Research Articles Base: Maternal Child Pathophysiology

Mantero Seta Spa : case study

Mantero Seta Spa Executive Summary             This case analysis is cantered on the investigation of Mantero Seta Spa, a leading textile and silk industry in Italy who now operates through E-commerce and plans to operate in China and UK. The recommended company mission states that the firm should be driven to become the global leader for business-to-business (B2B) textile and silk distribution. The recommended values statement, on the other hand, emphasised the importance of fulfilling the company’s corporate social responsibility in the drive towards achieving organisational goals. Four company objectives were suggested, which included the improvement of their website and the diversification of their business ventures through lucrative business collaborations. An analysis then ensued, which comprised of the political, economic, social, technological and environmental aspects, as well as the state of competition and the underlying economics within the textile and silk industry (using Michael Porter’s Five Forces Framework). The analysis presented a generally favourable and conducive external environment for which Mantero Seta Spa could conveniently operate in. From such examination, it could be garnered that Mantero Seta Spa has the right mix of core competencies to be able to survive this industry perpetrated by E-commerce.   Recommended Mantero Seta Spa Mission To become the global leader for business-to-business (B2B) textile and silk distribution to all business sizes and to further improve market leadership.   Recommended Mantero Seta Spa Values Statement In line with our mission to become the world leader in textile and silk distribution, the fulfilment of our corporate social responsibility would take precedence over any profitability objective. The environment, community, diversity and ethics are positively connected to our aimed corporate growth, and would therefore take a holistic approach to doing Mantero Seta Spa business.   Recommended Mantero Seta Spa Company Objectives <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> To provide the highest quality products and services to consumers worldwide in order to further improve market leadership.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> To expand to more business regions in order to establish a truly global presence in the textile and silk industry.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> To improve on the company website for better user experience.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> To further diversify our business ventures through studying potential business collaborations and determining which of the possibilities would present the most benefits for the company.</li> </ul>   Introduction It is now a widely held view that the world economy has entered a much more complex phase where individual national economies have become inextricably linked. In this new world economy, resources and markets have ceased to have the indelible national identity of the past. Restricted resources and markets that were once legally isolated have become much more accessible to enterprises that have acquired a global strategic vision. To the more visionary global enterprises, the world is but a borderless environment with homogeneous consumers who have developed an unforgiving taste for the most sophisticated and high-quality products. In response to the needs of these global consumers, the enterprises have developed global products. How such homogenised consumers are served, however, is a question of the strategic orientation of the enterprises and their ability to exploit the ever-evolving global economic environment. With this regard, the Mantero Seta Spa, a company from Italy engaged in textile manufacturing and a leader in silk business plans to enter the Chinese and UK market.  From the given case, there are lots of factor that directly hit the business of Mantero Seta Spa. Basically, this paper will be discussing the status of Mantero Seta Spa with respect to four important details in an organisation i.e. Product Life cycle/Value chain, Key success factors, Competitive advantage and Market attractiveness.   Product Life cycle/Value chain  (1985) in his seminal work of value chain proposed it as a tool to identify and to analyse the origins of competitive advantages and suggested that the activities of the business could be grouped into two: primary and support activities. What activities a business undertakes is linked to achieving its competitive advantage, and Mantero Seta Spa seemed to be best prepared to implement a global strategy, because of the superior competitive advantages of its foreign operations compared with other textile and silk business. It was not until 2003 attack in America that Mantero Seta Spa focused on developing a global strategy as a means to enhance its competitive position in the industry. Before then, Mantero Seta Spa largely focused on building a strategy that would allow the company to maintain its competitive position in its own home market, which was essential for progress. An analysis of the structural and institutional factors that shaped Mantero Seta Spa’s strategic response both to the new industry rules and the short-term challenges posed by other industry competitors explains this paradox. A number of broad sustainability challenges set the context for all of the value chain activities. These issues apply across the value chain: (1) Population growth; (2) Urbanisation; (3) Child mortality; (4) Maternal health; (5) Infectious diseases; (6) Biodiversity; (7) Loss of ecosystem services; (8) Poverty; (9) Education; and (10) Gender Equality. All these issues are attended to by the Mantero Seta Spa in alignment with their efforts to maintain sustainable competitive advantage through preserving the good public image that their clients expect from them.   Key Success Factors The key success factors affecting the operations of the Mantero Seta Spa business comprising of the political, economic, social, technological and environmental aspects, as well as the state of competition and the underlying economics within the industry (using Michael Porter’s Five Forces Framework) is important because these range of factors would influence the business organisation’s decisions and its performance, leading to a better deployment of the firm’s resources within its external environment in order to satisfy its long-term goals. Political.  With regards to the terrorist attack in 2001 and SARS crisis, there is a global economic slowdown in which most of the textile businesses suffers.  Since Mantero Seta Spa is in the process of globalising their scope of operations, they are naturally subject to international trade regulations, which make business operations considerably more intricate to perform. Consumer protection also is a major consideration, with the increasing number of consumer-protection laws abound in the China and UK market that seeks to look after the right of consumers, most notably in terms of product and service quality. Economic. Economic growth for the target markets is extremely positive. China and UK are the targeted markets by Mantero Seta Spa current CEO. Actually, these areas are good textile and silk market in the world, next to the United States, whose market is now in its saturation stage, and the textile and fashion industry itself is shown to have a highly optimistic position in the future of the world economy, with what the increasing number of consumers in which their fashion sense is evolving. The movement to further industry growth would significantly increase the demand for the products and services that Mantero Seta Spa has to offer. Additionally, prior to the introduction of the euro, the dollar exchange rates are relatively stable. However, since its creation and adoption and off course terrorism cases, the exchange rate of the US dollar has show significant variability (2006). There is therefore the current need to coordinate and stabilise exchange rates on a world scale, as the US dollar is a key currency. This instability would significantly affect the way Mantero Seta Spa deploys their corporate resourced in the fulfilment of organisational objectives. Lastly, the textile and silk supplies industry is only in the early stage of the business cycle in the rest of the world where Mantero Seta Spa has yet to penetrate in, which spells out huge potentialities for business growth and development. Social. Income distribution among target market of most businesses is uneven, as observed by several experts on the subject ( 1992;  2003; 2004), although an exclusive focus on the matter would give the impression that countries has done a way better job of maintaining income inequality low, which is directly affected by the industry’s business cycle. The primary consumers of the textile and silk industry are large business organisations engaged in fashion, that’s why most of the companies in this industry is classified as B2B. Businesses have fewer tendencies to change suppliers than individual consumers, as the cost to shift to another supplier is more costly for the former than for the latter, so it could be safely assumed that once the client is acquired, chances of changing suppliers is pretty slim. The main business is involved in the provision of textile and silk industry and it is much subject to fashion and fads, similar to the mobile communications industry or the clothing industry, in which consumer taste and preferences are relatively not predictable throughout the business cycle.             Technological. In accordance to the development in Mantero Seta Spa, the B2B process in which they are engaged in is focused on information technology (IT) platform research, as opposed to product research and development focus of other industries, because most of the industry players’ main marketing vehicle is the Internet. Large government spending on IT platform research is observed of the Italy, while the China scene is on its way to developing more laws supportive of such research nature. As a result of the focus on IT platform research, very fast technological transfer is characteristic of the industry. Likewise, a very fast rate of technological obsolescence is also an attribute. Legal. As with any other business industry of the world, there are rules and regulations that restrict or support the facilitation of the business in the textile and silk industry in the areas where Mantero Seta Spa operates. Currently, the Italy, UK and Chinese governments express support for this increasingly expanding and consolidating sector of the economy due to the large sums of taxes that it generates for the government. Environmental. There are currently no major environmental issues faced by the industry, except for the ever-present textile and silk production issue which catch environmentalists’ attention die to the fact that some of its raw materials and from the skin of rare animals. Threat of New Entrants. The threat of new entrants is very high due to low entry barriers to the industry. The economies of scale, i.e. the very competitive prices in the industry, the not-so-large amount of capital and investment requirements and the easy access to industry distribution channels are some of the contributors to the low barrier of entry to the textile and silk industry. Threat of Substitutes. Threat of substitutes is also high, as the price to shift from one textile and silk provider is relatively small. As companies are often looking for ways to save on company resources through buying cheaper textile and silk products, the buyer’s willingness to substitute is pretty high. Also, the relative price and performance of the substitutes, coupled with the relatively low cost of switching to substitutes present a grave threat. Bargaining Power of Buyers. As there are still a few B2B textile and silk retailers worldwide, the bargaining power of buyers is not as great coupled with the industry being a key supplying group for the buyers, which in this case, are large companies. Bargaining Power of Suppliers. There are a lot of dominant suppliers in the industry, but they so far have not threatened to integrate forward to the industry, or threaten to set up their own retail outlets due to absence of strong Internet presence and powerful IT platform, so the bargaining power of suppliers is relatively controlled. Intensity of Rivalry between Competitors. Rivalry is not very intense, as there are only a few dominant industry competitions, and fewer still have powerful and fully integrated IT platforms. Competitive Advantage Mantero Seta Spa’s competitive advantage in the textile and fashion industry of the Italy is mainly their admirable portfolio of references. With their years of experience and dominance in the market in providing textile and silk products, they have gained a long list of loyal clients who have impressive business backgrounds by themselves. This promotes the corporate image of Mantero Seta Spa to potential customers as one of trustworthiness and quality. If such companies in Mantero Seta Spa’s references were deeply satisfied with the products and services that Mantero Seta Spa provides, larger chances of attracting possible additional clients in their already long list are sizeable. This portfolio of clients could be Mantero Seta Spa’s most effective marketing tool yet. On a more general context, the competitive advantage of Mantero Seta Spa could be pointed at their good record in being able to keep clients satisfied, which is an attribute that not all rivals in the business can boast of. Another competitive advantage of the organisation is their ability to maintain market leadership in the Italy even after the entrance of multinational companies in the same line of business with better technologies and more market scope than Mantero Seta Spa.             Another Mantero Seta Spa aspect which can be considered as a core competency is their strategic business planning. Their planning is about setting a direction for the business, a direction to which everybody, executives and employees become committed. It ensures that every part of the company is in harmony, moving towards a clear business purpose that will give Mantero Seta Spa further competitive advantage and improve its performance even more. With the planning of Mantero Seta Spa’s business come actions or decisions with high impact, or those decisions that affect the company strategically, rather than those that merely concern its normal operating routine. Most of those decisions concern for instance, changing the business model, focusing on new market sectors, fundamental improvements in customer service, making critical investment decisions or obtaining a better return on research and development expenditure. Such action or decisions affect Mantero Seta Spa’s long-term performance and enable it to achieve its competitive advantage.   Market Attractiveness It cannot be denied that the world is full of competition and it is essential that every individual should have the ability to compete especially those who are assigned to mange people in organisation. Perhaps, it can be considered as the greatest challenge in every organisation particularly to international organisations to have members who will contribute to the growth and development of an organisation.  Furthermore good management skills are very important in order to achieve the mission and reach the vision of a certain organisation. Every organisation has work to do in the real world and someway it has responsibility to measure how well that work has been done. With regards to the market attractiveness, three factors should be considered i.e. segmentation, targeting, and positioning strategies of the company. In the same manner, the justifications on the decisions on employing these strategies will also be given.    Segmentation  (2004) defined the segmentation activity as “the act of dividing a market into distinct groups of buyers.” This indicates the process have to deal with the general market and possible buyers of the products of Mantero Seta Spa. In looking at the market, it seems that it could be identified and considerably large to acquire some level of profit for the company. With the platform used by the company, i.e. the internet, the consumers could easily reach the company provided that they have ready access to the web. In the same manner, those who intend to purchase the products of the company are easily reached by the company given that an account will be made on their name. However, given that the company is rather new in the market of China and UK, the potential consumers may yet display some responsiveness on the site of the company. Although the company is engaged in B2B marketing, they can now also get the individual users because of the internet,      Targeting In the same account,  (2004) defined targeting as “the act of developing measures of segment attractiveness and selecting one or more market segments to enter.” Although, the company is most likely related to B2B system, they may now target individual who have access to the internet. These segments are targeted given that these individuals have more time to access the web and are more inclined to purchase head gears as a part of their fashion statement. Based on the market, there is no particularly strong competitor that holds most of the market share. However, there are a considerable number of sites that offer the same services and products as those offered by the company. Being an online company, the consumers are able to substitute the services and products forwarded by the company with those in malls and other specialty shops within their community. However, it must be emphasised that the designs, artworks, and quality of the products of the company are exclusively distributed by the company. This means that there is some equal footing in the context of power with the suppliers and buyers in the market.      Positioning The act of positioning is characterised as “the act of designing a set of meaningful differences to distinguish the company’s offer from competitors’ offers.” (2004) Given that there is a considerable number of players in the industry and possible competitors in the web, the company has to position itself in terms of high quality items and well designed works along with a prompt service delivery. Along with these, the company will also attempt to sell the items in a slightly lower price as compared to its other competitors in the web.  On this manner, the consumers will be able to find more value for their money. On the same account, the company will be using marketing techniques such as word-of-mouth and product endorsements such that the public may become aware of the brand and products of the organisation.   Credit:ivythesis.typepad.com

Mantero Seta Spa : case study

Mantero Seta Spa Executive Summary This case analysis is cantered on the investigation of Mantero Seta Spa, a leading text...

World Health Organization

Research Essay Project: World Health Organization               The World Health Organization (WHO) is the health directing and coordinating body within the United Nations system. It provides leadership on matters of global health, thus molding the research agenda, and norms and standards, communicating evidence-based policies, and providing technical support to different countries around the world, to help monitor and assess their health trends and problems (  2007). Its headquarters is located in Geneva, Switzerland, and its member states are divided into six geographical regions, namely, Africa, Southeast Asia, Eastern Mediterranean, the Western Pacific, the Americas, and Europe. It was established on April 7, 1948, when three physicians, namely, Dr.  of China, Karl Evang of Norway, and Geraldo de Paula Souza of Brazil suggested formulating a single health organization in 1945, which would be responsible in addressing the health problems and needs of the people around the world. The proposition of the three doctors was then approved during the approval of its constitution in 1946. The main concern of the organization was to address certain health problems including malaria, tuberculosis, diseases caused by parasites, bacteria and viruses, mental health, maternal and child health, public health administration, and environmental sanitation (2007).              The establishment of the World Health Organization in April 7, 1948 has continually been celebrated to be the World Health Day ( 2007). Member states and donors, including various non-government organizations, pharmaceutical industries, and foundations, have continuously funded it. Eight thousand five hundred health workers and support staffs based in the headquarters and in all six regional offices, and individual representation in 147 countries around the world carry out internal and external work. In addition, its Goodwill Ambassadors is representing the mission and vision of the organization (2007).                 The main objective of the World Health Organization is to promote health and well-being of all the peoples around the world. It preserves, maintains, and improves the health of many peoples through education, nutritional support, health-related activities, disease outbreaks management, emergencies response, and various funding programs (2007). Specifically, it has six agendas, which enable the organization to respond to the different health problems and needs of the peoples of the world. This includes 1) promoting health development despite poverty and social problems; 2) fostering health security through collective action to combat health security threats; 3) strengthen health systems as a poverty-reduction strategy; 4) harness research, information and evidence for setting priorities, define strategies and measure results; 5) enhance partnerships through support and collaboration with partners; and 6) improve performance through participation in ongoing reforms aimed at improving the efficiency and effectiveness of the organization ( 2007). In line with the agendas of the World Health Organization are its programs (2007), which include the following: <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Health education – through promotion of breastfeeding </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Food, food safety and nutrition – through support of food production that improve local diets, and distribution of supplementary foods</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Safe water and basic sanitation</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Immunizations – tuberculosis, measles, tetanus, polio</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Prevention and control of local endemic diseases</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Treatment of common diseases and injuries</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Provision of essential drugs</li> Such programs would not be executed and achieved by the World Health Organization without the support of other international organizations and agencies. Such international agencies include the United Nations, the World Trade Organization, and the UNCTAD. In addition, WHO also focuses in monitoring its workplan, being an ongoing process, and allows the organization to have a detailed review of the delivery of its products and services to the all the individuals concerned (2007). It uses effective and efficient means of communication in order to coordinate and cooperate with its member states, staffs, and all the concerned peoples around the world. It also undergoes extensive researches and evaluation in order to effectively assess the needs and health-related problems of populations around the world. In this regard, for the organization to be able to achieve its objectives, it uses both its internal and external sources effectively to produce its desired outcomes.  It collaborates with different local and international organizations to be able to obtain relevant information and come up with effective health programs in order to promote health and well-being in all populations of the world. Particularly, it focuses on education and provision of health and medical services, in order to help prevent and inform many individuals regarding the condition of health in respective countries or populations. Furthermore, it collaborates with health care and medical institutions to help facilitate medical missions to provide cure and treatment to persons afflicted with diseases and illnesses.      Credit:ivythesis.typepad.com

World Health Organization

Research Essay Project: World Health Organization The World Health Organization (WHO) is the health directing and coordin...

The Sociological Imagination

The Sociological Imagination   Introduction             Sociological imagination was coined , a famed sociologist. It covers the aspect of viewing one’s life events as if it were part of a greater and grander sociological scheme. According to , the men of today feel that they live in a place where there are a “series of traps”. According to him, it was because people chose to look at their lives in a limited scope. If one were to view it in a grander scale, one would see that the issues in one’s personal life is greatly influenced and interlocked with public issues.             In the context of healthcare, sociological imagination can help broaden the minds of the people involved in the issues and can greatly help in pushing upward the state of healthcare organizations. In individual contexts, one can help move himself from the rot he has fallen into if he views himself as a part of a grand scheme. In this paper, sociological imagination is discussed, in the context of healthcare organization.   Discussion             Illness and disease are fast spreading in our community.  In reality, hunger kills more than a million people each day. Diseases and illnesses claim a million more. A book by Dr.  entitled, “As Sick as It Gets”, describes the factors that affect a lot of people. According to some reviews, America is the only country that charges its citizens for healthcare. “Dr.  explains the economic, political, medical and moral necessity of a universal healthcare system for the United States. The only advanced, industrialized nation, that does not have a national healthcare system is the United States. Americans pay 40% more for health care than the next highest-paying country.  The Pharmaceutical industry is the most profitable business in the U.S.     Drug companies alone made billion in profits in 2002, that’s nearly 18% profits after taxes.  The World Health Organization rates American healthcare 37th in the world.   There are 42,000,000 people who have NO insurance and another 45 million underinsured in America.. Patterns of illness are difficult to determine, were it not for the Sociological Imagination paradigm brought up by . “ (quoted from “As Sick As it Gets”, )             How does one view the situations above? One must try to use the ability of sociological imagination. Let us take for example hunger. Why is there excessive hunger in the world? According to The Hunger Site, “It is estimated that one billion people in the world suffer from hunger and malnutrition. That’s roughly 100 times as many as those who actually die from these causes each year. About 24,000 people die every day from hunger or hunger-related causes. This is down from 35,000 ten years ago, and 41,000 twenty years ago. Three-fourths of the deaths are children under the age of five. Famine and wars cause about 10% of hunger deaths, although these tend to be the ones you hear about most often. The majority of hunger deaths are caused by chronic malnutrition. Families facing extreme poverty are simply unable to get enough food to eat. The Hunger Site began on June 1, 1999. In 1999, a year marked by good economic news, 31 million Americans were food insecure, meaning they were either hungry or unsure of where their next meal would come from. Of these Americans, 12 million were children. “ ( 2007).             Examining the reasons and facts pointed out above, hunger is really a very persistent problem in the world. But taking sociological imagination into perspective, one can note that hunger is a part of a much larger happening in the world. According to some, it may be famine. Famine is in turn a great happening occurring on all sides of the globe. Being able to see such things can well determine the solution to the constant problem of hunger in the world. In another light, let us examine health care. Primary health care or PHC is the very much needed health care act based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self determination (1978). Primary health care is an approach for building interventions that can lead to improved health outcomes for an entire population (1997). Primary health care incorporates five principles: (a) Equitable distribution, (b) Appropriate technology, (c) A focus on health promotion and disease prevention, (d) Community participation and (e) A multi-sectoral approach ( 2004).     Deep concern about health care for the majority of the world’s population, specifically low life expectancies and high mortality rates among children led to the global health strategy of primary health care. The WHO declaration emphasized health or well-being as a fundamental right and a worldwide social goal. It attempted to address inequality in health status of persons in all countries and to target government responsibility for policies that would promote economic, social, and health development. Both economic and social developments are considered basic to the achievement of health for all. Rapid advancements in science and technology, along with investor dollars, have created major advances in medical care. These emerging technologies in medicine, which were increasingly housed in hospitals and physicians’ offices, not only laid the groundwork for the coming shift in the way health care was delivered, but also increased healthcare costs.             When it comes to the workplace, it is first important to discuss the role of health care professionals in the provision of primary health care in order to understand how it is applied to a specific workplace where individuals work. The health care process is a systematic, scientific, dynamic, on-going interpersonal process in which the health care professionals and the patients are viewed as a system with each affecting the other and both being affected by factors within the behavior. From this, one could surmise that not only the health care professionals are essential for the provision of effective health care but it also needs the cooperation of the patients.             In the hospital, which is the health care setting providing the most commonly used health care services, the principles and conditions of primary health care are also demonstrated. In this current work environment, the health care professionals work closely with all the other members of the health care team to plan, coordinate, and deliver care for patients. In this work environment, primary health care looks beyond primary care with essential elements that include health education, proper nutrition, maternal/child health care, family planning, immunizations, and control of locally endemic diseases. This model being followed by the hospital is consistent with primary health care principles and conditions.             The growth in the number of elderly, coupled with the previously-mentioned large increases in the cost of health care, are making long-term care for the elderly populations very expensive (1993). Although many of the most promising medical innovations will result in better health and longer life for the elderly populations, they will also increase–not decrease—healthcare costs and spending. This age group uses an uneven share of medical resources. In the elderly group, the social and personal requirements of residents who need some assistance with daily activities and health care are emphasized. Its an important distinction, in that the design of housing, services, activities, employee training, and such is truly customer-centered, or in other words, suited to their age group/population. At present there are many institutions or organizations that are specifically for the elder populations in the United States.             Almost all healthcare consumers would want to go to the “best” hospital in town, see their own doctor, and have access to the same new medicines. When one falls ill, gets a certain level of medical care, and tells the neighbor about it, the other’s expectations are raised accordingly (2001). Each individual consumer shares a common need for health and a desire for the absence of illness through the demand for health care services and products. This in return affects the healthcare costs. The role of the government in regulating health care providers will be limited to ensuring that providers and payers do not engage in anticompetitive practices and that the safety of consumers and patients is protected ( 1998). This means that the government tries its best to reduce the healthcare costs at all levels for the consumer’s benefits.                 Conclusion             In the sociological perspective, one can surmise that, the healthcare organizations can be viewed in a broader manner. Many people need a lot of medical attention. And healthcare organizations exist for that reason. The organization of healthcare can be influenced and changed through sociological imagination.             Illnesses and healthcare organizations can be changed and more or less accurately predicted by sociological imagination. Sociological imagination can provide the solution to other problems that surmount every now and then.                             Credit:ivythesis.typepad.com

The Sociological Imagination

The Sociological Imagination Introduction Sociological imagination was coined , a famed sociologist. It covers the aspec...

Critical Analysis of Childhood Obesity in UK using two Sociological Approaches

Childhood Obesity   Introduction Obesity is a growing public health concern in the United Kingdom. In 2001, estimates for England suggest that some 8.5 per cent of 6 year olds and 15 per cent of 15 year olds are obese. Childhood obesity is a concern because it is an important risk factor for mortality and a range of chronic diseases in adult life (2003). The prevalence of obesity among children, aged 2 to 10, rose, between 1995 and 2003, from 10% to 14%. The increase in obesity was most marked among older children aged 8-10, rising from 11% in 1995 to 17% in 2003 ( 2005). The increase in childhood obesity has become an increasingly important issue on the public health agenda, with concerns being raised not only about the risks to children’s health but also the current and future drain on the National Health Service (NHS) resources. Obesity is a casual factor in a number of chronic diseases and conditions including hypertension (high blood pressure), heart disease and type 2 diabetes. In 1998, the cost of treating diseases attributable to obesity was £470 million. This sum does not include the impact of being overweight (but nit technically obese), which can also be a significant risk factor for these diseases and conditions. By 2002, this cost was estimated to be approximately £1.075 billion. By 2010, if the current trend continues, the annual cost to the economy has been estimated to be £3.6 billion a year (2006).     Main Body   Obesity is a common condition where weight gain has got to the point that it poses a serious threat to health (  2003). A person is considered obese if his body weight is more than normal for a particular age, gender, and height. The degree of obesity can be assessed through BMI (Body Mass Index) calculations that are based on a person’s height and weight. A person gains weight when the energy input (food) exceeds output (exercise, activity). Every output comprises the thermal effect of food and activity. Even a small imbalance between energy input and output can lead to significant weight gain over time. Most obese children demonstrate a slow but consistent weight over several years (2003).             There is now abundant evidence that childhood obesity adversely affects health and is not simply a cosmetic issue. One of the most widespread consequence of overweight and obesity in children is psychological ill health. Social and psychological consequences can include stigmatization, discriminations and prejudice. Children are aware of the negative view held by society towards obese people and it this may have adverse impact on their developing sense of self and self esteem. Obesity has in general been linked to low self-image, low self-confidence and even depression in some obese children. The processes that lead to cardiovascular disease in later life are strongly associated with childhood obesity. Cardiovascular risk factors have been identified in obese children. These include the raise in blood lipid and insulin levels, and high blood pressure and abnormalities in the size and function of left ventricular mass. Childhood obesity is also associated with increased risk of asthma, and with exacerbation of existing asthma. There is a marked increase in risk of ill health in adulthood that arises from obesity in childhood, independent of adult weight (2006).   Functionalism The central idea of ‘function’ relates to activities necessary for the maintenance of the species, society or social group. These functions include such things as reproduction, economic production, education, religion and recreation and much more, all of which have to be undertaken for a society to achieve a stable existence. Functionalism lays down a general systems theory of human society drawing the ideas of biological imperatives such as reproduction and the maternal instinct. Functionalism views society as an organism that strives to resist change and maintain itself in some sort of balance or equilibrium. Stability and order are considered natural and desirable, whereas conflict and disorder are evidence of defiance and dysfunction in the system (1995;1997). In this way, functionalism is a remarkably conservative set of ideas that generates clear rules about what is ‘functional’, and therefore ‘good’ for society, and what is not ‘functional’, and is therefore ‘bad’ for society (1997). Within the functionalist perspective, roles provide the link between the individual and society in a fairly determinist fashion. As individuals we are linked to the various institutions of society by filling roles. At home, in the institution of kinship, we fill the roles of child or parent. Interaction between individuals is stabilized on the basis of a common value system; we agree on what should happen. Conflict which may occur is to be understood as poor role performance (1999). Childhood Obesity as a social problem can be considered as a product of poor role performance in the family. Childhood obesity occurs when the parents perform their role inside the family poorly. It is a well-accepted idea that the dietary practices of parents have a profound influence on the eating behavior of their children. As children grow, they learn to prefer some foods to others. This might happen because of the types of food that their parents offer them, which in turn might depend on the parent’s food preferences. In a study conducted by Oliveria et al. (1992), children having one parent who habitually ate foods with high total fat content were likely twice as likely to eat similar foods that were children whose parents had low total fat intakes. But when both parents consumed high fat foods, the probability of their children having high fat intakes was 3 to 6 times greater than in children whose parents had normal intakes (1999). Childhood obesity is caused by developing dysfunctional behaviours from a society that promotes excessive food intake and discourages physical activity (2004). Children with two obese parents are more than six times as likely to become obese than children with non-obese parents. Children raised in families who do not regularly prepare and eat family meals together are more likely to be overweight. Children whose parents exert an excessive degree of control over what and how much their children eat are more likely to be able to regulate their food in a healthy manner. Children are more likely to be overweight if they lack opportunities to participate in active recreation and sports and/or not encouraged to engage in physical play. Children who spend several hours daily watching television, playing video games, or working on the computer are at a greater risk for weight gain. Poverty and low education are predictors of obesity. The lower the family income, the greater the likelihood of being overweight (2004).   Symbolic Interactionism Symbolic interactionism is concerned primarily with meaning as a product of human interactions and how that meaning influences behaviour in social situations. It is assumed that people do not act randomly to objects and situations when they are in interactions with others (1996). A symbolic interactionist approach emphasizes that human thought is shaped by social interaction, that interaction is made possible by the meanings and symbols that people develop, and that people may change those meanings and symbols. Meanings are critically important to interactionalists. The nature of an object, according to the interactionalist perspective, consists of the meaning that it has for the person for whom it is an object (1999). According to symbolic interactionists, personal experience is derived from ongoing interaction with important social groups. This interaction is mediated through the use of symbols, allowing people to understand, shape, and share their experience, including their actions within the social world (2004). The meanings created by the children’s interaction with other members of the society, particularly the parents, are critical in their construction of obesity as a problem or not a problem. Parental influence is important during childhood. During this phase, the child develops behaviors from his/her ongoing interaction with his/her parents. If a child interacts in an environment, where the people encourage poor eating habits and sedentary lifestyle, then the child will adapt those behaviours. Both the school environment and the family environment are responsible for the rising incidence of childhood obesity. For nine to ten months of the year, children attend school five out of every seven days, for six to eight hours per day. The school cafeteria provides food choices, the physical education program determine the time allocated to physical activity, and the school curriculum controls opportunities to learn about the relationship personal behaviours and health. Away from school, the family environment strongly influences child health. Parents who decide to buy high-calorie foods and/or allow their children to engage in long periods of sedentary activity facilitate the imbalance between energy intake and expenditure that causes children to gain weight. ( 2004). Family behaviours and interactions contribute greatly to childhood obesity. In attacking disease epidemics, public health workers look for three components: the host, the agent, and the environment. In the childhood obesity epidemic, the home harbors all three – the host is the child, the agent is excess calories from food and drink, and the environment encompasses the behaviour, lifestyle, and surroundings that promote excess eating and sufficient activity. Once babies move from breast milk or formula solids, eating patterns emerge and taste preferences come into play. Most aspects of social development and acculturation of children involve food. The factors that shape children’s eating habits are availability, accessibility and convenience. Influences beyond the home such as advertising, peers, and school lunches – will affect children, but usually not to a significant degree until they reach kindergarten age. For young children, parents are the decision-makers (2004). By age three, children develop likes and dislikes for certain foods, notably vegetables. Younger children are easier to induce to try novel foods and to change preferences for familiar foods than older children. Children learn food preferences through repeated exposure to new food; a minimum of eight to ten times is required for children to accept and develop a preference for it. Children’s acceptance of foods follows the example of parents and siblings. Social atmosphere influences children’s food habits: a positive meal experience increases preference for a food; a negative meal decreases it ( 2004). It goes without saying that mealtimes are vital time and place to develop children’s eating behaviours and food preferences. However, mealtimes these days are more like flextime. Families who set a table and gather for a home-cooked dinner are growing increasingly rare. Fewer families regularly eat meals together at home because family members eat throughout the day, and overloaded schedules leave little time for meal preparation (2004). As children get older and move into adolescence, they may begin turning to food for reasons having more to do with their psychological needs than with their appetite. The parent-child relationship and the home setting may work together to foster an environment that makes eating the best response to emotional distress (2004).   Conclusion Childhood obesity is one of the major public health issues in the United Kingdom. It is a growing threat to children’s health as well as a current and future drain on the National Health Service (NHS) resources. Obesity is a condition where weight gain reached a point that it poses a serious threat to health. A child is considered obese if his/her body weight is more normal for his/her age, gender and height. Childhood obesity has adverse effects on health. One of these is psychological ill health. Childhood obesity is strongly associated with cardiovascular diseases and increased risk of asthma. Social and psychological consequences can include stigmatization, discriminations and prejudice. Functionalism views society as an organism that strives to resist change and maintain itself in some sort of balance and equilibrium. Within the functionalist perspective, roles provide the link between the individual and society. Obesity, based on the functionalist perspective is caused by the poor role performance in the social unit, the family in particular. Poor parental role can cause childhood obesity. Childhood obesity is caused by developing dysfunctional behaviours from a society that promotes excessive food intake and discourages physical activity. The symbolic intearctionist approach is primarily concerned with meanings as products of human interactions and how that meanings influences behaviour in social situations. A symbolic interactionist approach emphasizes that human thought is shaped by social interaction, that interaction is made possible by the meanings and symbols that people develop, and that people may change those meanings and symbols. A Child’s behaviour toward food is shaped by the meaning he or she attaches to his or her interactions with people in the society. The meanings created by the children’s interaction with other members of the society, particularly the parents, are critical in their construction of behaviour towards obesity. Parental influence plays an important role in the development of a child’s behavior. If the parents encourage poor eating habits and sedentary lifestyle, these bahaviours will be adapted by the child.                 Credit:ivythesis.typepad.com

Critical Analysis of Childhood Obesity in UK using two Sociological Approaches

Childhood Obesity Introduction Obesity is a growing public health concern in the United Kingdom. In 2001, estimates for England suggest ...

NATIONAL HEALTH POLICY

Introduction   For policies to come into being there must first be a perceived social problem. However, the existence of a problem is not sufficient to guarantee that policy will be implemented (or changed) to affect the problem. Along with the existence of the problem there must also be the means to draw attention to it. This can come about, for example, through the actions of pressure groups, or through media attention. Even when these conditions are met there may be a perceived change in policy or perhaps a change in the emphasis of a policy, but this may be just a token gesture. If, for example, insufficient resources are set aside for the implementation of the policy then any changes made may have no effect (, 1982). This chapter will discuss some of the influences on social and health policies and how they are formulated and implemented in the UK. Medical System in UK               Similar to other developing countries, UK has maintained to look for further efficient, suitable and competent income of rewarding the health needs of its increasing population. Past efforts towards equal accessibility to and availability of, health facilities in the country have not been successful.             Like any other third world countries UK has traditional and “Western” medical practices present everywhere.(, 1982) Colonialism, and its outcome, has had a foremost effect on guides of utilization of medicines, pharmacy education and services. In UK, in addition to the Western, or formal government, sector, the traditional health care sector, which includes herbalists and spiritual healers, remains an important source of health care that people move between the different health care sectors in addressing their health problems is widely documented. Factors such as the type of problem, availability of services, beliefs about the etiology and appropriate management of disease and the success of treatment determine how and why people resort to care in the different sectors. In UK, a Centre for Scientific Research into Herbal Medicine has been established and initiative as “an attempt to modernize and incorporate traditional herbal knowledge and treatment into the formal health sector”.             UK’s budget in health services has carried on to be confronted excessively to obtainable hospitals and other curative medical care, majorly for the urban minority. The result has been a denial of basic health care services to a large segment of the UK population, especially those in the rural areas. Some basic health indicators show that the health status of UK remains poor. Life expectancy, for instance is below fifty years compared to seventy five in developed countries. About 33 percent of all reported deaths are attributable to infectious and parasitic diseases that are preventable. The mortality rate among fewer than five year olds is high. Although this age group comprises only 25 percent of the population, it contributes almost half of all deaths in UK, 70 percent of these deaths caused by infectious diseases are usually compounded by malnutrition. Diseases such as malaria, measles, pneumonia and diarrhea remain serious health hazards.               There are three different sectors in the medical care of UK such as home remedy, traditional medical sector and modern medical system. In the home remedy sector, usually the first therapeutic intervention resorted to by most people, self-medication is the usual practice. The sick person initially consults friends, relatives, neighbors or experts about treatment modalities known to them for particular illnesses. Some local herbal preparations or patent drugs bought from a drug store or the pharmacy are used. This sector which  (1983) has called the “popular sector” can be thought of as a matrix containing several levels: individual, family, social network and community beliefs and activities.               Diseases and illnesses are first described and health care activities initiated by the patient or therapy managing group. Interaction with the other sectors of health care depends on how health problems is perceived and sanctioned by the sick person and most importantly, by relatives and close friends. A range of possible alternatives are thereby opened. The symptoms of illness may entirely be disregarded, treatment modalities known to the sick person or friends of the sick or neighbors in the locality may be instituted or a decision may be made to move beyond this sector to seek the services of either traditional healers or modern medical practitioners. Traditional Medical System in UK             Traditional medicine has been part of the culture of the people of UK. (Kleinman:1983)The traditional medical system comprises not only herbal cures or remedies for specific diseases but also the people’s medical taxonomy, folk knowledge, guidelines, traditional and values, health behavior rules and patterns, supportive social institutions and identified personnel and structures for delivery of preventive and restorative therapy.             Traditional medicine is not a unified system in UK. There are many types of practitioners available, each with their own method of diagnosis and therapy.(Janzen:1978) There are secular healers who may be referred to as “traditional pharmacists.” They employ or apply herbal medicine prepared from selected leaves, roots or other parts of plants and animals.(:1981) This category of healers includes those who regard themselves as naturopaths. They are more “scientific-oriented” and have introduced Western medical ideas, concepts and techniques into the practice of traditional medicine. The armamentaria at their clinics include clinical thermometers, syringes, microscopes and stethoscopes. White-overall coats, patient record cards and procedures similar to modern medical practitioners distinguish the naturopaths from the other types of healers. There are also plant drug peddlers who travel to towns and villages, as well as sell herbal medicines at work places, bus stops and in the streets.             Priests and priestesses of deities and gods are the most common type of healers in UK. They use techniques such as divination and ritual manipulation in their healing practices.(:1977) They cure both organic and spiritually caused diseases. Other groups of such sacred healers are the faith-healers who are usually the heads of the numerous Independent African Churches that exist in UK. They employ prayers, fasting, incantations and herbal medicines, as well as substantial elements of Western and Far East occultism. There are also the mallami who dispense both herbal and prophetic medicines. Among these different types of healers, there are differences in specialization. Some of the healers focus on one or a few illnesses, while others are generalists. Among the specializations are bone-setting, child care and delivery, and psychotherapists. Some are full-time practitioners, while others practice medicine as a secondary occupation. The fact that traditional medicine had nurtured and sustained the people of UK for thousands of years before the arrival of Europeans into the Gold Coast was blatantly ignored by the British when the country formally became a colonial territory in 1844.(:1985) The role and activities of traditional medical practitioners were nearly eclipsed, not only by the introduction of a Western-oriented medical system as well as the penetration of Christian beliefs and teachings, but also by the incorporation of the local economy into the world economic system. Traditional medical practices were denounced by the colonial administration and, most forcefully, by the various missionary bodies. The indigenous medical system was condemned as “satanic,” “primitive,” and “unscientific.” (:1985) Such an attitude, reinforced by the policy of Westernization of the medical care of the people and threats and other forms of intimidation, forced most of the local medical practitioners into clandestine practices and caused many to abandon their practices. Neglect of such an important health asset contributed considerably to the underdevelopment of indigenous pharmacopoeias and the loss of healers whose medical knowledge could have been tapped, improved and developed. The natives of UK exert their efforts to modernize traditional therapies, validate them by scientific procedures, and license “qualified” indigenous healers in the 1930s were prevented. A Society of African Herbalists, formed at Sekondi on December 12, 1931, sought “to raise the local practice of medical herbalism up to a high and refined standard, and to seek for free and unhindered practice of its members.” (:1981) But the colonial government denied this and other requests to seek official recognition. Even though the acting director of Medical Sanitary Services agreed that “a number of native drugs have definite utility in the treatment of disease,” the colonial government contended that official recognition of the healers was impossible. As an element of his efforts to Africanize his programs and policies, and to resuscitate the self-image and socio-cultural identity of the UK people, President Nkrumah after independence attempted to revive, promote and develop traditional medicine. In 1962 he requested the Pharmacology Department of the University of Science and Technology (UST), Kumasi, to investigate the efficacy of local herbs. (:1981)The government also appointed a university lecturer in 1963 to study, organize and help from an association of traditional healers to advance and improve traditional medicine. The UK Psychic and Traditional Healers’ Association was formed in the same year. The main objective was to bring organization, respectability and a common purpose to healers in the country. Unfortunately, the project at the Faculty of Pharmacy collapsed with the overthrow of the Nkrumah regime. According to ‘s laudable policy to give priority to the traditional medical system was not pursued after his government fell in 1966. (:1985) The purpose of the Centre was to conduct and promote scientific research relating to the improvement of plant medicine and to cooperate and liaise with the UK Psychic and Traditional Healers’ Association, research institutions, and commercial organizations in any part of the world in matters of plant medicine. This move was a major landmark in the history of the development of traditional medical resources. (:1978) The Centre now has a clinic that treats people with its own herbal mixtures. The Centre has also conducted clinical studies into anaemia, arthritis, malaria, piles, asthma, hypertension, epilepsy, peptic ulcer, infective hepatitis, rheumatic diseases, sickle-cell, skin diseases and diabetes mellitus. The role of traditional medical practitioners in the deployment of health services by the government, however, has been kept ambiguous, though the Ministry of Health has been stressing the need to rehabilitate and harness the practices of healers into the national health care delivery system.   The Modern Medical System in UK In UK, only the modern medical system has received formal recognition and planning. A variety of alternatives exists in this sector. (, 1978) There is the government-operated/financed health care delivery system, with medical care provided at hospitals, health centers, clinics, health posts, maternity homes and dressing stations. Some quasigovernment-operated health care services are also provided primarily for specific subsets of the UK population, for example, health care services operated by the army, the police and some large firms and corporations for their employees. Many private medical services provided by individual medical practitioners in the form of hospitals, clinics and pharmacies exist. In addition, private health care services are operated by religious missions, for example, the Catholic Mission, the Presbyterian Church and the Seventh Day Adventist Church. These mission health services are financially supported by the government. Many drug peddlers and local drug stores which sell all kinds of patent medicines also abound. The officially provided modern medical system, which is under the control of the Ministry of Health, provides medical care, maternal and child health services, health laboratory services, mental health services, dental health services, leprosy health services, nutritional health services, environmental health services and health education. ( :1965) The Western model of health care was first introduced into the country around 1844 when British medical officers arrived in the country. Provision of health care, however, was initially limited to colonial administrators, officials of mining companies, merchants and other Europeans, who settled mostly along the coastal areas and in a few interior urban centers. The small number of hospitals and clinics established were concentrated in the new urban centers, port towns, mining areas, and administrative centers. With the exception of some isolated locations in the rural areas where health posts were established by the missionaries for their converts, the colonial administration virtually neglected the health needs of the majority of the people. This effort was undertaken in an attempt to reduce the high infant mortality rate and protein-calorie malnutrition rampant in the rural areas, as well as to expand family planning programs. However, success was limited. Factors such as a locality’s allegiance to the military government, financial constraints and mismanagement affected the location of health care facilities. Areas that had the greatest need for simple health care services were neglected. Health care facilities in UK have increased considerably over the years. The major problem is that their distribution in the country has been grossly unequal. Inter-regional, intra-regional and rural-urban disparities continue to exist, owing essentially to the fact that the limited resources for them are frequently located on the basis of political and economic expediency rather than on careful analysis of the relative needs of the different sections of the country. Until recently, the Western-oriented health care model established by the colonialists had informed the policies and strategies of health authorities in post-independence UK. The government should pay much attention to traditional medical services in the country. (:1977) Efforts should be made to organize the local medical practitioners to contribute to the current program of health for all by the year 2000. Avenues need to be explored as to how best traditional medical practitioners can be integrated into the national health care delivery system. The Centre for Scientific Research into Plant Medicine should be given adequate funding for continued research into local herbs and possible manufacture of local drugs. Structural changes in the health care system are beginning to emerge from the current health policies being adopted by the Rawlings government. Efforts should be made to mobilize communities to contribute their quota to general health improvement in the country instead of relying solely on the government for the provision of medical services, healthy environments, better housing and a higher standard of living. Health education, family planning and primary health care programs should be given sustained priority by the government.           In 2001 a new government took office in UK.(:1977) Among its pledges was the abolition of the “cash and carry” system, in which people are required to pay for their drug therapy and often other services, and its replacement with health insurance. This is a big undertaking, especially in a poor country. The form that the new scheme will take is currently being discussed. The impact of the cash and carry system on access to medicines has been addressed by many researchers. One consequence of the policy was a greater resort to self-medication as an alternative to seeking medical advice, which was more marked in poorer sectors of society. Like in the United Kingdom, health problems and health behaviors follow a socioeconomic status gradient. For both the British and UK governments, addressing inequalities in health status between sectors of the population and, in UK in particular, inequities in access to care are a priority. In both countries, health care reforms and policy priorities have implications of pharmacy services. It is in the interests of the profession to identify new opportunities and strategies for their achievement. The Development of Health Policy in UK   Any examination of the evolution of government policy towards the provision of health and social services in the early part of the 19th century needs to address three issues. First it must address why government did not or could not provide an appropriate and comprehensive service as of right for all of the nation’s citizens, particularly those who had fallen on hard times. Second, the debate must provide an insight into the principle of deterrence that underlined government interventions. Third, interventions by government should be considered in terms of their overall contribution towards the future evolution of health and social services. The health care needs of the population were met through four discrete forms of service. First there was a range of practitioners such as barbers, surgeons, bone setters and midwives, performing their own specialised forms of treatment. Second, there were cruder forms of public health service dealing with areas such as vermin control or the maintenance of water supplies. These services were often overseen by local magistrates and funded from local taxation. Third, there was assistance provided by church charities such as alms houses and early forms of hospital for the chronically disabled, the poor, the widowed and the orphaned, although this form of service steadily decreased in power and influence with the rise in secularism. The fourth and largest provider of service, as it still is today, was the informal network of friends and family supporting their dependants without any form of outside intervention. The need for public education programmes addressing issues such as hygiene and cleanliness highlights the ideological debate between collective and individual action that existed at the time and continues to the present. Radical reformers argued that public health was directly influenced by a combination of environmental and social conditions and required community or government accountability for its enforcement. In spite of this, the beginnings of sanitary reform can be traced to early philanthropists and intellectuals from the middle classes, such as Florence Nightingale. The earliest form of a recognisable health visiting service, in Manchester and Salford in the 1860s, began as a group of middle class women collectively trying to meet the health needs of the poor through education about hygiene and sanitation ( and , 1998).     Health Care Policies in the UK   The Secretary of State for Health has overall responsibility for providing health services, which it discharges through NHS authorities who are their agents. Special Health Authorities, National Health Service Trusts and Family Health Services Authorities administer services at local level, but these authorities do not simply carry out the secretary of state’s wishes. NHS authorities have important policy-making responsibilities in their own right, and they interpret national policies to suit local circumstances. On the other hand, unlike local authorities, they lack the legitimacy derived from elections and have no significant independent sources of revenue.   Health policy is not determined by ministers alone; the medical profession is also involved in the management of health services at several different points. Within the Department of Health and through the department’s consultative machinery, professions contribute to policy making. Family Health Services Authorities include a GP among their membership and receive advice from local medical committees. Under the NHS reforms they have also started appointing independent medical advisers. Also, NHS trusts usually include a medical director on their boards and rely extensively on advice received from their medical staff.   The pace of change in the provision of welfare intensified in the late 1980s. Services such as housing have become increasingly marginalised, whilst legislation on education has had the effect of introducing more elements of supposed consumer choice into the public sector. In the health services developments include both a greater move towards a form of market system within the health service, and greater incentives for individuals to switch to private health care as an alternative to the NHS. Thus the third term of office for the Conservative government reinforced the concept of selective measures in welfare services and the use of the private sector wherever possible. In part the Conservative government was able to use a growing disillusionment with the welfare state amongst politicians, academics and society itself to support its changes. Systematic study of the scope and effect of social provisions has developed over the past 40 years, since the inception of the welfare state, to reveal the inequalities that still exist within the system. Thus access to education has proved to be far from equal, poverty exists despite the introduction of income support and a contributory system of benefits, and inequalities in health between the social classes remain despite the introduction of a national health service. In addition there had been growing discontent with the ways in which the services are delivered.   The income maintenance system and the health services have both been criticised for being too impersonal, too remote from the needs of those they serve, too intimidating and too bureaucratic. Consumers have voiced discontent with a variety of services (the officialdom of the housing authorities or of social services, for example), whilst those on the left have been critical of the social controls within the delivery of welfare services.   The Conservative government’s commitment to restricting state services to those who demonstrate genuine need, measured by means tests, and to increasing private provision as an alternative to state services must be seen within the context of existing concern over the ability of social policy to provide for the needs of all.   The research has been concerned on the lack of an effective measurement of Service improvement initiatives within the NHS which will be essential in indicating sustainability and improvement projects.  Health care has deemed it difficult whether improvement is taking place and what exactly is improving due to the complexities of its nature but it remains an imperative that this be performed.  Health care measurement involves a variety of factors that will indeed prove it difficult to be tracked.  It involves, more than just procedures or a measurement of skills and knowledge, a determination of outcomes in a community level.  Indeed, the success of a service improvement initiative in the field of health care would not be without sufficient reliable data that should be yielded through the duly participation of teams, organizations and individuals.  Without the proper means to measure improvement, projects within the NHS is at the risk of losing track in their mission, goals, objectives, aims and above all, priorities.   In this regard, an effective measurement framework will maintain organizational direction.    In the absence of such measurement, the research seeks to create a evaluation or framework that will then allow such venture to be completed.  In doing so, it will firstly review existing evaluation techniques and analyze how it may possibly measure the effectiveness of a service improvement initiative.    The research has stemmed from the premise that measuring or evaluating or improvements within NHS brought by a service improvement initiative sheds light on the dynamics of health care system changes, quality health care and the improvement of patients as well as clients welfare through efficient waste-free performances.  Through a measurement framework, one may be presented a guide as to what initiatives work and what does not.  It will further guide to the creation of new initiatives.    This chapter will detail several methodologies that will be deemed as effective tools in the building of a measurement framework for service improvement initiatives within the NHS.   It will tackle on the abilities and capacities of these methodologies to measure improvement.    Measurement of Service Improvement Initiatives exists in order to inspire positive changes in a practitioner.  In this research’s case, the evaluation framework for service improvement initiatives is the medical practitioners within the National Health Service.     and  (2003) believe in the capability of Measurement and evaluation to “strengthen performance improvement practices” and assess if they had been effective in their interventions and programs in the field.    and  believe that Measurement and evaluation of Service Improvement initiatives in the Health care field is increasingly complicated and difficult due to its nature of  its diversity which they name as “geographical settings, cultures, and health systems, coupled with a scarcity of resources”.  These limitations and hindrances will deem it difficult for an Improvement Measurement or evaluation undertaking to be possible due to the lack of availability.  For one thing, it is truly challenging to make a standard of how health care should be employed given the diverse and variety of situations.  According to  and , there are key aspects that needed to be taken note before Measurement and Evaluation for performance improvement may be considered.  Notable of which is the standardization of care “by describing the desired performance and the determination of whether selected interventions are closing performance gaps and contributing to the achievement of organizational health goals”  (2003, )    and  emphasize that some countries do not regulate their health practices especially in less-developed countries.  This is due to the fact that the regulations are not enforced and executed as a whole.  There is also the problem of datedness as the practices may not be the most prescribed today are still currently employed.  Measurement and evaluation would be truly a problem in a setting that does not make it a point to record and note the activities and any other evidences related to performance standards.  Some information or guidelines are also ignored and bypassed allowing performance to be unrated and unrecorded.  So far, they have tried to adapt easier methods of measurement and evaluation through “critical or clinical pathways, care maps, and self- and peer-assessment checklists”.  (2003, )   The United Kingdom Department of Health and Human Services (DHHS) would concur that Performance measurement is a must as it will “clarify goals, document the contribution towards achieving those goals, and document the benefits received from the investment in each program.”  The DHHS emphasized how it is important to keep a record or keep track of the performances in the Health field as a means to determine whether the set goals or the Health Service’s mission and visions are being followed.  Agreeing with  and , the DHHS also believe that Measurement would not be effective or made possible if it does not have sufficient sound data that will be used to “reliably measure public health or human service outcomes”.  The DHHS affirms that data acquisition in Health Services is complex, limited and oftentimes difficult which is why researchers must look into other aspects of Health care such that will depend on two things. (, 1998)   In the case of Health care, there are two several things that need to be taken in consideration.  The behavior itself and the outcomes the behavior will produce.  While behavior may be measured in an individual level through the correct following of a certain order in a clinical procedure, outcomes is measured in a more “systems and organizational level” as it will deal with the effects of the said behavior to the patient.  Measuring outcomes is also more complicated as there are several factors or “intervention” that may affect this.  (2003, )               In measuring outcomes or finding out how they had come to be, the study of procedure and the measures directly leading to such outcomes may be the most appropriate method.           Measuring individual performance and behavior through a test of skills and knowledge is always the easier way to study service improvement initiative although again, that is merely studying the theory of the Health care rather the practice or the application of the theory (training, skills and knowledge), which may be studied through the evaluation of better or high quality care.  This will take into account a health practitioner’s interventions and relationships with colleagues and the environment as a whole.    As mentioned earlier, what will make measurement and evaluation in the health practice possible is a set of standards (and at the same time, who sets the standards) which will be performed through a research on the perspectives of the service providers as well as the consumers themselves.   It should be a study in finding out what their “preferences” they are which would be developed into the standards that needed to be achieved.   It is important then to meet a consensus with regards to this standards and preferences.  (2003, )   Ideally, performance improvements would mean “expanded service coverage, improved effectiveness of care, or increased client satisfaction” (2003, )   Positive change or improvement should be nurtured in order to contribute to the continuous betterment of a working individual.  With the aid of measurement for Improvements, one may be able to pinpoint how changes take place, what changes are important and what are not.  Sorting out changes yield benefits especially in service improvement.  Measurements for Improvement is about identifying the right information that will identify progress, growth and development as well as agents of justification that enhancement has taken place.  Measurements of Improvement concretize and quantifies what otherwise is as abstract as a feeling of change.  They are able to show through scientific data that such change has indeed taken place and provide visual and hard data of such evidences of growth to demonstrate a change.  Measurements for improvement allow individuals to track and reward change as well as identify the lack thereof.  (, 2005)   The contribution of Measuring Service Improvement is also in a greater sense, for technical needs.  Health care resources can only be limited that it must be deployed in the best and most effective manner such that a performance measure ensures.  Performance Measurement is also a way to allow local agencies and government programs to come together.  In this manner the national health system may take notice and may indeed track the progress of the state of its Health care in the nation.    The DHHS notes that the United Kingdom local governments have already been employing a method of performance measurement.  In their experience, they emphasize that Measuring Improvement in Health Service needs to be “specific and result oriented, meaningful and understandable, adequate in data, valid, reliable and responsive”  If the Service Improvement Initiative has taken note in establishing these guidelines then a credible Measurement report may be established.  This will allow health systems to truly determine if there has been progress or in a certain sense, if goals are being met.  Monitoring performance leads to several implications about the state and welfare of a nation’s health system and allow them to continue improving.  (, 1998)   Institutions have been established for the sole goal of determining Healthcare Improvement such as the Institute for healthcare Improvement (IHI) which was founded 1990.  They are supposed to make efficient health care improvement not just in the United Kingdom, but also outside it.  The Institute teams up with various health care organizations and conduct “education, research, clinical trials and demonstration projects” in order to set up goals that Health care services will follow and will eventually lead to Performance improvement.  IHI works towards “improved health status inc communities through greater access to care, clinical outcomes improvement and cost reduction”.  IHI has so far collaborated with 367 teams scattered all over 256 health care organizations both national and international.  The teams work for specific areas of health care and they are said to contribute by “dramatically improving outcomes and reduced costs” through its collaborations in several areas of adult care, drugs, reproductive health, waits and delays before health care is administered, satisfaction of patient and “improving efficiency and access to care” as a whole.  It continues to strive more to involve other areas.  The IHI is particularly focused in reducing the instances of waste in health care work and resources.  They believe that the root of health care problems is solved through finding and ridding of waste.  This, IHI believes, allows efficiency in performance improvement while ensuring quality health care without having to waste in resources and in the demand of services as a whole.  Finally, as IHI itself only works if it is performed through collaborations, they believe in the necessity of cooperation in order to Measure Service Improvement Initiatives.  By merging with Health care organizations and by ensuring that they too are willing to move towards the improvement of its services, performance improvement may be truly activated as the Health care Organizations help in supplying the data needed for institutions such as IHI in order to sustain improvement and quality health care services (, 1998).     (2005) has some models and frameworks that exist in order to measure service improvements.  It has the Model for Improvement which is supposed to help in  “setting objectives and targets”.  Their models are specialized in setting up perceived goals and mission and then accomplishing them.  Models such as the PDSA or the Plan, Do, Study and Act exist in order to plan the changes or improvements needed to be made, before they are acted upon.  This allows improvements to be planned and to be focused and set through “aims and targets, measures and then plan the introduction of changes that will result in improvement” Another model for improvement is RAID which stands for: Review, Agree, Implement and Demonstrate.   In this model, the situation is firstly assessed through Review, then a consensus is met through Agree and then executing the planned changes through Implement and finally reveal the changes made through Demonstrate.  The models of improvement in NHS emphasize how planning and focus should be the topmost priority.  This involves the prior knowing of what is being trying to be fulfilled, determining whether a change can be considered an improvement and then identify the changes that can be made once improvement has manifested itself.  (, 2005)   NHS has also emphasized that Measurement for improvement is supposed to make efficient and effective the positive changes.  They emphasize how objectives and measures need to be connected and how it should reflect “other initiatives in the health community”.  This link has been emphasized in their models of improvement. (, 2005)   Despite these efforts, the research yielded few resources, most of which are dated.  This implies that the Evaluation or Measurement of Service Improvement Initiatives in Health care is not yet as present and centralized.  The resources are scattered and subjective to needs.  This research will then do well in attempting to put up a framework that may be used by various health care services.  The research however revealed that the NHS had been performing efforts in Measuring Performance Improvement only the information related to it remains insufficient.  The Literature Review has also realized the difficulties and complexities in the particular measurement of health care.  It is not as easy as measuring improvement in a business organization where data can be easily present, provided and recorded.  Health care deals with situations and activities that may be difficult to record as they must pass the subjective minds rather  business organizations which will have a set of measurements beforehand.  Health care involves several factors that are difficult to quantify but measuring improvement must nonetheless be performed as proved by this Literature Review.  Inevitably, the measurement of performance improvement or service improvement initiatives leads to quality health care as well as the focus and realization of goals.  It also significantly makes efficient health care and its resources and minimizes the instances of waste.    Services   Sanitation   Apart from the poor law amendment, one of the most important areas of government health policy was the provision of public health services that were created to promote the prevention of disease. Throughout the 19th century infectious diseases such as cholera and typhoid posed a major threat to the general population. Medical intervention was at this time largely powerless to intervene because little was understood about the nature of disease. Although normally only the most poverty-stricken areas of towns were affected, particularly virulent epidemics swept through whole communities, affecting both rich and poor. While home conditions were obviously bad for most people, the situation at work was even worse. Most factories employed large numbers of people in buildings that had poor ventilation, no sunlight and miserable hygiene facilities. Within these insanitary conditions diseases such as cholera were able to find a strong foothold. The cumulative effect of these poor conditions, along with the effects of poor quality of food and inadequate sewerage systems, prompted the government to set up boards of health. Early health boards instituted strict cleansing regimes during cholera outbreaks and also provided soup kitchens. Hospital Services   During the 18th century ever increasing numbers of people moved from their agrarian bases to the new industrial cities, whose populations were rapidly increasing. The population of Bristol, for example, rose from 20 000 to 60 000, Glasgow from 13 000 to 80 000. Manchester, by 1801, had trebled its size to approximately 85 000 in less than 25 years. These demographic changes, along with the growth of university-trained doctors, allowed for the creation of new voluntary hospitals in many British cities. Funding for these came from a combination of contributions from local industry and charitable organisations. The first such hospital to be opened, the Westminster in London, was quickly followed by similar establishments in Edinburgh, Bristol, York and Liverpool. Voluntary hospitals made a valuable contribution to health care. They were, however, far from the ideal model. In the first instance they operated on a privileged system of patronage in that the sick were required to bring a letter of recommendation from a subscriber to the hospital in order to gain admission. Second, voluntary hospitals did not provide services for maternity care, sick children, the dying, or people with tuberculosis, epilepsy, syphilis or any other infectious disease. The only form of institutional service for these people was in the workhouse infirmaries. The voluntary hospitals developed closer affinities with medical faculties in universities and care was gradually extended. The number of beds within each hospital increased and out-patient departments evolved, in which patients could be properly assessed and accurate reviews made of their progress. Nevertheless, care in hospital continued to focus on acute and treatable conditions, creating pressure for specialist hospitals. As a result new specialist services emerged, including new institutions catering for maternity care, sick children, eyes and particular diseases. Mental health care   Hospital services for the mentally ill evolved in a slightly different way to other health services in Britain. By the turn of the 19th century there were two forms of provision. There were private madhouses which operated as profit-making businesses, providing a service for those who could afford such provision. In addition, approval had been given to local counties to build county asylums for people with mental health problems. However, due to a lack of available funds and of motivation within the authorities, very few were actually built in the first decades of the century. People in need of mental health services either remained at home or, if that was not possible, they were accommodated along with the old, sick or homeless as inmates in the poor law workhouses or with criminals in gaols. With the passing of the 1845 Lunatics Act every county was compelled to provide purpose-built accommodation for the mentally ill, thus enabling the decanting and, at the same time, reclassification of large numbers of poor law paupers. It was originally intended that the milieu of these new asylums would focus on treatment and maximising the potential of cure for patients. The provision of in-patient services was supposed to be interpreted as a period of retreat or natural time out. None of this ever materialised. Social Issues   At the creation of the National Health Service (NHS), the intention was to provide universal health services available to all with every person receiving the same standard of service. Indeed, , the Minister for Health, describing the NHS to the House of Commons in 1946, stated that there was to be ‘no limitation on the kind of assistance given — the general practitioner service, the specialist, the hospitals, eye treatment, spectacles, dental treatment, hearing facilities, all these are to be made available free’ (quoted in  1991). However, despite the optimism surrounding the beginnings of the NHS, the realities then and now suggest that health services are not experienced by all in the same way. The distribution of health resources, the different patterns of illness suffered and other contributing factors ensure that different groups within the UK have unequal health needs and experience the unequal provision of health care. It is therefore important to be able to distinguish between the ideal that services are available to all free at the point of use with the reality of vastly different experiences.   Health Care Inequalities in UK Although most of UK’s population lives in rural areas, the vast majorities of pharmacists as other health professionals lives and work in the cities.  Although not dissimilar in kind to the Britain’s “post-code prescribing”, these discrepancies have a far wider impact in terms of service provision. A sizeable proportion of the population does not have access to pharmacy services. This presents a problem to the profession in terms of providing a nation-wide service with any uniformity. Urban-rural inequalities in health status and service provision are common in developing countries. They are not restricted to health care and their solution is seen in terms of wider socioeconomic development. Shortages of health professionals are further exacerbated by the significant numbers who seek professional opportunities abroad. In most industrialized countries pharmacies are the principal source of medicines, but in developing countries there are other outlets. These are accepted as a necessity if people in remote areas are to have access to much needed drug therapy. The Pharmacy Council in UK which oversees the registration of pharmacists licenses and provides some training for chemical sellers. In addition to these licensed chemical sellers, the activities of “drug peddlers”, especially among rural communities, have been described by many researchers. They are commonly itinerant, sell medicines alongside other products and generally have no formal training. In developing countries it is widely acknowledged that medicines elsewhere designated as “prescription-only” are widely available from pharmacies without a prescription. Stricter regulation on the availability of medicines as part of health care reforms in developing countries could reduce the potential opportunities for pharmacists to contribute to therapeutic management of common diseases, just as the new prescribing roles of pharmacists in Britain enhance their health provider activities. Other Health Care Issues in UK             Because of the relationship that exists between health, productivity and equitable development, health improvements form a key element of development. UK, after independence, has implemented several policies aimed at improving the health status of its people. Its seven-year and five-year development plans in the early days of independence, as well as economic policies in recent decades contain various measures to reduce the economic burden of disease, with a particular focus on morbidity, mortality and malnutrition among children. Indeed, the economic reforms and structural adjustment programs that have been pursued since 1983 have gradually been accompanied by reforms in the health sector. These put more emphasis on primary health care and stressed the importance of prevention. The Government of UK embarked on a health sector reform in the early 1990s to improve the accessibility and quality of services. The Health Service Act of 1996 and the Medium Term Health Strategy based on Vision-2020 are further moves towards an efficient health care delivery system (, 1997) For reasons of both efficiency and equity, there is ample scope for public interventions in health care markets. Subsidized expansion of facilities, health care providers, health education, and health insurance could not only improve efficiency in supply, but also promote equity. In particular, rural health care demand might be responsive to the proximity of providers, while extended insurance could account for care that would otherwise be unaffordable. To foster the health of its population, UK has set up an extensive network of public health care facilities, including hospitals, clinics, health centers, that offer subsidized care. In this way the public sector supplies health care as well as health insurance in kind. Yet, current public health care provision is still biased towards hospitals in urban areas supplying curative care, and puts less emphasis on prevention and basic health care in rural areas ( and , 2001). Local communities though become more involved in public health through direct provision of subsidized care to their members as well as through prevention and health promotion initiatives. Notwithstanding these efforts, many rural communities still experience high levels of morbidity and mortality due to lack of access to and poor utilization of health services, poor coverage of child welfare services and lack of technical support for initiating their own health programs ( and , 1998). In addition to supplying   In the above perspective, and given its poverty reduction agenda in the area of health, the Government of UK considers an identification of opportunities for an efficient and equitable increase of health care utilization a key development issue. The current paper wants to contribute to the debate by presenting recent data on the supply and demand of curative health care, and by an empirical exploration of equitable access opportunities.   References Credit:ivythesis.typepad.com

NATIONAL HEALTH POLICY

Introduction For policies to come into being there must first be a perceived social problem. However, the existence of a problem is n...