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Roles of health professionals are still unfortunately often stuck in the past. That is, before the shift of education of nurses and other health professionals into universities in the 1980s. So many are still not working to their full scope of practice.

There has been some expansion of roles in recent years – including pharmacists prescribing (under limited circumstances) and administering a wider range of vaccinations.

But the recently released paper from an independent Commonwealth review on health workers’ “scope of practice” identifies the myriad of barriers preventing Australians from fully benefiting from health professionals’ skills.

These include workforce design (who does what, where and how roles interact), legislation and regulation (which often differs according to jurisdiction), and how health workers are funded and paid.

There is no simple quick fix for this type of reform. But we now have a sensible pathway to improve access to care, using all health professionals appropriately.

Read more:
How do you fix general practice? More GPs won’t be enough. Here’s what to do

A new vision for general practice

I recently had a COVID booster. To do this, I logged onto my general practice’s website, answered the question about what I wanted, booked an appointment with the practice nurse that afternoon, got jabbed, was bulk-billed, sat down for a while, and then went home. Nothing remarkable at all about that.

But that interaction required a host of facilitating factors. The Victorian government regulates whether nurses can provide vaccinations, and what additional training the nurse requires. The Commonwealth government has allowed the practice to be paid by Medicare for the nurse’s work. The venture capitalist practice owner has done the sums and decided allocating a room to a practice nurse is economically rational.

The future of primary care is one involving more use of the range of health professionals, in addition to GPs.

It would be good if my general practice also had a physiotherapist, who I could see if I had back pain without seeing the GP, but there is no Medicare rebate for this. This arrangement would need both health professionals to have access to my health record. There also needs to be trust and good communication between the two when the physio might think the GP needs to be alerted to any issues.

Read more:
The physio will see you now. Why health workers need to broaden their roles to fix the workforce crisis

This vision is one of integrated primary care, with health professionals working in a team. The nurse should be able to do more than vaccination and checking vital signs. Do I really need to see the GP every time I need a prescription renewed for my regular medication? This is the nub of the “scope of practice” issue.

How about pharmacists?

An integrated future is not the only future on the table. Pharmacy owners especially have argued that pharmacists should be able to practise independently of GPs, prescribing a limited range of medications and dispensing them.

This will inevitably reduce continuity of care and potentially create risks if the GP is not aware of what other medications a patient is using.

But a greater role for pharmacists has benefits for patients. It is often easier and cheaper for the patient to see a pharmacist, especially as bulk billing rates fall, and this is one of the reasons why independent pharmacist prescribing is gaining traction.

It’s often easier for a patient to see a pharmacist than a GP.
PeopleImages.com – Yuri A/Shutterstock

Every five years or so the government negotiates an agreement with the Pharmacy Guild, the organisation of pharmacy owners, about how much pharmacies will be paid for dispensing medications and other services. These agreements are called “Community Pharmacy Agreements”. Paying pharmacists independent prescribing may be part of the next agreement, the details of which are currently being negotiated.

GPs don’t like competition from this new source, even though there will be plenty of work around for GPs into the foreseeable future. So their organisations highlight the risks of these changes, reopening centuries old turf wars dressed up as concerns about safety and risk.

Read more:
How rivalries between doctors and pharmacists turned into the ’turf war’ we see today

Who pays for all this?

Funding is at the heart of disputes about scope of practice. As with many policy debates, there is merit on both sides.

Clearly the government must increase its support for comprehensive general practice. Existing funding of fee-for-service medical benefits payments must be redesigned and supplemented by payments that allow practices to engage a range of other health professionals to create health-care teams.

This should be the principal direction of primary care reform, and the final report of the scope of practice review should make that clear. It must focus on the overall goal of better primary care, rather than simply the aspirations of individual health professionals, and working to a professional’s full scope of practice in a tram, not a professional silo.

In parallel, governments – state and federal – must ensure all health professionals are used to their best of their abilities. It is a waste to have highly educated professionals not using their skills fully. New funding arrangements should facilitate better access to care from all appropriately qualified health professionals.

In the case of prescribing, it is possible to reconcile the aspirations of pharmacists and the concerns of GPs. New arrangements could be that pharmacists can only renew medications if they have agreements with the GP and there is good communication between them. This may be easier in rural and suburban areas, where the pharmacists are better known to the GPs.

The second issues paper points to the complexity of achieving scope of practice reforms. However, it also sets out a sensible path to improve access to care using all health professionals appropriately.

Read more:
Pharmacists should be able to work with GPs to prescribe medicines for long-term conditions Läs mer…

It may come as a surprise to hear 2023 was Australia’s biggest bushfire season in more than a decade. Fires burned across an area eight times as big as the 2019–20 Black Summer bushfires that tore through 10 million hectares in southeast Australia.

My research shows the 2023 fires burned more than 84 million hectares of desert and savannah in northern Australia. This is larger than the whole of New South Wales, or more than three times the size of the United Kingdom. The scale of these fires is hard to comprehend.

The speed at which these fires spread was also incredible. In just a few weeks of September and October, more than 18 million hectares burned across the Barkly, Tanami and Great Sandy Deserts of the Northern Territory and Western Australia.

I presented this research into the 2023 fires at the International Fire Behaviour and Fuels Conference this month in Canberra. I described the scale of these fires, why they occurred, and how fires could be better managed to help protect remote but ecologically and culturally important regions of Australia.

2023 fire spread in North Australia animation, drawing on North Australia Fire Information from firenorth.org.au (Rohan Fisher)

Why did this happen?

Fire and rain are closely connected. Rain triggers grass growth. When it dries out, grass becomes fuel for fires.

For example, you can see the pattern of more fire following wet years repeating at periodic intervals over the past 20 years of fire in the Northern Territory.

In this way, La Niña is the major driver of these massive fires in the desert.

Although 2023 was a massive fire year, 2011 was even bigger. In the NT alone, more than 55 million hectares burned in 2011, compared with 43 million in 2023.

When fuel is dry and weather conditions are extreme, lightning strikes tend to start more fires across savannah and desert rangelands.

Lightning across Australia in late 2023 using data from Andrew Miskelly at Weather Zone (Rohan Fisher)

It has been variously suggested in the media and on social media that these fires are part of a “normal” cycle, a consequence of climate change, or largely the result of arson. Such simplifications fail to grasp the complexity and history of fire management in desert Country.

The main driver of these fires was the very large fuel loads. These wet growing seasons are part of the natural cycle. While climate change can make fire conditions more extreme, in this case it’s not the main cause. However, the scale of these fires was not “normal”. can we briefly say more on this last point?

Read more:
Fire is a chemical reaction. Here’s why Australia is supremely suited to it

How can fires be managed?

For many thousands of years, Indigenous people managed fuel loads across these vast landscapes.

The sophisticated use of fire in Australia’s highly flammable tropical savannas has been recognised as the world’s best wildfire management system.

Traces of this long history of traditional fire practice can be seen in aerial photos of desert Country from the 1940s. Research analysing these photos has shown extensive and complex “fuel mosaics” spread like patchwork quilts over vast parts of the WA deserts.

The term mosaic refers to having many patches of vegetation of different ages, some recently burnt with sparse cover, some long unburnt with old, large and connected spinnifex clumps and small trees.

This provides habitat for a broad range of animals, because different species prefer different amounts of ground cover. It also hinders the spread of fire because areas subject to more recent fire have insufficient fuel to carry new fires for many years.

Aerial image from the 1940s showing a complex mix of burns through spinifex in the Great Sandy Desert.
National Library Australia, CC BY

Efforts have only just begun to bring good fire management back into these landscapes in a coordinated and large-scale way.

In 2022–23 Indigenous ranger groups conducted extensive burning operations. They travelled more than 58,000km by air and road, burning from cars, on foot and dropping incendiaries.

These burns were astoundingly effective. Even though large fires still ripped through these deserts in 2023, by mapping the fuel reduction fires and overlaying the spread of subsequent wildfires, we can see the 2023 fires were limited by previous burns.

For example, the fire spread animation below shows fires moving through a complex mosaic comprising fuel of different ages. One fire can be seen moving more than 600km from near the NT border almost to the coast south of Broome. The fire weaves around previous burns and cheekily finds small gaps of older, continuous fuel.

Animation showing fire spreading through the Great Sandy Desert in 2023 (North Australia and Rangelar)

So without these earlier smaller controlled burns, the out-of-control fires would have been larger.

In the Great Sandy Desert of WA, the complex mosaic of spinifex of different ages persisted after these fires. The Indigenous Desert Alliance puts this down to more controlled burning in the past couple of years than in the ten years prior.

Read more:
Invasive grasses are worsening bushfires across Australia’s drylands

The fires of greatest concern to government agencies were the Barkly fires that threatened the town of Tennant Creek. These fires were large and fast-moving, feeding off fuel in a vast area of unmanaged country east of the town.

Here, a lack of land management increased disaster risk. The fire only stopped when it encountered four-year-old burned areas from lightning strikes.

The summer of 2023–24 was very wet across the Barkly and Tanami regions in the NT. Bushfires NT chief fire control officer Tony Fuller has warned of another big fire year to come as we head into the northern dry season of 2024.

Read more:
Indigenous rangers are burning the desert the right way – to stop the wrong kind of intense fires from raging

Preparing for the future

Desert fire management is still under-resourced and poorly understood.

Ultimately the only effective way to prevent these massive fires in very remote parts of Australia is through a long-term, well-funded strategy of using fire over our vast desert landscapes to control fuel, as was done during previous millennia.

Read more:
Our planet is burning in unexpected ways – here’s how we can protect people and nature Läs mer…

Though Hollywood movies about courtroom dramas often glamorize the closing arguments given by lawyers, in reality the opening statement is likely the most important single event of a trial.

Such was the case in the hush money trial involving former President Donald Trump and alleged payments to porn star Stormy Daniels when lawyers for both sides presented their opening statements on April 22, 2024, in New York.

In this case, Manhattan District Attorney Alvin Bragg charged the former president with 34 felony counts of falsifying business records as part of an effort to influence voters’ knowledge about him before the 2016 presidential election. Trump entered a plea of not guilty.

During his opening argument, prosecutor Matthew Colangelo told the jury that Trump was part of a conspiracy to conceal negative information about him in order to help get him elected. “Then he covered up that conspiracy by lying in his New York business records, over and over and over again,” Colangelo said.

For Trump’s defense, lawyer Todd Blanche was direct. “President Trump did not commit any crimes.”

Blanche explained that Trump was “not involved and unaware” about the specifics of the hush-money payments because he left it all to Michael Cohen, his former lawyer and fixer who is expected to testify for the prosecution. Blanche described Cohen as being a “criminal” who was “obsessed” with Trump and looking to take personal revenge.

How will these contrasting opening arguments play on the jury?

Academic psychologists tell us that between 65% and 75% of jurors make up their minds about a case after the opening statement. What’s even more incredible is that 85% of those jurors maintain the position they formed after the opening statement once all evidence is received and the trial is closed.

More often than not, it is too late by closing arguments to win over the jury.

This phenomenon comes as no surprise to veteran trial lawyers. They are aware of two theories that define how jurors – indeed, people generally – process information: the concepts of primacy and recency.

These ideas suggest that jurors best remember what they hear first and what they hear last. It is vitally important, then, for lawyers on both sides to start their opening arguments with a bang.

The psychology of jurors

I have taught a course on trial advocacy for the past two decades at Harvard Law School. Part of my curriculum is to teach budding lawyers how to deliver effective opening statements.

If the idea is to win over the jury by the end of the lawyer’s opening statement, how, in practice, is that done?

Trial lawyers steeped in the research know that juries respond to a well-considered theory of the case, punctuated by a pithy theme.

A theory of the case is a brief, three- to five-sentence statement akin to what is known as an “elevator pitch.” The theme is a short, pithy summary of the theory of the case that is easy for a juror to remember. Often the theme is the first sentence out of the lawyer’s mouth, followed by a fuller description of the theory.

Indeed, in my class at Harvard, the very first skill I teach is how to develop theories and themes. In order to effectively convey a theory in a case, many lawyers start their opening statements with “This is a case about…” and then fill in the specific details.

So it went on the first day of Trump’s trial.

“This case is about a criminal conspiracy and fraud,” Colangelo, the prosecutor, told the jury. “The defendant, Donald Trump, orchestrated a criminal scheme to corrupt the 2016 presidential election.”

Manhattan District Attorney Alvin Bragg speaks during a news conference about former President Donald Trump’s arraignment on April 4, 2023.
Kena Betancur/Getty Images

In stark contrast, Trump’s defense lawyers said: “There’s nothing wrong with trying to influence an election. It’s called democracy.”

Though prosecutors have tried to put a “sinister” spin on this, Blanche said jurors will learn it’s not a crime.

In each example, the jury is given enough information to frame the evidence they will hear throughout the trial.

After both sides have finished their openings, data shows that more than two-thirds of the jury will have come to a decision that will persist through the remainder of the trial.

Why do juries tend to behave this way?

Research also has taught trial lawyers that if you connect the jury with your theory of a case at the beginning of the trial, jurors will process all the rest of the evidence – whether potentially helpful to the prosecution or to the defense – through the prism of that theory.

The importance of opening statements cannot be overstated. They set the tone and offer the jury a framework to understand the upcoming months of testimony they are about to hear.

Material used in this story was originally published on April 22, 2024. Läs mer…

The Jewish holiday cycle is, to a large extent, an exploration and commemoration of the experience of exile. The fall festival of Sukkot, for example, is celebrated in small booths, temporary shelters that recall the Israelites’ experience sheltering in tents while wandering in the desert for 40 years after fleeing slavery in Egypt. The story of Purim, a springtime festival, takes place when ancient Jews lived in exile in the Persian Empire – and illustrates the precariousness of life as a minority.

And then there’s Passover, which begins on April 22, 2024. It marks the Israelites’ Exodus from Egypt – the first step toward redemption. The theme of freedom dominates the holiday.

Passover is the only holiday that marks the transition from exile to wandering, and not to homecoming, highlighting the complexity of exile – the focus of my recently published book, “Exile and the Jews,” co-edited with Marc Saperstein.

As a literary scholar, I look to novels and memoirs for examples that illustrate exile and its aftermath from different perspectives. Here I focus on those from the Jewish communities of Egypt and Iraq, sites of the two major exiles in Jewish history.

Into the unknown

In her 1983 novella “The Miracle Hater,” the late Israeli novelist Shulamit Hareven depicts the Hebrews in their passage from Egypt and their first taste of freedom. Writing a modern “midrash” – a rabbinic genre that elaborates on a biblical text – she reimagines the story of Exodus.

Whereas the biblical description centers on heroic leaders like Moses and Joshua, Hareven concentrates on the unnamed masses: the Jewish slaves who have just crossed the Red Sea, now faced with life in the desert and becoming a new community.

‘The Flight out of Egypt,’ by Richard Dadd.
Tate Britain/Wikimedia Commons

Hareven’s narrative elaborates on the uprooting wrought by the Exodus, exploring the unexpected ambivalence with which the Hebrews face their newfound freedom. They have fled oppression, but that means leaving everything familiar to wander, seemingly endlessly, in the great unknown of the desert.

Israeli writer Orly Castel-Bloom weaves family lore, history and some alternative history into “An Egyptian Novel,” published in 2015. She both invents and lays claim to the one family who did not join the exodus in ancient times but remained in Egypt throughout the ages. Although they are merely a passing mention, their existence gives the reader pause to wonder if indeed any of the Hebrews stayed behind.

Many Jews did stay behind after the next major exile in Jewish history, which began when Babylonia besieged Jerusalem and deported residents of the conquered city in 586 B.C.E. When Persian king Cyrus the Great issued an edict almost 50 years later inviting the Jews to return to Jerusalem and the land of Judah, only a minority did so. Those who remained in Babylon became the root of the diaspora and established the oldest continuous Jewish community in the world.

‘Out of Egypt’

More recently, Jews have lived in both of these sites of ancient exiles: modern-day Egypt and Iraq. While those in Iraq could claim a history of hundreds of years, those in Egypt were more likely to have moved there within the last few generations.

In his 1995 memoir “Out of Egypt,” novelist, essayist and professor André Aciman – best known for the book-turned-film “Call Me By My Name” – writes movingly and memorably about living on the eve of exile.

By the early 1960s, Jews found themselves less welcome in Egypt. Aciman details the harassment his family endured – anonymous phone calls, surveillance, seizure of the family business by the government – before they were given orders to leave.

“It never occurred to us that a seder in Egypt was a contradiction in terms,” he wrote in The New York Times, describing the Passover meal his family held the night before their departure. The Egypt of the Exodus story seemed far from the Egypt of Aciman’s childhood, the one he loved.

Writer André Aciman attends the Salerno Letteratura festival on June 18, 2022, in Italy.
Ivan Romano/Getty Images

Looking back at that last meal, the novelist wondered just what was being celebrated, and which departure of the Jews the Seder was commemorating. “The fault lines of exile and diaspora always run deep, and we are always from elsewhere, and from elsewhere before that,” he noted.

In “Out of Egypt,” the irony of the family preparing to leave on Passover is not lost on the author, the reader or, one suspects, the characters themselves. After a rather dismal attempt at a Seder, the narrator wandered through the streets of Alexandria, mourning a place that had become home. Until this moment, the idea of Egypt as a place of exile had not occurred to him; the idea of Israel being a place of return foreign.

On that last evening, the narrator walked the promenade along the waterfront and was offered “fiteer,” sold on street corners in honor of the Muslim holiday of Ramadan. It is not kosher for Passover, when leavened grains are forbidden, but the boy enjoyed the fried dough, the taste of which he recalled with pleasure many years later.

The blend of cultures, foreign and local, shows the family to be not unlike other cosmopolitan-mongrel Jews living in Egypt at the time. The city was “so inseparable from who I was at that very instant,” the narrator recalls. “And suddenly I knew … that I would always remember this night.”

Jewish women in Egypt bid each other farewell at the Cairo airport in 1956.
Max Scheler/Picture Post via Getty Images

It is a poignant account of the very personal nature of exile. And yet it is an experience potentially shared by everyone in the Jewish community. Exile is a place unknown, over the edge of the precipice.

Into Iraq

The Passover holiday is also at the center of British journalist Tim Judah’s visit to Iraq to cover the 2003 American invasion. He was the first of his family in many years to “return” to Baghdad. His father’s family had left Iraq in the 19th century for India in the wake of persecutions during Dawud Pasha’s reign.

Noting that his visit would coincide with the holiday, Judah set out to meet as many of the estimated three dozen Jews who still lived in Iraq. The journalist found faint traces of the once-thriving community: palimpsests of stars of David in brickwork, a Hebrew inscription in Ezekiel’s tomb. At the time of Iraq’s independence in 1932, Jews comprised a plurality in the capital; business came to a standstill on Saturdays, the Jewish Sabbath.

A Jewish girls school in Baghdad, photographed in the late 1800s.
Culture Club/Hulton Archive via Getty Images

The rise of Arab nationalism, the establishment of the state of Israel and shifting geopolitics led to the mass emigration of the Jewish community in the early 1950s. By 2003, the few Jews Judah found lived in trepidation and ramshackle homes.

“I tried to picture my forebears, in the fields or perhaps in the shops or the market, but I couldn’t,” Judah wrote in Granta magazine. “A cold grey dust filled the air. Wrecked cars and burnt-out tanks littered the road back to Baghdad. … So my ancestors lived here for 2,500 years? So what? My pilgrimage was over. I will never need to do it again.”

Judah’s pilgrimage leads not to a renewed sense of belonging but a break. His family’s uprooting is complete.

And so it goes, the cycle of exile and remembrance, uprooting and rerooting. With the Passover holiday, those free can celebrate their freedom, and those who are rooted, their rootedness. Yet at the same time, families around the Seder table can remember those who are not yet free, and those still suffering from being uprooted. Läs mer…

For many decades, if not centuries, researchers, medical professionals and the general population have believed that people with flat feet are more prone to developing a variety of problems.

Specifically, having flat feet was believed to predispose individuals to future pain and other musculoskeletal problems (i.e. to muscles, tendons and/or ligaments).

Flat feet were believed to be a kind of time bomb.

However, in a recent editorial published in the British Journal of Sports Medicine, my research team challenges this myth. We demonstrate that the theory that having flat feet inevitably leads to pain or other musculoskeletal problems, is unfounded.

As a researcher in podiatric medicine at the Université du Québec à Trois-Rivières (UQTR), I will explain the main conclusions of our study here.

Where does this theory come from?

The idea that flat feet are a problem dates back centuries.

It was revived in the second half of the 20th century by the American podiatrists Merton L. Root, William P. Orien and John H. Weed, who popularized the concept of “ideal” or “normal” feet.

These clinician-researchers were the first to propose that if feet did not meet the specific criteria of normality (for example, a well-defined plantar arch, a straight heel in line with the tibia) they were abnormal, less efficient and more prone to injury because of multiple biomechanical compensations, such as greater arch flattening while walking.

This theory became central to the educational programs of health professionals. Although today it is gradually disappearing as modern curricula are updated, the theory was taught for almost five decades throughout the world, even though the scientific basis was weak. In fact, science has never validated the theory: it has remained at the hypothesis stage.

Nevertheless, over the years up until the present, many health professionals have continued to support the theory that flat feet pose a major risk for developing musculoskeletal disorders.

As a result, this idea is still firmly anchored in the beliefs of the general public.

Do flat feet cause musculoskeletal injuries?

Contrary to the theory of Root and colleagues, meta-analyses, the highest level of scientific evidence, have shown no increased risk of developing the vast majority of musculoskeletal injuries among people with flat feet.

These meta-analyses only identified weak links between having flat feet and the risk of developing medial tibial stress syndrome (pain in the tibia), patellofemoral syndrome (pain around the kneecap), and non-specific overuse injuries of the lower limbs.

That’s it.

Furthermore, a systematic review and a meta-analysis concluded that runners with flat feet are no more at risk of injury than those with regular feet.

These analyses call into question the idea that people with flat feet have a substantial risk of developing musculoskeletal disorders.

However, despite these findings, various sources such as grey literature, professional websites, forums and other media, often suggest that people with flat feet run a higher risk of injury, or even require treatment — even when they don’t have any symptoms.

Unfortunately, this frequently results in people having unnecessary interventions, such as using orthopaedic shoes or custom-made foot orthoses for asymptomatic flat feet. It also leads to significant concerns among patients about the appearance of their feet.

Runners with flat feet are no more at risk of injury than those with regular feet.
(Shutterstock)

Setting the record straight

Asymptomatic flat feet generally do not require the intervention of health professionals. Based on current scientific knowledge, assessing whether a person has flat feet to determine their risk of injury is ineffective and counterproductive.

While it is possible for a person with flat feet to develop a musculoskeletal injury, this does not necessarily mean that flat feet caused the injury.

It is quite possible for two variables to be present at the same time without there being a causal link. There is an important difference between a causal link and a correlation. A cause-and-effect relationship implies that a change in one variable (the cause) leads to a change in another variable (the effect). When two variables are correlated, changes in one variable may be associated with changes in the other, but this does not mean that one causes the other.

To illustrate the concept, let’s take the following example: we give 500 children aged six to 12 the same math test. By carrying out correlation tests, we notice a trend: the bigger the children’s feet, the higher their final mark in the exam.

This raises the question, does foot size really influence mathematical skills? Of course not!

Another variable that is not taken into account, age, plays a major role in this correlation. Since feet get bigger as we grow older, there is a strong but false correlation!

The same principle applies to flat feet. If a musculoskeletal injury occurs in a person with flat feet, current research indicates that flat feet are not necessarily the cause and that other factors need to be explored.

The link is one of correlation, not cause and effect.

Reducing overdiagnosis in health care

Reducing overdiagnosis in health care has become crucial. This phenomenon, defined as the diagnosis of a condition that brings no net benefit to the individual, constitutes a global burden with potential adverse effects on patients’ physical, psychological and financial well-being.

In financial terms, it is easy to understand that prescribing custom-made foot orthoses costing hundreds of dollars to prevent musculoskeletal injuries associated with asymptomatic flat feet, has a substantial negative impact. This is especially true given that the presence of flat feet only slightly increases the risk of developing these injuries.

To solve this problem, health-care professionals must help to reduce the overdiagnosis of flat feet by making a clearer distinction for their patients between harmless anatomical variants, and conditions of potential concern.

Since overdiagnosis often leads to overtreatment, avoiding unnecessary treatments will help to alleviate patients’ concerns about their flat feet.

Finally, we must abandon the outdated idea, still widespread, that says having flat feet is a problem that exposes individuals to a high risk of musculoskeletal injury. It’s time to change our perspective and our approach to the significance of flat feet and to recognize their natural diversity in the context of overall foot health.

Above all, it’s time to consider asymptomatic flat feet for what they are…simply an anatomical variant! Läs mer…

Many Australians with disability feel on the edge of a precipice right now. Recommendations from the disability royal commission and the NDIS review were released late last year. Now a draft NDIS reform bill has been tabled. In this series, experts examine what new proposals could mean for people with disability.

Recent media coverage about the National Disability Insurance Scheme (NDIS) frames the choices of people with disability as threats to their safety or the safety of others. Such reports suggest participants who use unregistered providers could be putting themselves in harm’s way. Or that some participants – such as those with criminal backgrounds – pose unacceptable dangers to support providers.

But research shows choice and safety are not at odds when it comes to disability support. What does this mean for the recommendations from the review of the NDIS – especially given its push for evidence-based practice?

Read more:
Choice and control: are whitegoods disability supports? Here’s what proposed NDIS reforms say

Choosing services and who provides them

Part of the original thinking in developing an NDIS structured around principles of choice and control was recognising that not having those things puts people with disability in more vulnerable situations. Research indicates people with disability are more likely to be safe and free from abuse when they have choice over what services they receive and who provides them.

Previous research by one of us (Sophie) also found some people feel safe as a result of having more choice.

When we interviewed people about why they use unregistered NDIS providers, most described feeling more secure when they were able to choose the right people for the job – those with the right attitudes and skills. One told us:

Safety for me means being able to work with people that I know have relevant qualifications and people that are embedded in my community.

This means being able to look beyond whichever providers happen to be NDIS registered and available in their area. Some people feel less safe with registered providers if they’ve had bad experiences with them before or they aren’t sure who the provider will send each week.

People we interviewed also talked about how they select their support worker team for themselves or their family members via interviews, trial shifts and reference checks. This builds a sense of whether the relationship will work or not.

Limited service options, particularly in regional, rural and remote areas, place people with disability in disempowering and risky positions. They may be dependent upon one provider for essential services.

Reforms that restrict participant choice could have a detrimental effect on many people’s NDIS experiences.

Read more:
Unregistered NDIS providers are in the firing line – but lots of participants have good reasons for using them

There is more than one way to support safety

Regulatory oversight is just one (albeit important) piece of the safeguarding puzzle. Choice – which promotes safety – is best supported when participants are informed, empowered, and have a range of people to go to for help, including when things go wrong.

Laura’s recent research found many in the disability sector, including people with disability, family members and advocates, view the NDIS commission’s complaints processes as inaccessible and difficult to navigate. One disability advocate pointed out:

You shouldn’t need an advocate to liaise with the body that has the responsibility of safeguarding your rights and protection.

Unfortunately, the NDIS review had relatively little to say about strengthening the complaints processes.

It did make other quality and safety recommendations that have not received the same degree of attention as the controversial recommendation on mandatory provider registration. These proposals should not be allowed to fall by the wayside.

One recommendation is to invest in “nationally consistent access to individual disability advocacy services” so Australians with disability all have a right to speak up for what they want and need. There are also recommendations to help all people with disability to navigate NDIS, foundational and other services and increase decision-making support.

The recommendations to diversify housing and living supports are critical for expanding both choice and safety.

What about worker safety?

The disability support workforce has a high proportion of female and low-paid workers. They face increasingly insecure employment arrangements. These workers experience different pay and working conditions depending on the provider they work for and industrial award they are employed under.

Since the introduction of the NDIS, there has been a rapid rise in gig economy-style employment. NDIS participants can use online platforms to employ sole-trader support workers rather than going through agencies. Some self-managing participants also choose to directly employ their support workers, effectively becoming small businesses in the process.

Gig economy work potentially involves risks for workers, as well as participants, because there isn’t any oversight or monitoring. That said, workers employed by disability service organisations also report low levels of confidence in organisational safety and reporting systems.

All of this points to the need for strategies to build and retain a high-quality, well-paid and safe workforce. This was noted in the NDIS review and the government’s draft National Strategy for the Care and Support Economy released last year.

Some NDIS participants employ and screen their own support workers, rather than using agencies.
Shutterstock

What could support safety for everyone?

Rather than assuming choice and safety are in opposition to each other and further restricting choice, our research suggests the following priorities:

clear complaints pathways, with “no wrong door” referral models so people don’t miss the chance to lodge issues

accessible and responsive formats for submitting complaints
accessible and up-to-date information so people know their rights, can navigate the NDIS and choose providers
peer support with resources to promote these networks.

Both NDIS-specific and mainstream safeguarding institutions such as police, health authorities, consumer bodies and community services, need to build their capacity to listen and respond to people with disability.

Read more:
For people with communication disability, complaining about their treatment isn’t so simple

Lastly, we need to foster “natural safeguards” – the relationships with family, friends and the community that keep everyone safe (not just people with disability).

Safety is about being connected and embedded within the community, where many people are looking out for you, checking in on you and noticing if you don’t show up to your usual activities. Supporting all people with disability to build and sustain these relationships should be a priority.

NDIS participants and workers face distinct challenges but the voices and concerns of both groups need to be heard and addressed by service providers and government. Ultimately, a scheme where people with disability are empowered to make meaningful decisions between quality services, and workers are valued and supported in their roles, will promote safety for everyone.

Read more:
States agreed to share foundational support costs. So why the backlash against NDIS reforms now? Läs mer…

Landscapes that have escaped fire for decades or centuries tend to harbour vital structures for wildlife, such as tree hollows and large logs. But these “long unburnt” habitats can be eliminated by a single blaze.

The pattern of fire most commonly experienced within an ecosystem is known as the fire regime. This includes aspects such as fire frequency, season, intensity, size and shape.

Fire regimes are changing across the globe, stoked by climate and land-use change. Recent megafires in Australia, Brazil, Canada and United States epitomise the dire consequences of shifting fire regimes for humanity and biodiversity alike.

We wanted to find out how Australian fire regimes are changing and what this means for biodiversity.

In our new research, we analysed the past four decades of fires across southern Australia. We found fires are becoming more frequent in many of the areas most crucial for protecting threatened wildlife. Long unburnt habitat is disappearing faster than ever.

Read more:
Research reveals fire is pushing 88% of Australia’s threatened land mammals closer to extinction

Uncovering long-term changes

“Fire regimes that cause declines in biodiversity” was recently listed as a key threatening process under Australia’s environmental protection legislation.

However, evidence of how fire regimes are shifting within both threatened species’ ranges and protected areas is scarce, particularly at the national scale and over long periods.

To address this gap, we compiled maps of bushfires and prescribed burns in southern Australia from 1980 to 2021.

We studied how fire activity has changed across 415 Australian conservation reserves and state forests (‘reserves’ hereafter), a total of 21.5 million hectares. We also studied fire activity within the ranges of 129 fire-threatened species, spanning birds, mammals, reptiles, frogs and invertebrates.

We focused on New South Wales, the Australia Capital Territory, Victoria, South Australia and Western Australia because these states and territories have the most complete fire records.

Large areas of long unburnt forest in New South Wales were burnt in the 2019-20 fire season.
Tim Doherty

More fire putting wildlife at risk

We found areas of long unburnt vegetation (30 years or more without fire) are shrinking. Meanwhile, areas of recently burnt vegetation (5 years or less since the most recent fire) are growing. And fires are burning more frequently.

On average, the percentage of long unburnt vegetation within reserves declined from 61% to 36% over the four decades we studied. We estimate the total area of long unburnt vegetation decreased by about 52,000 square kilometres, from about 132,000 sq km in 1980 to about 80,000 sq km in 2021. That’s an area almost as large as Tasmania.

At the same time, the mean amount of recently burnt vegetation increased from 20% to 35%. Going from about 42,000 sq km to about 64,000 sq km in total, which is an increase of 22,000 square kilometres.

And the average number of times a reserve burnt within 20 years increased by almost a third.

While the extent of unburnt vegetation has been declining since 1980, increases in fire frequency and the extent of recently burnt vegetation were mainly driven by the record-breaking 2019–20 fire season.

Changes in the proportions of unburnt and recently burnt vegetation across 415 conservation reserves and state forests in southern Australia.
Tim Doherty

Which areas have seen the biggest changes?

The strongest increases in fire frequency and losses of long unburnt habitat occurred within reserves at high elevation with lots of dry vegetation. This pattern was most prominent in southeastern Australia, including the Kosciuszko and Alpine national parks.

Read more:
Fire almost wiped out rare species in the Australian Alps. Feral horses are finishing the job

In these locations, dry years with low rainfall can make abundant vegetation more flammable. These conditions contribute to high fire risk across very large areas, as observed in the 2019–20 fire season.

Threatened species living at high elevations, such as the spotted tree frog, the mountain skink and the mountain pygmy possum, have experienced some of the biggest losses of long unburnt habitat and largest increases in fire frequency.

Multiple fires in the same region can be particularly problematic for some fire-threatened animals as they prevent the recovery of important habitats like logs, hollows and deep leaf-litter beds. Frequent fire can even turn a tall forest into shrubland.

Fire-threatened species Australia include (clockwise from top-left) the kyloring (western ground parrot), mountain skink, stuttering frog and mountain pygmy possum.
Clockwise from top-left: Jennene Riggs, Jules Farquhar, Jules Farquhar, Zoos Victoria.

What does this mean for Australia’s wildlife?

Fire management must adapt to stabilise fire regimes across southern Australia and alleviate pressure on Australia’s wildlife.

Indigenous land management, including cultural burning, is one approach that holds promise in reducing the incidence of large fires while providing fire for those species that need it.

Strategic fire management within and around the ranges of fire-threatened species may also help prevent large bushfires burning extensive portions of species’ ranges within a single fire season.

We can also help wildlife become more resilient to shifting fire regimes by reducing other pressures such as invasive predators.

However, our efforts will be continually undermined if we persist in modifying our atmosphere by burning fossil fuels. This means conservation managers must also prepare for a future in which these trends continue, or hasten.

Our findings underscore the increased need for management strategies that conserve threatened species in an increasingly fiery future.

Read more:
200 experts dissected the Black Summer bushfires in unprecedented detail. Here are 6 lessons to heed Läs mer…

Here’s something for the board of the Reserve Bank of Australia to ponder as it meets next month to set interest rates.

It has pushed up rates on 13 occasions since it began its attempt to restrain inflation in May 2022.

On each occasion, its rationale was that by making borrowing more expensive, it would take money out of the economy. Yet, at the same time, it has also been pushing money into the economy and potentially feeding inflation.

It helps to know a bit about the relationship between the Reserve Bank and the private banks that bank with it.

Banker to the banks

Each of the private banks has an exchange settlement account at the Reserve Bank. The banks use these accounts to make payments to one another.

Here’s why. Every day some of the customers of each bank want to transfer to money to the customers of other banks, usually to pay for services or goods.

To a large extent, the transactions cancel each other out, because, say, Westpac needs to transfer about as much to the ANZ as the ANZ needs to transfer to Westpac. But they don’t cancel out completely, meaning that at the end of each day Westpac might need to make a net payment to the ANZ.

Banks transfer cash to other banks through accounts at the RBA.
AAP

It does this by transferring funds from its exchange settlement account at the Reserve Bank to the ANZ’s settlement account at the Reserve Bank.

If Westpac doesn’t have enough cash in its account, it will borrow from another bank that does, at a rate known as the overnight cash rate.

The overnight cash rate is the rate the Reserve Bank tries to influence when it adjusts interest rates.

How it adjusts the overnight cash rate is slightly more complicated. It sets two other rates.

The Reserve Bank pays interest to banks that have excess cash in their settlement accounts and it charges interest to banks that need to borrow cash from it to settle their payments.

It is by setting these two rates – either side of the overnight cash rate – that the Reserve Bank nudges the cash rate up or down.

Historically, the Reserve Bank ensured there was just enough cash in the exchange settlement system to meet the banks’ needs, neither too much nor too little. It called it a “scarce reserves” system.

From just enough cash to an abundance of cash

If there was too much cash in the system, the Reserve Bank sold financial instruments such as bonds to banks, requiring them to pay from their exchange settlement account. If there was too little, it bought financial instruments from them, paying cash into their account.

That’s until COVID. In 2020 it stopped buying bonds from banks, leaving cash to accumulate in their accounts in what it called an “abundant reserves” system. This was done to ensure the banking system had more than enough cash to deal with whatever was in store.

And because the Reserve Bank was also lending billions to the banks through its Term Funding Facility an awful lot of cash accumulated in these accounts.

Beginning in 2020, the amount of surplus cash in the system exploded, from very little in the years leading up to COVID to A$450 billion.

To start with, the Reserve Bank wasn’t required to pay much interest on these extra hundreds of billions because its cash rate target was close to zero. But as it lifted rates to get on top of inflation, it began to pay serious sums.

My calculations suggest that since the Reserve Bank began lifting rates in May 2022 it has paid out more than $25 billion in interest, in some months paying more than $1.3 billion.

To put that $25 billion in perspective, it is more than the $20 billion the government plans to spend on modernising the electricity network. An important difference is that for the billions paid out by the Reserve Bank, there’s no direct benefit to the public.

Each time the Reserve Bank has pushed up rates, it has had to pay out more in interest, which means it has been been pumping money into the economy potentially feeding inflation at the same time as it announced measures to restrain it.

Against this, in recent months the COVID-era Term Funding Facility has been winding down, as the three-year loans issued to banks expire. The last will expire in the middle of this year, winding back the surplus cash in exchange settlement accounts.

But my calculations suggest when this happens there is still likely to be $200 billion of surplus cash in the accounts and about $700 million paid to the banks in interest each month this year.

Excess cash is set to stay

It’d be open to the Reserve Bank to soak up the excess cash by selling the banks enough financial instruments to return to the system of scarce reserves.

But earlier this month it announced it wasn’t planning to go that far.

It said ensuring the banks had just enough cash to transfer funds to each other had required a lot of effort on its part, forcing it to buy and sell financial assets daily, and sometimes more than daily.

And it said the banks seem to have adapted to having more than enough reserves, and the extra reserves made the system resilient to shocks.

It will move instead to a new system it will call “ample reserves”, selling enough bonds to limit excess reserves, but not too harshly.

Read more:
As the COVID cash glut comes to an end, the Reserve Bank is changing the way it sets and maintains interest rates

This new system will mean that when it next pushes up rates (most likely not for a long time) it will again be working against itself to some extent, putting more money into the hands of the banks.

How much has the interest paid out by the Reserve Bank contributed to Australia’s inflation problem? I don’t know. But I think it’s time we consider the whole picture. Läs mer…

Are all single people insecure? When we think about people who have been single for a long time, we may assume it’s because single people have insecurities that make it difficult for them to find a partner or maintain a relationship.

But is this true? Or can long-term single people also be secure and thriving?

Our latest research published in the Journal of Personality suggests they can. However, perhaps unsurprisingly, not everybody tends to thrive in singlehood. Our study shows a crucial factor may be a person’s attachment style.

Singlehood is on the rise

Singlehood is on the rise around the world. In Canada, single status among young adults aged 25 to 29 has increased from 32% in 1981 to 61% in 2021. The number of people living solo has increased from 1.7 million people in 1981 to 4.4 million in 2021.

People are single for many reasons: some choose to remain single, some are focusing on personal goals and aspirations, some report dating has become harder, and some become single again due to a relationship breakdown.

People may also remain single due to their attachment style. Attachment theory is a popular and well-researched model of how we form relationships with other people. An Amazon search for attachment theory returns thousands of titles. The hashtag #attachmenttheory has been viewed over 140 million times on TikTok alone.

What does attachment theory say about relationships?

Attachment theory suggests our relationships with others are shaped by our degree of “anxiety” and “avoidance”.

Attachment anxiety is a type of insecurity that leads people to feel anxious about relationships and worry about abandonment. Attachment avoidance leads people to feel uncomfortable with intimacy and closeness.

People who are lower in attachment anxiety and avoidance are considered “securely attached”, and are comfortable depending on others, and giving and receiving intimacy.

Read more:
Is attachment theory actually important for romantic relationships?

Single people are often stereotyped as being too clingy or non-committal. Research comparing single and coupled people also suggests single people have higher levels of attachment insecurities compared to people in relationships.

At the same time, evidence suggests many single people are choosing to remain single and living happy lives.

Single people represent a diverse group of secure and insecure people

In our latest research, our team of social and clinical psychologists examined single people’s attachment styles and how they related to their happiness and wellbeing.

We carried out two studies, one of 482 younger single people and the other of 400 older long-term singles. We found overall 78% were categorised as insecure, with the other 22% being secure.

Looking at our results more closely, we found four distinct subgroups of singles:

secure singles are relatively comfortable with intimacy and closeness in relationships (22%)
anxious singles question whether they are loved by others and worry about being rejected (37%)
avoidant singles are uncomfortable getting close to others and prioritise their independence (23% of younger singles and 11% of older long-term singles)
fearful singles have heightened anxiety about abandonment, but are simultaneously uncomfortable with intimacy and closeness (16% of younger singles and 28% of older long-term singles).

Insecure singles find singlehood challenging, but secure singles are thriving

Our findings also revealed these distinct subgroups of singles have distinct experiences and outcomes.

Secure singles are happy being single, have a greater number of non-romantic relationships, and better relationships with family and friends. They meet their sexual needs outside romantic relationships and feel happier with their life overall. Interestingly, this group maintains moderate interest in being in a romantic relationship in the future.

Anxious singles tend to be the most worried about being single, have lower self-esteem, feel less supported by close others and have some of the lowest levels of life satisfaction across all sub-groups.

Singles with different attachment styles often have very different experiences.
Fergus Coyle / Shutterstock

Avoidant singles show the least interest in being in a romantic relationship and in many ways appear satisfied with singlehood. However, they also have fewer friends and close relationships, and are generally less satisfied with these relationships than secure singles. Avoidant singles also report less meaning in life and tend to be less happy compared to secure singles.

Fearful singles reported more difficulties navigating close relationships than secure singles. For instance, they were less able to regulate their emotions, and were less satisfied with the quality of their close relationships relative to secure singles. They also reported some of the lowest levels of life satisfaction across all sub-groups.

It’s not all doom and gloom

These findings should be considered alongside several relevant points. First, although most singles in our samples were insecure (78%), a sizeable number were secure and thriving (22%).

Further, simply being in a romantic relationship is not a panacea. Being in an unhappy relationship is linked to poorer life outcomes than being single.

It is also important to remember that attachment orientations are not necessarily fixed. They are open to change in response to life events.

Read more:
Single doesn’t mean being lonely or alone

Similarly, sensitive and responsive behaviours from close others and feeling loved and cared about by close others can soothe underlying attachment concerns and foster attachment security over time.

Our studies are some of the first to examine the diversity in attachment styles among single adults. Our findings highlight that many single people are secure and thriving, but also that more work can be done to help insecure single people feel more secure in order to foster happiness. Läs mer…

Robert Adamson, one of our greatest poets, died aged 79 on December 16, 2022. By that time, as recorded in the biographical note in his final book, Birds and Fish: Life on the Hawkesbury, he had published 21 volumes of poetry and had long been a renowned editor, critic and publisher. He made a significant and lasting contribution to Australian literature.

Birds and Fish: Life on the Hawkesbury – Robert Adamson (Upswell)

In 2004, Adamson published Inside Out: An Autobiography. Several long excerpts are included in Birds and Fish, a selection of his writings on the natural world. The first of these excerpts begins:

From as far back as I can remember, I was fascinated by animals and felt compelled to get close to them in whatever way I could – by hunting them, studying them, keeping them in cages or imitating their behaviour.

Adamson grew up in Neutral Bay on Sydney’s lower north shore, which afforded him ample opportunity to pursue his interest. He frequented Taronga Zoo, “sometimes through the front gates, but more often over the fence near [his] favourite part, the quarantine area at Athol Bay”.

On one such occasion, aged “ten or eleven”, Adamson fell into an enclosure and found himself “face to face with an angry cassowary”. He stood “utterly still with the great black bird” circling around him, with its “deep, resonant, furious-sounding voice” and “horn of a head fringed with iridescent blue feathers shivering in the moonlight”.

It is a terrifying, beautiful scene, recounted not by the fallen boy, of course, but the poet he became.

Australian Cassowary (Casuarius australis): illustration by Elizabeth Gould for John Gould’s Birds of Australia.
Rawpixel, via Wikimedia Commons, CC BY-SA

Adamson says of the injured rainbow lorikeets his younger self would take home to nurse that

I wanted to will myself inside the bird’s head – not to tame it exactly. What I think I was aiming for when I stared into each bird’s eyes was some flicker of recognition, some sign of connection between us. I wanted the bird to recognise and accept me. But as what?

Adamson is very often on philosophical ground. What does it mean for a person to want an animal “to recognise and accept” him? Do animals have such a capacity? Can an animal be a person?

Theories of recognition have a long history, which in the Western tradition date back at least as far as Hegel. To think on “recognition” raises questions of respect and understanding, friendship, love and empathy, and law.

To and from whom is recognition given, or withheld? As we know from history, and it seems always newly apparent, the answer to such a question can be a hinge point for calamity.

In the scene with the injured lorikeet, as earlier with the angry cassowary, the philosophy is implicit. We knew it would be, for the book’s epigraph is from Gerard Manley Hopkins: “What you look hard at seems to look hard at you.”

Mutual recognition, self-consciousness: it’s Hegel again.

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Poetry goes nuclear: 3 recent books delve into present anxieties, finding beauty amid the terror

Blunt and honest

It wasn’t only non-human animals to whom the young Adamson looked for recognition:

The year I turned ten was my best year, when I was class captain for the final term. This was the year of Mr Roberts, the teacher who introduced me to poetry and what they called nature studies.

Mr Roberts “would read poems to the class and go through them explaining what they meant and how poetry worked.”

The young Adamson seemed to find therein “a secret code”. He excelled at memorising poems, a talent which saw him selected to represent his school “on an ABC radio program that came on just before The Argonauts every Friday afternoon”.

It helped, too, that Mr Roberts “knew a bit about birds” and that he was encouraging about projects and assignments. The young Adamson lights up, a recognition undimmed, even when a new teacher tells him “to forget [his] ambition”.

He has a strong sense already that the natural world is “pure compared to the hypocrisies of humans”:

There was no third party, no good manners, no god involved – no reasoning or theology, let alone spelling and maths. Nature was blunt and honest.

For Adamson, the natural world offers a form of deliverance:

Fishing sustains the soul because it was once one of the most natural things a human being could do; that is why you can enter that state of grace, that lightness of being, while fishing. It is to do with the field of being; you can project yourself back to the original lores, rites and rituals.

All of which carries us from Hegel and recognition to the Spinoza Journal, which takes up the last 30 pages of the book. Adamson writes:

Spinoza’s given name [Baruch] means “Blessed” in Hebrew. Spinoza argued that God exists and is abstract and impersonal. His view of God can be described as Classical Pantheism, with infinite manifestations of divinity.

The Spinoza of Adamson’s journal is not the 17th century Dutch philosopher, but an unfledged bird that Adamson and his wife, the photographer Juno Gemes, find on the side of the road close to their house on the Hawkesbury River.

Adamson realises that the chick is only a few days old. He carries her “into the garage” and sets “her on the makeshift nest”. Every two hours, he feeds her a “mixture of rolled oats, crushed walnut and egg yolk”. A lifetime’s acquaintance with birds informs his actions:

When you find a baby bird, the thing to do is to place it near the tree it may have fallen from and wait for the parents to turn up. I did this and watched from a distance. It was a hot afternoon, so after about an hour, I decided that was long enough. I looked around for likely foster parents – currawongs, magpies and maybe kookaburras? No action at all. I took the baby bird back inside and put it into the cat carrier. To my relief, next morning the chick was still alive and squawking for food.

Adamson worries at the domestication of a channel-billed cuckoo, fearing “Spin the domestic companion would be like having Arthur Rimbaud as a pet”. He looks hard at the bird and the bird looks right back. There are regular feeding times and flying lessons, affording Adamson an occasion to write about Pliny the Elder and Charles Darwin, and to recall the “Cuckoo Song”, the “oldest secular lyric written in English, dating from 1250”.

There is some terrific writing and detailed observation. Then, some six weeks into the relationship:

I’m feeling embarrassed today: I finally realised Spin is not a channel-billed cuckoo. Spinoza is a satin bowerbird!

Spin has been misidentified, but not unrecognised:

Spin was in a lovely mood today in my study. I was working on the manuscript for my new book. As I look into Spin’s eye, when he turns his head to one side, I sense an empathy between us.

We should be thankful to Upswell Publishing and the editor of Birds and Fish, the American poet Devin Johnston, for ensuring the publication of this last of Adamson’s books.

The sort of recognition it suggests is a capacity of the imagination, or the moral imagination. It is imperfect, “blunt and honest”, and perhaps in a final sense, hopeful. Adamson deserves the last word:

Although I have loved birds all my life and love Spin deeply, it is Spin who has taught me that birds are nothing at all like humans. They are far removed from us, really, except that sometimes they let us project ourselves onto what we imagine them to be. Läs mer…