This week’s ABC Four Corners episode Pain Factory highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain.

The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain.

One in five Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated A$139 billion a year, including $12 billion in direct health-care costs.

The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work?

Opioids and invasive procedures

Treatments offered to people with chronic pain include strong pain medicines such as opioids and invasive procedures such as spinal cord stimulators or spinal fusion surgery. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm.

Spinal fusion surgery and spinal cord stimulators are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual.

Addressing the contributors to pain

Recommendations from the latest Australian and World Health Organization clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as:

• education
• advice
• structured exercise programs
• physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.

Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain.

The interventions have minimal side effects and are cost-effective.

In the RESOLVE trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move.

In the RESTORE trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it.

Why isn’t everyone with chronic pain getting this care?

While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session can cost $90–$150.

In contrast, Medicare provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions.

Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs.

Access to trained clinicians is another barrier. This problem is particularly evident in regional and rural Australia, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited.

Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The rate of opioid use, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas.

So what can we do about it?

We need to reform Australia’s health system, private and public, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments.

Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian trial, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain.

Advocacy and improving the public’s understanding of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.

Christine Lin, Professor, University of Sydney; Christopher Maher, Professor, Sydney School of Public Health, University of Sydney; Fiona Blyth, Professor, University of Sydney; James Mcauley, Professor of Psychology, UNSW Sydney, and Mark Hancock, Professor of Physiotherapy, Macquarie University

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

Food labels are intended to support healthy choices. But not all labelling schemes are equal.

Australia currently uses a voluntary Health Star Rating system. Food manufacturers can choose to add a star label to their packaging to indicate how it compares to other similar products. Or they can choose not to show a star rating on a product at all.

The Australian government is now considering making it mandatory.

But our new research on parenting and food in Australia found the Health Star Ratings are often confusing, misunderstood and have little credibility among shoppers.

If Health Stars are mandated, the system will also need a major overhaul to be trusted and useful for shoppers.

How do Health Star Ratings work?

The government set up the front-of-pack Health Star Rating system in 2014 in collaboration with the food industry, public health and consumer groups.

Product ratings range from (bad) ½ to (good) 5 stars.

Calories, saturated fat, sugars and sodium decrease the rating. Fibre, protein, and the content of fruit, vegetables, nuts and legumes increase it.

The good and bad offset each other. This means companies can strategically formulate products to boost the rating and mask unhealthy ingredients.

Processing and additives – such as sweeteners, colouring, emulsifiers, preservatives and artificial flavourings – are not part of the calculation.

Previous research has found the ratings can incentivise ultra-processed foods over minimally and unprocessed foods, and misrepresent healthfulness. Some researchers have also suggested practical ways to modify the rating algorithm to account for processing.

The Health Star Rating’s own consumer research found 74% of consumers do not understand that the rating cannot be used to compare dissimilar products.

What parents told us

In our interviews with 34 parents in Australia, participants often described the Health Star Ratings as “misleading”, “not helpful” and “on the wrong product”. One participant called it the “fake health star rating”.

They gave many examples:

Like you might buy 100% orange juice or fruit juice and it might have only half a star health star rating, but then you can buy like a box of processed muesli bars and it will have five stars. – Mother of three high school aged children, urban WA

Coco Pops or Nutrigrain have three and a half star rating, and what exactly does that mean? – Mother of one primary school aged child, urban WA

Participants wondered if the Health Stars were something companies paid for, a “marketing thing”.

Positivity bias

Part of the problem with the Health Stars is the positivity bias of the symbol. As one participant put it, “All stars are good. Right?”

Another noted their children comment on the stars, saying “but look Mum, it’s five stars.”

However, parents were not convinced:

A lot of packaged stuff is rated as five stars. I’m like yeah, well, don’t know about that. It’s still packaged. – Mother of two primary school aged children, urban NSW

Participants thought discretionary foods should not have any stars. As one participant said:

The other day, we saw a mud cake and it has a two out of five star health rating. How can that be a two out of five star?… Like there should not even be a star available for this. – Mother of pre-school aged child, urban NSW

Burden on parents

Parents often disregarded the rating. For example:

This particular thing, you know, had all sorts of additives, had actually had a much higher rating than something that actually didn’t have any additives… what I ended up buying was rated slightly lower. – Mother of two primary school aged children, rural Victoria

Instead participants used ingredients lists, apps such as Yuka, and “hours of internet research” to guide healthier choices.

But there was a sense of frustration that the burden was on them. Participants said:

I feel like food labels are extremely deceptive and by producers, purposely confusing. – Mother of one primary school aged child, urban SA

It has to be government driven because companies won’t change unless they’re forced to by the government. – Father of two primary school aged children, urban Tasmania

We need a food labelling system that works

Still, the parents we spoke to think a front-of-pack system is valuable. As one participant explained:

I do think if I had a better system for that, that would get a lot of use. – Mother of two primary school aged children, urban NSW

Parents repeatedly stated a desire for transparency over food, for information they can trust and food policies that prioritise consumer health.

As one mother put it, the “multi-billion dollar” food industry will not do this on their own, and “that’s where the government needs to step in.”

If Health Stars are mandatory, how could labelling be overhauled?

Chile, Mexico, Brazil and other countries, including Canada from 2026, are now using “stop-sign” warnings to steer consumers away from the least healthy products. Large Black Octagons alert consumers to high sugar, sodium and saturated fats, and ultra-processing.

Evidence shows these warning labels have improved nutrition and public health in other countries and could be an option for Australia.

We need to mandate a fit-for-purpose food labelling system that supports healthy eating. Governments should centre the voices of consumers in these and other national food policies to ensure they work as intended.

Juliet Bennett, Postdoctoral Research Fellow, University of Sydney; Alex Broom, Professor of Sociology & Director, Sydney Centre for Healthy Societies, University of Sydney, and David Raubenheimer, Leonard P. Ullman Chair in Nutritional Ecology, Nutrition Theme Leader Charles Perkins Centre, Chair Sydney Food and Nutrition Network, University of Sydney

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