news/nsw/ozempic-shame-why-users-are-embarrassed-to-admit-using-weight-loss-wonder-drug/news-story/ee52a819c69459afe6576d25988f9bd6">shamed for “cheating” or taking shortcuts</a> by using medication.</p> <h2>Drugs are tools, not silver bullets</h2> <p>The creation of these drugs is a start, but they remain expensive, and the hype has been followed by <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#:%7E:text=Consumer%20Medicine%20Information%20.-,Why%20the%20Ozempic%20shortage%20happened,label%20prescribing%20for%20weight%20loss.">shortages</a>. Ultimately, complex challenges aren’t addressed with simple solutions. This is particularly true when people are involved, and even more so when there isn’t even an agreement on what the challenge is.</p> <p>Many organisations and individuals see obesity is a disease and believe this framing helps people to seek treatment.</p> <p>Others think it’s unnecessary to attach medical labels to body types and <a href="https://www.forbes.com/sites/geoffreykabat/2013/07/09/why-labeling-obesity-as-a-disease-is-a-big-mistake/?sh=5ca95cc2103b">argue</a> it confuses risk factors (things that are linked to increased risk of illness) with illness itself.</p> <p>Regardless, two things will always remain true. Drugs can only ever be tools, and those tools need to be applied in a context. To use these tools ethically, we need to remain mindful of who this application harms along the way.</p> <hr /> <p><em>Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219309/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></em></p> <p><em><a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, Adjunct Senior Lecturer, Nutrition, Dietetics &amp; Food Innovation - School of Health Sciences, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drugs-like-ozempic-wont-cure-obesity-but-they-might-make-us-more-fat-phobic-219309">original article</a>.</em></p>

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Who will look after us in our final years? A pay rise alone won’t solve aged-care workforce shortages

<p><a href="https://theconversation.com/profiles/stephen-duckett-10730">Stephen Duckett</a>, <em><a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p>Aged-care workers will receive a significant pay increase after the Fair Work Commission <a href="https://www.fwc.gov.au/documents/decisionssigned/pdf/2024fwcfb150.pdf">ruled</a> they deserved substantial wage rises of up to 28%. The federal government <a href="https://ministers.dewr.gov.au/burke/fair-work-decision-aged-care">has committed to</a> the increases, but is yet to announce when they will start.</p> <blockquote class="twitter-tweet"> <p dir="ltr" lang="en">Tens of thousands of aged care workers will receive a major pay rise after the Fair Work Commission recommended the increase. <a href="https://t.co/NeNt1Gvxd9">https://t.co/NeNt1Gvxd9</a></p> <p>— SBS News (@SBSNews) <a href="https://twitter.com/SBSNews/status/1768557710537068889?ref_src=twsrc%5Etfw">March 15, 2024</a></p></blockquote> <p>But while wage rises for aged-care workers are welcome, this measure alone will not fix all workforce problems in the sector. The number of people over 80 is expected to <a href="https://treasury.gov.au/sites/default/files/2023-08/p2023-435150.pdf">triple over the next 40 years</a>, driving an increase in the number of aged care workers needed.</p> <h2>How did we get here?</h2> <p>The Royal Commission into Aged Care Quality and Safety, which delivered its <a href="https://www.royalcommission.gov.au/aged-care/final-report">final report</a> in March 2021, identified a litany of tragic failures in the regulation and delivery of aged care.</p> <p>The former Liberal government was dragged reluctantly to accept that a total revamp of the aged-care system was needed. But its <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/respect-care-and-dignity-aged-care-royal-commission-452-million-immediate-response-as-government-commits-to-historic-reform-to-deliver-respect-and-care-for-senior-australians#:%7E:text=Minister%20for%20Senior%20Australians%20and,%2C%20dementia%2C%20food%20and%20nutrition.">weak response</a> left the heavy lifting to the incoming Labor government.</p> <p>The current government’s response started well, with a <a href="https://theconversation.com/anthony-albanese-offers-2-5-billion-plan-to-fix-crisis-in-aged-care-180419">significant injection of funding</a> and a promising regulatory response. But it too has failed to pursue a visionary response to the problems identified by the Royal Commission.</p> <p>Action was needed on four fronts:</p> <ul> <li>ensuring enough staff to provide care</li> <li>building a functioning regulatory system to encourage good care and weed out bad providers</li> <li>designing and introducing a fair payment system to distribute funds to providers and</li> <li>implementing a financing system to pay for it all and achieve intergenerational equity.</li> </ul> <p>A government taskforce which proposed a <a href="https://theconversation.com/what-will-aged-care-look-like-for-the-next-generation-more-of-the-same-but-higher-out-of-pocket-costs-225551">timid response to the fourth challenge</a> – an equitable financing system – was released at the start of last week.</p> <p>Consultation closed on a <a href="https://media.opan.org.au/uploads/2024/03/240308_Aged-Care-Act-Exposure-Draft-Joint-Submission_FINAL.pdf">very poorly designed new regulatory regime</a> the week before.</p> <p>But the big news came at end of the week when the Fair Work Commission handed down a further <a href="https://www.fwc.gov.au/documents/decisionssigned/pdf/2024fwcfb150.pdf">determination</a> on what aged-care workers should be paid, confirming and going beyond a previous <a href="https://www.fwc.gov.au/documents/sites/work-value-aged-care/decisions-statements/2022fwcfb200.pdf">interim determination</a>.</p> <h2>What did the Fair Work Commission find?</h2> <p>Essentially, the commission determined that work in industries with a high proportion of women workers has been traditionally undervalued in wage-setting. This had consequences for both care workers in the aged-care industry (nurses and <a href="https://training.gov.au/Training/Details/CHC33021">Certificate III-qualified</a> personal-care workers) and indirect care workers (cleaners, food services assistants).</p> <p>Aged-care staff will now get significant pay increases – 18–28% increase for personal care workers employed under the Aged Care Award, inclusive of the increase awarded in the interim decision.</p> <figure class="align-center "><figcaption></figcaption>Indirect care workers were awarded a general increase of 3%. Laundry hands, cleaners and food services assistants will receive a further 3.96% <a href="https://www.fwc.gov.au/documents/decision-summaries/2024fwcfb150-summary.pdf">on the grounds</a> they “interact with residents significantly more regularly than other indirect care employees”.</figure> <p>The final increases for registered and enrolled nurses will be determined in the next few months.</p> <h2>How has the sector responded?</h2> <p>There has been no push-back from employer groups or conservative politicians. This suggests the uplift is accepted as fair by all concerned.</p> <p>The interim increases of up to 15% probably facilitated this acceptance, with the <a href="https://theconversation.com/what-does-the-budget-mean-for-medicare-medicines-aged-care-and-first-nations-health-192842">recognition of the community</a> that care workers should be paid more than fast food workers.</p> <p>There was <a href="https://www.accpa.asn.au/media-releases/accpa-welcomes-further-aged-care-wage-rises">no criticism from aged-care providers</a> either. This is probably because they are facing difficulty in recruiting staff at current wage rates. And because government payments to providers reflect the <a href="https://www.ihacpa.gov.au/">actual cost of aged care</a>, increased payments will automatically flow to providers.</p> <p>When the increases will flow has yet to be determined. The government is due to give its recommendations for staging implementation by mid-April.</p> <h2>Is the workforce problem fixed?</h2> <p>An increase in wages is necessary, but alone is not sufficient to solve workforce shortages.</p> <p>The health- and social-care workforce is <a href="https://www.jobsandskills.gov.au/data/employment-projections">predicted</a> to grow faster than any other sector over the next decade. The “care economy” will <a href="https://theconversation.com/care-economy-to-balloon-in-an-australia-of-40-5-million-intergenerational-report-211876">grow</a> from around 8% to around 15% of GDP over the next 40 years.</p> <p>This means a greater proportion of school-leavers will need to be attracted to the aged-care sector. Aged care will also need to attract and retrain workers displaced from industries in decline and attract suitably skilled migrants and refugees with appropriate language skills.</p> <p>The <a href="https://theconversation.com/demand-driven-funding-for-universities-is-frozen-what-does-this-mean-and-should-the-policy-be-restored-116060">caps on university and college enrolments</a> imposed by the previous government, coupled with weak student demand for places in key professions (such as nursing), has meant workforce shortages will continue for a few more years, despite the allure of increased wages.</p> <p>A significant increase in intakes into university and vocational education college courses preparing students for health and social care is still required. Better pay will help to increase student demand, but funding to expand place numbers will ensure there are enough qualified staff for the aged-care system of the future. <!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/225898/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/stephen-duckett-10730">Stephen Duckett</a>, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice and Primary Care, <em><a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/who-will-look-after-us-in-our-final-years-a-pay-rise-alone-wont-solve-aged-care-workforce-shortages-225898">original article</a>.</em></p> <p><em>Image: Getty</em></p>

Retirement Income

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Thinking of using an activity tracker to achieve your exercise goals? Here’s where it can help – and where it probably won’t

<p><em><a href="https://theconversation.com/profiles/corneel-vandelanotte-209636">Corneel Vandelanotte</a>, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a></em></p> <p>It’s that time of year when many people are getting started on their resolutions for the year ahead. Doing more physical activity is a popular and <a href="https://link.springer.com/article/10.1007/s13668-016-0175-5">worthwhile</a> goal.</p> <p>If you’re hoping to be more active in 2024, perhaps you’ve invested in an activity tracker, or you’re considering buying one.</p> <p>But what are the benefits of activity trackers? And will a basic tracker do the trick, or do you need a fancy one with lots of features? Let’s take a look.</p> <h2>Why use an activity tracker?</h2> <p>One of the <a href="https://doi.org/10.1186/s12966-020-01001-x">most powerful predictors</a> for being active is whether or not <a href="https://www.sciencedirect.com/science/article/abs/pii/S0140673621026301">you are monitoring</a> how active you are.</p> <p>Most people have a vague idea of how active they are, but this is inaccurate a lot of the time. Once people consciously start to keep track of how much activity they do, they often realise it’s less than what they thought, and this motivates them to be more active.</p> <p>You can self-monitor without an activity tracker (just by writing down what you do), but this method is hard to keep up in the long run and it’s also a lot less accurate compared to devices that track your every move 24/7.</p> <p>By tracking steps or “activity minutes” you can ascertain whether or not you are meeting the <a href="https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians/for-adults-18-to-64-years">physical activity guidelines</a> (150 minutes of moderate to vigorous physical activity per week).</p> <p>It also allows you to track how you’re progressing with any personal activity goals, and view your progress over time. All this would be difficult without an activity tracker.</p> <p>Research has shown the most popular brands of activity trackers are generally reliable when it comes to tracking basic measures such as <a href="https://doi.org/10.2196/18694">steps</a> and <a href="https://doi.org/10.1123/jmpb.2019-0072">activity minutes</a>.</p> <h2>But wait, there’s more</h2> <p>Many activity trackers on the market nowadays track a range of other measures which their manufacturers promote as important in monitoring health and fitness. But is this really the case? Let’s look at some of these.</p> <p><strong>Resting heart rate</strong></p> <p>This is your heart rate at rest, which is normally somewhere <a href="https://www.healthdirect.gov.au/resting-heart-rate">between 60 and 100 beats per minute</a>. Your resting heart rate will gradually go down as you become fitter, especially if you’re doing a lot of high-intensity exercise. Your risk of dying of any cause (all-cause mortality) is much lower when you have a <a href="https://pubmed.ncbi.nlm.nih.gov/28552551/">low resting heart rate</a>.</p> <p>So, it is useful to keep an eye on your resting heart rate. Activity trackers are pretty good at tracking it, but you can also easily measure your heart rate by monitoring your pulse and using a stopwatch.</p> <p><strong>Heart rate during exercise</strong></p> <p>Activity trackers will also measure your heart rate when you’re active. To improve fitness efficiently, professional athletes focus on having their heart rate in certain “<a href="https://chhs.source.colostate.edu/how-to-target-heart-rate-training-zones-effectively/">zones</a>” when they’re exercising – so knowing their heart rate during exercise is important.</p> <p>But if you just want to be more active and healthier, without a specific training goal in mind, you can exercise at a level that feels good to you and not worry about your heart rate during activity. The <a href="https://doi.org/10.1097/HCO.0000000000000437">most important thing</a> is that you’re being active.</p> <p>Also, a dedicated heart rate monitor with a strap around your chest will do a much better job at measuring your actual heart rate <a href="https://doi.org/10.1038/s41746-020-0226-6">compared</a> to an activity tracker worn around your wrist.</p> <p><strong>Maximal heart rate</strong></p> <p>This is the hardest your heart could beat when you’re active, not something you could sustain very long. Your maximal heart rate is not influenced by how much exercise you do, or your fitness level.</p> <p>Most activity trackers <a href="https://jamanetwork.com/journals/jamacardiology/article-abstract/2566167">don’t measure it accurately</a> anyway, so you might as well forget about this one.</p> <p><strong>VO₂max</strong></p> <p>Your muscles need oxygen to work. The more oxygen your body can process, the harder you can work, and therefore the fitter you are.</p> <p>VO₂max is the volume (V) of oxygen (O₂) we could breathe maximally (max) over a one minute interval, expressed as millilitres of oxygen per kilogram of body weight per minute (ml/kg/min). Inactive women and men would have a VO₂max lower than 30 and 40 ml/kg/min, respectively. A reasonably good VO₂max would be mid thirties and higher for women and mid forties and higher for men.</p> <p>VO₂max is another measure of fitness that <a href="https://doi.org/10.1001/jamanetworkopen.2018.3605">correlates well</a> with all-cause mortality: the higher it is, the lower your risk of dying.</p> <p>For athletes, VO₂max is usually measured in a lab on a treadmill while wearing a mask that measures oxygen consumption. Activity trackers instead look at your running speed (using a GPS chip) and your heart rate and compare these measures to values from other people.</p> <p>If you can run fast with a low heart rate your tracker will assume you are relatively fit, resulting in a higher VO₂max. These estimates are <a href="https://doi.org/10.1007/s40279-021-01639-y">not very accurate</a> as they are based on lots of assumptions. However, the error of the measurement is reasonably consistent. This means if your VO₂max is gradually increasing, you are likely to be getting fitter.</p> <p>So what’s the take-home message? Focus on how many steps you take every day or the number of activity minutes you achieve. Even a basic activity tracker will measure these factors relatively accurately. There is no real need to track other measures and pay more for an activity tracker that records them, unless you are getting really serious about exercise.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219235/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/corneel-vandelanotte-209636">Corneel Vandelanotte</a>, Professorial Research Fellow: Physical Activity and Health, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/thinking-of-using-an-activity-tracker-to-achieve-your-exercise-goals-heres-where-it-can-help-and-where-it-probably-wont-219235">original article</a>.</em></p>

Body

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Flying home for Christmas? Carbon offsets are important, but they won’t fix plane pollution

<p><em><a href="https://theconversation.com/profiles/susanne-becken-90437">Susanne Becken</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/brendan-mackey-152282">Brendan Mackey</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></p> <p>Australia is an important player in the global tourism business. In 2016, <a href="https://www.tra.gov.au/research/research">8.7 million visitors arrived in Australia and 8.8 million Australians went overseas</a>. A further 33.5 million overnight trips were made domestically.</p> <p>But all this travel comes at a cost. According to the <a href="http://tourismdashboard.org/explore-the-data/carbon-emissions/">Global Sustainable Tourism Dashboard</a>, all Australian domestic trips and one-way international journeys (the other half is attributed to the end point of travel) amount to 15 million tonnes of carbon dioxide for 2016. That is 2.7% of global aviation emissions, despite a population of only 0.3% of the global total.</p> <p>The peak month of air travel in and out of Australia is December. Christmas is the time where people travel to see friends and family, or to go on holiday. More and more people are <a href="http://climatecommunication.yale.edu/publications/analysis-of-a-119-country-survey-predicts-global-climate-change-awareness/">aware of the carbon implications of their travel</a> and want to know whether, for example, they should purchase carbon offsets or not.</p> <p>Our <a href="http://www.sciencedirect.com/science/article/pii/S0969699716302538">recent study in the Journal of Air Transport Management</a> showed that about one third of airlines globally offer some form of carbon offsetting to their customers. However, the research also concluded that the information provided to customers is often insufficient, dated and possibly misleading. Whilst local airlines <a href="https://www.qantasfutureplanet.com.au/#aboutus">Qantas</a>, <a href="https://www.virginaustralia.com/nz/en/about-us/sustainability/carbon-offset-program/">Virgin Australia</a> and <a href="https://www.airnewzealand.co.nz/sustainability-customer-carbon-offset">Air New Zealand</a> have relatively advanced and well-articulated carbon offset programs, others fail to offer scientifically robust explanations and accredited mechanisms that ensure that the money spent on an offset generates some real climate benefits.</p> <p>The notion of carbon compensation is actually more difficult than people might think. To help explain why carbon offsetting does make an important climate contribution, but at the same time still adds to atmospheric carbon, we created an <a href="https://www.youtube.com/watch?v=xsh-erzGlR0">animated video clip</a>.</p> <figure><iframe src="https://www.youtube.com/embed/xsh-erzGlR0?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">Jack’s journey.</span></figcaption></figure> <p>The video features Jack, a concerned business traveller who begins purchasing carbon credits. However, he comes to the realisation that the carbon emissions from his flights are still released into the atmosphere, despite the credit.</p> <p>The concept of “carbon neutral” promoted by airline offsets means that an equal amount of emissions is avoided elsewhere, but it does not mean there is no carbon being emitted at all – just relatively less compared with the scenario of not offsetting (where someone else continues to emit, in addition to the flight).</p> <p>This means that, contrary to many promotional and educational materials (see <a href="https://www.youtube.com/watch?v=cGB2OAg5ffA">here</a> for instance), carbon offsetting will not reduce overall carbon emissions. Trading emissions means that we are merely maintaining status quo.</p> <p>A steep reduction, however, is what’s required by every sector if we were to reach the net-zero emissions goal by 2050, agreed on in the <a href="http://unfccc.int/paris_agreement/items/9485.php">Paris Agreement</a>.</p> <p>Carbon offsetting is already an important “<a href="http://www.sciencedirect.com/science/article/pii/S0261517714000910">polluter pays</a>” mechanism for travellers who wish to contribute to climate mitigation. But it is also about to be institutionalised at large scale through the new UN-run <a href="https://www.icao.int/environmental-protection/Pages/market-based-measures.aspx">Carbon Offsetting and Reduction Scheme for International Aviation (CORSIA)</a>.</p> <p>CORSIA will come into force in 2021, when participating airlines will have to purchase carbon credits for emissions above 2020 levels on certain routes.</p> <p>The availability of carbon credits and their integrity is of major concern, as well as how they align with national obligations and mechanisms agreed in the Paris Agreement. Of particular interest is <a href="http://www.carbon-mechanisms.de/en/introduction/the-paris-agreement-and-article-6/">Article 6</a>, which allows countries to cooperate in meeting their climate commitments, including by “trading” emissions reductions to count towards a national target.</p> <p>The recent COP23 in Bonn highlighted that CORSIA is widely seen as a potential source of billions of dollars for offset schemes, supporting important climate action. Air travel may provide an important intermediate source of funds, but ultimately the aviation sector, just like anyone else, will have to reduce their own emissions. This will mean major advances in technology – and most likely a contraction in the fast expanding global aviation market.</p> <h2>Travelling right this Christmas</h2> <p>In the meantime, and if you have booked your flights for Christmas travel, you can do the following:</p> <ul> <li> <p>pack light (every kilogram will cost additional fuel)</p> </li> <li> <p>minimise carbon emissions whilst on holiday (for instance by biking or walking once you’re there), and</p> </li> <li> <p>support a <a href="http://www.co2offsetresearch.org/consumer/Standards.html">credible offsetting program</a>.</p> </li> </ul> <p>And it’s worth thinking about what else you can do during the year to minimise emissions – this is your own “carbon budget”.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/89148/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/susanne-becken-90437">Susanne Becken</a>, Professor of Sustainable Tourism and Director, Griffith Institute for Tourism, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/brendan-mackey-152282">Brendan Mackey</a>, Director of the Griffith Climate Change Response Program, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/flying-home-for-christmas-carbon-offsets-are-important-but-they-wont-fix-plane-pollution-89148">original article</a>.</em></p>

Travel Trouble

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Bring a plate! What to take to Christmas lunch that looks impressive (but won’t break the bank)

<p><em><a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/amy-kirkegaard-1401256">Amy Kirkegaard</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/breanna-lepre-1401257">Breanna Lepre</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>, and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p>Christmas lunch is at your friend’s house this year, and they’ve asked you to bring a plate. Money is tight. So, you find yourself wondering, “What’s cheap, healthy but also looks impressive?”</p> <p>While a tray of mangoes would certainly be a cheap, healthy and colourful contribution, you want to look as if you’ve put in a bit of effort.</p> <p>If you’re struggling for inspiration, here are some tried and tested ideas.</p> <h2>First, choose your ingredients</h2> <p>Check your pantry for inspiration or ingredients. Crackers, dried fruit or nuts are great ideas for a charcuterie board. You can use herbs and spices to add flavour to dishes, or you could use up packets of dried pasta to make a <a href="https://nomoneynotime.com.au/healthy-easy-recipes/salmon-and-pasta-salad">pasta salad</a>. This is also a great way to clean out your pantry.</p> <p>Focus on fruit and vegetables that are in season, so are cheaper and more readily available. Keep an eye out at your local fruit and veggie shop or market as it will usually have in-season fruit and vegetables in bulk quantities at reduced prices. Check out <a href="http://seasonalfoodguide.com/australia-general-seasonal-fresh-produce-guide-fruits-vegetables-in-season-availability.html">this seasonal food guide</a> to help you plan your Christmas menu.</p> <p>Ask around for deals by chatting to your local butcher, fishmonger or grocer and let them know your budget. They may suggest cheaper cuts of meat (such as, <a href="https://www.australianbutchersguild.com.au/the-blog/the-abg-blog/underrated-cuts-of-beef/">oyster</a>, <a href="https://www.australianbeef.com.au/know-your-meat/beef-cuts/">blades, rump caps</a>). Try cooking <a href="https://www.bestrecipes.com.au/recipes/slow-cooker-corned-beef-mustard-sauce-recipe/z47lwrbv?r=entertaining/9clz7475&amp;h=entertaining">corned beef</a> or <a href="https://www.bbcgoodfood.com/recipes/slow-cooker-roast-chicken">roast chicken</a> in a slow cooker with lots of vegetables. Slow-cooked meals can be frozen and can come in handy for left-overs.</p> <p>Lean into <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608274/">legumes</a>. These are packed with fibre, protein, vitamins and minerals. They are also budget-friendly and a great way to add texture to salads. Tinned chickpeas, or cannellini, kidney, or butter beans are quick and easy additions that can make filling dishes go further. You could even turn tinned chickpeas into homemade hommus for a healthy and delicious side dish. Check out these healthy legume <a href="https://nomoneynotime.com.au/healthy-easy-recipes/filter/keywords--legumes">recipes</a>.</p> <h2>7 ways to keep food costs down this Christmas</h2> <p><strong>1. Plan ahead</strong></p> <p>Plan your menu by asking how many people are coming and checking for any food preferences or dietary requirements. Check for items you already have at home, and make a shopping list for only what you <a href="https://www.emerald.com/insight/content/doi/10.1108/BFJ-12-2017-0726/full/html">need</a>.</p> <p><strong>2. Use free recipes</strong></p> <p>Use free online recipe collections and e-books tailored for budget cooking that can help you design your Christmas menu to meet your budget. This <a href="https://nomoneynotime.com.au/uploads/Our-Guide-to-the-Perfect-Christmas-Feast.pdf">one</a> was created by a group of <a href="https://dietitiansaustralia.org.au/working-dietetics/standards-and-scope/role-accredited-practising-dietitian">accredited practising dietitians</a> and has healthy, budget friendly recipes and ideas. You could also try this budget friendly collection of Christmas recipes from <a href="https://www.taste.com.au/recipes/collections/budget-christmas-recipes">taste</a>.</p> <p><strong>3. Involve the family</strong></p> <p>Get together with other family members and make it a challenge to see who can make the cheapest, most delicious dish. Get the kids involved in fun activities, such as making a DIY gingerbread house or putting together mixed skewers for the barbecue.</p> <p><strong>4. Pool your resources</strong></p> <p>Larger quantities of a single dish will be cheaper than multiple different dishes (and easier to prepare).</p> <p><strong>5. Frozen is fine</strong></p> <p>Use frozen fruits and vegetables if you need to. These can have just as <a href="https://pubmed.ncbi.nlm.nih.gov/25526594/">many vitamins and minerals</a> as fresh, are often cheaper than fresh produce and last longer. Try using frozen berries to decorate the pavlova or add them to your favourite cake, muffin or pie.</p> <p><strong>6. Make your own drinks</strong></p> <p>You could make your own drinks, such as home-brewed iced tea. See if anyone in your family has a soda stream you can borrow to make sparkling mineral water. Add some freshly squeezed lemon or lime for extra flavour.</p> <p><strong>7. Reduce waste</strong></p> <p>Use your own crockery and re-use leftovers to reduce waste. After all, washing up is cheaper than buying plastic or paper plates and better for the environment. Remember to save any leftovers and re-use them. Leftover fresh vegetables could be used to make a hearty soup or chutney.</p> <h2>It doesn’t have to be perfect</h2> <p>Christmas comes and goes quickly. If your cooking ideas don’t work out, it’s not the end of the world. Choosing healthy foods on a budget is important all year around, so you may like to think about trying these tips throughout the years to come. <!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/196565/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/lauren-ball-14718"><em>Lauren Ball</em></a><em>, Professor of Community Health and Wellbeing, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/amy-kirkegaard-1401256">Amy Kirkegaard</a>, Postdoctoral Research Fellow, School of Human Movement and Nutrition Sciences, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/breanna-lepre-1401257">Breanna Lepre</a>, Research Fellow, Mater Research Institute, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>, and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, Dietitian and Researcher, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/bring-a-plate-what-to-take-to-christmas-lunch-that-looks-impressive-but-wont-break-the-bank-196565">original article</a>.</em></p>

Food & Wine

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Why Gladys likely won't be the new Optus CEO

<p>Rumours are swirling that former NSW premier Gladys Berejiklian could be taking the top job at Optus after former chief executive Kelly Bayer Rosmarin resigned on Monday. </p> <p>According to NCA NewsWire, the former premier has flagged her interest in the role as Optus launched its global search for the chief's replacement. </p> <p>Berejiklian was responsible for managing the company’s business customers in early 2022, but there's one massive roadblock that might stop her from becoming the next Optus CEO. </p> <p>Any decision to promote Berejiklian could be seen as risky after she was found to have engaged in serious corrupt conduct with former Wagga Wagga MP and partner Daryl Maguire, by the NSW Independent Commission Against Corruption (ICAC). </p> <p>Despite appealing the findings, it is highly unlikely that Berejiklian would get the job after the ICAC ruling. </p> <p>Although the decision itself would ultimately fall with the Optus board, Greens senator Sarah Hanson-Young said that she wanted someone who “understands that we need better regulation and work with the government, not against them”.</p> <p>“I think Gladys will have to get some other things off her desk before she steps forward," she said. </p> <p>“What I want to see is somebody who puts the public interest first, is honest and has integrity.”</p> <p>Berejiklian has stayed silent on the matter, with Optus chief financial officer Michael Venter currently taking on the role of interim chief executive as the telecom company continues to lookout for a replacement. </p> <p>Image: Mark Kolbe/Getty Images</p>

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Slashing salt can save lives – and it won’t hurt your hip pocket or tastebuds

<p><em><a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/lachlan-fox-1283428">Lachlan Fox</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a></em></p> <p>Each year, more than <a href="https://www.aihw.gov.au/getmedia/eb5fee21-7f05-4be1-8414-8b2bba7b4070/ABDS-2018-Risk-factor-supp-data-tables.xlsx.aspx">2,500 Australians</a> die from diseases linked to eating too much salt.</p> <p>We shouldn’t be putting up with so much unnecessary illness, mainly from heart disease and strokes, and so many deaths.</p> <p>As a new <a href="https://grattan.edu.au/report/sneaky-salt/">Grattan Institute report</a> shows, there are practical steps the federal government can take to save lives, reduce health spending and help the economy.</p> <h2>We eat too much salt, with deadly consequences</h2> <p>Eating too much salt is bad for your health. It <a href="https://www.nature.com/articles/s41569-018-0004-1">raises blood pressure</a>, which increases the risk of <a href="https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.119.14240">heart disease and stroke</a>.</p> <p>About <a href="https://www.aihw.gov.au/reports/risk-factors/high-blood-pressure/contents/summary">one in three</a> Australians has high blood pressure, and eating too much salt is the biggest individual contributor.</p> <p>Unfortunately, the average Australian eats far too much salt – <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja17.00394">almost double</a> the recommended daily maximum of 5 grams, equivalent to <a href="https://www.heartfoundation.org.au/sodium-and-salt-converter#:%7E:text=We%20recommend%20adults%20eat%20less,about%201%20teaspoon%20a%20day">a teaspoon</a>.</p> <p>Australian governments know excessive salt intake is a big problem. That’s why in <a href="https://www.health.gov.au/resources/publications/national-preventive-health-strategy-2021-2030?language=en">2021 they set a target</a> to reduce salt intake by at least 30% by 2030.</p> <p>It’s an ambitious and worthy goal. But we’re still eating too much salt and we don’t have the policies to change that.</p> <h2>Most of the salt we eat is added to food during manufacturing</h2> <p>Most of the salt Australians eat doesn’t come from the shaker on the table. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231587/">About three-quarters</a> of it is added to food during manufacturing.</p> <p>This salt is hidden in everyday staples such as bread, cheese and processed meats. Common foods such as ready-to-eat pasta meals or a ham sandwich can have up to half our total recommended salt intake.</p> <h2>Salt limits are the best way to cut salt intake</h2> <p>Reducing the amount of salt added to food during manufacturing is the most effective way to reduce intake.</p> <p>Salt limits can help us do that. They work by setting limits on how much salt can be added to different kinds of food, such as bread or biscuits. To meet these limits, companies need to change the recipes of their products, reducing the amount of salt.</p> <p>Under salt limits, the United Kingdom reduced salt intake <a href="https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.16649">by 20% in about a decade</a>. <a href="https://www.nature.com/articles/s41371-021-00653-x">South Africa</a> is making even faster gains. Salt limits are cheap and easy to implement, and can get results quickly.</p> <p>Most consumers won’t notice a change at the checkout. Companies will need to update their recipes, but even if all the costs of updating recipes were passed on to shoppers, we calculate that at most it would cost about 10 cents each week for the average household.</p> <p>Nor will consumers notice much of a change at the dinner table. <a href="https://www.mdpi.com/2072-6643/6/10/4354">Most people don’t notice</a> when some salt is removed <a href="https://www.sciencedirect.com/science/article/pii/S0022316622031224">from common foods</a>. There are many ways companies can make foods taste just as salty without adding as much salt. For example, they can make <a href="https://www.wsj.com/articles/SB10001424052748704534904575131602283791566">salt crystals finer</a>, or use <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520464/">potassium-enriched salt</a>, which swaps some of the harmful sodium in salt for potassium. And because the change will be gradual, our tastebuds will <a href="https://doi.org/10.1093/eurjcn/zvac060.077">adapt to less salty foods</a> over time.</p> <h2>Australia’s salt limits are failing</h2> <p>Australia has had voluntary salt limits since 2009, but they are badly designed, poorly implemented, and have reduced population salt intake by just <a href="https://www.abs.gov.au/articles/healthy-food-partnership-reformulation-program-two-year-progress">0.3%</a>.</p> <p>Because Australia’s limits are voluntary, many food companies have chosen not to participate in the scheme. Our analysis shows that 73% of eligible food products are not participating, and only 4% have reduced their salt content.</p> <h2>Action could save lives</h2> <p>Modelling from the University of Melbourne <a href="https://mspgh.unimelb.edu.au/__data/assets/pdf_file/0004/4783405/The-Health-and-Cost-Impacts-of-Sodium-Reduction-Interventions-in-Australia.pdf">shows</a> that fixing our failed salt limits could add 36,000 extra healthy years of life, across the population, over the next 20 years.</p> <p>This would delay more than 300 deaths each year and reduce health-care spending by A$35 million annually, the equivalent of 6,000 hospital visits.</p> <p><a href="https://www.nature.com/articles/jhh2013105">International experience</a> <a href="https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.16649">shows</a> the costs of implementing such salt limits would be very low and far outweighed by the benefits.</p> <h2>How to fix our failed salt limits</h2> <p>To achieve these gains, the federal government should start by enforcing the limits we already have, by making compliance mandatory. <a href="https://www.sciencedirect.com/science/article/abs/pii/S216183132300042X">Fifteen countries</a> have mandatory salt limits, and 14 are planning to introduce them.</p> <p>The number of foods covered by salt limits in Australia should more than double, to be as broad as those the <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/604338/Salt_reduction_targets_for_2017.pdf">UK set in 2014</a>. Broader targets would include common foods for which Australia does not currently set targets, such as baked beans, butter, margarine and canned vegetables.</p> <p>A loophole in the current scheme that lets companies leave out a fifth of their products should be closed. The federal government should design the policy, rather than doing it jointly with industry representatives.</p> <p>Over the coming decades, Australia will need many new and improved policies to reduce diet-related disease. Reducing salt intake must be part of this agenda. For too long, Australia has let the food industry set the standard, with almost no progress against a major threat to our health.</p> <p>Getting serious about salt would save lives, and it would more than pay for itself through reduced health-care costs and increased economic activity.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/213980/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/peter-breadon-1348098"><em>Peter Breadon</em></a><em>, Program Director, Health and Aged Care, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/lachlan-fox-1283428">Lachlan Fox</a>, Associate, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/slashing-salt-can-save-lives-and-it-wont-hurt-your-hip-pocket-or-tastebuds-213980">original article</a>.</em></p>

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Qantas won’t like it, but Australian travellers could be about to get a better deal on flights

<p><em><a href="https://theconversation.com/profiles/gui-lohmann-1476773">Gui Lohmann</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/justin-wastnage-489752">Justin Wastnage</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></p> <p>Weeks after Qantas chief executive Alan Joyce brought forward his resignation to help Qantas “accelerate its renewal”, the company’s chairman Richard Goyder today announced he too is retiring early, to “<a href="https://cdn-api.markitdigital.com/apiman-gateway/ASX/asx-research/1.0/file/2924-02723591-2A1480044?access_token=83ff96335c2d45a094df02a206a39ff4">support restoration of trust</a>”.</p> <p>But the early retirement will take place “prior to the company’s annual general meeting in late 2024” – meaning Goyder will be in the chair for a while yet.</p> <p>This will give him time to (among other things) help Qantas respond to the Senate inquiry into air services, which <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Commonwealth_Bilateral_Air_Service_Agreements/cbasa/Report">reported on Monday</a>.</p> <p>If acted on, some of the report’s recommendations would shift power away from Qantas – such as by giving travellers automatic cash compensation for delayed or cancelled flights.</p> <p>But the inquiry arguably still didn’t go far enough, shying away from bolder action already taken in Europe.</p> <h2>What did the Senate inquiry recommend?</h2> <p>The Senate inquiry was set up to investigate the Albanese government’s refusal to approve <a href="https://theconversation.com/what-will-putting-the-interests-of-qantas-ahead-of-qatar-airways-cost-1-billion-per-year-and-a-new-wave-of-protectionism-of-legacy-carriers-212495">extra flights into Australia sought by Qatar Airways</a>, but broadened its scope to examine the way Qantas has been <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Commonwealth_Bilateral_Air_Service_Agreements/cbasa/Report/Recommendations">treating its customers</a>.</p> <p>Among its recommendations are that:</p> <ul> <li> <p>the government immediately review its decision not to increase capacity under Australia’s bilateral air services agreement with Qatar</p> </li> <li> <p>when making decisions relating to bilateral air service agreements, the government have regard to cost benefit analysis, consult widely with key stakeholders, and publish a statement of reasons for decisions taken</p> </li> <li> <p>the government review reform options to strengthen competition in the domestic aviation industry, including potential divestiture powers</p> </li> <li> <p>the government direct the Australian Competition and Consumer Commission to conduct an inquiry into potential anti-competitive behaviour in the domestic aviation market</p> </li> <li> <p>the government develop and implement consumer protection reforms as soon as reasonably practicable to address significant delays, cancellations, lost baggage and devaluation of loyalty programs.</p> </li> </ul> <p>The committee also wanted to be reappointed so it would be able to reexamine witnesses who were unable to appear, including Alan Joyce and Transport Minister Catherine King.</p> <h2>Consumer cashback and action on Sydney Airport</h2> <p>Specific suggestions in the report would shift power away from Qantas.</p> <p>One is automatic cash compensation for delayed or cancelled flights, of the kind Europeans have enjoyed for <a href="https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:52016XC0615%2801%29">almost 20 years</a>.</p> <p>Another is for the government to respond to an independent review’s recommendations on improving Sydney Airport’s “slot management system” (how air traffic is managed), which <a href="https://www.infrastructure.gov.au/infrastructure-transport-vehicles/airports/review-sydney-airport-demand-management-scheme">reported back almost three years ago</a>.</p> <p>Yet another concerned “<a href="https://theconversation.com/explainer-cabotage-and-why-foreign-airlines-dont-fly-domestic-42350">cabotage</a>”: the ability for foreign airlines to pick up domestic passengers on a domestic leg of an international flight. The committee recommended the government consider limited cabotage.</p> <p>The government hasn’t yet indicated which of the recommendations it plans to act on.</p> <h2>Open skies, or tightly-controlled skies?</h2> <p>The committee could have, and perhaps should have, put forward bolder recommendations.</p> <p>One would have been unrestricted <a href="https://theconversation.com/under-open-skies-the-market-not-the-minister-would-decide-how-often-airlines-could-fly-into-australia-213214">open skies</a> agreements, of the kind Australia already has with China, India, Japan, New Zealand and Singapore. This would see the government remove itself from decisions about landing slots and leave that to the airports.</p> <p>An alternative approach – almost the opposite – would be retaining the power to decide who lands, but using it to achieve outcomes the government wants, such as commitments from countries including Qatar on things such as workers’ rights.</p> <p>The European Union has shown what could be done. It extracted key <a href="https://ec.europa.eu/commission/presscorner/detail/en/ip_21_5344">concessions</a> from Qatar over workers’ rights and environmental protection before signing off on an Open Skies agreement in 2021.</p> <p>Prime Minister Anthony Albanese, a former transport minister who understands the detail of aviation policy, might be particularly keen on this idea, given Labor’s commitment to workers’ rights.</p> <h2>Sweeping changes ahead</h2> <p>Next year, the government will release a white paper on aviation policy through to 2050, after obtaining <a href="https://minister.infrastructure.gov.au/c-king/media-release/aviation-green-paper-open-feedback">feedback</a> on a green paper it released last month.</p> <p>Those next 30 years will be far from business-as-usual for airlines and airports, whatever decisions the government takes now, and however Qantas responds.</p> <p>Ultra-long-haul aircraft are likely to link Paris with Perth, and even London with Sydney within a decade. They are likely to force new alliances between airlines that today seem unlikely bedfellows.</p> <p>And the chorus against the excesses of long-haul travel is likely to become louder.</p> <p>Prince William’s <a href="https://www.stuff.co.nz/sport/fifa-womens-world-cup-2023/132776452/large-carbon-footprint-behind-prince-william-not-attending-world-cup-final">refusal to travel to Sydney</a> for the Women’s World Cup Final because of the size of the carbon footprint might be a sign of things to come.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/214718/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/gui-lohmann-1476773"><em>Gui Lohmann</em></a><em>, Professor in Air Transport and Tourism Management, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/justin-wastnage-489752">Justin Wastnage</a>, Adjunct Industry Fellow, Griffith Institute for Tourism, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></p> <p><em>Image </em><em>credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/qantas-wont-like-it-but-australian-travellers-could-be-about-to-get-a-better-deal-on-flights-214718">original article</a>.</em></p>

Domestic Travel

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“She’s still with us, but it won’t be long": Hughesy's heartbreaking family news

<p>Dave 'Hughesy' Hughes has held back tears as he shared the heartbreaking details of his mum's health battle live on his radio show. </p> <p>Speaking candidly on <em>2Day FM’s Hughesy, Ed & Erin</em>, Hughesy shared that it had been a "tough few weeks" for his family as his mum, Carmel, was nearing the end of her life. </p> <p>“My mum’s unwell, and the family have gathered around her, and we’re celebrating her life,” Hughesy told co-hosts Erin Molan and Ed Kavalee. </p> <p>“She’s still with us, but it won’t be long. She’s a beautiful woman who’s been a great matriarch of the family, and we’re all around her at the moment.”</p> <p>While holding back tears, Hughesy then revealed that “she’s asleep now and she probably won’t wake up again”.</p> <p>He explained the family had been “going through photos” recently in celebration of Carmel’s life.</p> <p>“Mum grew up in an orphanage, and there’s a photo of her teaching a class with nuns looking over her … She had to leave the orphanage because she didn’t want to be a teacher, so she left with nothing and went and became a nurse, and met Dad.”</p> <p>Reflecting on his mother’s legacy during the segment on Friday, Hughesy told his co-hosts: “She’s been a beautiful mother, who really supports her children.”</p> <p>He went on: “Everyone goes through [losing their parents] … but the memories of all the sacrifice, and all the good times … She’s done so well in her life. We’ll miss her a lot. </p> <p>“She’s always been stoic and never complained.”</p> <p>Despite the difficult time Hughesy and his family are going through, the comedian was still able to smile and laugh as he reflected on his mum's sense of humour that she has kept "until the end". </p> <p>“We were around and didn’t think she could even speak again, and one of the nurses was lifting her and said, ‘I’m sorry if I drop you’, and Mum just whispered, ‘it doesn't matter now’, and made the nurse laugh.”</p> <p>“So she was still coming out with zingers … she’s a beautiful woman.”</p> <p><em>Image credits: Instagram</em></p>

Family & Pets

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8 tips for keeping pets healthy that won’t break the bank

<p>Australia is a nation of animal lovers. Collectively, we have more pets than people (<a href="https://kb.rspca.org.au/knowledge-base/how-many-pets-are-there-in-australia/#ftn1">28.7 million pets</a> vs <a href="https://www.abs.gov.au/statistics/people/population/population-clock-pyramid">26.7 million people</a>) and <a href="https://kb.rspca.org.au/knowledge-base/how-many-pets-are-there-in-australia/#:~:text=Overall%252C%2520Australian%2520households%2520are%2520estimated,spent%2520per%2520animal%2520each%2520year.">spent $33 billion on them</a> in 2022. Not only is a healthy pet a happy one, but healthy = wealthy with fewer vet bills and medications, plus less time off work to look after them. But how can you keep spending under control without sacrificing your pet’s health? Read on!</p> <p><strong>1. Choose the right pet</strong></p> <p>Save yourself considerable drama – and money – by getting the right pet for your family from the outset.</p> <p>For instance:</p> <ul> <li>Small dogs eat less, making them more suitable for tighter budgets.</li> <li>Energetic breeds won’t thrive if you can’t exercise them sufficiently. </li> <li>Low-allergy breeds (like Poodles and Burmese cats) can save allergy suffers on antihistamines and tissues.</li> </ul> <p><strong>2. Secure your yard</strong></p> <p>Prevention is always better than cure, so a secure yard/enclosure is a worthwhile investment.</p> <p>The cost of a new fence (especially if split with neighbours) often dwarfs the vet bills if your beloved is hit by a car. </p> <p>A secure pet is less likely to fight with other animals or eat things they shouldn’t. </p> <p>Plus, many areas impose fines for unrestrained pets.</p> <p><strong>3. Be organised</strong></p> <p>An old phrase says: “For every minute spent organising, an hour is earned.” I’d suggest that hour earned also brings dollars saved.</p> <p>For pets, organisation includes:</p> <ul> <li>Staying up-to-date with treatments and veterinary visits. Overdue parasite treatments, vaccinations, and check-ups often cause unnecessary and expensive complications.</li> <li>A tidy home, which saves replacing destroyed shoes etc and fees on overdue bills where the notice was chewed.</li> <li>Keeping household dangers – e.g., toxic plants, chemicals, foods (chocolate!) – out of your pets’ reach to avoid accidental poisoning.</li> </ul> <p><strong>4. Weigh up insurance</strong></p> <p>Many people say they’ll put money aside instead of buying pet insurance. But they don’t – the money winds up elsewhere.</p> <p>When considering insurance, weigh up each policy’s conditions, your pet’s health, and your ability to pay unexpected bills.</p> <p>Without insurance, small amounts may not be problematic. But unexpected surgeries or specialist tests and treatments could see you thousands of dollars out of pocket. </p> <p>The more claims you’re likely to make, the more valuable insurance may be.</p> <p>If you do get insurance, choose a reputable provider with positive reviews for paying claims promptly.</p> <p><strong>5. Master DIY </strong></p> <p>Put your hands to work and make your pet’s essentials at a fraction of buying new. </p> <p>Consider making your own:</p> <ul> <li>Toys – such as uncooked rice or pasta in a PET bottle. (Beware things like sticks, which can cause injuries and splinters.)</li> <li>Meals – cook in bulk and freeze portions for added savings and convenience. Homemade meals may be healthier too, since you know exactly what they’re eating.</li> <li>Bedding and towels – from your old clothing, linen etc.</li> </ul> <p>Always use safe materials and ingredients that won’t be a choking hazard. Monitor items for wear and tear.</p> <p><strong>6. Involve your kids</strong></p> <p>Getting kids/grandkids involved with animal care is good for everyone – including your wallet.</p> <p>Kids love animals. Pets love children’s playtime energy. And you’ll save paying someone else to do it when you’re short for time. </p> <p>Ask them to walk the dog, clean the litter tray, collect the eggs, top up food and water. </p> <p>You can make it form part of their pocket money – teaching them the value of earning – all while helping them develop important life skills like empathy and responsibility.</p> <p><strong>7. Consider legalities</strong></p> <p>Custody and inheritance matters affect furbabies too, so it’s important to have a plan:</p> <ul> <li>Wills – who will have guardianship if you die suddenly? Is that person willing and able? Have you left money to pay for their ongoing care?</li> <li>Separation/divorce – pets sadly are sometimes used as weapons in a separation. It could be emotional blackmail over custody, or one partner is given custody but cannot afford to keep them on a single income. The stress adversely affects everyone – including your pet. </li> </ul> <p><strong>8. Spend time with them</strong></p> <p>Companionship is important for your pet’s health – and yours. And it’s free!</p> <p>Research suggests <a href="https://www.health.harvard.edu/staying-healthy/having-a-dog-can-help-your-heart--literally">dog ownership improves heart health for humans</a> and <a href="https://www.psychologicalhealthcare.com.au/blog/mental-health-benefits-pets/">patting pets lowers blood pressure and stress hormones</a>. Plus, you’ll both benefit from being more active and making new friends (such as at the dog park).</p> <p>So, what are you waiting for? Hitch up the lead or pick up a toy and give your furbaby some love!</p> <p><strong><em>Helen Baker is a licensed Australian financial adviser and author of the new book, On Your Own Two Feet: The Essential Guide to Financial Independence for all Women (Ventura Press, $32.99). Helen is among the 1% of financial planners who hold a master’s degree in the field. Proceeds from book sales are donated to charities supporting disadvantaged women and children. Find out more at <a href="http://www.onyourowntwofeet.com.au">www.onyourowntwofeet.com.au</a></em></strong></p> <p><em>Image credits: Shutterstock</em></p>

Family & Pets

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Renaming obesity won’t fix weight stigma overnight. Here’s what we really need to do

<p><em><a href="https://theconversation.com/profiles/ravisha-jayawickrama-1457644">Ravisha Jayawickrama</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/blake-lawrence-1452739">Blake Lawrence</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>, and <a href="https://theconversation.com/profiles/briony-hill-1041619">Briony Hill</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p>The stigma that surrounds people living in larger bodies is pervasive and deeply affects the people it’s directed at. It’s been described as one of the last acceptable <a href="https://theconversation.com/how-australias-discrimination-laws-and-public-health-campaigns-perpetuate-fat-stigma-80471">forms of</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592337">discrimination</a>.</p> <p>Some researchers think the term “obesity” itself is part of the problem, and are calling for a <a href="https://pubmed.ncbi.nlm.nih.gov/27967229/">name change</a> to reduce stigma. They’re <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13590">proposing</a> “adipose-based chronic disease” instead.</p> <p>We study the stigma that surrounds obesity – around the time of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/obr.13147">pregnancy</a>, among <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/oby.23266">health professionals</a> and health <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00071-8/fulltext">students</a>, and in <a href="https://www.phrp.com.au/issues/october-2022-volume-32-issue-3/weight-stigma-in-australia/">public health</a> more widely. Here’s what’s really needed to reduce weight stigma.</p> <h2>Weight stigma is common</h2> <p>Up to <a href="https://pubmed.ncbi.nlm.nih.gov/26596238/">42% of adults</a> living in larger bodies experience weight stigma. This is when others have negative beliefs, attitudes, assumptions and judgements towards them, unfairly viewing them as lazy, and lacking in willpower or self-discipline.</p> <p>People in larger bodies experience <a href="https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2008.636">discrimination</a> in many areas, including in the workplace, intimate and family relationships, education, health care and the media.</p> <p>Weight stigma is associated with <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1116-5">harms</a> including increased cortisol levels (the main stress hormone in the body), negative body image, increased weight gain, and poor mental health. It leads to decreased uptake of, and quality of, health care.</p> <p>Weight stigma may even pose a <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1116-5">greater threat</a> to someone’s health than increasing body size.</p> <h2>Should we rename obesity?</h2> <p>Calls to remove or rename health conditions or identifications to reduce stigma are not new. For example, in the 1950s homosexuality was classed as a “<a href="https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp-rj.2022.180103">sociopathic personality disturbance</a>”. Following many years of protests and activism, the term and condition <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695779/">were removed</a> from the globally recognised classification of mental health disorders.</p> <p>In recent weeks, European researchers have renamed non-alcoholic fatty liver disease “metabolic dysfunction-associated steatotic liver disease”. This occurred after <a href="https://www.bmj.com/content/382/bmj.p1587">up to 66%</a> of health-care professionals surveyed felt the terms “non-alcoholic” and “fatty” to be stigmatising.</p> <p>Perhaps it is finally time to follow suit and rename obesity. But is “adiposity-based chronic disease” the answer?</p> <h2>A new name needs to go beyond BMI</h2> <p>There are two common ways people view obesity.</p> <p>First, most people use the term for people with a body-mass index (BMI) of 30kg/m² or above. Most, if not all, public health organisations also use BMI to categorise obesity and <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00138-9/fulltext">make assumptions</a> about health.</p> <p>However, BMI alone is not enough to accurately summarise someone’s health. It does not account for muscle mass and <a href="https://www.cdc.gov/obesity/downloads/bmiforpactitioners.pdf">does not provide</a> information about the distribution of body weight or adipose tissue (body fat). A high BMI can occur <a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">without</a> biological indicators of poor health.</p> <p>Second, obesity is sometimes used to describe the condition of excess weight when mainly <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13590">accompanied by</a> metabolic abnormalities.</p> <p>To simplify, this reflects how the body has adapted to the environment in a way that makes it more susceptible to health risks, with excess weight a by-product of this.</p> <p>Renaming obesity “adiposity-based chronic disease” acknowledges the chronic metabolic dysfunction associated with what we currently term obesity. It also avoids labelling people purely on body size.</p> <h2>Is obesity a disease anyway?</h2> <p>“Adiposity-based chronic disease” is an acknowledgement of a disease state. Yet there is still no universal consensus on whether obesity is a disease. Nor is there clear agreement on the definition of “disease”.</p> <p>People who take a biological-dysfunction approach to disease <a href="https://pubmed.ncbi.nlm.nih.gov/25336733/">argue</a> dysfunction occurs when physiological or psychological systems don’t do what they’re supposed to.</p> <p>By this definition, obesity may <a href="https://pubmed.ncbi.nlm.nih.gov/37279872/">not be classified as a disease</a> until after harm from the additional weight occurs. That’s because the excess weight itself may not initially be harmful.</p> <p>Even if we do categorise obesity as a disease, there may still be value in renaming it.</p> <p>Renaming obesity may improve public understanding that while obesity is often associated with an increase in BMI, the increased BMI <em>itself</em> is not the disease. This change could move the focus from obesity and body size, to a more nuanced understanding and discussion of the biological, environmental, and lifestyle factors <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13590">associated</a> with it.</p> <h2>Workshopping alternatives</h2> <p>Before deciding to rename obesity, we need discussions between obesity and stigma experts, health-care professionals, members of the public, and crucially, <a href="https://www.phrp.com.au/issues/october-2022-volume-32-issue-3/weight-stigma-in-australia/">people living with obesity</a>.</p> <p>Such discussions can ensure robust evidence informs any future decisions, and proposed new terms are not also stigmatising.</p> <h2>What else can we do?</h2> <p>Even then, renaming obesity may not be enough to reduce the stigma.</p> <p>Our constant exposure to the socially-defined and acceptable idealisation of smaller bodies (the “thin ideal”) and the pervasiveness of weight stigma means this stigma is deeply ingrained at a societal level.</p> <p>Perhaps true reductions in obesity stigma may only come from a societal shift – away from the focus of the “thin ideal” to one that acknowledges health and wellbeing can occur at a range of body sizes.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/209224/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/ravisha-jayawickrama-1457644">Ravisha Jayawickrama</a>, PhD candidate, School of Population Health, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/blake-lawrence-1452739">Blake Lawrence</a>, Lecturer, Curtin School of Population Health, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>, and <a href="https://theconversation.com/profiles/briony-hill-1041619">Briony Hill</a>, Deputy Head, Health and Social Care Unit and Senior Research Fellow, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/renaming-obesity-wont-fix-weight-stigma-overnight-heres-what-we-really-need-to-do-209224">original article</a>.</em></p>

Body

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10 things cruise lines won’t tell you

<p>Cruiser industry insiders reveal the secrets that cruise lines choose to conceal from passengers.</p> <p>1. “Our ships might sink, but we won’t.”</p> <p>Not necessarily sink, but there are numerous examples of accidents, leaving thousands of passengers stranded at sea waiting for assistance.</p> <p>2. “Feeling queasy? It might be more than seasickness.”</p> <p>Remember if the food seems strange, it might be best not to eat it.</p> <p>3. “We’ve got a drinking problem.”</p> <p>The cruiser liners WANT you to drink as much as you can. It’s where the money is at.</p> <p>4. “Hire a tour guide, just not through us.”</p> <p>If you book excursions through the cruise liners, you are paying an inflated price. Go to a local operator at your cruise destination instead, or even book online.</p> <p>5. “We’ll find a way to hit you up.”</p> <p>The cruise liner is always going to try to convince you to pay for all sort of extras. And like travellers stuck at an airport, passengers on cruises are a captive audience.</p> <p>6. “You need a Ph.D. to choose your cabin.”</p> <p>With thousands of passengers and therefore thousands of rooms, choosing the right cabin is an art. Space is limited and rooms are inevitably near engines or decks.</p> <p>7. “Running late? See you later.”</p> <p>Don’t expect your cruise to give you your money back the closer it is to your departure date.</p> <p>8. “There is still plenty of peril on the sea.”</p> <p>Cruises sounds like a nice, relaxing, safe holiday option but there’s still plenty of danger on board. Because of the heavy drinking, rates of sexual assault are 50 per cent higher than on land.</p> <p>9. “Labour laws don’t always apply to us.”</p> <p>Passengers rarely appreciate how hard the staff in the cruising industry work, and since cruise liners can be registered in other countries, it means sometimes staff don’t get minimum wage, over time or sick time.</p> <p>10. “Don’t swim in our wake.”</p> <p>From sulphurous engine emissions that contribute to smog to so-called blackwater (essentially what goes down the toilet), cruise liners leave a lot of waste in its wake.</p> <p><em>Images: Getty</em></p>

Cruising

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The best anti-ageing secrets dermatologists won’t tell you for free

<p><strong>The best tips from top dermatologists </strong></p> <p>A wide array of over-the-counter anti-ageing skincare products aim to improve the signs of ageing, such as skin spots, fine lines, wrinkles, and boost collagen. Yet, most of these products are more hype – it’s important for consumers to understand when a product is a cosmetic, drug, or both to evaluate the validity of these claims. So, which products can actually deliver results that improve the signs of ageing?</p> <p>We spoke with medical experts who told us the best anti-ageing secrets for better skin health.</p> <p><strong>Opt for sunscreen to fight ageing skin</strong></p> <p>Sunscreen is one of the best weapons when it comes to protecting your skin against skin cancer, and it’s also one of the best ways to keep your skin looking younger and healthier. “The sun emits ultraviolet radiation that damages skin, both the overlying epidermis and the underlying dermis,” explains dermatologist, Dr Jerome Garden. “In addition to increasing your risk of skin cancer, the sun causes brown spots, red spots, and wrinkles.”</p> <p><strong>Expensive products are not always more effective</strong></p> <p>It may be tempting to splurge on a skin-care item that promises to yield worthy results, but pricey doesn’t always equal quality. There are some great inexpensive products that can produce great results, according to dermatologist, Dr Dendy Engelman. “A higher price tag can mean better quality ingredients or a higher concentration of an ingredient, but the ingredients list is always more important than the brand selling the product,” she says.</p> <p><strong>Don't buy generic skincare</strong></p> <p>You don’t need to spend a fortune to get a high-quality skincare product, but there is a difference between a brand name product and a generic one, according to dermatologist, Dr Joshua Zeichner.</p> <p>“Many generic products are packaged to look similar to the original, and may even have the same ingredients list, however, the difference is the quality of the ingredients and how they are actually formulated,” he says.</p> <p><strong>Skimp on a fancy cleanser</strong></p> <p>No matter what an expensive cleanser may cost, it’s not going to work any more magic than most lower-cost competitors, according to dermatologists. “The goal of a cleanser is to remove dirt, oil, makeup and pollution from the skin without disrupting the outer skin layer – and the ingredients used to create a product that can do this are not expensive,” says Dr Zeichner. “In fact, some of the best quality cleansers are actually among the least expensive products on the market.”</p> <p><strong>Opt for a serum</strong></p> <p>Serums, which are meant to be layered underneath your daily and nightly moisturiser, often are the first skincare products to be skipped. But, they actually play an important role in your daily routine. “Serums contain a high concentration of active ingredients and are lightweight, so they penetrate deeper into your skin to provide maximum benefits,” says dermatologist, Dr Whitney Bowe.</p> <p>She recommends looking for serums that contain ceramides and amino acids, which help to bolster the skin’s natural barrier, and antioxidants, which protect skin from sun damage and free radicals.</p> <p><strong>Don't trust anti-wrinkle face cream claims </strong></p> <p>“We develop fine lines because of repeated folding of the skin from underlying muscles,” explains Dr Zeichner. “Young, healthy skin has a strong foundation that resists folding and bounces back to its original shape, but, with age, that skin foundation gets weaker.”</p> <p>While topical creams will certainly help keep the skin barrier strong, the only way to truly reduce wrinkles is to relax the muscles underneath the skin, according to Dr Zeichner.</p> <p><strong>Wear sunscreen year-round</strong></p> <p>It’s true that even on the cloudiest or snowiest of days, sunscreen should be a part of your daily skincare routine. “Incidental sun exposure for only 10 to 15 minutes a day adds up over time and can cause significant sun damage and accelerated photoaging,” says Dr Engelman.</p> <p>In order to keep skin looking its youngest and healthiest, she recommends applying sunscreen every single day of the year, as brief sun exposures throughout the year can add up to significant damage (think driving with the sunroof open or walking around outdoor shopping centres during peak sun hours).</p> <p><strong>Use retinol - it really works</strong></p> <p>According to dermatologist, Dr Hadley King, topical retinoids are the most effective topical anti-ageing products (after sun protection). “There is great data that supports their effectiveness and safety,” she says. “While prescription retinoids are the most effective, there are now plenty of over-the-counter products that contain retinol and work well, especially on those with sensitive skin.”</p> <p><strong>Invest in laser treatments</strong></p> <p>If you’re looking for fast results without the use of creams, Dr Garden recommends laser treatments, which he specialises in. “We have lasers for brown spots, red spots, blood vessels and wrinkles,” he says. “Newer devices called fractionated lasers can produce impressive results with less downtime than before.” Although they’re on the pricier side, he says that these treatments can offer results far superior to creams.</p> <p>But the only caveat is that these machines are powerful and, in many states, can be operated by unqualified individuals who are not even physicians. He recommends making sure that your laser treatments are being performed by a board-certified dermatologist to avoid complications.</p> <p><strong>Try collagen supplements </strong></p> <p>Collagen is a protein that’s a building block for our hair, skin and nails. “Supplemental collagen is fragmented pieces of amino acids and peptides that connect in the bloodstream with enzymes that trigger the production of collagen,” explains Dr Engelman. “In a collagen-deficient system, this will support and increase collagen production.” It’s important, however, that you choose the right type of collagen, since 16 different strains exist.</p> <p>“For oral supplements, hydrolysed collagen is easiest to digest, as it is broken down into the smallest forms of peptides and amino acids,” she says. “I like pills and powders because they are easy to incorporate no matter what your lifestyle.”</p> <p><strong>Don't fall for 'trendy' products</strong></p> <p>The latest and greatest products on the market might be eye-catching, but their popularity doesn’t mean that they’re effective. “Just because something is ‘hot’ right now in the beauty industry, does not mean that you should run out to purchase it,” says Dr Bowe. “I always encourage my patients to look for scientific studies and statistics which prove that products deliver the results they promise.”</p> <p><strong>Follow a healthy diet</strong></p> <p>No matter how much time, energy and money you spend on your skincare regimen, if you’re not supplementing it with a healthy diet, you’re wasting your efforts, according to experts. “Your skin is a reflection of your overall health and wellness and your diet absolutely impacts the appearance and health of your skin,” says Dr Bowe.</p> <p>“For example, sugar in any form causes multiple changes in our body, from our cellular membranes and our arteries to our hormones, immune systems, gut, and even microbiome – the microbes in our intestines that affect our biology all the way out to our skin.”</p> <p><strong>Allergy pill and a nap may reduce dark circles and puffy eyes</strong></p> <p>There are other causes of dark circles that are unrelated to your skin, such as seasonal allergies or lack of sleep. Dermatologist, Dr Joel Schlessinger recommends trying Clarityne or Zyrtec, drinking more water, or heading to bed an hour earlier to clock in more sleep. If your dark circles and puffiness aren’t improved by any of those suggestions, then he says a well-formulated and hydrating eye cream could help.</p> <p><strong>Avoid sleeping on your side</strong></p> <p>Believe it or not, the way you sleep does have an effect on the smoothness of your skin. “Sleeping on your side presses your cheek into the pillow and causes the skin on your chest to be scrunched, creating new or reinforcing existing wrinkles,” warns Dr Schlessinger. “Train yourself to sleep on your back as much as you can – it will keep skin as flat and smooth as possible.”</p> <p><strong>Don't wait until it's too late too start Botox</strong></p> <p>Some fine lines and wrinkles are caused by repetitive movements, so starting these treatments early, even in your late 20s and early 30s, may potentially help prevent them or slow their progression, according to cosmetic dermatologist, Dr Sejal Shah.</p> <p>“People are often afraid of injectables because they don’t want to look ‘frozen’ or overdone, but many neurotoxins (Botox, Dysport, Xeomin, and Jeuveau) can look very natural when appropriately placed.” Just be sure to seek treatment from trained individuals, such as a board-certified dermatologist.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://www.readersdigest.com.au/healthsmart/beauty/the-best-anti-ageing-secrets-dermatologists-wont-tell-you-for-free?pages=1" target="_blank" rel="noopener">Reader's Digest</a>. </em></p>

Beauty & Style

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Won’t somebody please think of the children? Their agency is ignored in the moral panic around drag storytime

<p><a href="https://www.news.com.au/national/victoria/politics/protesters-clash-over-drag-story-time-event-at-melbourne-council-meeting/news-story/f8671b4047b59f9fc27d8ffee803c9f8">Protesters derailed</a> a Monash City Council meeting on Wednesday, demanding the cancellation of a sold-out drag storytime event at Oakleigh Library in Melbourne’s south-east. </p> <p>This is just the latest in a string of drag performances for children throughout Victoria being cancelled or postponed in response to protest. </p> <p>The central message of these campaigns (accompanied by varying levels of vitriol) is the same: “let our kids be kids”, “protect our children” and “hands off our kids”, while simultaneously labelling performers and supporters of the events “paedophiles”. </p> <p>This is part of a global backlash. Similar protests and cancellations have happened in <a href="https://www.nzherald.co.nz/nz/unhinged-conspiracy-theorists-auckland-drag-queen-targeted-in-avondale-library-protest-speaks-out/TE6BFUOXVJC6VFYMU4VAUAERTQ/">New Zealand</a>, the <a href="https://www.bbc.com/news/uk-england-london-64610724">United Kingdom</a> and the <a href="https://www.theguardian.com/world/2023/jan/21/anti-drag-show-laws-bans-republican-states">United States</a>. </p> <p>The argument in support of drag emphasises the impact on the performers at the centre of these events and queer community, arguing that the cancellation of these events is a form of <a href="https://fortune.com/2023/03/02/drag-queens-tennessee-law-minors/">discrimination and a contravention of human rights</a>.</p> <p>But the debate so far overlooks the agency and rights of the events’ intended audiences: children and young people.</p> <h2>Children as citizens</h2> <p>Calls to “protect the children” from drag performers and trans people assume children are, in fact, in need of safeguarding. </p> <p>Such messaging is rooted in a tendency for Western societies to reduce childhood to an <a href="https://www.cambridge.org/au/academic/subjects/sociology/sociology-general-interest/importance-being-innocent-why-we-worry-about-children?format=PB&amp;isbn=9780521146975">idyllic innocence</a>, which positions children as “in need of protection” and amplifies their constant vulnerability. </p> <p>Children’s vulnerability played a critical role in motivating the adoption of the United Nations’ <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-child">Convention on the Rights of the Child</a> in 1989.</p> <p>Since the adoption of the charter, new laws and policies have been established in Australia to criminalise forced marriage, to remove children from detention and to change the Family Law Act to better protect the rights of children. </p> <p>The charter details children’s need for safeguarding and special care. But it also confirms the evolving capacity of children to assert their rights as cultural citizens and their need for freedom of thought and expression.</p> <h2>The power of drag and imaginative play</h2> <p>Drag as a form of creative, physical and spiritual expression has existed within theatre and cultural performance <a href="https://www.grunge.com/1243587/drag-shows-older-realize-real-history/">for millennia</a>.</p> <p>Drag and queer performance studies have given rise to understandings of gender as an everyday performance: from the clothes we pick out, to the products we gravitate towards in supermarkets, to our repeated physical and vocal gestures. </p> <p>Drag pokes fun at the gender binary and, in doing so, it aims to blur the boundaries and expose the artificiality of gender roles.</p> <p>While the success of television shows like <em>RuPaul’s Drag Race</em> have established drag as something more accessible and relatable for a range of audiences, the visibility of queerness that comes with drag – especially when moving outside designated queer spaces – is an apparent step too far.</p> <p>But the way drag asks us to question the socially constructed nature of gender offers children a vision of self-determination. You can do what you want to do, you can be who you want to be.</p> <p>The potentiality within the play of drag engages the power of children’s imaginations today to conceive better tomorrows. </p> <p>Philosopher David Harvey refers to moments of “<a href="https://academic.oup.com/book/40603">free play</a>” as fertile ways of exploring and expressing a vast range of ideas, of taking on power structures and social practices, and imagining new possibilities for how we structure and support community. </p> <h2>The insights of the child</h2> <p>In post-plebiscite Australia, the success of targeted campaigns against drag-themed events for children exposes certain conditions around what are “acceptable” encounters of queer expression for children. </p> <p>The all-too-familiar campaign messages that swirled around the marriage debate – “protect the sanctity of marriage”, “protect families” – are rearing up again with only a minor rhetorical shift. </p> <p>The more obvious difference now is that the messages have been co-opted by extreme groups who are targeting individuals and threatening violence. </p> <p>The drag storytime event at the centre of the protests at Monash City Council remains scheduled to take place at Oakleigh Library on May 19. At the time of writing, an online petition to cancel the event has 820 supporters, while another in support of the event has over 3,300 signatures. </p> <p>Perhaps, then, the social temperature is not as heated towards drag performers as recent cancellations suggest. Instead, a minority of vocal and visible dissenters are dictating the rights and freedoms of the majority.</p> <p>The image of a drag performer in relation to a child elicits violent responses for some because it is an image of progress and change and of queer acceptance and love set against a long history of homophobia and transphobia in this country. </p> <p>But there are two figures in this image and one has been kept silent. </p> <p>In debating rights and agency, perhaps it’s time to ask and be guided by the insights of the child.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/wont-somebody-please-think-of-the-children-their-agency-is-ignored-in-the-moral-panic-around-drag-storytime-204182" target="_blank" rel="noopener">The Conversation</a>. </em></p>

Caring

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Travelling overseas? Here’s what the embassy will – and won’t – do to help if you get in trouble

<p>Australians are jetting back out into the world again. The numbers are still below pre-pandemic levels, but almost <a href="https://www.abs.gov.au/statistics/industry/tourism-and-transport/overseas-arrivals-and-departures-australia">1.1 million Australians left the country</a> in December last year – compared to 1.3 million in December 2019. According to information provided by the Department of Foreign Affairs and Trade, passport applications smashed records in 2022, averaging more than 250,000 each month in the second half of the year.</p> <p>International travel is a safe, positive experience for most people, but unfortunately things do go wrong for some travellers. Trouble, when it comes, can involve anything from lost passports and small-scale theft to serious welfare problems, hospitalisation and arrests.</p> <p>In these cases, DFAT’s consular service will be expected to do what it can to assist. But where does personal responsibility begin and end when we leave our shores? What should we expect from our government, and what can we do ourselves to minimise the risks?</p> <h2>Travellers behaving badly</h2> <p>As a former head of the consular service in the early 2000s, I know the caseload involving overseas Australians is not limited to major, news-grabbing situations, like the recent <a href="https://www.theguardian.com/world/2023/feb/23/png-hostage-freed-australian-professor-researchers-captive-papua-new-guinea-mount-bosavi">kidnapping</a> of an Australia-based academic by a criminal gang in Papua New Guinea, or the impact of the <a href="https://www.theguardian.com/australia-news/2023/feb/11/turkey-and-syria-earthquake-australian-death-toll-believed-to-have-risen-to-three">devastating earthquake</a> in Turkey and Syria on Australians and their families.</p> <p>These were serious situations requiring intensive work from our diplomats, but there is much more to the job than that.</p> <p><a href="https://www.smartraveller.gov.au/sites/default/files/2022-11/consular-state-of-play-2021-22.pdf">From June 2021-22</a>, an average of four Australians died overseas every day, while an average of two Australians were arrested every day - on matters ranging from immigration breaches to drugs crime, theft and fraud. </p> <p>In total, nearly 16,000 Australians turned to their local Australian overseas mission that year for help in “crisis cases” – more than triple the number in 2018-19 before the pandemic. COVID-related repatriations arranged by DFAT were counted separately – there were more than 62,000 of these in the past three years.</p> <p>Carrying an Australian passport means we can rely on a consular service to <a href="https://www.abc.net.au/radionational/programs/saturdayextra/what-happens-when-things-go-wrong-for-australians-overseas/13973350">provide support in these situations</a>. But expectations have grown among travellers in recent decades, partly because of the speed of our communications and the instant public feedback we receive via social media.</p> <p>While most Australians are self-reliant travellers, there are still many not living up to their side of the bargain. Most importantly, there are still too many not taking out appropriate travel insurance. Others disregard official travel warnings and then turn to the government for help when things go wrong. </p> <p>Then there are those whose expectations are just inappropriate – asking officials to arrange opera tickets or look after their pets, for example. </p> <p>More seriously, expectations can be very hard to manage in arrest cases overseas. Some Australians are shocked their citizenship doesn’t come with a “get out of jail free card”. But we are all subject to local laws and authority, no matter what notions we might have about the standards of justice that apply in some countries. </p> <p>At any given time, there are between <a href="https://www.smartraveller.gov.au/sites/default/files/2022-11/consular-state-of-play-2021-22.pdf">300 and 400 Australians imprisoned</a> overseas. Under the Vienna Convention on Consular Relations, there are real <a href="https://www.smartraveller.gov.au/consular-services/resources/arrested-jailed-overseas-factsheet">limits to what the Australian consular service can do</a> in these cases. </p> <p>The service will check periodically on the welfare of prisoners overseas, guide them towards local legal representation and monitor their trials. But that’s about it. This applies to foreigners imprisoned in Australia, too.</p> <p>To be sure, there is occasionally a case that is clearly so arbitrary or unjust, our government calls for the release of the individual. This was the case for Sean Turnell, <a href="https://theconversation.com/how-australian-economist-sean-turnell-came-to-be-in-and-freed-from-a-myanmar-jail-195419">who was imprisoned in Myanmar</a> for political reasons until being released last year. But unlike Turnell, most Australian prisoners overseas probably have a case to answer.</p> <h2>Three ways to stay safe</h2> <p><strong>1) Be informed about where you are going</strong></p> <p>Australians have a responsibility to know what’s happening at their planned destinations. The conflicts in Ukraine and elsewhere have impacted many travellers, as have major weather events and natural disasters. </p> <p>With international flights returning to normality over the last year, DFAT’s COVID repatriation program has largely wound up. Travellers once again need to look to their own resources – or their travel insurance policies – to ensure they get home.</p> <p>The government’s <a href="https://www.smartraveller.gov.au/">Smartraveller</a> website is a reliable source of up-to-date information on everything from emerging health risks to cultural and legal issues in specific countries to the local security situation. They have recently launched a <a href="https://www.smartraveller.gov.au/news-and-updates/sneak-peek-our-new-ad-campaign">fresh advertising campaign</a> in an effort to highlight the importance of avoiding trouble in the first place. </p> <p><strong>2) Stay in touch with family back home</strong></p> <p>The consular service deals with hundreds of “whereabouts” inquiries each year. And if disaster strikes when you are travelling somewhere, your family and friends will be worried. </p> <p>In each of the major consular disaster responses I was involved in, including the September 11 attacks and the 2002 Bali bombings, there were people who caused their loved ones untold grief by not letting them know they were safe. </p> <p>In my recent book, <a href="https://www.amazon.com.au/Consul-Insider-Australias-Diplomatic-Frontline/dp/0702263494">The Consul</a>, I recount the story of one Australian who worked on an upper floor of the World Trade Center in New York, but took ten days to let his family know he had actually been in London when the attacks took place.</p> <p><strong>3) Buy good travel insurance</strong></p> <p>If there’s one thing travellers really should do, it’s to take out travel insurance. Most people think about insurance as a way of covering themselves for flight cancellations or for the theft of personal items. But if you get sick or are injured overseas – or even in the case of a death – insurance is critical. The Australian government cannot just step in and pay for a medical evacuation.</p> <p>From my time as consular chief, I know that some Australians were forced to sell their homes to cover their medical costs overseas. People also often find themselves under-insured, or are surprised to learn that certain activities, such as adventure sports, are not covered. </p> <p>Young people are the least likely to take out insurance. <a href="https://insurancecouncil.com.au/resource/aussies-planning-to-travel-more-but-need-to-do-more-travel-planning/">Travel industry surveys</a> indicate about 12% of travellers below the age of 30 do not intend to take out insurance, and the number is higher for those heading to destinations in the developed world regarded as “safe”. It really doesn’t work like that though - hospitalisation in the United States without insurance can mean financial disaster.</p> <p>It doesn’t take much to minimise the risk of difficulties turning into disasters overseas.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/travelling-overseas-heres-what-the-embassy-will-and-wont-do-to-help-if-you-get-in-trouble-198589" target="_blank" rel="noopener">The Conversation</a>. </em></p>

Travel Tips

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15 facts you won’t believe are true

<p>Sometimes we become so jaded that we forget the world is an amazing place.</p> <p>In this list we’ve put together 15 facts you won’t believe are true.</p> <p><strong>To see the full list of amazing facts, scroll down.</strong></p> <p>1. Honey will <a href="http://www.smithsonianmag.com/science-nature/the-science-behind-honeys-eternal-shelf-life-1218690/?no-ist" target="_blank" rel="noopener"><span style="text-decoration: underline;"><strong>never go off</strong></span></a>, no matter how long you store it.</p> <p>2. The Turritopsis Nutricula jellyfish is <a href="http://immortal-jellyfish.com/" target="_blank" rel="noopener"><span style="text-decoration: underline;"><strong>c</strong></span></a><span style="text-decoration: underline;"><strong><a href="http://immortal-jellyfish.com/" target="_blank" rel="noopener">onsidered biologically immortal</a></strong></span>.</p> <p>3. The heart of a blue whale is so big a human could potentially swim through its arteries (of course why you’d want to do so is another matter altogether).</p> <p>4. Yet the throat of a blue whale is <a href="https://en.wikipedia.org/wiki/Blue_whale#Description_and_behaviour" target="_blank" rel="noopener"><span style="text-decoration: underline;"><strong>so small</strong></span></a> (comparatively speaking at least) it is physically incapable of swallowing anything bigger than a beach ball. </p> <p>5. For every person on Earth there are <a href="http://www.peta.org/issues/wildlife/dealing-household-guests/ants/" target="_blank" rel="noopener"><span style="text-decoration: underline;"><strong>around 1.6 million ants</strong></span></a>.</p> <p>6. An octopus has <a href="http://www.smithsonianmag.com/ist/?next=/science-nature/ten-curious-facts-about-octopuses-7625828/" target="_blank" rel="noopener"><span style="text-decoration: underline;"><strong>three hearts</strong></span></a>.</p> <p>7. Feng shui was originally the art of choosing the <a href="http://www.awarenessmag.com/marapr07/ma07_feng_shui.htm" target="_blank" rel="noopener"><span style="text-decoration: underline;"><strong>best place for a grave</strong></span></a>.</p> <p>8. There are <span style="text-decoration: underline;"><strong><a href="http://www.sciencedaily.com/releases/2008/06/080603085914.htm" target="_blank" rel="noopener">ten times more bacteria</a></strong></span> than cells in the human body.</p> <p>9. Believe it or not, this is what sand looks like under a microscope:</p> <p>10. Oxford University actually <a href="http://thetab.com/uk/oxford/2013/10/20/six-things-oxford-predates-11736" target="_blank" rel="noopener"><span style="text-decoration: underline;"><strong>predates the Aztec Empire</strong></span></a>.</p> <p>11. No one has <a href="https://www.ar15.com/archive/topic.html?b=1&amp;f=5&amp;t=1163790" target="_blank" rel="noopener"><span style="text-decoration: underline;"><strong>successfully tamed</strong></span></a> an African elephant.</p> <p>12. Catfish have <a href="http://www.itv.com/news/central/2015-07-09/ten-facts-about-fish-that-might-surprise-you/" target="_blank" rel="noopener"><span style="text-decoration: underline;"><strong>27,000 taste buds</strong></span></a> (four times as many as humans). </p> <p>13. Santa Claus <a href="https://en.wikipedia.org/wiki/Basil_of_Caesarea#Commemorations_of_Basil" target="_blank" rel="noopener"><span style="text-decoration: underline;"><strong>is called Basil</strong></span></a> in Cyprus.</p> <p>14. Scientists have suggested <a href="http://www.bbc.com/news/science-environment-24477667" target="_blank" rel="noopener"><span style="text-decoration: underline;"><strong>rain is made</strong></span></a> from diamonds on Saturn and Jupiter.</p> <p>15. The image on the left is a candle burning on Earth, and the image on the right is a candle burning in a zero gravity environment. What a difference! </p> <p><strong>Related links:</strong></p> <p><span style="text-decoration: underline;"><em><a href="../news/news/2016/03/couple-give-60-million-lottery-away/"><strong>Couple gives $60 million lottery win away</strong></a></em></span></p> <p><span style="text-decoration: underline;"><em><a href="../news/news/2016/03/find-letter-t-image-puzzle/"><strong>Can you find the letter “T” in this image?</strong></a></em></span></p> <p><span style="text-decoration: underline;"><em><a href="../news/news/2016/03/stunning-images-antarctica-remote-beauty/"><strong>Stunning images of Antarctica’s remote beauty</strong></a></em></span></p> <p><em>Image credit: Shutterstock</em></p>

News

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Three years into the pandemic, it’s clear COVID won’t fix itself. Here’s what we need to focus on next

<p>On March 11 2020 the World Health Organization classified COVID as a <a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020">pandemic</a>. Three years on, it remains just that.</p> <p>As much as we don’t want it to be, and as much as it is off the front pages, COVID is still very much with us.</p> <p>But how bad has it really been? And, more importantly, what have we learned that could help us accelerate a real and sustained exit?</p> <h2>COVID has hit us hard</h2> <p>There was a <a href="https://theconversation.com/too-late-already-bolted-how-a-faster-who-response-could-have-slowed-covid-19s-spread-160860">slow initial</a> global response to what we now call SARS-CoV-2, the virus that causes COVID. This allowed the virus to get a foothold, contributing to unexpectedly rapid <a href="https://theconversation.com/why-are-there-so-many-new-omicron-sub-variants-like-ba-4-and-ba-5-will-i-be-reinfected-is-the-virus-mutating-faster-182274">viral evolution</a>.</p> <p>Three years into the pandemic, with the removal of almost all mitigation measures in most countries, it’s clear the virus has hit the world very hard. <a href="https://www.worldometers.info/coronavirus/">So far</a>, almost 681 million infections and more than 6.8 million deaths have been reported.</p> <p>This is perhaps best visualised by its impact on life expectancy. There were <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/padr.12477">sharp declines</a> seen across the world in 2020 and 2021, reversing 70 years of largely uninterrupted progress. </p> <p>The excess mortality driving this drop in life expectancy has continued. This includes in Australia, <a href="https://www.actuaries.digital/2023/03/06/almost-20000-excess-deaths-for-2022-in-australia/">where over 20,000 more lives</a> than the historical average are estimated to have been lost in 2022.</p> <h2>Not just COVID deaths</h2> <p>The indirect impacts on the health systems in rich and poor countries alike continue to be substantial. Disruptions to health services have led to <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00079-6/fulltext">increases</a> in stillbirths, maternal mortality and postnatal depression.</p> <p>Routine <a href="https://www.who.int/news/item/15-07-2022-covid-19-pandemic-fuels-largest-continued-backslide-in-vaccinations-in-three-decades">child immunisation coverage</a> has decreased. Crucial malaria, tuberculosis and HIV programs have been <a href="https://www.theglobalfund.org/en/news/2021/2021-09-08-global-fund-results-report-reveals-covid-19-devastating-impact-on-hiv-tb-and-malaria-programs/#:%7E:text=GENEVA%20%E2%80%93%20The%20COVID%2D19%20pandemic,history%20of%20the%20Global%20Fund">disrupted</a>. </p> <p>A paper out this week highlights the <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1107560/full">severe impact</a> of the pandemic on mental health globally.</p> <h2>Then there’s long COVID</h2> <p>Meanwhile, more evidence of long COVID has emerged around the world. At least <a href="https://www.nature.com/articles/s41579-022-00846-2">65 million people</a> were estimated to be experiencing this debilitating syndrome by the end of 2022. </p> <p>The Australian Institute of Health and Welfare <a href="https://www.aihw.gov.au/reports/covid-19/long-covid-in-australia-a-review-of-the-literature/summary">estimates</a> 5-10% of people who are infected with SARS-CoV-2 will develop long COVID, with symptoms persisting more than three months. That’s between 550,000 and 1.1 million Australians, based on the more than 11 million cases reported <a href="https://www.worldometers.info/coronavirus/country/australia/">so far</a>.</p> <h2>COVID highlighted inequalities</h2> <p>The pandemic has also had a huge economic impact, both directly and indirectly. </p> <p>The United States alone spent <a href="https://impact.economist.com/perspectives/economic-development/understanding-economic-consequences-covid-19-pandemic">US$4 trillion</a> on its response. Economists have estimated the pandemic will contribute an average 0.75% reduction in GDP in countries with high infection rates and high productivity in 2025.</p> <p>Studies in the <a href="https://www.local.gov.uk/health-inequalities-deprivation-and-poverty-and-covid-19">United Kingdom</a>, <a href="https://www.theguardian.com/world/2022/apr/04/us-covid-devastating-toll-poor-low-income-communities">US</a> and <a href="https://www.theguardian.com/australia-news/2022/feb/25/disease-of-disadvantage-melbournes-lower-socioeconomic-areas-suffer-most-covid-deaths-amid-omicron">Australia</a> show COVID has had a disproportionate impact – including higher death rates – in disadvantaged communities and ethnic minorities. </p> <p>The causes range from high exposure in low-paid jobs to inadequate access to health care. And <a href="https://www.brookings.edu/blog/future-development/2021/05/27/covid-19-is-a-developing-country-pandemic/">poorer countries</a> have fared terribly on all fronts from COVID, including inequitable access to vaccines.</p> <h2>There’s no end in sight</h2> <p>We cannot assume there will be a natural exit to the pandemic, where the virus reaches some benign endemicity, a harmless presence in the background. </p> <p>In fact, there is little indication anything like that is imminent.</p> <p>In Australia, since the beginning of January, <a href="https://www.worldometers.info/coronavirus/country/australia/">more than 235,000 COVID cases</a> have been reported, almost as many as in 2020 and 2021 combined. Since the start of January, there have been 2,351 COVID-related deaths, more than twice as many as in the whole of 2020 and around the same as in the whole of 2021.</p> <h2>What needs to happen next?</h2> <p>The future response can be practically distilled into three overlapping actions.</p> <p><strong>1. Politicians need to be frank</strong></p> <p>Our political leaders need to communicate frankly with the public that the pandemic is not over. They need to stress we still have an exceptional problem on our hands with acute disease as well as worrying concerns about long COVID. It’s crucial politicians acknowledge sufferers and those who have died. They need to do this while delivering the good news that addressing COVID does not require lockdowns or mandates. </p> <p>If our politicians did this, the public would be more likely to have their booster vaccines, get tested and treated, and adopt measures such as improving indoor ventilation and wearing high-quality masks.</p> <p>The health system also needs to be greatly strengthened to deal with long COVID.</p> <p><strong>2. Avoiding infections is still important</strong></p> <p>Suppressing the virus is still important. We still can and should reduce the burden of newly acquired COVID and, therefore, long COVID. We have the tools to do this. </p> <p>We need full recognition that COVID is transmitted largely through the air. As this just-published article in the journal <a href="https://www.nature.com/articles/d41586-023-00642-9">Nature</a> discusses, there are things we can do right now to ensure we all breathe air that is safer, not just from SARS-CoV-2 but from other respiratory viruses.</p> <p><strong>3. Adopt new knowledge and technology</strong></p> <p>We should be focusing on the science and be ready to adopt new knowledge and products rapidly. </p> <p>Just a few days ago we had trials of a <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4375620&amp;utm_source=substack&amp;utm_medium=email">promising new approach</a> to treat long COVID with the diabetes drug metformin. </p> <p>There is also intriguing research that has identified <a href="https://www.nature.com/articles/s41579-022-00846-2">persistent infection</a> as a potential underlying cause of organ damage and disease after COVID and in long COVID. This suggests anti-viral drugs such as Paxlovid may have an important role to play in reducing the impact of chronic disease. </p> <p>Many types of new COVID vaccines are being trialled, such as <a href="https://www.nature.com/articles/d41586-022-02824-3">versions administered by nasal sprays</a>, which may be game changers.</p> <h2>The virus won’t fix itself</h2> <p>As we enter the fourth year of the pandemic, we must not leave it up to the virus to fix itself. </p> <p>The biggest lesson of the past three years is there’s little chance that is going to work, at least without an intolerably high cost. </p> <p>Rather, we can end the pandemic by choice. We know <a href="https://theconversation.com/from-covid-control-to-chaos-what-now-for-australia-two-pathways-lie-before-us-174325">what to do</a>. But we are simply not doing it.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/three-years-into-the-pandemic-its-clear-covid-wont-fix-itself-heres-what-we-need-to-focus-on-next-201181" target="_blank" rel="noopener">The Conversation</a>. </em></p>

Caring

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“You won’t believe it”: An a-moo-sing new addition for one Victorian farm

<p>Megan and Barry Coster, two dairy farmers from Victoria’s West Gippsland region, were given the smiling surprise of a lifetime during their latest round of calving. </p> <p>“My husband was collecting calves to bring in for the day,” Megan told ABC’s rural reporter Annie Brown. “And I think I was off with the kids at sport, and I just got this text message of this calf, and he’s [Barry] like ‘you won’t believe it’.</p> <p>“Originally when he got the calf up he didn’t notice, and then he turned around and looked on the other side, and couldn’t believe it.” </p> <p>The calf, affectionately named ‘Happy’ by the family, had been born with an award-winning grin - just not where one would expect. On his side was a very unique marking - two eyes, a nose, and a big smile. </p> <p>When asked how old Happy was, Megan explained that he had only been born three or four days prior to the discovery, and went on to add that they had a lot of calving going on, so it was a busy time for them, and likely why they hadn’t immediately noticed what made Happy so special. </p> <p>“We’ve seen some number sevens, or love hearts on the head, and a few strange markings but we’ve never seen anything that resembles a smiley face before … we’ve had thousands over the years, and we’ve never had anything like it,” Megan said. </p> <p>“I couldn’t believe it,” she went on, before admitting she’d checked to ensure none of their staff had added any of the lines to the young cow. “And then I was pretty quickly sharing it with some of my friends - none of them could believe it either.” </p> <p>Megan went on to <a href="https://www.facebook.com/groups/1591950161115622/permalink/3523334507977168/" target="_blank" rel="noopener">post to Facebook</a>, sharing a photo of their spectacular latest addition with the caption “the funniest marking we’ve had for a while”, to the delight of fellow dairy fans around the world. </p> <p>“They look fake! How awesome,” wrote one individual, who seemed to share Megan’s initial disbelief, “best marking I’ve seen.”</p> <p>“I guess that's his good side,” joked another. </p> <p>“Love it. That's got to be a keeper as a pet,” said one, unaware that the family had every intention of keeping Happy on a pet - though he might also have to pull his weight as a lawn mower.</p> <p>“One very happy calf,” came one declaration. </p> <p>One person hit the nail on the head when they said “this one will always put a smile on your face every time u c [you see] it.” </p> <p>Although not everyone was quite so onboard with the lovefest, with one woman admitting that she found it to be “a little bit clown-creepy”. </p> <p><em>Images: Facebook</em></p>

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