If you’ve been pregnant in the past few months, you may have faced a dilemma. You wake up with a fever, a pounding headache or back pain – and then pause. Is it safe to take paracetamol?

That hesitation isn’t surprising. In September last year, the United States government sowed widespread doubt and anxiety by linking paracetamol use in pregnancy to autism and attention-deficit hyperactivity (ADHD).

But now a major new international study, published today in The Lancet, provides some much-needed clarity.

The research confirms that taking paracetamol – also known as acetaminophen, or by brand names such as Panadol and Tylenol – does not increase a baby’s risk of autism, ADHD or intellectual disability when used in pregnancy.

Paracetamol remains a safe and effective way to treat fever and pain at any stage of pregnancy.

What the new study looked at

The researchers carried out a large systematic review and meta-analysis, meaning they didn’t just study one group of people. Instead, they pulled together results from many previous studies.

In total, they reviewed 43 studies that focused on whether children exposed to paracetamol in the womb were more likely to later be diagnosed with autism, ADHD or intellectual disability.

Crucially, the authors prioritised sibling-comparison studies. Sibling studies compare siblings from the same family, where one used paracetamol during pregnancy and another didn’t.

This approach produces higher-quality results for comparison. It helps researchers isolate what they’re studying – in this case, paracetamol.

Siblings’ shared genetics, home environment and family background mean there won’t be differences in these factors, which could distort results (known as “confounding factors”).

The authors used extensive statistical methods to ensure their results were accurate.

So, what did they find?

Across these higher-quality studies, the researchers found no meaningful increase in the risk of autism, ADHD, or intellectual disability in children whose mothers used paracetamol during pregnancy.

This was true when the authors (a) looked only at sibling studies, (b) focused on studies with low risk of bias and (c) examined children followed for more than five years.

In other words, when the strongest methods were used, the earlier alarming links simply didn’t hold up. The study concludes that paracetamol, when used as directed, remains safe during pregnancy.

These results echo those of another landmark study in 2024, conducted in Sweden and including almost 2.5 million children (born between 1995 and 2019).

This Swedish study illuminated the need for good controls in scientific research.

It showed when studies didn’t use sibling comparison as a way to control confounding factors, there appeared to be a small increased risk of autism and ADHD associated with using paracetamol while pregnancy.

However, when the researchers used rigorous statistical methodology in sibling studies to account for the confounding factors between people – differences such as genetics or living conditions – these associations disappeared.

The Swedish study, just like the current Lancet study, also concluded there was absolutely no evidence of increased risk of autism, ADHD or neurodevelopmental disability with paracetamol use in pregnancy.

Why this is important

Paracetamol isn’t just another medication. It’s often the only recommended option for treating pain and fever in pregnancy.

The Therapeutics Goods Administration, responsible for regulating medication safety and quality in Australia, maintains that paracetamol remains a pregnancy “Category A” drug. This means it is safe for use in pregnancy when used according to directions.

Being able to rely on a safe drug to reduce fever is really important for pregnant people.

Leaving fever untreated during pregnancy can be harmful for both the fetus and the mother. Fever in pregnancy has been linked to miscarriage, pre-term birth and birth complications.

So avoiding paracetamol “just in case” in fact isn’t a cautious choice. The risks of not treating pain or fever may be greater than the risks of the medication itself.

For pregnant people weighing up whether to take a tablet for a feverish night or pregnancy aches, this study should help reassure them taking paracetamol is safe and evidence-based.

Paracetamol remains, as it has for decades, the first-line option.

If you have concerns, speak to your health-care provider.

Anya Arthurs, Research Fellow in Cell and Molecular Biology, College of Medicine and Public Health, Flinders University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

While period pain and heavy menstrual bleeding are common, they’re often dealt with privately. Yet they take a profound toll on a person’s health – and finances.

Now, our new study has calculated how much these menstrual symptoms cost the broader Australian economy.

Our study was based on a survey of 1,796 Australian working women and is published today in The Australian Journal of Social Issues. We found period pain and heavy bleeding costs the Australian economy about A$14 billion every year in lost productivity.

Women aged 35–44 reported significantly higher lost productivity than their younger counterparts.

Our findings highlight the substantial economic rationale for government and workplace policies to help people manage menstrual symptoms.

Periods can be debilitating

In Australia, girls experience their first period (menarche) around 12 years of age.

Periods (menstruation) typically happen every 21–34 days. Most women (and those who menstruate) have regular periods until around 45–55 years of age. Then, menstrual cycles become less regular before stopping altogether at menopause.

Most women will experience around 400–600 periods over their lifetime, unless their menstrual cycles are suppressed by hormonal contraception.

For the majority of women, periods often have significant negative impacts on overall wellbeing.

Two common causes of problematic periods are dysmenorrhea (period pain) and heavy menstrual bleeding.

The most common type of period pain (primary dysmenorrhea) affects around 90% of young women under 25 in Australia.

This type of period pain is often worst during the first two days of bleeding. It is primarily caused by high levels of prostaglandin hormones, which are responsible for cramps. Many women also feel fatigue, dizziness, back pain and headaches.

Heavy menstrual bleeding is when the period is so heavy that excessive blood loss affects health and quality of life. This affects 20–25% of women of reproductive age in Australia.

People with heavy menstrual bleeding often also experience moderate to severe period pain.

Excessive iron loss due to heavy bleeding also contributes to fatigue.

The stigma and taboo associated with menstruation means many women feel they must work very hard to conceal period problems at work. This labour is usually invisible and exhausting. Some women quit work altogether.

What we did and what we found

Our research aimed to investigate:

• how common period pain and other menstrual symptoms are for Australian women in paid employment over 18 years and
• the impact of menstruation on work productivity (via presenteeism and absenteeism).

Presenteeism accounts for productivity losses at work while an employee is present but not working at full capacity. It’s like going to work with a migraine: you might be physically present but you aren’t doing your best work.

Absenteeism is being away from work on paid or unpaid sick leave.

We collected data via an online survey of 1,796 Australian working women.

Survey participants were over 18, currently living in Australia and had had at least one period in the last three months. They were in paid employment (including self-employment) and/or volunteering for at least three months.

Our study found that 97% of women who responded had period pain in the last three months, and 75% said they always have period pain when menstruating. Previous research in Australia has found that over 90% of young women report period pain and around 71% worldwide.

Because of this we used more conservative estimates of 90% of women experiencing period pain (high) and 70% experiencing period pain (low) to calculate our range of economic figures for the population.

We estimated lost productivity in Australia associated with menstrual symptoms at A$7,176 per person annually, with an estimated total annual economic burden of $14.005 billion.

Together, presenteeism and absenteeism accounted for 46% of total productivity loss.

And remember, our study only looked at paid employment among full‑time and part‑time workers. The implications for unpaid labour, particularly women’s unpaid care work and its profound economic and social importance, demands further study (which we are progressing).

We also note that the impact of menstruation on the Australian economy is more complex than is established through our current data set, which doesn’t account for things such as the economy-wide costs of medical care and treatment.

In other words, our estimate is conservative.

Why does this matter?

Given the substantive economic impacts demonstrated through our study, menstrual symptom management in the workplace is not a private concern to be managed by individual workers.

Menstrual symptoms affect the broader economy and society. Workplace policies and guidelines are needed to support employees experiencing period pain, fatigue and associated symptoms.

At the workplace level, employers have an opportunity to start a dialogue with staff about changes to workplace conditions that could enhance employee productivity, health and wellbeing.

This could, for instance, include things such as reproductive leave (on top of the usual sick leave provisions), remote and hybrid work arrangements and flexible time management policies (including rest periods).

Our study findings also highlight the significant economic rationale for government to address this workplace issue with laws and policies.

Enshrining minimum standards for workplaces to support employees impacted by menstrual symptoms reduces the burden on individual workplaces to formulate policies and eliminates reliance on senior management’s interest.

If governments and employers want to increase productivity, our research shows the answer could be hiding in plain sight.

Michelle O'Shea, Senior Lecturer, School of Business, Western Sydney University and Mike Armour, Associate Professor at NICM Health Research Institute, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

In recent decades, millions of Australians have embraced body art – an estimated 30% of adults have a tattoo. Over a third of those with tattoos have five or more pieces.

Trend reporting from industry and lifestyle sources suggests designs are becoming increasingly large, colourful and complex. Although tattoos have become more common, less attention has been paid to what’s in the inks being injected into people’s skin.

In a study published today in the Journal of Hazardous Materials, our team analysed tattoo inks available in Australia. We found they contain carcinogenic organic chemicals and toxic metals at levels that wouldn’t meet existing European safety standards.

Tattoo ink regulations

Injected into living tissue, tattoo inks are designed to last essentially permanently. Once in the body, pigments can persist, migrate through the lymphatic system or slowly break down over time.

Concerns about tattoo ink composition are not new. In Europe, early guidance on such inks emerged more than a decade ago, and was initially non-binding. As tattooing became more widespread, regulators moved towards stricter controls.

Since 2022, the European Union has enforced binding chemical limits on tattoo inks, restricting metals including arsenic, cadmium and lead as well as specific organic compounds that are known or suspected to be carcinogenic. Tattoo inks that don’t comply cannot be legally sold in EU member countries.

Australia doesn’t have an equivalent national framework for regulating tattoo ink. There’s minimal routine oversight of what tattoo inks contain in Australia, and consumers have limited information available. There’s no requirement to perform routine batch testing of inks sold in Australia.

Oversight relies on voluntary compliance, with one government survey released in 2016, and updated in 2018. That survey found many inks wouldn’t meet European guidelines, which at the time were less restrictive than the current EU framework.

Similar issues with tattoo inks have been found in the United States, Sweden and Turkey. Problems included inaccurate labelling, elevated metal concentrations, and in some cases evidence of cellular toxicity in lab tests. While people sometimes have acute reactions to tattoo ink, detecting potential long-term or chronic exposures is much harder.

What we did and what we found

The project began with an interesting question from a high school student. As part of her senior year research project, Bianca Tasevski, then at St Mary Star of the Sea College in Wollongong, contacted the School of Chemistry at UNSW Sydney to ask what was actually in tattoo inks.

To answer the question, we analysed 15 tattoo inks including black and coloured inks sold in Australia. The inks were all from major, established international brands widely used by tattoo artists.

This analysis provides a snapshot of inks currently sold in Australia, and was not intended to monitor batches across locations as a surveillance exercise, which is a role arguably more suited to regulators. Thus, specific brands are not disclosed.

With two standard, widely used laboratory approaches, we measured the concentrations of metals in the inks and screened for a broad range of organic chemicals.

Every ink we tested would have failed at least one EU safety requirement. We detected multiple toxic metals at concentrations exceeding EU law. These include arsenic, cadmium, chromium and lead. Although detected at trace levels, these concentrations are considered unacceptable for tattoo inks by EU regulators.

We also identified organic compounds in some inks, including aromatic amines restricted in EU countries because of their carcinogenic potential.

Some patterns emerged across ink types. Black inks contained a broader range of regulated metals, while brightly coloured inks often contained high levels of specific pigment-associated metals.

Why pigments often contain metals

Ideally, tattoo pigments should be bright, stable and resistant to fading. Metals are particularly important in obtaining such properties.

Metals are not always intentionally included in inks. They can be residues or impurities from pigment manufacturing, or byproducts from incomplete purification.

In our study, we found extremely high concentrations of some pigment-associated metals including titanium, aluminium and zirconium in specific coloured inks.

These metals aren’t currently restricted in tattoo ink under EU legislation, but their presence at such high levels is notable because of long exposure times, unknown chemical forms, and unknown effects of chronic exposure.

Ink chemistry is not the same as health risk

We’re not toxicologists, and our study doesn’t assess health effects. Our work was limited to analysing the chemical composition of tattoo inks. We didn’t measure how much of these substances are absorbed into the body, how they behave over time, or whether they cause any harm.

Health effects will depend strongly on many factors including chemical form, dose, exposure time and individual biology. Cancer Council Australia advises tattoos have not been shown to cause cancer, but notes concerns about ink composition.

A number of epidemiological studies have examined potential links between tattoos and health outcomes. However, such studies are challenging to interpret without directly measuring ink chemistry or exposure.

We need better regulation

The findings point to a clear regulatory gap in consumer protection. Many tattoo inks available in Australia wouldn’t meet current EU standards and there’s no routine system in place to identify or address this blind spot.

A sensible, practical step would be increasing the monitoring of tattoo inks and reviewing Australian standards to align with international best practice. This would improve transparency, provide clearer information to consumers, and reduce unnecessary exposure to hazardous substances.

Tattoos are a form of self-expression that many Australians value. As with other products that are injected into the body, knowing what they contain is a reasonable starting point for oversight and informed decision-making.

William Alexander Donald, Professor of Chemistry, UNSW Sydney and Jake P. Violi, Postdoctoral Fellow, School of Chemistry, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

When we think of the world’s oldest art, Europe usually comes to mind, with famous cave paintings in France and Spain often seen as evidence this was the birthplace of symbolic human culture. But new evidence from Indonesia dramatically reshapes this picture.

Our research, published today in the journal Nature, reveals people living in what is now eastern Indonesia were producing rock art significantly earlier than previously demonstrated.

These artists were not only among the world’s first image-makers, they were also likely part of the population that would eventually give rise to the ancestors of Indigenous Australians and Papuans.

A hand stencil from deep time

The discovery comes from limestone caves on the island of Sulawesi. Here, faint red hand stencils, created by blowing pigment over a hand pressed against the rock, are visible on cave walls beneath layers of mineral deposits.

By analysing very small amounts of uranium in the mineral layers, we could work out when those layers formed. Because the minerals formed on top of the paintings, they tell us the youngest possible age of the art underneath.

In some cases, when paintings were made on top of mineral layers, these can also show the oldest possible age of the images.

One hand stencil was dated to at least 67,800 years ago, making it the oldest securely dated cave art ever found anywhere in the world.

This is at least 15,000 years older than the rock art we had previously dated in this region, and more than 30,000 years older than the oldest cave art found in France. It shows humans were making cave art images much earlier than we once believed.

This hand stencil is also special because it belongs to a style only found in Sulawesi. The tips of the fingers were carefully reshaped to make them look pointed, as though they were animal claws.

Altering images of human hands in this manner may have had a symbolic meaning, possibly connected to this ancient society’s understanding of human-animal relations.

In earlier research in Sulawesi, we found images of human figures with bird heads and other animal features, dated to at least 48,000 years ago. Together, these discoveries suggest that early peoples in this region had complex ideas about humans, animals and identity far back in time.

Not a one-off moment of creativity

The dating shows these caves were used for painting over an extraordinarily long period. Paintings were produced repeatedly, continuing until around the Last Glacial Maximum about 20,000 years ago – the peak of the most recent ice age.

After a long gap, the caves were painted again by Indonesia’s first farmers, the Austronesian-speaking peoples, who arrived in the region about 4,000 years ago and added new imagery over the much older ice age paintings.

This long sequence shows that symbolic expression was not a brief or isolated innovation. Instead, it was a durable cultural tradition maintained by generations of people living in Wallacea, the island zone separating mainland Asia from Australia and New Guinea.

What this tells us about the first Australians

The implications go well beyond art history.

Archaeological and genetic evidence suggests modern humans reached the ancient continent of Sahul, the combined landmass of Australia and New Guinea, by around 65,000 to 60,000 years ago.

Getting there required deliberate ocean crossings, representing the earliest known long-distance sea voyages undertaken by our species.

Researchers have proposed two main migration routes into Sahul. A northern route would have taken people from mainland Southeast Asia through Borneo and Sulawesi, before crossing onward to Papua and Australia. A southern route would have passed through Sumatra and Java, then across the Lesser Sunda Islands, including Timor, before reaching north-western Australia.

Until now, there has been a major gap in archaeological evidence along these pathways. The newly dated rock art from Sulawesi lies directly along the northern route, providing the oldest direct evidence of modern humans in this key migration corridor into Sahul.

In other words, the people who made these hand stencils in the caves of Sulawesi were very likely part of the population that would later cross the sea and become the ancestors of Indigenous Australians.

Rethinking where culture began

The findings add to a growing body of evidence showing that early human creativity did not emerge in a single place, nor was it confined to ice age Europe.

Instead, symbolic behaviour, including art, storytelling, and the marking of place and identity, was already well established in Southeast Asia as humans spread across the world.

This suggests that the first populations to reach Australia carried with them long-standing cultural traditions, including sophisticated forms of symbolic expression whose deeper roots most probably lie in Africa.

The discovery raises an obvious question. If such ancient art exists in Sulawesi, how much more remains to be found?

Large parts of Indonesia and neighbouring islands remain archaeologically unexplored. If our results are any guide, evidence for equally ancient, or even older, cultural traditions may still be waiting on cave walls across the region.

As we continue to search, one thing is already clear. The story of human creativity is far older, richer and more geographically diverse than we once imagined.

The research on early rock art in Sulawesi has been featured in a documentary film, Sulawesi l'île des premières images produced by ARTE and released in Europe today.

Maxime Aubert, Professor of Archaeological Science, Griffith University; Adam Brumm, Professor of Archaeology, Griffith University; Adhi Oktaviana, Research Centre of Archeometry, Badan Riset dan Inovasi Nasional (BRIN), and Renaud Joannes-Boyau, Professor in Geochronology and Geochemistry, Southern Cross University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Autistic people are so rarely depicted in media and entertainment, it’s no wonder most people don’t really understand much about the neurotype.

So we were pleased to see the launch of autistic Barbie.

Autism is a life-long neurodevelopmental difference, meaning autistic children grow into autistic adults. As autistic researchers, who advocate for the increased meaningful representation of our community, it was a good sign that multinational toy company Mattel worked with an autistic-led advocacy organisation based in the US, the Autistic Self Advocacy Network, in creating this new toy.

We have seen mixed reviews from autistic people since the launch, with some praising representation while others have been more critical of the doll.

Here are some considerations about her features to help you make up your own mind.

The tablet

Autistic Barbie is shown with a tablet with an augmented and alternative communication (AAC) application, which speaks aloud when buttons are pressed.

Some autistic people find communicating extremely challenging, and around a third cannot communicate reliably by speaking. This leads to needs going unmet, feeling misunderstood and often significant distress.

That is, unless an alternative mode of communication is available. Applications available on tablets, such as Proloquo2Go and Coughdrop, are helpful for some autistic people to communicate their needs and preferences.

Although some non-speaking autistic people find it easier to communicate with non-digital options such as printed cards, or using a low-tech signboard with letter tiles alongside a skilled communication partner, we think it’s great that this Barbie comes with a tablet.

The headphones

Sensory sensitivities are a core element of autistic lived experience. Autistic people are commonly sensitive to noise, light, smells, textures and taste. To represent this, autistic Barbie comes with noise-cancelling headphones which can be vital for some autistic people with noise sensitivities. However, other autistic people may find them too uncomfortable to wear and prefer in-ear options. For this reason, autistic people should be allowed to wear ear protection any time it is safe.

Eye contact

The development team reportedly gave Barbie a sideways glance, which aimed to show that eye contact may be uncomfortable and thus avoided in autistic people. An additional way to strengthen autistic Barbie could be to show the potential of visual distress, and to provide her with a coloured glasses accessory. Coloured lenses are a helpful tool to reduce the pain some autistic people feel in response to light, movement and colours. In reality, a specialist test can be used to help autistic people figure out what colour is best for them.

The outfit

Mattel seem to have invested thought in making Barbie’s outfit comfortable from a sensory point of view. Her outfit does not come with labels sewn in – a common cause of irritation to autistic people.

Her dress is loose and flowing, which may appeal to those with tactile hypersensitivity. We didn’t have an autistic Barbie to hand, so we aren’t sure what the fabric is like, but soft and comfortable fabric is a must for many autistic people.

It is worth noting that autistic people often have individual clothing preferences, and some may prefer tight – or even restrictive – clothing as it provides proprioceptive feedback, which can be comforting. It can also support hypermobile joints, which are at least three times as common in autistic people compared to non-autistic people. Furthermore, many autistic people are gender non-conforming, so may not see themselves represented in this outfit.

Autistic Barbie is wearing Mary Jane-style flat shoes, rather than Barbie’s typical high heels. Many autistic people struggle with shoes and rigid slim shoes may be uncomfortable for some. Almost half of autistic young people also walk on their tiptoes as a way of stimming, so allowing a movable ankle would have allowed this to be visible.

The stim tool

Stimming is an important way for autistic people to stay comfortable and regulated. It can undo some of the pain and discomfort of an unsuitable sensory environment. For this reason, we were really pleased to see that Barbie has two opportunities to stim. First, she has bendable elbows and wrists – many autistic people do some form of repetitive movement of their arms and hands as part of stimming. Also, Barbie holds a fidget spinner. This is a small toy that creates an interesting tactile and visual response.

Although not all autistic people will like fidget spinners, most engage in stims with their hands, so this is a good representation of one object that autistic people use to stim.

So how did Mattel do?

Social science researchers have claimed that Barbie – regardless of neurotype – has historically been reductive and problematic. Barbie is unachievably thin, extremely feminine and all too often white. It is important not to ignore these criticisms, however, Barbies are very popular toys and have a reach beyond other brands, and their range of disabled Barbies feels important to raise awareness.

There is no single “look” to being autistic, so the Barbie Mattel created can’t represent everyone, especially as her design is limited to visual elements. Despite these issues, we think, in general, that Mattel and the Autistic Self Advocacy Network have done a great job of creating the autistic Barbie doll.

Her existence is an overall positive. Her inclusion creates a much-needed opportunity for representation, education and normalises the use of disability accommodations.

Aimee Grant, Associate Professor in Public Health and Wellcome Trust Career Development Fellow, Swansea University and Rebecca Ellis, Assistant Researcher in Public Health, Swansea University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

At the start of the new year, many of us will commit to joining a gym, eating healthier or cutting back on drinking and smoking. We do this knowing that investing in our health today will pay off into to the future – that prevention is better (and cheaper) than the cure.

It’s advice the Productivity Commission thinks federal and state governments should also follow to improve Australia’s finances and productivity.

Late last year, my co-authors and I gave the federal government the final report of our inquiry on delivering quality care more efficiently.

We found preventative investments could save taxpayers billions of dollars in health and social care costs. But to achieve these gains, the way we think about investing in prevention needs to change.

Investing in early intervention

Australia’s spending on health and social care is growing as a share of the economy and now makes up five of the top seven fiscal pressures facing the federal budget. The care sector is also absorbing more of our workforce – close to one-third of new jobs since the pandemic have been in the care sector.

In many respects this reflects changing preferences. As the nation has become wealthier, we care more about our health and wellbeing. But making the most of this spending is one of Australia’s key productivity challenges.

That means investing early to save costs later. Take for example the SunSmart skin cancer awareness campaign, which is estimated to have prevented more than 43,000 skin cancers from 1988 to 2010.

Investments like this save lives and money. We estimate that an investment of A$1.5 billion across all prevention programs over five years could be expected to save governments $2.7 billion over ten years. Factoring in the broader health, social and economic benefits, the total benefits would be about $5.4 billion.

Other countries are ahead of the game: Canada, the UK and Finland spend over twice as much of their health budgets on prevention as Australia.

Australia’s own health prevention strategy recommends that we increase spending on prevention from 2% to 5% of the health budget.

The big picture

Prevention goes beyond just health care. Investments in youth justice, out of home care and homelessness improve outcomes in a range of other areas, improving Australians’ quality of life and governments’ bottom lines.

For example, when people experiencing homelessness get stable housing, they tend to end up in hospital less often, make fewer trips to the emergency department, and in some cases, even avoid incarceration. It’s also easier to look for and hold down a job when you have a stable place to call home.

Such investments can also address systemic inequities in both access and quality of care.

One early childhood education program in outer Melbourne led to improved IQ and language development among socially disadvantaged Australian children, with participants reaching the same level of development as their peers within three years.

Evaluations of similar initiatives in the United States suggest that benefits can persist well into adulthood and even intergenerationally, through improved lifetime education attainment, employment and health, and reduced criminal behaviour.

A whole of government approach

Unfortunately, the way our government is structured can work against these investments. While it’s often one agency or level of government that needs to put up the money for these investments, they only enjoy part of the benefit.

The way governments think about and invest in prevention and early intervention needs to change. The Productivity Commission’s proposed solution is for a National Prevention and Early Intervention Framework to support strategic investments in programs that improve outcomes and reduce demand for future services.

The framework’s consistent approach to assessing interventions would bring all levels of government to the table, so that worthwhile investments no longer fall between the cracks.

It offers a practical way to put into operation the government’s Measuring What Matters framework. By directing funding towards outcomes and tracking progress against them, it would give federal and state governments confidence that they are investing in effective programs.

Like a person struggling with a new year’s resolution, policymakers often find it hard to delay gratification.

But given health and social care spending is only set to grow further, we need to start thinking long term to ensure we can afford to give future generations the standard of care we enjoy today. With a greater focus on prevention and early intervention, we can better care for future generations and put our care sector on a more sustainable path.

Angela Jackson, Social Policy Commissioner, Productivity Commission, and Adjunct Associate Professor, University of Tasmania

This article is republished from The Conversation under a Creative Commons license. Read the original article.

In what has become a familiar, exhausting cycle, the rest of the world is left with the futile task of trying to dredge meaning from the wreckage left behind by US President Donald Trump.

As Trump departed the World Economic Forum meeting in Davos, Switzerland, much was made of the content of his rambling, hour-long speech because the president had so escalated his rhetoric over Greenland.

Trump had said the United States would take the semi-autonomous Danish territory “whether they like it or not”. He had threatened direct tariffs on NATO allies that opposed him. Europe was considering reciprocal tariffs and had even gotten to the point of sending troops to Greenland as a demonstration of resolve.

NATO itself seemed on the verge of collapse.

While some analysis suggests a reprieve, there is no permanence to Trump’s statements. This president plays with lives, and the future of entire countries, with no care for the consequences.

‘Big, beautiful piece of ice’

Those who seek clarity in the chaos may have been relieved to hear the president make what may seem, on the face of it, a definitive statement of his position on Greenland:

I don’t have to use force. I don’t want to use force. I won’t use force.

That may well seem a clear statement of intent. But attempting to impose clarity by stripping sentences of their context risks dramatically misinterpreting that intent.

Even the sentences around this one hint that Trump has far from given up on acquiring that “big, beautiful piece of ice”.

In a speech riddled with inaccuracies, the president continued:

All the United States is asking for is a place called Greenland. Where were we already had it as a trustee but respectfully returned it back to Denmark not long ago after we defeated the Germans, the Japanese, the Italians and others in World War Two. We gave it back to them. We were a powerful force then, but we are a much more powerful force now.

Never mind that Greenland was never the US’ to “give” or “take” back – this is a president who has long demonstrated himself impervious to fact checking.

Trump went on to describe, in detail, his plan to build new battleships for the US Navy. The implication is fairly straightforward. Trump’s United States may not have to use force, but it can if it wants to.

Be grateful, or else

In this same section of the speech, Trump fell back on a familiar theme – that the US bears all the burden of global security, with none of the benefits. As he put it,

We’ve never gotten anything except we pay for NATO.

(Never mind the hundreds of NATO troops who died fighting with the Americans in Afghanistan after September 11, the only time Article 5 of the NATO alliance has been invoked).

That Trumpian resentment was only fuelled, unsurprisingly, by a striking speech by Canadian Prime Minister Mark Carney.

Carney’s excoriation of the Trump administration’s attacks on the world order was unlikely to be met with anything else from Trump.

Canada gets a lot of freebies from us, by the way. They should be grateful also. But they’re not. I watched their prime minister yesterday. He wasn’t so grateful, they should be grateful to us. Canada, Canada lives because of the United States. Remember that Mark [Carney], the next time you make your statements.

The Trump administration is seeking “ownership” of the western hemisphere – that is, all of the continents of north and south America and surrounds. By implication, that leaves the other hemispheres to other great powers and strongmen, with whom Trump “has always had a very good relationship”.

This is the violent world Trump wants to create – a world divided into fiefdoms run by Mafia-style bosses paid simpering tributes by their weaker supplicants.

The rhetoric of white supremacy

Trump went to Europe to give a speech dripping with disdain for the people who live there. In contrast to those leaders with whom he has a “great relationship” (Putin, Xi, Kim Jong Un, et al), the Trump administration sees Europe and European leaders not just as weak, but as responsible for the demise of western civilisation – something only he can reverse.

After a racist rant directed at Somali immigrants, Trump claimed:

The explosion of prosperity and conclusion and progress that built the West did not come from our tax codes. It ultimately came from our very special culture. This is the precious inheritance that America and Europe have in common.

Trump’s talk of inheritance, of his pure European bloodlines, of the “mass import of foreign cultures” reveal, once again, the ideological drive behind his administration and its attempt to radically remake not just the US but the world.

While the president may have softened his rhetoric on Greenland specifically, this drive is a constant for the administration.

Live the truth

This is why Carney’s speech was so striking. It identified, in clear language, the truth of what the Trump administration is doing.

We knew the story of the international rules-based order was partially false. That the strongest would exempt themselves when convenient. That trade rules were enforced asymmetrically. And we knew that international law applied with varying rigour depending on the identity of the accused or the victim.

This fiction was useful. And American hegemony, in particular, helped provide public goods: open sea lanes, a stable financial system, collective security and support for frameworks for resolving disputes.

So, we placed the sign in the window. We participated in the rituals. And we largely avoided calling out the gaps between rhetoric and reality.

This bargain no longer works.

Trump may have temporarily “backed down” on Greenland, but as Carney put it, the “rupture in the world order” cannot be undone. But what comes next is not inevitable, and it does not have to be left up to Trump.

Carney’s speech is a clear indication that while the American president will not break his constant cycle of chaotic cruelty, the rest of the world may be attempting to step outside it.

There is meaning in that.

Emma Shortis, Adjunct Senior Fellow, School of Global, Urban and Social Studies, RMIT University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Sussan Ley may pay the price for the implosion of the Coalition, but the blame rests squarely with Nationals leader David Littleproud. He’s the one whose leadership should be on the line.

When you stand back from it, the behaviour of the Nationals has been extraordinary and, many would argue, reprehensible.

What was the issue the Nationals chose to make their stand on? It was the provision in the government’s legislation that will enable the banning of hate-spruiking groups, notably the Islamist extremist group Hizb ut-Tahrir, and neo-Nazi groups.

The Nationals said this was too broad, and endangered free speech. However important the principle of free speech is, dealing with these purveyors of hate outweighs it in this instance. Also, the measure as passed is surrounded by reasonable guardrails.

The Nationals’ claims they want radical Islamists dealt with are hollow when they oppose this measure – which is also attacked, it should be noted, by some on the progressive side of politics, in the name of free speech. The antisemitism issue has produced a convergence of sections of the right and the left, aligned against the pragmatic centre.

In the run up to the Coalition crisis, a Sunday night meeting of shadow cabinet, which included Littleproud, decided to seek changes to the hate crime legislation; on Monday the opposition obtained concessions from the government.

Ley says that was the proper end of the process, clearing the way for the opposition to support the bill, and therefore the Nationals frontbench senators who voted against it had broken shadow cabinet solidarity.

Littleproud argues there should have been further processes. He claims it was “persecution” to insist on the resignation of the three frontbenchers who voted against the bill, who were following the orders of their party room.

Regardless of the argument over process, Ley ended up with no choice but to discipline the three senators. Liberals (some with reservations) who had stayed in line with the decision to vote for the bill would have been appalled if their leader had then turned a blind eye to the Nationals’ action. That is especially the case given many of the Liberals are enduring blowback on social media for their stand.

Occupying the same kennel requires give and take. Liberals point out that some of their frontbenchers would have preferred to vote for the government’s gun reform bill. But they accommodated the Nationals, and their own rural members, by opposing it. There was no quid pro quo from the Nationals.

If Littleproud had wanted, he could have found a middle course over the hate-crime legislation, potentially avoiding a crisis: he could have had the Nationals abstain on the vote. That may perhaps have allowed a skate-through for both leaders. But Litteproud and his party chose to be as provocative as possible.

The Nationals showed poor judgement in deciding to oppose the legislation. Their subsequent breaking of the Coalition is a massive blow for an already enfeebled opposition. Moreover, Littleproud’s announcement on the day of national mourning over the Bondi massacre was completely tone deaf. Sources said Ley had counseled him all media should be paused for 24 hours, advice he did not take.

The Nationals are self-indulgent. They have become more overbearing in recent times, preempting the Liberals on the Voice and insisting they agree to demands after the election. Littleproud likes to point out the Liberals can’t reach government without them (which is true).

His lack of respect for Ley goes back a long way. In Thursday’s comments, he painted Ley as the villain in the crisis and declared, “Sussan Ley has put protecting her own leadership ahead of maintaining the Coalition”. He made it all as personal as possible, and essentially told the Liberals to get a new leader. “There is no [Nationals] shadow minister that wants to be ultimately serving in Sussan Ley’s shadow ministry,” he said.

But the Nationals are not just self-indulgent – they are deeply frightened. They’re spooked by the One Nation vote surge and the defection of Barnaby Joyce. The Newspoll published at the weekend had One Nation on 22%, with the Coalition 21%.

Given Joyce couldn’t lead the Nationals again, he is trying to make One Nation the replacement for his old party in regional Australia. He responded to the Littleproud announcement by saying:

David just hasn’t thought this through. It is going to be a cartwheel cluster. […] Maybe they’re on a recruitment drive for One Nation. Of course, it’s going to help us.

The Liberals are furious with Littleproud, and scathing in their personal descriptions of him. But that doesn’t mean they will stick by their leader, reluctant as some might be to appear to reward the Nationals, whose departure has left the official opposition with just 28 in the House of Representatives and forced Ley into yet another reshuffle.

Even before this crisis it was generally accepted Ley would not survive for long. This has made the prospect of her demise as leader even more likely, although the timing is uncertain. That could be influenced by the opinion polls to come.

But where do the Liberals turn? The alternatives, Andrew Hastie and Angus Taylor (who has been overseas and missed the crisis), are both deeply flawed as potential leaders. Taylor, though a conservative and a poor performer as shadow treasurer last term, may have more appeal to moderates who fear some of Hastie’s hard right views. But Hastie could appeal to the younger Liberals, looking for generational change.

To replace Ley, the Liberals first need to agree on a contender. If both Hastie and Taylor ran, and Ley (who doesn’t lack guts) contested too, she might come through the middle. That would just prolong the agony.

While timelines are totally unclear, this week’s events will trigger numbers-counting by supporters of the aspirants.

With little fix on what will or should happen now, or when the next eruption might come, many shell-shocked Liberals are comforting themselves by unloading their feelings about Littleproud and his band of bomb throwers.

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The federal Coalition is dead, with Nationals leader David Littleproud on Thursday morning declaring it “untenable” after Liberal leader Sussan Ley stared down the Liberals’ minor partner.

This followed all Nationals frontbenchers resigning from the shadow ministry on Wednesday night, in protest at Ley’s retaliation against three Nationals senators, Bridget McKenzie, Ross Cadell and Susan McDonald, breaking shadow cabinet solidarity.

In a statement, Littleproud said Ley “has put protecting her own leadership ahead of maintaining the Coalition”.

“We can not be part of a shadow ministry under Sussan Ley”, Littleproud told a news conference early Thursday.

“No one in our ministry could work in a Sussan Ley ministry.”

This leaves the Liberals alone as the opposition, with the Nationals as a crossbench party with no role in the official opposition.

Littleproud said the parties would be “two different armies” going forward for “the time being”.

The crisis dramatically increases the threat to Ley’s leadership, which was already unstable and not expected to last. Although Littleproud would not acknowledge it explicitly, the Nationals are encouraging a change in the Liberal leadership.

Most immediately, Ley will have to reshuffle her frontbench with Liberal members only.

Littleproud said the “sovereign position of the National party had been disrespected” and the three senators had been “courageous”.

“We were not going to stand by and have three of our senators be made scapegoats. We were going to stand with them because they did the right thing.”

The senators voted against the government’s hate crimes legislation, which passed with Liberal support. Their action was in accord with the Nationals’ decision to oppose the legislation. The Nationals disagreed in particular with the bill’s provision to enable the banning of hate-spruiking organisations. The party argued it was too wide and would endanger free speech.

Ley insisted there had been a shadow cabinet decision to obtain changes to the bill and then support it. Littleproud said a final decision on the legislation had not been made by the shadow cabinet or the joint parties.

Littleproud accused Ley of mismanaging the situation.

He stressed he had warned Ley of the consequences if she accepted the three senators’ resignations.

He spoke to her again early Thursday morning before announcing the decision. She held to her position.

This is the second break in the Coalition since the election.

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The federal Coalition was imploding on Wednesday night, with all Nationals frontbenchers, including leader David Littleproud, quitting the shadow ministry.

They were retaliating against Opposition Leader Sussan Ley’s insistence three Nationals senators must resign for defying shadow cabinet solidarity.

The Nationals ratified the mass walkout in a special party hook up at 6pm. This followed Ley accepting the resignation of the trio – Bridget McKenzie, Ross Cadell and Susan McDonald – who voted, in accordance with their party’s decision, against the government’s hate crime bill, which passed with Liberal support on Tuesday night.

The chaos deepened further when Ley declined to accept the latest batch of resignations.

As she desperately tries to hold the disintegrating opposition together, she said in a 9pm statement:

This evening, I spoke with Leader of the Nationals, David Littleproud, and strongly urged him not to walk away from the Coalition.

I have received additional offers of resignation from National Party Shadow Ministers, which I and my Liberal Leadership Group have determined are unnecessary.

The Liberal Party supports the Coalition arrangements because they deliver the most effective political alliance for good government. I note that in David’s letter, he has not indicated that the Nationals are leaving the Coalition.

No permanent changes will be made to the Shadow Ministry at this time, giving the National Party time to reconsider these offers of resignation.

The crisis plunges Ley’s leadership into fresh turmoil, and is also putting Littleproud under pressure.

While the resignations do not automatically break the Coalition, its future appears untenable in the present circumstances. Ley sent Littleproud a message on Wednesday evening, asking him to pass it on to Nationals colleagues, in which she said maintaining a strong and functional Coalition “is in the national interest”.

Early Wednesday, Littleproud warned Ley of the walkout if the Senate trio was forced off the frontbench.

The Nationals had put the Liberal leader in a diabolical position. The party’s Senate frontbenchers had defied the principle of shadow cabinet solidarity, and convention would indicate they should resign or be sacked. As Cadell told Sky early Wednesday, “I understand if you do the crime you take the time”.

But the question for Ley was: should she press the convention, or let the “crime” go unpunished to avoid a blow up?

To turn a blind eye, however, would be seen as weakness and further harm her fragile leadership. To let the Nationals get away with their defiance would be interpreted as a dramatic case of the tail wagging the dog.

Liberals, who are now getting blowback for voting for the hate crime legislation, would have been infuriated if the Nationals had been shown lenience.

Former Liberal prime minister John Howard backed Ley, telling The Australian, “She had no choice. She behaved absolutely correctly.”

After hours of public silence in which she consulted with her senior colleagues, Ley issued a statement just before 3pm, indicating the three Nationals would pay the price for their action.

“Shadow cabinet solidarity is not optional. It is the foundation of serious opposition and credible government,” she said.

She said shadow cabinet had on Sunday night examined the government’s hate crime legislation. “The unanimous shadow cabinet decision was to negotiate specific fixes with the government and having secured those amendments, members of the shadow cabinet were bound not to vote against the legislation.”

Ley said that when the Coalition re-formed after last year’s brief split, “the foundational principle underpinning that agreement was a commitment to shadow cabinet solidarity”.

She said she’d made it clear on Tuesday to Littleproud “that members of the shadow cabinet could not vote against the shadow cabinet position”.

Littleproud understood action was now required, she said.

But a letter Littleproud sent Ley early Wednesday made it clear the Nationals’ leader disputed her version of events.

He wrote that there was “also a conventíon of shadow cabinet that a final bill position must be approved by shadow cabinet”.

“This did not take place for this bill, nor was the position presented to the joint party room,” he said.

Littleproud wrote that, “If these [three] resignations are accepted, the entire National Party ministry will resign to take collective responsibility.

"Opposing this bill was a party room decision. The entire National Party shadow ministry is equally bound.”

In her statement Ley said the three senators had offered their resignations from the shadow cabinet, “as is appropriate, and I have accepted them”.

“All three Senators have written to me confirming that they ‘remain ready to continue serving the Coalition in whatever capacity you consider appropriate,’” and she’d asked them to continue serving “in the Coalition team”, outside the frontbench.

She’d also asked Littleproud to nominate replacements.

Last year, Ley was seen as emerging well in her post-election tussle with the Nationals, even though Littleproud extracted concessions.

Prime Minister Anthony Albanese, who a week ago had been on the defensive over his legislation, has now had passed much (albeit not all) of what he initially wanted, and had the additional advantage of seeing the opposition thrown into chaos. The political wheel can turn very fast.

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.