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Ozempic, Wegovy, Rybelsus: Are we losing sight of overall health? Here’s what the science says

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/aude-bandini-1488512">Aude Bandini</a>, <a href="https://theconversation.com/institutions/universite-de-montreal-1743">Université de Montréal</a>; <a href="https://theconversation.com/profiles/jean-philippe-drouin-chartier-1533338">Jean-Philippe Drouin-Chartier</a>, <a href="https://theconversation.com/institutions/universite-laval-1407">Université Laval</a>; <a href="https://theconversation.com/profiles/pierre-marie-david-1375228">Pierre-Marie David</a>, <a href="https://theconversation.com/institutions/universite-de-montreal-1743">Université de Montréal</a>, and <a href="https://theconversation.com/profiles/remi-rabasa-lhoret-1533515">Rémi Rabasa-Lhoret</a>, <a href="https://theconversation.com/institutions/universite-de-montreal-1743">Université de Montréal</a> The craze for new drugs in the GLP-1 (Glucagon-like peptide 1) and GIP (Gastric inhibitory polypeptide) analogue class, better known under the trade names Ozempic and Wegovy, is remarkable, but it’s not totally unprecedented in the history of pharmaceutical blockbusters. The volume of prescriptions and the budget allocated to them by public health insurance schemes are exploding, as are the <a href="https://www.forbes.com/sites/roberthart/2024/05/02/ozempic-maker-novo-nordisk-beats-profit-forecasts-amid-weight-loss-drug-frenzy/">profits of the companies that manufacture them</a>. Part of the popularity of these drugs owes to social networks, but these are not always the best source for health information. When it comes to the subject of weight loss, both fantasy and prejudice come into play. This works to the detriment of everyone’s well-being, but particularly those who are already stigmatized. As specialists in the philosophy of medicine (Université de Montréal), nutrition and food science (Université Laval), the sociology of medication (Université de Montréal) and endocrinology (Institut de recherches cliniques de Montréal), we feel it’s necessary to step back and take stock of both the promises and the limitations of these new treatments. <h2>The best of both worlds</h2> GLP-1/GIP analogues were originally developed to regulate glycemia (blood sugar levels) in people with Type 2 diabetes, thereby preventing the complications associated with this disease. When studies were carried out to assess their safety and efficacy, it was discovered that these drugs also led to weight loss. This prompted new research which showed that at higher doses, the drugs could lead to <a href="https://pubmed.ncbi.nlm.nih.gov/38078870/">very significant weight loss</a>, from 15 to 25 per cent of the starting weight. The mode of action of these drugs on blood sugar regulation is clear: they simulate incretin hormones which, in turn, increase insulin secretion. Weight loss, on the other hand, was only explained after the fact: in addition to the pancreas, these molecules also act on the brain by regulating the sensation of satiety and, indirectly, on the stomach by slowing gastric emptying. These two combined effects reduce appetite and lead to weight reduction. This is how a new use for the drug appeared, at which point the company Novo Nordisk began marketing the same drug under two different names: Ozempic to treat Type 2 diabetes, and <a href="https://theconversation.com/considering-taking-wegovy-to-lose-weight-here-are-the-risks-and-benefits-and-how-it-differs-from-ozempic-237308">Wegovy to manage obesity</a>. <h2>A new era</h2> GLP-1/GIP analogues are a welcome therapeutic breakthrough at a time when the <a href="https://www.diabetes.ca/advocacy---policies/advocacy-reports/national-and-provincial-backgrounders/diabetes-in-canada">prevalence of Type 2 diabetes</a> and <a href="https://www.statcan.gc.ca/o1/en/plus/5742-overview-weight-and-height-measurements-world-obesity-day">obesity</a> is exploding and affecting people younger and younger. These diseases particularly affect women, members of racialized groups and socio-economically disadvantaged populations. The physical and mental suffering these cause and the costs associated with treating them are both considerable. So the arrival of new weapons in the therapeutic arsenal is a source of hope. Draconian changes in lifestyle are certainly effective. But they are very difficult to implement and maintain over time for reasons that go beyond the individual sphere; on the one hand, genetic predisposition plays a major role in the development of Type 2 diabetes and obesity; on the other, because these conditions are <a href="https://obesitycanada.ca/managing-obesity/">multifactorial</a>, management of them must be comprehensive to be effective and long lasting: it must combine medical interventions but also nutritional, functional, psycho-social, environmental and even institutional interventions. Support services of this kind do exist, but only in large university hospital centres to which many people do not have access. Nor do many people have easy access to <a href="https://health-infobase.canada.ca/health-inequalities/index">healthy and varied food options</a>, sports facilities or social and psychological support. <h2>Treating the effects but not the causes</h2> To be effective over the long term, GLP-1/GIP analogues must be taken continuously: without drastic lifestyle changes, the <a href="https://pubmed.ncbi.nlm.nih.gov/35441470/">weight that was lost is regained within a year of stopping</a>, and glycemic control is compromised once again. In other words, the drugs treat the effects of Type 2 diabetes and obesity but not their causes. And yet some of these causes are modifiable: for example, according to <a href="https://www150.statcan.gc.ca/n1/pub/75-006-x/2023001/article/00013-eng.htm">Statistics Canada</a>, less than half the Canadian population (49.2 per cent for adults; 43.9 per cent for young people and children) achieves the recommended amount of weekly physical activity. According to the same source, <a href="https://www150.statcan.gc.ca/n1/pub/75-006-x/2023001/article/00013-eng.htm">food insecurity</a> affects around 14 per cent of the Québec population (22 per cent in Alberta). Pharmacological treatment, even if it allows an individual to eat less, does not necessarily mean that person will <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10837702/">eat better</a>. Similarly, losing weight does not mean one will become more active or healthier. So these new drugs do not cure Type 2 diabetes or obesity. Nor do they prevent these diseases from developing, although they do help to limit the many complications to which they give rise. <h2>Prescribe and treat</h2> A drug such as Mounjaro is as effective at weight loss as bariatric surgery. Much easier to administer and much less risky, it could be a real game changer in the treatment of obesity. Prescribed directly by family doctors and dispensed in pharmacies, it would also be much more accessible and easier to administer for those who need it. This raises the question of costs and reimbursement, but not only that: prescribing is not the same as treating. Here, the manufacturers are following the recommendations of the health authorities: this treatment must be preceded by a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10748770/">careful assessment</a>, then management, and above all a close and regular monitoring of diet, physical activity, mental health, and if necessary, socio-economic assistance. This requires not only time that GPs do not have, but also co-ordination with other players in the health-care network. The problem is not whether the treatment will be effective, but what can happen if it is. Losing 25 per cent of your body weight in just a few months has serious consequences, which are not always beneficial: it involves a loss of body fat, but also of muscle mass, which is associated with intense fatigue. Nor should we underestimate the <a href="https://pubmed.ncbi.nlm.nih.gov/37990685/">challenge of adapting physically and psychologically</a> to a body transformation of this scale. Losing weight doesn’t solve everything, and expectations must remain realistic. <h2>What lessons can we learn?</h2> The clinical effectiveness of GLP-1/GIP analogues in reducing the complications associated with Type 2 diabetes and obesity is indisputable. However, these drugs are not suitable for everyone, and they are certainly not miracle cures that will make it possible for one to regain health without making any changes to lifestyle or environment. We must bear in mind that their success, both commercial and medical, is also the result of a failure: that of our societies to prevent these diseases, to promote healthy lifestyles and to develop environments conducive to the health of all.<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/238484/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/aude-bandini-1488512">Aude Bandini</a>, Professeure agrégée, Philosophie (épistémologie et philosophie de la médecine), <a href="https://theconversation.com/institutions/universite-de-montreal-1743">Université de Montréal</a>; <a href="https://theconversation.com/profiles/jean-philippe-drouin-chartier-1533338">Jean-Philippe Drouin-Chartier</a>, Professeur agrégé, Faculté de pharmacie, <a href="https://theconversation.com/institutions/universite-laval-1407">Université Laval</a>; <a href="https://theconversation.com/profiles/pierre-marie-david-1375228">Pierre-Marie David</a>, Professeur adjoint à la faculté de pharmacie, <a href="https://theconversation.com/institutions/universite-de-montreal-1743">Université de Montréal</a>, and <a href="https://theconversation.com/profiles/remi-rabasa-lhoret-1533515">Rémi Rabasa-Lhoret</a>, Professeur de médecine et de nutrition, <a href="https://theconversation.com/institutions/universite-de-montreal-1743">Université de Montréal</a> Image credits: Shutterstock 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/ozempic-wegovy-rybelsus-are-we-losing-sight-of-overall-health-heres-what-the-science-says-238484">original article</a>. </div>

Body

The internet is worse than it used to be. How did we get here, and can we go back?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/marc-cheong-998488">Marc Cheong</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/wonsun-shin-1300054">Wonsun Shin</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> When it comes to our experience of the internet, “the times, <a href="https://en.wikipedia.org/wiki/The_Times_They_Are_a-Changin%27_(song)">they are a-changin’</a>”, as Bob Dylan would say. You can’t quite recall how, but the internet certainly feels different these days. To some, it is “<a href="https://www.npr.org/2024/01/16/1224878097/everyday-users-are-complaining-that-the-internet-is-more-chaotic-than-ever">less fun and less informative</a>” than it used to be. To others, online searches are made up of “<a href="https://www.theverge.com/c/23998379/google-search-seo-algorithm-webpage-optimization?src=longreads">cookie cutter</a>” pages that drown out useful information and are saturated with scams, spam and content generated by artificial intelligence (AI). Your social media feeds are full of eye-catching, provocative, hyper-targeted, or anger-inducing content, from <a href="https://theconversation.com/the-dead-internet-theory-makes-eerie-claims-about-an-ai-run-web-the-truth-is-more-sinister-229609">bizarre AI-generated imagery</a> to robot-like comments. You’re lucky if your video feeds are not solely made up of exhortations to “subscribe”. How did we get here? And can we claw our way back? <h2>Commercial interests rule</h2> One major factor contributing to the current state of the internet is its over-commercialisation: financial motives drive much of the content. This has arguably led to the prevalence of sensationalism, prioritising virality over information quality. Covert and deceptive advertising is widespread, blurring the line between commercial and non-commercial content to attract more attention and engagement. Another driving force is the dominance of tech giants like Google, Meta and Amazon. They reach billions worldwide and wield immense power over the content we consume. Their platforms use advanced tracking technologies and opaque algorithms to generate hyper-targeted media content, powered by extensive user data. This creates <a href="https://www.campaignasia.com/article/the-echo-chamber-effect-how-algorithms-shape-our-worldview/491762">filter bubbles</a>, where users are exposed to limited content that reinforces their existing beliefs and biases, and <a href="https://philarchive.org/archive/NGUECA">echo chambers</a> where other viewpoints are actively discredited. Bad actors like <a href="https://abcnews.go.com/Technology/ai-fuel-financial-scams-online-industry-experts/story?id=103732051">cyber criminals and scammers</a> have been an enduring problem online. However, evolving technology like generative AI has further empowered them, enabling them to create highly realistic fake images, deepfake videos and <a href="https://www.newyorker.com/science/annals-of-artificial-intelligence/the-terrifying-ai-scam-that-uses-your-loved-ones-voice">voice cloning</a>. AI’s ability to automate content creation has also flooded the internet with low-quality, misleading and harmful material at an unprecedented scale. In sum, the accelerated commercialisation of the internet, the dominance of media tech giants and the presence of bad actors have infiltrated content on the internet. The rise of AI further intensifies this, making the internet more chaotic than ever. <h2>Some of the ‘good’ internet remains</h2> So, what was the “good internet” some of us long for with nostalgia? At the outset, the internet was meant to be a free egalitarian space people were meant to “surf” and “browse”. Knowledge was meant to be shared: sites such as Wikipedia and The Internet Archive are continuing bastions of knowledge. Before the advent of filter bubbles, the internet was a creative playground where people explored different ideas, discussed varying perspectives, and collaborated with individuals from “outgroups” – those outside their social circles who may hold opposing views. Early social media platforms were built on the ethos of reconnecting with long-lost classmates and family members. Many of us have community groups, acquaintances and family we reach out to via the internet. The “connection” aspect of the internet remains as important as ever – as we all saw during the COVID pandemic. What else do we want to preserve? Privacy. A New Yorker cartoon joke in 1993 stated that “<a href="https://web.archive.org/web/20051029045942/http://www.unc.edu/depts/jomc/academics/dri/idog.html">on the internet, nobody knows you’re a dog</a>”. Now everyone – especially advertisers – wants to know who you are. To quote the <a href="https://www.oaic.gov.au/privacy/your-privacy-rights/your-personal-information/what-is-privacy">Office of the Australian Information Commissioner</a>, one of the tenets of privacy is “to be able to control who can see or use information about you”. At the very least, we want to control what big tech knows about us, especially if they could stand to profit from it. <h2>Can we ever go back?</h2> We can’t control “a changin’” times, but we can keep as much of the good parts as we can. For starters, we can vote with our feet. Users can enact change and bring awareness to problems on existing platforms. In recent times, we have seen this with the <a href="https://theconversation.com/thinking-of-breaking-up-with-twitter-heres-the-right-way-to-do-it-195002">exodus of users</a> from X (formerly Twitter) to other platforms, and the <a href="https://www.economist.com/the-economist-explains/2023/06/26/why-reddit-users-are-protesting-against-the-sites-leadership">platform-wide protest against Reddit</a> for changing its third-party data access policies. However, voting with our feet is only possible when there’s competition. In the case of X, various other platforms – from Mastodon to Threads to Bluesky – enable users to pick one that aligns with their preferences, values and social circles. Search engines have alternatives, too, such as DuckDuckGo or Ecosia. But competition can only be created by moving to decentralised systems and removing monopolies. This actually happened in the early days of the internet during the 1990s “<a href="https://thehistoryoftheweb.com/browser-wars/">browser wars</a>”, when Microsoft was eventually accused of illegally monopolising the web browser market in <a href="https://en.wikipedia.org/wiki/United_States_v._Microsoft_Corp.">a landmark court case</a>. As users of technology, all of us must remain vigilant about threats to our privacy and knowledge. With cheap and ubiquitous generative AI, misleading content and scams are more realistic as ever. We must exercise healthy scepticism and ensure those most at risk from online threats – such as children and older people – are educated about potential harms. Remember, the internet is not optimised for your best interests. It’s up to you to decide how much power you give to the tech giants who are fuelling theirs.<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/236513/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/marc-cheong-998488">Marc Cheong</a>, Senior Lecturer of Information Systems, School of Computing and Information Systems; and (Honorary) Senior Fellow, Melbourne Law School, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/wonsun-shin-1300054">Wonsun Shin</a>, Associate Professor in Media and Communications, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Shutterstock 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/the-internet-is-worse-than-it-used-to-be-how-did-we-get-here-and-can-we-go-back-236513">original article</a>. </div>

Technology

What causes food cravings? And what can we do about them?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/gabrielle-weidemann-91497">Gabrielle Weidemann</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> and <a href="https://theconversation.com/profiles/justin-mahlberg-1634725">Justin Mahlberg</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Many of us try to eat more fruits and vegetables and less ultra-processed food. But why is sticking to your goals so hard? High-fat, sugar-rich and salty foods are simply so enjoyable to eat. And it’s not just you – we’ve evolved that way. These foods <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928395/">activate</a> the brain’s reward system because in the past they were <a href="https://doi.org/10.1037/a0030684">rare</a>. Now, they’re all around us. In wealthy modern societies we are bombarded by <a href="https://theconversation.com/junk-food-is-promoted-online-to-appeal-to-kids-and-target-young-men-our-study-shows-234285">advertising</a> which intentionally reminds us about the sight, smell and taste of calorie-dense foods. And in response to these powerful cues, our brains respond just as they’re designed to, triggering <a href="https://doi.org/10.1111/obr.12354">an intense urge</a> to eat them. Here’s how food cravings work and what you can do if you find yourself hunting for sweet or salty foods. <h2>What causes cravings?</h2> A food craving is an intense desire or urge to eat something, <a href="https://pubmed.ncbi.nlm.nih.gov/15589112/">often focused on a particular food</a>. We are programmed to learn how good a food tastes and smells and where we can find it again, especially if it’s high in fat, sugar or salt. Something that <a href="https://doi.org/10.1111/obr.12354">reminds us</a> of enjoying a certain food, such as an eye-catching ad or delicious smell, can cause us to <a href="https://doi.org/10.1111/obr.12354">crave it</a>. The cue triggers a physical response, increasing saliva production and gastric activity. These responses are relatively automatic and difficult to control. <h2>What else influences our choices?</h2> While the effect of cues on our physical response is relatively automatic, what we do next is influenced by <a href="https://journals.sagepub.com/doi/pdf/10.1177/1090198107303308">complex</a> factors. Whether or not you eat the food might depend on things like cost, whether it’s easily available, and if eating it would align with your health goals. But it’s usually hard to keep healthy eating in mind. This is because we tend to prioritise a more immediate reward, like the <a href="https://doi.org/10.1016/j.physbeh.2010.04.029">pleasure of eating</a>, over one that’s delayed or abstract – including health goals that will make us feel good in the long term. <a href="https://doi.org/10.1016/S0022-3999(00)00076-3">Stress</a> can also make us eat more. When hungry, we <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8656885/">choose larger portions</a>, underestimate calories and find eating more <a href="https://www.sciencedirect.com/science/article/pii/S0195666315000793">rewarding</a>. <h2>Looking for something salty or sweet</h2> So what if a cue prompts us to look for a certain food, but it’s not available? <a href="https://doi.org/10.1016/j.appet.2014.04.005">Previous research</a> suggested you would then look for anything that makes you feel good. So if you saw someone eating a doughnut but there were none around, you might eat chips or even drink alcohol. But our <a href="https://doi.org/10.1016/j.appet.2024.107640">new research</a> has confirmed something you probably knew: it’s more specific than that. If an ad for chips makes you look for food, it’s likely a slice of cake won’t cut it – you’ll be looking for something salty. Cues in our environment don’t just make us crave food generally, they prompt us to look for certain food “categories”, such as salty, sweet or creamy. <h2>Food cues and mindless eating</h2> Your <a href="https://core.ac.uk/download/pdf/161283824.pdf">eating history</a> and <a href="https://doi.org/10.1002/eat.24179">genetics</a> can also make it harder to suppress food cravings. But don’t beat yourself up – relying on willpower alone is <a href="https://doi.org/10.1016/j.appet.2015.01.004">hard</a> for almost everyone. Food cues are so powerful they can prompt us to <a href="https://doi.org/10.1177/0956797613484043">seek</a> out a certain food, even if we’re not overcome by a particularly <a href="https://doi.org/10.1177/0956797613484043">strong urge</a> to eat it. The effect is more intense if the food is easily available. This helps explain why we can eat an entire large bag of chips that’s in front of us, even though our pleasure decreases as we <a href="https://doi.org/10.1016/0031-9384(81)90310-3">eat</a>. Sometimes we use finishing the packet as the signal to stop <a href="https://doi.org/10.1016/j.physbeh.2015.03.025">eating</a> rather than hunger or desire. <h2>Is there anything I can do to resist cravings?</h2> We largely don’t have control over cues in our environment and the cravings they trigger. But there are some ways you can try and control the situations you make food choices in. <ul> <li> Acknowledge your craving and think about a healthier way to satisfy it. For example, if you’re craving chips, could you have lightly-salted nuts instead? If you want something sweet, you could try fruit. </li> <li> Avoid shopping when you’re hungry, and make a list beforehand. Making the most of supermarket “click and collect” or delivery options can also help avoid ads and impulse buys in the aisle. </li> <li> At home, have fruit and vegetables easily available – and easy to see. Also have other nutrient dense, fibre-rich and unprocessed foods on hand such as nuts or plain yoghurt. If you can, remove high-fat, sugar-rich and salty foods from your environment. </li> <li> Make sure your goals for eating are <a href="https://www.aafp.org/pubs/fpm/issues/2018/0300/p31.html">SMART</a>. This means they are specific, measurable, achievable, relevant and time-bound. </li> <li> Be kind to yourself. Don’t beat yourself up if you eat something that doesn’t meet your health goals. Just keep on trying.<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/237035/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> </li> </ul> <a href="https://theconversation.com/profiles/gabrielle-weidemann-91497">Gabrielle Weidemann</a>, Associate Professor in Psychological Science, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> and <a href="https://theconversation.com/profiles/justin-mahlberg-1634725">Justin Mahlberg</a>, Research Fellow, Pyschology, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock 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/what-causes-food-cravings-and-what-can-we-do-about-them-237035">original article</a>. </div>

Food & Wine

Pay-by-weight airfares are an ethical minefield. We asked travellers what they actually think

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/denis-tolkach-11345">Denis Tolkach</a>, <a href="https://theconversation.com/institutions/james-cook-university-1167">James Cook University</a> and <a href="https://theconversation.com/profiles/stephen-pratt-335188">Stephen Pratt</a>, <a href="https://theconversation.com/institutions/university-of-central-florida-1925">University of Central Florida</a> Imagine checking in for a flight with your two teenage children. At the counter, you are told that your youngest teenager’s suitcase is two kilograms over the limit. You get slapped with a $75 penalty for their excess luggage. This penalty feels arbitrary and unfair. The youngest weighs about 45 kg, and their luggage weighs 25 kg, making their total payload on the flight 70 kg. Their older sibling, on the other hand, weighs 65 kg, and has brought 23 kg of luggage to check in. Their total weight is higher – 88 kg – yet they receive no penalty. Obviously, things aren’t that simple. Charging passengers based on their weight is highly controversial for many reasons. But that hasn’t stopped some airlines <a href="https://theweek.com/articles/466035/should-airlines-charge-passengers-by-weight">experimenting</a> with such policies. Imagine checking in for your flight only to have the staff tell you to <a href="https://edition.cnn.com/travel/article/plus-size-travelers-slam-airline-seat-policies/index.html">purchase an extra seat</a> as you are a plus-size passenger. You feel discriminated against because you are using the same service as other passengers and your weight is beyond your control. But despite the lived experience of many and hot debate in the media, there has not been a formal study into what passengers themselves think about this matter. Our recently published <a href="https://doi.org/10.1002/jtr.2691">research</a> examined air passengers’ views on alternative airfare policies to understand whether the public finds them acceptable and what ethical considerations determine their views. Though we found a range of ethical contradictions, most travellers were guided by self-interest. <h2>A controversial but important topic</h2> The issue of whether airlines should weigh passengers is an ethical minefield with no easy answers. Despite its sensitivity, the aviation industry can’t ignore passenger weight. Airlines intermittently undertake <a href="https://www.forbes.com/sites/marisagarcia/2024/02/11/despite-backlash-heres-why-airlines-need-to-weigh-passengers/?sh=5f07623e1bfa">passenger weight surveys</a> as they need to accurately calculate payload to ensure flight safety and estimate fuel consumption. The evidence shows passengers are <a href="https://www.forbes.com/sites/marisagarcia/2024/02/11/despite-backlash-heres-why-airlines-need-to-weigh-passengers/?sh=5f07623e1bfa">getting heavier</a>. Airlines including the now-defunct <a href="https://theweek.com/articles/466035/should-airlines-charge-passengers-by-weight">Samoa Air</a> and <a href="https://www.theguardian.com/us-news/2016/oct/23/hawaiian-airlines-american-samoa-weight-passengers">Hawaiian Airlines</a> have taken things one step further and experimented with weighing passengers regularly. Samoa Air, for example, became the first airline to introduce a “pay-as-you-weigh” policy, where the cost of your ticket was directly proportional to the combined weight of you and your luggage. In contrast, Canada has now long had a “<a href="https://otc-cta.gc.ca/eng/publication/additional-seating-and-one-person-one-fare-requirement-domestic-travel-a-guide">one person, one fare</a>” policy. It is prohibited and deemed discriminatory to force passengers living with a disability to purchase a second seat for themselves if they require one, including those with functional disability due to obesity. To complicate matters further, the issue of passenger and luggage weight is not only ethical and financial, but also environmental. More weight on an aircraft leads to more jet fuel being burned and more carbon emissions. About <a href="https://www.nature.com/articles/s41467-021-24091-y">5%</a> of human-driven climate change can be attributed to aviation, and the industry faces enormous pressure to reduce fuel consumption while it waits for low carbon substitutes to become available. <h2>What do passengers actually think?</h2> To get a better sense of how the public actually feels about this issue, we surveyed 1,012 US travellers of different weights, presenting them with three alternatives: <ul> <li>standard policy – currently the most widely used policy with passengers paying a standard price, irrespective of their weight</li> <li>threshold policy – passengers are penalised if they are over a threshold weight</li> <li>unit of body weight policy – passengers pay a personalised price based on their own body weight, per each pound.</li> </ul> The standard policy was the most acceptable for participants of differing weight, although the heavier the passenger, the more they preferred the standard policy. This can be partially explained by status quo bias. Generally, people are likely to choose a familiar answer. The threshold policy was the least acceptable. This policy was seen to violate established social norms and be generally less fair. The unit of body weight policy was preferred to the threshold policy, although participants raised concerns about whether it would be accepted by society. Perhaps unsurprisingly, we found that self-interest played a clear role in determining whether respondents considered a policy acceptable. Younger, male, financially well-off travellers with lower personal weight generally found the alternative policies more acceptable. <h2>An ethical conflict</h2> Alternative airfare policies that are based on passenger weight bring environmental and ethical concerns into conflict. Obviously, the effect isn’t from any one traveller, in particular, but averages over the entire industry. Interestingly, respondents that were more concerned about the environment – “ecocentric” – preferred air fare policies that would reduce the carbon emissions. This made them more open to the controversial alternatives. While the threshold policy was clearly rejected by many respondents as discriminatory, environmental concern played a role in the level of acceptance of the unit of body weight policy. It’s important to apply a critical lens here. These ecocentric travellers were also generally younger and had lower personal weights, so many would benefit from the alternative policies financially. For policymakers overall, our study suggests when it comes to controversial ticketing policies, the public is more likely to be swayed by self-interest than anything else.<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/237856/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/denis-tolkach-11345">Denis Tolkach</a>, Senior Lecturer, <a href="https://theconversation.com/institutions/james-cook-university-1167">James Cook University</a> and <a href="https://theconversation.com/profiles/stephen-pratt-335188">Stephen Pratt</a>, Professor, <a href="https://theconversation.com/institutions/university-of-central-florida-1925">University of Central Florida</a> Image credits: Shutterstock 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/pay-by-weight-airfares-are-an-ethical-minefield-we-asked-travellers-what-they-actually-think-237856">original article</a>. </div>

Travel Trouble

What’s a recession – and how can we tell if we’re in one?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/leonora-risse-405312">Leonora Risse</a>, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Today’s <a href="https://www.abs.gov.au/statistics/economy/national-accounts/australian-national-accounts-national-income-expenditure-and-product/latest-release">economic data</a> shows that, outside of the pandemic, the Australian economy has slowed down to its lowest annual rate of growth since the early-1990s recession. That’s prompting the dreaded question: are we headed for another one? Any mention of the “R” word can trigger anxiety. Recessions bring job losses and financial strain, and put serious pressure on people’s mental health. These impacts can be especially severe for people who are already experiencing disadvantage and vulnerabilities. But what exactly does it mean to be in a recession? What are the different ways we define them? And are these current approaches the best way to measure people’s economic pain? <h2>What’s a recession?</h2> A bit like the waves of the ocean, our economy is characterised by ebbs and flows in overall activity. Spending and business growth can swell during times of confidence, but slow down when optimism deflates or the economy is hit by an unexpected shock such as a pandemic or climate disaster. This pattern is what economists describe as “the business cycle”. Most of the time, our economy is constantly growing, even if the pace varies. Conventionally, we measure this pace by tracking changes in the level of <a href="https://www.rba.gov.au/education/resources/explainers/economic-growth.html">gross domestic product</a> (GDP) – the overall volume of items and services being produced, bought and sold in the economy. The <a href="https://www.abs.gov.au/statistics/economy/national-accounts/australian-national-accounts-national-income-expenditure-and-product/jun-2024">latest economic growth rates</a> of 0.2% for the June quarter, and 1% over the past year, tell us that the Australian economy is still growing, even if at a slower pace than previous years. Occasionally, the economy slows down to such a grind that economic activity, from one quarter to the next, shrinks. When this happens, the GDP measurements come out negative. When we have two negative measurements of GDP in a row, this is defined as a <a href="https://www.rba.gov.au/education/resources/explainers/recession.html">technical recession</a>. This is what happened to most countries around the globe during the COVID-19 pandemic. Prior to the pandemic, Australia hadn’t experienced a technical recession since 1991. The latest figures tell us Australia is staying afloat for now. But that doesn’t mean it doesn’t feel like a recession to many people. Some other metrics show why. <h2>Other measures of recession</h2> Growth in economic activity is fuelled, in part, by a growing population. Dividing total economic output by the population size, GDP per capita can offer a more accurate picture of people’s economic reality. This population-adjusted measure of economic growth has long fallen into negative territory. Today’s figures tell us that Australia’s GDP per person has been shrinking for 18 months. Our annual per capita growth rate is now -1.5%. <figure class="align-right zoomable"></figure> In the United States, recessions are measured differently again. Recessions are officially declared by the National Bureau of Economic Research (<a href="https://www.nber.org/research/business-cycle-dating">NBER</a>). Unlike technical recessions, these aren’t based on a simple rule. NBER considers a range of measures beyond GDP – including personal income, employment, personal consumption, wholesale and retail sales, and industrial production across multiple sectors – when deciding whether to declare a US recession. <h2>Is Australia heading for a recession?</h2> This is a challenging question to answer because the GDP figures economists conventionally use to diagnose the situation only come to light after a recession hits. Today’s economic figures from the ABS are for the June 2024 quarter – now more than two months old. Measurements of the current economic climate won’t come through in official statistics for some time. If it occurs, by the time a recession is officially diagnosed, we’re usually well and truly in it. A similar limitation applies to the retrospective approach of the <a href="https://www.nber.org/research/business-cycle-dating">NBER</a>, which “waits until it is confident that a recession has occurred”. It’s like a weather forecaster declaring a cyclone has hit only after the wind gusts have blown your roof away. But we can use other metrics to alert ourselves to recession risks before the eye of the storm hits. <h2>Using jobs numbers as a recession alert</h2> One approach is the <a href="https://fred.stlouisfed.org/series/SAHMCURRENT">Sahm Rule</a>, named after its creator, US economist Claudia Sahm. By analysing patterns in the monthly unemployment data that preceded past recessions, Sahm devised a <a href="https://stayathomemacro.substack.com/p/the-sahm-rule-step-by-step">formula</a> to detect when increases in the current unemployment rate were rapid enough to pose a recession risk. The advantage of this approach is that unemployment statistics come out more quickly and frequently than GDP numbers. Many would also argue that monitoring unemployment, rather than GDP, is a more meaningful metric to reflect people’s everyday experiences of the economy and wellbeing. The Sahm approach tracks how quickly the national unemployment rate is currently rising compared to the past year. It’s calculated by comparing the current three-month moving average of the national unemployment rate to this figure’s lowest value in the previous 12 months. This “moving average” approach smooths out the bumpiness of monthly figures. A jump of 0.5% or more signals the economy’s current pattern is on the cusp of recession. While the Sahm formula was developed for the US economy, it does a fairly good job of waving a red flag where recessions previously occurred in the Australian economy, too. Australia’s latest unemployment rate – inching up to 4.2% in July 2024 – pushed the Sahm value up to 0.5%. <iframe id="3d239" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/3d239/5/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> This indicator doesn’t necessarily mean that a recession will occur. But it suggests policymakers should be on high alert. The Sahm indicator also validates the experiences of job seekers who – despite official definitions that the economy is not in recession – are personally feeling the pressures of a slowing economy and shrinking job opportunities. As our approaches to measuring and managing the ups and downs of the economy continue to evolve, these people-centred metrics are an increasingly important part of our toolkit.<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/238199/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/leonora-risse-405312">Leonora Risse</a>, Associate Professor in Economics, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Image credits: Shutterstock 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/whats-a-recession-and-how-can-we-tell-if-were-in-one-238199">original article</a>. </div>

Money & Banking

Australia’s gender pay gap has hit a record low – but we still have work to do

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/leonora-risse-405312">Leonora Risse</a>, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Australia’s gender pay gap – a key measure of economic inequality between men and women – has fallen to a record low of 11.5%. That’s down from 13% this time last year, the steepest annual fall since 2016. Ten years ago, it was almost 19%. The latest figures are great news for our economy and our society – evidence we’re getting better at recognising and fairly valuing women’s capabilities and contributions. More opportunities are now open to women in the workforce, helping them gain and retire with greater financial independence than in previous decades. But national averages don’t tell the whole story. While gender pay gaps have fallen in some industries, they’ve also been rising in others. Today, August 19, is <a href="https://www.wgea.gov.au/pay-and-gender/equal-pay-day-2024">equal pay day</a>. This marks the 50 extra days past the end of the last financial year that Australian women would need to work for their earnings to match those of their male colleagues. This offers us a timely opportunity to reflect on what exactly has driven this year’s improvement – and where we still have work to do. <h2>Women’s earnings picking up pace</h2> We calculate the gender pay gap by comparing the average weekly ordinary-time, full-time <a href="https://www.abs.gov.au/statistics/labour/earnings-and-working-conditions/average-weekly-earnings-australia">earnings</a> for men and women. In dollar terms, women are now earning $231.50, or 11.5%, less than men, on average, in their weekly full-time pay packet. <hr /> <iframe id="HwwJ5" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/HwwJ5/1/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> The recent narrowing is being driven by women’s average earnings growth picking up pace. This contrasts with <a href="https://www.abc.net.au/news/2018-10-02/fact-check-gender-pay-gap/10302358">earlier periods</a> in which the narrowing of the gap tended to be due to a slowdown in the growth of men’s earnings. <hr /> <iframe id="R7uFE" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/R7uFE/1/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> <h2>What’s behind the improvement?</h2> While changes in the gender pay gap reflect a range of economy-wide factors, the Albanese government has been quick to attribute the recent fall to the various <a href="https://www.linkedin.com/feed/update/urn:li:activity:7229747376511447040/">targeted actions</a> it has taken since coming to office. Let’s look at whether and how these actions have played a role. First, the government sought to make wage information more transparent. It <a href="https://theconversation.com/pay-secrecy-clauses-are-now-banned-in-australia-heres-how-that-could-benefit-you-195814">banned pay secrecy clauses</a> and now requires the gender pay gaps of all large companies in Australia to be <a href="https://theconversation.com/qantas-pays-women-37-less-telstra-and-bhp-20-fifty-years-after-equal-pay-laws-we-still-have-a-long-way-to-go-223870">publicly reported</a>. These reforms took effect from 2023, targeting private companies. The gender pay gap in the private sector, though higher to begin with, has fallen more swiftly than that of the public sector, suggesting these actions have had an effect. <hr /> <iframe id="ZKMdm" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/ZKMdm/1/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> Second, the government targeted gender-patterned biases in industrial relations – including the <a href="https://theconversation.com/50-years-after-equal-pay-the-legacy-of-womens-work-remains-118761">legacy effects</a> of past decisions – and instilled gender equity as a new objective of Australia’s Fair Work Act. The Fair Work Commission is now required to take gender equity into account in its wage deliberations, including its <a href="https://www.fwc.gov.au/documents/resources/2024fwcfb3500.pdf">minimum wage decision</a>. The government also introduced multi-employer bargaining in an attempt to strengthen workers’ bargaining capacity in female-concentrated sectors. The effects of these changes will continue to flow across the workforce as the Fair Work Commission undertakes its review of modern awards, prioritising those affecting <a href="https://www.fwc.gov.au/hearings-decisions/major-cases/gender-undervaluation-priority-awards-review">female-concentrated industries</a>. <figure class="align-right zoomable"><figcaption></figcaption></figure> And third, further addressing the historical undervaluation of “women’s work”, the government directly addressed low pay in female-concentrated sectors by supporting a pay rise for <a href="https://www.fairwork.gov.au/newsroom/news/15-per-cent-wage-increase-aged-care-sector">aged care workers</a>. Targeting the low pay and under-valuation of an industry that is about 87% female helped fuel the downward momentum in the overall gender pay gap. The government’s recently announced pay rise for <a href="https://ministers.education.gov.au/anthony-albanese/pay-rise-early-educators-while-keeping-fees-down-families">early childhood education and care workers</a> – a workforce that is around 95% female – will also target gender patterns in low pay once they come into effect. These government actions have been essential for undoing the gender biases embedded in existing systems. And they have complemented other initiatives that have taken effect in the past year, such as the <a href="https://www.respectatwork.gov.au/new-positive-duty-employers-prevent-workplace-sexual-harassment-sex-discrimination-and-victimisation">Respect At Work Act</a>, requiring employers to proactively stamp out sexual harassment. But there is still a way to go to keep closing the gender gaps across all parts of the workforce. <h2>Falling in some industries, rising in others</h2> Breaking down the gender pay gap in earnings by sector paints a more varied picture. In industries like construction, public administration and safety, and retail trade, it has fallen notably over the past two years. <hr /> <iframe id="poLND" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/poLND/1/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> But it remains high in industries like healthcare and social assistance, at over 20%, and finance and insurance at 18%. <hr /> <iframe id="6cLnT" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/6cLnT/2/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> In some industries, the gap has actually increased over the past two years. In arts and recreation services, as well as electricity, gas, waste and water services, it’s been continually rising. <hr /> <iframe id="M8fve" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/M8fve/1/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> <h2>That could reflect a bigger shift</h2> It’s important to interpret these figures carefully. In some instances, a widening of the gender pay gap can reflect a positive shift in an industry’s makeup, if it reflects more women joining a male-dominated sector at entry level, and growing a pipeline of senior women for the future. That’s why the Workplace Gender Equality Agency (WGEA) gives organisations a chance to explain these dynamics in their <a href="https://www.wgea.gov.au/about/our-legislation/publishing-employer-gender-pay-gaps">employer statements</a>, which are published on the WGEA website alongside organisations’ gender pay gaps. Over time, the entry of more women at the junior level can flow through to more gender balance as these women progress to senior and decision-making roles. The real test will be to ensure – by fostering more gender equitable, inclusive and respectful work cultures and systems – that they do.<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/236894/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/leonora-risse-405312">Leonora Risse</a>, Associate Professor in Economics, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Image credits: Shutterstock 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/australias-gender-pay-gap-has-hit-a-record-low-but-we-still-have-work-to-do-236894">original article</a>. </div>

Money & Banking

We reviewed the health habits of centenarians. These 4 things could lead to a longer life

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/zhaoli-dai-keller-1547476">Zhaoli Dai-Keller</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> and <a href="https://theconversation.com/profiles/perminder-sachdev-46869">Perminder Sachdev</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> The number of centenarians around the world rose from <a href="https://population.un.org/wpp/Download/Standard/Population/">151,000 in 2000</a> to 573,000 in 2021. People are living longer, and we can expect to see more people reach 100 in the years to come. Centenarians <a href="https://academic.oup.com/biomedgerontology/article/67A/4/395/623695">exemplify successful ageing</a>, often experiencing <a href="https://agmr.hapres.com/htmls/AGMR_1264_Detail.html">fewer chronic diseases</a> and maintaining independence in daily life well into their 90s. While <a href="https://link.springer.com/article/10.1186/s12979-016-0066-z">genetics contribute</a> to longevity, modifiable factors account for more than 60% <a href="https://pubmed.ncbi.nlm.nih.gov/14624729/">of successful aging</a>. But what sort of factors specifically contribute to living to 100? To find out, we reviewed lifestyle and health habits of centenarians and near-centenarians (those aged 95–99) worldwide. Our <a href="https://link.springer.com/article/10.1007/s11357-024-01247-4">recent review</a> included 34 observational studies published since 2000. Here are four key factors we found contribute to extreme longevity. <h2>1. A diverse diet with controlled salt intake</h2> Centenarians and near-centenarians typically had a balanced and diverse diet. We found, on average, they consumed between 57% and 65% of their energy intake from carbohydrates, 12% to 32% from protein, and 27% to 31% from fat. Their diets included staple foods (such as rice and wheat), fruits, vegetables, and protein-rich foods like poultry, fish and legumes, with moderate red meat consumption. This dietary pattern, similar to the <a href="https://pubmed.ncbi.nlm.nih.gov/29852087/">Mediterranean diet</a>, is linked to lower risks of <a href="https://doi.org/10.3390/ijerph14111364">physical function impairment</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/31685303/">death</a>. Most centenarians also preferred a low-salt diet. While only one study in our review measured the mean daily sodium intake, finding 1.6 grams, this was within the <a href="https://www.who.int/data/gho/indicator-metadata-registry/imr-details/3082#:%7E:text=A%20salt%20intake%20of%20less,much%20more%20salt%20than%20recommended">World Health Organization’s</a> recommendation of less than 2g of sodium per day (equivalent to about 5g of salt). The <a href="https://pubmed.ncbi.nlm.nih.gov/20234038/">traditional Okinawan diet</a>, known for its consumption by Japanese centenarians on Okinawa Island, contains an estimated 1.1g of sodium. We found higher salt intake (those who preferred salty food or added extra salt to meals) had a 3.6-fold increased risk of physical function impairment compared to those without a preference for salt. Practically, these findings suggest we should include plenty of wholegrains, root vegetables, beans, legumes, fruits and vegetables in our diet, minimise red meat consumption and opt for lean poultry, fish, and plant-based protein, and monitor salt in our food. <h2>2. Lower medication use</h2> Centenarians are not free from chronic conditions but typically develop them much later than average adults. More than half of the people in our review experienced common issues such as hypertension (high blood pressure), dementia, or cognitive impairment. We found people in our review took an average of 4.6 medications. The most frequently used medications included blood pressure medications and drugs for heart disease. This is similar to the results of <a href="https://doi.org/10.3390/jcm9051563">a large health register-based study</a> in Spain, which found centenarians took an average of 4.9 medications. Non-centenarians in this study took 6.7 medications on average. The fact centenarians appear to take fewer medications may indicate better health with fewer medical conditions. However, data on medication use is often self-reported and so may not be entirely accurate, especially among those with cognitive impairment. <a href="https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(24)00007-2/fulltext">Polypharmacy</a> is often defined as taking five or more medications simultaneously, and is common in older adults. Inappropriate polypharmacy is associated with <a href="https://www.nia.nih.gov/news/dangers-polypharmacy-and-case-deprescribing-older-adults">increased risks</a> of adverse events such as falls, cognitive impairment and hospitalisation, due to harmful drug interactions. While the type or number of prescribed medications may not be within a patient’s control, it’s important for doctors to <a href="https://link.springer.com/article/10.1186/s12875-017-0642-0">prescribe medications</a> only when necessary, fully inform patients about benefits and risks, and regularly review treatment plans. <h2>3. Getting good sleep</h2> Sleep quality and quantity <a href="https://newsinhealth.nih.gov/2013/04/benefits-slumber">affect</a> the immune system, stress hormones, and cardiometabolic functions such as obesity, high blood pressure, and diabetes. Good <a href="https://academic.oup.com/biomedgerontology/article/74/2/204/4837199">sleep</a> is associated with extended years of good health and reduced risks of chronic diseases. In our review, 68% of the centenarians were satisfied with their sleep quality. In a survey of adults’ sleep satisfaction in 13 countries in 2020, sleep satisfaction ranged from <a href="https://www.statista.com/statistics/1233775/adults-worldwide-satisfied-sleep-country/">29% to 67%</a>. The <a href="https://academic.oup.com/biomedgerontology/article/74/2/204/4837199">optimal sleep duration</a> is between seven and eight hours per night. Tips to <a href="https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/sleep/art-20048379">achieving better sleep</a> include keeping a regular sleep routine, creating a restful environment, exercising regularly and managing stress. <h2>4. Living environment</h2> More than 75% of the centenarians and near-centenarians in our review lived in rural areas. This is a pattern reflected in “<a href="https://www.bluezones.com/">blue zones</a>”, areas known for high concentrations of centenarians, such as Okinawa in Japan, Sardinia in Italy, the Nicoya Peninsula in Costa Rica, and Ikaria in Greece. This may be partly related to the connection between nature and health and wellbeing. For example, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6562165/">exposure to green space</a> has been associated with lower stress, depression, blood pressure, type 2 diabetes and heart disease, potentially increasing <a href="https://doi.org/10.1016/j.envint.2023.107785">life expectancy</a>. <h2>Other important factors</h2> We didn’t look at all lifestyle factors associated with longevity in our review. Research also shows <a href="https://www.sciencedirect.com/science/article/abs/pii/S053155650700143X">not smoking</a>, <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802963">avoiding alcohol</a> or drinking moderately, staying <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3618983/">physically active</a> and maintaining <a href="https://doi.org/10.1098/rspb.2019.1991">social connections</a> are important for boosting a person’s chances of living to 100. Of course, adopting the lifestyle changes discussed in this article won’t guarantee you’ll reach the ripe old age of 100. And on the flip side, some centenarians have shared <a href="https://theconversation.com/why-you-should-never-take-nutrition-advice-from-a-centenarian-229159">questionable</a> health habits. But many older adults are seeking to adopt <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9092121/">healthier lifestyles</a> to prevent and manage chronic conditions, while health-care professionals are similarly recognising the value of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5638636/">lifestyle medicine</a>. The earlier you can adopt positive lifestyle changes and healthier habits, the better placed you’ll be to achieve a long and healthy life. Becoming a centenarian is a lifelong endeavour.<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/235100/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/zhaoli-dai-keller-1547476">Zhaoli Dai-Keller</a>, Honorary Senior Lecturer, School of Pharmacy, University of Sydney; Nutritional epidemiologist and Lecturer, School of Population Health, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> and <a href="https://theconversation.com/profiles/perminder-sachdev-46869">Perminder Sachdev</a>, Scientia Professor of Neuropsychiatry, Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Shutterstock 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/we-reviewed-the-health-habits-of-centenarians-these-4-things-could-lead-to-a-longer-life-235100">original article</a>. </div>

Body

No, your aches and pains don’t get worse in the cold. So why do we think they do?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/manuela-ferreira-161420">Manuela Ferreira</a>, <a href="https://theconversation.com/institutions/george-institute-for-global-health-874">George Institute for Global Health</a> and <a href="https://theconversation.com/profiles/leticia-deveza-1550633">Leticia Deveza</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> It’s cold and wet outside. As you get out of bed, you can feel it in your bones. Your right knee is flaring up again. That’ll make it harder for you to walk the dog or go to the gym. You think it must be because of the weather. It’s a common idea, but a myth. When we looked at the evidence, <a href="https://www.sciencedirect.com/science/article/pii/S0049017224000337">we found</a> no direct link between most common aches and pains and the weather. In the first study of its kind, we found no direct link between the temperature or humidity with most joint or muscle aches and pains. So why are so many of us convinced the weather’s to blame? Here’s what we think is really going on. <h2>Weather can be linked to your health</h2> The weather is often associated with the risk of new and ongoing health conditions. For example, cold temperatures <a href="https://pubmed.ncbi.nlm.nih.gov/27021573/">may worsen</a> asthma symptoms. Hot temperatures <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(22)00117-6/fulltext">increase the risk</a> of heart problems, such as arrhythmia (irregular heartbeat), cardiac arrest and coronary heart disease. Many people are also convinced the weather is linked to their aches and pains. For example, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1479-8077.2004.00099.x?casa_token=jvpSbA4szqoAAAAA%3ATyHyGaqXmfevWyuJe6LW_3Pap3IPHC8HSMTl3RN63mFzNO0X7ozQjBb6Bi3yVFuPjqkrf-WlB-J5A1q1">two in every three</a> people with knee, hip or hand osteoarthritis <a href="https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-15-66">say</a> cold temperatures trigger their symptoms. Musculoskeletal conditions affect more than <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/musculoskeletal-conditions-comorbidity-australia/summary">seven million Australians</a>. So we set out to find out whether weather is really the culprit behind winter flare-ups. <h2>What we did</h2> Very few studies have been specifically and appropriately designed to look for any direct link between weather changes and joint or muscle pain. And ours is the first to evaluate data from these particular studies. We looked at data from more than 15,000 people from around the world. Together, these people reported more than 28,000 episodes of pain, mostly back pain, knee or hip osteoarthritis. People with rheumatoid arthritis and gout were also included. We then compared the frequency of those pain reports between different types of weather: hot or cold, humid or dry, rainy, windy, as well as some combinations (for example, hot and humid versus cold and dry). <h2>What we found</h2> We found changes in air temperature, humidity, air pressure and rainfall do not increase the risk of knee, hip or lower back pain symptoms and are not associated with people seeking care for a new episode of arthritis. The results of this study suggest we do not experience joint or muscle pain flare-ups as a result of changes in the weather, and a cold day will not increase our risk of having knee or back pain. In order words, there is no direct link between the weather and back, knee or hip pain, nor will it give you arthritis. It is important to note, though, that very cold air temperatures (under 10°C) were rarely studied so we cannot make conclusions about worsening symptoms in more extreme changes in the weather. The only exception to our findings was for gout, an inflammatory type of arthritis that can come and go. Here, pain increased in warmer, dry conditions. Gout has a very different underlying biological mechanism to back pain or knee and hip osteoarthritis, which may explain our results. The combination of warm and dry weather may lead to increased dehydration and consequently increased concentration of uric acid in the blood, and deposition of uric acid crystals in the joint in people with gout, resulting in a flare-up. <h2>Why do people blame the weather?</h2> The weather can influence other factors and behaviours that consequently shape how we perceive and manage pain. For example, some people may change their physical activity routine during winter, choosing the couch over the gym. And we know <a href="https://pubmed.ncbi.nlm.nih.gov/28700451/">prolonged sitting</a>, for instance, is directly linked to worse back pain. Others may change their sleep routine or sleep less well when it is either too cold or too warm. Once again, a bad night’s sleep can trigger your <a href="https://link.springer.com/article/10.1007/s00586-021-06730-6">back</a> and <a href="https://www.sciencedirect.com/science/article/pii/S1063458421007020">knee</a> pain. Likewise, changes in mood, often experienced in cold weather, trigger increases in both <a href="https://link.springer.com/article/10.1007/s00586-021-06730-6">back</a> and <a href="https://www.sciencedirect.com/science/article/pii/S1063458421007020">knee</a> pain. So these changes in behaviour over winter may contribute to more aches and pains, and not the weather itself. Believing our pain will feel worse in winter (even if this is not the case) may also make us feel worse in winter. This is known as the <a href="https://link.springer.com/article/10.1186/s12891-018-1943-8">nocebo effect</a>. <h2>What to do about winter aches and pains?</h2> It’s best to focus on risk factors for pain you can control and modify, rather than ones you can’t (such as the weather). You can: <ul> <li> become more physically active. This winter, and throughout the year, aim to walk more, or talk to your health-care provider about gentle exercises you can safely do at home, with a physiotherapist, personal trainer or at the pool </li> <li> lose weight if obese or overweight, as this is linked to <a href="https://jamanetwork.com/journals/jama/article-abstract/2799405">lower levels</a> of joint pain and better physical function </li> <li> keep your body warm in winter if you feel some muscle tension in uncomfortably cold conditions. Also ensure your bedroom is nice and warm as we tend to sleep <a href="https://www.sciencedirect.com/science/article/pii/S0033350623003359">less well</a> in cold rooms </li> <li> maintain a healthy diet and <a href="https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00098-X/fulltext">avoid smoking</a> or drinking high levels of alcohol. These are among <a href="https://ard.bmj.com/content/annrheumdis/82/1/48.full.pdf">key lifestyle recommendations</a> to better manage many types of arthritis and musculoskeletal conditions. For people with back pain, for example, a healthy lifestyle is linked with <a href="https://pubmed.ncbi.nlm.nih.gov/36208321/">higher levels</a> of physical function.<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/235117/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> </li> </ul> <a href="https://theconversation.com/profiles/manuela-ferreira-161420">Manuela Ferreira</a>, Professor of Musculoskeletal Health, Head of Musculoskeletal Program, <a href="https://theconversation.com/institutions/george-institute-for-global-health-874">George Institute for Global Health</a> and <a href="https://theconversation.com/profiles/leticia-deveza-1550633">Leticia Deveza</a>, Rheumatologist and Research Fellow, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock 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/no-your-aches-and-pains-dont-get-worse-in-the-cold-so-why-do-we-think-they-do-235117">original article</a>. </div>

Body

What’s inflation – and how exactly do we measure it?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/kevin-fox-16896">Kevin Fox</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> If the price of a cup of coffee goes up, coffee drinkers are worse off if their income doesn’t increase by at least the same amount – they have less money to spend on other things. But if the prices of many different goods and services all go up at the same time, it can have a significant impact on people’s ability to buy the things they want or need, such as food and paying the rent. This is inflation – a general increase in prices that reduces the purchasing power of money. High inflation is not good for most households, nor is deflation. Low and stable inflation is generally regarded as beneficial for economic prosperity. But how and why do we measure it? <h2>Tracking a ‘basket’ of important items</h2> A range of factors can cause or contribute to rising prices. Demand for certain products can exceed their supply, particularly when there are reductions in taxes or increases in government spending. Disruptions in supply chains and tariffs on imports can also increase prices. But how do we know if prices are going up across the whole economy, or just for some products? One popular solution is to create an aggregate measure of price changes, such as the consumer price index, or CPI for short. The CPI measures changes in the price of products that are important to consumers, as measured by relative expenditures. It’s calculated by the Australian Bureau of Statistics (ABS). The CPI covers a wide range of products that come under the following categories: <ul> <li>food and non-alcoholic beverages</li> <li>alcohol and tobacco</li> <li>clothing and footwear</li> <li>housing</li> <li>furnishings, household equipment and services</li> <li>health</li> <li>transport</li> <li>communication</li> <li>recreation and culture</li> <li>education</li> <li>insurance and financial services.</li> </ul> Currently, the full CPI is constructed on a quarterly basis. The ABS collects prices from sellers – nowadays often electronically, such as transaction data from barcode scanners at supermarket checkouts. If information on quantities sold is available, this will also be used to understand the economic importance of particular products to consumers. The main source of information on expenditure patterns is the <a href="https://www.abs.gov.au/statistics/economy/finance/household-expenditure-survey-australia-summary-results/2015-16">Household Expenditure Survey</a>. <hr /> <iframe id="9C4Qr" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/9C4Qr/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> All this information from the eight capital cities in Australia is weighted and indexed to create the CPI. <h2>What do we use it for?</h2> The CPI releases attract a lot of attention. They allow us to adjust welfare payments to maintain purchasing power, negotiate wage increases more fairly, and predict how costs are likely to change over time. Most importantly though, the figure is instrumental in determining interest rates. Our central bank – the Reserve Bank of Australia (RBA) – has the legislated responsibility to keep inflation between 2-3% per year. But because it cannot control things like taxes and government spending, the key way it does this is by adjusting interest rates. <hr /> <iframe id="CSV4V" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/CSV4V/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> The Reserve Bank sets the target cash rate – the interest rate on overnight loans between banks. Increasing this rate increases the costs to banks of borrowing. Banks pass this cost on, charging their customers higher interest rates. By increasing the cost of mortgage repayments and discouraging consumers from borrowing money for spending, this reduces consumer demand for products and can help lower inflation. <h2>Headline versus underlying</h2> The CPI is unlikely to be the inflation rate faced by any one individual – we all spend differently. It’s even possible to construct your own inflation rate, if you keep thorough spending records and understand the index methodology. But the CPI is not the only measure of inflation that is produced. It is often referred to “headline” inflation, to contrast it with measures of “underlying” inflation. Underlying inflation can better represent persistent domestic inflationary pressures which may need a policy response. Why can’t we always trust headline CPI? Some items prone to weather conditions or supply shocks, such as fruit and petrol, can face sharp, volatile price movements that skew the headline figure. Excluding them from the calculation can reveal underlying inflation conditions. Alternatives take a statistical approach to adjusting the headline rate, such as the trimmed-mean and weighted median estimates produced by the ABS and used by the RBA. By excluding certain items, these measures don’t reflect full changes in the cost of living faced by households – but neither does headline CPI. <h2>Other ‘flations</h2> You’ll often hear other inflation-related terms bandied about in the news. Here’s a helpful guide to a few of them: Deflation This is negative inflation. This can be bad as consumers will delay purchases as they wait for prices to fall further, leading to economic stagnation. Disinflation Inflation is still positive (overall prices are going up), but the rate of inflation decreases. If inflation was 4% and falls to 3%, this is disinflation, not deflation. Stagflation The economy simultaneously has stagnant growth, high inflation and high unemployment. This is rare, but famously happened during the oil crisis of the 1970s. Hyperinflation The annual rate of inflation in Argentina is currently 271.5%. In 2018 in Venezuela, it was over 1,000,000% per month. This is hyperinflation. The costs of this are enormous. Even with moderately high inflation, consumers are unable to differentiate relative price changes from general price changes in their consumption choices. With hyperinflation, money becomes virtually worthless. <hr /> This article is part of The Conversation’s “<a href="https://theconversation.com/au/topics/business-basics-157462">Business Basics</a>” series where we ask experts to discuss key concepts in business, economics and finance.<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/235673/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/kevin-fox-16896">Kevin Fox</a>, Professor, School of Economics; Director of the Centre for Applied Economic Research, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Shutterstock 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/whats-inflation-and-how-exactly-do-we-measure-it-235673">original article</a>. </div>

Money & Banking

Our research shows 4 in 10 Australians in aged care are malnourished. What can we do about it?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/jonathan-foo-1551045">Jonathan Foo</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/marie-claire-oshea-1373994">Marie-Claire O'Shea</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> In the next 40 years <a href="https://treasury.gov.au/sites/default/files/2023-08/p2023-435150-fs.pdf">in Australia</a>, it’s predicted the number of Australians aged 65 and over will more than double, while the number of people aged 85 and over will more than triple. If you’re not really interested in aged care, you should be. Given these figures, you will almost certainly be engaging with aged care services at some stage – either for yourself, or supporting family members or friends seeking aged care. One service you are likely to encounter is residential aged care homes. In the past few years this sector has been under more scrutiny than ever before. Changes to legislation, workforce and funding are in motion. But the question remains as to whether these changes can happen fast enough to meet our ageing population’s needs. One area of need not being adequately met at present is nutrition. In a <a href="https://www.mdpi.com/2227-9032/12/13/1296">new study</a>, we’ve found four in ten older Australians living in residential aged care are not receiving enough of the right types of nutrients, resulting in loss of weight and muscle. This is known as malnutrition. <h2>Good nutrition is essential for healthy ageing</h2> Malnutrition in older people is <a href="https://www.agedcarequality.gov.au/providers/food-nutrition-dining/why-meals-matter">associated with</a> poorer overall health, such as increased risk of falls and infections. This can accelerate loss of independence for older people, including the need for extra assistance with basic activities such as bathing and dressing. Older people are at increased risk of <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02612-5/abstract">malnutrition</a> for a range of reasons. These can include decreased appetite, difficulties with chewing and swallowing, and the presence of other chronic diseases such as Parkinson’s disease or dementia. Importantly, ensuring adequate nutrition is about more than just offering healthy foods. We eat not only to meet nutritional requirements, but for enjoyment and socialisation. We each have different preferences around what we want to eat, when and with whom. Food provision poses a challenge for residential aged care providers who must navigate the range of residents’ preferences together with dietary restrictions and texture modifications. This must also be balanced against the practicalities of having the right number of appropriately trained kitchen and mealtime assistance staff, and working within funding constraints. Understanding more about who is malnourished in aged care can help providers better address this problem. <h2>Malnutrition is an ongoing problem in aged care</h2> We looked at more than 700 aged care residents in New South Wales, Queensland and South Australia. We assessed participants for malnutrition using a screening tool that collects data on medical history and dietary intake, and includes a physical examination of muscle and fat. We found 40% were malnourished, including 6% who were severely malnourished. This likely underestimates the true rate of malnutrition, as residents with dementia were excluded. International <a href="https://www.mdpi.com/2072-6643/15/13/2927">studies</a> have shown an average of 80% of aged care residents with dementia are malnourished or at risk of developing malnutrition. Our findings are broadly in line with a synthesis of <a href="https://www.sciencedirect.com/science/article/pii/S0378512219301148">38 international studies</a>, which reported an average malnutrition rate in residential aged care of 52%. In Australia, malnutrition was highlighted as <a href="https://www.royalcommission.gov.au/aged-care">a priority</a> for immediate attention in the 2021 Royal Commission into Aged Care Quality and Safety. Its report cited <a href="https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/dairy-food-supplementation-may-reduce-malnutrition-risk-in-institutionalised-elderly/52E93ADD586C634A3913A2AFE9D07847">an Australian study</a> of 215 residents, published in 2017, which found 68% were malnourished or at risk of malnutrition. It’s difficult to directly compare malnutrition rates between studies due to differences in diagnostic measurements. But it’s clear malnutrition is an ongoing challenge in aged care. <h2>What can we do about it?</h2> Since the royal commission, we’ve seen the strengthening of the <a href="https://www.agedcarequality.gov.au/providers/quality-standards/strengthened-quality-standards">quality standards</a> to be included in the new Aged Care Act, anticipated to be introduced to parliament in 2025. The strengthened quality standards provide an important framework to guide action by aged care providers on malnutrition. Key requirements include partnering with residents to design food options, regular assessment and reassessment of resident nutrition requirements, developing systems to monitor and improve satisfaction with food, designing pleasant dining environments, and providing staff with the training they need to achieve all of the above. However, achieving these standards will require investment of money and time. At the moment, <a href="https://kpmg.com/au/en/home/insights/2023/09/australian-aged-care-sector-analysis.html">64% of residential aged care providers</a> in Australia are operating at a financial loss. While we know carers and facility managers want to provide the best care possible, it’s difficult to achieve this when contending with underlying financial problems. As such, our teams at Monash and Griffith universities are focusing on strategies that minimise the burden on staff and providers. We are working on automating malnutrition screening. Current tools take 10–15 minutes and should be used when a new resident moves into an aged care home and regularly during their stay. But anecdotal evidence suggests providers lack the staff and funding needed to routinely carry out this screening. Instead, we aim to use existing data from aged care providers, including quarterly reports from the <a href="https://www.health.gov.au/our-work/qi-program">National Aged Care Mandatory Quality Indicator Program</a>, to detect malnutrition automatically. This will allow staff to focus more on care. Given the complexity of malnutrition, it’s likely that addressing the issue at a national scale will take some time. In the short term, for those with loved ones in aged care homes, we encourage you to be actively involved in their care, including noticing and speaking up if you think more can be done to optimise their nutrition.<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/235507/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jonathan-foo-1551045">Jonathan Foo</a>, Lecturer, Physiotherapy, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/marie-claire-oshea-1373994">Marie-Claire O'Shea</a>, Senior Lecturer, School of Health Sciences and Social Work, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Shutterstock 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/our-research-shows-4-in-10-australians-in-aged-care-are-malnourished-what-can-we-do-about-it-235507">original article</a>. </div>

Body

"We should give back": Bill Gates' ex-wife on giving away her $16bn fortune

Melinda French Gates has opened up on her decision to give away her fortune after leaving the Bill & Melinda Gates Foundation in June. Melinda, who is reportedly worth $16.8 billion, said that she will stick with her decision to give away her fortune on The Late Show with Stephen Colbert, as it's "the right thing to do for society". "If we grew up in the United States, anybody who has grown up in this country has been really lucky and I don't care who you are," she explained. "To be able to go to a decent school, grow up and pursue your career, and if so you are a billionaire, my gosh, you have benefited from this country, right? "So we should give back." She also feels there is "a responsibility and to do it in a way that's incredibly thoughtful". Melinda, who divorced the Microsoft founder Bill Gates back in 2021, has announced her plans to focus on her organisation Pivotal Ventures, which she founded in 2015. The organisation's aim is to "advance social progress by removing barriers that hold people back." She said that she is determined to ensure that "women's rights are not only on the agenda, but that women are setting the agenda" – especially after watching women's rights be rolled back internationally over the last few years." "What I saw, part of why our women's rights got rolled back in the United States is that those organisations were starved for funding, and they were playing defense," she explained. Melinda has pledged to donate $1 billion to this end over the next two years. Image: Julien De Rosa/EPA/ Shutterstock Editorial

Money & Banking

Our obsession with taking photos is changing how we remember the past

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/giuliana-mazzoni-175429">Giuliana Mazzoni</a>, <a href="https://theconversation.com/institutions/university-of-hull-1191">University of Hull</a> I recently visited the <a href="http://hermitage--www.hermitagemuseum.org/wps/portal/hermitage/?lng=sv">Hermitage</a> in St Petersburg, Russia – one of the best art museums in the world. I was expecting to serenely experience its masterpieces, but my view was blocked by a wall of smart phones taking pictures of the paintings. And where I could find a bit of empty space, there were people taking selfies to create lasting memories of their visit. For many people, taking hundreds, if not thousands, of pictures is now a crucial part of going on holiday – documenting every last detail and posting it on social media. But how does that affect our actual memories of the past – and how we view ourselves? As an expert on memory, I was curious. Unfortunately, psychological research on the topic is so far scant. But we do know a few things. We use smart phones and new technologies <a href="http://studie-life.de/en/life-reports/smart-payments;%20https://www.researchgate.net/profile/Tim_Fawns/publication/275331048_Blended_Memory_the_Changing_Balance_of_Technologically-mediated_Semantic_and_Episodic_Memory/links/56962c6d08ae820ff07594ee.pdf">as memory repositories</a>. This is nothing new – humans have always used external devices as an aid when acquiring knowledge and remembering. Writing certainly serves this function. Historical records are collective external memories. Testimonies of migrations, settlement or battles help entire nations trace a lineage, a past and an identity. In the life of an individual, written diaries serve a similar function. <h2>Memory effects</h2> Nowadays we tend to commit very little to memory – we entrust a huge amount to the cloud. Not only is it almost unheard of to recite poems, even the most personal events are generally recorded on our cellphones. Rather than remembering what we ate at someone’s wedding, we scroll back to look at all the images we took of the food. This has serious consequences. Taking photos of an event rather than being immersed in it has been shown to lead to <a href="https://theconversation.com/memory-loss-isnt-just-an-old-persons-problem-heres-how-young-people-can-stay-mentally-fit-102352">poorer recall of the actual event</a> – we get distracted in the process. Relying on photos to remember has a similar effect. Memory needs to be exercised on a regular basis in order to function well. There are many studies documenting the importance of memory retrieval practice – <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.738.2035&rep=rep1&type=pdf">for example in university students</a>. Memory is and will remain essential for learning. There is indeed some evidence showing that committing almost all knowledge and memories to the cloud <a href="https://www.journals.uchicago.edu/doi/10.1086/691462">might hinder the ability to remember</a>. However, there is a silver lining. Even if some studies claim that all this makes us more stupid, what happens is actually shifting skills from purely being able to remember to being able to manage the way we remember more efficiently. This is called metacognition, and it is an overarching skill that is also essential for students – for example when planning what and how to study. There is also substantial and reliable evidence that external memories, selfies included, <a href="https://www.ncbi.nlm.nih.gov/pubmed/23957379">can help</a> individuals with memory impairments. But while photos can in some instances help people to remember, the quality of the memories may be limited. We may remember what something looked like more clearly, but this could be at the expense of other types of information. One study showed that while photos could help people remember what they saw during some event, they <a href="https://journals.sagepub.com/doi/abs/10.1177/0956797617694868">reduced their memory of what was said</a>. <h2>Identity distortions?</h2> There are some rather profound risks when it comes to personal memory. Our identity is a product of our life experiences, which can be easily accessed through our memories of the past. So, does constant photographic documentation of life experiences alter how we see ourselves? There is no substantial empirical evidence on this yet, but I would speculate that it does. Too many images are likely to make us remember the past in a fixed way – blocking other memories. While it is <a href="https://theconversation.com/what-is-your-first-memory-and-did-it-ever-really-happen-95953">not uncommon for early childhood memories</a> to be based on photos rather than the actual events, these are not always true memories. Another issue is the fact that research has uncovered <a href="https://www.sciencedirect.com/science/article/pii/S0747563216302503;%20http://www.vulture.com/2014/01/history-of-the-selfie.html">a lack of spontaneity in selfies</a> and many other photos. They are planned, the poses are not natural and at times the image of the person is distorted. They also reflect a narcissistic tendency which shapes the face in unnatural mimics – artificial big smiles, sensual pouts, funny faces or offensive gestures. Importantly, selfies and many other photos are also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318447/">public displays</a> of specific attitudes, intentions and stances. In other words, they do not really reflect who we are, they reflect what we want to show to others about ourselves at the moment. If we rely heavily on photos when remembering our past, we may create a distorted self identity based on the image we wanted to promote to others. That said, our natural memory isn’t actually perfectly accurate. Research shows that we often <a href="https://theconversation.com/the-real-you-is-a-myth-we-constantly-create-false-memories-to-achieve-the-identity-we-want-103253">create false memories about the past</a>. We do this in order to maintain the identity that we want to have over time – and avoid conflicting narratives about who we are. So if you have always been rather soft and kind – but through some significant life experience decide you are tough – you may dig up memories of being aggressive in the past or even completely make them up. Having multiple daily memory reports on the phone of how we were in the past might therefore render our memory less malleable and less adaptable to the changes brought about by life – making our identity more stable and fixed. But this can create problems if our present identity becomes different from our fixed, past one. That is an uncomfortable experience and exactly what the “normal” functioning of memory is aimed to avoid – it is malleable so that we can have a non-contradictory narrative about ourselves. We want to think of ourselves as having a certain unchanging “core”. If we feel unable to change how we see ourselves over time, this could seriously affect our sense of agency and mental health. So our obsession with taking photos may be causing both memory loss and uncomfortable identity discrepancies. It is interesting to think about how technology changes the way we behave and function. As long as we are aware of the risks, we can probably mitigate harmful effects. The possibility that actually sends shivers to my spine is that we lose all those precious pictures because of some widespread malfunctioning of our smart phones. So the next time you’re at a museum, do take a moment to look up and experience it all. Just in case those photos go missing.<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/109285/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/giuliana-mazzoni-175429">Giuliana Mazzoni</a>, Professor of Psychology, <a href="https://theconversation.com/institutions/university-of-hull-1191">University of Hull</a> Image credits: Shutterstock 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/our-obsession-with-taking-photos-is-changing-how-we-remember-the-past-109285">original article</a>. </div>

Mind

Poor sleep is really bad for your health. But we found exercise can offset some of these harms

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/bo-huei-huang-1243280">Bo-Huei Huang</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/emmanuel-stamatakis-161783">Emmanuel Stamatakis</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Despite the well-known links between poor sleep and poorer health, getting enough good quality sleep has become a luxury in modern society. Many of us struggle to improve our sleep, while amid the COVID pandemic and recurring lock-downs, <a href="https://theconversation.com/were-sleeping-more-in-lockdown-but-the-quality-is-worse-155797">our sleep has deteriorated</a>. But <a href="https://doi.org/10.1136/bjsports-2021-104046">our new study</a>, published today in the British Journal of Sports Medicine, bears some encouraging news. We found doing enough physical activity (including exercise such as running or going to the gym) may counter some of the adverse health effects of unhealthy sleep patterns. Let us explain. <h2>Does poor sleep really harm our health?</h2> Unhealthy sleep patterns include: <ul> <li> not sleeping for long enough (less than seven hours per night for adults) </li> <li> sleeping for too long (more than nine hours per night for adults) </li> <li> snoring </li> <li> insomnia </li> <li> being a night owl, also known as “late chronotype”. This is people who naturally feel most awake and motivated in the evening, and are sluggish in the morning. </li> </ul> They are <a href="https://doi.org/10/ggjqrt">all associated</a> with poorer health. Recent research shows poor sleep may: <ul> <li> cause <a href="https://doi.org/10.1038/s41577-019-0190-z">inflammation</a> </li> <li> impair the metabolism of glucose (also known as blood sugar) and reduce the number of calories burned, thereby increasing the risk of <a href="https://theconversation.com/why-sleep-is-so-important-for-losing-weight-145058">obesity</a> </li> <li> increase the risk of <a href="https://doi.org/10/gg6x87">heart disease</a> and <a href="https://doi.org/10/ggnw5h">premature death</a>. </li> </ul> However, very few studies have examined how sleep and physical activity interact and impact our health. We set out to answer the question: if I have poor sleep but I do quite a lot of physical activity, can that offset some of the harms of my poor sleep in the long-term? Or would this not make any difference? <h2>What did we do?</h2> We analysed the information provided by 380,055 middle-aged adults in the UK Biobank study, recruited between 2006 and 2010. Participants reported their level of physical activity and five aspects of their sleep. We grouped people based on their sleep behaviour into healthy, intermediate or poor. We categorised people’s level of physical activity based on <a href="https://bjsm.bmj.com/content/54/24/1451">the World Health Organization (WHO) guidelines</a>. People who met the upper bounds of the guidelines did 300 minutes of moderate intensity physical activity a week, or 150 minutes of vigorous exercise, or a combination of both. Those who met the lower bound did 150 minutes of moderate intensity exercise a week, or 75 minutes of vigorous exercise, or a combination. Moderate intensity physical activity usually makes you slightly out of breath if sustained for a few minutes and includes brisk walking or cycling at a leisurely pace. Vigorous exercise usually makes you breath hard and can include running, swimming, and playing sports like tennis, netball, soccer or footy. <figure class="align-center "><img src="https://images.theconversation.com/files/408096/original/file-20210624-15-1qfe1ay.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/408096/original/file-20210624-15-1qfe1ay.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/408096/original/file-20210624-15-1qfe1ay.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/408096/original/file-20210624-15-1qfe1ay.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/408096/original/file-20210624-15-1qfe1ay.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=515&fit=crop&dpr=1 754w, https://images.theconversation.com/files/408096/original/file-20210624-15-1qfe1ay.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=515&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/408096/original/file-20210624-15-1qfe1ay.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=515&fit=crop&dpr=3 2262w" alt="" /><figcaption>Doing at least 150 minutes of moderate intensity physical activity a week, or 75 minutes of vigorous exercise, can offset some of the health harms of poor sleep. <a class="source" href="https://apps.who.int/iris/bitstream/handle/10665/336656/9789240015128-eng.pdf?sequence=1&isAllowed=y">World Health Organization, CC BY-NC-SA 3.0 IGO</a></figcaption></figure> <h2>What did we find?</h2> We followed up with the participants after 11 years. By May 2020, 15,503 participants had died, of which 4,095 died from heart disease and 9,064 died from cancer. <a href="https://doi.org/10.1136/bjsports-2021-104046">We found</a> that, compared to healthy sleepers, people with poor sleep had a 23% higher risk of premature death, a 39% higher risk of dying from heart disease, and a 13% higher risk of dying from cancer. We then compared the data of people who slept well with those who slept poorly, and how much they exercised. We found people who had the highest risk of dying from heart disease and cancer were those who had poor sleep and didn’t meet the WHO physical activity guidelines. On the other hand, those who had poor sleep but did enough physical activity to meet the WHO guidelines didn’t have as high a risk of dying from heart disease or cancer, compared to those who slept poorly and didn’t meet the physical activity guidelines. For example, let’s look at the risk of dying from cancer. Those who had poor sleep and did no physical activity had a 45% higher risk of dying from cancer compared to those who had healthy sleep and exercised a lot. But among those who met the physical activity guidelines, despite poor sleep, they didn’t really have a higher risk of dying from cancer any more. We found physical activity levels which met at least the bottom threshold of the WHO guidelines could reduce or eliminate some of the health harms of poor sleep. So people who did at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity exercise per week were to some extent protected against the detrimental health effects of poor sleep. Those who had both poor sleep and did no moderate-to-vigorous intensity physical activity had the highest risks of premature death. Our study wasn’t designed to find out how and why physical activity may counteract some of the bad physiological impacts of poor sleep. But other research provides theories. For example, adequate physical activity may <a href="https://doi.org/10.1249/MSS.0000000000001179">reduce inflammation, help maintain a healthy glucose metabolism</a>, and <a href="https://doi.org/10.1016/j.pcad.2018.07.014">increase the number of calories burned</a>. It’s important to note our study was what’s called an “observational study”. It shows an association between adequate physical activity and reduced harms from poor sleep, but we must be careful in interpreting causation. It can’t conclusively say adequate physical activity causes the reduction of harms from poor sleep, though there’s strong evidence for an association in the right direction. Our study offers a hopeful message, that even if you haven’t been able to improve your sleep, you can still offset some of the health harms by doing enough exercise. <a href="https://www.sciencedirect.com/science/article/abs/pii/S009174352030339X">Our previous research</a> has also shown physical activity may help improve poor sleep patterns, which are a serious health problem across the world. In addition to combating some of the negative outcomes of poor sleep, physical activity can also provide many other health benefits and extend our lives. For example, a 2019 study found people who met WHO’s physical activity target above <a href="https://doi.org/10.1186/s12916-019-1339-0">lived three years longer on average</a> than those who didn’t. During lockdowns, access to parks, gyms, and swimming pools might be limited in many places. But there are still many ways to <a href="https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/publications-and-technical-guidance/noncommunicable-diseases/stay-physically-active-during-self-quarantine">to stay fit and active at home during the coronavirus</a>.<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/163270/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/bo-huei-huang-1243280">Bo-Huei Huang</a>, PhD candidate, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/emmanuel-stamatakis-161783">Emmanuel Stamatakis</a>, Professor of Physical Activity, Lifestyle, and Population Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock 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/poor-sleep-is-really-bad-for-your-health-but-we-found-exercise-can-offset-some-of-these-harms-163270">original article</a>. </div>

Body

Compulsory voting in Australia is 100 years old. We should celebrate how special it makes our democracy

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/paul-strangio-1232">Paul Strangio</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> For nearly 200 years, the notion of American political exceptionalism has had currency in the United States: it is an idea rooted in the nation’s status as the first modern republic. As we watch from afar, disturbed yet mesmerised by the latest chapter of violent political division in America, the country seems less a paragon than a symbol of democratic pathology. America’s certainty in its political uniqueness is symptomatic of a brash national chauvinism. By way of contrast, Australia is prone, if anything, to undue bashfulness about its democratic credentials. How else can we explain that this month marks the centenary of the most extraordinary feature of the country’s democratic architecture, and yet the anniversary is slipping by with neither comment nor reflection. I refer to compulsory voting, which was legislated in the federal parliament in July 1924. Compulsory voting is not unique to Australia. Calculating how many countries abide by the practice is notoriously difficult, since in around half the nations where compulsory voting exists in name it is not enforced. Most estimates, however, put the figure in the vicinity of 20 to 30. If not unique, Australia’s experience of compulsory voting is highly distinctive for a number of reasons. First, its emergence in the early 20th century was consistent with the nation’s larger tradition of innovation and experimentation when it came to electoral institutions and practices. This record is typically traced back to the pioneering in the 1850s of the secret ballot (sometimes called the “Australian ballot”) in a number of the Australian colonies and the embrace of other advanced democratic measures in the second half of the 19th century. These included manhood suffrage, payment of MPs and the extension of the franchise to women, beginning in South Australia in 1894. The innovations continued in the 20th century with such things as preferential voting and non-partisan bureaucratic electoral administration. Second, Australia is alone in embracing compulsory voting among the Anglophone democracies to which it typically compares itself. The electoral systems of Britain, Canada, New Zealand and the United States are all based on voluntary voting. Third, unlike many other compulsory voting countries, Australia does not pay lip service to its operation. Electoral authorities enforce compulsory voting, albeit leniently. It has been strongly upheld by the courts and is backed by a regime of sanctions for non-compliance. Fourth, compulsory voting has been consistently and unambiguously successful in achieving high voter turnout. Though there has been a slight downward trend in turnout at the past five national elections (it hit a low of 90.5% in 2022), it has not fallen below 90% since the adoption of compulsory voting a century ago. This is around 30% higher than the recent average turnout in countries with voluntary voting. It is also well above the recent average in countries with compulsory voting systems. Fifth, the public has strongly and consistently backed the practice. Evidence from more than half a century of opinion polls and election study surveys shows support hovering around the 70% mark. <h2>An impregnable practice</h2> Perhaps the most singular aspect of the nation’s experience of compulsory voting, however, is how seemingly impregnable is the practice if measured by its durability, the dearth of controversy over it, the consistency of its enforcement by authorities and the way citizens have dutifully complied with and supported it. Together these things make Australia an exemplar of compulsory voting internationally. This is not to say compulsory voting has been a sacred cow in Australia. In the final decades of the 20th century and first decade of this century, there was a concerted push to end the practice emanating principally from within the Liberal Party. The torchbearer of the agitation for voluntary voting was the avowed libertarian South Australian senator, Nick Minchin. <a href="https://classic.austlii.edu.au/au/journals/SGSocUphAUCon/2003/11.html">For Minchin</a>, compulsory voting was anathema: <blockquote> […] in relation to the most important single manifestation of democratic will, the act of voting, I profoundly detest Australia’s denial of individual choice. It seems to me that an essential part of a liberal democracy should be the citizen’s legal right to decide whether or not to vote. The denial of that right is an affront to democracy. </blockquote> Minchin had a number of like-minded supporters of voluntary voting in the Liberal Party. Among them, importantly, was John Howard, whose prime ministership coincided with the mobilisation to abolish compulsory voting. Howard had been on record as an opponent of the practice since his entry to the federal parliament in 1974. The Liberal Party campaign against compulsory voting manifested in, among other things: <ul> <li>the party’s federal council resolving in favour of voluntary voting</li> <li>shadow cabinet endorsing a recommendation for a change of policy to voluntary voting being placed before the joint Liberal-National party parliamentary room</li> <li>the introduction in the South Australian parliament of two bills to repeal compulsory voting by successive Liberal state governments</li> <li>Coalition members of the Joint Standing Committee on Electoral Matters repeatedly recommending the abolition of the practice.</li> </ul> In the end, these agitations achieved nought. The most fundamental reason was that the opponents of compulsory voting failed to generate community resentment towards the system. Howard, while restating his preference for voluntary voting, admitted as much in 2005 when shutting down debate on the issue in his government: <blockquote> As I move around the country, I don’t get people stopping me in the street and saying, “You’ve got to get rid of compulsory voting.” </blockquote> Indeed, election survey data suggests the Liberal campaign coincided with a firming of public support for compulsory voting. In the two decades since, opposition has been dormant. For the foreseeable future, Australia’s compulsory voting regime is secure. <h2>An Australian democratic exceptionalism?</h2> As noted above, compulsory voting has kept voter turnout at elections above 90% for the past century. Kindred democracies marvel at, and envy, this level of participation. It affords legitimacy to election outcomes in this country. Significantly, it also produces a socially even turnout. Compare this to the situation in this month’s United Kingdom election. Turnout <a href="https://www.theguardian.com/politics/article/2024/jul/12/lowest-turnout-in-uk-general-election-since-universal-suffrage-report-shows">is estimated</a> to have slumped to a record low 52%. There was a clear pattern of the “haves” exercising much greater say at the ballot box than the “have nots”. Those who stayed away from the polls were predominantly less well-off, non-homeowners, the young, the lower-educated and of minority ethnic background. Australia cannot be complacent in this regard. Low and declining turnout in remote electorates with high Indigenous populations is the most worrying chink in the performance of compulsory voting. In 2022, turnout in the Northern Territory seat of Lingiari fell to 66.8%. Even so, the practice largely succeeds in achieving inclusive voter participation across the country. Crucially, compulsory voting is also recognised as one reason the political centre holds better in Australia than in many comparable nations. It exercises a moderating influence because it ensures it is not only impassioned partisans at either end of the political spectrum who participate in elections. This in turn means they are not the chief focus of governments and political parties. Under a compulsory voting system, middle-of-the-road citizens and their concerns and sensibilities count. This inhibits the trend towards polarisation and grievance politics evident in other parts of the globe. It helps explain why Australia has been less receptive to the aggressive conservative populism that has taken root in the United States and Europe. Compulsory voting also goes hand in hand with other institutional bulwarks of the nation’s democracy. While there is plenty of evidence in Australia of increasing disaffection with politics, one thing that helps bolster faith in the democratic system is the politically independent national electoral authority, the Australian Electoral Commission. The AEC’s trusted impartial administration of the electoral system lends integrity to the democratic process. So do the many procedures it manages to facilitate voting. To name a few: Saturday election days, assistance for the ill, aged and those from non-English-speaking backgrounds, mobile polling stations, postal, absentee and early voting, and active and regular updating of registration. Indeed, Australia has been described as “the most voter-friendly country in the world”. Compulsory voting encourages this accessibility: if citizens are obliged to vote, then it becomes incumbent to smooth the path to them participating. The ease of voting in Australia contrasts with what goes on elsewhere, for example, the rampant state-based voter-suppression practices in the United States. Dare we suggest, then, that compulsory voting is a mainstay of an Australian democratic exceptionalism? That we little note, let alone extol, the practice is perhaps not only a product of an inherent national modesty but because it is second nature after 100 years. Habituated to being compelled to participate in elections, we are inured to its specialness. Let’s hope this casual familiarity does not induce apathy rather than vigilance when next the system is challenged.<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/234801/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/paul-strangio-1232">Paul Strangio</a>, Emeritus Professor of Politics, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock 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/compulsory-voting-in-australia-is-100-years-old-we-should-celebrate-how-special-it-makes-our-democracy-234801">original article</a>. </div>

Legal

We have too few aged care workers to care for older Australians. Why? And what can we do about it?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/hal-swerissen-9722">Hal Swerissen</a>, <a href="https://theconversation.com/institutions/la-trobe-university-842">La Trobe University</a> In a country like Australia, we all expect that when we get old, we’ll be able to rely on a robust aged care system. But aged care providers can’t find staff and a crisis is brewing. If the problem isn’t fixed, there are serious risks to quality and access to services for older people who need support. There are also broader social, economic and political consequences for undervaluing the rapidly expanding health and social assistance workforce. Aged care <a href="https://www.health.gov.au/sites/default/files/documents/2021/10/2020-aged-care-workforce-census.pdf">employs</a> around 420,000 people. Around 80% of those are front line staff providing care and demand for them is increasing rapidly. <h2>Australians are ageing</h2> The number of people aged 80 and over is <a href="https://treasury.gov.au/sites/default/files/2019-03/IGR_2010_Overview.pdf">projected to double</a> by 2050. At the same time, informal family care is becoming less available. In the next 25 years, <a href="https://www.australianageingagenda.com.au/executive/shortfall-of-400000-aged-care-workers-predicted-by-2050/">twice as many</a> aged care staff will be needed. Currently, about 1.4 million older people <a href="https://www.aihw.gov.au/reports/older-people/older-australians/contents/aged-care">receive</a> aged care services, including basic and more intensive home care and residential care. Health care and social support job vacancies and ads are the highest of any industry. Between 30,000 and 35,000 additional direct aged care workers a year are already needed. By 2030 the <a href="https://cedakenticomedia.blob.core.windows.net/cedamediacontainer/kentico/media/attachments/ceda-duty-of-care-3.pdf">shortfall</a> is likely to be 110,000 full time equivalent workers. <h2>Why don’t enough people want to work in aged care?</h2> Despite recent <a href="https://www.health.gov.au/topics/aged-care-workforce/what-were-doing/better-and-fairer-wages">pay increases</a>, it is difficult to attract and retain aged care workers because the work is under-valued. The Australian workforce is undergoing profound change. A generation ago, manufacturing made up 17% of the workforce. Today it has fallen to 6%. By contrast, the health care and social assistance workforce has doubled from 8% to 16%. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=423&fit=crop&dpr=1 754w, https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=423&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=423&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>The manufacturing workforce has declined, while health, aged care and social assistance has risen. ABS 6291.0.55.001 Labour Force, Australia.</figcaption></figure> Manufacturing jobs were <a href="https://australiainstitute.org.au/wp-content/uploads/2020/12/Manufacturing-Briefing-Paper-FINAL.pdf">mainly</a> secure, full-time, reasonably paid jobs dominated by male workers. By contrast, jobs in aged care are often insecure, part-time and poorly paid, dominated by women, with many workers coming from non-English speaking backgrounds. Since moving to take over aged care in the 1980s, the federal government has over-emphasised <a href="https://arena.org.au/a-genealogy-of-aged-care/">cost constraint</a> through service privatisation, activity-based funding and competition, often under the cover of consumer choice. The result is a highly fragmented and poorly coordinated aged care sector with almost 3,200, often small and under-resourced providers centrally funded and regulated from Canberra. This has <a href="https://www.health.gov.au/sites/default/files/a-matter-of-care-australia-s-aged-care-workforce-strategy.pdf">led to</a> high levels of casualisation, low investment in training and professional development, and inadequate supervision, particularly in the home care sector. Aged care is facing a perfect storm. Demand for care and support staff is increasing dramatically. The sector is poorly coordinated and difficult to navigate. Pay and conditions remain poor and the workforce is relatively untrained. There are no minimum standards or registration requirements for many front-line aged care staff. <h2>What are the consequences?</h2> An understaffed and under-trained aged care workforce reduces access to services and the quality of care and support. Aged care providers <a href="https://www.agedhealth.com.au/content/compliance-and-governance/news/troubled-outlook-for-aged-care-reforms-1224428737#:%7E:text=Its%20report%20found%20that%2053.8,was%20%22impossible%20to%20achieve%22.">routinely report</a> it is difficult to attract staff and they can’t meet the growing demand for services from older people. Staff shortages are already having an impact on residential care occupancy rates falling, with some regional areas now down to only 50% occupancy. That means older people either don’t get care or they are at increased risk of neglect, malnutrition, avoidable hospital admissions and a poorer quality of life. Inevitably, lack of aged care workers puts pressure on hospital services when older people have nowhere else to go. <h2>What needs to be done?</h2> Addressing these challenges requires a multifaceted approach. Australia will need a massive increase in the number of aged care workers and the quality of the care they provide. Wages have to be competitive to attract and retain staff. But better pay and conditions is only part of the story. Unless aged care becomes a career the community recognises, values and supports, it will continue to be difficult to train, attract and retain staff. The recent <a href="https://www.royalcommission.gov.au/aged-care">Royal Commission on Aged Care Quality and Safety</a> highlighted the need for a more skilled workforce, emphasising the importance of ongoing professional development for all staff. To date the federal government’s aged care workforce initiatives have been underwhelming. They are a limited and piecemeal rather than a coherent workforce strategy. In the short term, skilled migration may be part of the solution. But progress to bring in skilled aged care workers has been glacial. Currently only about 1% of providers <a href="https://theconversation.com/overseas-recruitment-wont-solve-australias-aged-care-worker-crisis-189126">have agreements</a> to bring in staff from overseas. At best, overseas migration will meet only 10% of the workforce shortfall. Registration, qualifications and training for direct care work have to become mandatory to make sure care standards are met. Much more significant and systematic incentives and support for training will be needed. Supervision, career progression and staff development will also have to be dramatically improved if we are to attract and retain the workforce that is needed. “Learn and earn” incentives, including scholarships and traineeships for aged care, are needed to attract the future workforce. At the same time, a much broader investment in upskilling the entire workforce through continuing professional development and good quality supervision is necessary. Like manufacturing a generation ago, aged care needs to become valued, skilled, secure and well-paid employment if it is going to attract the staff that are needed to avoid a looming crisis.<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/232707/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/hal-swerissen-9722">Hal Swerissen</a>, Emeritus Professor of Public Health, <a href="https://theconversation.com/institutions/la-trobe-university-842">La Trobe University</a> Image credits: Shutterstock 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/we-have-too-few-aged-care-workers-to-care-for-older-australians-why-and-what-can-we-do-about-it-232707">original article</a>. </div>

Caring

We know what to eat to stay healthy. So why is it so hard to make the right choices?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/nina-van-dyke-822557">Nina Van Dyke</a>, <a href="https://theconversation.com/institutions/victoria-university-1175">Victoria University</a> A healthy diet <a href="https://www.who.int/initiatives/behealthy/healthy-diet">protects us</a> against a number of chronic diseases, including heart disease, diabetes and cancer. From early childhood, we receive an abundance of <a href="https://cdn.who.int/media/docs/default-source/healthy-diet/healthy-diet-fact-sheet-394.pdf?sfvrsn=69f1f9a1_2&download=true">information</a> about how we <a href="https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating">should eat</a> to be healthy and reduce our risk of disease. And most people have a <a href="https://link.springer.com/content/pdf/10.1186/1479-5868-11-63.pdf">broad understanding</a> of what healthy eating looks like. But this knowledge <a href="https://www.sciencedirect.com/science/article/pii/S0001209216310584?casa_token=6CZgCmT1RMgAAAAA:sSRsj2o6swVfvoBxMIVrMTxqdczSAiFwfTCYzYQ8U3z4ey_WLQ6knpmk8WRH77zugAS3wEAQrA">doesn’t always result</a> in healthier eating. In our new research, we set out to <a href="https://link.springer.com/content/pdf/10.1186/s12889-024-18432-x.pdf">learn more</a> about why people eat the way they do – and what prevents them from eating better. Lack of time was a major <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/obr.12472?casa_token=1D1mi-l0TR0AAAAA:dgebTQx-wgw7jbREfdawxZ5AZSDRztvrt8t1tuKyDy1x2mmXlyLDY8z9NbUf0v4hnh80HY_RbAk08Q">barrier</a> to cooking and eating healthier foods. <h2>How do you decide what to eat?</h2> We spoke with <a href="https://link.springer.com/content/pdf/10.1186/s12889-024-18432-x.pdf">17 adults</a> in a regional centre of Victoria. We chose a regional location because less research <a href="https://link.springer.com/content/pdf/10.1186/s40900-020-0179-6.pdf">has been done</a> with people living outside of metropolitan areas and because rates of obesity and other diet-related health issues are <a href="https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health">higher</a> in such areas in Australia. Participants included a mix of people, including some who said they were over their “most healthy weight” and some who had previously dieted to lose weight. But all participants were either: <ul> <li>young women aged 18–24 with no children</li> <li>women aged 35–45 with primary school aged children</li> <li>men aged 35–50 living with a partner and with pre- or primary-school aged children.</li> </ul> We selected these groups to target <a href="https://www.sciencedirect.com/science/article/pii/S0022318212803669">ages and life-stages</a> in which shifts in eating behaviours may occur. Previous research has found younger women <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1470-6431.2007.00642.x?casa_token=33QKWwhc2ogAAAAA:ZvJ6wfXiRC_6eoqvoxD121JOSKSPmIRHcrdiGl2uHzkq5pY6VVPL6WI2DhmxQ2q9i6bBGvLiFl8afQ">tend to</a> be particularly concerned about appearance rather than healthy eating, while women with children often shift their focus to providing for their family. Men <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/obr.12472?casa_token=KakMB6hAOQ0AAAAA:fLnpoxZQiiJIdEkg_TOcCq8hBwZef1iZETZKTiG5W6zW2x_PYzK0oLeOg5F9arKThq9RzMWEi4x4Xw">tend to be less interested</a> in what they eat. We asked participants about how they decided what food to eat, when, and how much, and what prevented them from making healthier choices. <h2>It’s not just about taste and healthiness</h2> We found that, although such decisions were determined in part by taste preferences and health considerations, they were heavily influenced by a host of other factors, many of which are outside the person’s control. These included other household members’ food preferences, family activities, workplace and time constraints, convenience and price. <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2767106">Healthy eating</a> means consuming a balanced diet rich in nutrients, including a variety of fruits, vegetables, whole grains, lean proteins and healthy fats, while limiting processed foods, added sugars and excessive salt. Healthy eating also includes how we eat and <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244292">how we think about</a> food and eating, such as having a positive relationship with food. One 35- to 45-year-old woman, for example, said that time constraints and family preferences made it difficult to prepare healthier food: <blockquote> I love the chance when I can actually get a recipe and get all of the ingredients and make it properly, but that doesn’t happen very often. It’s usually what’s there and what’s quick. And what everyone will eat. </blockquote> One of the 35- to 50-year-old men also noted the extent to which family activities and children’s food preferences dictated meal choices: <blockquote> Well, we have our set days where, like Wednesday nights, we have to have mackie cheese and nuggets, because that’s what the boys want after their swimming lesson. </blockquote> <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/joss.12649?casa_token=gsnU9O_G2GQAAAAA:mV2vtHlnEd0jqBGJPFkfml_ecLIDqwSlH5xksSwt4eQb_FP_UShyAKm9sLNnKy6Mkf2q9aKAlDEixA">Research shows</a> that children are often more receptive to new foods than their parents think. However, introducing new dishes takes additional time and planning. An 18- to 24-year-old woman discussed the role of time constraints, her partner’s activities, and price in influencing what and when she eats: <blockquote> My partner plays pool on a Monday and Wednesday night, so we always have tea a lot earlier then and cook the simple things that don’t take as long, so he can have dinner before he goes rather than buying pub meals which cost more money. </blockquote> Despite popular perceptions, healthy diets are not more expensive than unhealthy diets. A <a href="https://preventioncentre.org.au/wp-content/uploads/2017/03/1702_FB_LEE_4p_final_lr.pdf">study</a> comparing current (unhealthy) diets with what the <a href="https://www.health.gov.au/resources/publications/the-australian-dietary-guidelines">Australian Dietary Guidelines</a> recommend people should eat found that the healthy diet was 12–15% cheaper than unhealthy diets for a family of two adults and two children. However, learning and planning to prepare new types of meals <a href="https://www.mdpi.com/2072-6643/12/3/877">takes effort and time</a>. Simply educating people about what they should eat won’t necessarily result in healthier eating. People want to eat healthier, or at least know they should eat healthier, but other things <a href="https://link.springer.com/content/pdf/10.1007/s00394-017-1458-3.pdf">get in the way</a>. A key to improving people’s eating behaviours is to make it easy to eat more healthily. Policy changes to make healthy eating easier could include subsidising healthier foods such as fresh produce, providing incentives for retailers to offer healthy options, and ensuring access to nutritious meals in schools and workplaces. <h2>So how can you make healthier food choices easier?</h2> Here are five tips for making healthy choices easier in your household: <ol> <li> If certain days of the week are particularly busy, with little time to prepare fresh food, plan to cook in bulk on days when you have more time. Store the extra food in the fridge or freezer for quick preparation. </li> <li> If you’re often pressed for time during the day and just grab whatever food is handy, have healthy snacks readily available and accessible. This could mean a fruit bowl in the middle of the kitchen counter, or wholegrain crackers and unsalted nuts within easy reach. </li> <li> Discuss food preferences with your family and come up with some healthy meals everyone likes. For younger children, <a href="https://healthykids.nsw.gov.au/downloads/file/campaignsprograms/NewFoodsFussyEaters.pdf">try serving</a> only a small amount of the new food, and serve new foods alongside foods they already like eating and are familiar with. </li> <li> If you rely a lot on take-away meals or meal delivery services, try making a list ahead of time of restaurants and meals you like that are also healthier. You might consider choosing lean meat, chicken, or fish that has been grilled, baked or poached (rather than fried), and looking for meals with plenty of vegetables or salad. </li> <li> Remember, fruit and vegetables taste better and are often cheaper when they are in season. Frozen or canned vegetables are a <a href="https://www.sbs.com.au/news/article/the-cost-of-fresh-fruit-and-veggies-is-rising-is-canned-or-frozen-produce-just-as-healthy/tzuhnfrnr">healthy and quick alternative</a>.<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/231489/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> </li> </ol> <a href="https://theconversation.com/profiles/nina-van-dyke-822557">Nina Van Dyke</a>, Associate Professor and Associate Director, Mitchell Institute, <a href="https://theconversation.com/institutions/victoria-university-1175">Victoria University</a> Image credits: Shutterstock 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/we-know-what-to-eat-to-stay-healthy-so-why-is-it-so-hard-to-make-the-right-choices-231489">original article</a>. </div>

Food & Wine

Breast cancer screening in Australia may change. Here’s what we know so far

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/brooke-nickel-200747">Brooke Nickel</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/katy-bell-134554">Katy Bell</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> The way women are screened for breast cancer in Australia may <a href="https://www.cancer.org.au/about-us/policy-and-advocacy/early-detection/breast-cancer/rosa/key-findings">change</a>. There’s international debate on the <a href="https://www.bmj.com/content/385/bmj.q1353">age</a> women should be invited for screening. But an even larger change being considered worldwide is whether to screen women at <a href="https://www.nature.com/articles/s41416-021-01550-3">high and low risk</a> of breast cancer differently. But what such a “risk-based” approach to screening might look like in Australia is not yet clear. Here’s why researchers and public health officials are floating a change to breast cancer screening in Australia, and what any changes might mean. <h2>Why breast cancer screening may need to change</h2> Mass screening (known as population-based screening) for breast cancer was introduced in Australia and many other developed countries in the 1980s and 90s. This was based on <a href="https://pubmed.ncbi.nlm.nih.gov/26756588/">robust research</a> that found early detection and treatment of cancers before there were symptoms prevented some women from dying from breast cancer. These programs offer regular breast cancer screening to women within a specific age group. For example, <a href="https://www.aihw.gov.au/reports/cancer-screening/national-cancer-screening-programs-participation/contents/breastscreen-australia">in Australia</a>, women aged 40-74 years can have free mammograms (x-rays of the breasts) every two years. The BreastScreen program sends invitations for screening to those aged 50-74. However, evidence has been mounting that mammography screening could be inadvertently causing <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61611-0/abstract">harm</a> for some women. For some, screening causes a false alarm that may cause anxiety, and unnecessary tests and procedures. Even though these tests rule out cancer, these women may remain anxious and perceive something is wrong <a href="https://bmjopen.bmj.com/content/13/4/e072188">for many years</a>. A more insidious harm is <a href="https://theconversation.com/five-warning-signs-of-overdiagnosis-110895">overdiagnosis</a>, where screening detects a non-growing or slow-growing lesion that looks like “cancer” under the microscope, but would not have progressed or caused harm if it had been left alone. This means some women are having unnecessary surgery, radiotherapy and hormone therapy that will not benefit them, but may harm. Although trials have shown screening reduces the risk of dying from breast cancer, questions are being raised about how much it <a href="https://www.bmj.com/content/352/bmj.h6080.abstract">saves lives overall</a>. That is, it’s uncertain how much the reduced risk of dying from breast cancer translates into improvements in a woman’s overall survival. <h2>How about better targeting women?</h2> One idea is to target screening to those most likely to benefit. Under such a “<a href="https://www.nature.com/articles/s41416-021-01550-3">risk-based</a>” approach, a women’s personal risk of breast cancer is estimated. This may be based on her age and many other factors that may include breast density, family history of breast cancer, body-mass index, genetics, age she started and stopped her periods, and the number of children she’s had. Women who are at higher risk would be recommended to start screening at a younger age and to screen more frequently or to use different, more sensitive, imaging tests. Women at lower risk would be recommended to start later and to screen less often. The idea of this more “precise” approach to screening is to direct efforts and resources towards the smaller number of women most likely to benefit from screening via the early detection of cancer. At the same time, this approach would reduce the risk of harm from false positives (detection of an anomaly but no cancer is present) and overdiagnosis (detection of a non-growing or slow-growing cancer) for the larger number of women who are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6230256/">unlikely to benefit</a>. On face value this sounds like a good idea, and could be a favourable change for breast cancer screening. <h2>But there’s much we don’t know</h2> However, it’s uncertain how this would play out in practice. For one thing, someone’s future risk of a cancer diagnosis includes the risk of detecting both <a href="https://www.acpjournals.org/doi/10.7326/m17-2792">overdiagnosed cancers</a> as well as potentially lethal ones. This is proving to be a problem in risk-based screening for <a href="https://www.nature.com/articles/s41698-022-00266-8">prostate cancer</a>, another cancer prone to overdiagnosis. Ideally, we’d want to predict someone’s risk of <a href="https://www.thelancet.com/journals/landig/article/PIIS2589-7500(23)00113-9/fulltext">potentially lethal cancers</a> as these are the ones we want to catch early. It is also still uncertain how many women found to be at <a href="https://pubmed.ncbi.nlm.nih.gov/31701797/">low risk</a> will accept a recommendation for <a href="https://pubmed.ncbi.nlm.nih.gov/23092125/">less screening</a>. These uncertainties mean we need robust evidence the benefits outweigh the harms for Australian women before we make changes to the breast cancer screening program. There are several international <a href="https://www.nature.com/articles/s41416-021-01550-3">randomised controlled trials</a> (the gold standard for research) under way to evaluate the effectiveness of risk-based screening compared to current practice. So it may be prudent to wait for their findings before making changes to policy or practice. Even if such trials did give us robust evidence, there are still a number of issues to address before implementing a risk-based approach. One key issue is having enough staff to run the program, including people with the skills and time to discuss with women any concerns they have about their calculated risk. <h2>How about breast density?</h2> Women with dense breasts are at <a href="https://www.sciencedirect.com/science/article/pii/S0960977622001618#:%7E:text=Mammographic%20density%20is%20a%20well,increased%20risk%20of%20breast%20cancer.">higher risk of breast cancer</a>. So notifying women about their breast density has been proposed as a “first step” on the pathway to risk-based screening. However, this ignores the many other factors that determine a woman’s risk of breast cancer. Legislation in the <a href="https://www.fda.gov/radiation-emitting-products/mammography-quality-standards-act-and-program">United States</a> and changes in some <a href="https://australianbreastcancer.org.au/news-stories/latest-news/breast-density-reporting-at-all-sa-clinics/">Australian states</a> mean some women are already being notified about their breast density. The idea is to enhance their knowledge about their breast cancer risk so they can make informed decisions about future screening. But this has happened before we know what the best options are for such women. An <a href="https://www.mja.com.au/journal/2023/219/9/psychosocial-outcomes-and-health-service-use-after-notifying-women-participating">ongoing Australian trial</a> is investigating the effects that breast density notification has on individual women and the health system. <h2>What next?</h2> Robust evidence and careful planning are needed before risk-based screening or other changes are made to Australia’s breast cancer screening program. Where changes are made, there needs to be early evaluation of both the <a href="https://www.bmj.com/content/350/bmj.h1566.abstract">benefits and harms</a>. Programs also need <a href="https://www.bmj.com/content/374/bmj.n2049.long">independent, regular re-evaluation</a> in the longer term.<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/231917/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/brooke-nickel-200747">Brooke Nickel</a>, NHMRC Emerging Leader Research Fellow, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/katy-bell-134554">Katy Bell</a>, Professor in Clinical Epidemiology, Sydney School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock 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/breast-cancer-screening-in-australia-may-change-heres-what-we-know-so-far-231917">original article</a>. </div>

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Ambulance ramping is getting worse in Australia. Here’s why – and what we can do about it

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/jonathan-karnon-290">Jonathan Karnon</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> and <a href="https://theconversation.com/profiles/andrew-partington-93821">Andrew Partington</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> We’ve seen countless <a href="https://www.heraldsun.com.au/leader/ballarat/ambulance-ramping-leaves-paramedics-unable-to-respond-to-emergencies-says-union/news-story/54b6fee380eb7b7f1c9b2784edf3d2cd">media reports</a> in recent days, weeks and months about the <a href="https://www.couriermail.com.au/news/queensland/qld-politics/worst-cases-of-ambulance-ramping-at-queensland-hospitals-revealed/news-story/bcf4833b5197774329cf983029d77cb4">ramping of ambulances</a> at <a href="https://thewest.com.au/news/health/ambulance-ramping-reaches-record-levels-in-june-as-hospitals-struggle-with-surging-winter-demand-c-15192504">hospital emergency departments</a> (EDs) around Australia. Ambulance ramping occurs when paramedics are made to wait at the hospital’s entrance and are unable to transfer their patient into the emergency department within an appropriate time frame – defined as <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/about+us/our+performance/ambulance+waiting+times">30 minutes</a> in South Australia. Ramping is an indicator of hospital stress. It means patients are waiting longer to receive care in the emergency department, and patients requiring inpatient care are waiting longer to access a hospital bed. Research suggests <a href="https://www.mja.com.au/journal/2022/217/5/influence-ambulance-offload-time-30-day-risks-death-and-re-presentation-patients">ambulance ramping</a> and <a href="https://onlinelibrary.wiley.com/doi/10.1111/1742-6723.13699">having to wait longer</a> for a hospital bed are associated with a greater risk of patients dying up to 30 days after their initial presentation. So why is ambulance ramping still a problem? And what can we do to fix it? <h2>Ramping is getting worse</h2> Available data indicate the problem has become worse over time. In <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/about+us/our+performance/ambulance+waiting+times">South Australia</a>, for example, ramping has been steadily increasing since 2017, from around 500 hours “ramped” per month to around 4,000 hours per month in 2024. This is the sum of the time ambulances spend waiting beyond 30 minutes after arriving at the hospital. In <a href="https://www.bhi.nsw.gov.au/data-portal">New South Wales</a>, we calculate the numbers of patients being ramped increased from around 44,000 patients per month in early 2022 to more than 50,000 in early 2024. <h2>What’s driving the increase in ramping?</h2> The ambulance ramping bottleneck reflects an imbalance between the number of people presenting at emergency departments and the capacity to treat patients and transfer those requiring inpatient care to a ward. Potential drivers of this imbalance are increased emergency department presentations and reduced availability of inpatient beds. The latter may reflect increased demand for beds, including longer hospital stays. Between the financial years 2018–19 and 2022–23 (the latest period for which figures are available), Australian Institute of Health and Welfare data show the numbers of more serious presentations (triage categories 1 to 3) increased by <a href="https://www.aihw.gov.au/reports-data/myhospitals/sectors/emergency-department-care">almost 700,000</a> across Australia. Some 100,000 fewer patients who presented to an emergency department were <a href="https://www.aihw.gov.au/reports-data/myhospitals/sectors/admitted-patients">admitted as inpatients</a> during this period, but the additional presentations will nonetheless have contributed to more ramping. In the same period, admissions to inpatient beds that did not come through an emergency department increased by <a href="https://www.aihw.gov.au/reports-data/myhospitals/sectors/admitted-patients">almost 400,000</a> across the country. These include admissions for the management of chronic conditions (such as diabetes, heart disease, asthma and so on) and infections and viruses (COVID, flu, RSV and others). Further, COVID and other viruses are likely to have contributed to increased hospital stress via <a href="https://www.aihw.gov.au/reports/workforce/health-workforce">workforce shortages</a>. This has possibly led to delays in seeing patients in the emergency department and in discharging patients from hospital. There has not been a significant increase in <a href="https://www.aihw.gov.au/reports-data/myhospitals/sectors/admitted-patients">patients’ time in hospital</a> receiving required care, but there appear to be increasing numbers of patients waiting for placement in an aged care facility or for home care services after their treatment <a href="https://www.ama.com.au/sites/default/files/2023-02/Hospital%20exit%20block%20-%20a%20symptom%20of%20a%20sick%20health%20system_Final.pdf">has finished</a>. <h2>Many admissions may be preventable</h2> Increased vaccination rates could reduce the impact of viruses. For example, only <a href="https://www.aihw.gov.au/reports/australias-health/immunisation-and-vaccination">21% of Australians</a> aged 65 to 74 received the 2023 COVID booster recommended for their age group. We know there were significant increases in people delaying or avoiding seeing a GP <a href="https://www.abs.gov.au/media-centre/media-releases/more-people-putting-seeing-health-professionals-due-cost">due to cost</a> in 2022–23, which can put extra pressure on hospitals. The government is trying to address this issue by increasing <a href="https://www.health.gov.au/our-work/increases-to-bulk-billing-incentive-payments">incentives to GPs</a> to reduce costs to patients. Meanwhile, government health departments may not have been provided with enough funding to meet increasing demand for health care. Year on year the gap between supply and demand grows. <a href="https://www.theguardian.com/australia-news/article/2024/jun/27/victoria-hospitals-recruitment-freeze-cost-cuts-premier-jacinta-allan">Victorian hospitals</a> are reportedly scrambling to reduce spending in light of proposed budget cuts. <h2>What are the solutions?</h2> The creation of new hospital beds is not the only option for increasing capacity. Governments should design, implement and scale up services that free up hospital capacity by providing appropriate and cost-effective out-of-hospital care. For example, there is further scope to care for patients admitted to hospital in their own homes with the support of digital technologies. Programs such as <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/services/hospitals/my+home+hospital/my+home+hospital">My Home Hospital</a> in South Australia aim to provide an alternative to inpatient care. Across Australia, such “hospital in the home” care was provided 150,000 times in 2022–23, compared to <a href="https://www.aihw.gov.au/reports-data/myhospitals/sectors/admitted-patients">6.8 million episodes of care</a> in public hospitals. Virtual ED services are a growing phenomenon across Australia, using <a href="https://theconversation.com/what-is-a-virtual-emergency-department-and-when-should-you-visit-one-228098">virtual consultations</a> to identify patients for whom urgent care can be provided outside hospital. The Victorian virtual ED service is targeting a capacity of <a href="https://www.afr.com/policy/health-and-education/meet-the-two-doctors-revolutionising-emergency-healthcare-20240415-p5fjud">1,000 consults</a> per day. Longer-term solutions require co-operation between state and territory governments and the federal government to prevent and better manage chronic conditions, such as diabetes and heart disease, outside hospital. This includes boosting access to GPs and improving communication between GPs and hospitals. Greater investment in well-designed policies and programs to support healthy ageing would also likely help, as well as improving access to required out-of-hospital aged care and disability services for patients waiting to leave hospital. All these measures could ease the pressure on hospitals and reduce the likelihood of patients waiting in an ambulance, unable to get inside and receive the care they need.<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/232720/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jonathan-karnon-290">Jonathan Karnon</a>, Professor of Health Economics, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> and <a href="https://theconversation.com/profiles/andrew-partington-93821">Andrew Partington</a>, Research Fellow (Health Economics), <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> Image credits: Shutterstock 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/ambulance-ramping-is-getting-worse-in-australia-heres-why-and-what-we-can-do-about-it-232720">original article</a>. </div>

Caring

Just 15 centimetres of water can float a car – but we are failing to educate drivers about the dangers of floodwaters

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/amy-peden-1136424">Amy Peden</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> and <a href="https://theconversation.com/profiles/kyra-hamilton-331594">Kyra Hamilton</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Every year in Australia, people driving into floodwaters drown and many more are <a href="https://www.ses.nsw.gov.au/disaster-tabs-header/flood/">rescued</a>. Do you know what to do when there’s water on the road? We searched all state and territory learner and driver handbooks for information about floodwaters, including signage. Our findings, published in the <a href="https://www.sciencedirect.com/science/article/pii/S0022437524000860?via%3Dihub">Journal of Safety Research</a>, are disturbing. Across half of Australia’s states and territories, the driver handbook ignores flooding. That’s a missed opportunity, considering the handbook contains road rules and provides advice on how to navigate safely. While some states fail to provide any flood-related information, others give detailed practical guidance. Only the New South Wales handbook includes explanation of the meaning and purpose of flood signage. This is despite almost all states and territories experiencing vehicle-related flood <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/jfr3.12616">deaths</a>, including <a href="https://currents.plos.org/disasters/article/causal-pathways-of-flood-related-river-drowning-deaths-in-australia/">drowning</a>, between 2001 and 2017. It’s a major problem that is only going to get worse as the climate changes. So our research shows driver education needs to come up to speed, fast. <h2>Why do people drive into floodwaters?</h2> Our previous <a href="https://www.sciencedirect.com/science/article/abs/pii/S2212420918301869">research</a> revealed motorists can feel compelled to drive into floodwaters for a range of reasons. These include time pressures such as being late for work or school, or needing to get home to family or pets. Sometimes they feel pressured by their passengers, or motorists behind them on the road, urging them to cross. People also report having been encouraged or instructed as learners to drive into floodwaters. Past experience as a passenger also influences a <a href="https://www.sciencedirect.com/science/article/pii/S1369847823000475">learner driver’s</a> future willingness to drive into floodwaters. So the views of significant others, such as their supervising driver, strongly influence decisions around driving into floodwaters. <figure><iframe src="https://www.youtube.com/embed/ZtlXpDBjU1Q?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Avoid driving into floodwaters, for life’s sake.</figcaption></figure> <h2>What we did and what we found</h2> We assessed all publicly available, government-issued learner and driver handbooks (12 documents) across all six Australian states and two territories. We also looked for flood-related signage. We used a method for reviewing online material through a systematic search including in-document key words and imagery. Four jurisdictions provided no information on flooding in the handbook. In the ACT, South Australia, Tasmania and Victoria, drivers need to look elsewhere for information on floodwaters and driving safety. Only one jurisdiction provided information on flood signage such as depth markers and “road subject to flooding”. Hats off to the <a href="https://www.nsw.gov.au/sites/default/files/2022-11/Road-User-Handbook-English.pdf">NSW Road User Handbook</a>, which warns: <blockquote> Floodwater is extremely dangerous. Find another way or wait until the road is clear. It’s safer to turn around than to drive in floodwater. </blockquote> For the states and territories that did provide information on floodwaters in the handbook, the content varied. NSW, Queensland and the Northern Territory warned against entering floodwaters in a vehicle. They highlighted the dangers and financial penalties associated with driving on closed roads. In the NT and Western Australia, handbooks provided practical information on when and how to cross floodwaters safely, such as how to gauge safe water depth based on vehicle size, and to avoid fast-flowing water. Although well-intentioned, judgements around what constitutes fast-flowing water are subjective and hard for any driver to assess, let alone learner drivers. Even drivers of larger vehicles such as four-wheel drives are regularly involved in flood-related <a href="https://currents.plos.org/disasters/article/causal-pathways-of-flood-related-river-drowning-deaths-in-australia/">vehicle drowning fatalities</a>. Just <a href="https://www.ses.vic.gov.au/news-and-media/campaigns/15-to-float">45cm</a> of water can float a large 4WD, and considerably less for smaller vehicles. <figure><iframe src="https://www.youtube.com/embed/t4ilUbMXZAQ?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>A small car can float in just 15cm of water.</figcaption></figure> Handbooks represent valuable sources of safety information, particularly for new drivers who must learn important road rules to progress from one licence to another. Such graduated driver licensing schemes reduce road traffic injury, particularly among <a href="https://www.sciencedirect.com/science/article/pii/S0022437523000385">young people</a>. However, many of these handbooks fail to provide consistent, practical evidence-based information about flooding. There is an opportunity here to support safer driving behaviours. <h2>Safety tips for all drivers</h2> We encourage drivers to follow these safety tips: <ul> <li>avoid driving into floodwaters</li> <li>identify alternative routes, so you have a <a href="https://theconversation.com/when-roads-become-rivers-forming-a-plan-b-can-stop-people-driving-into-floodwaters-183036">plan B</a></li> <li>familiarise yourself, and any learner drivers in the household or under your care, with the meaning and purpose of flood signage</li> <li>understand the legal consequences of crossing a road closed sign</li> <li>discuss the dangers of driving into floodwaters with learner drivers and help them formulate their own plan B</li> <li>model safe driving for all passengers, including children.</li> </ul> <h2>Time to lift our game</h2> Driving into floodwaters remains the main cause of <a href="https://currents.plos.org/disasters/article/causal-pathways-of-flood-related-river-drowning-deaths-in-australia/">flood-related drowning</a> in Australia. For our emergency service personnel, driver behaviour, including people ignoring road closed signs, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/hpja.181">significantly complicates</a> the already dangerous act of performing a flood rescue. Extreme weather and flooding are likely to become more frequent and intense in the future. That means the chance of being faced with a flooded road is growing. So information about driving during floods is vital for all, from the newly licensed to the experienced driver. We hope our research will encourage all states and territories to include provide practical, evidence-based advice on floods in driver handbooks as soon as possible.<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/233116/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/amy-peden-1136424">Amy Peden</a>, NHMRC Research Fellow, School of Population Health & co-founder UNSW Beach Safety Research Group, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> and <a href="https://theconversation.com/profiles/kyra-hamilton-331594">Kyra Hamilton</a>, Associate Professor in Applied Psychology, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Shutterstock 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/just-15-centimetres-of-water-can-float-a-car-but-we-are-failing-to-educate-drivers-about-the-dangers-of-floodwaters-233116">original article</a>. </div>

Travel Trouble

We finally know why some people got COVID while others didn’t

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/marko-nikolic-1543289">Marko Nikolic</a>, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> and <a href="https://theconversation.com/profiles/kaylee-worlock-1543639">Kaylee Worlock</a>, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> Throughout the pandemic, one of the key questions on everyone’s mind was why some people avoided getting COVID, while others caught the virus multiple times. Through a collaboration between University College London, the Wellcome Sanger Institute and Imperial College London in the UK, we set out to answer this question using the world’s first controlled <a href="https://www.nature.com/articles/s41591-022-01780-9">“challenge trial” for COVID</a> – where volunteers were deliberately exposed to SARS-CoV-2, the virus that causes COVID, so that it could be studied in great detail. Unvaccinated healthy volunteers with no prior history of COVID were exposed – via a nasal spray – to an extremely low dose of the original strain of SARS-CoV-2. The volunteers were then closely monitored in a quarantine unit, with regular tests and samples taken to study their response to the virus in a highly controlled and safe environment. For our <a href="https://www.nature.com/articles/s41586-024-07575-x">recent study</a>, published in Nature, we collected samples from tissue located midway between the nose and the throat as well as blood samples from 16 volunteers. These samples were taken before the participants were exposed to the virus, to give us a baseline measurement, and afterwards at regular intervals. The samples were then processed and analysed using single-cell sequencing technology, which allowed us to extract and sequence the genetic material of individual cells. Using this cutting-edge technology, we could track the evolution of the disease in unprecedented detail, from pre-infection to recovery. To our surprise, we found that, despite all the volunteers being carefully exposed to the exact same dose of the virus in the same manner, not everyone ended up testing positive for COVID. In fact, we were able to divide the volunteers into three distinct infection groups (see illustration). Six out of the 16 volunteers developed typical mild COVID, testing positive for several days with cold-like symptoms. We referred to this group as the “sustained infection group”. Out of the ten volunteers who did not develop a sustained infection, suggesting that they were able to fight off the virus early on, three went on to develop an “intermediate” infection with intermittent single positive viral tests and limited symptoms. We called them the “transient infection group”. The final seven volunteers remained negative on testing and did not develop any symptoms. This was the “abortive infection group”. This is the first confirmation of abortive infections, which were previously <a href="https://www.nature.com/articles/s41586-021-04186-8">unproven</a>. Despite differences in infection outcomes, participants in all groups shared some specific novel immune responses, including in those whose immune systems prevented the infection. When we compared the timings of the cellular response between the three infection groups, we saw distinct patterns. For example, in the transiently infected volunteers where the virus was only briefly detected, we saw a strong and immediate accumulation of immune cells in the nose one day after infection. This contrasted with the sustained infection group, where a more delayed response was seen, starting five days after infection and potentially enabling the virus to take hold in these volunteers. In these people, we were able to identify cells stimulated by a key antiviral defence response in both the nose and the blood. This response, called the “interferon” response, is one of the ways our bodies signal to our immune system to help fight off viruses and other infections. We were surprised to find that this response was detected in the blood before it was detected in the nose, suggesting that the immune response spreads from the nose very quickly. <h2>Protective gene</h2> Lastly, we identified a specific gene called HLA-DQA2, which was expressed (activated to produce a protein) at a much higher level in the volunteers who did not go on to develop a sustained infection and could hence be used as a marker of protection. Therefore, we might be able to use this information and identify those who are probably going to be protected from severe COVID. These findings help us fill in some gaps in our knowledge, painting a much more detailed picture regarding how our bodies react to a new virus, particularly in the first couple of days of an infection, which is crucial. We can use this information to compare our data to other data we are currently generating, specifically where we are “challenging” volunteers to other viruses and more recent strains of COVID. In contrast to our current study, these will mostly include volunteers who have been vaccinated or naturally infected – that is, people who already have immunity. Our study has significant implications for future treatments and vaccine development. By comparing our data to volunteers who have never been exposed to the virus with those who already have immunity, we may be able to identify new ways of inducing protection, while also helping the development of more effective vaccines for future pandemics. In essence, our research is a step towards better preparedness for the next pandemic.<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/233063/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/marko-nikolic-1543289">Marko Nikolic</a>, Principal Research Fellow/Honorary consultant Respiratory Medicine, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> and <a href="https://theconversation.com/profiles/kaylee-worlock-1543639">Kaylee Worlock</a>, Postdoc Research Fellow, Molecular and Cellular Biology, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> Image credits: Shutterstock 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/we-finally-know-why-some-people-got-covid-while-others-didnt-233063">original article</a>. </div>

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