Time or money? Why you need both to be healthy

by Bianca Nogrady

Eating well, being active and maintaining relationships: most of us know what we need to do to be healthy - we just don't have the time to do it.

Time poor? Of course you are. Who isn't, these days? We're all desperately trying to cram two-days' worth of activity into one, and it seems like everything has to have happened yesterday.

Deadlines scream at you while yet another crumpled note from your child's school gently nudges you to volunteer your time for something. Your dog gives you THAT look then stands pointedly next to its long-neglected leash. You know you should catch that spin class and cook a healthy meal afterwards, but by the time your workday ends all you can manage is to grab some take-away and slump guiltily in front of Game of Thrones.

Sound familiar? Maybe not the exact details, but there's no doubt that time is one commodity in short supply in the modern world.

Unfortunately, being time poor doesn't just mean we're not getting things done. It's also making us sick, according to Associate Professor Lyndall Strazdins, senior fellow at the National Centre for Epidemiology and Population Health, at the Australian National University.

"Pretty much every single study that has gone out and asked people why don't you eat healthy, why don't you do more exercise – because most people these days do know that they should – [reveals] the most common reason given will be lack of time," Strazdins says.

Health trade-off

Social determinants of health – socioeconomic factors such as income, employment status, access to education, access to healthcare, access to affordable housing, transport, stress, age, and disability – are increasingly being discussed in public health circles.

We know that poverty is linked with poor health, via a range of mechanisms, but Strazdins says we're yet to grasp that time is itself a significant determinant of health, and one that we often trade away for income.

"If you have a high income you are often healthy to start with or you wouldn't be able to do that [job]. But you are probably also not doing the physical activity – if you are working long hours – and the other things that you need to do," Strazdins says.

"We know that chronic disease takes time to build up; it's those little changes in your lifestyle that will have big impacts on your health later."

Those who are worst off are those who aren't earning a high enough income to at least enable them to afford healthy food or get help around the house to get things done. It's these people who are working the long hours needed to support themselves and their families, and who may also be caring for others at the same time.

"They won't have the high incomes but they'll have very high time loads, and there's a lot of research showing they just don't do things like exercise or eat healthy food –not regularly – because they have these time conflicts."

Strazdins and colleagues recently looked at the amount of time spent in care and in work, and measures of time 'intensity', which is judged by asking people how often they feel rushed or pressed for time.

They found that people who spent more than 80 hours a week on care and work felt they had poorer mental health and took part in less physical activity. But they also found the same for people who had higher scores for 'rushing'.

Interestingly, they found 'rushing' was linked to being female, being a single parent, having a disability, a sense of lack of control, and work-family conflicts.

While there isn't strong evidence of a direct link between feeling time-pressured and experiencing heart disease or stroke, some studies suggest that people who feel short on time report sleep problems, headaches and gut issues and poorer health overall.

There's a strong link between feeling time-poor and having mental health problems too. For example, one study found that time pressure predicted depression in both men and women.

The health effects of caring

Another time-poor group are those juggling work with care-giving, whether it be caring for children, elderly parents, or a family member.

"If you're combining work with care – which pretty much will be the new norm as we move into a system where we're trying to make sure as many people work as possible – then those people are particularly time-poor," Strazdins says.

Australian Council of Social Services CEO Cassandra Goldie says Australia has a real challenge in providing job opportunites which are not only adequately paid and secure, but also flexible enough to accommodate other responsibilities such as parenting and caring.

"We know increasing numbers of people are under financial pressure but are also quite understandably prioritising their desire and sense of responsibility to care for a family member who has a disability, for example, or ageing parents," Goldie says.

"It is entirely appropriate and understandable to care for parents at home as long as possible, but all of these impact on the financial circumstances of individuals."

This is why policies such as paid parental leave (PPL) can have such a huge impact, not only on the incomes of families but also on their time, both of which are likely to have a knock-on effect on health.

"Paid parental leave is a policy that gave families time and money," Strazdins says.

PPL (Paid parental leave), time and infant health

The Federal Department of Social Services report on the original federal paid parental leave scheme – which was introduced in 2010 and funded eligible families up to 18 weeks payment at the national minimum wage – showed it resulted in more mothers staying home until 18 weeks after the birth of their child, particularly mothers with lower incomes.

"The PPL evaluation found … an improvement in mothers' and babies' health and wellbeing and work-life balance particularly amongst those for whom PPL made the most difference – mothers least likely to have access to employer funded parental leave, and those with least financial security due to precarious employment," the report's author said.

They also found that the scheme was associated with a reduction in mothers: "feeling rushed and pressed for time, thus enhancing their work-life balance as a result of the additional time and security provided by the PPL".

Goldie says the World Health Organisation recommends a minimum of 26 weeks of paid parental leave, because of the demonstrated health benefits for early childhood development, breastfeeding, and bonding.

"There was overwhelming evidence that in Australia, prior to having any kind of mandated paid parental leave scheme, we had parents going back to work two weeks after their child was born because of their financial situation. They simply had to go back to get that income coming in," Goldie says.

It demonstrates how time and money are two sides of the same coin. We spend one to get the other.

This article is one in a series looking at social determinants of health. Previous stories include Understanding what really makes us sick and The Indigenous gap: social factors hit hard.

Source: ABC Health & Wellbeing


New food pyramid: what to eat 'at a glance'

by Cathy Johnson

If publicity over fad diets and celebrity eating plans has left you utterly confused about what you're really supposed to eat to stay healthy, take heart. We have a new food pyramid which aims to set the record straight.

Avoid all saturated fat. No, saturated fat is fine (in fact, put butter in your coffee). Whole grains are the basis of a healthy diet. No, don't eat any carbs.

Trying to make sense of what we should or shouldn't be eating is difficult and many of us are unsure about how to choose the right foods in the right amounts to have a healthy diet.

But Australia's new Healthy Eating Pyramid aims to make it a whole lot easier to eat better.

The pyramid has been designed as a visual tool to reflect the latest Australian dietary guidelines, which were released in 2013. Unlike celebrity diets, these guidelines are based on a painstaking review of a massive body of research papers (55,000 or so) to give us the most
evidence-based advice. But if you find a picture is worth 1000 words,
this new pyramid may just hit the spot.

Think you've seen something that looks like it before? You're probably  right. There are many triangle-shaped food selection models around, says Nutrition Australia, the non-profit, non-government nutrition education group behind the new model.

All have been built on a 'more to less' concept developed in Sweden in the 1970s. Australia's first pyramid dates back to the 1980s and there have been numerous iterations since. The last update was 15 years ago, with a couple of design refreshes since.

As an 'at a glance' way to grasp our most up-to-date understanding of good nutrition, here are some key points from the latest pyramid to take on board.





© Copyright The Australian Nutrition Foundation Inc, 3rd edition, 2015

Source: ABC Health & Wellbeing

 1. Eat mainly vegetables (and legumes and fruit)

The bottom layer of the pyramid is now filled with 'vegetables and legumes' and 'fruit'. In one of the pyramid's biggest changes, carb-rich foods are no longer included in with vegetables, but moved up a level. This placement of the bottom two layers reflects the view that plant foods (vegetables, fruit and grains) should make up the largest portion of our diet– around 70 per cent of what we eat.

This is because a diet with plenty of unprocessed plant foods has been linked to a reduced incidence of some of our biggest killers, including cancer, heart disease and type 2 diabetes. Plus plant foods are high in fibre, which helps us feel full and manage our weight.

Previously, vegetables were lumped in with breads and cereals (which are more carb-rich), but the latest view is that carbohydrates foods should get slightly less focus.

While vegetables and fruit are both healthy, we should eat more veg than fruit.

2. Eat healthy whole grains

Carbs have copped such bad press in recent years, you'd be forgiven for thinking they are tantamount to poison. In fact, we do need carbs, but the new pyramid reduces the proportion of carbohydrate-rich foods, putting them in a category all of their own (second from the bottom) and renaming them 'grains'.

That's because they are still energy dense so we should not eat as much of them as we do vegetables. And we now know when we're choosing carbs, they're not all equal. We should choose mostly whole grains (such as brown rice, oats and quinoa) and eat less white bread, pasta and processed breakfast cereals. So go for the densest grainiest breads you can, choose wholemeal pasta over regular pasta and select breakfast cereals that are as close to their natural state as possible (eg porridge made from traditional oats rather than corn flakes).

3. Mix up your protein

When it comes to choosing a source of protein (the second top layer), aim to have a variety of meat and non-meat options, in roughly the proportions shown. That's because each type provides a unique mix of nutrients. Don't forget milk, yoghurt, cheese and alternatives for protein that also gives you calcium (needed for healthy bones, muscles and nerves), along with other vitamins and minerals.

4. A little good fat is good

The top layer refers to healthy fats, because not all fat is bad. You do need to include a little fat in your diet (to support heart healthy and brain function). The thing to note here is that the bulk of existing evidence still suggests we should limit the amount of saturated fat. So that means choosing plant oils rich in unsaturated fats like olive oil and canola. Healthy fats are also in foods like avocados, nuts, seeds and fish (which feature in other layers of the pyramid). So you only need a little extra from oils and spreads each day.

5. Limit salt and added sugar

Too much salt and added sugar is linked to increased risk of heart disease, type 2 diabetes and some cancers. Don't add it when you're cooking or eating and avoid processed or packaged foods high in added sugars and salt. Avoiding junk food like biscuits, chips and chocolate bars is a good way to limit salt and sugar (and unhealthy fat).

6. Drink water

It's the best drink to stay hydrated and when you choose it, you're not choosing sugary options like soft drinks, sports drinks and energy drinks.

And a final word. If you're eagle-eyed, you might have noticed legumes (also known as pulses, which includes beans, peas and lentils) are listed twice in the pyramid; they're in with both vegetables and protein.

That's because they can count towards your vegetable intake (being plants high in fibre, carbs, vitamins and minerals like other vegies) or as a protein food (because they also happen to be high in protein), Nutrition Australia says.

High in a variety of important vitamins and nutrients, legumes are also dirt cheap. It's just that their tendency to generate intestinal gas might mean those around you don't feel quite as enthusiastic.

Perhaps legumes just need a celebrity to promote them.