Journal articles on the topic 'Medical planning commission (Great Britain)'

This article reviews recent climatically extreme periods in Great Britain and presents results from the latest general circulation model (GCM) experiments showing the possible spatial patterns and magnitude of future climate change for this region. During the last decade the British Isles has seen record-breaking periods of above-average temperatures, alongside periods with above and below-average precipitation, combined with an increase in winter precipitation and a decrease in summer precipitation. The impacts of these anomalies, coupled with the possibility that future climate change may increase their frequency and/or severity, have prompted the UK Department of the Environment, Transport and Regions and other organizations involved in environmental management, such as the Environment Agency, to commission a number of studies into their impacts. These have highlighted wide-ranging impacts on the natural environment of Great Britain and on human ativities to the extent of affecting the national economy. The use of GCMs for the development of future climate change scenarios is reviewed. Results from recent ensemble GCM experiments with and without the effects of sulphate aerosols are presented. These show broadly similar changes in temperature and precipitation to previous climate change scenarios prepared for Great Britain. In summary, the scenarios suggest the following: a warming of about 3 8C (3.5 8C) over the region by 2100 with (without) the effects of sulphate aerosols; slight increases in annual precipitation over northern England and Scotland, more pronounced increases over the whole of the region in winter; and slight decreases in precipitation over Wales and central England in summer. These changes are synchronous with decreases in the number of wet-days and increases in the intensity of precipitation on wet-days. The high level of uncertainty associated with regional scenarios of temperature and precipitation is discussed and emphasized

Purpose – The purpose of this paper is to put the issue of ageing on the agenda of the English voluntary sector; to support the development of strategies about resourcing, supporting, governing and making relevant the voluntary sector for the next 20 years. Design/methodology/approach – An independent Commission hosted by New Philanthropy Capital and the International Longevity Centre, funded by the Big Lottery and the Prudential Methodology: issuing a discussion paper, created by the Commissioners and based on futures work and an evidence review; holding national and international seminars and conferences. Findings – Our ageing society has the potential to lead the voluntary sector into a viable future by building bridges between generations and communities, by expanding the resources available to it through rethinking its workforce, both paid and unpaid, by inspiring and delivering a more integrated and committed sense of social obligations and mutuality – if it embraces “The Age of Opportunity”. Research limitations/implications – This is a policy and practice led review with implications for the UK voluntary sector, its role in society and its resourcing. Practical implications – The Commission on the Voluntary Sector & Ageing takes as its basic premise that if we can grasp the potential, we can invest the skills and resources available to us to create a thriving, relevant and creative place for the voluntary sector and civil society. The Commission is setting a challenge to charities and social enterprises. The authors want them to rethink their work so that they can help make Britain a great place to grow old and one that encourages reciprocity between generations and over a lifetime. Social implications – A more integrated and mutually empowering society that builds on an asset-based model of ageing. Originality/value – The work of the Commission has never been done before and has been seen as creating an opportunity for rethinking the role, purpose and potential of the voluntary sector.

The letter briefly describes cooperation of the St. Petersburg Medical Academy of Postgraduate Studies and Royal college of general practitioners (Great Britain) with active participation of the author, aimed at improving the training of general practitioners in Russia and the contribution of the Department of Family Medicine of St. Petersburg Medical Academy of Postgraduate Studies (now North-Western State Medical University named after I.I. Mechnikov) in the implementation of joint international projects.

The National Health and Family Planning Commission of the People's Republic of China has proposed to improve the medical capacity of general practitioners and the establishment of general practice in recent health reform. For the first time, the ability to conduct scientific research was included in this reform, which demands community healthcare centres (CHCs) to strengthen their research capacity. The evaluation of community scientific research capacity has become an important endeavour to promote the implementation of research in CHCs. Since 2016, our research team has been working on an evaluation system and has published the scientific research capacity ranking for the top 100 CHCs in China. The latest released ranking of scientific research capacities of China CHCs has aroused great attention in the country.

Over time we can observe a dramatic global shift in shipbuilding activities, from Great Britain to Continental Europe to Japan to South Korea; most recently China is gaining ground. Every transition is accompanied by institutional and political reactions, leading to protectionism and trade conflicts. The most recent of these battles is being fought out between the European Commission, in particular Germany as a major player in this market, and South Korea, which is accused of illegally supporting its shipyards. As state support has traditionally played an important role, both in establishing and in protecting shipbuilding as a strategic industry within a national economy, the concept of political lock-in appears to provide a promising method for explaining both the rise, through its enabling element, and delayed fall, through its constraining element, of these specific regional economies. Against the background of this theoretical concept, an empirical study comparing two competing shipbuilding regions—Mecklenburg-Vorpommern in eastern Germany and Gyeongnam in South Korea—was conducted; the results are twofold. First, restructuring the shipbuilding industry in these two regions seems less affected by local and regional factors than it is by national and international organisations. National and international organisations are, under globalisation conditions, increasingly responsible for regulating the conditions of competition, but are failing to do so. Second, because of the multiscale involvement of political and economic actors and, hence, the increasing complexity of the restructuring process, the concept of political lock-in needs to be integrated into a much broader explanatory framework—which the authors develop.

Medical waste has strict classification standards. However, in reality, the process of collection and disposal of most medical waste does not strictly follow the corresponding standards, thus resulting in great potential risks to people’s health. Our research analyzed existing problems with medical waste classification management, optimized the medical waste recycling business model, and then used the simulation software AnyLogic to design mixed and classification simulation models based on current literature regarding the standards of medical waste classification and composition in China. Furthermore, we simulated and calculated the generation of nonrecyclable medical waste, recyclable medical waste, and domestic waste in the three models based on 30,000 tons of medical waste generated in Beijing in 2015. We compared and analyzed the output, generation rate, disposal cost, recycling revenue, and cost–benefit based on the disposal cost standards of the Beijing Municipal Commission of Development and Reform and the China Renewable Resources Price Index in Beijing. The importance of strengthening the classification and recycling of medical waste was further validated by modeling and simulation. The study provides an important reference to hospitals, disposal plants, and government regulatory departments in their decision-making.

INTRODUCTION:Drugs are a special commodity for treating diseases and protecting health. There are problems in China's drug research, production, distribution and use (1) thus the national drug policies, including government long-term frameworks and specific policies, play an important role (2). This study summarized and analyzed drug policies in China since the New Medical Reform, to determine patterns of policy change, and aiming to provide theoretical support for drug policy making for the world.METHODS:We downloaded all drug policies issued between April 2009 to December 2016 on State Council, National Development and Reform Commission, National Health and Family Planning Commission, China Food and Drug Administration websites. These documents were combined with academic articles to extract data, which was processed in Microsoft Excel 2013. We also use the Advocacy Coalition Framework to analyze dynamic factors for drug policy change in China.RESULTS:There are 113 drug policies during last 8 years on 4 websites; 76 of them are released by a single ministry. Thirteen, ten, ten, fifteen, seven, fourteen, twenty-six and eighteen policies are issued each year, respectively. Fifteen are classified in long-term frameworks, while the other ninety-eight are specific policies. And fourteen of ninety-eight policies are focusing on basic drug systems, while six are on centralized purchases, nine on public hospitals reform, seven on drug safety, sixteen on prices, fourteen on distribution, twelve on administration, five on traditional medicine, and fifteen on specific drugs.CONCLUSIONS:After the basic drug system was built in 2009, the government started to focus on its distribution over the next 7 years. Policies on centralized purchases are mainly issued in 2010 and 2015, and creative modes have been coming up since 2015. The Government cares not only about production safety, but also safety in sales. Prices were decided by government at first but then follow the market forces. Work focus shifted from the above contents to drug distribution, price, management and traditional medicine after 2012. The peak of policy releases occurred when the great reform took place, such as 2009 when reform began, and in 2012 the Twelfth Five-year plan began. There was a decrease in 2013 due to national leadership change (3). Overall, dynamic factors for policy change mainly are social conditions, public issues and opinions, and feedback on former policy effects.

Disseminated aspergillosis in the compromised host is an important and intractable problem in Great Britain, having a general incidence, when post-mortem data are included, approaching that quoted for the United States. It emerges as a most important cause of death in units where prolonged granulocytopenia accompanies treatment.Rhame has presented a persuasive account of the environmental origin of aspergillus infection and the possibility of its control by environmental measures. This is an important issue for those involved in the planning of new units, for the use of protective isolation is under criticism as failing to provide significant benefit, and even general provision of filtered air to the unit may be beyond the budget allowed. We have to consider the minimum necessary measures to reduce the risk. Providing HEPA-filtered air to the unit may not be sufficient in itself; British heart transplant patients have died of aspergillosis (A. fumigatus), in some cases initiated soon after surgery, despite nursing in rooms with filtered ventilation (Newsom SWB, personal communication); and respiratory ventilators have been suspected as one source within such a unit. We also have to consider other approaches to the problem. Is there an endogenous element in the production of aspergillosis? Is there any prospect of successful chemoprophylaxis?

This article investigates the role of the West German family planning association Pro Familia in the abortion reform of the 1960s and 1970s. It examines the question of legal abortion from the perspective of reproductive decision-making and asks who was to make a decision about having an abortion in the reform process—the woman, her doctor, or a counsellor. During the early reform suggestions of §218 in the 1960s, Pro Familia supported the West German solution of allowing legal abortion only in medical emergencies. Opinions within the organization changed as leading members witnessed legalization in Great Britain and New York. The feminist movement and the Catholic opposition to legal abortion influenced positions in the reform phase of the 1970s. Meanwhile, Pro Familia put emphasis on compulsory pregnancy crisis counselling as aid in decision-making for individual women and a tool for putting a decision into practice. Throughout the reform process, Pro Familia continued to perceive legal abortion not as way to enable women to make their own decision but as a pragmatic solution to emergencies.

The primary task of our work is to determine the distribution and functioning of healthcare facilities in the planning structure of large cities in domestic and foreign practice. Domestic experience is present in cities which are characterized by introducing reforms in the health system: Moscow, St. Petersburg, Kazan, Tomsk, Perm. We studied the features of the distribution of healthcare facilities in cities which are characterized by an active policy of reforming the health care system: Singapore, Hong Kong, Great Britain, Germany, Israel. The research have been conducted on the basis of general scientific methods: analysis, synthesis and systematization of data identified from literary, graphic and Internet resources. As a result of analysis the spatial placement of the components the healthcare facilities we have been compiled the heat maps, which demonstrating the features of placement in the planning structure of cities. We have been analyzing a land plots of healthcare facilities to identify the compliance to the current regulatory documents and to determine the density of development depending on the location in the structure of the city. We have been carrying out a comparative analysis of the domestic and foreign experience of the spatial distribution of healthcare facilities. As a result, we have been identified two forms of spatial organization of healthcare facilities: point-based «network» and interconnected and functionally dependent organizations concentrated on a local territory the «medical clusters» – one of the most important trends of health care system

Peter Harman and Simon Mitton (eds.), Cambridge Scientific Minds and David Millar, Ian Millar, John Millar and Margaret Millar, The Cambridge Dictionary of Scientists. By Maria Yamalidou 466Maria Michela Sassi, The Science of Man in Ancient Greece. By Laurence M. V. Totelin 467H. L. L. Busard, Johannes de Tinemue's Redaction of Euclid's Elements, the So-called Adelard III Version. Volume I: Introduction, Sigla and Descriptions of the Manuscripts, Editorial Remarks, Euclides, Elementa. Volume II: Conspectus Siglorum, Apparatus Criticus, Addenda. By Jackie Stedall 468Gerhard W. Kramer, The Firework Book: Gunpowder in Medieval Germany. By Simon Werrett 469Robert Crocker (ed.), Religion, Reason and Nature in Early Modern Europe. By Scott Mandelbrote 470Rienk Vermij, The Calvinist Copernicans: The Reception of the New Astronomy in the Dutch Republic, 1575–1750. By Owen Gingerich 471Rina Knoeff, Herman Boerhaave (1668–1738): Calvinist Chemist and Physician. By Georgette Ironside 472J. Christiaan Boudri, What was Mechanical about Mechanics: The Concept of Force between Metaphysics and Mechanics from Newton to Lagrange. By Niccolò Guicciardini 473Ken Alder, The Measure of All Things: The Seven-Year Odyssey that Transformed the World. By Graeme Gooday 474Berit Pedersen (ed.), A Guide to the Archives of the Royal Entomological Society. By J. F. M. Clark 476Richard Yeo, Science in the Public Sphere: Natural Knowledge in British Culture 1800–1860. By Leigh D. Bregman 477Louise Purbrick (ed.), The Great Exhibition of 1851: New Interdisciplinary Essays. By Nick Fisher 478Hermione Hobhouse, The Crystal Palace and the Great Exhibition: Art, Science and Productive Industry. A History of the Royal Commission for the Exhibition of 1851. By Sophie Forgan 479Michael Worboys, Spreading Germs: Disease Theories and Medical Practice in Britain, 1865–1900. By Kenneth F. Kiple 480Greta Jones, ‘Captain of All these Men of Death’: The History of Tuberculosis in Nineteenth and Twentieth Century Ireland. By Juliana Adelman 481Christopher Herbert, Victorian Relativity: Radical Thought and Scientific Discovery. By Hazel Hutchison 482Paul Ziche (ed.), Monismus um 1900: Wissenschaftskultur und Weltanschauung. By Peter Zigman 484Maggie Mort, Building the Trident Network: A Study of the Enrollment of People, Knowledge, and Machines. By Sean Johnston 485A. M. Moulin and A. Cambrosio (eds.), Singular Selves: Historical Issues and Contemporary Debates in Immunology/Dialogues entre soi: Questions historiques et débats contemporains en immunologie. By Pauline M. H. Mazumdar 486Ioan James, Remarkable Mathematicians: From Euler to von Neutmann. By Claire Jones 487Joseph W. Dauben and Christoph J. Scriba (eds.), Writing the History of Mathematics: Its Historical Development. By Adrian Rice 488Jill Ker Conway, Kenneth Keniston and Leo Marx (eds.), Earth, Air, Fire, Water: Humanistic Studies of the Environment. By Leigh Clayton 490Steven Weinberg, Facing Up: Science and Its Cultural Adversaries. By Steven French 491

Introduction: Digitalization has revolutionized dentistry in the last decade. Current application in digitization has increased which includes use of various systems such as cone-beam computed tomography for implant purpose, temporomandibular joint disease diagnosis, utilization of computer-aided design–computer-aided manufacturing system (CAD-CAM system) for prosthodontics. The usage of digital dentistry is made right from diagnosis to treatment planning which reduces the time consumption & human efforts to a great extent & increases accuracy for treatment planning. Therefore, this review focuses on analysis of implementation of digitization in dentistry from 2011 to 2021. Objectives: This study aims to analyze the scientific literature on digitization in dentistry by examining the origin of manuscripts, study types, and levels of evidence. Materials and Methods: The study retrieved data from journals indexed in Scopus. Subsequently, a descriptive analysis was conducted on bibliographic data, collaboration network, and keyword co-occurrence. The articles were then classified based on their field of interest, main research question, study type, and level of evidence. Results: The study has identified 203 original papers on digital dentistry, published in 112 journals, and co-authored by 1436 individuals affiliated with 89 institutions from 45 countries. While the majority (81.4%) of these papers were from a single country, we observed high collaboration among institutions from the United States, Britain, and Brazil. The primary focus of these papers was on the potential uses of digital technology in dentistry. Regarding study type, most articles were systematic reviews, cross-sectional studies, and original research papers. Conclusion: Integrating digital technology in dentistry has brought numerous benefits, including a more organized and streamlined approach to medical records and thorough investigation and treatment planning within a shorter timeframe. Furthermore, digital technology enables the accurate detection of even the minutest details, minimizing errors and eliminating human bias. The use of three-dimensional imaging techniques allows for the precise determination of objects’ geometrical characteristics and spatial orientation, resulting in the accurate placement of implants and prosthetics. Clinical Relevance: Digitization in dentistry has opened a whole new world for practitioners to focus on the patient satisfaction approach. Digital platforms can help optimize diagnosis and consulting and provide an excellent base for treatment planning.

The article analyses the most recent experience of anti-recessionary policies in several EU member nations, such as UK, Nordic countries (especially Sweden), Ireland, Baltic countries and Greece. As for Great Britain, its government implemented traditional package of anti-crisis measures aimed at support of national financial system and stimulation of economic growth. By 2010 the nation reached relative economic stability and then proceeded into a slow recovery. Still, the crisis highlighted serious risks of ongoing financialization and de-industrialization in the UK. So, the government began to develop a long-term program of modernization and structural reshaping of national economy. Nordic countries also actively used Keynesian-type anti-crisis measures. The most interesting is Swedish case. The nation passed the global financial and economic crisis of 2008-2009 smoother than other EU members due to deep institutional reforms undertaken after the acute crisis of 1991-1993. Then Sweden experienced a deep fall of GDP combined with a crisis of local banks, surge of interest rates and unemployment level, weakening of national currency. This pushed Riksbank to introduce strict measures for limiting the inflation rate, Riksdag – caps for state budget expenditure. State sector of national economy was substantially decreased. These measures proved to have long-term positive implications. In contrast, Ireland that enjoyed an impressive economic growth before 2008 was badly prepared to external shocks. The Irish government’s reactions to financial and economic turmoil were rather spontaneous. The main task was to stabilize the local financial system that suffered from excessive dependency on foreign markets. Only by 2014 Ireland showed signs of economic recovery. Similarly, Baltic countries found themselves to be ill prepared for functioning under economic crisis conditions. Neither national governments nor EU Commission succeeded to propose efficient anti-crisis actions. As a result, population of Baltic nations most heavily suffered from the crisis. In Greece crisis made inevitable substantial revision of national social and economic model, as well as the political parties’ system. Under strong pressures from the EU Greece at last started to implement long-needed reforms in such spheres as budget planning, labor legislation, social insurance, healthcare and education. Acknowledgments. The article has been supported by a grant of the Russian Humanitarian Scientific Foundation. Project № 14-07-00047a “European Union as a Testing Site of New Anti-Crisis Technologies under Conditions of Globalization”.

Abstract Background Coronavirus disease has appeared at home and abroad since December 2019. In order to effectively control the epidemic and save lives, the government has taken a series of isolation and family work measures. The sudden outbreak of the epidemic has disturbed normal life and had a great impact on the teaching of colleges and universities in China. The purpose of this study was to investigate the mental health status and emotional regulation ability of college teachers during the coronavirus epidemic in 2019. Research Objects and Methods Cluster sampling method was used to select 400 school groups from a university in Hunan Province. 363 valid data were collected, with an effective rate of 90.75%. There are 187 boys and 176 girls; 104 liberal arts students, 95 science students and 164 engineering students; 205 only children and 158 non only children; The age range was 17-22 years old, with an average age of 19.26 ± 0.93 years. Results Participating in Psychodrama can effectively reduce the psychological pressure of college teachers and prevent depression. The data showed that the comprehensive score of DASS-21 of teachers who did not participate in Psychodrama was 1.7 times that of teachers who participated in psychodrama. In contrast, college teachers who do not participate in Psychodrama are more likely to show depression, anxiety and stress, and tend to be passive in simple coping styles. Participating in psychological drama can effectively alleviate the psychological pressure of college teachers and improve their ability to actively deal with the pressure during the epidemic. Because the path coefficient of emotional regulation self-efficacy to express positive emotional self-efficacy is small (γ= 0.15), therefore, the mediating role of the three components of emotion regulation self-efficacy is specifically analyzed. Correlation analysis found that only the self-efficacy of managing depression / pain and anger / anger were significantly correlated with social anxiety, aggression and depression (Ps < 0.01). According to the mediation effect test procedure [22], calculate the mediation effect and explain the total effect as β a ×β b/ β c. It can be seen from table 2 that social anxiety is the independent variable and aggression and depression are the dependent variables respectively. When the self-efficacy of managing depression / pain is the intermediary variable, the total effect of intermediary effect interpretation is 40.61% and 34.06% respectively; When the self-efficacy of managing anger / anger was the mediating variable, the total mediating effect was 55.77% and 31.81% respectively. Conclusion Most teachers have excessive psychological pressure and anxiety, and a few teachers have serious problems. Dass scored 21. At the same time, the comparative experimental study shows that participating in Psychodrama can alleviate the working pressure of teachers to a certain extent, effectively reduce the psychological pressure of college teachers during the epidemic and prevent depression. The data showed that during the epidemic period, the DASS-21 mental health score of teachers who did not participate in Psychodrama was 1.7 times that of teachers who participated in psychodrama. College teachers who did not participate in Psychodrama were more likely to show depression, anxiety and stress, and tended to be passive in simple coping styles. Acknowledgements The authors acknowledge the Medical Research Key Project of Chongqing Health and Family Planning Commission, 2016ZDXM003 and the Exploring self injury suicidal behavior and prevention strategies of depressed adolescents based on family factors, key project of Chongqing Municipal Education Commission, 19SKGH018; The effect of socialdrama group psychological counseling on the improvement of psychological elasticity and the prevention of job burnout of front-line medical workers in the fight against epidemic diseases, school level project of Chongqing Medical University, CQMUNCP0307.

Arthritis is the disease that kills the fewest but cripples the most. With the aging of the population in the United States and the antiquated DRG reimbursement system for hospital surgical intervention, it is inevitable that the Medicare assistant will bankrupt itself prior to the proposed bankruptcy date of 2026 if changes are not made. It may change would be to insist that the system in Maryland for reimbursement to hospitals for essential joint replacement surgery of the elderly be adapted nationwide. Medicaid expenditures are driven by a variety of factors, including the demand for care, the complexity of medical services provided, medical inflation, and life expectancy. The Medicare program has two separate trust funds – the Hospital Insurance (HI) Trust Fund and the Supplementary Medical Insurance (SMI) Trust Fund. Under the Hospital Insurance Trust, payroll taxes from workers and their employers go towards paying for the Part A benefits for today’s Medicare beneficiaries. In 2019, Medicare provided benefits to over 60 million elderly patients at an estimated cost of $796 billion [1]. While excluding the significant decrease in payroll taxes during the COVID-19 pandemic, the latest 2020 projections calculate Medicare Hospital Trust insolvency by 2026 [2]. The 2020 report declared that funds would be sufficient to pay for only 90 percent of Part A expenses at the time of this writing. Since inception, the Hospital Insurance Trust has never been insolvent, because there are no provisions in the Social Security Act that govern what would happen if insolvency were to occur. Ten of the last twelve years have witnessed expenditure outflows outpacing the Hospital Insurance Trust inflows, resulting in total Medicare spending obligations outpacing the increasing demands on the federal budget, as the number of elderly beneficiaries and the per capita health care costs continue to grow [2]. One of the principal goals of the following study is to determine how elderly patients, who often suffer from acute stages of arthritis and other orthopedic diseases, due in part to wear and tear, can continue to demand surgical intervention, in particular joint replacement surgery. Arthritis has been described as the disease that kills the fewest but cripples the most. With that in mind, the hospital systems ability to absorb the ever increasing number of elderly patients who demand joint replacement surgeries will continue to outstrip supply. The principal author of this study completed his PhD dissertation at the University of Manchester in 1977 by measuring the cost-benefit analysis of the treatment of chronic rheumatoid arthritis in Great Britain. Therefore, the author of this study aims to show the only reasonable method of payment for the imminent immeasurable demand for treatment for the elderly for age related diseases such as joint replacement surgery [3]. A recent Journal of Rheumatology article projects Medicare will finance approximately 2.67 million joint replacement surgeries by 2035, plus an additional 2.35 million joint replacement surgeries by the year 2040 [4]. The author believes that the current nationwide Diagnostic Related Groups (DRGs) system that helps determine how much Medicare pays the hospital for each “product” needs to be phased out as soon as possible. Our research shows that prior to Medicare implementing the DRGs payment system, Maryland proved that their total cost model of state-wide rewards and penalties compensated “efficient and effective” hospitals, providing care as defined by metrics set up by the Health Services Cost Review Commission (HSCRC). The Maryland legislature granted this independent government agency the broad powers to insulate the HSCRC from conflicts of interests, regulatory capture, and political meddling in the long term. In exchange, the HSCRC had the freedom to design a system that must deliver on three areas: cost reduction of hospital services, health improvement for all Maryland residents, and quality of life care improvements. Since inception of the HSCRC, all stakeholders are legally required to comply with robust auditing and data-submission requirements that allow the agency to collect data on the costs, patient volume, and financial condition of all inpatient, hospital-based outpatient, and emergency services in Maryland. This level of transparency allows the agency to set prices for hospital services, and hospitals must obey because it is Maryland law. Because of this methodology, HSCRC-approved average Maryland hospital markups ranged from 18 percent in 1980 to only 22 percent in 2008. During that same period, the average hospital markup nationally skyrocketed from 20 percent in 1980 to more than 187 percent in 2008 [5]. This strong evidence is the primary reason why the HSCRC has continued to receive a federal waiver from the Centers for Medicare and Medicaid Services, which requires both Medicare and Medicaid to pay the HSCRC-approved rates statewide. No discounts are given because of volume, nor any shifting of costs to other payers. There is a mandate: same price for the same service at the same hospital, no exceptions. Adjustments for uncompensated medical care are automatically bundled into the HSCRC-approved rates, as thus, this financial burden is shared by all hospitals in Maryland. This article explores the important milestones taken by the state of Maryland and how the lessons learned are responsible for the impressive results of their program today. This author believes that by applying the Maryland Total Cost of Care Model (Maryland TCOC Model) nationwide will yield financial savings of at least $227 billion by 2035, plus another $280 billion by 2040, exclusively from joint replacement surgeries reimbursed at HSCRC-approved rates and not any other method.

Purpose The purpose of this paper is to present the results of a critical analysis of the disability models developed to date and of how they function in practice. Furthermore, it aims to answer the following question: which model of disability (MD) will provide the most suitable foundation for any course of action undertaken in the process of planning accessible tourism development in the future? Design/methodology/approach In the first stage of the study a critical analysis of the MDs described in the literature as well as in selected reports and expert opinions relating to people with disability (PwD) was performer. These findings then became the basis for the second stage of the study which focuses on identifying attitudes within society towards the types of tourism on offer connected to the analysed MDs. The applied research methods include an analysis of a survey (2013, 2014) carried out face-to-face and on the SurveyMonkey web site. The study group consisted of 619 people (from Poland, Russia, Germany, Portugal, Slovakia, Canada, Tunisia and Great Britain). Findings The great diversity of disabilities makes finding a universal solution in the creation of accessible tourism supply a complex task. This supports the need for a flexible “mix of various models” aimed at finding optimal solutions and the personalisation of tourism. In this context the greatest potential in the development of accessible tourism are models which are a synthesis of many determiners of disability such as the biopsychosocial or the geographical model of disability. The dynamics of accessible tourism development is likely to be increasingly influenced by the economic model, reflecting current trends for the personalisation of tourism supply. Research limitations/implications The survey was carried out mainly within the European Community, the exception being respondents from Irkutsk in eastern (Asian) Russia. In order to gain a global view of the development of accessible tourism, research should be performed in countries representing all continents or tourist regions. Additionally, reflecting the definition of accessible tourism its beneficiaries – PwD – should participate in decision-making processes. Tourism service providers who are directly engaged in tourism supply also have a role to play. Their opinions and attitudes towards the development of accessible tourism determine its very nature in reality. Practical implications The survey on attitudes in society regarding the organisation of tourist trips for PwD confirmed conclusions from the analysis of the practical implications of various disability models in the creation of tourism supply that a single universal, optimal solution does not exist. All of the described MD can be applied in the development of a diverse tourism supply. The proposed model “diversification of supply […]” is the theoretical basis for the conscious development of accessible tourism in practice which in accordance with changes observed in the tourism market is undergoing increasing diversification and personalisation. Social implications In each of the tourism supply for PwD types the economic model of disability based on the identification of PwD needs and surrounding society is important. The number of PwD and the scope of necessary services, social support (PwD often travel accompanied by one to three people) is determined by income in all the sectors identified in the structure of tourism supply. From the economic point of view, awareness of different types of disability and the diverse models describing it are significant aids in the segmentation of tourism supply and placement of products accessible to PwD on the tourism market. Originality/value The paper presents a new, critical perspective on the selected MD, the key to which is the search for optimal solutions in the development of accessible tourism. The analysis performed indicated the need for a synthesis of paradigms at the core of the conceptualisation of particular models, including those often regarded as being contrary (medical and social). The results of studies would give tourism providers important data on an increasingly competitive tourism market, and also affect changes in how PwD, the elderly, are viewed, from the category of “relatively poor” to “attractive, using a wide range of services”.

After the Gallipoli War, Great Britain established a commission by the parliament on 12 August 1916 to investigate the cause, planning and why it was defeated in the war, based on the combined authority of the law, the king and the parliament. The Dardanelles Commission, consisting of ten people, published three reports. The first of these reports was named as Dardanelles Commission First Report and included the origin and beginning of the Dardanelles War and the Dardanelles Naval Wars. The second report was prepared as the First Report to Supplement, which is complementary to the first report. The third report, called The Final Report of the Dardanelles Commission, covered the Gallipoli landing, land wars, evacuation of Gallipoli, supply issues and the general results consisting of sixteen items during the execution of the operations. The first report and the supplementary report were published in 1917, and the final report in 1919. In the final report, a summary of sixteen items was presented under the general conclusions heading, including the other two reports. The study examines sixteen items in the general conclusions section of the final report. The aim of the study is to evaluate the issues related to the sixteen-point general conclusions published in the final report of the commission established to investigate the reasons for the defeat of the Allied Powers in the Gallipoli Campaign, by making use of domestic and foreign sources in the literature.

Abstract During the Second World War, representatives of occupied European countries fled the continent, mostly to Great Britain. From 1940 onwards, exiled political representatives of Belgium, Czechoslovakia, Greece, Luxembourg, the Netherlands, Norway, Poland, Yugoslavia and Free France were situated in London. This initiated debates about a broad range of legal issues, ranging from recognition and legitimacy to post-war justice. Law thus became a focal point in London, both imperative to uphold statehood and legitimacy in exile and an indispensable tool for planning and structuring the post-war world. This article looks at the pre-history of the UNWCC and presents interests and forces behind the creation of such a commission, and the attempts of different groups, states and individuals to maintain agency. This article will introduce discussions around the St James’s Declaration, the London International Assembly (LIA) and at Chatham House as important steps leading towards the UNWCC.

A major international donor conference for sustained support for the Rohingya refugees was convened on October 22, 2021. It was a virtual conference organized and co-hosted by the Secretary of State of the United States of America, the High Representative of Foreign Affairs and Security Policy of the European Union and the Vice-President of the European Commission, the Minister of State for South Asia and the Commonwealth of the United Kingdom of Great Britain and Northern Ireland and the United Nations High Commissioner for Refugees. This article critically evaluates this important event and explores the extent to which this international aid donor conference was consistent with the main principles of international aid effectiveness. It provides a critical analysis of a large-scale donor conference which reveals gaps in the theories, promises and practices of international aid. The focus is on the ownership of aid policies and who determines the aid agenda in this case of the large number of Rohingya refugees who have fled persecution in Myanmar and sought refuge in Bangladesh.

Accurate forecasts of ambulance demand are crucial inputs when planning and deploying staff and fleet. Such demand forecasts are required at national, regional, and sub-regional levels and must take account of the nature of incidents and their priorities. These forecasts are often generated independently by different teams within the organization. As a result, forecasts at different levels may be inconsistent, resulting in conflicting decisions and a lack of coherent coordination in the service. To address this issue, we exploit the hierarchical and grouped structure of the demand time series and apply forecast reconciliation methods to generate both point and probabilistic forecasts that are coherent and use all the available data at all levels of disaggregation. The methods are applied to daily incident data from an ambulance service in Great Britain, from October 2015 to July 2019, disaggregated by nature of incident, priority, managing health board, and control area. We use an ensemble of forecasting models and show that the resulting forecasts are better than any individual forecasting model. We validate the forecasting approach using time series cross-validation.

ObjectivesThis study aims to identify factors among British community-based adults associated with advance care planning engagement. Factors are then compared among six domains of wishes: medical care, spiritual and religious needs, privacy and peace, dignified care, place of death and pain relief.MethodsCross-sectional data were analysed from a stratified random sample of adults across Great Britain (England, Scotland and Wales) who were interviewed on their attitudes towards death and dying. Weighted multivariable logistic regression tested for associations with expressing any end-of-life wishes and then for each separate domain.ResultsAnalysis of 2042 respondents (response rate: 53.5%) revealed those less likely to have discussed their wishes were: male, younger, born in the UK, owned their residence, had no experience working in health or social care, had no chronic conditions or disabilities, had not experienced the death of a close person in the last 5 years and feel neither comfortable nor uncomfortable or uncomfortable talking about death. Additional factors among the six domains associated with having not discussed wishes include: having less and more formal education, no religious beliefs, lower household income and living with at least one other person.ConclusionsThis study is the first to be conducted among a sample of community-dwelling British adults and the first of its kind to compare domains of end-of-life wishes. Our findings provide an understanding of social determinants which can inform a public health approach to end-of-life care that promotes advance care planning among compassionate communities.

In the modern world Total Quality Management (TQM) respecting the past ensures the triumph of the future and Artificial Intelligence. Fulfilling the absence in the universal medical journal of multi-organ supportive therapy (MOST) replacement models of the central nervous system, immune and energy system functions, have been completed by describing extracorporeal and intracorporeal prosthetics of immune and energy system functions. Prosthetics, assistive support, and replacement of nervous system function contributed to the foundation of Artificial Intelligence (AI) and the creation of the robot as an intellect-technocrat combination. Using the Da Vinci robot with four arms, surgeons in Spain performed a lung transplant [3], relevant and timely also in the complications of COVID-19 SARS-CoV-2. As a result, the robot reduced the discrepancy between the predominance of the human and technocratic intellectual factors in the creation of the product useful to humanity. At the foundation of AI is TQM recognized by the scientific community of the modern world and in the context of alternative medicine models as a promoter of science. Thanks to the US development over 40 years of transgenic pig organ transplantation, as a model conceived in Moldova (1984), as an alternative to human donor organs. The prized TQM medicine is successfully assimilated by competitive marketing, in which AI is already included, with an essential social financial role. IA was supported by Antonio Guterres, Secretary General of the United Nations, Ursula von der Leyen, President of the European Commission. Thus AI has been considered at the level of the United Nations, the European Union, Japan, China and others. The head of the European Commission, Ursula von der Leyen from Great Britain at the First AI Safety Summit in the world, named 4 conditions for ensuring safety in the use of AI. 1) A thriving and independent scientific community equipped to evaluate AI systems, with funding and access to the best supercomputers; 2) Development of internationally recognized procedure and standards for AI safety testing. 3) A standard procedure whereby every significant incident caused by errors or misuse of AI is reported and accounted for. 4) Establishment of a reliable international notification system.

For the fifth year in a row, the international symposium SMART LION (Science Medicine Arts Research Translational Lviv International Opportunity Network) is taking place in Lviv, which has become a good tradition in scientific and practical communication. This year, the symposium is focused on the “Medical Imagining and Global Health”. The scientific event was held in Lviv on October 7–9, 2021. The format was mixed. The event was held with the support of Danylo Halytsky Lviv National Medical University, Medical Commission of the Shevchenko Scientific Society, Lviv City Council and Lviv Convention Bureau. The symposium was focused on providing a unique opportunity for young and experienced scientists and doctors working on the development of innovative technologies in medicine, to further cooperate in the field of science and integrate their knowledge and achievements into world science. The interesting and eventful agenda included over 20 lectures and poster presentations delivered by national and foreign lecturers, as well as a master class on “How to use the online Open Journal System to publish scientific articles in medical journals”. To focus the attention of young scientists, students and interns on topical issues of medicine, well-known scientists from different countries of Europe and America are annually invited to attend the symposium as speakers. During the two days of the conference, Ukrainian and foreign leading experts in the field of medicine – Leo Wolansky (USA), Sandor Szabo (USA), Vassyl Lonchyna (USA), Klaus Holzmann (Austria), Siegfried Knasmüller (Austria), Armen Gasparyan (Great Britain), Ivan Wolansky (USA), Yuriy Ivaniv (Ukraine), Nelya Oryshchyn (Ukraine), Andriy Netliukh (Ukraine), Yuriy Mylyan (Ukraine), Oksana Zayachkivska (Ukraine), Roman Plyatsko (Ukraine), Khrystyna Lishchuk-Yakymovych (Ukraine), Olena Zimba (Ukraine) – shared their experience and the latest achievements in the field of medicine. After a two-year break due to a COVID-19 pandemic, joint live discussions between young scientists – students, interns, post-graduate students – with leading scientists during poster presentations and panel discussions held at the symposium helped them rethink the need for systemic changes in medical education and the implementation of modern diagnostic methods utilizing real-time visualization with elements of artificial intelligence into curriculums. In conclusion, Oksana Zayachkivska (Professor, Chair of the Department of Normal Physiology, Danylo Halytsky Lviv National Medical University; Editor-in-Chief of the “Proceeding of the Shevchenko Scientific Society. Medical Sciences”) and Vassyl Lonchyna (Professor, University of Chicago Pritzker School of Medicine, Ukrainian Catholic University) summed up the symposium and expressed hope to meet again at SMART LION 2022.

Currently, the issues of human resources are raised by many Russian and foreign scientists. Personnel, being the main, most valuable and significant part of health resources, ultimately ensure the effectiveness, efficiency and quality of medical care to the population. Therefore, there is no accidental scientific interest in studying the state of human resources of draft commissions carrying out military medical expertise. The purpose of the study is to characterize the personnel composition of doctors of conscription commissions of municipalities of the Orenburg region. Materials and methods. The analysis of the personnel of doctors working in the draft commissions of the Orenburg region was carried out. Statistical, analytical and sociological research methods were used. The following indicators were analyzed: staffing of draft commissions with medical personnel; age composition of doctors; general medical experience of doctors and work experience in draft commissions; availability of certificates of specialists and medical categories. To compile a social “portrait” of doctors working in the draft commissions of the Orenburg region, a sociological survey was carried out, in which 393 specialist doctors took part. The sociological survey made it possible to study the opinion of doctors who carry out medical examination of conscripts on the organization of medical care for young men in the pre-conscription period. Results. The average doctor working in the conscription commission of the Orenburg region municipality is characterized by a high level of professional training, which proves that he has a great medical experience, medical category and a specialist certificate. Conclusion. The article presents the results of the analysis of staffing indicators and the level of professional training of doctors working in the draft commissions of the Orenburg region. Taking into account the completed questionnaire, a social “portrait” of doctors carrying out medical examination of persons of military age was compiled. The opinion of doctors on the organization of medical care for young men in children’s polyclinics and draft commissions was studied. The information received should be taken into account when planning priority measures at the regional level aimed at improving the quality of medical support for the preparation of citizens for military service.

AimThe demand for bowel cancer screening (BCS) is expected to increase significantly within the next decade. Little is known about the intentions of the workforce required to meet this demand. The Joint Advisory Group on Gastrointestinal Endoscopy (JAG), the British Society of Gastroenterology (BSG) and Association of Coloproctology of Great Britain and Ireland (ACPGBI) developed the first BCS workforce survey. The aim was to assess endoscopist career intentions to aid in future workforce planning to meet the anticipated increase in BCS colonoscopy.MethodsA survey was developed by JAG, BSG and ACPGBI and disseminated to consultant, clinical and trainee endoscopists between February and April 2020. Descriptive and comparative analyses were undertaken, supported with BCS data.ResultsThere were 578 respondents. Screening consultants have a median of one programmed activity (PA) per week for screening, accounting for 40% of their current endoscopy workload. 38% of current screening consultants are considering giving up colonoscopy in the next 2–5 years. Retirement (58%) and pension issues (23%) are the principle reasons for this. Consultants would increase their screening PAs by 70% if able to do so. The top three activities that endoscopists would relinquish to further support screening were outpatient clinics, acute medical/surgical on call and ward cover. An extra 155 colonoscopists would be needed to fulfil increased demand and planned retirement at current PAs.ConclusionThis survey has identified a serious potential shortfall in screening colonoscopists in the next 5–10 years due to an ageing workforce and job plan pressures of aspirant BCS colonoscopists. We have outlined potential mitigations including reviewing job plans, improving workforce resources and supporting accreditation and training.

This paper considers the problem of abortion in modern Russia. Using official statistics, we analyze the dynamics of abortion indicators since the early 1990s. On the basis of representative national sample surveys, we conclude that official statistics are complete and reliable. This in turn confirms the steady decline of abortions during the post-Soviet years. A particularly rapid decline in abortions is seen among the youngest women. Modern teenagers have fewer abortions than their predecessors at this age. The current level of induced abortions in women under age 20 in Russia today is less than in France, Great Britain, Sweden, and a number of other developed countries of European culture. The major differentiating factor for frequency of abortion is age. There are no clear correlations between the risks of abortion in Russia and such standard social characteristics as income, type of settlement and education. Despite the positive trend, Russia remains one of the countries with the highest abortion rates in the world. The country’s turn to traditional values and the allegedly growing role of religion are inadequate mechanisms to reduce abortions. Government support is given not to proven, evidence-based measures like the promotion of family planning, sex education, etc., but to repression and restrictions. During the past 10-15 years, a number of restrictive amendments have been introduced into legislation. The authors indicate the counterproductive effects of these restrictions on abortion as an instrument of a pronatalist population policy. This article recommends paying more attention to improvements in the quality of abortion provision by the introduction of modern medical standards and protocols. In the conclusion, the authors suggest ways to improve the official statistics on abortions.

Introduction The scientific validity of climate change claims, how to intervene (if at all) in environmental, economic, political and social consequences of climate change, and the adaptation and mitigation needed with any given climate change scenario, are contested areas of public, policy and academic discourses. For marginalised populations, the climate discourses around adaptation, mitigation, vulnerability and resilience are of particular importance. This paper considers the silence around disabled people in these discourses. Marci Roth of the Spinal Cord Injury Association testified before Congress in regards to the Katrina disaster: [On August 29] Susan Daniels called me to enlist my help because her sister in-law, a quadriplegic woman in New Orleans, had been unsuccessfully trying to evacuate to the Superdome for two days. […] It was clear that this woman, Benilda Caixetta, was not being evacuated. I stayed on the phone with Benilda, for the most part of the day. […] She kept telling me she’d been calling for a ride to the Superdome since Saturday; but, despite promises, no one came. The very same paratransit system that people can’t rely on in good weather is what was being relied on in the evacuation. […] I was on the phone with Benilda when she told me, with panic in her voice “the water is rushing in.” And then her phone went dead. We learned five days later that she had been found in her apartment dead, floating next to her wheelchair. […] Benilda did not have to drown. (National Council on Disability, emphasis added) According to the Intergovernmental Panel on Climate Change (IPCC), adaptation is the “Adjustment in natural or human systems in response to actual or expected climatic stimuli or their effects, which moderates harm or exploits beneficial opportunities” (IPCC, Climate Change 2007). Adaptations can be anticipatory or reactive, and depending on their degree of spontaneity they can be autonomous or planned (IPCC, Fourth Assessment Report). Adaptations can be private or public (IPCC, Fourth Assessment Report), technological, behavioural, managerial and structural (National Research Council of Canada). Adaptation, in the context of human dimensions of global change, usually refers to a process, action or outcome in a system (household, community, group, sector, region, country) in order for that system to better cope with, manage or adjust to some changing condition, stress, hazard, risk or opportunity (Smit and Wandel). Adaptation can encompass national or regional strategies as well as practical steps taken at the community level or by individuals. According to Smit et al, a framework for systematically defining adaptations is based on three questions: (i) adaptation to what; (ii) who or what adapts; and (iii) how does adaptation occur? These are essential questions that have to be looked at from many angles including cultural and anthropological lenses as well as lenses of marginalised and highly vulnerable populations. Mitigation (to reduce or prevent changes in the climate system), vulnerability (the degree to which a system is susceptible to, and unable to cope with, the adverse effects of climate change), and resilience (the amount of change a system can undergo without changing state), are other important concepts within the climate change discourse. Non-climate stresses can increase vulnerability to climate change by reducing resilience and can also reduce adaptive capacity because of resource deployment to competing needs. Extending this to the context of disabled people, ableism (sentiment to expect certain abilities within humans) (Wolbring, “Is there an end to out-able?”) and disablism (the unwillingness to accommodate different needs) (Miller, Parker and Gillinson) are two concepts that will thus play themselves out in climate discourses. The “Summary for Policymakers” of the IPCC 2007 report, Climate Change 2007: Impacts, Adaptation and Vulnerability, states: “Poor communities can be especially vulnerable, in particular those concentrated in high-risk areas. They tend to have more limited adaptive capacities, and are more dependent on climate-sensitive resources such as local water and food supplies.” From this quote one can conclude that disabled people are particularly impacted, as the majority of disabled people live in poverty (Elwan). For instance, CARE International, a humanitarian organisation fighting global poverty, the UN Office for the Coordination of Humanitarian Affairs, and Maplecroft, a company that specialises in the calculation, analysis and visualisation of global risks, conclude: “The degree of vulnerability is determined by underlying natural, human, social, physical and financial factors and is a major reason why poor people—especially those in marginalised social groups like women, children, the elderly and people with disabilities—are most affected by disasters” (CARE International). The purpose of this paper is to expose the reader to (a) how disabled people are situated in the culture of the climate, adaptation, mitigation and resilience discourse; (b) how one would answer the three questions, (i) adaptation to what, (ii) who or what adapts, and (iii) how does adaptation occur (Smit et al), using a disabled people lens; and (c) what that reality of the involvement of disabled people within the climate change discourse might herald for other groups in the future. The paper contends that there is a pressing need for the climate discourse to be more inclusive and to develop a new social contract to modify existing dynamics of ableism and disablism so as to avoid the uneven distribution of evident burdens already linked to climate change. A Culture of Neglect: The Situation of Disabled People As climates changes, environmental events that are classified as natural disasters are expected to be more frequent. In the face of recent disaster responses, how effective have these efforts been as they relate to the needs and challenges faced by disabled people? Almost immediately after Hurricane Katrina devastated the Gulf Coast, the National Council on Disability (NCD) in the United States estimated that 155,000 people with disabilities lived in the three cities hardest hit by the hurricane (about 25 per cent of the cities’ populations). The NCD urged emergency managers and government officials to recognise that the need for basic necessities by hurricane survivors with disabilities was “compounded by chronic health conditions and functional impairments … [which include] people who are blind, people who are deaf, people who use wheelchairs, canes, walkers, crutches, people with service animals, and people with mental health needs.” The NCD estimated that a disproportionate number of fatalities were people with disabilities. They cited one statistic from the American Association of Retired Persons (AARP): “73 per cent of Hurricane Katrina-related deaths in New Orleans area were among persons age 60 and over, although they comprised only 15 per cent of the population in New Orleans.” As the NCD stated, “most of those individuals had medical conditions and functional or sensory disabilities that made them more vulnerable. Many more people with disabilities under the age of 60 died or were otherwise impacted by the hurricanes.” As these numbers are very likely linked to the impaired status of the elderly, it seems reasonable to assume similar numbers for non-elderly disabled people. Hurricane Katrina is but one example of how disabled people are neglected in a disaster (Hemingway and Priestley; Fjord and Manderson). Disabled people were also disproportionately impacted in other disasters, such as the 1995 Great Hanshin Earthquake in Japan (Nakamura) or the 2003 heatwave in France, where 63 per cent of heat-related deaths occurred in institutions, with a quarter of these in nursing homes (Holstein et al.). A review of 18 US heatwave response plans revealed that although people with mental or chronic illnesses and the homeless constitute a significant proportion of the victims in recent heatwaves, only one plan emphasised outreach to disabled persons, and only two addressed the shelter and water needs of the homeless (Ebi and Meehl; Bernhard and McGeehin). Presence of Disabled People in Climate Discourse Although climate change will disproportionately impact disabled people, despite the less than stellar record of disaster adaptation and mitigation efforts towards disabled people, and despite the fact that other social groups (such as women, children, ‘the poor’, indigenous people, farmers and displaced people) are mentioned in climate-related reports such as the IPCC reports and the Human Development Report 2007/2008, the same reports do not mention disabled people. Even worse, the majority of the material generated by, and physically set up for, discourses on climate, is inaccessible for many disabled people (Australian Human Rights Commission). For instance, the IPCC report, Climate Change 2007: Impacts, Adaptation and Vulnerability, contains Box 8.2: Gender and natural disasters, makes the following points: (a) “men and women are affected differently in all phases of a disaster, from exposure to risk and risk perception; to preparedness behaviour, warning communication and response; physical, psychological, social and economic impacts; emergency response; and ultimately to recovery and reconstruction”; (b) “natural disasters have been shown to result in increased domestic violence against, and post-traumatic stress disorders in, women”; and (c) “women make an important contribution to disaster reduction, often informally through participating in disaster management and acting as agents of social change. Their resilience and their networks are critical in household and community recovery.” The content of Box 8.2 acknowledges the existence of different perspectives and contributions to the climate discourse, and that it is beneficial to explore these differences. It seems reasonable to assume that differences in perspectives, contributions and impact may well also exist between people with and without disabilities, and that it may be likewise beneficial to explore these differences. Disabled people are differently affected in all phases of a disaster, from exposure to risk and risk perception; to preparedness behaviour, warning communication and response; physical, psychological, social and economic impacts; emergency response; and ultimately to recovery and reconstruction. Disabled people could also make an important contribution to disaster reduction, often informally through participating in disaster management and acting as agents of social change. Their resilience and their networks are critical in household and community recovery, important as distributors of relief efforts and in reconstruction design. The Bonn Declaration from the 2007 international conference, Disasters are always Inclusive: Persons with Disabilities in Humanitarian Emergency Situations, highlighted many problems disabled people are facing and gives recommendations for inclusive disaster preparedness planning, for inclusive response in acute emergency situations and immediate rehabilitation measures, and for inclusive post-disaster reconstruction and development measures. Many workshops were initiated by disabled people groups, such as Rehabilitation International. However, the disabled people disaster adaptation and mitigation discourse is not mainstreamed. Advocacy by people with disability for accessible transport and universal or “life-cycle” housing (among other things) shows how they can contribute significantly to more effective social systems and public facilities. These benefit everyone and help to shift public expectations towards accessible and flexible amenities and services—for example, emergency response and evacuation procedures are much easier for all if such facilities are universally accessible. Most suggestions by disabled people for a more integrative, accessible physical environment and societal attitude benefit everyone, and gain special importance with the ever-increasing proportion of elderly people in society. The IPCC Fourth Assessment Report is intended to be a balanced assessment of current knowledge on climate change mitigation. However, none of the 2007 IPCC reports mention disabled people. Does that mean that disabled people are not impacted by, or impact, climate change? Does no knowledge of adaptation, mitigation and adaptation capacity from a disabled people lens exist, or does the knowledge not reach the IPCC, or does the IPCC judge this knowledge as irrelevant? This culture of neglect and unbalanced assessment of knowledge evident in the IPCC reports was recognised before for rise of a ‘global’ climate discourse. For instance, a 2001 Canadian government document asked that research agendas be developed with the involvement of, among others, disabled people (Health Canada). The 2009 Nairobi Declaration on Africa’s response to climate change (paragraph 36) also asks for the involvement of disabled people (African Ministerial Conference on the Environment). However, so far nothing has trickled up to the international bodies, like the IPCC, or leading conferences such as the United Nations Climate Change Conference Copenhagen 2009. Where Will It End? In his essay, “We do not need climate change apartheid in adaptation”, in the Human Development Report 2007/2008, Archbishop Desmond Tutu suggests that we are drifting into a situation of global adaptation apartheid—that adaptation becomes a euphemism for social injustice on a global scale (United Nations Development Programme). He uses the term “adaptation apartheid” to highlight the inequality of support for adaptation capacity between high and low income countries: “Inequality in capacity to adapt to climate change is emerging as a potential driver of wider disparities in wealth, security and opportunities for human development”. I submit that “adaptation apartheid” also exists in regard to disabled people, with the invisibility of disabled people in the climate discourse being just one facet. The unwillingness to accommodate, to help the “other,” is nothing new for disabled people. The ableism that favours species-typical bodily functioning (Wolbring, “Is there an end to out-able?”; Wolbring, “Why NBIC?”) and disablism (Miller, Parker, and Gillinson)—the lack of accommodation enthusiasm for the needs of people with ‘below’ species-typical body abilities and the unwillingness to adapt to the needs of “others”—is a form of “adaptation apartheid,” of accommodation apartheid, of adaptation disablism that has been battled by disabled people for a long time. In a 2009 online survey of 2000 British people, 38 per cent believed that most people in British society see disabled people as a “drain on resources” (Scope). A majority of human geneticist concluded in a survey in 1999 that disabled people will never be given the support they need (Nippert and Wolff). Adaptation disablism is visible in the literature and studies around other disasters. The 1988 British Medical Association discussion document, Selection of casualties for treatment after nuclear attack, stated “casualties whose injuries were likely to lead to a permanent disability would receive lower priority than those expected to fully recover” (Sunday Morning Herald). Famine is seen to lead to increased infanticide, increased competitiveness and decreased collaboration (Participants of the Nuclear Winter: The Anthropology of Human Survival Session). Ableism and disablism notions experienced by disabled people can now be extended to include those challenges expected to arise from the need to adapt to climate change. It is reasonable to expect that ableism will prevail, expecting people to cope with certain forms of climate change, and that disablism will be extended, with the ones less affected being unwilling to accommodate the ones more affected beyond a certain point. This ableism/disablism will not only play itself out between high and low income countries, as Desmond Tutu described, but also within high income countries, as not every need will be accommodated. The disaster experience of disabled people is just one example. And there might be climate change consequences that one can only mitigate through high tech bodily adaptations that will not be available to many of the ones who are so far accommodated in high income countries. Desmond Tutu submits that adaptation apartheid might work for the fortunate ones in the short term, but will be destructive for them in the long term (United Nations Development Programme). Disability studies scholar Erik Leipoldt proposed that the disability perspective of interdependence is a practical guide from the margins for making new choices that may lead to a just and sustainable world—a concept that reduces the distance between each other and our environment (Leipoldt). This perspective rejects ableism and disablism as it plays itself out today, including adaptation apartheid. Planned adaptation involves four basic steps: information development and awareness-raising; planning and design; implementation; and monitoring and evaluation (Smit et al). Disabled people have important knowledge to contribute to these four basic steps that goes far beyond their community. Their understanding and acceptance of, for example, the concept of interdependence, is just one major contribution. Including the concept of interdependence within the set of tools that inform the four basic steps of adaptation and other facets of climate discourse has the potential to lead to a decrease of adaptation apartheid, and to increase the utility of the climate discourse for the global community as a whole. References African Ministerial Conference on the Environment. Nairobi Declaration on the African Process for Combating Climate Change. 2009. 26 Aug. 2009 ‹ http://www.unep.org/roa/Amcen/Amcen_Events/3rd_ss/Docs/nairobi-Decration-2009.pdf ›. American Association of Retired Persons. We Can Do Better: Lessons Learned for Protecting Older Persons in Disasters. 2009. 26 Aug. 2009 ‹ http://assets.aarp.org/rgcenter/il/better.pdf ›. Australian Human Rights Commission. “Climate Change Secretariat Excludes People with Disabilities.” 2008. 26 Aug. 2009 ‹ http://www.hreoc.gov.au/about/media/media_releases/2008/95_08.html ›. Bernhard, S., and M. McGeehin. “Municipal Heatwave Response Plans.” American Journal of Public Health 94 (2004): 1520-21. CARE International, the UN Office for the Coordination of Humanitarian Affairs, and Maplecroft. Humanitarian Implications of Climate Change: Mapping Emerging Trends and Risk Hotspots for Humanitarian Actors. CARE International, 2008. 26 Aug. 2009 ‹ http://www.careclimatechange.org/files/reports/Human_Implications_PolicyBrief.pdf ›, ‹ http://www.careclimatechange.org/files/reports/CARE_Human_Implications.pdf ›. "Disasters Are Always Inclusive: Persons with Disabilities in Humanitarian Emergency Situations." Bonn Declaration from the International Conference: Disasters Are Always Inclusive: Persons with Disabilities in Humanitarian Emergency Situations. 2007. 26 Aug. 2009 ‹ http://www.disabilityfunders.org/webfm_send/6, http://www.disabilityfunders.org/emergency_preparedness ›, ‹ http://bezev.de/bezev/aktuelles/index.htm ›. Ebi, K., and G. Meehl. Heatwaves and Global Climate Change: The Heat Is On: Climate Change and Heatwaves in the Midwest. 2007. 26 Aug. 2009 ‹ www.pewclimate.org/docUploads/Regional-Impacts-Midwest.pdf ›. Elwan, A. Poverty and Disability: A Survey of the Literature. Worldbank, Social Protection Discussion Paper Series (1999): 9932. 26 Aug. 2009 ‹ http://siteresources.worldbank.org/DISABILITY/Resources/Poverty/Poverty_and_Disability_A_Survey_of_the_Literature.pdf ›. Fjord, L., and L. Manderson. “Anthropological Perspectives on Disasters and Disability: An Introduction.” Human Organisation 68.1 (2009): 64-72. Health Canada. First Annual National Health and Climate Change Science and Policy Research Consensus Conference: How Will Climate Change Affect Priorities for Your Health Science and Policy Research? Health Canada, 2001. 26 Aug. 2009 ‹ http://www.hc-sc.gc.ca/ewh-semt/pubs/climat/research-agenda-recherche/population-eng.php ›. Hemingway, L., and M. Priestley. “Natural Hazards, Human Vulnerability and Disabling Societies: A Disaster for Disabled People?” The Review of Disability Studies (2006). 26 Aug. 2009 ‹ http://www.rds.hawaii.edu/counter/count.php?id=13 ›. Holstein, J., et al. “Were Less Disabled Patients the Most Affected by the 2003 Heatwave in Nursing Homes in Paris, France?” Journal of Public Health Advance 27.4 (2005): 359-65. Intergovernmental Panel on Climate Change. Climate Change 2007: Impacts, Adaptation and Vulnerability. 2007. 26 Aug. 2009 ‹ http://www.ipcc.ch/publications_and_data/publications_ipcc_fourth_assessment_report_wg2_report_impacts_adaptation_and_vulnerability.htm ›. Intergovernmental Panel on Climate Change. “Summary for Policymakers.” Eds. O. F. Canziani, J. P. Palutikof, P. J. van der Linden, C. E. Hanson, and M.L.Parry. Cambridge, UK: Cambridge University Press, 2007. 7-22. 26 Aug. 2009 ‹ http://www.ipcc.ch/pdf/assessment-report/ar4/wg2/ar4-wg2-spm.pdf ›. Intergovernmental Panel on Climate Change. IPCC Fourth Assessment Report Working Group III Report: Mitigation of Climate Change Glossary. 2007. 26 Aug. 2009 ‹ http://www.ipcc.ch/ipccreports/ar4-wg3.htm, http://www.ipcc.ch/pdf/assessment-report/ar4/wg3/ar4-wg3-annex1.pdf ›. Leipoldt, E. “Disability Experience: A Contribution from the Margins. Towards a Sustainable Future.” Journal of Futures Studies 10 (2006): 3-15. Miller, P., S. Parker and S. Gillinson. “Disablism: How to Tackle the Last Prejudice.” Demos, 2004. 26 Aug. 2009 ‹ http://www.demos.co.uk/files/disablism.pdf ›. Nakamura, K. “Disability, Destitution, and Disaster: Surviving the 1995 Great Hanshin Earthquake in Japan.” Human Organisation 68.1 (2009): 82-88. National Council on Disability, National Council on Independent Living, National Organization on Disability, and National Spinal Cord Injury Association and the Paralyzed Veterans of America. Emergency Management and People with Disabilities: before, during and after Congressional Briefing, 10 November 2005. 26 Aug. 2009 ‹ http://www.ncd.gov/newsroom/publications/2005/transcript_emergencymgt.htm ›. National Council on Disability. National Council on Disability on Hurricane Katrina Affected Areas. 2005. 26 Aug. 2009 ‹ http://www.ncd.gov/newsroom/publications/2005/katrina2.htm ›. National Research Council of Canada. From Impacts to Adaptation: Canada in a Changing Climate 2007. 26 Aug. 2009 ‹ http://adaptation.nrcan.gc.ca/assess/2007/pdf/full-complet_e.pdf ›. Nippert, I. and G. Wolff. “Ethik und Genetik: Ergebnisse der Umfrage zu Problemaspekten angewandter Humangenetik 1994-1996, 37 Länder.” Medgen 11 (1999): 53-61. Participants of the Nuclear Winter: The Anthropology of Human Survival Session. Proceedings of the 84th American Anthropological Association's Annual Meeting. Washington, D.C., 6 Dec. 1985. 26 Aug. 2009 ‹ http://www.fas.org/sgp/othergov/doe/lanl/lib-www/la-pubs/00173165.pdf ›. Scope. “Most Britons Think Others View Disabled People ‘As Inferior’.” 2009. 26 Aug. 2009 ‹ http://www.scope.org.uk/cgi-bin/np/viewnews.cgi?id=1244379033, http://www.comres.co.uk/resources/7/Social%20Polls/Scope%20PublicPoll%20Results%20May09.pdf ›. Smit, B., et al. “The Science of Adaptation: A Framework for Assessment.” Mitigation and Adaptation Strategies for Global Change 4 (1999): 199-213. Smit, B., and J. Wandel. “Adaptation, Adaptive Capacity and Vulnerability.” Global Environmental Change 16 (2006): 282-92. Sunday Morning Herald. “Who Lives and Dies in Britain after the Bomb.” Sunday Morning Herald 1988. 26 Aug. 2009 ‹ http://news.google.com/newspapers?nid=1301&dat=19880511&id=wFYVAAAAIBAJ&sjid=kOQDAAAAIBAJ&pg=3909,113100 ›. United Nations Development Programme. Human Development Report 2007/2008: Fighting Climate Change – Human Solidarity in a Divided World. 2008. 26 Aug. 2009 ‹ http://hdr.undp.org/en/media/HDR_20072008_EN_Complete.pdf ›. Wolbring, Gregor. “Is There an End to Out-Able? Is There an End to the Rat Race for Abilities?” M/C Journal 11.3 (2008). 26 Aug. 2009 ‹ http://journal.media-culture.org.au/index.php/mcjournal/article/viewArticle/57 ›. Wolbring, Gregor. “Why NBIC? Why Human Performance Enhancement?” Innovation: The European Journal of Social Science Research 21.1 (2008): 25-40.

Problem setting. This article examines the legal regulation of the institute of inquiry in Ukraine and abroad. It is concluded that the institution of inquiry in foreign countries is inherently different from the national form of pre-trial inquiry, but has some similarities. In particular, the differences are in the establishment of different terms of pre-trial investigation, the subjects of the criminal investigation procedure, the specifics of the use of additional evidence, the presence of a mandatory condition – a guilty plea to the suspect, the prosecutor’s participation in the proceedings. The author identifies common features and differences of the institute of inquiry in Ukraine and other countries, which in turn allows to identify ways to improve existing legislation. The purpose of the article is to compare the legal regulation of the institution of inquiry in the current criminal procedure legislation of Ukraine and similar pre-trial investigation procedures in France, Germany, Austria, the Czech Republic (here in after – the Czech Republic), the Republic of Poland (here in after – Poland), Great Britain, Belarus, Kazakhstan in order to identify positive features in order to improve it. Analysis of recent researches and publications. The scientific works of Ukrainian scientists: N. I. Brovka, S. I. Simakov, O. V. Kerevych, K. B. Kalinovsky, etc. are devoted to the study of various aspects of inquiry in foreign countries. However, due to the lack of thorough research on the comparative analysis of the legal regulation of the institution of inquiry, as a simplified form of pre-trial investigation, with other countries, there is a need for such an analysis and highlight the positive aspects. Articles main body. The institute of inquiry belongs to a simplified form of pre-trial investigation, which speeds up the trial in order to ensure greater efficiency of the criminal justice system and reduce costs. Thus, the investigated form of pre-trial investigation came into force on July 1, 2020 in criminal procedure legislation, in accordance with the Law of Ukraine “On Amendments to Certain Legislative Acts of Ukraine to Simplify Pre-trial Investigation of Certain Categories of Criminal Offenses” № 2617-VIII of 22.11.2018. The need for inquiry as a simplified form of criminal proceedings is due, in particular, to the heavy workload of investigators (for example, the National Police) in cases of minor crimes, which are now called criminal offenses. Inquiry is conducted during the investigation of criminal offenses, special subject – the connoisseu of the subdivisions of the inquiry or the authorized persons of other subdivisions; inquiry is carried out in a short time – 72 hours in case of notification to the person on suspicion of commission of a criminal offense. Additional sources of evidence in criminal proceedings on criminal offenses, in addition to general sources of evidence, are also explanations of persons, results of medical examination, expert opinion, testimony of technical devices and technical means that have the functions of photography and filming, video or photo and filming, video recording. The procedure of simplified investigation of minor criminal offenses operates successfully in many foreign countries, in particular in the French Republic, the Kingdom of Spain, Kazakhstan, Germany, Austria, the Republic of Belarus, the Czech Republic, Poland. The simplified procedure in Poland does not apply to: – accused persons deprived of liberty, except in cases of prior arrest to the perpetrator of certain types of crimes; – minors; deaf, dumb or blind; – in the presence of reasonable doubts about the sanity of the suspect; – if the person does not speak Polish. The bodies investigating cases under the simplified procedure are the police, as well as other bodies authorized to conduct investigations (Article 471). The total term of the simplified investigation is 1 month. Regarding the legal regulation of the institute of inquiry in Austria, it should be noted that the preliminary investigation is carried out only in the form of inquiry. Immediate investigative actions related to the identification of the perpetrator, as well as other circumstances, are conducted by the police before the initiation of a criminal case and end with the transfer of all materials to the prosecutor. At the same time, the body of inquiry is authorized to carry out any investigative and operative-search actions (which is unique in comparison with Ukraine). It should be noted that a comparative analysis of the criminal procedure legislation of foreign countries allows to state the existence of a tendency to improve the pre-trial investigation towards its simplification. In international activities in the field of simplification of criminal procedure, there is a direction to adhere to such forms of justice that would optimally take into account the gravity of the crime, the consequences that may occur as a result. It is as a result of such simplification of criminal proceedings that it is possible to ensure procedural savings of forces, time and resources of participants in criminal proceedings. Conclusions and prospects for further research. As for the overall impact of criminal offenses on the criminal justice system, it should be agreed that it is mostly positive. The system itself has become more humane as the number of detentions has decreased and the number of precautionary measures applied during the investigation has been minimal. This is one of Ukraine’s important commitments to the Council of Europe. The average length of a pre-trial investigation has accelerated by about half. This article will be useful for scholars studying the features of forms of pre-trial investigation, as it contains a comparative study of the institute of foreign inquiry and national criminal procedure law. Attention is also focused on some problematic issues related to the simplified form of pre-trial investigation. It can serve as a springboard for scientists to further research the institute of inquiry.

BASTARDYAll children born before matrimony, or so long after the death of the husband as to render it impossible that the child could be begotten by him, are bastards.– Cro. Jac. 451William Toone: The Magistrates Manual, 1817 (66)On 4 September 1832, the body of a newborn baby boy was found washed up on the shore at the port town of Fremantle, Western Australia. As the result of an inquest into the child’s suspicious death, a 20-year-old, unmarried woman named Mary Summerland was accused of concealing his birth. In October 2014, 25-year-old Irish backpacker Caroline Quinn faced court in Perth, Western Australia, over claims that she concealed the birth of her stillborn child after giving birth in the remote north west town of Halls Creek during May of the same year. Both women denied the existence of their children, both appear to have given birth to their “illegitimate” babies alone, and both women claimed that they did not know that they had ever been pregnant at all. In addition, both women hid the body of their dead child for several days while the people they lived with or were close to, did not appear to notice that the mother of the child had had a baby. In neither case did any person associated with either woman seek to look for the missing child after it had been born.Despite occurring 182 years apart, the striking similarities between these cases could lead to the assumption that it is almost as if there were a written script of behaviour that would explain the actions of both young women. Close examination of the laws surrounding child murder, infanticide and concealment of birth reveals evidence of similar behaviours being enacted by women as far back as the 1600s (and earlier), and all are shaped in response to the legal frameworks that prosecuted women who gave birth outside of marriage.This article traces the history of child murder law from its formation in England in the 1600s and explores how early moral assumptions concerning unmarried mothers echoed through the lived experiences of women who killed their illegitimate babies in colonial Western Australia, and continue to resonate in the treatment of, and legal response to, women accused of similar crimes in the present day. The Unlicensed ChildThe unlicensed child is a term coined by Swain and Howe to more accurately define the social matrix faced by single women and their children in Australia. The term seeks to emphasise the repressive and controlling religious, legal and social pressures that acted on Australian women who had children outside marriage until the mid-1970s (xxi, 1, 92, 94). For the purposes of this article, I extend Swain and Howe’s term the unlicensed child to coin the term the unlicensed mother. Following on from Swain and Howe’s definition, if the children of unmarried mothers did not have a license to be born, it is essential to acknowledge that their mothers did not have a license to give birth. Women who had children without social and legal sanction gave birth within a society that did not allocate them “permission” to be mothers, something that the corporeality of pregnancy made it impossible for them not to be. Their own bodies—and the bodies of the babies growing inside them—betrayed them. Unlicensed mothers were punished socially, religiously, legally and financially, and their children were considered sinful and inferior to children who had married parents simply because they had been born (Scheper-Hughes 410). This unspoken lack of authorisation to experience the unavoidably innate physicality of pregnancy, birth and motherhood, in turn implies that, until recently unmarried mothers did not have license to be mothers. Two MothersAll that remains of the “case” of Mary Summerland is a file archived at the State Records Office of Western Australia under the title CONS 3472, Item 10: Rex V Mary Summerland. Yet revealed within those sparse documents is a story echoed by the events surrounding Caroline Quinn nearly two hundred years later. In September 1832, Mary Summerland was an unmarried domestic servant living and working in Fremantle when the body of a baby was found lying on a beach very close to the settlement. Western Australia had only been colonized by the British in 1829. The discovery of the body of an infant in such a tiny village (colonial Fremantle had a population of only 436 women and girls out of 1341 non-Aboriginal emigrants) (Gardiner) set in motion an inquest that resulted in Mary Summerland being investigated over the suspicious death of the child.The records suggest that Mary may have given birth, apparently alone, over a week prior to the corpse of the baby being discovered, yet no one in Fremantle, including her employer and her family, appeared to have noticed that Mary might have been pregnant, or that she had given birth to a child. When Mary Summerland was eventually accused of giving birth to the baby, she strongly denied that she had ever been pregnant, and denied being the mother of the child. It is not known how her infant ended up being disposed of in the ocean. It is also not known if Mary was eventually charged with concealment or child murder, but in either scenario, the case against her was dismissed as “no true bill” when she faced her trial. The details publically available on the case of Caroline Quinn are also sparse. Even the sex of her child has not been revealed in any of the media coverage of the event. Yet examination of the limited details available on her charge of “concealment of birth” reveal similarities between her behaviours and those of Mary Summerland.In May 2014 Caroline Quinn had been “travelling with friends in the Kimberly region of Western Australia” (Lee), and, just as Mary did, Caroline claims she “did not realise that she was pregnant” when she went into labour (Independent.ie). She appears, like Mary Summerland, to have given birth alone, and also like Mary, when her child died due to unexplained circumstances she hid the corpse for several days. Also echoing Mary’s story, no person in the sparsely populated Hall’s Creek community (the town has a populace of 1,211) or any friends in Caroline’s circle of acquaintances appears to have noticed her pregnancy, nor did they realise that she had given birth to a baby until the body of the child was discovered hidden in a hotel room several days after her or his birth. The media records are unclear as to whether Caroline revealed her condition to her friends or whether they “discovered” the body without her assistance. The case was not brought to the attention of authorities until Caroline’s friends took her to receive medical attention at the local hospital and staff there notified the police.Media coverage of the death of Caroline Quinn’s baby suggests her child was stillborn or died soon after birth. As of 13 August 2014 Caroline was granted leave by the Chief Magistrate to return home to Ireland while she awaited her trial, as “without trivialising the matter, nothing more serious was alleged than the concealing of the birth” (Collins, "Irish Woman"). Caroline Quinn was not required to return to Australia to appear at her trial and when the case was presented at the Perth Magistrates Court on Thursday 2 October, all charges against her were dropped as the prosecutor felt “it was not in the public interest” to proceed with legal action (Collins, "Case").Statutory MarginalisationTo understand the similarities between the behaviours of, and legal and medical response to, Mary Summerland and Caroline Quinn, it is important to situate the deaths of their children within the wider context of child murder, concealment of birth and “bastardy” law. Tracing the development of these methods of law-making clarifies the parallels between much of the child murder, infanticide and concealment of birth narrative that has occurred in Western Australia since non-Aboriginal settlement.Despite the isolated nature of Western Australia, the nearly 400 years since the law was formed in England, and the extremely remote rural locations where both these women lived and worked, their stories are remarkably alike. It is almost as if there were a written script and each member of the cast knew what role to play: both Mary and Caroline knew to hide their pregnancies, to deny the overwhelmingly traumatic experience of giving birth alone, and to conceal the corpses of their babies. The fathers of their children appear to have cut off any connection to the women or their child. The family, friends, or employers of the parents of the dead babies knew to pretend that they did not know that the mother was pregnant or who the father was. The police and medical officers knew to charge these women and to collect evidence that could be used to simultaneously meet the needs of the both prosecution and the defence when the cases were brought to trial.In reference to Mary Summerland’s case, in colonial Western Australia when a woman gave birth to an infant who died under suspicious circumstances, she could be prosecuted with two charges: “child murder” and/or “concealment of birth”. It is suggestive that Mary may have been charged with both. The laws regarding these two offences were focused almost exclusively on the deaths of unlicensed children and were so deeply interconnected they are difficult to untangle. For Probyn, shame pierces the centre of who we think we are, “what makes it remarkable is that it reveals with precision our values, hopes and aspirations, beyond the generalities of good manners and cultured norms” (x). Dipping into the streams of legal and medical discourse that flow back to the seventeenth century highlights the pervasiveness of discourses marginalising single women and their children. This situates Mary Summerland and Caroline Quinn within a ‘burden on society’ narrative of guilt, blame and shame that has been in circulation for over 500 years, and continues to resonate in the present (Coull).An Act to Prevent the Destroying and Murthering of Bastard ChildrenIn England prior to the 17th century, penalties for extramarital sex, the birth and/or maintenance of unlicensed children or for committing child murder were expressed through church courts (Damme 2-6; Rapaport 548; Butler 61; Hoffer and Hull 3-4). Discussion of how the punishment of child murder left the religious sphere and came to be regulated by secular laws that were focused exclusively on the unlicensed mother points to two main arguments: firstly, the patriarchal response to unlicensed (particularly female) sexuality; and secondly, a moral panic regarding a perceived rise in unlicensed pregnancies in women of the lower classes, and the resulting financial burden placed on local parishes to support unwanted, unlicensed children (Rapaport 532, 48-52; McMahon XVII, 126-29; Osborne 49; Meyer 3-8 of 14). In many respects, as Meyer suggests, “the legal system subtly encouraged neonaticide through its nearly universally negative treatment of bastard children” (240).The first of these “personal control laws” (Hoffer and Hull 13) was the Old Poor Law created by Henry VIII in 1533, and put in place to regulate all members of English society who needed to rely on the financial assistance of the parish to survive. Prior to 1533, “by custom the children of the rich depended on their relations, while the ‘fatherless poor’ relied on the charity of the monastic institutions and the municipalities” (Teichman 60-61). Its implementation marks the historical point where the state began to take responsibility for maintenance of the poor away from the church by holding communities responsible for “the problem of destitution” (Teichman 60-61; Meyer 243).The establishment of the poor law system of relief created a hierarchy of poverty in which some poor people, such as those suffering from sickness or those who were old, were seen as worthy of receiving support, while others, who were destitute as a result of “debauchery” or other self-inflicted means were seen as undeserving and sent to a house of correction or common gaol. Underprivileged, unlicensed mothers and their children were seen to be part of the category of recipients unfit for help (Jackson 31). Burdens on SocietyIt was in response to the narrative of poor unlicensed women and their children being undeserving fiscal burdens on law abiding, financially stretched community members that in 1576 a law targeted specifically at holding genetic parents responsible for the financial maintenance of unlicensed children entered the secular courts for the first time. Called the Elizabethan Poor Law it was enacted in response to the concerns of local parishes who felt that, due to the expenses exacted by the poor laws, they were being burdened with the care of a greatly increased number of unlicensed children (Jackson 30; Meyer 5-6; Teichman 61). While the 1576 legislation prosecuted both parents of unlicensed children, McMahon interprets the law as being created in response to a blend of moral and economic forces, undergirded by a deep, collective fear of illegitimacy (McMahon 128). By the 1570s “unwed mothers were routinely whipped and sent to prison” (Meyer 242) and “guardians of the poor” could force unlicensed mothers to wear a “badge” (Teichman 63). Yet surprisingly, while parishes felt that numbers of unlicensed children were increasing, no concomitant rise was actually recorded (McMahon 128).The most damning evidence of the failure of this law, was the surging incidence of infanticide following its implementation (Rapaport 548-49; Hoffer and Hull 11-13). After 1576 the number of women prosecuted for infanticide increased by 225 percent. Convictions resulting in unlicensed mothers being executed also rose (Meyer 246; Hoffer and Hull 8, 18).Infanticide IncreasesBy 1624 the level of infanticide in local communities was deemed to be so great An Act to Prevent the Destroying and Murthering of Bastard Children was created. The Act made child murder a “sex-specific crime”, focused exclusively on the unlicensed mother, who if found guilty of the offence was punished by death. Probyn suggests that “shame is intimately social” (77) and indeed, the wording of An Act to Prevent highlights the remarkably similar behaviours enacted by single women desperate to avoid the shame and criminal implication linked to the social position of unlicensed mother: Whereas many lewd Women that have been delivered of Bastard Children, to avoyd their shame and to escape punishment [my italics], doe secretlie bury, or conceale the Death of their Children, and after if the child be found dead the said Women doe alleadge that the said Children were borne dead;…For the preventing therefore of this great Mischiefe…if any Woman…be delivered of any issue of the Body, Male or Female, which being born alive, should by the Lawes of this Realm be a bastard, and that she endeavour privatlie either by drowning or secret burying thereof, or any other way, either by herselfe of the procuring of others, soe to conceale the Death thereof, as that it may not come to light, whether it be borne alive or not, but be concealed, in every such Case the Mother so offending shall suffer Death… (Davies 214; O'Donovan 259; Law Reform Commission of Western Australia 104; Osborne 49; Rose 1-2; Rapaport 548). An Act to Prevent also “contained an extraordinary provision which was a reversion of the ordinary common law presumption of dead birth” (Davies 214), removing the burden of proof from the prosecution and placing it on the defence (Francus 133; McMahon 128; Meyer 2 of 14). The implication being that if the dead body of a newborn, unlicensed baby was found hidden, it was automatically assumed that the child had been murdered by their mother (Law Reform Commission of Western Australia 104; Osborne 49; Rapaport 549-50; Francus 133). This made the Act unusual in that “the offence involved was the concealment of death rather than the death itself” (O'Donovan 259). The only way an unlicensed mother charged with child murder was able to avoid capital punishment was to produce at least one witness to give evidence that the child was “borne dead” (Law Reform Commission of Western Australia 104; Meyer 238; McMahon 126-27).Remarkable SimilaritiesClearly, the objective of An Act to Prevent was not simply to preserve infant life. It is suggestive that it was enacted in response to women wishing to avoid the legal, social, corporal and religious punishment highlighted by the implementation of the poor law legislation enacted throughout earlier centuries. It is also suggestive that these pressures were so powerful that threat of death if found guilty of killing their neonate baby was not enough to deter women from concealing their unlicensed pregnancies and committing child murder. Strikingly analogous to the behaviours of Mary Summerland in 19th century colonial Western Australia, and Caroline Quinn in 2014, the self-preservation implicit in the “strategies of secrecy” (Gowing 87) surrounding unlicensed birth and child murder often left the mother of a dead baby as the only witness to her baby’s death (McMahon xvii 49-50).An Act to Prevent set in motion the legislation that was eventually used to prosecute Mary Summerland in colonial Western Australia (Jackson 7, Davies, 213) and remnants of it still linger in the present where they have been incorporated into the ‘concealment of birth law’ that prosecuted Caroline Quinn (Legal Online TLA [10.1.182]).Changing the ‘Script’Shame runs like a viral code through the centuries to resonate within the legal response to women who committed infanticide in colonial Western Australia. It continues on through the behaviours of, and legal responses to, the story of Caroline Quinn and her child. As Probyn observes, “shame reminds us about the promises we keep to ourselves” in turn revealing our desire for belonging and elements of our deepest fears (p. x). While Caroline may live in a society that no longer outwardly condemns women who give birth outside of marriage, it is fascinating that the suite of behaviours manifested in response to her pregnancy and the birth of her child—by herself, her friends, and the wider community—can be linked to the narratives surrounding the formation of “child murder” and “concealment” law nearly 400 years earlier. Caroline’s narrative also encompasses similar behaviours enacted by Mary Summerland in 1832, in particular that Caroline knew to say that her child was “born dead” and that she had merely concealed her or his body—nothing more. This behaviour appears to have secured the release of both women as although both Mary and Caroline faced criminal investigation, neither was convicted of any crime. Yet, neither of these women or their small communities were alone in their responses. My research has uncovered 55 cases linked to child murder in Western Australia and the people involved in all of these incidences share unusually similar behaviours (Gardiner). Perhaps, it is only through the wider community becoming aware of the resonance of child murder law echoing through the centuries, that certain women who are pregnant with unwanted children will be able to write a different script for themselves, and their “unlicensed” children. ReferencesButler, Sara, M. "A Case of Indifference? Child Murder in Later Medieval England." Journal of Women's History 19.4 (2007): 59-82. Collins, Padraig. "Case against Irish Woman for Concealing Birth Dropped." The Irish Times 2 Oct. 2014. ---. "Irish Woman Held for Hiding Birth in Australia Allowed Return Home." The Irish Times 13 Aug. 2014. Coull, Kim. “The Womb Artist – A Novel: Translating Late Discovery Adoptee Pre-Verbal Trauma into Narrative”. Dissertation. Perth, WA: Edith Cowan University, 2014.Damme, Catherine. "Infanticide: The Worth of an Infant under Law." Medical History 22.1 (1978): 1-24. Davies, D.S. "Child-Killing in English Law." The Modern Law Review 1.3 (1937): 203-23. Dickinson, J.R., and J.A. Sharpe. "Infanticide in Early Modern England: The Court of Great Sessions at Chester, 1650-1800." Infanticide: Historical Perspectives on Child Murder and Concealment, 1550-2000. Ed. Mark Jackson. Hants: Ashgate, 2002. 35-51.Francus, Marilyn. "Monstrous Mothers, Monstrous Societies: Infanticide and the Rule of Law in Restoration and Eighteenth-Century England." Eighteenth-Century Life 21.2 (1997): 133-56. Gardiner, Amanda. "Sex, Death and Desperation: Infanticide, Neonaticide and Concealment of Birth in Colonial Western Australia." Dissertation. Perth, WA: Edith Cowan University, 2014.Gowing, Laura. "Secret Births and Infanticide in Seventeenth-Century England." Past & Present 156 (1997): 87-115. Hoffer, Peter C., and N.E.H. Hull. Murdering Mothers: Infanticide in England and New England 1558-1803. New York: New York University Press, 1984. Independent.ie. "Irish Woman Facing Up to Two Years in Jail for Concealing Death of Her Baby in Australia." 8 Aug. 2014. Law Reform Commission of Western Australia. "Chapter 3: Manslaughter and Other Homicide Offences." Review of the Law of Homicide: Final Report. Perth: Law Reform Commission of Western Australia, 2007. 85-117.Lee, Sally. "Irish Backpacker Charged over the Death of a Baby She Gave Birth to While Travelling in the Australia [sic] Outback." Daily Mail 8 Aug. 2014. Legal Online. "The Laws of Australia." Thomson Reuters 2010. McMahon, Vanessa. Murder in Shakespeare's England. London: Hambledon and London, 2004. Meyer, Jon'a. "Unintended Consequences for the Youngest Victims: The Role of Law in Encouraging Neonaticide from the Seventeenth to Nineteenth Centuries." Criminal Justice Studies 18.3 (2005): 237-54. O'Donovan, K. "The Medicalisation of Infanticide." Criminal Law Review (May 1984): 259-64. Osborne, Judith A. "The Crime of Infanticide: Throwing Out the Baby with the Bathwater." Canadian Journal of Family Law 6 (1987): 47-59. Rapaport, Elizabeth. "Mad Women and Desperate Girls: Infanticide and Child Murder in Law and Myth." Fordham Urban Law Journal 33.2 (2006): 527-69.Rose, Lionel. The Massacre of the Innocents: Infanticide in Britain, 1800-1939. London: Routledge & Kegan, 1986. Scheper-Hughes, Nancy. Death without Weeping: The Violence of Everyday Life in Brazil. Los Angeles: University of California Press, 1992. Swain, Shurlee, and Renate Howe. Single Mothers and Their Children: Disposal, Punishment and Survival in Australia. Cambridge: Cambridge University Press, 1995. Teichman, Jenny. Illegitimacy: An Examination of Bastardy. Oxford: Cornell University Press, 1982. Toone, William. The Magistrate's Manual: Or a Summary of the Duties and Powers of a Justice of the Peace. 2nd ed. London: Joseph Butterworth and Son, 1817.

Photo by 14825144 © Alita Xander | Dreamstime.com ABSTRACT The US government's approach to the War on Drugs has created laws to deter people from using illicit drugs through negative punishment. These laws have not controlled illicit drug use, nor has it stopped the opioid pandemic from growing. Instead, these laws have created a negative bias surrounding addiction and have negatively affected particularly vulnerable patient populations, including pregnant women with substance use disorder and newborns with neonatal abstinence syndrome. This article highlights some misconceptions and underscores the challenges they face as they navigate the justice and healthcare systems while also providing possible solutions to address their underlying addiction. INTRODUCTION Pregnant women with substance use disorder require treatment that is arguably for the benefit of both the mother and the fetus. Some suggest that addiction is a choice; therefore, those who misuse substances should not receive treatment. Proponents of this argument emphasize social and environmental factors that lead to addiction but fail to appreciate how chronic substance use alters the brain’s chemistry and changes how it responds to stress, reward, self-control, and pain. The medical community has long recognized that substance use disorder is not simply a character flaw or social deviance, but a complex condition that requires adequate medical attention. Unfortunately, the lasting consequences of the War on Drugs have created a stigma around addiction medicine, leading to significant treatment barriers. There is still a pervasive societal bias toward punitive rather than rehabilitative approaches to addiction. For example, many women with substance use disorder lose custody of their baby or face criminal penalties, including fines and jail time.[1] These punitive measures may cause patients to lose trust in their physicians, ultimately leading to high-risk pregnancies without prenatal care, untreated substance misuse, and potential lifelong disabilities for their newborns.[2] As a medical student, I have observed the importance of a rehabilitative approach to addiction medicine. Incentivizing pregnant women with substance use disorder to safely address their chronic health issues is essential for minimizing negative short-term and long-term outcomes for women and their newborns. This approach requires an open mind and supportive perspective, recognizing that substance use disorder is truly a medical condition that requires just as much attention as any other medical diagnosis.[3] BACKGROUND The War on Drugs was a government-led initiative launched in 1970 by President Richard M. Nixon with the aim of curtailing illegal drug use, distribution, and trade by imposing harsher prison sentences and punishments.[4] However, it is worth noting that one can trace the roots of this initiative back further. In 1914, Congress enacted the Harrison Narcotics Tax Act to target the recreational use of drugs such as morphine and opium.[5] Despite being in effect for over four decades, the War on Drugs failed to achieve its intended goals. In 2011, the Global Commission on Drug Policy released a report that concluded that the initiative had been futile, as “arresting and incarcerating tens of millions of these people in recent decades has filled prisons and destroyed lives and families without reducing the availability of illicit drugs or the power of criminal organizations.”[6] One study published in the International Journal of Drug Policy in the same year found that funding drug law enforcement paradoxically contributed to increasing gun violence and homicide rates.[7] The Commission recommended that drug policies focus on reducing harm caused by drug use rather than solely on reducing drug markets. Recognizing that many drug policies were of political opinion, it called for drug policies that were grounded in scientific evidence, health, security, and human rights.[8] Unfortunately, policy makers did not heed these recommendations. In 2014, Tennessee’s legislature passed a “Fetal Assault Law,” which made it possible to prosecute pregnant women for drug use during pregnancy. If found guilty, pregnant women could face up to 15 years in prison and lose custody of their child. Instead of deterring drug use, the law discouraged pregnant women with substance use disorder from seeking prenatal care. This law required medical professionals to report drug use to authorities, thereby compromising the confidentiality of the patient-physician relationship. Some avoided arrest by delivering their babies in other states or at home, while others opted for abortions or attempted to go through an unsafe withdrawal prior to receiving medical care, sacrificing the mother's and fetus's wellbeing. The law had a sunset provision and expired in 2016. During the two years this law was in effect, officials arrested 124 women.[9] The fear that this law instilled in pregnant women with substance use disorder can still be seen across the US today. Many pregnant women with substance use disorders stated that they feared testing positive for drugs. Due to mandatory reporting, they were not confident that physicians would protect them from the law.[10] And if a woman tried to stop using drugs before seeking care to avoid detection, she often ended up delaying or avoiding care.[11] The American College of Obstetricians and Gynecologists (ACOG) recognizes the fear those with substance use disorders face when seeking appropriate medical care and emphasizes that “obstetric–gynecologic care should not expose a woman to criminal or civil penalties, such as incarceration, involuntary commitment, loss of custody of her children, or loss of housing.”[12] Mandatory reporting strains the patient-physician relationship, driving a wedge between the doctor and patient. Thus, laws intended to deter people from using substances through various punishments and incarceration may be doing more harm than good. County hospitals that mainly serve lower socioeconomic patients encounter more patients without consistent health care access and those with substance use disorders.[13] These hospitals are facing the consequences of the worsening opioid pandemic. At one county hospital where I recently worked, there has been a dramatic increase in newborns with neonatal abstinence syndrome born to mothers with untreated substance use disorders during pregnancy. Infants exposed to drugs prenatally have an increased risk of complications, stillbirth, and life-altering developmental disabilities. At the hospital, I witnessed Child Protective Services removing two newborns with neonatal abstinence syndrome from their mother’s custody. Four similar cases had occurred in the preceding month. In the days leading up to their placement with a foster family, I saw both newborns go through an uncomfortable drug withdrawal. No baby should be welcomed into this world by suffering like that. Yet I felt for the new mothers and realized that heart-wrenching custody loss is not the best approach. During this period, I saw a teenager brought to the pediatric floor due to worsening psychiatric symptoms. He was born with neonatal abstinence syndrome that neither the residential program nor his foster family could manage. His past psychiatric disorders included attention deficit disorder, conduct disorder, major depressive disorder, anxiety disorder, disruptive mood dysregulation disorder, intellectual developmental disorder, and more. During his hospitalization, he was so violent towards healthcare providers that security had to intervene. And his attitude toward his foster parents was so volatile that we were never sure if having them visit was comforting or agitating. Throughout his hospital course, it was difficult for me to converse with him, and I left every interview with him feeling lost in terms of providing an adequate short- and long-term assessment of his psychological and medical requirements. What was clear, however, was that his intellectual and emotional levels did not match his age and that he was born into a society that was ill-equipped to accommodate his needs. Just a few feet away from his room, behind the nurses’ station, were the two newborns feeling the same withdrawal symptoms that this teenager likely experienced in the first few hours of his life. I wondered how similar their paths would be and if they would exhibit similar developmental delays in a few years or if their circumstance may follow the cases hyped about in the media of the 1980s and 1990s regarding “crack babies.” Many of these infants who experienced withdrawal symptoms eventually led normal lives.[14] Nonetheless, many studies have demonstrated that drug use during pregnancy can adversely impact fetal development. Excessive alcohol consumption can result in fetal alcohol syndrome, characterized by growth deficiency, facial structure abnormalities, and a wide range of neurological deficiencies.[15] Smoking can impede the development of the lungs and brain and lead to preterm deliveries or sudden infant death syndrome.[16] Stimulants like methamphetamine can also cause preterm delivery, delayed motor development, attention impairments, and a wide range of cognitive and behavioral issues.[17] Opioid use, such as oxycodone, morphine, fentanyl, and heroin, may result in neonatal opioid withdrawal syndrome, in which a newborn may exhibit tremors, irritability, sleeping problems, poor feeding, loose stools, and increased sweating within 72 hours of life.[18] In 2014, the American Association of Pediatrics (AAP) reported that one newborn was diagnosed with neonatal abstinence syndrome every 15 minutes, equating to approximately 32,000 newborns annually, a five-fold increase from 2004.[19] The AAP found that the cost of neonatal abstinence syndrome covered by Medicaid increased from $65.4 million to $462 million from 2004 to 2014.[20] In 2020, the CDC published a paper that showed an increase in hospital costs from $316 million in 2012 to $572.7 million in 2016.[21] Currently, the impact of the COVID-19 pandemic on the prevalence of newborns with neonatal abstinence syndrome is unknown. I predict that the increase in opioid and polysubstance use during the pandemic will increase the number of newborns with neonatal abstinence syndrome, thereby significantly increasing the public burden and cost.[22] In the 1990s, concerns arose about the potentially irreparable damage caused by intrauterine exposure to cocaine on the development of infants, which led to the popularization of the term “crack babies.”[23] Although no strong longitudinal studies supported this claim at the time, it was not without merit. The Maternal Lifestyle Study (NCT00059540) was a prospective longitudinal observational study that compared the outcomes of newborns exposed to cocaine in-utero to those without.[24] One of its studies revealed one month old newborns with cocaine exposure had “lower arousal, poorer quality of movements and self-regulation, higher excitability, more hypertonia, and more nonoptimal reflexes.”[25] Another study showed that at one month old, heavy cocaine exposure affected neural transmission from the ear to the brain.[26] Long-term follow up from the study showed that at seven years old, children with high intrauterine cocaine exposure were more likely to have externalizing behavior problems such as aggressive behavior, temper tantrums, and destructive acts.[27] While I have witnessed this behavior in the teenage patient during my pediatrics rotation, not all newborns with intrauterine drug exposure are inevitably bound to have psychiatric and behavioral issues later in life. NPR recorded a podcast in 2010 highlighting a mother who used substances during pregnancy and, with early intervention, had positive outcomes. After being arrested 50 times within five years, she went through STEP: Self-Taught Empowerment and Pride, a public program that allowed her to complete her GED and provided guidance and encouragement for a more meaningful life during her time in jail. Her daughter, who was exposed to cocaine before birth, had a normal childhood and ended up going to college.[28] From a public health standpoint, more needs to be done to prevent the complications of substance misuse during pregnancy. Some states consider substance misuse (and even prescribed use) during pregnancy child abuse. Officials have prosecuted countless women across 45 states for exposing their unborn children to drugs.[29] With opioid and polysubstance use on the rise, the efficacy of laws that result in punitive measures seems questionable.[30] So far, laws are not associated with a decrease in the misuse of drugs during pregnancy. Millions of dollars are being poured into managing neonatal abstinence syndrome, including prosecuting women and taking their children away. Rather than policing and criminalizing substance use, pregnant women should get the appropriate care they need and deserve. I. Misconception One: Mothers with Substance Use Disorder Can Get an Abortion If an unplanned pregnancy occurs, one course of action could be to terminate the pregnancy. On the surface, this solution seems like a quick fix. However, the reality is that obtaining an abortion can be challenging due to two significant barriers: accessibility and mandated reporting. Abortion laws vary by state, and in Tennessee, for instance, abortions are banned after six weeks of gestation, typically when fetal heart rhythms are detected. An exception to this is in cases where the mother's life is at risk.[31] Unfortunately, many women with substance use disorders are from lower socioeconomic backgrounds and cannot access pregnancy tests, which could indicate they are pregnant before the six-week cutoff. If a Tennessee woman with substance use disorder decides to seek an abortion after six weeks, she may need to travel to a neighboring state. However, this is not always a feasible option, as the surrounding states (WV, MO, AR, MI, AL, and GA) also have restrictive laws that either prohibit abortions entirely or ban them after six weeks. Moreover, she may be hesitant to visit an obstetrician for an abortion, as some states require physicians by law to report their patients' substance use during pregnancy. For example, Virginia considers substance use during pregnancy child abuse and mandates that healthcare providers report it. This would ultimately limit her to North Carolina if she wants to remain in a nearby state, but she must go before 20 weeks gestation.[32] For someone who may or may not have access to reliable transportation, traveling to another state might be impossible. Without resources or means, these restrictive laws have made it incredibly difficult to obtain the medical care they need. II. Misconception Two: Mothers with SUD are Not Fit to Care for Children If a woman cannot take care of herself, one might wonder how she can take care of another human being. Mothers with substance use disorders often face many adversities, including lack of economic opportunity, trauma from abuse, history of poverty, and mental illness.[33] Fortunately, studies suggest keeping mother and baby together has many benefits. Breastfeeding, for example, helps the baby develop a strong immune system while reducing the mother’s risk of cancer and high blood pressure.[34] Additionally, newborns with neonatal abstinence syndrome who are breastfed by mothers receiving methadone or buprenorphine require less pharmacological treatment, have lower withdrawal scores, and experience shorter hospital stays.[35] Opioid concentration in breastmilk is minimal and does not pose a risk to newborns.[36] Moreover, oxytocin, the hormone responsible for mother-baby bonding, is increased in breastfeeding mothers, reducing withdrawal symptoms and stress-induced reactivity and cravings while also increasing protective maternal instincts.[37] Removing an infant from their mother’s care immediately after birth would result in the loss of all these positive benefits for both the mother and her newborn. The newborns I observed during my pediatrics rotation probably could have benefited from breastfeeding rather than bottle feeding and being passed around from one nurse to the next. They probably would have cried less and suffered fewer withdrawal symptoms had they been given the opportunity to breastfeed. And even if the mothers were lethargic and unresponsive while going through withdrawal, it would still have been possible to breastfeed with proper support. Unfortunately, many believe mothers with substance use disorder cannot adequately care for their children. This pervasive societal bias sets them up for failure from the beginning and greatly inhibits their willingness to change and mend their relationship with their providers. It is a healthcare provider’s duty to provide non-judgmental care that prioritizes the patient’s well-being. They must treat these mothers with the same empathy and respect as any other patient, even if they are experiencing withdrawal. III. Safe Harbor and Medication-Assisted Treatment Addiction is like any other disease and society should regard treatment without stigma. There is no simple fix to this problem, given that it involves the political, legal, and healthcare systems. Punitive policies push pregnant women away from receiving healthcare and prevent them from receiving beneficial interventions. States need to enact laws that protect these women from being reported to authorities. Montana, for example, passed a law in 2019 that provides women with substance use disorders safe harbor from prosecution if they seek treatment for their condition.[38] Medication-assisted treatment with methadone or buprenorphine is the first line treatment option and should be available to all pregnant women regardless of their ability to pay for medical care.[39] To promote continuity of care, health officials could include financial incentives to motivate new mothers to go to follow-up appointments. For example, vouchers for groceries or enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may offset financial burdens and allow a mother to focus on taking care of her child and her recovery. IV. Mandated Substance Abuse Programs Although the number of people sentenced to state prisons for drug related crimes has been declining, it is still alarming that there were 171,300 sentencings in 2019.[40] Only 11 percent of the 65 percent of our nation’s inmates with substance use disorder receive treatment, implying that the other 89 percent were left without much-needed support to overcome their addiction.[41] It is erroneous to assume that their substance use disorder would disappear after a period without substance use while behind bars. After withdrawal, those struggling with substance use disorder may still have cravings and the likelihood of relapsing remains high without proper medical intervention. Even if they are abstinent for some time during incarceration, the underlying problem persists, and the cycle inevitably continues upon release from custody. In line with the recommendations by Global Commission on Drug Policy and the lessons learned from the failed War on Drugs, one proposed change in our criminal justice system would be to require enrollment and participation in assisted alcohol cessation programs before legal punishment. Policy makers must place emphasis on the safety of the patient and baby rather than the cessation of substance use. This would incentivize people to actively seek medical care, restore the patient-physician relationship, and ensure that they take rehabilitation programs seriously. If the patient or baby is unsafe, a caregiver could intervene while the patient re-enrolls in the program. Those currently serving sentences in prisons and jails can treat their substance use disorder through medication assisted treatment, cognitive behavioral therapy, and programs like Self Taught Empowerment and Pride (STEP). Medication assisted treatment under the supervision of medical professionals can help inmates achieve and maintain sobriety in a healthy and safe way. Furthermore, cognitive behavioral therapy can help to identify triggers and teach healthier coping mechanisms to prepare for stressors outside of jail. Finally, multimodal empowerment programs can connect people to jobs, education, and support upon release. People often leave prisons and jail without a sense of purpose, which can lead to relapse and reincarceration. Structured programs have been shown to decrease drug use and criminal behavior by helping reintegrate productive individuals into society.[42] V. Medical Education: Narcotic Treatment Programs and Suboxone Clinics Another proactive approach could be to have medical residency programs register with the Drug Enforcement Administration (DEA) as Narcotic Treatment Programs and incorporate suboxone clinics into their education and rotations. Rather than family medicine, OB/GYN, or emergency medicine healthcare workers having to refer their patients to an addiction specialist, they could treat patients with methadone for maintenance or detoxification where they would deliver their baby. Not only would this educate and prepare the future generation of physicians to handle the opioid crisis, but it would allow pregnant women to develop strong patient-physician relationships. CONCLUSION Society needs to change from the mindset of tackling a problem after it occurs to taking a proactive approach by addressing upstream factors, thereby preventing those problems from occurring in the first place. Emphasizing public health measures and adequate medical care can prevent complications and developmental issues in newborns and pregnant women with substance use disorders. Decriminalizing drug use and encouraging good health habits during pregnancy is essential, as is access to prenatal care, especially for lower socioeconomic patients. Many of the current laws and regulations that policy makers initially created due to naïve political opinion and unfounded bias to serve the War on Drugs need to be changed to provide these opportunities. To progress as a society, physicians and interprofessional teams must work together to truly understand the needs of patients with substance use disorders and provide support from prenatal to postnatal care. There should be advocation for legislative change, not by providing an opinion but by highlighting the facts and conclusions of scientific studies grounded in scientific evidence, health, security, and human rights. There can be no significant change if society continues to view those with substance use disorders as underserving of care. Only when the perspective shifts to compassion can these mothers and children receive adequate care that rehabilitates and supports their future and empowers them to raise their children. - [1] NIDA. 2023, February 15. Pregnant People with Substance Use Disorders Need Treatment, Not Criminalization. https://nida.nih.gov/about-nida/noras-blog/2023/02/pregnant-people-substance-use-disorders-need-treatment-not-criminalization [2] Substance Use Disorder Hurts Moms and Babies. National Partnership for Women and Families. June 2021 [3] All stories have been fictionalized and anonymized. [4] A History of the Drug War. Drug Policy Alliance. https://drugpolicy.org/issues/brief-history-drug-war [5] The Harrison Narcotic Act (1914) https://www.druglibrary.org/Schaffer/library/studies/cu/cu8.html [6] The War on Drugs. The Global Commission on Drug Policy. Published June 2011. https://www.globalcommissionondrugs.org/reports/the-war-on-drugs [7] Werb D, Rowell G, Guyatt G, Kerr T, Montaner J, Wood E. Effect of drug law enforcement on drug market violence: A systematic review. Int J Drug Policy. 2011;22(2):87-94. doi:10.1016/j.drugpo.2011.02.002 [8] Global Commission on Drug Policy, 2011 [9] Women NA for P. Tennessee’s Fetal Assault Law: Understanding its impact on marginalized women - New York. Pregnancy Justice. Published December 14, 2020. https://www.pregnancyjusticeus.org/tennessees-fetal-assault-law-understanding-its-impact-on-marginalized-women/ [10] Roberts SCM, Nuru-Jeter A. Women’s perspectives on screening for alcohol and drug use in prenatal care. Womens Health Issues Off Publ Jacobs Inst Womens Health. 2010;20(3):193-200. doi:10.1016/j.whi.2010.02.003 [11] Klaman SL, Isaacs K, Leopold A, et al. Treating Women Who Are Pregnant and Parenting for Opioid Use Disorder and the Concurrent Care of Their Infants and Children: Literature Review to Support National Guidance. J Addict Med. 2017;11(3):178-190. doi:10.1097/ADM.0000000000000308 [12] Substance Abuse Reporting and Pregnancy: The Role of the Obstetrician–Gynecologist. https://www.acog.org/en/clinical/clinical-guidance/committee-opinion/articles/2011/01/substance-abuse-reporting-and-pregnancy-the-role-of-the-obstetrician-gynecologist [13] R. Ghertner, G Lincoln The Opioid Crisis and Economic Opportunity: Geographic and Economic Trends. ASPE. Office of Assistant Secretary for Planning and Evaluation. DHHS Revised September 11, 2018 https://aspe.hhs.gov/reports/economic-opportunity-opioid-crisis-geographic-economic-trends [14] Midon, M. Z., Gerzon, L. R., & de Almeida, C. S. (2021). Crack and motor development of babies living in an assistance shelter. ABCS Health Sciences, 46, e021215-e021215. And for example, see Crack Babies: Twenty Years Later : NPR https://www.npr.org/templates/story/story.php?storyId=126478643 [15] Williams JF, Smith VC, the Committee on Substance Abuse. Fetal Alcohol Spectrum Disorders. Pediatrics. 2015;136(5):e20153113. doi:10.1542/peds.2015-3113 [16] CDC Tobacco Free. Smoking During Pregnancy. Centers for Disease Control and Prevention. Published April 11, 2022. https://www.cdc.gov/tobacco/basic_information/health_effects/pregnancy/index.htm [17] Abuse NI on D. What are the risks of methamphetamine misuse during pregnancy? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/methamphetamine/what-are-risks-methamphetamine-misuse-during-pregnancy [18] CDC. Basics About Opioid Use During Pregnancy | CDC. Centers for Disease Control and Prevention. Published July 21, 2021. https://www.cdc.gov/pregnancy/opioids/basics.html [19] Honein MA, Boyle C, Redfield RR. Public Health Surveillance of Prenatal Opioid Exposure in Mothers and Infants. Pediatrics. 2019;143(3):e20183801. doi:10.1542/peds.2018-3801 [20] Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM, Patrick SW. Incidence and Costs of Neonatal Abstinence Syndrome Among Infants with Medicaid: 2004–2014. Pediatrics. 2018;141(4):e20173520. doi:10.1542/peds.2017-3520 [21] Strahan AE, Guy GP Jr, Bohm M, Frey M, Ko JY. Neonatal Abstinence Syndrome Incidence and Health Care Costs in the United States, 2016. JAMA Pediatr. 2020;174(2):200-202. doi:10.1001/jamapediatrics.2019.4791 [22] Ghose R, Forati AM, Mantsch JR. Impact of the COVID-19 Pandemic on Opioid Overdose Deaths: a Spatiotemporal Analysis. J Urban Health Bull N Y Acad Med. 2022;99(2):316-327. doi:10.1007/s11524-022-00610-0 [23] Mayes LC, Granger RH, Bornstein MH, Zuckerman B. The Problem of Prenatal Cocaine Exposure: A Rush to Judgment. JAMA. 1992;267(3):406-408. doi:10.1001/jama.1992.03480030084043 [24] NICHD Neonatal Research Network. The Maternal Lifestyle Study. clinicaltrials.gov; 2016. https://clinicaltrials.gov/ct2/show/study/NCT00059540 [25] Lester BM, Tronick EZ, LaGasse L, et al. The maternal lifestyle study: effects of substance exposure during pregnancy on neurodevelopmental outcome in 1-month-old infants. Pediatrics. 2002;110(6):1182-1192. doi:10.1542/peds.110.6.1182 [26] Lester BM, Lagasse L, Seifer R, et al. The Maternal Lifestyle Study (MLS): effects of prenatal cocaine and/or opiate exposure on auditory brain response at one month. J Pediatr. 2003;142(3):279-285. doi:10.1067/mpd.2003.112 [27] Bada HS, Bann CM, Bauer CR, et al. Preadolescent behavior problems after prenatal cocaine exposure: Relationship between teacher and caretaker ratings (Maternal Lifestyle Study). Neurotoxicol Teratol. 2011;33(1):78-87. doi:10.1016/j.ntt.2010.06.005 [28] N, P, R. Crack Babies: Twenty Years Later. NPR. Published May 3, 2010. https://www.npr.org/templates/story/story.php?storyId=126478643 [29] Miranda L, Dixon V, September CRP on, 30, 2015. How States Handle Drug Use During Pregnancy http://projects.propublica.org/graphics/maternity-drug-policies-by-state [30] NCDAS: Substance Abuse and Addiction Statistics [2023]. NCDAS. https://drugabusestatistics.org/ [31] (Tenn. Code Ann. § 39-15-216). [32] Institute G. Interactive Map: US Abortion Policies and Access After Roe. https://states.guttmacher.org/policies/ [33] Whitesell M, Bachand A, Peel J, Brown M. Familial, Social, and Individual Factors Contributing to Risk for Adolescent Substance Use. J Addict. 2013;2013:579310. doi:10.1155/2013/579310 [34] CDC. Five Great Benefits of Breastfeeding. Centers for Disease Control and Prevention. Published July 27, 2021. https://www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/index.html [35] Welle-Strand GK, Skurtveit S, Jansson LM, Bakstad B, Bjarkø L, Ravndal E. Breastfeeding reduces the need for withdrawal treatment in opioid-exposed infants. Acta Paediatr. 2013;102(11):1060-1066. doi:10.1111/apa.12378 [36] Ilett KF, Hackett LP, Gower S, Doherty DA, Hamilton D, Bartu AE. Estimated dose exposure of the neonate to buprenorphine and its metabolite norbuprenorphine via breastmilk during maternal buprenorphine substitution treatment. Breastfeed Med Off J Acad Breastfeed Med. 2012;7:269-274. doi:10.1089/bfm.2011.0096 [37] Pedersen CA, Smedley KL, Leserman J, et al. Intranasal Oxytocin Blocks Alcohol Withdrawal in Human Subjects. Alcohol Clin Exp Res. 2013;37(3):484-489. doi:10.1111/j.1530-0277.2012.01958.x [38] Montana SB0289. https://leg.mt.gov/bills/2019/billhtml/SB0289.htm [39] Mullins N, Galvin SL, Ramage M, Gannon M, Lorenz K, Sager B, Coulson CC. Buprenorphine and Naloxone Versus Buprenorphine for Opioid Use Disorder in Pregnancy: A Cohort Study. J Addict Med. 2020 May/Jun;14(3):185-192. doi: 10.1097/ADM.0000000000000562. PMID: 31567599. [40] Drug Related Crime Statistics [2023]: Offenses Involving Drug Use. NCDAS. https://drugabusestatistics.org/drug-related-crime-statistics/ [41] Association APH. Online only: Report finds most U.S. inmates suffer from substance abuse or addiction. Nations Health. 2010;40(3):E11-E11. [42] Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) | NIDA Archives. Published January 17, 2018. http://archives.nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition

Kangatarianism is the rather inelegant word coined in the first decade of the twenty-first century to describe an omnivorous diet in which the only meat consumed is that of the kangaroo. First published in the media in 2010 (Barone; Zukerman), the term circulated in Australian environmental and academic circles including the Global Animal conference at the University of Wollongong in July 2011 where I first heard it from members of the Think Tank for Kangaroos (THINKK) group. By June 2017, it had gained enough attention to be named the Oxford English Dictionary’s Australian word of the month (following on from May’s “smashed avo,” another Australian food innovation), but it took the Nine Network reality television series Love Island Australia to raise kangatarian to trending status on social media (Oxford UP). During the first episode, aired in late May 2018, Justin, a concreter and fashion model from Melbourne, declared himself to have previously been a kangatarian as he chatted with fellow contestant, Millie. Vet nurse and animal lover Millie appeared to be shocked by his revelation but was tentatively accepting when Justin explained what kangatarian meant, and justified his choice on the grounds that kangaroo are not farmed. In the social media response, it was clear that eating only the meat of kangaroos as an ethical choice was an entirely new concept to many viewers, with one tweet stating “Kangatarian isn’t a thing”, while others variously labelled the diet brutal, intriguing, or quintessentially Australian (see #kangatarian on Twitter).There is a well developed literature around the arguments for and against eating kangaroo, and why settler Australians tend to be so reluctant to do so (see for example, Probyn; Cawthorn and Hoffman). Here, I will concentrate on the role that ethics play in this food choice by examining how the adoption of kangatarianism can be understood as a bargain struck to help to manage grief in the Anthropocene, and the limitations of that bargain. As Lesley Head has argued, we are living in a time of loss and of grieving, when much that has been taken for granted is becoming unstable, and “we must imagine that drastic changes to everyday life are in the offing” (313). Applying the classic (and contested) model of five stages of grief, first proposed by Elisabeth Kübler-Ross in her book On Death and Dying in 1969, much of the population of the western world seems to be now experiencing denial, her first stage of loss, while those in the most vulnerable environments have moved on to anger with developed countries for destructive actions in the past and inaction in the present. The next stages (or states) of grieving—bargaining, depression, and acceptance—are likely to be manifested, although not in any predictable sequence, as the grief over current and future losses continues (Haslam).The great expansion of food restrictive diets in the Anthropocene can be interpreted as part of this bargaining state of grieving as individuals attempt to respond to the imperative to reduce their environmental impact but also to limit the degree of change to their own diet required to do so. Meat has long been identified as a key component of an individual’s environmental footprint. From Frances Moore Lappé’s 1971 Diet for a Small Planet through the United Nations’ Food and Agriculture Organisation’s 2006 report Livestock’s Long Shadow to the 2019 report of the EAT–Lancet Commission on Healthy Diets from Sustainable Food Systems, the advice has been consistent: meat consumption should be minimised in, if not eradicated from, the human diet. The EAT–Lancet Commission Report quantified this to less than 28 grams (just under one ounce) of beef, lamb or pork per day (12, 25). For many this would be keenly felt, in terms of how meals are constructed, the sensory experiences associated with eating meat and perceptions of well-being but meat is offered up as a sacrifice to bring about the return of the beloved healthy planet.Rather than accept the advice to cut out meat entirely, those seeking to bargain with the Anthropocene also find other options. This has given rise to a suite of foodways based around restricting meat intake in volume or type. Reducing the amount of commercially produced beef, lamb and pork eaten is one approach, while substituting a meat the production of which has a smaller environmental footprint, most commonly chicken or fish, is another. For those willing to make deeper changes, the meat of free living animals, especially those which are killed accidentally on the roads or for deliberately for environmental management purposes, is another option. Further along this spectrum are the novel protein sources suggested in the Lancet report, including insects, blue-green algae and laboratory-cultured meats.Kangatarianism is another form of this bargain, and is backed by at least half a century of advocacy. The Australian Conservation Foundation made calls to reduce the numbers of other livestock and begin a sustainable harvest of kangaroo for food in 1970 when the sale of kangaroo meat for human consumption was still illegal across the country (Conservation of Kangaroos). The idea was repeated by biologist Gordon Grigg in the late 1980s (Jackson and Vernes 173), and again in the Garnaut Climate Change Review in 2008 (547–48). Kangaroo meat is high in protein and iron, low in fat, and high in healthy polyunsaturated fatty acids and conjugated linoleic acid, and, as these authors showed, has a smaller environmental footprint than beef, lamb, or pork. Kangaroo require less water than cattle, sheep or pigs, and no land is cleared to grow feed for them or give them space to graze. Their paws cause less erosion and compaction of soil than do the hooves of common livestock. They eat less fodder than ruminants and their digestive processes result in lower emissions of the powerful greenhouse gas methane and less solid waste.As Justin of Love Island was aware, kangaroo are not farmed in the sense of being deliberately bred, fed, confined, or treated with hormones, drugs or chemicals, which also adds to their lighter impact on the environment. However, some pastoralists argue that because they cannot prevent kangaroos from accessing the food, water, shelter, and protection from predators they provide for their livestock, they do effectively farm them, although they receive no income from sales of kangaroo meat. This type of light touch farming of kangaroos has a very long history in Australia going back to the continent’s first peopling some 60,000 years ago. Kangaroos were so important to Aboriginal people that a wide range of environments were manipulated to produce their favoured habitats of open grasslands edged by sheltering trees. As Bill Gammage demonstrated, fire was used as a tool to preserve and extend grassy areas, to encourage regrowth which would attract kangaroos and to drive the animals from one patch to another or towards hunters waiting with spears (passim, for example, 58, 72, 76, 93). Gammage and Bruce Pascoe agree that this was a form of animal husbandry in which the kangaroos were drawn to the areas prepared for them for the young grass or, more forcefully, physically directed using nets, brush fences or stone walls. Burnt ground served to contain the animals in place of fencing, and regular harvesting kept numbers from rising to levels which would place pressure on other species (Gammage 79, 281–86; Pascoe 42–43). Contemporary advocates of eating kangaroo have promoted the idea that they should be deliberately co-produced with other livestock instead of being killed to preserve feed and water for sheep and cattle (Ellicott; Wilson 39). Substituting kangaroo for the meat of more environmentally damaging animals would facilitate a reduction in the numbers of cattle and sheep, lessening the harm they do.Most proponents have assumed that their audience is current meat eaters who would substitute kangaroo for the meat of other more environmentally costly animals, but kangatarianism can also emerge from vegetarianism. Wendy Zukerman, who wrote about kangaroo hunting for New Scientist in 2010, was motivated to conduct the research because she was considering becoming an early adopter of kangatarianism as the least environmentally taxing way to counter the longterm anaemia she had developed as a vegetarian. In 2018, George Wilson, honorary professor in the Australian National University’s Fenner School of Environment and Society called for vegetarians to become kangatarians as a means of boosting overall consumption of kangaroo for environmental and economic benefits to rural Australia (39).Given these persuasive environmental arguments, it might be expected that many people would have perceived eating kangaroo instead of other meat as a favourable bargain and taken up the call to become kangatarian. Certainly, there has been widespread interest in trying kangaroo meat. In 1997, only five years after the sale of kangaroo meat for human consumption had been legalised in most states (South Australia did so in 1980), 51% of 500 people surveyed in five capital cities said they had tried kangaroo. However, it had not become a meat of choice with very few found to eat it more than three times a year (Des Purtell and Associates iv). Just over a decade later, a study by Ampt and Owen found an increase to 58% of 1599 Australians surveyed across the country who had tried kangaroo but just 4.7% eating it at least monthly (14). Bryce Appleby, in his study of kangaroo consumption in the home based on interviews with 28 residents of Wollongong in 2010, specifically noted the absence of kangatarians—then a very new concept. A study of 261 Sydney university students in 2014 found that half had tried kangaroo meat and 10% continued to eat it with any regularity. Only two respondents identified themselves as kangatarian (Grant 14–15). Kangaroo meat advocate Michael Archer declared in 2017 that “there’s an awful lot of very, very smart vegetarians [who] have opted for semi vegetarianism and they’re calling themselves ‘kangatarians’, as they’re quite happy to eat kangaroo meat”, but unless there had been a significant change in a few years, the surveys did not bear out his assertion (154).The ethical calculations around eating kangaroo are complicated by factors beyond the strictly environmental. One Tweeter advised Justin: “‘I’m a kangatarian’ isn’t a pickup line, mate”, and certainly the reception of his declaration could have been very cool, especially as it was delivered to a self declared animal warrior (N’Tash Aha). All of the studies of beliefs and practices around the eating of kangaroo have noted a significant minority of Australians who would not consider eating kangaroo based on issues of animal welfare and animal rights. The 1997 study found that 11% were opposed to the idea of eating kangaroo, while in Grant’s 2014 study, 15% were ethically opposed to eating kangaroo meat (Des Purtell and Associates iv; Grant 14–15). Animal ethics complicate the bargains calculated principally on environmental grounds.These ethical concerns work across several registers. One is around the flesh and blood kangaroo as a charismatic native animal unique to Australia and which Australians have an obligation to respect and nurture. Sheep, cattle and pigs have been subject to longterm propaganda campaigns which entrench the idea that they are unattractive and unintelligent, and veil their transition to meat behind euphemistic language and abattoir walls, making it easier to eat them. Kangaroos are still seen as resourceful and graceful animals, and no linguistic tricks shield consumers from the knowledge that it is a roo on their plate. A proposal in 2009 to market a “coat of arms” emu and kangaroo-flavoured potato chip brought complaints to the Advertising Standards Bureau that this was disrespectful to these native animals, although the flavours were to be simulated and the product vegetarian (Black). Coexisting with this high regard to kangaroos is its antithesis. That is, a valuation of them informed by their designation as a pest in the pastoral industry, and the use of the carcasses of those killed to feed dogs and other companion animals. Appleby identified a visceral, disgust response to the idea of eating kangaroo in many of his informants, including both vegetarians who would not consider eating kangaroo because of their commitment to a plant-based diet, and at least one omnivore who would prefer to give up all meat rather than eat kangaroo. While diametrically opposed, the end point of both positions is that kangaroo meat should not be eaten.A second animal ethics stance relates to the imagined kangaroo, a cultural construct which for most urban Australians is much more present in their lives and likely to shape their actions than the living animals. It is behind the rejection of eating an animal which holds such an iconic place in Australian culture: to the dexter on the 1912 national coat of arms; hopping through the Hundred Acre Wood as Kanga and Roo in A.A. Milne’s Winnie-the-Pooh children’s books from the 1920s and the Disney movies later made from them; as a boy’s best friend as Skippy the Bush Kangaroo in a fondly remembered 1970s television series; and high in the sky on QANTAS planes. The anthropomorphising of kangaroos permitted the spectacle of the boxing kangaroo from the late nineteenth century. By framing natural kangaroo behaviours as boxing, these exhibitions encouraged an ambiguous understanding of kangaroos as human-like, moving them further from the category of food (Golder and Kirkby). Australian government bodies used this idea of the kangaroo to support food exports to Britain, with kangaroos as cooks or diners rather than ingredients. The Kangaroo Kookery Book of 1932 (see fig. 1 below) portrayed kangaroos as a nuclear family in a suburban kitchen and another official campaign supporting sales of Australian produce in Britain in the 1950s featured a Disney-inspired kangaroo eating apples and chops washed down with wine (“Kangaroo to Be ‘Food Salesman’”). This imagining of kangaroos as human-like has persisted, leading to the opinion expressed in a 2008 focus group, that consuming kangaroo amounted to “‘eating an icon’ … Although they are pests they are still human nature … these are native animals, people and I believe that is a form of cannibalism!” (Ampt and Owen 26). Figure 1: Rather than promoting the eating of kangaroos, the portrayal of kangaroos as a modern suburban family in the Kangaroo Kookery Book (1932) made it unthinkable. (Source: Kangaroo Kookery Book, Director of Australian Trade Publicity, Australia House, London, 1932.)The third layer of ethical objection on the ground of animal welfare is more specific, being directed to the method of killing the kangaroos which become food. Kangaroos are perhaps the only native animals for which state governments set quotas for commercial harvest, on the grounds that they compete with livestock for pasturage and water. In most jurisdictions, commercially harvested kangaroo carcasses can be processed for human consumption, and they are the ones which ultimately appear in supermarket display cases.Kangaroos are killed by professional shooters at night using swivelling spotlights mounted on their vehicles to locate and daze the animals. While clean head shots are the ideal and regulations state that animals should be killed when at rest and without causing “undue agonal struggle”, this is not always achieved and some animals do suffer prolonged deaths (NSW Code of Practice for Kangaroo Meat for Human Consumption). By regulation, the young of any female kangaroo must be killed along with her. While averting a slow death by neglect, this is considered cruel and wasteful. The hunt has drawn international criticism, including from Greenpeace which organised campaigns against the sale of kangaroo meat in Europe in the 1980s, and Viva! which was successful in securing the withdrawal of kangaroo from sale in British supermarkets (“Kangaroo Meat Sales Criticised”). These arguments circulate and influence opinion within Australia.A final animal ethics issue is that what is actually behind the push for greater use of kangaroo meat is not concern for the environment or animal welfare but the quest to turn a profit from these animals. The Kangaroo Industries Association of Australia, formed in 1970 to represent those who dealt in the marsupials’ meat, fur and skins, has been a vocal advocate of eating kangaroo and a sponsor of market research into how it can be made more appealing to the market. The Association argued in 1971 that commercial harvest was part of the intelligent conservation of the kangaroo. They sought minimum size regulations to prevent overharvesting and protect their livelihoods (“Assn. Backs Kangaroo Conservation”). The Association’s current website makes the claim that wild harvested “Australian kangaroo meat is among the healthiest, tastiest and most sustainable red meats in the world” (Kangaroo Industries Association of Australia). That this is intended to initiate a new and less controlled branch of the meat industry for the benefit of hunters and processors, rather than foster a shift from sheep or cattle to kangaroos which might serve farmers and the environment, is the opinion of Dr. Louise Boronyak, of the Centre for Compassionate Conservation at the University of Technology Sydney (Boyle 19).Concerns such as these have meant that kangaroo is most consumed where it is least familiar, with most of the meat for human consumption recovered from culled animals being exported to Europe and Asia. Russia has been the largest export market. There, kangaroo meat is made less strange by blending it with other meats and traditional spices to make processed meats, avoiding objections to its appearance and uncertainty around preparation. With only a low profile as a novelty animal in Russia, there are fewer sentimental concerns about consuming kangaroo, although the additional food miles undermine its environmental credentials. The variable acceptability of kangaroo in more distant markets speaks to the role of culture in determining how patterns of eating are formed and can be shifted, or, as Elspeth Probyn phrased it “how natural entities are transformed into commodities within a context of globalisation and local communities”, underlining the impossibility of any straightforward ethics of eating kangaroo (33, 35).Kangatarianism is a neologism which makes the eating of kangaroo meat something it has not been in the past, a voluntary restriction based on environmental ethics. These environmental benefits are well founded and eating kangaroo can be understood as an Anthropocenic bargain struck to allow the continuation of the consumption of red meat while reducing one’s environmental footprint. Although superficially attractive, the numbers entering into this bargain remain small because environmental ethics cannot be disentangled from animal ethics. The anthropomorphising of the kangaroo and its use as a national symbol coexist with its categorisation as a pest and use of its meat as food for companion animals. Both understandings of kangaroos made their meat uneatable for many Australians. Paired with concerns over how kangaroos are killed and the commercialisation of a native species, kangaroo meat has a very mixed reception despite decades of advocacy for eating its meat in favour of that of more harmed and more harmful introduced species. Given these constraints, kangatarianism is unlikely to become widespread and indeed it should be viewed as at best a temporary exigency. As the climate warms and rainfall becomes more erratic, even animals which have evolved to suit Australian conditions will come under increasing pressure, and humans will need to reach Kübler-Ross’ final state of grief: acceptance. In this case, this would mean acceptance that our needs cannot be placed ahead of those of other animals.ReferencesAmpt, Peter, and Kate Owen. Consumer Attitudes to Kangaroo Meat Products. Canberra: Rural Industries Research and Development Corporation, 2008.Appleby, Bryce. “Skippy the ‘Green’ Kangaroo: Identifying Resistances to Eating Kangaroo in the Home in a Context of Climate Change.” BSc Hons, U of Wollongong, 2010 <http://ro.uow.edu.au/thsci/103>.Archer, Michael. “Zoology on the Table: Plenary Session 4.” Australian Zoologist 39, 1 (2017): 154–60.“Assn. Backs Kangaroo Conservation.” The Beverley Times 26 Feb. 1971: 3. 22 Feb. 2019 <http://nla.gov.au/nla.news-article202738733>.Barone, Tayissa. “Kangatarians Jump the Divide.” Sydney Morning Herald 9 Feb. 2010. 13 Apr. 2019 <https://www.smh.com.au/lifestyle/kangatarians-jump-the-divide-20100209-gdtvd8.html>.Black, Rosemary. “Some Australians Angry over Idea for Kangaroo and Emu-Flavored Potato Chips.” New York Daily News 4 Dec. 2009. 5 Feb. 2019 <https://www.nydailynews.com/life-style/eats/australians-angry-idea-kangaroo-emu-flavored-potato-chips-article-1.431865>.Boyle, Rhianna. “Eating Skippy.” Big Issue Australia 578 11-24 Jan. 2019: 16–19.Cawthorn, Donna-Mareè, and Louwrens C. Hoffman. “Controversial Cuisine: A Global Account of the Demand, Supply and Acceptance of ‘Unconventional’ and ‘Exotic’ Meats.” Meat Science 120 (2016): 26–7.Conservation of Kangaroos. Melbourne: Australian Conservation Foundation, 1970.Des Purtell and Associates. Improving Consumer Perceptions of Kangaroo Products: A Survey and Report. Canberra: Rural Industries Research and Development Corporation, 1997.Ellicott, John. “Little Pay Incentive for Shooters to Join Kangaroo Meat Industry.” The Land 15 Mar. 2018. 28 Mar. 2019 <https://www.theland.com.au/story/5285265/top-roo-shooter-says-harvesting-is-a-low-paid-job/>.Garnaut, Ross. Garnaut Climate Change Review. 2008. 26 Feb. 2019 <http://www.garnautreview.org.au/index.htm>.Gammage, Bill. The Biggest Estate on Earth: How Aborigines Made Australia. Sydney: Allen and Unwin, 2012.Golder, Hilary, and Diane Kirkby. “Mrs. Mayne and Her Boxing Kangaroo: A Married Woman Tests Her Property Rights in Colonial New South Wales.” Law and History Review 21.3 (2003): 585–605.Grant, Elisabeth. “Sustainable Kangaroo Harvesting: Perceptions and Consumption of Kangaroo Meat among University Students in New South Wales.” Independent Study Project (ISP). U of NSW, 2014. <https://digitalcollections.sit.edu/isp_collection/1755>.Haslam, Nick. “The Five Stages of Grief Don’t Come in Fixed Steps – Everyone Feels Differently.” The Conversation 22 Oct. 2018. 28 Mar. 2019 <https://theconversation.com/the-five-stages-of-grief-dont-come-in-fixed-steps-everyone-feels-differently-96111>.Head, Lesley. “The Anthropoceans.” Geographical Research 53.3 (2015): 313–20.Kangaroo Industries Association of Australia. Kangaroo Meat. 26 Feb. 2019 <http://www.kangarooindustry.com/products/meat/>.“Kangaroo Meat Sales Criticised.” The Canberra Times 13 Sep. 1984: 14. 22 Feb 2019 <http://nla.gov.au/nla.news-article136915919>.“Kangaroo to Be Food ‘Salesman.’” Newcastle Morning Herald and Miners’ Advocate, 2 Dec. 1954. 22 Feb 2019 <http://nla.gov.au/nla.news-article134089767>.Kübler-Ross, Elisabeth. On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, and their own Families. New York: Touchstone, 1997.Jackson, Stephen, and Karl Vernes. Kangaroo: Portrait of an Extraordinary Marsupial. Sydney: Allen and Unwin, 2010.Lappé, Frances Moore. Diet for a Small Planet. New York: Ballantine Books, 1971.N’Tash Aha (@Nsvasey). “‘I’m a Kangatarian’ isn’t a Pickup Line, Mate. #LoveIslandAU.” Twitter post. 27 May 2018. 5 Apr. 2019 <https://twitter.com/Nsvasey/status/1000697124122644480>.“NSW Code of Practice for Kangaroo Meat for Human Consumption.” Government Gazette of the State of New South Wales 24 Mar. 1993. 22 Feb. 2019 <http://nla.gov.au/nla.news-page14638033>.Oxford University Press, Australia and New Zealand. Word of the Month. June 2017. <https://www.oup.com.au/dictionaries/word-of-the-month>.Pascoe, Bruce. Dark Emu, Black Seeds: Agriculture or Accident? Broome: Magabala Books, 2014.Probyn, Elspeth. “Eating Roo: Of Things That Become Food.” New Formations 74.1 (2011): 33–45.Steinfeld, Henning, Pierre Gerber, Tom Wassenaar, Vicent Castel, Mauricio Rosales, and Cees d Haan. Livestock’s Long Shadow: Environmental Issues and Options. Rome: Food and Agriculture Organisation of the United Nations, 2006.Trust Nature. Essence of Kangaroo Capsules. 26 Feb. 2019 <http://ncpro.com.au/products/all-products/item/88139-essence-of-kangaroo-35000>.Victoria Department of Environment, Land, Water and Planning. Kangaroo Pet Food Trial. 28 Mar. 2019 <https://www.wildlife.vic.gov.au/managing-wildlife/wildlife-management-and-control-authorisations/kangaroo-pet-food-trial>.Willett, Walter, et al. “Food in the Anthropocene: The EAT–Lancet Commission on Healthy Diets from Sustainable Food Systems.” The Lancet 16 Jan. 2019. 26 Feb. 2019 <https://www.thelancet.com/commissions/EAT>.Wilson, George. “Kangaroos Can Be an Asset Rather than a Pest.” Australasian Science 39.1 (2018): 39.Zukerman, Wendy. “Eating Skippy: The Future of Kangaroo Meat.” New Scientist 208.2781 (2010): 42–5.

Introduction: Our current obsession with the lives of others “Biography—that is to say, our creative and non-fictional output devoted to recording and interpreting real lives—has enjoyed an extraordinary renaissance in recent years,” writes Nigel Hamilton in Biography: A Brief History (1). Ian Donaldson agrees that biography is back in fashion: “Once neglected within the academy and relegated to the dustier recesses of public bookstores, biography has made a notable return over recent years, emerging, somewhat surprisingly, as a new cultural phenomenon, and a new academic adventure” (23). For over a decade now, commentators having been making similar observations about our obsession with the intimacies of individual people’s lives. In a lecture in 1994, Justin Kaplan asserted the West was “a culture of biography” (qtd. in Salwak 1) and more recent research findings by John Feather and Hazel Woodbridge affirm that “the undiminished human curiosity about other peoples lives is clearly reflected in the popularity of autobiographies and biographies” (218). At least in relation to television, this assertion seems valid. In Australia, as in the USA and the UK, reality and other biographically based television shows have taken over from drama in both the numbers of shows produced and the viewers these shows attract, and these forms are also popular in Canada (see, for instance, Morreale on The Osbournes). In 2007, the program Biography celebrated its twentieth anniversary season to become one of the longest running documentary series on American television; so successful that in 1999 it was spun off into its own eponymous channel (Rak; Dempsey). Premiered in May 1996, Australian Story—which aims to utilise a “personal approach” to biographical storytelling—has won a significant viewership, critical acclaim and professional recognition (ABC). It can also be posited that the real home movies viewers submit to such programs as Australia’s Favourite Home Videos, and “chat” or “confessional” television are further reflections of a general mania for biographical detail (see Douglas), no matter how fragmented, sensationalized, or even inane and cruel. A recent example of the latter, the USA-produced The Moment of Truth, has contestants answering personal questions under polygraph examination and then again in front of an audience including close relatives and friends—the more “truthful” their answers (and often, the more humiliated and/or distressed contestants are willing to be), the more money they can win. Away from television, but offering further evidence of this interest are the growing readerships for personally oriented weblogs and networking sites such as MySpace and Facebook (Grossman), individual profiles and interviews in periodical publications, and the recently widely revived newspaper obituary column (Starck). Adult and community education organisations run short courses on researching and writing auto/biographical forms and, across Western countries, the family history/genealogy sections of many local, state, and national libraries have been upgraded to meet the increasing demand for these services. Academically, journals and e-mail discussion lists have been established on the topics of biography and autobiography, and North American, British, and Australian universities offer undergraduate and postgraduate courses in life writing. The commonly aired wisdom is that published life writing in its many text-based forms (biography, autobiography, memoir, diaries, and collections of personal letters) is enjoying unprecedented popularity. It is our purpose to examine this proposition. Methodological problems There are a number of problems involved in investigating genre popularity, growth, and decline in publishing. Firstly, it is not easy to gain access to detailed statistics, which are usually only available within the industry. Secondly, it is difficult to ascertain how publishing statistics are gathered and what they report (Eliot). There is the question of whether bestselling booklists reflect actual book sales or are manipulated marketing tools (Miller), although the move from surveys of booksellers to electronic reporting at point of sale in new publishing lists such as BookScan will hopefully obviate this problem. Thirdly, some publishing lists categorise by subject and form, some by subject only, and some do not categorise at all. This means that in any analysis of these statistics, a decision has to be made whether to use the publishing list’s system or impose a different mode. If the publishing list is taken at face value, the question arises of whether to use categorisation by form or by subject. Fourthly, there is the bedeviling issue of terminology. Traditionally, there reigned a simple dualism in the terminology applied to forms of telling the true story of an actual life: biography and autobiography. Publishing lists that categorise their books, such as BookScan, have retained it. But with postmodern recognition of the presence of the biographer in a biography and of the presence of other subjects in an autobiography, the dichotomy proves false. There is the further problem of how to categorise memoirs, diaries, and letters. In the academic arena, the term “life writing” has emerged to describe the field as a whole. Within the genre of life writing, there are, however, still recognised sub-genres. Academic definitions vary, but generally a biography is understood to be a scholarly study of a subject who is not the writer; an autobiography is the story of a entire life written by its subject; while a memoir is a segment or particular focus of that life told, again, by its own subject. These terms are, however, often used interchangeably even by significant institutions such the USA Library of Congress, which utilises the term “biography” for all. Different commentators also use differing definitions. Hamilton uses the term “biography” to include all forms of life writing. Donaldson discusses how the term has been co-opted to include biographies of place such as Peter Ackroyd’s London: The Biography (2000) and of things such as Lizzie Collingham’s Curry: A Biography (2005). This reflects, of course, a writing/publishing world in which non-fiction stories of places, creatures, and even foodstuffs are called biographies, presumably in the belief that this will make them more saleable. The situation is further complicated by the emergence of hybrid publishing forms such as, for instance, the “memoir-with-recipes” or “food memoir” (Brien, Rutherford and Williamson). Are such books to be classified as autobiography or put in the “cookery/food & drink” category? We mention in passing the further confusion caused by novels with a subtitle of The Biography such as Virginia Woolf’s Orlando. The fifth methodological problem that needs to be mentioned is the increasing globalisation of the publishing industry, which raises questions about the validity of the majority of studies available (including those cited herein) which are nationally based. Whether book sales reflect what is actually read (and by whom), raises of course another set of questions altogether. Methodology In our exploration, we were fundamentally concerned with two questions. Is life writing as popular as claimed? And, if it is, is this a new phenomenon? To answer these questions, we examined a range of available sources. We began with the non-fiction bestseller lists in Publishers Weekly (a respected American trade magazine aimed at publishers, librarians, booksellers, and literary agents that claims to be international in scope) from their inception in 1912 to the present time. We hoped that this data could provide a longitudinal perspective. The term bestseller was coined by Publishers Weekly when it began publishing its lists in 1912; although the first list of popular American books actually appeared in The Bookman (New York) in 1895, based itself on lists appearing in London’s The Bookman since 1891 (Bassett and Walter 206). The Publishers Weekly lists are the best source of longitudinal information as the currently widely cited New York Times listings did not appear till 1942, with the Wall Street Journal a late entry into the field in 1994. We then examined a number of sources of more recent statistics. We looked at the bestseller lists from the USA-based Amazon.com online bookseller; recent research on bestsellers in Britain; and lists from Nielsen BookScan Australia, which claims to tally some 85% or more of books sold in Australia, wherever they are published. In addition to the reservations expressed above, caveats must be aired in relation to these sources. While Publishers Weekly claims to be an international publication, it largely reflects the North American publishing scene and especially that of the USA. Although available internationally, Amazon.com also has its own national sites—such as Amazon.co.uk—not considered here. It also caters to a “specific computer-literate, credit-able clientele” (Gutjahr: 219) and has an unashamedly commercial focus, within which all the information generated must be considered. In our analysis of the material studied, we will use “life writing” as a genre term. When it comes to analysis of the lists, we have broken down the genre of life writing into biography and autobiography, incorporating memoir, letters, and diaries under autobiography. This is consistent with the use of the terminology in BookScan. Although we have broken down the genre in this way, it is the overall picture with regard to life writing that is our concern. It is beyond the scope of this paper to offer a detailed analysis of whether, within life writing, further distinctions should be drawn. Publishers Weekly: 1912 to 2006 1912 saw the first list of the 10 bestselling non-fiction titles in Publishers Weekly. It featured two life writing texts, being headed by an autobiography, The Promised Land by Russian Jewish immigrant Mary Antin, and concluding with Albert Bigelow Paine’s six-volume biography, Mark Twain. The Publishers Weekly lists do not categorise non-fiction titles by either form or subject, so the classifications below are our own with memoir classified as autobiography. In a decade-by-decade tally of these listings, there were 3 biographies and 20 autobiographies in the lists between 1912 and 1919; 24 biographies and 21 autobiographies in the 1920s; 13 biographies and 40 autobiographies in the 1930s; 8 biographies and 46 biographies in the 1940s; 4 biographies and 14 autobiographies in the 1950s; 11 biographies and 13 autobiographies in the 1960s; 6 biographies and 11 autobiographies in the 1970s; 3 biographies and 19 autobiographies in the 1980s; 5 biographies and 17 autobiographies in the 1990s; and 2 biographies and 7 autobiographies from 2000 up until the end of 2006. See Appendix 1 for the relevant titles and authors. Breaking down the most recent figures for 1990–2006, we find a not radically different range of figures and trends across years in the contemporary environment. The validity of looking only at the top ten books sold in any year is, of course, questionable, as are all the issues regarding sources discussed above. But one thing is certain in terms of our inquiry. There is no upwards curve obvious here. If anything, the decade break-down suggests that sales are trending downwards. This is in keeping with the findings of Michael Korda, in his history of twentieth-century bestsellers. He suggests a consistent longitudinal picture across all genres: In every decade, from 1900 to the end of the twentieth century, people have been reliably attracted to the same kind of books […] Certain kinds of popular fiction always do well, as do diet books […] self-help books, celebrity memoirs, sensationalist scientific or religious speculation, stories about pets, medical advice (particularly on the subjects of sex, longevity, and child rearing), folksy wisdom and/or humour, and the American Civil War (xvii). Amazon.com since 2000 The USA-based Amazon.com online bookselling site provides listings of its own top 50 bestsellers since 2000, although only the top 14 bestsellers are recorded for 2001. As fiction and non-fiction are not separated out on these lists and no genre categories are specified, we have again made our own decisions about what books fall into the category of life writing. Generally, we erred on the side of inclusion. (See Appendix 2.) However, when it came to books dealing with political events, we excluded books dealing with specific aspects of political practice/policy. This meant excluding books on, for instance, George Bush’s so-called ‘war on terror,’ of which there were a number of bestsellers listed. In summary, these listings reveal that of the top 364 books sold by Amazon from 2000 to 2007, 46 (or some 12.6%) were, according to our judgment, either biographical or autobiographical texts. This is not far from the 10% of the 1912 Publishers Weekly listing, although, as above, the proportion of bestsellers that can be classified as life writing varied dramatically from year to year, with no discernible pattern of peaks and troughs. This proportion tallied to 4% auto/biographies in 2000, 14% in 2001, 10% in 2002, 18% in 2003 and 2004, 4% in 2005, 14% in 2006 and 20% in 2007. This could suggest a rising trend, although it does not offer any consistent trend data to suggest sales figures may either continue to grow, or fall again, in 2008 or afterwards. Looking at the particular texts in these lists (see Appendix 2) also suggests that there is no general trend in the popularity of life writing in relation to other genres. For instance, in these listings in Amazon.com, life writing texts only rarely figure in the top 10 books sold in any year. So rarely indeed, that from 2001 there were only five in this category. In 2001, John Adams by David McCullough was the best selling book of the year; in 2003, Hillary Clinton’s autobiographical Living History was 7th; in 2004, My Life by Bill Clinton reached number 1; in 2006, Nora Ephron’s I Feel Bad About My Neck: and Other Thoughts on Being a Woman was 9th; and in 2007, Ishmael Beah’s discredited A Long Way Gone: Memoirs of a Boy Soldier came in at 8th. Apart from McCulloch’s biography of Adams, all the above are autobiographical texts, while the focus on leading political figures is notable. Britain: Feather and Woodbridge With regard to the British situation, we did not have actual lists and relied on recent analysis. John Feather and Hazel Woodbridge find considerably higher levels for life writing in Britain than above with, from 1998 to 2005, 28% of British published non-fiction comprising autobiography, while 8% of hardback and 5% of paperback non-fiction was biography (2007). Furthermore, although Feather and Woodbridge agree with commentators that life writing is currently popular, they do not agree that this is a growth state, finding the popularity of life writing “essentially unchanged” since their previous study, which covered 1979 to the early 1990s (Feather and Reid). Australia: Nielsen BookScan 2006 and 2007 In the Australian publishing industry, where producing books remains an ‘expensive, risky endeavour which is increasingly market driven’ (Galligan 36) and ‘an inherently complex activity’ (Carter and Galligan 4), the most recent Australian Bureau of Statistics figures reveal that the total numbers of books sold in Australia has remained relatively static over the past decade (130.6 million in the financial year 1995–96 and 128.8 million in 2003–04) (ABS). During this time, however, sales volumes of non-fiction publications have grown markedly, with a trend towards “non-fiction, mass market and predictable” books (Corporall 41) resulting in general non-fiction sales in 2003–2004 outselling general fiction by factors as high as ten depending on the format—hard- or paperback, and trade or mass market paperback (ABS 2005). However, while non-fiction has increased in popularity in Australia, the same does not seem to hold true for life writing. Here, in utilising data for the top 5,000 selling non-fiction books in both 2006 and 2007, we are relying on Nielsen BookScan’s categorisation of texts as either biography or autobiography. In 2006, no works of life writing made the top 10 books sold in Australia. In looking at the top 100 books sold for 2006, in some cases the subjects of these works vary markedly from those extracted from the Amazon.com listings. In Australia in 2006, life writing makes its first appearance at number 14 with convicted drug smuggler Schapelle Corby’s My Story. This is followed by another My Story at 25, this time by retired Australian army chief, Peter Cosgrove. Jonestown: The Power and Myth of Alan Jones comes in at 34 for the Australian broadcaster’s biographer Chris Masters; the biography, The Innocent Man by John Grisham at 38 and Li Cunxin’s autobiographical Mao’s Last Dancer at 45. Australian Susan Duncan’s memoir of coping with personal loss, Salvation Creek: An Unexpected Life makes 50; bestselling USA travel writer Bill Bryson’s autobiographical memoir of his childhood The Life and Times of the Thunderbolt Kid 69; Mandela: The Authorised Portrait by Rosalind Coward, 79; and Joanne Lees’s memoir of dealing with her kidnapping, the murder of her partner and the justice system in Australia’s Northern Territory, No Turning Back, 89. These books reveal a market preference for autobiographical writing, and an almost even split between Australian and overseas subjects in 2006. 2007 similarly saw no life writing in the top 10. The books in the top 100 sales reveal a downward trend, with fewer titles making this band overall. In 2007, Terri Irwin’s memoir of life with her famous husband, wildlife warrior Steve Irwin, My Steve, came in at number 26; musician Andrew Johns’s memoir of mental illness, The Two of Me, at 37; Ayaan Hirst Ali’s autobiography Infidel at 39; John Grogan’s biography/memoir, Marley and Me: Life and Love with the World’s Worst Dog, at 42; Sally Collings’s biography of the inspirational young survivor Sophie Delezio, Sophie’s Journey, at 51; and Elizabeth Gilbert’s hybrid food, self-help and travel memoir, Eat, Pray, Love: One Woman’s Search for Everything at 82. Mao’s Last Dancer, published the year before, remained in the top 100 in 2007 at 87. When moving to a consideration of the top 5,000 books sold in Australia in 2006, BookScan reveals only 62 books categorised as life writing in the top 1,000, and only 222 in the top 5,000 (with 34 titles between 1,000 and 1,999, 45 between 2,000 and 2,999, 48 between 3,000 and 3,999, and 33 between 4,000 and 5,000). 2007 shows a similar total of 235 life writing texts in the top 5,000 bestselling books (75 titles in the first 1,000, 27 between 1,000 and 1,999, 51 between 2,000 and 2,999, 39 between 3,000 and 3,999, and 43 between 4,000 and 5,000). In both years, 2006 and 2007, life writing thus not only constituted only some 4% of the bestselling 5,000 titles in Australia, it also showed only minimal change between these years and, therefore, no significant growth. Conclusions Our investigation using various instruments that claim to reflect levels of book sales reveals that Western readers’ willingness to purchase published life writing has not changed significantly over the past century. We find no evidence of either a short, or longer, term growth or boom in sales in such books. Instead, it appears that what has been widely heralded as a new golden age of life writing may well be more the result of an expanded understanding of what is included in the genre than an increased interest in it by either book readers or publishers. What recent years do appear to have seen, however, is a significantly increased interest by public commentators, critics, and academics in this genre of writing. We have also discovered that the issue of our current obsession with the lives of others tends to be discussed in academic as well as popular fora as if what applies to one sub-genre or production form applies to another: if biography is popular, then autobiography will also be, and vice versa. If reality television programming is attracting viewers, then readers will be flocking to life writing as well. Our investigation reveals that such propositions are questionable, and that there is significant research to be completed in mapping such audiences against each other. This work has also highlighted the difficulty of separating out the categories of written texts in publishing studies, firstly in terms of determining what falls within the category of life writing as distinct from other forms of non-fiction (the hybrid problem) and, secondly, in terms of separating out the categories within life writing. Although we have continued to use the terms biography and autobiography as sub-genres, we are aware that they are less useful as descriptors than they are often assumed to be. In order to obtain a more complete and accurate picture, publishing categories may need to be agreed upon, redefined and utilised across the publishing industry and within academia. This is of particular importance in the light of the suggestions (from total sales volumes) that the audiences for books are limited, and therefore the rise of one sub-genre may be directly responsible for the fall of another. Bair argues, for example, that in the 1980s and 1990s, the popularity of what she categorises as memoir had direct repercussions on the numbers of birth-to-death biographies that were commissioned, contracted, and published as “sales and marketing staffs conclude[d] that readers don’t want a full-scale life any more” (17). Finally, although we have highlighted the difficulty of using publishing statistics when there is no common understanding as to what such data is reporting, we hope this study shows that the utilisation of such material does add a depth to such enquiries, especially in interrogating the anecdotal evidence that is often quoted as data in publishing and other studies. Appendix 1 Publishers Weekly listings 1990–1999 1990 included two autobiographies, Bo Knows Bo by professional athlete Bo Jackson (with Dick Schaap) and Ronald Reagan’s An America Life: An Autobiography. In 1991, there were further examples of life writing with unimaginative titles, Me: Stories of My Life by Katherine Hepburn, Nancy Reagan: The Unauthorized Biography by Kitty Kelley, and Under Fire: An American Story by Oliver North with William Novak; as indeed there were again in 1992 with It Doesn’t Take a Hero: The Autobiography of Norman Schwarzkopf, Sam Walton: Made in America, the autobiography of the founder of Wal-Mart, Diana: Her True Story by Andrew Morton, Every Living Thing, yet another veterinary outpouring from James Herriot, and Truman by David McCullough. In 1993, radio shock-jock Howard Stern was successful with the autobiographical Private Parts, as was Betty Eadie with her detailed recounting of her alleged near-death experience, Embraced by the Light. Eadie’s book remained on the list in 1994 next to Don’t Stand too Close to a Naked Man, comedian Tim Allen’s autobiography. Flag-waving titles continue in 1995 with Colin Powell’s My American Journey, and Miss America, Howard Stern’s follow-up to Private Parts. 1996 saw two autobiographical works, basketball superstar Dennis Rodman’s Bad as I Wanna Be and figure-skater, Ekaterina Gordeeva’s (with EM Swift) My Sergei: A Love Story. In 1997, Diana: Her True Story returns to the top 10, joining Frank McCourt’s Angela’s Ashes and prolific biographer Kitty Kelly’s The Royals, while in 1998, there is only the part-autobiography, part travel-writing A Pirate Looks at Fifty, by musician Jimmy Buffet. There is no biography or autobiography included in either the 1999 or 2000 top 10 lists in Publishers Weekly, nor in that for 2005. In 2001, David McCullough’s biography John Adams and Jack Welch’s business memoir Jack: Straight from the Gut featured. In 2002, Let’s Roll! Lisa Beamer’s tribute to her husband, one of the heroes of 9/11, written with Ken Abraham, joined Rudolph Giuliani’s autobiography, Leadership. 2003 saw Hillary Clinton’s autobiography Living History and Paul Burrell’s memoir of his time as Princess Diana’s butler, A Royal Duty, on the list. In 2004, it was Bill Clinton’s turn with My Life. In 2006, we find John Grisham’s true crime (arguably a biography), The Innocent Man, at the top, Grogan’s Marley and Me at number three, and the autobiographical The Audacity of Hope by Barack Obama in fourth place. Appendix 2 Amazon.com listings since 2000 In 2000, there were only two auto/biographies in the top Amazon 50 bestsellers with Lance Armstrong’s It’s Not about the Bike: My Journey Back to Life about his battle with cancer at 20, and Dave Eggers’s self-consciously fictionalised memoir, A Heartbreaking Work of Staggering Genius at 32. In 2001, only the top 14 bestsellers were recorded. At number 1 is John Adams by David McCullough and, at 11, Jack: Straight from the Gut by USA golfer Jack Welch. In 2002, Leadership by Rudolph Giuliani was at 12; Master of the Senate: The Years of Lyndon Johnson by Robert Caro at 29; Portrait of a Killer: Jack the Ripper by Patricia Cornwell at 42; Blinded by the Right: The Conscience of an Ex-Conservative by David Brock at 48; and Louis Gerstner’s autobiographical Who Says Elephants Can’t Dance: Inside IBM’s Historic Turnaround at 50. In 2003, Living History by Hillary Clinton was 7th; Benjamin Franklin: An American Life by Walter Isaacson 14th; Dereliction of Duty: The Eyewitness Account of How President Bill Clinton Endangered America’s Long-Term National Security by Robert Patterson 20th; Under the Banner of Heaven: A Story of Violent Faith by Jon Krakauer 32nd; Leap of Faith: Memoirs of an Unexpected Life by Queen Noor of Jordan 33rd; Kate Remembered, Scott Berg’s biography of Katharine Hepburn, 37th; Who’s your Caddy?: Looping for the Great, Near Great and Reprobates of Golf by Rick Reilly 39th; The Teammates: A Portrait of a Friendship about a winning baseball team by David Halberstam 42nd; and Every Second Counts by Lance Armstrong 49th. In 2004, My Life by Bill Clinton was the best selling book of the year; American Soldier by General Tommy Franks was 16th; Kevin Phillips’s American Dynasty: Aristocracy, Fortune and the Politics of Deceit in the House of Bush 18th; Timothy Russert’s Big Russ and Me: Father and Son. Lessons of Life 20th; Tony Hendra’s Father Joe: The Man who Saved my Soul 23rd; Ron Chernow’s Alexander Hamilton 27th; Cokie Roberts’s Founding Mothers: The Women Who Raised our Nation 31st; Kitty Kelley’s The Family: The Real Story of the Bush Dynasty 42nd; and Chronicles, Volume 1 by Bob Dylan was 43rd. In 2005, auto/biographical texts were well down the list with only The Year of Magical Thinking by Joan Didion at 45 and The Glass Castle: A Memoir by Jeanette Walls at 49. In 2006, there was a resurgence of life writing with Nora Ephron’s I Feel Bad About My Neck: and Other Thoughts on Being a Woman at 9; Grisham’s The Innocent Man at 12; Bill Buford’s food memoir Heat: an Amateur’s Adventures as Kitchen Slave, Line Cook, Pasta-Maker, and Apprentice to a Dante-Quoting Butcher in Tuscany at 23; more food writing with Julia Child’s My Life in France at 29; Immaculée Ilibagiza’s Left to Tell: Discovering God amidst the Rwandan Holocaust at 30; CNN anchor Anderson Cooper’s Dispatches from the Edge: A Memoir of War, Disasters and Survival at 43; and Isabella Hatkoff’s Owen & Mzee: The True Story of a Remarkable Friendship (between a baby hippo and a giant tortoise) at 44. In 2007, Ishmael Beah’s discredited A Long Way Gone: Memoirs of a Boy Soldier came in at 8; Walter Isaacson’s Einstein: His Life and Universe 13; Ayaan Hirst Ali’s autobiography of her life in Muslim society, Infidel, 18; The Reagan Diaries 25; Jesus of Nazareth by Pope Benedict XVI 29; Mother Teresa: Come be my Light 36; Clapton: The Autobiography 40; Tina Brown’s The Diana Chronicles 45; Tony Dungy’s Quiet Strength: The Principles, Practices & Priorities of a Winning Life 47; and Daniel Tammet’s Born on a Blue Day: Inside the Extraordinary Mind of an Autistic Savant at 49. Acknowledgements A sincere thank you to Michael Webster at RMIT for assistance with access to Nielsen BookScan statistics, and to the reviewers of this article for their insightful comments. Any errors are, of course, our own. References Australian Broadcasting Commission (ABC). “About Us.” Australian Story 2008. 1 June 2008. ‹http://www.abc.net.au/austory/aboutus.htm>. Australian Bureau of Statistics. “1363.0 Book Publishers, Australia, 2003–04.” 2005. 1 June 2008 ‹http://www.abs.gov.au/ausstats/abs@.nsf/mf/1363.0>. Bair, Deirdre “Too Much S & M.” Sydney Morning Herald 10–11 Sept. 2005: 17. Basset, Troy J., and Christina M. Walter. “Booksellers and Bestsellers: British Book Sales as Documented by The Bookman, 1891–1906.” Book History 4 (2001): 205–36. Brien, Donna Lee, Leonie Rutherford, and Rosemary Williamson. “Hearth and Hotmail: The Domestic Sphere as Commodity and Community in Cyberspace.” M/C Journal 10.4 (2007). 1 June 2008 ‹http://journal.media-culture.org.au/0708/10-brien.php>. Carter, David, and Anne Galligan. “Introduction.” Making Books: Contemporary Australian Publishing. St Lucia: U of Queensland P, 2007. 1–14. Corporall, Glenda. Project Octopus: Report Commissioned by the Australian Society of Authors. Sydney: Australian Society of Authors, 1990. Dempsey, John “Biography Rewrite: A&E’s Signature Series Heads to Sib Net.” Variety 4 Jun. 2006. 1 June 2008 ‹http://www.variety.com/article/VR1117944601.html?categoryid=1238&cs=1>. Donaldson, Ian. “Matters of Life and Death: The Return of Biography.” Australian Book Review 286 (Nov. 2006): 23–29. Douglas, Kate. “‘Blurbing’ Biographical: Authorship and Autobiography.” Biography 24.4 (2001): 806–26. Eliot, Simon. “Very Necessary but not Sufficient: A Personal View of Quantitative Analysis in Book History.” Book History 5 (2002): 283–93. Feather, John, and Hazel Woodbridge. “Bestsellers in the British Book Industry.” Publishing Research Quarterly 23.3 (Sept. 2007): 210–23. Feather, JP, and M Reid. “Bestsellers and the British Book Industry.” Publishing Research Quarterly 11.1 (1995): 57–72. Galligan, Anne. “Living in the Marketplace: Publishing in the 1990s.” Publishing Studies 7 (1999): 36–44. Grossman, Lev. “Time’s Person of the Year: You.” Time 13 Dec. 2006. Online edition. 1 June 2008 ‹http://www.time.com/time/magazine/article/0%2C9171%2C1569514%2C00.html>. Gutjahr, Paul C. “No Longer Left Behind: Amazon.com, Reader Response, and the Changing Fortunes of the Christian Novel in America.” Book History 5 (2002): 209–36. Hamilton, Nigel. Biography: A Brief History. Cambridge, MA: Harvard UP, 2007. Kaplan, Justin. “A Culture of Biography.” The Literary Biography: Problems and Solutions. Ed. Dale Salwak. Basingstoke: Macmillan, 1996. 1–11. Korda, Michael. Making the List: A Cultural History of the American Bestseller 1900–1999. New York: Barnes & Noble, 2001. Miller, Laura J. “The Bestseller List as Marketing Tool and Historical Fiction.” Book History 3 (2000): 286–304. Morreale, Joanne. “Revisiting The Osbournes: The Hybrid Reality-Sitcom.” Journal of Film and Video 55.1 (Spring 2003): 3–15. Rak, Julie. “Bio-Power: CBC Television’s Life & Times and A&E Network’s Biography on A&E.” LifeWriting 1.2 (2005): 1–18. Starck, Nigel. “Capturing Life—Not Death: A Case For Burying The Posthumous Parallax.” Text: The Journal of the Australian Association of Writing Programs 5.2 (2001). 1 June 2008 ‹http://www.textjournal.com.au/oct01/starck.htm>.

Introduction The counterculture that arose during the 1960s and 1970s left lasting social and political reverberations in developed nations. This was a time of increasing affluence and liberalisation which opened up remarkable political opportunities for social change. Within this context, an array of new social movements were a vital ingredient of the ferment that saw existing norms challenged and the establishment of new rights for many oppressed groups. An expanding arena of concerns included the environmental damage caused by 200 years of industrial capitalism. This article examines one aspect of a current environment movement in Australia, the anti-Coal Seam Gas (CSG) movement, and the part played by participants. In particular, the focus is upon one action that emerged during the recent Bentley Blockade, which was a regional mobilisation against proposed unconventional gas mining (UGM) near Lismore, NSW. Over the course of the blockade, the conventional ritual of waving at passers-by was transformed into a mechanism for garnering broad community support. Arguably, this was a crucial factor in the eventual outcome. In this case, we contend that the wave, rather than a countercultural artefact being appropriated by the mainstream, represents an everyday behaviour that builds social solidarity, which is subverted to become an effective part of the repertoire of the movement. At a more general level, this article examines how counterculture and mainstream interact via the subversion of “ordinary” citizens and the role of certain cultural understandings for that purpose. We will begin by examining the nature of the counterculture and its relationship to social movements before discussing the character of the anti-CSG movement in general and the Bentley Blockade in particular, using the personal experience of one of the writers. We will then be able to explore our thesis in detail and make some concluding remarks. The Counterculture and Social Movements In this article, we follow Cox’s understanding of the counterculture as a kind of meta-movement within which specific social movements are situated. For Cox (105), the counterculture that flourished during the 1960s and 1970s was an overarching movement in which existing social relations—in particular the family—were rejected by a younger generation, who succeeded in effectively fusing previously separate political and cultural spheres of dissent into one. Cox (103-04) points out that the precondition for such a phenomenon is “free space”—conditions under which counter-hegemonic activity can occur—for example, being liberated from the constraints of working to subsist, something which the unprecedented prosperity of the post WWII years allowed. Hence, in the 1960s and 1970s, as the counterculture emerged, a wave of activism arose in the western world which later came to be referred to as new social movements. These included the civil rights movement, women’s liberation, pacifism and the anti-nuclear and environment movements. The new movements rejected established power and organisational structures and tended, some scholars argued, to cross class lines, basing their claims on non-material issues. Della Porta and Diani claim this wave of movements is characterised by: a critical ideology in relation to modernism and progress; decentralized and participatory organizational structures; defense of interpersonal solidarity against the great bureaucracies; and the reclamation of autonomous spaces, rather than material advantages. (9) This depiction clearly announces the countercultural nature of the new social movements. As Carter (91) avers, these movements attempted to bypass the state and instead mobilise civil society, employing a range of innovative tactics and strategies—the repertoire of action—which may involve breaking laws. It should be noted that over time, some of these movements did shift towards accommodation of existing power structures and became more reformist in nature, to the point of forming political parties in the case of the Greens. However, inasmuch as the counterculture represented a merging of distinctively non-mainstream ways of life with the practice of actively challenging social arrangements at a political level (Cox 18–19; Grossberg 15–18;), the tactic of mobilising civil society to join social movements demonstrates in fact a reverse direction: large numbers of people are transfigured in radical ways by their involvement in social movements. One important principle underlying much of the repertoire of action of these new movements was non-violence. Again, this signals countercultural norms of the period. As Sharp (583–86) wrote at the time, non-violence is crucial in that it denies the aggressor their rationale for violent repression. This principle is founded on the liberal notion, whose legacy goes back to Locke, that the legitimacy of the government rests upon the consent of the governed—that is, the people can withdraw their consent (Locke in Ball & Dagger 92). Ghandi also relied upon this idea when formulating his non-violent approach to conflict, satyagraha (Sharp 83–84). Thus an idea that upholds the modern state is adopted by the counterculture in order to undermine it (the state), again demonstrating an instance of counterflow from the mainstream. Non-violence does not mean non-resistance. In fact, it usually involves non-compliance with a government or other authority and when practised in large numbers, can be very effective, as Ghandi and those in the civil rights movement showed. The result will be either that the government enters into negotiation with the protestors, or they can engage in violence to suppress them, which generally alienates the wider population, leading to a loss of support (Finley & Soifer 104–105). Tarrow (88) makes the important point that the less threatening an action, the harder it is to repress. As a result, democratic states have generally modified their response towards the “strategic weapon of nonviolent protest and even moved towards accommodation and recognition of this tactic as legitimate” (Tarrow 172). Nevertheless, the potential for state violence remains, and the freedom to protest is proscribed by various laws. One of the key figures to emerge from the new social movements that formed an integral part of the counterculture was Bill Moyer, who, in conjunction with colleagues produced a seminal text for theorising and organising social movements (Moyer et al.). Many contemporary social movements have been significantly influenced by Moyer’s Movement Action Plan (MAP), which describes not only key theoretical concepts but is also a practical guide to movement building and achieving aims. Moyer’s model was utilised in training the Northern Rivers community in the anti-CSG movement in conjunction with the non-violent direct action (NVDA) model developed by the North-East Forest Alliance (NEFA) that resisted logging in the forests of north-eastern NSW during the late 1980s and 1990s (Ricketts 138–40). Indeed, the Northern Rivers region of NSW—dubbed the Rainbow Region—is celebrated, as a “‘meeting place’ of countercultures and for the articulation of social and environmental ideals that challenge mainstream practice” (Ward and van Vuuren 63). As Bible (6–7) outlines, the Northern Rivers’ place in countercultural history is cemented by the holding of the Aquarius Festival in Nimbin in 1973 and the consequent decision of many attendees to stay on and settle in the region. They formed new kinds of communities based on an alternative ethics that eschewed a consumerist, individualist agenda in favour of modes of existence that emphasised living in harmony with the environment. The Terania Creek campaign of the late 1970s made the region famous for its environmental activism, when the new settlers resisted the logging of Nightcap National Park using nonviolent methods (Bible 5). It was also instrumental in developing an array of ingenious actions that were used in subsequent campaigns such as the Franklin Dam blockade in Tasmania in the early 1980s (Kelly 116). Indeed, many of these earlier activists were key figures in the anti-CSG movement that has developed in the Rainbow Region over the last few years. The Anti-CSG Movement Despite opposition to other forms of UGM, such as tight sands and shale oil extraction techniques, the term anti-CSG is used here, as it still seems to attract wide recognition. Unconventional gas extraction usually involves a process called fracking, which is the injection at high pressure of water, sand and a number of highly toxic chemicals underground to release the gas that is trapped in rock formations. Among the risks attributed to fracking are contamination of aquifers, air pollution from fugitive emissions and exposure to radioactive particles with resultant threats to human and animal health, as well as an increased risk of earthquakes (Ellsworth; Hand 13; Sovacool 254–260). Additionally, the vast amount of water that is extracted in the fracking process is saline and may contain residues of the fracking chemicals, heavy metals and radioactive matter. This produced water must either be stored or treated (Howarth 273–73; Sovacool 255). Further, there is potential for accidents and incidents and there are many reports—particularly in the United States where the practice is well established—of adverse events such as compressors exploding, leaks and spills, and water from taps catching fire (Sovacool 255–257). Despite an abundance of anecdotal evidence, until recently authorities and academics believed there was not enough “rigorous evidence” to make a definitive judgment of harm to animal and human health as a result of fracking (Mitka 2135). For example, in Australia, the Queensland Government was unable to find a clear link between fracking and health complaints in the Tara gasfield (Thompson 56), even though it is known that there are fugitive emissions from these gasfields (Tait et al. 3099-103). It is within this context that grassroots opposition to UGM began in Australia. The largest and most sustained challenge has come from the Northern Rivers of New South Wales, where a company called Metgasco has been attempting to engage in UGM for a number of years. Stiff community opposition has developed over this time, with activists training, co-ordinating and organising using the principles of Moyer’s MAP and NEFA’s NVDA. Numerous community and affinity groups opposing UGM sprang up including the Lock the Gate Alliance (LTG), a grassroots organisation opposing coal and gas mining, which formed in 2010 (Lock the Gate Alliance online). The movement put up sustained resistance to Metgasco’s attempts to establish wells at Glenugie, near Grafton and Doubtful Creek, near Kyogle in 2012 and 2013, despite the use of a substantial police presence at both locations. In the event, neither site was used for production despite exploratory wells being sunk (ABC News; Dobney). Metgasco announced it would be withdrawing its operations following new Federal and State government regulations at the time of the Doubtful Creek blockade. However it returned to the fray with a formal announcement in February 2014 (Metgasco), that it would drill at Bentley, 12 kilometres west of Lismore. It was widely believed this would occur with a view to production on an industrial scale should initial exploration prove fruitful. The Bentley Blockade It was known well before the formal announcement that Metgasco planned to drill at Bentley and community actions such as flash mobs, media releases and planning meetings were part of the build-up to direct action at the site. One of the authors of this article was actively involved in the movement and participated in a variety of these actions. By the end of January 2014 it was decided to hold an ongoing vigil at the site, which was still entirely undeveloped. Participants, including one author, volunteered for four-hour shifts which began at 5 a.m. each day and before long, were lasting into the night. The purpose of a vigil is to bear witness, maintain a presence and express a point of view. It thus accords well with the principle of non-violence. Eventually the site mushroomed into a tent village with three gates being blockaded. The main gate, Gate A, sprouted a variety of poles, tripods and other installations together with colourful tents and shelters, peopled by protesters on a 24-hour basis. The vigils persisted on all three gates for the duration of the blockade. As the number of blockaders swelled, popular support grew, lending weight to the notion that countercultural ideas and practices were spreading throughout the community. In response, Metgasco called on the State Government to provide police to coincide with the arrival of equipment. It was rumoured that 200 police would be drafted to defend the site in late April. When alerts were sent out to the community warning of imminent police action, an estimated crowd of 2000 people attended in the early hours of the morning and the police called off their operation (Feliu). As the weeks wore on, training was stepped up, attendees were educated in non-violent resistance and protestors willing to act as police liaison persons were placed on a rotating roster. In May, the State Government was preparing to send up to 800 police and the Riot Squad to break the blockade (NSW Hansard in Buckingham). Local farmers (now a part of the movement) and activist leaders had gone to Sydney in an effort to find a political solution in order to avoid what threatened to be a clash that would involve police violence. A confluence of events, such as: the sudden resignation of the Premier; revelations via the Independent Commission against Corruption about nefarious dealings and undue influence of the coal industry upon the government; a radio interview with locals by a popular broadcaster in Sydney; and the reputed hesitation of the police themselves in engaging with a group of possibly 7,000 to 10,000 protestors, resulted in the Office for Coal Seam Gas suspending Metgasco’s drilling licence on 15 May (NSW Department of Resources & Energy). The grounds were that the company had not adequately fulfilled its obligations to consult with the community. At the date of writing, the suspension still holds. The Wave The repertoire of contention at the Bentley Blockade was expansive, comprising most of the standard actions and strategies developed in earlier environmental struggles. These included direct blocking tactics in addition to the use of more carnivalesque actions like music and theatre, as well as the use of various media to reach a broader public. Non-violence was at the core of all actions, but we would tentatively suggest that Bentley may have provided a novel addition to the repertoire, stemming originally from the vigil, which brought the first protestors to the site. At the beginning of the vigil, which was initially held near the entrance to the proposed drilling site atop a cutting, occupants of passing vehicles below would demonstrate their support by sounding their horns and/or waving to the vigil-keepers, who at first were few in number. There was a precedent for this behaviour in the campaign leading up to the blockade. Activist groups such as the Knitting Nannas against Gas had encouraged vehicles to show support by sounding their horns. So when the motorists tooted spontaneously at Bentley, we waved back. Occupants of other vehicles would show disapproval by means of rude gestures and/or yelling and we would wave to them as well. After some weeks, as a presence began to be established at the site, it became routine for vigil keepers to smile and wave at all passing vehicles. This often elicited a positive response. After the first mass call-out discussed above, a number of us migrated to another gate, where numbers were much sparser and there was a perceived need for a greater presence. At this point, the participating writer had begun to act as a police liaison person, but the practice of waving routinely was continued. Those protecting this gate usually included protestors ready to block access, the police liaison person, a legal observer, vigil-keepers and a passing parade of visitors. Because this location was directly on the road, it was possible to see the drivers of vehicles and make eye contact more easily. Certain vehicles became familiar, passing at regular times, on the way to work or school, for example. As time passed, most of those protecting the gate also joined the waving ritual to the point where it became like a game to try to prise a signal of acknowledgement from the passing motorists, or even to win over a disapprover. Police vehicles, some of which passed at set intervals, were included in this game. Mostly they waved cheerfully. There were some we never managed to win over, but waving and making direct eye contact with regular motorists over time created a sense of community and an acknowledgement of the work we were doing, as they increasingly responded in kind. Motorists could hardly feel threatened when they encountered smiling, waving protestors. By including the disapprovers, we acted inclusively and our determined good humour seemed to de-escalate demonstrated hostility. Locals who did not want drilling to go ahead but who were nevertheless unwilling to join a direct action were thus able to participate in the resistance in a way that may have felt safe for them. Some of them even stopped and visited the site, voicing their support. Standing on the side of the road and waving to passers-by may seem peripheral to the “real” action, even trivial. But we would argue it is a valuable adjunct to a blockade (which is situated near a road) when one of the strategies of the overall campaign is to win popular backing. Hence waving, whilst not a completely new part of the repertoire, constitutes what Tilly (41–45) would call innovation at the margins, something he asserts is necessary to maintain the effectiveness and vitality of contentious action. In this case, it is arguable that the sheer size of community support probably helped to concentrate the minds of the state government politicians in Sydney, particularly as they contemplated initiating a massive, taxpayer-funded police action against the people for the benefit of a commercial operation. Waving is a symbolic gesture indicating acknowledgement and goodwill. It fits well within a repertoire based on the principle of non-violence. Moreover, it is a conventional social norm and everyday behaviour that is so innocuous that it is difficult to see how it could be suppressed by police or other authorities. Therein lies its subversiveness. For in communicating our common humanity in a spirit of friendliness, we drew attention to the fact that we were without rancour and tacitly invited others to join us and to explore our concerns. In this way, the counterculture drew upon a mainstream custom to develop and extend upon a new form of dissent. This constitutes a reversal of the more usual phenomenon of countercultural artefacts—such as “hippie clothing”—being appropriated or co-opted by the prevailing culture (see Reading). But it also fits with the more general phenomenon that we have argued was occurring; that of enticing ordinary residents into joining together in countercultural activity, via the pathway of a social movement. Conclusion The anti-CSG movement in the Northern Rivers was developed and organised by countercultural participants of previous contentious challenges. It was highly effective in building popular support whilst at the same time forging a loose coalition of various activist groups. We have surveyed one practice—the wave—that evolved out of mainstream culture over the course of the Bentley Blockade and suggested it may come to be seen as part of the repertoire of actions that can be beneficially employed under suitable conditions. Waving to passers-by invites them to become part of the movement in a non-threatening and inclusive way. It thus envelops supporters and non-supporters alike, and its very innocuousness makes it difficult to suppress. We have argued that this instance can be referenced to a similar reverse movement at a broader level—that of co-opting liberal notions and involving the general populace in new practices and activities that undermine the status quo. The ability of the counterculture in general and environment movements in particular to innovate in the quest to challenge and change what it perceives as damaging or unethical practices demonstrates its ingenuity and spirit. This movement is testament to its dynamic nature. References ABC News. Metgasco Has No CSG Extraction Plans for Glenugie. 2013. 30 July 2014 ‹http://www.abc.net.au/news/2013-01-22/metgasco-says-no-csg-extraction-planned-for-glenugie/4477652›. Bible, Vanessa. Aquarius Rising: Terania Creek and the Australian Forest Protest Movement. Bachelor of Arts (Honours) Thesis, University of New England, 2010. 4 Nov. 2014 ‹http://www.rainforestinfo.org.au/terania/Vanessa%27s%20Terania%20Thesis2.pdf›. Buckingham, Jeremy. Hansard of Bentley Blockade Motion 15/05/2014. 16 May 2014. 30 July 2014 ‹http://jeremybuckingham.org/2014/05/16/hansard-of-bentley-blockade-motion-moved-by-david-shoebridge-15052014/›. Carter, Neil. The Politics of the Environment: Ideas, Activism, Policy. 2nd ed. New York: Cambridge UP, 2007. Cox, Laurence. Building Counter Culture: The Radical Praxis of Social Movement Milieu. Helsinki: Into-ebooks 2011. 23 July 2014 ‹http://www.into-ebooks.com/book/building_counter_culture/›. Della Porta, Donatella, and Mario Diani. Social Movements: An Introduction. 2nd ed. Oxford: Blackwell Publishing, 2006. Dobney, Chris. “Drill Rig Heads to Doubtful Creek.” Echo Netdaily Feb. 2013. 30 July 2014 ‹http://www.echo.net.au/2013/02/drill-rig-heads-to-doubtful-creek/›. Ellsworth, William. “Injection-Induced Earthquakes”. Science 341.6142 (2013). DOI: 10.1126/science.1225942. 10 July 2014 ‹http://www.sciencemag.org.ezproxy.scu.edu.au/content/341/6142/1225942.full?sid=b4679ca5-0992-4ad3-aa3e-1ac6356f10da›. Feliu, Luis. “Battle for Bentley: 2,000 Protectors on Site.” Echo Netdaily Mar. 2013. 4 Aug. 2014 ‹http://www.echo.net.au/2014/03/battle-bentley-2000-protectors-site/›. Finley, Mary Lou, and Steven Soifer. “Social Movement Theories and Map.” Doing Democracy: The MAP Model for Organizing Social Movements. Eds. Bill Moyer, Johann McAllister, Mary Lou Finley, and Steven Soifer. Gabriola Island, Canada: New Society Publishers, 2001. Grossberg, Lawrence. “Some Preliminary Conjunctural Thoughts on Countercultures”. Journal of Gender and Power 1.1 (2014). Hand, Eric. “Injection Wells Blamed in Oklahoma Earthquakes.” Science 345.6192 (2014): 13–14. Howarth, Terry. “Should Fracking Stop?” Nature 477 (2011): 271–73. Kelly, Russell. “The Mediated Forest: Who Speaks for the Trees?” Belonging in the Rainbow Region: Cultural Perspectives on the NSW North Coast. Ed. Helen Wilson. Lismore: Southern Cross UP, 2003. 101–20. Lock the Gate Alliance. 2014. 15 July 2014 ‹http://www.lockthegate.org.au/history›. Locke, John. “Toleration and Government.” Ideals and Ideologies: A Reader. Eds. Terence Ball & Richard Dagger. New York: Pearson Longman, 2004 (1823). 79–93. Metgasco. Rosella E01 Environment Approval Received 2104. 4 Aug. 2014 ‹http://www.metgasco.com.au/asx-announcements/rosella-e01-environment-approval-received›. Mitka, Mike. “Rigorous Evidence Slim for Determining Health Risks from Natural Gas Fracking.” The Journal of the American Medical Association 307.20 (2012): 2135–36. Moyer, Bill. “The Movement Action Plan.” Doing Democracy: The MAP Model for Organizing Social Movements. Eds. Bill Moyer, Johann McAllister, Mary Lou Finley, and Steven Soifer. Gabriola Island, Canada: New Society Publishers, 2001. NSW Department of Resources & Energy. “Metgasco Drilling Approval Suspended.” Media Release, 15 May 2014. 30 July 2014 ‹http://www.resourcesandenergy.nsw.gov.au/__data/assets/pdf_file/0005/516749/Metgasco-Drilling-Approval-Suspended.pdf›. Reading, Tracey. “Hip versus Square: 1960s Advertising and Clothing Industries and the Counterculture”. Research Papers 2013. 15 July 2014 ‹http://opensuic.lib.siu.edu/gs_rp/396›. Ricketts, Aiden. “The North East Forest Alliance’s Old-Growth Forest Campaign.” Belonging in the Rainbow Region: Cultural Perspectives on the NSW North Coast. Ed. Helen Wilson. Lismore: Southern Cross UP. 2003. 121–148. Sharp, Gene. The Politics of Nonviolent Action: Power and Struggle. Boston, Mass.: Porter Sargent, 1973. Sovacool, Benjamin K. “Cornucopia or Curse? Reviewing the Costs and Benefits of Shale Gas Hydraulic Fracturing (Fracking).” Renewable and Sustainable Energy Reviews (2014): 249–64. Tait, Douglas, Isaac Santos, Damien Maher, Tyler Cyronak, and Rachael Davis. “Enrichment of Radon and Carbon Dioxide in the Open Atmosphere of an Australian Coal Seam Gas Field.” Environmental Science & Technology 47 (2013): 3099–3104. Tarrow, Sidney. Power in Movement: Social Movements and Contentious Politics. 3rd ed. New York: Cambridge UP, 2011. Thompson, Chuck. “The Fracking Feud.” Medicus 53.8 (2013): 56–57. Tilly, Charles. Regimes and Repertoires. Chicago: UCP, 2006. Ward, Susan, and Kitty van Vuuren. “Belonging to the Rainbow Region: Place, Local Media, and the Construction of Civil and Moral Identities Strategic to Climate Change Adaptability.” Environmental Communication 7.1 (2013): 63–79.