¿Qué pasaría en España si mañana desapareciera la inmigración?

Source: The Conversation – (in Spanish) – By Paula Costa Correa, Investigadora del área de Filosofía del Derecho. Abogada especializada en Migraciones y Derecho Penal, Universidad de Navarra

Unai Huizi Photography/Shutterstock

Mientras algunos medios y discursos políticos describen la migración como una amenaza o una “avalancha”, los datos muestran lo contrario: España no vive una invasión, sino una relación de interdependencia funcional con los países del Sur Global. En otras palabras, lo que se presenta como un problema es, en realidad, una necesidad estructural. El país necesita población migrante para sostener su pirámide demográfica, su economía y su sistema de bienestar.

Esta simbiosis migratoria no es una metáfora. Es una realidad demográfica. Desde 1950, la población mundial se ha triplicado. En regiones como África Subsahariana o Asia Meridional, el crecimiento es constante y sostenido, ejerciendo presión sobre recursos, empleo y sistemas sociales. En cambio, Europa y América del Norte enfrentan el fenómeno contrario: envejecimiento poblacional, bajas tasas de fecundidad y reducción progresiva de la población activa.

En el caso español, el contraste es claro. La tasa de fecundidad se sitúa desde hace años por debajo de 1,3 hijos por mujer, muy lejos del umbral de reemplazo generacional (2,1). Sin flujos migratorios constantes, España perdería millones de habitantes en las próximas décadas, con efectos directos sobre el sistema fiscal, las pensiones y el empleo. Según proyecciones del INE y de Naciones Unidas, de mantenerse la fecundidad actual sin migración, la población podría descender hasta 30 millones en 2100, frente a los 47 millones actuales.

En todos estos escenarios debemos tener en cuenta que los bebés que nacen hoy no empezarían a cotizar hasta 2045. Es decir, apostar por una fecundidad de tres hijos por mujer supondría un esfuerzo económico adicional para el estado de bienestar durante al menos dos décadas, antes de que esas nuevas generaciones pudieran sostener el sistema.

Ni la natalidad basta, ni la migración sobra

Ante este panorama, ¿puede la natalidad compensar por sí sola el déficit demográfico? La respuesta es negativa. Hemos modelado tres escenarios de política natalista, y todos presentan limitaciones estructurales.

En el mejor de los casos –con políticas públicas sostenidas durante 20 años– no habría ningún impacto real antes de 2045. En escenarios más intensivos (como aumentar a tres o cuatro hijos por mujer en una legislatura), los resultados son ineficaces, fiscalmente insostenibles y socialmente inviables. No se puede compensar un problema estructural con medidas de corto plazo ni con presión sobre los cuerpos de las mujeres.

En cambio, la migración sí tiene efectos inmediatos. La llegada de personas jóvenes en edad de trabajar ha contribuido en las últimas décadas a equilibrar la relación entre cotizantes y jubilados. Un estudio estima que sin migración el indicador de sostenibilidad demográfica –que mide cuántas personas en edad de trabajar hay por cada persona mayor de 65 años– habría sido un 30 % inferior, agravando aún más la presión sobre el sistema de pensiones. Esto significa que la presión sobre dicho sistema de pensiones habría sido mucho mayor con menos trabajadores sosteniéndolo.

Lejos de ser una amenaza, la migración ha contribuido a mantener el equilibrio entre cotizantes y jubilados, retrasando un colapso que, de otro modo, ya estaría en marcha.

Pero la función de la migración no es solo económica. La movilidad humana cumple un rol redistributivo a nivel global: traslada población activa desde regiones con exceso de presión demográfica hacia otras con escasez de mano de obra y envejecimiento. Esta relación de interdependencia –aunque desigual– permite mantener en funcionamiento sectores esenciales como los cuidados, la agricultura o la hostelería. Negar esta realidad por motivos ideológicos no cambia los hechos: solo impide gestionarla de forma realista, con planificación y justicia.

Ni milagro ni amenaza

En paralelo, el envejecimiento plantea retos adicionales. Menos trabajadores significa menos cotizaciones, pero también más gasto sanitario, más dependencia y más personas mayores viviendo solas. En España, la esperanza de vida ha aumentado y la feminización de la vejez introduce nuevas desigualdades: muchas mujeres mayores carecen de pensión propia o dependen de redes familiares cada vez más frágiles.

Las proyecciones muestran que sin una política migratoria sostenida, el sistema de bienestar español se enfrentará a una presión insostenible. Los discursos que rechazan la migración apelan al mito de la autosuficiencia nacional, pero ese modelo nunca ha existido. Desde los años 2000, el crecimiento español ha estado directamente vinculado al trabajo y las contribuciones de millones de personas migrantes.

Esto no significa que la migración sea una solución mágica. También necesita planificación, integración y derechos. Pero sí constituye un componente esencial de cualquier estrategia demográfica realista. De hecho, países como Canadá o Alemania ya aplican políticas activas para atraer y retener población extranjera cualificada y no cualificada. España, sin embargo, sigue atrapada en una narrativa de emergencia, inseguridad y control.

Por eso, debemos dejar de ver a España solo como puerta de entrada de migración hacia Europa, y empezar a entender su posición como una oportunidad estratégica: atraer talento, corregir desequilibrios y rejuvenecer el tejido social. Seguir anclados en el miedo y la mentira emotiva no solo perjudica a las personas migrantes, sino que priva al país de una herramienta imprescindible para su sostenibilidad.

La simbiosis migratoria entre Norte y Sur es una realidad del siglo XXI. Negarla no elimina el problema, solo impide encontrar soluciones eficaces.

The Conversation

Paula Costa Correa es presidenta de la Asociación de Migración y Derechos Humanos de Navarra (MIGENE), un observatorio independiente sobre la situación migratoria en España y sus implicaciones sociales y jurídicas.

ref. ¿Qué pasaría en España si mañana desapareciera la inmigración? – https://theconversation.com/que-pasaria-en-espana-si-manana-desapareciera-la-inmigracion-259355

Microplásticos en la sal: el aderezo involuntario en nuestra cocina

Source: The Conversation – (in Spanish) – By María del Mar Cledera-Castro, Profesora Titular, Departamento de Ingeniería Mecánica, Área Medioambiente, Universidad Pontificia Comillas

Just Life/Shutterstock

Los microplásticos son fragmentos o partículas de plástico con un tamaño inferior a los cinco milímetros, por lo que en algunos casos son visibles al ojo humano. Sabemos que están en todas partes, incluso en nuestros alimentos cuando agregamos sal a ellos. Se estima que hay 500 fragmentos de microplásticos por kilogramo de este condimento, según un estudio realizado con 13 marcas europeas.

Teniendo en cuenta que consumimos entre 6 y 18 gramos de sal al día, estamos ingiriendo entre 3 y 9 fragmentos de plástico.

¿Cómo acaban los microplástico en la sal?

La producción de sal es una industria especialmente vulnerable a la contaminación por microplásticos, sobre todo cuando se trata de salinas de evaporación solar en el litoral. Este tipo de salinas obtiene la materia prima –el agua salada– del mar o de una ría, que de por sí puede traer cierta concentración de microplásticos. Si además hay presencia de vertidos de aguas residuales, arrastre de sedimentos o vertidos de residuos sólidos, su concentración será aún mayor.




Leer más:
Océanos de plástico: mucho más allá de lo visible


Además, en un reciente estudio que hemos realizado en las salinas de evaporación solar de la península ibérica hemos comprobado que los microplásticos también contaminan la sal a través del aire. Este hallazgo va contra la corriente actual que establece que las sales obtenidas por métodos tradicionales se contaminan únicamente debido a su presencia en el agua de la que se extrae la sal.

Hemos estimado concentraciones que oscilan entre 256 y 1 500 microplásticos por litro de agua desde la entrada de la salina hasta la entrada a los cristalizadores –la última etapa del proceso–, y entre 79 y 193 por cada kilo para la sal envasada.

Para el estudio obtuvimos muestras de salmuera y sal de cada etapa de producción, desde la entrada de agua de mar/salmuera hasta la etapa final del producto listo para la venta, en seis salinas de España, tres de interior y tres de litoral.

Las salinas de interior se alimentan de agua salada de manantial, que procede de la disolución de las sales que quedaron tras la evaporación de antiguos mares (Thetys, Zechstein…) en épocas geológicas pasadas (por ejemplo, en el Mioceno, hace aproximadamente 5 millones de años, o en el Triásico, hace cerca de 200 millones de años).

Los productos finales de las salinas ubicadas geográficamente en espacios naturales protegidos presentan un número inferior de microplásticos, lo cual permite deducir que el entorno y el ambiente donde se sitúa la salina influye de manera determinante en la exposición a estas micropartículas.

Además, en las salinas de interior, cuando el agua se saca del pozo, no aparecen microplásticos en los análisis, mientras que en etapas posteriores sí hallamos estos contaminantes. Hemos estudiado salinas aisladas y en desuso desde hace muchos años y alejadas de poblaciones, y también hemos detectado la presencia de microplásticos. De ahí que podamos concluir que parte de las partículas presentes en la sal son de procedencia aérea.

Gráfico que muestra el porcentaje de microplásticos en el agua en diferentes etapas de una salina para seis salinas diferentes
Proporción de microplásticos en las diferentes etapas para varias salinas españolas.
Las autoras, CC BY-SA

A pesar de que diversas investigaciones han detectado microplásticos en la sal a nivel mundial durante la última década, la mayoría se han centrado en la sal ya envasada; no existía hasta ahora ningún trabajo que analizara el proceso completo de producción de este condimento. Por esa razón, nuestro estudio es pionero para entender el origen y las causas de la contaminación por microplásticos en las salinas en España y prevenir así la contaminación en la sal alimentaria.

¿Cómo se obtiene sal por evaporación?

Para obtener sal por evaporación solar se expone el agua salada, almacenada en balsas de gran tamaño, al sol y al viento, para que se vaya evaporando el agua y se concentre la sal. En la última serie de balsas, los cristalizadores, la sal alcanza tal concentración en el agua, que esta se satura y la sal precipita al fondo, desde donde se recoge.

El agua de mar suele tener una concentración de 30-40 gramos por litro de cloruro sódico o sal común, mientras que en el cristalizador alcanza los 300 gramos por litro.

Una vez cosechada, la sal se amontona en grandes pilas para que escurra el agua. Dada la altura de estos montones, que puede alcanzar una decena de metros, actúan de barrera para el viento y atrapan los microplásticos que transporta.

Desde ahí, la sal se traslada a un almacén donde se lava, muele y envasa, preparada ya para la venta. En todos estos procesos, la sal tiene contacto con los neumáticos de las cosechadoras, el caucho de las cintas transportadoras y los propios envases, que suelen ser de plástico. Hay, por tanto, numerosas situaciones en las que se puede contaminar la sal, sin contar con los microplásticos que traiga el agua de origen.

Charcas de unas salinas con el agua rosada y montones de sal entre ellas, con el mar al fondo
Salinas de Fuencaliente, en la isla de La Palma.
Christian Kaehler/Shutterstock

Es por tanto esencial conocer bien los procesos de producción de sal, de los que existen infinitas variantes, e identificar los puntos en los que hay mayor riesgo de contaminación por microplásticos, para minimizar su presencia y garantizar así la calidad y seguridad alimentaria de este nutriente esencial.

Los efectos sobre la salud de este contaminante emergente son cada vez más conocidos. Por ejemplo, pueden bloquear membranas celulares e impedir el correcto funcionamiento de ciertos procesos fisiológicos. Además, los plásticos vienen acompañados de sustancias que pueden resultar también perjudiciales para la salud y pueden ser además vectores para microorganismos patógenos y especies potencialmente invasoras.

The Conversation

Las personas firmantes no son asalariadas, ni consultoras, ni poseen acciones, ni reciben financiación de ninguna compañía u organización que pueda obtener beneficio de este artículo, y han declarado carecer de vínculos relevantes más allá del cargo académico citado anteriormente.

ref. Microplásticos en la sal: el aderezo involuntario en nuestra cocina – https://theconversation.com/microplasticos-en-la-sal-el-aderezo-involuntario-en-nuestra-cocina-260320

As Netanyahu meets Trump in Washington, what hope for peace in Gaza? Expert Q&A

Source: The Conversation – UK – By Jonathan Este, Senior International Affairs Editor, Associate Editor

The US government “remains upbeat” about the prospects for at least a ceasefire in Gaza, according to the latest reports from Washington, where the Israeli prime minister, Benjamin Netanyahu, has been meeting the US president, Donald Trump.

Netanyahu handed the US president a letter nominating him for the Nobel peace prize, saying he deserved it for “forging peace, as we speak, in one country in the region after another”. But as yet there are no signs that either Hamas or Israel have moved any closer to accepting each other’s terms.

In fact, reports emerging from the White House meeting are that the two leaders discussed the displacement of much of the Palestinian population. And a plan revealed by the Israeli foreign minister, Israel Katz, proposed the contruction of a “humanitarian city” at Rafah in the north of the Gaza Strip to house more than 600,000 Palestinians.

The Conversation’s senior international affairs editor, Jonathan Este, spoke with Middle East expert, Scott Lucas, of University College Dublin to address this and other questions.

The two leaders’ discussions in Washington seemed to centre around displacement of the Palestinian population in lieu of a two-state solution. What does this tell you about the chance of a ceasefire deal?

I am fascinated – and sometimes disillusioned – by how some media outlets, led by the nose, miss the main story. Last week Donald Trump pronounced on social media that Israel had agreed to a 60-day ceasefire and Hamas “should take this deal”.

But the Netanyahu government has not accepted the framework, circulated by Trump’s envoy Steve Witkoff, let alone consented to a halt of their attacks, which have continued even as the Israeli prime minister travelled to Washington to meet the US president.

As Trump hosted Netanyahu in the White House on Monday, the line was that the US president was “upbeat on Gaza ceasefire talks”. Meanwhile, few of them seemed to notice the important development. Hamas responded to the US framework with proposals for the staged release of 28 of the remaining 50 Israeli hostages over the 60 days while Israeli troops withdrew from positions inside the Strip and humanitarian aid was restored.

But the Israeli government has thus far not given a substantive response. Instead, while pursuing a plan for the long-term military occupation of Gaza, it may also be seeking the displacement of a large portion of the more than 2.2 million population.


Sign up to receive our weekly World Affairs Briefing newsletter from The Conversation UK. Every Thursday we’ll bring you expert analysis of the big stories in international relations.


Hard-right members of Netanyahu’s cabinet, such as finance minister, Bezalel Smotrich, and internal security minister, Itamar Ben-Gvir, have long called for more than a million Gazans to be moved out of the territory. Reports over the weekend confirmed that this is not rhetoric. Israeli businessmen and venture capitalists have reportedly been working on plans for postwar Gaza, to include a “Trump riviera”, mirroring the displacement declaration by the US President, and an “Elon Musk smart manufacturing zone”.

On Tuesday, security cabinet member Ze’ev Elkin, a Netanyahu loyalist, proclaimed “a substantial chance” for a ceasefire. But Qatari negotiators have said there are currently no talks, only discussions with each side about the framework for talks.

Meanwhile, citing the killing of five Israeli soldiers in Gaza on Sunday night by an improvised explosive device, Ben-Gvir said: “We should not negotiate with those who kill our soldiers. They should be crushed to pieces, starved to death, and not resuscitated with humanitarian aid that gives them oxygen.”

He called for “a complete siege, crushing them militarily” and reiterated the plan for “encouraging [Palestinian] immigration and [Jewish] settlement — these are the keys to complete victory”.

Smotrich also called for a ban on any aid to Gaza: “In addition, I demand … that any territory that was conquered and cleansed of terror with the blood of our fighters not be abandoned.”

So I am not optimistic at the moment.

Looking at the region as a whole, two events have ‘reset’ the Middle East: the October 7 Hamas attacks and Israel’s recent 12-day war. Can you tell me more about the kaleidoscope effect these two events had?

In October 2023, there was no open-ended war in Gaza. Benjamin Netanyahu’s focus was on curbing the Palestinian Authority in the West Bank, blocking any possibility of a two-state solution. His tactic was to ease the economic pressure on Gaza and Hamas, maintaining that organisation as a balance against its West Bank rivals.

Hamas ripped up that approach with its mass murder on October 7 – the first of the two kaleidoscope moments which changed the whole picture in a matter of hours. The attack triggered the deadly Israeli response that continues 21 months later. That response did not “destroy” Hamas, as Netanyahu pledged, but it led the Israelis to take on other foes in the region.

Pursuing its “octopus doctrine”, Israel severely damaged one of the tentacles, Hezbollah, when it destroyed much of the Lebanese group’s leadership in the autumn of 2024. It assassinated senior Iranian commanders and officials in Damascus, and received a further boost when Turkish-backed factions toppled the Assad regime in December.

The 12-day war in June aimed to destroy the head of the octopus: Iran. Israel’s strikes and assassinations killed much of the country’s military leadership and many of its top nuclear scientists. The supreme leader, Ali Khamenei, hid in a bunker, only emerging on July 6. But Israel failed to topple his regime, as it had hoped.

The war was another kaleidoscope moment. Israel had its regional victory. But paradoxically, because there has been no resolution in Gaza, this has come at the cost of further international isolation. Gulf States, having moved away from “normalisation” with Israel, put out tougher statements about “genocide” of Gazans and the violation of Iranian sovereignty. Saudi Arabia’s state media highlighted a letter from Iranian foreign minister Abbas Araghchi to Saudi counterpart Faisal bin Farhan for “ways to support and enhance [relations] across all fields”.

This implies that for any normalisation to occur, Israel must end its military operation in Gaza?

That question cuts to the chase. The Gulf states, with the notable exception of Qatar, are no friends of Hamas. They might even have accepted the destruction of the group if Israel had been able to accomplish it quickly.

But there is no way that they can publicly acquiesce in the killing of almost 60,000 Gazans, the large majority of them civilians, and the humanitarian blockade that threatens every single person living in the Gaza Strip. Nor will they want to see Israel export Gazans across the region in an echo of the 1948 “Nakba” whose legacy is the millions of Palestinians living in refugee camps across the Middle East.

Netanyahu can pursue his “absolute destruction” of Hamas by pursuing the destruction and displacement of Gazans. Or he can try to capitalise on his war with Iran through links with Arab countries. He cannot do both.

Will Donald Trump get his Nobel peace prize?

I don’t know, for that is a question which does not have a logical answer.

Herny Kissinger was the US secretary of state who oversaw an escalation of the Vietnam war in which up to 3 million Vietnamese, 310,000 Cambodians, 62,000 Laotians and 58,220 US service members died. The singer-songwriter Tom Lehrer aptly noted: “Political satire became obsolete when Henry Kissinger was awarded the Nobel Peace Prize.”

We are in a world where having caused so much disorder and chaos, having enabled violence, including Israel’s open-ended war, Donald Trump may succeed in a pose as “peacemaker”.

Some may see the least worst option as flattery, which seems to work as a strategy for dealing with the US president. They may accept the White House theatre in which Netanyahu, wanted by the International Criminal Court for war crimes, personally hands Trump a peace prize nomination.

Meanwhile, in the past 24 hours, according to the Hamas-run Gaza health ministry, the number of casualties in Gaza rose to 57,575 people killed and 136,879 wounded. Twenty hostages spent another day in limbo. That’s what matters here.

The Conversation

ref. As Netanyahu meets Trump in Washington, what hope for peace in Gaza? Expert Q&A – https://theconversation.com/as-netanyahu-meets-trump-in-washington-what-hope-for-peace-in-gaza-expert-qanda-260722

Brics is sliding towards irrelevance – the Rio summit made that clear

Source: The Conversation – UK – By Amalendu Misra, Professor of International Politics, Lancaster University

The Brics group of nations has just concluded its 17th annual summit in the Brazilian city of Rio de Janeiro. But, despite member states adopting a long list of commitments covering global governance, finance, health, AI and climate change, the summit was a lacklustre affair.

The two most prominent leaders from the group’s founding members – Brazil, Russia, India, China and South Africa – were conspicuously absent. Russia’s president, Vladimir Putin, only attended virtually due to an outstanding arrest warrant issued by the International Criminal Court over his role in the war in Ukraine.

China’s Xi Jinping avoided the summit altogether for unknown reasons, sending his prime minister, Li Qiang, instead. This was Xi’s first no-show at a Brics summit, with the snub prompting suggestions that Beijing’s enthusiasm for the group as part of an emerging new world order is in decline.

Perhaps the most notable takeaway from the summit was a statement that came not from the Brics nations but the US. As Brics leaders gathered in Rio, the US president, Donald Trump, warned on social media: “Any Country aligning themselves with the Anti-American policies of BRICS, will be charged an ADDITIONAL 10% Tariff. There will be no exceptions to this policy.”


Get your news from actual experts, straight to your inbox. Sign up to our daily newsletter to receive all The Conversation UK’s latest coverage of news and research, from politics and business to the arts and sciences.


Trump has long been critical of Brics. This is largely because the group has consistently floated the idea of adopting a common currency to challenge the dominance of the US dollar in international trade.

Such a move makes sense if we focus on trade figures. In 2024, the value of trade among the Brics nations was around US$5 trillion, accounting for approximately 22% of global exports. Member nations have always felt their economic potential could be fully realised if they were not reliant upon the US dollar as their common currency of trade.

During their 2024 summit, which was held in the Russian city of Kazan, the Brics nations entered into serious discussions around creating a gold-backed currency. At a time when the Trump administration is waging a global trade war, the emergence of an alternative to the US dollar would be a very serious pushback against US economic hegemony.




Read more:
Why Donald Trump’s election could hasten the end of US dollar dominance


But the freshly concluded Brics summit did not present any concrete move towards achieving that objective. In fact, the 31-page Rio de Janeiro joint declaration even contained some reassurances about the global importance of the US dollar.

There are two key obstacles hindering Brics from translating its vision of a common currency into reality. First is that some founding member nations are uncomfortable with adopting such an economic model, in large part due to internal rivalries within Brics itself.

India, currently the fourth-largest economy in the world, has a history of periodic confrontation and strategic competition with China. It is reticent about adopting an alternative to the US dollar, concerned that this could make China more powerful and undercut India’s long-term interests.

Second is that the Brics member nations are dependent on their bilateral trade with the US. Simply put, embracing an alternative currency is counterproductive when it comes to the current economic interests of individual countries. Brazil, China and India, for example, all export more to the US than they import from it.

In December 2024, following his election as US president, Trump said: “We require a commitment from these countries that they will neither create a new Brics currency nor back any other currency to replace the mighty US dollar or they will face 100% tariffs and should expect to say goodbye to selling into the wonderful US economy”. This blunt message all but killed any enthusiasm that was there for this grand economic model.

Caught in contradiction

The Brics group is a behemoth. Its full 11 members account for 40% of the world’s population and economy. But the bloc is desperately short of providing any cohesive alternative global leadership.

While Brazil used its position as host to highlight Brics as a truly multilateral forum capable of providing leadership in a new world order, such ambitions are thwarted by the many contradictions plaguing this bloc.

Among these are tensions between founding members China and India, which have been running high for decades.

There are other contradictions, too. In their joint Rio declaration, the group’s members decried the recent Israeli and US attacks on Iran. Brazil’s president, Luiz Inácio “Lula” da Silva, also used his position as summit host to criticise the Israeli offensive in Gaza.

But this moral high ground appears hollow when you consider that the Russian Federation, a key member of Brics, is on a mission to destroy Ukraine. And rather than condemning Russia, Brics leaders used the Rio summit to criticise recent Ukrainian attacks on Russia’s railway infrastructure.

Brics declared intention to address the issue of climate change is also problematic. The Rio declaration conveyed the group’s support for multilateralism and unity to achieve the goals of the Paris agreement. But, despite China making significant advances in its green energy sector, Brics contains some of the world’s biggest emitters of greenhouse gases as well as several of the largest oil and gas producers.

Brics can only stay relevant and provide credible leadership in a fast-changing international order when it addresses its many inner contradictions.

The Conversation

Amalendu Misra is a recipient of British Academy and Nuffield Foundation Fellowships.

ref. Brics is sliding towards irrelevance – the Rio summit made that clear – https://theconversation.com/brics-is-sliding-towards-irrelevance-the-rio-summit-made-that-clear-260653

How to support someone who is grieving: five research-backed strategies

Source: The Conversation – UK – By Lucy Poxon, Senior Lecturer in Counselling Psychology, Department of Social Work Counselling & Social Care , School of Childhood and Social Care, University of East London

PeopleImages.com – Yuri A/Shutterstock

When someone we care about is grieving the loss of a loved one, our natural instinct is to ease their pain. But when words feel clumsy and gestures fall short, it can be hard to know how to help.

Drawing on both my research as a counselling psychologist and 18 years of supporting bereaved clients in therapy, I’ve identified five compassionate, research-backed ways to walk alongside someone who is mourning.

Whether you’re a close friend, family member, or caring colleague, these approaches will help you offer support in meaningful and authentic ways.

1. Grief wears many disguises

Our expectations of how grief should look are often shaped by culture, the media or personal experience, and they may bear little resemblance to how grief is actually lived.

Grief can appear as physical symptoms like exhaustion, loss of appetite, or insomnia; as behaviour like withdrawing from others or drinking more; and as thoughts or emotions ranging from apathy and numbness to anger or intense sadness.

It can be loud and overwhelming or quiet and barely perceptible. Some people feel deep sorrow immediately; others feel nothing for weeks or even months. A lack of overt sadness isn’t necessarily cause for concern; it may reflect relief that a loved one is no longer suffering, or be a sign of early adjustment.




Read more:
Not all mourning happens after bereavement – for some, grief can start years before the death of a loved one


One of the most compassionate things you can do is validate whatever shape grief takes. Reassure the person that there’s no “right” way to grieve and support them in tuning into what their body and emotions need.

2. Acknowledge the death and don’t rush the tears

Nearly every grieving client I’ve worked with has described someone, often a friend, colleague, or even family member, who avoided or ignored them after the loss. It’s one of the most painful experiences for someone already feeling vulnerable.

Often, the avoidance isn’t malicious. It’s driven by fear of saying the wrong thing or not knowing how to help. But by avoiding the subject, we send an unintended message: your grief is too much.

Acknowledging the death, even simply by saying “I’m so sorry to hear about your loss”, is not a reminder of their pain, it’s a sign that you see it and honour it. Inviting someone out, even if they decline, communicates that they still belong and are welcome.

If someone begins to cry, it’s natural to want to fix things, to offer comfort, or even to pass a tissue. But giving a tissue too soon can inadvertently signal that they should stop crying. Sometimes the most supportive thing you can do is to sit with your own discomfort, and simply be present. That silent witness can help a grieving person feel less alone.

3. Let go of the “stages of grief” myth

Many people are still taught to expect a tidy progression of grief: denial, anger, bargaining, depression and acceptance, popularised by Swiss-American psychiatrist Elisabeth Kübler-Ross in the 1960s. While these emotions are real and common, research shows that most people don’t experience them in a neat order, or even experience all five at all.

Despite being widely critiqued, stage-based models are still found in healthcare training manuals and TV scripts, and they can leave people feeling like they’re grieving “wrong”.

If your loved one is worried they should feel more sadness, or wonders why they haven’t yet felt angry, remind them: grief is personal and unpredictable. There’s no timeline, no script and no shame in not following one.

Helping someone let go of these expectations may ease guilt, reduce internal pressure and encourage gentler self-care.

4. Encourage communication – with the living and the lost

Grief often comes with emotional loneliness, a deep sense of aloneness that persists even in the presence of others. It’s different from social isolation; it’s the ache of missing someone irreplaceable.




Read more:
What we can learn from death rites of the past will help us treat the dead and grieving better today


While you can’t fix that loneliness, you can help the bereaved maintain a continuing bond with their loved one. This might include writing letters to the person who has died, speaking to them at a graveside or special place, saying prayers or engaging in meditation or creating memory boxes or rituals.

These forms of connection can help integrate the loss into a new reality. You might offer to visit a meaningful place together, or support them in planning a small memorial gesture.

5. Make specific, practical offers

It’s common to say “Let me know if you need anything”, but for someone in deep grief, reaching out can feel impossible. Emotional overwhelm, fatigue and even shame can prevent them from asking for help, even when they desperately need it.

Instead, make intentional, concrete offers that remove decision-making and emotional labour. These might include:

  • delivering a home-cooked meal once a week

  • taking care of pets or houseplants

  • helping with funeral admin or paperwork

  • offering regular lifts to appointments

  • updating others on their behalf

  • messaging with a clear “no need to reply” reassurance

If you live far away, sending a card, text, or voice note can still be powerful; just be mindful that they may receive many, and feel pressure to respond. A line like, “No need to write back, just wanted you to know I’m thinking of you” can go a long way.

Grief is not a puzzle to solve or a wound to fix. It’s a human response to love and loss – and it’s different for everyone.

The most powerful thing you can do? Be there. Stay present. Listen without judgement. And remember that it’s okay not to have the perfect words. Showing up with authenticity, patience and compassion is what matters most.

The Conversation

Lucy Poxon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

ref. How to support someone who is grieving: five research-backed strategies – https://theconversation.com/how-to-support-someone-who-is-grieving-five-research-backed-strategies-260265

The Shrouds: new Cronenberg film is an elusive meditation on death, grief and environmental ethics

Source: The Conversation – UK – By Laura O’Flanagan, PhD Candidate, School of English, Dublin City University

American filmmaker David Cronenberg is a leading figure in body horror, a film genre that explores disturbing and often grotesque aspects of the human body. Films such as The Fly (1986), eXistenZ (1999) and Crimes of the Future (2022) depict scenes of physical mutilation, illness and technological invasion to represent deeper fears about identity, society and the human condition.

Through intense bodily imagery, Cronenberg’s films raise powerful questions about human relationships with technology and nature. As our relationship with technology rapidly evolves alongside escalating environmental catastrophe, there is a timely significance in these ideas.

His latest film, The Shrouds, evokes the writing of Stacy Alaimo, a scholar known for her work exploring the connections between the human body, the environment, and the social forces that shape both. Alaimo’s work combines feminist and materialist ideas and examines how our bodies are physically connected to the world around us – not separate from nature or society, but shaped by both ecological systems and social structures.

Looking for something good? Cut through the noise with a carefully curated selection of the latest releases, live events and exhibitions, straight to your inbox every fortnight, on Fridays. Sign up here.


Like Cronenberg, Alaimo is interested in the entanglement of human flesh with more-than-human worlds, alongside the interplay between bodies and objects.

In The Shrouds, the body, specifically that of Becca (Diane Kruger) is placed firmly at the centre of the story. Appearing both as a decaying corpse and naked in dream sequences, her body bears fresh surgical scars which are unbandaged and exposed.

Becca’s body is shown as intensely vulnerable, a gendered depiction of femaleness which is controlled literally by the male gaze through the “shroud”, a piece of sci-fi wearable tech. It comprises a suit of MRI and X-ray cameras which encases a corpse, allowing decomposition to be monitored through a live video link with an app.

This conceit embeds Becca both in the Earth and in technology, creating deeply memorable imagery which challenges viewers to think about death, grief and the environmental ethics surrounding human burial.

The presentation of Becca’s body evokes Alaimo’s concept of transcorporeality. In her 2010 book Bodily Natures, Alaimo describes transcorporeality as the idea that “the human is ultimately inseparable from ‘the environment’” – continually transformed through interactions with the landscape, chemicals, technology and non-human forces. Becca’s corpse, decaying in real-time on a live link, highlights this connection.

Grief: the fictional and the personal

The film opens with Karsh (Vincent Kassel), Becca’s bereaved husband, in a dentist’s chair being told, “Grief is rotting your teeth”. The film as a whole can be read as a meditation on how grief seeps into and changes the body.

Written following the death of David Cronenberg’s wife (and initially conceived of as a Netflix series), Cronenberg has rejected the idea that it is fully autobiographical. It is, however, difficult to fully separate the director from the story.

Cassel as Karsh physically resembles Cronenberg in the film, blurring the boundary between fiction and the personal. Physical duplication is a disorienting motif of the film. Kruger reappears as Becca’s sister Terri and as an animated AI assistant named Honey.

Alongside the grotesque images of her decaying body, these versions of Kruger are especially striking. Cassel’s performance as the controlling and obsessive Karsh is nuanced and understated. His desire to monitor Becca’s decomposition is presented as a logical step to regain possession of her from her illness, and is deeply disturbing.

It also has ominous and timely resonance in our modern world, where controversial technology exists that permits artificial intelligence to create avatars of the dead to comfort the bereaved.

The film becomes a mimetic piece on grief, where boundaries between imagination and reality dissolve. Cronenberg’s frequent collaborator Howard Shore provides an ambient score that reinforces this dissolution. Ethereal and bass-rich, it features spacious, slowly evolving melodies wrapped in velvety synth textures which evoke a dream-like soundscape.

As the plot progresses into a tangle of conspiracy theories, lines blur between Karsh’s dreams and reality. Background plots drift unresolved, characters are vaguely sketched. Themes of environmental activism versus capitalist enterprise, the exploitation of technology, illegal surveillance and government corruption are all threaded through the story, but none are fully realised. This is not a film which offers a straightforward narrative or closure. Like grief, it remains raw, fluid and difficult to contain.

Throughout, the film returns to Becca’s decaying body, encased in a shroud that is described as both toxic and radioactive, an object of controversy for eco-activists. “She’s dead, remember, she can’t do anything,” Karsh’s companion reminds him.

But this is not true for Becca. In death, her body is watched and consumed by systems of surveillance and ecological anxiety. Symbolising Alaimo’s concept of transcorporeality, Becca’s decaying corpse, wrapped in technology, but buried in the Earth, is deeply connected to the environment and cannot be separated from it. Her body is influenced by both its natural surroundings and social factors such as the shroud’s technology, outside interference and Karsh’s control.

Karsh asserts that burial is a complex matter, converging politics, religion and economics. The Shrouds raises questions that touch on all of these, but provides no tangible answers. Some viewers will be frustrated by the film’s lack of logical structure and resolution. But it is also fair to say that this is how it mirrors the pathways of grief itself: unwieldy, unpredictable and consuming.

The Conversation

Laura O’Flanagan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

ref. The Shrouds: new Cronenberg film is an elusive meditation on death, grief and environmental ethics – https://theconversation.com/the-shrouds-new-cronenberg-film-is-an-elusive-meditation-on-death-grief-and-environmental-ethics-260009

Golden eagles were reintroduced to Ireland, but without prey they’re now struggling to thrive

Source: The Conversation – UK – By Fiona McAuliffe, Lecturer of Ecology, Scotland’s Rural College

Dennis Jacobsen/Shutterstock

In the early 2000s, golden eagles soared once again over the hills of Donegal in northwest Ireland, for the first time in nearly a century. Their return was celebrated as a landmark in Irish conservation, a hopeful sign that one of the island’s most iconic predators was back.

But two decades on, the reality is sobering. The population remains small with just five territorial pairs and an estimated total population of just 20-25 birds. Breeding success is poor, and the golden eagle’s future in Ireland is uncertain. So what went wrong?

Our research published in the Irish Naturalists’ Journal suggests the problem isn’t with the eagles themselves – it’s with the landscape they were released into. On paper, Donegal’s uplands looked ideal: open terrain, low human disturbance and ample wild prey. But over time, key parts of that ecosystem have quietly unravelled.

Golden eagles rely on a steady supply of prey to thrive and raise chicks – notably red grouse and Irish hares. Yet, during our recent surveys along transects (predetermined lines through an area) and footage from camera traps in and around Glenveagh national park, the uplands seemed eerily quiet. Not just quiet of eagles, but of the smaller animals they prey on for food. The landscape looked wild, but had lost some of its vital living components.

When comparing the available prey biomass, that’s the combined weight of grouse and hares per unit area, Donegal had 74-83% less prey than equivalent areas in the Scottish Highlands where golden eagles are thriving. That’s an enormous shortfall. Without enough food, adult eagles must travel further to hunt and spend more energy – and so are less likely to raise chicks successfully. A few lean years can tip a small population like this into crisis.

Why is prey so scarce? One of the main culprits is overgrazing. Red deer numbers have exploded across Ireland in recent decades. In places such as Donegal, their constant browsing and grazing has severely degraded upland habitats. This damages the heather moorlands that grouse and hares depend on, leaving them with less cover and fewer food sources.

A red deer looks at a camera trap in an upland environment.
Red deer were the most common species recorded during camera trap surveys.
Queen’s University Belfast

Add to this the growing pressure from medium-sized predators, including foxes and badgers. Without apex predators such as wolves or lynx to keep them in check, these “mesopredators” flourish. This well-documented phenomenon is known as mesopredator release where populations of mid-sized predators increase after the loss of top predators, often leading to greater pressure on prey species, such as ground-nesting birds and young hares, compounding the challenges for these struggling prey species.

And while Ireland’s conservation laws look strong on paper, implementation often lags behind. Some protected areas remain heavily grazed, burned or unmanaged. Management plans are either missing, unenforced or outdated. This weakens the very protections meant to sustain wildlife.

A lesson for rewilding

The reintroduction of golden eagles was based on the best available knowledge at the time. But ecosystems aren’t static. What may have been viable habitat in the 1990s no longer meets the needs of a breeding eagle population today.

Reintroducing a species isn’t enough. The systems that sustain it also need to be restored. The clichéd paradigm that nature-is-good and humans-are-bad isn’t helpful. Instead modern landscapes are often so degraded that they can’t recover if left alone.

Upland habitat with exposed peat and areas of rock.
Upland areas within Glenveagh national park are overgrazed, leading to exposed peat and erosion.
Fiona McAuliffe

Conservation can facilitate active recovery. Real rewilding is about more than simply “putting animals back” and “letting nature take its course”. It is about putting systems back: predators, prey, plants and the processes that connect them.

Despite the challenges, the golden eagle population has not failed in Ireland – not yet at least. To turn the tide, conservation efforts must go beyond charismatic species and focus on landscape restoration. That means reducing overgrazing, supporting prey recovery, rebalancing predator dynamics and making sure protected areas are actually protected.

Encouragingly, Glenveagh national park has begun some of this work, by reducing deer overgrazing and regenerating native woodlands. If this landscape restoration is sustained and expanded, golden eagles could still thrive in a more balanced, functioning upland ecosystem.

These birds are more than just a symbol of wildness. They are a litmus test of ecosystem health. Right now, they’re telling us something important. Something those calling for the reintroduction of other top predators, including wolves, would do well to consider.


Don’t have time to read about climate change as much as you’d like?

Get a weekly roundup in your inbox instead. Every Wednesday, The Conversation’s environment editor writes Imagine, a short email that goes a little deeper into just one climate issue. Join the 45,000+ readers who’ve subscribed so far.


The Conversation

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

ref. Golden eagles were reintroduced to Ireland, but without prey they’re now struggling to thrive – https://theconversation.com/golden-eagles-were-reintroduced-to-ireland-but-without-prey-theyre-now-struggling-to-thrive-258832

Four reasons why many of us feel the global economy is not on our side

Source: The Conversation – UK – By Cahal Moran, Visiting Fellow in the Department of Psychological and Behavioural Science, London School of Economics and Political Science

During my adult life, I have never experienced what it’s like to live in a “good” economy. Starting with the global financial crash in 2008, which hit just as I began studying economics, the world seems to have lurched from crisis to crisis and the UK economy even more so.

Some of those crises, like the crash and COVID, are sudden shocks. Others have been more gradual, such as increasingly unaffordable housing or the rising dominance of the world’s ultra rich.

As I explore in my new book, Why We’re Getting Poorer, the result of these crises is an economic system which works for some much more than it does for others. Here are four reasons why you may be feeling let down.

1. Grasping for growth

Like many of his fellow leaders across the world, the British prime minister, Keir Starmer, is aiming to make economic growth the primary mission of his government. And understandably so.

A growing economy puts more money in people’s pockets and brings other benefits such as low unemployment. But economic growth is not easy (in the UK it has been poor for a long time).

That’s because there’s no GDP dial that a prime minister or president can simply turn up. Research shows that economic growth is an amorphous and difficult goal which depends on many factors – geopolitical, demographic, technological – outside any single country’s control.

One option is to focus on achievable goals around investment, like the public investments of £113 billion on homes, transport and energy planned in the UK. But big projects can take a long time to build and develop, so even if they do boost growth, it can take a while for households to feel the benefits.

2. Inherent inequality

Against the backdrop of low growth in the UK has been high inequality, under Conservative and Labour governments. And again, inequality is an international issue.

The wealth of the richest people in the world skyrocketed over COVID, buoyed in many cases by the increased importance of the tech sector during lockdowns. Even before the pandemic, wealth inequality was a problem across the globe.

This imbalance has given the very richest opportunities to buy up commercial competitors, indulge in space travel and control large parts of the media, exerting extreme economic, social and political power. Needless to say, their economic priorities are not the same as everyone else’s.

Meanwhile, communities and regions may be left behind, with declining physical and social infrastructure. People living in hollowed out areas where incomes and opportunities are limited are unlikely to feel that the economic system is working for them.

3. Globalisation

Globalisation has made a lot of people – in places like China, India and Brazil – better off. But it is not a system which ensures economic benefits for everyone.

With global competition, big businesses are often under pressure to reduce costs. Free trade deals have often failed to enforce labour standards or redistribute gains to poorly paid workers, and in many cases simply made the rich richer.

Such a distorted form of economic governance, where large sections of society end up feeling left behind was bound to provoke a response. Some would link it to recent political events like Brexit and the presidencies of Donald Trump, whose international tariffs are a clear attempt to reverse the rise of globalisation.

Row of parked up colourful lorries.
Sporadic supply chains.
Corona Borealis Studio/Shutterstock

Since the pandemic, more fault-lines have been exposed. The global economy has become too dependent on certain regions, epitomised by Taiwanese dominance in the manufacturing of semiconductors, or European reliance on Russia for gas and oil.

Recent years have also seen supply chain bottlenecks, leading to shortages of goods including cars, phones and even salad ingredients. Inflexible global systems have been ineffective, and internationally agreed fixes are hard to achieve.

4. Climate change

World news at the start of 2020 was dominated by the massive wildfires raging across Australia. At the start of 2025, Los Angeles burned.

As the global climate shifts and lurches, extreme weather events are becoming more common. Floods, hurricanes and extreme temperatures look to be the likely outcome.

When sea levels rise, countless coastal cities will experience flooding, and many Pacific islands may disappear altogether. The UN’s climate science advisory group, the Intergovernmental Panel on Climate Change (IPCC) suggests that humanity will struggle with food production, disease and massive migration.

This will all result in huge economic costs, impeding growth and disrupting livelihoods across the world. According to the IPCC, the impacts could range from extreme weather events disrupting infrastructure to changing weather reducing yields in agriculture, forestry and fishing.

Yet many countries appear to be backtracking on their commitment to reducing emissions. It seems they would prefer to deal with the fallout of climate change rather than invest in potential solutions like carbon taxes, walkable cities or alternative fuels. But such acts of self-harm are not a sound basis for a prosperous economy, society or planet.

The Conversation

Cahal Moran does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

ref. Four reasons why many of us feel the global economy is not on our side – https://theconversation.com/four-reasons-why-many-of-us-feel-the-global-economy-is-not-on-our-side-252220

I rode the Tour de France to study its impact on the human body – here’s what I learned

Source: The Conversation – UK – By Steve Faulkner, Senior Lecturer in Exercise Physiology, Nottingham Trent University

The Tour de France is often called the world’s biggest annual sporting event. Each July up to 12 million people line the roadside, while the cumulative TV audience tops 3 billion viewers across 190 countries.

In 2025, 184 riders will compete in teams of eight, racing a punishing 3,500 km route with nearly 50,000 metres of climbing – roughly the height of Mount Everest six times over. Across 21 stages riders tackle time trials, flat sprints and brutal mountain passes through the Alps, Pyrenees and Massif Central.

Professional cyclists possess extraordinary endurance and are capable of generating high power outputs day after day. Yet, despite having far less training and support, in recent years a number of amateur cyclists have begun riding the Tour route just days before the pros. The Tour 21 is one such effort and offers cyclists a chance to follow in the tyre tracks of the elite while raising money for a good cause.

In 2021 I joined 19 others to ride the full route in support of Cure Leukaemia, with a shared goal of raising £1 million for blood cancer research. As a blood cancer survivor diagnosed at 16, this challenge combined my love of cycling, my background in science and my deep desire to give back to the community that helped save my life. It was also a unique opportunity to study how amateur cyclists cope with one of the most demanding endurance events in the world.

The research findings were published in the Journal of Science and Cycling, to coincide with 2025’s Grand Départ (the official start of the race) in Lille.

Training for the impossible

Originally, the study planned to include lab-based physiological assessments of the amateur cyclists undertaking the Tour de France route, but the COVID-19 pandemic forced us to adapt and rely instead on data from training diaries. These gave us insight into how much (or little) training had been done leading up to the ride, and how riders managed the physical and mental strain during the event itself.

While professional cyclists typically train 20–25 hours a week – often at altitude, with tailored coaching and racing schedules – our group of amateurs had full-time jobs, were typically 15–20 years older than the pros and trained around seven to ten hours a week.

Our preparation was far from ideal, averaging just 47km per ride and 350 metres of climbing; a fraction of what the Tour demands. In fact, this amounted to less than 10% of the required climbing during the mountain stages.

Once the ride began, the contrast between training and reality was stark. The group averaged nearly seven hours of riding a day, a 300% increase from their usual routine. Within four days signs of overtraining began to emerge: riders were no longer able to elevate their heart rates, a classic marker of central nervous system fatigue and excessive physical stress.

As the days progressed, performance metrics continued to decline: heart rates dropped, power outputs fell and mood scores deteriorated. The cumulative fatigue was undeniable.

Surprisingly, when we compared our amateur data to metrics from professional riders, we found that although pros ride at much higher power outputs, amateurs were subject to greater relative stress. On some days they spent almost double the time in the saddle, which meant they operated closer to their physical limits, with far less time for recovery – and often suboptimal sleep and nutrition.

By the final week many of the riders could no longer produce the same power they had in the first few days. In some cases, heart rates wouldn’t rise above 100 beats per minute – a clear sign of accumulated fatigue and physiological overload.

How to prepare for an ultra-endurance challenge

If you’re planning to take on a major endurance event – whether it’s cycling, running, or hiking – here are some lessons from the road:

1. Train specifically for the event

Your training should mirror the challenge ahead. For the Tour, this meant preparing for long, back-to-back days with significant climbing. Mimic the intensity, volume and terrain as closely as possible.

2. Understand how quickly fatigue builds

Over multiple days, fatigue doesn’t just accumulate – it compounds. Listen to your body, adapt your plan and include plenty of recovery time.

3. Prioritise nutrition and recovery

These two factors can make or break your performance. You’ll need to consume enough energy to fuel the effort, but avoid excessive intake that leads to unnecessary weight gain. Recovery – through sleep, rest and refuelling – is equally vital.

4. Work with an experienced coach

More than fancy bikes or high-tech gear, a good coach is your best investment. They can help tailor your training plan, track your progress and adapt strategies as needed. Don’t underestimate this support.

A ride to remember

Completing the Tour de France route is a monumental achievement for any cyclist — amateur or pro. In 2021, our team not only rode the full route, but also raised over £1 million for Cure Leukaemia. For me, it marked a deeply personal milestone in my cancer journey.

Throughout those 21 days, I thought often of the physical and emotional battles I faced during treatment; moments when I didn’t know if I’d survive, let alone ride across France. That experience gave me the resilience to keep going, even when my body was screaming to stop.

Riding the Tour taught me that we’re capable of far more than we realise, especially when we ride with purpose.

The Conversation

Steve Faulkner does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

ref. I rode the Tour de France to study its impact on the human body – here’s what I learned – https://theconversation.com/i-rode-the-tour-de-france-to-study-its-impact-on-the-human-body-heres-what-i-learned-260524

Why many kidney patients are still choosing hospital dialysis – and how the NHS can help more people access care at home

Source: The Conversation – UK – By Leah McLaughlin, Research Fellow in Health Services, Bangor University

PeopleImages.com – Yuri A/Shutterstock

Every week, thousands of people with kidney disease in the UK spend long hours in hospital receiving life-saving dialysis. For many, this means travelling to a kidney unit three times a week and sitting through sessions that last four hours or more. It’s a huge commitment that affects people’s ability to work, travel and maintain a normal social life.

But for many with kidney failure, there’s another option: dialysis at home. It’s more flexible, often less disruptive and, in the long run, more cost-effective for the NHS. So why do most people still choose hospital dialysis?

A parliamentary summit in May reflected on how to make dialysis more accessible to patients at home. My colleagues and I published research on this topic in 2019. Working in partnership with people who have kidney disease, their families, NHS staff, dialysis providers and kidney charities, we explored the barriers to home dialysis, and how to overcome them.

People with kidney failure need either a transplant or regular dialysis to filter waste from their blood. Despite NHS guidance that at least 20% of people on dialysis should be supported to have this treatment at home, this target isn’t being met in many parts of the UK.

A close up of a kidney dialysis machine.
A kidney dialysis machine.
ali.can0707/Shutterstock

Our research team, which included people who had experienced dialysis, held discussions with 50 people from across Wales. Many told us that hospital dialysis was presented by healthcare staff as the default option. For those who had not yet come to terms with needing dialysis, or who had delayed planning due to the unpredictable nature of kidney disease, hospital treatment felt like the path of least resistance.

Some were concerned about the disruption home dialysis might bring. This included changes to their living space or worries that partners or family members might become their carers. Others valued the routine and regular social contact of hospital dialysis.

Healthcare professionals may unintentionally reinforce this choice. Some feel more comfortable monitoring patients in clinical settings or are unsure about how to support home dialysis effectively. In some cases, home dialysis isn’t an option because local services don’t have the infrastructure to support it.

Rather than simply identifying problems, we worked together to develop practical solutions. In 2021, working with patients, healthcare professionals, charities, commissioners and industry, we devised a new service plan that outlines how kidney services could be redesigned to support more people to choose home dialysis.

One important finding was the power of talking to others already doing it. It’s not just about practical advice, but reassurance that it can work.

We also identified the need for better training for both professionals and patients. People told us they wanted to understand their options earlier, ideally a year before dialysis starts. That means tackling difficult topics, such as advance care planning, sooner and with the right support.

Social care also has an important role to play. People with complex needs – like living alone, having mobility challenges, or experiencing financial hardship – may need home support, welfare advice or help navigating the system.

The cost of choice

In a linked study, published in 2022, we analysed the costs of different dialysis options. Home dialysis was found to cost between £16,000 and £23,000 per person per year.

Hospital dialysis costs more, between £20,000 and £24,000, rising to over £30,000 when ambulance transport is needed. This suggests that encouraging more people to have dialysis at home could deliver savings for the NHS.

In Wales, where all kidney services are coordinated through a single clinical network, home dialysis is more widely available. But in England, services are more fragmented, so access can depend on where you live.

Even if these changes were implemented, fundamental issues may still prevent progress. Beneath the surface of patient satisfaction lies a deeper problem – the NHS dialysis service is no longer working as intended.

Transport is one of the most frequently cited concerns among people receiving hospital dialysis, and no one seems satisfied with current arrangements. But satisfaction surveys fail to capture the complexity of the situation.

People often begin dialysis in a unit that isn’t closest to home due to availability. Later, when given the option to move closer or switch to home dialysis, they may decline. These dialysis units begin to function as surrogate families, offering comfort, routine and social interaction, especially for people who live alone or are isolated.

This emotional connection can obscure the bigger picture. Patients may focus on transport as the issue, rather than recognising that their own decisions – shaped by understandable human needs and system design – are part of the wider challenge.

A close up of an arm receiving kidney dialysis.
shutterstock.
ali.can0707/Shutterstock

Staff are caught in the same dynamic. They worry about losing patients they’ve built relationships with or fear someone may not cope alone. But as a result, the service ends up operating not to help people live well for longer but to preserve a sense of satisfaction with a suboptimal status quo.

By focusing too heavily on keeping people content with the status quo, we risk obscuring what’s truly working, or not. Worse, we may end up wasting already limited resources trying to fix problems that are byproducts of a system shaped more by sentiment than strategy.

Meanwhile, staff are caught in the middle, trying to deliver care under mounting pressure, with increasingly blurred expectations.

What needs to change

To break out of this cycle, different questions should be asked, and not just whether people are satisfied, but whether they are living well, maintaining independence and receiving care that truly reflects their needs and values.

Our research shows that people already on home dialysis are a valuable and underused resource. They can offer support and insight to others who are starting their treatment.

The collaborative approach we used could be a model for other parts of the NHS. By designing services with people, not just for them, we can move closer to a future where more people live comfortably with kidney disease, and care that truly fits around their lives and not the other way round.

The Conversation

Leah McLaughlin receives funding from Health and Care Research Wales. She is affiliated with the Wales Kidney Research Unit.

We would like to acknowledge Dr Gareth Roberts Chief Investigator of the Dialysis Options and Choices study. Dr Gareth Roberts is a Consultant Nephrologist and Associate Medical Director at Aneurin Bevan University Health Board and is clinical lead of the Welsh Renal Clinical Network.

ref. Why many kidney patients are still choosing hospital dialysis – and how the NHS can help more people access care at home – https://theconversation.com/why-many-kidney-patients-are-still-choosing-hospital-dialysis-and-how-the-nhs-can-help-more-people-access-care-at-home-254747