Morrison’s health handout is bad policy (but might be good politics)



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The funding proposal is no fix for Australia’s health system but it could take some political pressure off the Coalition in the lead up to the 2019 federal election.
OnE studio/Shutterstock

Stephen Duckett, Grattan Institute

The A$1.25 billion Community Health and Hospitals Program Prime Minister Scott Morrison announced this week should be awarded a big policy fail.

The move sets back Commonwealth-state relations by decades – and it’s unclear exactly how much money will actually be provided.

Rather than being based on any coherent policy direction, it appears designed to shore up support in marginal electorates.

Bad for Commonwealth-state relations

One of the complicating factors in providing health care to Australians is the fact that the Commonwealth and states each have leadership roles in different parts of the system: the Commonwealth for primary care; and the states for public hospitals.

Health professionals yearn for the Holy Grail of a single level of government being responsible for all aspects of a patient’s care. That quest has proved illusory. But recent policy direction has at least sought to clarify the roles of the two levels of government.




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For the past five years, the states have been acknowledged as the “system managers” of the public hospital system. A rational, formula-driven funding framework has been created.

Under this framework, the Commonwealth shares the cost of growth in public hospital activity with the states. This exposes the Commonwealth directly to growing costs of technology-driven needs and giving it an incentive to work with the states to meet needs in the most efficient way.

This framework means there is one level of government to whom all public hospitals are accountable: the state. And it means voters can hold their state government accountable for hospital planning and management.

The new Morrison proposal tramples all over this policy rationality in the interests of electoral expediency. It replaces state-based planning with submission-based funding, which will enable a politician with a whiteboard in Canberra to override state priorities in favour of projects which have the greatest electoral appeal in targeted marginal seats.

It makes accountability for the overall system more confusing, and it assumes Canberra knows best.

It is a federalism fail.

An opaque policy

Labor ran a devastating campaign in the July federal by-elections, especially in the Queensland seat of Longman, which involved calculating and publicising precisely how much worse off the local hospital was under the Liberal health policy – where the Commonwealth funds 45% of hospital growth – compared with Labor’s 50% sharing policy.

In the Longman case, Labor asserted there was a A$2.9 million cut to Caboolture Hospital based on the decisions taken in the 2014 Abbott/Hockey “slash and burn” budget.

Scott Morrison’s new cash splash is no doubt designed to overcome this political weakness for the Coalition.




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However, unlike Labor’s funding, which is ongoing, it’s unclear whether the extra largess the Coalition is offering will continue beyond the budget “forward estimates” (that is, the next four years). It’s unclear how much will be devoured from existing Commonwealth funding agreements, such as the dental agreement, which are coming to an end.

The Commonwealth has responsibility for most aspects of policy to address social determinants of health, particularly employment and income policies. Rational health policy would recognise the importance of considering these issues and balancing the health benefits of, for example, lifting the Newstart allowance, against funding for specific health initiatives. There is no hint this has happened with this announcement.

New handouts under the Morrison package will be portrayed as being for specific areas of “high political need”. But the reality is funding will eventually be swept into the Grants Commission allocation process and redirected according to the Grants Commission formula.

This may restore some rationality into the health handout, albeit with a lag of a few years. But the actual level of funding to be allocated to specific areas will be shrouded in Grants Commission opacity. Insiders will be able to follow the money, but voters will be kept in dismal ignorance about how much they will benefit in the long-term – after the gloss of a local funding handout has worn off.

This policy is a transparency fail.

Politics versus policy

The Community Health and Hospitals Program lists four feel-good, worthy funding targets:

  • specialist hospital services such as cancer treatment, rural health and hospital infrastructure
  • drug and alcohol treatment
  • preventive health, primary care and chronic disease management, and
  • mental health.



Read more:
Morrison government promises $1.25 billion for health care


Everyone has a potential place in this funding Nirvana. Lobby your local MP, and your local hospital or community health program might be the lucky health policy lottery winner!

Provided voters don’t see this as a cynical political exercise – and that is a big risk in an electorate which already ranks politicians low on the trustworthiness scale – then the new policy could be smart politics. We won’t know until the votes in next year’s federal election are counted.

In the meantime, given the drubbing the Liberals received in last month’s Victorian state election, the biggest challenge for the Morrison Government might be deciding which electorates are now marginal and worth shoring up.The Conversation

Stephen Duckett, Director, Health Program, Grattan Institute

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

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Health Check: when should you throw away leftovers?



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If it’s been out longer than four hours, it’s best to throw it away.
By Merrimon Crawford

Enzo Palombo, Swinburne University of Technology

Refrigeration is the most important invention in the history of food. But while commercial and home refrigerators have only been used for the past 100 years or so, people have long used cool natural environments to store foods for extended periods.

Temperature is important for controlling microbial growth. Just as we find food wholesome, bacteria and fungi also enjoy the nutritional benefits of foods. They will consume the food and multiply, eventually “spoiling” the food (think mouldy bread or slimy lettuce).




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If the microbe can cause disease – such as Salmonella, Campylobacter, E. coli or Listeria – you’re at risk of food poisoning. Most disease-causing microbes can grow to dangerous levels even before the food is noticeably spoiled without changing the smell, taste or appearance of the food.

How to stop bugs growing in our food

All forms of life require a few basic things to grow: a source of energy, (sugar for us, sunlight for plants), oxygen (for higher forms of life), water and simple chemical building blocks that provide nitrogen, phosphorous and sulphur – and the correct temperature. Water is key, and denying it severely restricts microbial growth.

That’s why salt has long been used as a preservative for perishable foods like meats; salt binds the water and makes it unavailable to microbes. Acid can also be used (via pickling or fermentation), as most microbes don’t like acidic conditions.

Don’t delay – put it in the fridge as soon as you can.
Gary Perkin/Shutterstock

Of course, cooking kills the microbes of concern, but they can contaminate and grow in the food afterwards.

If the food can’t be salted or pickled, or you have leftovers of cooked food, you’ll need to store the food at a temperature microbes don’t like. Refrigeration is the most effective and economical option.

Typically, the greater the moisture level, the more perishable the food. That’s why we can store dry foods (such as nuts) in the cupboard but high-moisture foods (such as fresh meat, vegetables) will quickly spoil if unrefrigerated.




Read more:
Food safety: are the sniff test, the five-second rule and rare burgers safe?


How to store food safely

The “danger zone” is the temperature range between 5°C and 60°C, where most common food poisoning bacteria like to grow. To avoid the danger zone, keep hot foods above 60°C and store foods below 5°C.

The two-hour/four-hour guidelines can also help avoid food poisoning from leftovers. If perishable food has been in the danger zone for:

  • less than two hours, use it immediately or store it appropriately
  • two to four hours, use it immediately
  • longer than four hours, discard it.

So, if the food has been sitting on the table after a long lunch on a warm day, it’s probably best to discard or consume it soon afterwards.

If the food is OK, store it in small portions, as these will reach the right temperature sooner than larger volumes, before refrigerating or freezing.




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Monday’s medical myth: leave leftovers to cool before refrigerating


Using some common sense, and understanding how microbes grow, can help avoid a nasty case of diarrhoea – or worse. All food business must comply with food safety standards but how we prepare, store and consume food in our homes is equally important in preventing food-borne illness.The Conversation

Enzo Palombo, Professor of Microbiology, Swinburne University of Technology

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

Trust Me, I’m An Expert: the science of sleep and the economics of sleeplessness


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You know you’re not supposed to do this – but you do.
Shutterstock

Dilpreet Kaur, The Conversation and Sunanda Creagh, The Conversation

How did you sleep last night? If you had anything other than eight interrupted hours of peaceful, restful sleep then guess what? It’s not that bad – it’s actually pretty normal.

We recently asked five sleep researchers if everyone needs eight hours of sleep a night and they all said no, you don’t.




Read more:
We asked five experts: does everyone need eight hours of sleep?


In fact, only about one quarter of us report getting eight or more hours of sleep. That’s according to the huge annual Household, Income and Labour Dynamics in Australia (HILDA) survey which now tracks more than 17,500 people in 9500 households.

We’ll hear today from Roger Wilkins, who runs the HILDA survey at University of Melbourne, on what exactly the survey found about how much and how well Australians sleep.

But first, you’ll hear from sleep expert Melinda Jackson, Senior Research Fellow in the School of Health and Biomedical Sciences, RMIT University, about what the evidence shows about how we used to sleep in pre-industrial times, and what promising research is on the horizon. Here’s a taste:

Listen.

Trust Me, I’m An Expert is a podcast where we ask academics to surprise, delight and inform us with their research. You can download previous episodes here.

And please, do check out other podcasts from The Conversation – including The Conversation US’ Heat and Light, about 1968 in the US, and The Anthill from The Conversation UK, as well as Media Files, a podcast all about the media. You can find all our podcasts over here.

The two segments in today’s podcast were recorded and edited by Dilpreet Kaur Taggar. Additional editing by Sunanda Creagh.




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Additional audio and credits

Kindergarten by Unkle Ho, from Elefant Traks

Morning Two by David Szesztay, Free Music Archive.The Conversation

Dilpreet Kaur, Editorial Intern, The Conversation and Sunanda Creagh, Head of Digital Storytelling, The Conversation

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

We asked five experts: does everyone need eight hours of sleep?



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How much sleep we need depends on us as individuals and varies by age.
from http://www.shutterstock.com

Alexandra Hansen, The Conversation

Many of us try to live by the mantra eight hours of work, eight hours of leisure, eight hours of rest. Conventional wisdom has long told us we need eight hours of sleep per day, but some swear they need more, and some (politicians, mostly) say they function fine on four or five.

So is the human brain wired to require eight hours, or is it different for everyone? We asked five experts if everyone needs eight hours of sleep per day.

Five out of five experts said no

Here are their detailed responses:

https://cdn.theconversation.com/infographics/300/de319186cdafd9c3ab8c28724f96e5322c67f0c5/site/index.html


If you have a “yes or no” health question you’d like posed to Five Experts, email your suggestion to: alexandra.hansen@theconversation.edu.au


Disclosures: Hailey Meaklim is the recipient of an Australian Government Research Training Program Scholarship.The Conversation

Alexandra Hansen, Chief of Staff, The Conversation

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

Explainer: how a dust storm, and hazardous air quality, can harm your health


Mark Patrick Taylor, Macquarie University and Cynthia Isley, Macquarie University

A major dust storm swept through Sydney and regional New South Wales this week. Red skies over Broken Hill on Wednesday night and Sydney on Thursday resembled those seen during intense bushfire activity and the massive 2009 dust storm.

The NSW government updated its air quality index to “hazardous”. People were advised to stay indoors unless it is essential to go outside, minimise strenuous physical activity and seek emergency medical assistance if they experience breathing difficulties, chest pains, or if other serious health concerns arise.

The hazardous air quality warning arose because fine dust levels were high relative to Australian air quality standards. Air quality levels of PM10 – particles at or less than 10 microns (µg) – were more than twice the Australian standard, of 50 µg/m³ measured over a 24-hour period, on Friday morning. They remained high throughout the day.

Perhaps of greater concern are the smaller PM2.5 dust particles, which were above the Australian standard of 25 µg/m³ at St Marys in Sydney’s west on Friday morning. Fine PM2.5 dust particles can penetrate deep into the lungs and cause respiratory difficulties. Short-term exposures aggravate asthma, increasing the number of emergency department visits, as well as causing wheezing and breathing difficulties.

Even for those not affected by asthma, exposure can cause coughing, a sore throat and a runny nose. Elevated dust exposure can also aggravate heart conditions. For example, increased short-term exposure to both PM10 and PM2.5 has been linked to increased death and hospitalisation rates due to heart disease, arrhythmias (palpitations) and stroke.

The city of Newcastle is experiencing much worse conditions. On Friday morning PM10 levels were four times the Australian standard of 50 µg/m³ due to additional smoke particles from local bushfires. Throughout the day PM2.5 levels in Newcastle have remained just below the maximum acceptable upper value of 25 µg/m³.

Fine dust particles are usually too small to see individually but high concentrations make them visible as a brown haze. Even as the dust begins to clear, the unseen fine particles outside or even inside your house can still present a health risk.




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It’s advisable to use any prescribed relieving medications and seek medical advice if symptoms do not improve. For those who own an air conditioner, it may be appropriate to use it as long as the fresh air intake is closed and the filter is clean, preventing particles from being drawn into the home.

It is also important to keep an eye on air quality, which can be done in real-time via the NSW government’s air quality monitoring network.

The previous major dust storm in 2009 was made of predominantly natural elements – aluminium, silicon and iron. These originate from desert soils and did not contain significant concentrations of toxic elements. The current dust storm is likely similar in composition.

While there is some evidence the source and composition of dust has health implications, the most critical factor is the size of the particles. Evidence shows there is no safe level of fine PM2.5 dust.

Dust storms like this and the one in 2009 are unlikely to present a long-term health risk. However, they are concerning in the short term, especially for the elderly, people with pre-existing respiratory conditions and children, who breathe more air per kilogram of body mass than adults.

A health impact assessment of the 2009 dust storm showed marked increases in emergency admissions for asthma and respiratory conditions but no significant increase in cardiovascular (heart and vessel) hospital admissions. The age groups most affected were those known to be most vulnerable – people older than 65 and those aged five and younger.




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A similar situation is being experienced in California, where wildfires are causing high concentrations of dust and smoke in the air and significant concerns about human health.

Australia generally enjoys good air quality, which is not the case for many lower- to middle-income countries. According to the World Health Organisation (WHO), more than 600,000 children died in 2016 due to air pollution.

Air quality is a global public health issue. Around 91% of the world’s population live in areas where the WHO’s fine particle (PM2.5) guidelines are not met.


For those concerned about dust, Macquarie University’s DustSafe program will provide information on the dust in your home free of charge.The Conversation

Mark Patrick Taylor, Professor of Environmental Science, Macquarie University and Cynthia Isley, Researcher, Macquarie University

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

Victoria votes: your guide to the 2018 election health promises



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There are major differences – plus a few similarities – between the health promises from Labor, the Coalition and the Greens.
rawpixel/unsplash

Vijaya Sundararajan, La Trobe University; Alan Shiell, La Trobe University; Hassan Vally, La Trobe University, and Steven Lewis, University of Saskatchewan

With health care spending accounting for 30% of the Victorian budget, or A$20 billion, health is a major policy area for the Victorian election on Saturday.

While the Commonwealth pays for general practice, private specialists, pharmaceutical benefits and aged care, the states are responsible for running hospitals, community health services and ambulance services. They also want to keep Victorians healthy and out of hospital.

This election campaign, Labor has committed $4.3 billion to health; the Coalition has promised $1.3 billion, and the Greens have pledged $1.35 billion. Much of the difference comes down to infrastructure spending.




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Waiting for better care: why Australia’s hospitals and health care is failing


Labor

Labor’s health policy emphasises its commitment to a public health system. A re-elected Labor government would build a new hospital in the western Melbourne suburb of Footscray ($1.5 billion) and spend $1.2 billion on capital improvements to other hospitals in outer suburban Melbourne and regional areas.

Labor’s hospital package also includes $675 million for ten new or upgraded community hospitals. These health services would provide day surgeries, diagnostic imaging and specialist outpatients, in addition to admitted and urgent care.

The remainder of nearly A$1 billion goes to a range of other promises, including:

The boost in hospital funding is likely to enhance care in the hospital catchment areas and ease the pressure on surrounding hospitals. Improved nurse-to-patient ratios will likely improve the safety and quality of care in the state’s emergency departments and hospital wards.




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Is it necessary to commit $3.3 billion to hospitals, presumably on top of current levels of funding?

Much of this goes to capital improvements. Without such investments now, the existing hospital capacity in and around Melbourne will not be able to keep up. But it’s unclear where the money will come from to run these extra hospitals and hospital expansions. It’s hoped that operating costs will not then be taken from existing hospitals.

Coalition

The Coalition’s funding commitments are spread across the key sectors of health including:

There is evidence for much of the Coalition’s commitments. In particular, palliative care has been shown in trials to not only improve quality of life, but also, in some cancers, survival.




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Improving access to community care for disadvantaged groups and in rural and regional areas has the potential to improve the management of chronic disease, such as asthma and diabetes, leading to better health in the long term.

Greens

The Greens’ platform is anchored in a social determinants of health and a population health approach that conceives of health more explicitly as an outcome of broader social and economic conditions.




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The Victorian Greens party’s main priorities are:

The Greens’ funding for free ambulance services would ensure nobody misses out on timely care for traumatic injuries and heart attacks because they don’t have ambulance cover. A similar program operates in Queensland.

The Greens have a well-developed policy, conceiving of health and well-being broadly. The package includes substantial commitments to mental health, community health care and dental health.

But there is no extra funding for hospitals beyond the current budget.

Comparing the three parties

The biggest difference in the health funding commitments between the three parties is Labor’s focus on hospital infrastructure funding (which accounts for 78% of its health promises). It’s not clear whether the Coalition and the Greens oppose the bulk of Labor’s hospital commitments or are simply silent.

Although this level of funding to hospitals may seem like an inordinate amount, it’s important to consider the role of modern hospitals. They have become the providers of not only admitted care, but emergency care (including GP-type visits), specialist care in outpatient clinics, chronic disease management and palliative care.

When this hospital infrastructure funding is taken out of consideration, the three parties are hard to distinguish. Labor is promising $960 million, Coalition is pledging $816 million and the Greens have committed $1.3 billion to a range of community, mental health, ambulance, chronic disease and prevention services.




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The most evident gaps are Labor’s lack of funding for prevention and innovation, and the Greens’ lack of extra hospital capital funding.

A change to the Coalition would likely mean less hospital funding, particularly for a new Footscray hospital, but significant funding for community palliative care services and hospital in the home.

A more comprehensive list of the three parties’ election health promises is available on the Victorian Healthcare Association’s Election Alert.The Conversation

Vijaya Sundararajan, Professor and Head of Department, Public Health, La Trobe University; Alan Shiell, Professor of Health Economics, La Trobe University; Hassan Vally, Senior Lecturer in Epidemiology, La Trobe University, and Steven Lewis, Adjunct Professor at Simon Fraser University and Clinical Professor, University of Saskatchewan

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

One in four Australians are lonely, which affects their physical and mental health



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Younger Australians struggle more with loneliness than older generations.
Toa Heftiba

Michelle H Lim, Swinburne University of Technology

One in four Australians are lonely, our new report has found, and it’s not just a problem among older Australians – it affects both genders and almost all age groups.

The Australian Loneliness Report, released today by my colleagues and I at the Australian Psychological Society and Swinburne University, found one in two (50.5%) Australians feel lonely for at least one day in a week, while more than one in four (27.6%) feel lonely for three or more days.

Our results come from a survey of 1,678 Australians from across the nation. We used a comprehensive measure of loneliness to assess how it relates to mental health and physical health outcomes.




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We found nearly 55% of the population feel they lack companionship at least sometime. Perhaps unsurprisingly, Australians who are married or in a de facto relationship are the least lonely, compared to those who are single, separated or divorced.

While Australians are reasonably connected to their friends and families, they don’t have the same relationships with their neighbours. Almost half of Australians (47%) reported not having neighbours to call on for help, which suggests many of us feel disengaged in our neighbourhoods.

Impact on mental and physical health

Lonely Australians, when compared with their less lonely counterparts, reported higher social anxiety and depression, poorer psychological health and quality of life, and fewer meaningful relationships and social interactions.

Loneliness increases a person’s likelihood of experiencing depression by 15.2% and the likelihood of social anxiety increases by 13.1%. Those who are lonelier also report being more socially anxious during social interactions.

This fits with previous research, including a study of more than 1,000 Americans which found lonelier people reported more severe social anxiety, depression, and paranoia when followed up after three months.

Older Australians are less socially anxious than younger folks.
Fabio Neo Amato

Interestingly, Australians over 65 were less lonely, less socially anxious, and less depressed than younger Australians.

This is consistent with previous studies that show older people fare better on particular mental health and well-being indicators.

(Though it’s unclear whether this is the case for adults over 75, as few participants in our study were aged in the late 70s and over).

Younger adults, on the other hand, reported significantly more social anxiety than older Australians.

The evidence outlining the negative effects of loneliness on physical health is also growing. Past research has found loneliness increases the likelihood of an earlier death by 26% and has negative consequences on the health of your heart, your sleep, and levels of inflammation.




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Loneliness is a health issue, and needs targeted solutions


Our study adds to this body of research, finding people with higher rates of loneliness are more likely to have more headaches, stomach problems, and physical pain. This is not surprising as loneliness is associated with increased inflammatory responses.

What can we do about it?

Researchers are just beginning to understand the detrimental effects of loneliness on our health, social lives and communities but many people – including service providers – are unaware. There are no guidelines or training for service providers.

So, even caring and highly trained staff at emergency departments may trivialise the needs of lonely people presenting repeatedly and direct them to resources that aren’t right.

Increasing awareness, formalised training, and policies are all steps in the right direction to reduce this poor care.

For some people, simple solutions such as joining shared interest groups (such as book clubs) or shared experienced groups (such as bereavement or carers groups) may help alleviate their loneliness.

But for others, there are more barriers to overcome, such as stigma, discrimination, and poverty.

Shared interest groups can help some people feel less alone.
Danielle Cerullo

Many community programs and social services focus on improving well-being and quality of life for lonely people. By tackling loneliness, they may also improve the health of Australians. But without rigorous evaluation of these health outcomes, it’s difficult to determine their impact.

We know predictors of loneliness can include genetics, brain functioning, mental health, physical health, community, work, and social factors. And we know predictors can differ between groups – for example, young versus old.

But we need to better measure and understand these different predictors and how they influence each other over time. Only with Australian data can we predict who is at risk and develop effective solutions.




Read more:
The deadly truth about loneliness


There are some things we can do in the meantime.

We need a campaign to end loneliness for all Australians. Campaigns can raise awareness, reduce stigma, and empower not just the lonely person but also those around them.

Loneliness campaigns have been successfully piloted in the United Kingdom and Denmark. These campaigns don’t just raise awareness of loneliness; they also empower lonely and un-lonely people to change their social behaviours.

A great example of action arising from increased awareness comes from the Royal College of General Practitioners, which developed action plans to assist lonely patients presenting in primary care. The college encouraged GPs to tackle loneliness with more than just medicine; it prompted them to ask what matters to the lonely person rather than what is the matter with the lonely person.

Australia lags behind other countries but loneliness is on the agenda. Multiple Australian organisations have come together after identifying a need to generate Australian-specific data, increase advocacy, and develop an awareness campaign. But only significant, sustained government investment and bipartisan support will ensure this promising work results in better outcomes for lonely Australians.The Conversation

Michelle H Lim, Senior Lecturer and Clinical Psychologist, Swinburne University of Technology

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