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HEALTH

In praise of the Sunday roast

Germans like meat. But if the whole world ate like them, we'd need at least two planets to feed everyone. A proper Sunday roast free of toxic feed could be the answer, says Dagmar Dehmer from Der Tagesspiegel.

In praise of the Sunday roast
Photo: DPA

A good roast needs a lot of time and love. To make the effort worthwhile, you need good meat – so you should be prepared to spend a bit of money.

Only 30 years ago, in many German homes meat was only served on Sunday. A Sunday roast was a feast for the eyes, the nose, and the palate, and it was a social event. When there was a roast, the whole family would gather round the table to savour it, to talk and laugh.

In 1980, the average German ate 30 kilos of meat and sausage every year. By 2009, it was 88 kilos. That figure has occasionally climbed even higher in the intervening years.

It took the BSE crisis in the late 1990s and various other meat scandals to derail the steady rise in German meat consumption. But even in the years directly after the mad cow disease scare, the average was around 80 kilos.

The mass consumption of meat, eggs and milk causes a multitude of environmental problems, as well as some ethical ones. And as the current dioxin feed scandal shows – once again – the cheap industrial production of farm animals also creates a host of health issues.

If the entire population of the world – soon to reach seven billion people – lived like Germany and other industrial nations, we’d need at least two planets to feed everyone. Around a third of the world’s greenhouse gas emissions comes from farming food.

The biggest threat for the climate, biodiversity and local water cycles is the transformation of jungles and marshes into farming land. This conversion is the largest single cause of climate change, estimated at between six and 17 percent. The actual agricultural production from this land accounts for another 15 to 16 percent.

Livestock play an important part in this, not only because cows, sheep and goats produce the dangerous greenhouse gas methane when they digest. But what is much worse for the climate is growing animal feed crops using chemical fertilizers, because artificial fertilizers produce nitrous oxide – also known as laughing gas – whose effect on the climate is even worse than methane.

Nitrous oxide is also released when marshes are drained, which is why transforming land for agricultural use plays such a big part in unbalancing our climate.

Keeping livestock is not only a climate problem. Huge quantities of water are needed to produce feed, and agricultural land is much worse at storing water than forests. And there are moral problems as well, because so many ways of raising farm animals amount to pure torture.

Pigs are kept in tiny boxes on their own until a bolt gun releases them from a wretched life. Chickens do have a little more space than they did in the old battery farms, but keeping smaller groups in cages hardly amounts to ensuring a good quality of life.

The pressure to produce feed as cheaply as possible is for many manufacturers little more than a welcome invitation to mix any old trash into the feeding troughs. It’s no coincidence that almost all the food scandals of the last 20 years had their origins in the animal feed.

But a good steak or a nice Sunday roast isn’t necessarily all bad. That is at least the opinion of Berlin veterinarian Anita Idel, one of the authors of the new global agriculture report.

Idel argues that cattle could even have a positive effect on the climate, if cows were allowed to be cows – that is, if cows, sheep and goats were fed only grass, for which they are optimally designed.

Around 40 percent of the world’s land surface is grassland. If it is not over-grazed, grassland can store substantial quantities of carbon dioxide. According to the pioneer of German climate research Hartmut Graßl, the world’s forests and grasslands can absorb between 2.5 and 2.8 gigatonnes of CO2 every year.

Alexander Popp, Hermann Lotze-Campen und Benjamin Bodirsky of the Potsdam-Institute for Climate Impact Research (PIK) argue that if we returned to the tradition of the Sunday roast – or any day of the week you might prefer – and consumed fewer dairy products, Germans could be healthier and do the atmosphere a service too.

But the scientists have calculated if people in the industrialize world do not alter their lifestyles, and if the developing nations catch up at the same breakneck pace they have done in the past 15 years, emissions of methane and nitrous oxide will have increased by 75 percent by 2050 compared to 1995.

Hartmut Graßl has been campaigning for the Sunday roast mainly because three important factors have already converged that “go beyond what the Earth can endure.” “The nitrogen cycle has gone out of control,” he says. The planet’s atmosphere is overloaded with greenhouse gases and the speed with which animal and plant species as well as whole ecosystems are disappearing is far outstripping the pace of evolution.

The Sunday roast is not the solution to all these problems, but a return to this stuffy ritual – which holds happy childhood memories for many people – could ease them a little. It’s a question of “setting a precedent,” says Popp. And not least it’s a question of health.

Eat less meat, and when you do buy the more expensive kind, farmed under animal-friendly conditions without poisonous feed. Go on, treat yourself and your family to something special.

This article was published with the kind permission of Berlin newspaper Der Tagesspiegel, where it originally appeared in German. Translation by The Local.

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HEALTH

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

Sweden theoretically has a "healthcare guarantee" limiting your wait to see a GP to three days, and to see a consultant to three months. The reality is somewhat different. Here's what you can do if you face a long wait.

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

What is Sweden’s ‘healthcare guarantee’? 

Sweden’s “National Guaranteed Access to Healthcare” or vårdgaranti, is a right to care, protected by law, that has applied in Sweden since 2005. You can see the latest version of the relevant laws here and here. Here is a summary of the guarantee on the website of the Swedish Association of Local Authorities and Regions (SKR).

Under the system, all patients are guaranteed:

  • contact with a primary care centre by phone, in-person, or by video-link on the day they seek care 
  • an appointment with a doctor, nurse, physio, or psychotherapist within three days of seeking help 
  • an appointment with a specialist doctor or consultant within 90 days of seeking help 
  • treatment or operation within 90 days, if the specialist considers this necessary 

Does the guarantee mean I have a right to treatment? 

No. If the doctor at the primary care centre, after examining you and questioning you, decides that there is no reason to refer you to a specialist doctor, they do not need to do so. 

Similarly, if the specialist doctor, after examining you, decides that no treatment is necessary, then your case is considered completed.  

Can the waiting times to see a specialist or to get treatment be longer than 90 days? 

Absolutely. In fact, they very often are. 

According to the Swedish Association of Local Authorities and Regions (SKR), in February, 32 percent of patients had been waiting 90 days or more to see a specialist, and 43 percent of those who had seen a specialist had been waiting for treatment for more than 90 days.  

The situation in primary care was a little better, with 80 percent of those seeking care in contact with their primary care centre on the same day, and 83 percent having their case assessed by a doctor or nurse within three days. 

In addition, if you agree with your specialist doctor that you are willing to wait longer for an operation, then that wait doesn’t get counted in the statistics. 

So what can I do if I’ve been waiting longer than the guaranteed time? 

In reality, it’s actually less a guarantee than a target.

In primary care, there is no way for individual patients to complain that they have had to wait too long to see a doctor or nurse, or to cut their waiting times by citing the guarantee. 

“There’s no system for enforcing that guarantee,” says Emma Spak, the primary care doctor who doubles as section chief for SKR’s healthcare division. 

It would make no sense to set up a complaints line for those who have had to wait too long for phone contact with their primary care centre, she points out, when they could instead talk to patients seeking a primary care appointment in the first place. 

“It’s more of an incentive system for the regions,” she explains.

Every primary care unit and every region reports their waiting times to the national waiting time register, and then as part of the access agreement between SKR and the government, the regional health authorities receive a bonus if they meet their waiting times goal, or if they improve their waiting times. “That’s one way of sort of enforcing this guarantee,” she says. 

When it comes to specialist treatment, though, patients do have the right to demand to be examined or treated by an alternative specialist or hospital if they’ve had to wait longer than 90 days.

If your primary care centre issues you a referral to a specialist, and the specialist cannot then offer you an appointment within 90 days, the specialist, at the same time as offering you a later appointment, will often put you in contact with a unit at the regional health authority who will offer to find you an alternative specialist, either within the region or elsewhere in Sweden. 

The regional health authority will then have to reimburse any extra travel or hotel costs incurred by the patient.  

Similarly, if after examining you, a specialist cannot offer you treatment within 90 days, they will normally put you in contact with the same unit. 

Some regions have a phone line for people who have been waiting too long, or else you can contact your specialist or primary care centre and ask for information on seeking an alternative specialist. 

What happens if I don’t want to travel to see a specialist or get treatment? 

If your regional health authority offers you an alternative specialist, either within your region or in another region, so that you can get treated within the 90 day period, and you are unwilling to travel, then you lose your rights under the guarantee. . 

“If you’re in Gothenburg, and they say you have to go to Stockholm to get your treatment, and you say, ‘no, I want to go here, then then you’ve sort of forfeited your right, and you have to take what’s on offer,” Spak says. 

What happens if I agree with my specialist to wait longer? 

If your specialist says that they can treat you in four months, but also offers you treatment elsewhere within the guaranteed 90 days, and you choose to be treated by your specialist, then that counts as a patient choice, which will not then be counted in the statistics. 

“The specialist might say, ‘I don’t think you will get any worse for waiting two months extra, and if you wait five months, then I can make sure that you get your surgery done here, and we can make sure that you get all the aftercare and everything here as well,” Spak says. 

But these patient decisions are also counted in the statistics, and if a region sees a sharp rise in patients choosing to wait, SKR will tend to investigate. 

“If some region all of a sudden has a lot of patients choosing a longer waiting time, then we will call them and ask what’s going on here, because patients don’t tend to want to wait extra,” Spak says.  

Can I get financial compensation if I’ve been waiting too long? 

No. 

What other ways are there of speeding up the wait for treatment? 

Don’t underplay your symptoms

When drawing up their timetable for treatment and assessment, specialists will tend to give different patients different wait times depending on the urgency of their case.

For this reason, it’s important not to underplay your symptoms when visiting a primary care doctor, as they will tend to include a few lines on the urgency of your case when they write their referral. 

Stress your flexibility 

If you are unemployed, a student, retired, or have a very flexible job, it is worth telling your primary care doctor about this, because they may write in your referral that you are able to make appointments at very short notice. The specialist may then put you on their list of people to ring if one of their patients cancels. 

“Sometimes I write in my referrals that this patient could easily come at short notice, so please put the patient on the list for people you can call if there’s a time slot available,” Spak says. 

If you haven’t told your primary care doctor this, it’s not too late. You can ring the specialist yourself and tell their receptionist that you are very flexible, and ask to be put on the back-up list. This is particularly useful if you’re waiting for a scan, but you could also potentially work even if you’re waiting for heart surgery or a hip replacement. 

“If they’ve accepted you as a patient, and they’ve made sure that you fulfil the criteria for having that scan or whatever, then you can call them and say, ‘I have a really flexible job, I can come anytime if you have a gap,'” Spak says.

“A lot of people do that, because they can have [back-up] waiting lists. If you tell them ‘I work around the corner and I only need 15 minutes to be there’, then they might call you if someone doesn’t show up.” 

Ring up your specialist 

The queue system tends to be quite ad hoc, with no strict rules over who should be treated first, so it is often possible to reduce your wait by ringing up your specialist a few times a month, just to bring your case to their attention. Sometimes the receptionist will remember a slot that has just come free and bring forward your treatment while you are still on the telephone. 

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