Smoking and Coronary Heart Disease Impact

Smoking and Coronary Heart Disease Impact Introduction Medical innovations and rapidly evolving technology has led to a decrease in the rate of mortality from diseases. However, the fast and constantly changing hectic lifestyle of today has led to the introduction of new diseases, unhealthy lifestyle and early, premature deaths. Todays technology has provided us with the benefits of early detection and preventive treatments and answers to some of the previously incurable diseases. But it has brought in increased stress and unhealthy eating and other habits that have in some ways caused more harm than benefit. This report titled Smoking: The Heart Breaker is a look at the current situation of coronary heart diseases caused by smoking, relevant legislations, policies and practices, strategies to deal with the situation and future of the disease at local, national and global levels. The report will start by discussing the smoking and coronary heart disease as a public health issue and the reasons for concern. It will provide a background to help better understand the present situation along with an epidemiology of the disease and its causes, with special reference to smoking. It will then go on to report about the legislative policies and strategies that are being currently undertaken in the region of Burnley, East Lancashire to counter this particular health issue. The report will also discuss the policies and initiatives and the status of the health issue at national and global level, so as to provide a complete and holistic picture of the seriousness of the health issue. Finally the report will discuss the current strategies being employed by the government as well as non-government agencies to tackle the health issue. Recommendations will also be made to help make an improvement in the current situation. Public Health Issue: Coronary Heart Disease due to Smoking The term Coronary heart disease is used to describe a condition of blockage or interruption of blood supply to the heart due to build-up of fatty substances in the coronary arteries (NHS, 2009). This build-up (called atheroma) can lead to insufficient supply of blood to the heart causing pain in the chest known as angina. A completely blocked artery can lead to a heart attack (called myocardial infarction) (NHS, 2009). There are various mild to critical impacts of this condition that even result in death. According to the British Heart Foundation Statistics (2009), diseases related to the heart and circulatory issues are the biggest cause of deaths in the UK, resulting in over 90,000 deaths in the UK in a year. This has resulted in not only raised concerns about the disease but also growing efforts to increase the awareness about the disease, its causes, and preventive as well as precautionary measures that can help to avoid the disease. The situation isn t any brighter in other par ts of the world. According to the World Health Organisation (WHO), the majority of countries around the world are affected by coronary heart disease and the disease is a major killer, especially in developing and transitional countries of the world. In a WHO report, cardiovascular diseases including coronary heart disease is considered to be the leading cause of death and is projected to increase from 17.1 million in 2004 to 23.4 million in 2030 (WHO, 2004). Among the various causes of coronary heart disease, smoking is regarded to be one of the primary causes. According to the WHO report, tobacco-related deaths are expected to rise from 5.4 million in 2004 to 8.3 million in 2030, representing 10% of all global deaths; and smoking has been associated to cardiovascular diseases and subsequent deaths (WHO, 2004). According to a study conducted in 2008, smoking is the leading cause of cardiovascular diseases including coronary heart disease (Bullen, 2008). Though increasing age has been thought as a cau se of coronary heart disease, two studies have found that improper lifestyle, stress, etc are increasing the mortality rates due to coronary heart disease among the young population in the UK, USA and Australia (Nemetz, Roger Ransom, 2008) (Ford Capewell, 2007). Therefore, the growing concern for this disease and its preventable yet common cause is the choice of topic for this report. Background and Epidemiology Cardiovascular diseases including coronary heart disease have been found to be an unbiased killer that can create havoc in any society irrespective of its economic, political, cultural, religious, regional or racial identity. Similarly, tobacco smoking (either active or passive) is known to be a major cause of many diseases including the coronary heart disease. Given the stressful lifestyle in today s world, many people take up smoking to tackle the stress levels and in the process get addicted. They not only harm themselves but also people around them. The region of Burnley in East Lancashire, is no exception to this trend. Being witness to many friends and family members taking up smoking in the name of relieving stress and then getting addicted and finally ending up suffering from diseases, especially coronary heart disease inspired the choice of topic for this report. There are several causes that can result in coronary heart disease. The NHS lists smoking as the major cause of the disease (NHS, 2009). The various other causes of coronary heart disease have been listed as high blood pressure, high level of cholesterol in blood, presence of thrombosis and / or diabetes unhealthy lifestyle with no regular exercise, obesity and a family history of angina and / or heart attack (which are hereditary) (Nemetz et al, 2008). The risk factors associated with coronary heart diseases which cannot be treated, modified or changed include age, gender and heredity (or race). Increasing age increases the risks of coronary heart disease and fatality from it. Men are found to be at a greater risk of suffering from coronary heart disease in comparison to women (Wells, 1999). Heredity of coronary disease or its causes such as diabetes, high blood pressure, and cholesterol are also known to create risks of coronary heart conditions. The causes such as smoking, high le vel of cholesterol in blood, high blood pressure, physical inactivity, being overweight and / or obesity and diabetes (diabetes mellitus) are some of the risk factors of coronary heart disease that can be modified, changed and controlled by taking medication and / or by adopting a healthy lifestyle. Other risk factors and causes of the disease include stress and alcohol addiction and can in certain circumstances prove to be fatal causes of the coronary heart disease (Ewles Simnet, 2003). Comparative data of the effects of coronary heart disease in different countries do not provide a very positive picture (see appendix 1). According to a World Health Organisation survey report, the mortality from cardiovascular diseases in 2002 for the developed nations like the United Kingdom and the United States was higher than many other developing nations like China, India, even Nigeria (WHO, 2002). It is clear from the data, that developing countries have a much higher mortality rate from cardiovascular and consequently coronary heart diseases in the developed countries like UK, USA, Germany; and an important fact to notice is that the death rate is higher in the European region in comparison to other regions of the world. This most probably can be attributed to the excessive use of tobacco, alcohol, improper lifestyle that increases stress levels, improper eating habits that leads to blood sugar and cholesterol in the blood. The tobacco usage in different countries around the world also points towards the grimness and enormity of the situation, through which one can appreciate the risk of tobacco causing further deaths due to coronary heart disease (WHO, 2008). The WHO report on tobacco consumption in different countries show that despite government initiatives and regulations, the tobacco consumption has mostly increased and has led to increased mortality especially in the age groups between 25-45 years. Though coronary heart disease is of global nature without any kind of boundary, various specific groups of people are in greater risk of having the disease in comparison to others. The affinity to having coronary heart disease is dependent on factors such as geography, heredity, age and gender. Men are at an increased risk of suffering from coronary heart conditions as compared to women (Wells, 1999). Increase in age increases the chances of suffering from coronary heart disease (DoH, 2004). Coronary heart conditions are also known to be prevalent among Mexican Americans, some Asian Americans, American Indians, and Native Hawaiians (American Heart Association, 2010). England is one of the most vulnerable nations in Europe when it comes to coronary heart diseases (NHS, 2009). Populations in developing and underdeveloped nations of the world too are at a higher risk of suffering from coronary heart disease and related fatalities (American Heart Association, 2010). Smokers, obese people and people with high blood cholesterol are also included in the high risk group for coronary heart disease. Female smokers are more susceptible to the disease especially with increased age since females are more susceptible to the dangers of smoking in comparison to men (WHO, 2002). With increased impact of aggressive and unhealthy lifestyle and stress, the young population across the developed nations of the world too are increasingly coming under the risk of coronary heart disease (NHS, 2008). Therefore, these risk factors result in the coronary heart disease taking on a pandemic nature if certain precautionary and preventive measures are not taken to control the risk factors that can be influenced. Strategies, Policies and Initiatives Given the growing concern about coronary heart diseases, deaths due to the disease and the impact on the younger population, government agencies around the world are taking steps to combat the growing menace. Non-governmental and private agencies too are joining the efforts to promote a healthy lifestyle and awareness about preventive techniques that can help to bring down the risks associated with the disease and the rising cases of fatalities. This section of the report looks at the strategies, agenda, policies, that are being undertaken at the local (NHS East Lancashire, 2010), national and global levels to combat coronary heart disease. Local Public Health In East Lancashire, several workshops and other programmes have been undertaken to increase awareness, educate and help the residents of the area give up smoking and adopt a healthy lifestyle that will help prevent and fight coronary heart disease. The MPs in the region are encouraging antismoking legislations and policies being adopted by the authorities. The NHS has introduced the concept of smoke free zones. The SMYL programme is promoting healthy lifestyle and eating habits (NHS East Lancashire, 2010). Another campaign called Could it be you was also started in 2008 to help people fight coronary heart disease and adopt healthy and preventive lifestyle (Chime Communications Plc, 2008). The authorities in East Lancashire have also collaborated with different agencies to start networks that can promote anti tobacco campaign and raise awareness on coronary heart disease (NHS Networks, 2010). This involvement of the government as well as non-government agencies in the area, one can b e hopeful that headway will be made into the matter. However, it is important that the public realise the criticality of the situation and take advantages of the programmes being undertaken to have a long, healthy and disease free life. Implications at the National Level The National Heart Forum (2006) indicated that heart diseases cost the UK around  £29 billion per year and was termed as economic burden . There are several programmes that have been taken up by the health care authorities and the government in collaboration with non-government agencies to promote anti smoking habits in the country. Several regional programmes such as Bolsover Teenage Smoking Programme, Corby Smoking Cessation Programme, Halton Smoke-Free Programme, London Borough of Tower Hamlets Tobacco Control Alliance, Pendle Smoke-free Council, Heartbeat Awards, the GO Smokefree Campaign, etc have been launched in an earnest to curb the growing effect of smoking in the country (IDeA, 2009). Several governmental legislations have also been put into place (IDeA, 2007). The Department of Health has also started programmes such as Start4Life, 5 A Day, National Support Teams and Let s Get Moving to promote healthy lifestyle that can help to prevent coronary heart disease (DoH, 201 0). Therefore the various government and nongovernment agencies in UK are making effort to control smoking habit and improve lifestyle of the citizens of the country thereby ensuring a brighter future free from smoking and coronary heart disease. Global Health The fight against smoking and coronary heart disease has taken enormous proportions with the growing realisation that these are two of the most important killers in the world today. Especially, the understanding that smoking causes diseases such as the coronary heart disease not only in the smoker but also in non-smokers who have been in the presence of smokers, has led major organisations and developed nations of the world to taking a stand against smoking. The Work with Heart project by WHO is helping to spread the message of preventive actions that can help in prohibiting coronary heart disease and other cardiovascular diseases (WHO, 2010a). WHO has also taken up research and global partnership initiatives to help the developing countries of the world fight cardiovascular diseases (WHO, 2010b). Furthermore, WHO has aligned with several countries in the world to promote regional activities under the global strategy to counter cardiovascular diseases which includes America, Eastern Mediterranean, Africa, South-East Asia, European region and Western Pacific (WHO, 2010c). To help fight the smoking addiction growing among countries, WHO has set up the Global Tobacco Surveillance System (GTSS) (WHO, 2010d) and is also collaborating with different international organisations such as the United Nations and the governments of various countries to help campaign against sale and use of tobacco among different nations (WHO, 2010e). Recommendations and Conclusion Upon analysing the current situation on a local, national and global basis, the following recommendations can be made: Initiatives to prevent coronary heart disease and promote anti smoking habits need to be undertaken at the grass root level, i.e. at local level. This will make the initiatives and campaigns more effective. The developing nations such as India, Brazil and China need to be targeted with confidence. Further researches into preventive and curative medicines and technologies for coronary heart diseases need to be promoted. Healthy lifestyle needs to be promoted at every level since preventive practices are more beneficial than curative ones. It is important to realise that despite several initiatives being taken by local, national and global agencies and governments, smoking trends are increasing around the world and has started to affect the young population. Coronary heart disease too has started to take its toll on the population around the world due to the hectic and unhealthy lifestyles that have come to permeate people s lives. It is highly essential that for the success of the initiatives and programmes, people must be involved in them and everyone across the globe has to realise that simple changes to their lifestyle, eating habits and anti smoking measures will help to fight and prevent coronary heart disease. The changes in lifestyle will also bring down coronary heart disease caused due to other factors such as stress, alcohol, blood sugar and cholesterol. To conclude, it can be stated that prevention is better than cure and quitting smoking and leading a healthy lifestyle can protect everyone from the silent killer, the coronary heart disease (Ewles Simnet, 2003). References American Heart Association (2010) Risk Factors and Coronary Heart Disease [Online] last accessed 2nd December 2009 at http://www.americanheart.org/presenter.jhtml?identifier=4726 ASH (2009) Ash facts at a glance: Implementation of the Smoke-free Law in England, Wales and Northern Ireland [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_594.pdf Ash (2007) Ash facts at a glance: Smoking and Diseases [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_94.pdf Ash (2010) Ash facts at a glance: Smoking Statistics [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_93.pdf Ash (2010) Ash facts at a glance: Tobacco Economics [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_95.pdf Ash (2009) Ash facts at a glance: Tobacco Regulations [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_96.pdf British Heart Foundation Statistics Website (2009) Mortality [Online] last accessed 2nd December 2009 at http://www.heartstats.org/topic.asp?id=17 Bullen, C. (July, 2008). Impact of Tobacco Smoking and Smoking Cessation on Cardiovascular Risk and Disease. Expert Review of Cardiovascular Therapy, Vol. 6, No. 6, pp. 883-895. Chime Communications Plc (2008) East Lancashire PCT Enlists BMT to Develop a Campaign to Tackle the Region s Biggest Killer [Online] last accessed 2nd December 2009 at http://www.chime.plc.uk/press-releases/bmt-launches-east-lancashire-pct-campaign-could-it-be-you Department of Health (DoH) (2010) Public Health [Online] last accessed 2nd December 2009 at http://www.dh.gov.uk/en/Publichealth/index.htm Department of Health (DoH) (2004) The National Service Framework for Coronary Heart Disease: Wining the War on Heart Disease [Online] last accessed 2nd December 2009 at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4077154 Ewles L, Simnett I. (2003). Promoting Health: A Practical Guide. London: Balliere Tindall. Ford, E. S. Capewell, S. (2007) Coronary Heart Disease Mortality Among Young Adults in the U.S. from 1980 Through 2002. Concealed Levelling of Mortality Rates Journal of the American College of Cardiology Vol. 50, pp. 2128-2132. Improvement and Development Agency (IDeA) (2009) Smoking [Online] last accessed 2nd December 2009 at http://www.idea.gov.uk/idk/core/page.do?pageId=5889940 Improvement and Development Agency (IDeA) (2007) Smoke-free Legislation [Online] last accessed 2nd December 2009 at http://www.idea.gov.uk/idk/core/page.do?pageId=6166044 National Health Service (NHS) (2009) Health A-Z: Coronary Heart Disease [Online] last accessed 2nd December 2009 at http://www.nhs.uk/conditions/Coronary-heart-disease/Pages/Introduction.aspx National Health Service (NHS) (2008) Rates of Heart Disease in the Young [Online] last accessed 2nd December 2009 at http://www.nhs.uk/news/2007/January08/Pages/Ratesofheartdiseaseintheyoung.asp National Heart Forum (2006) Economic Cost of Heart Disease [Online] last accessed 2nd December 2009 at http://www.heartforum.org.uk/AboutCHD_Economicburden.aspx Nemetz, P. N., Roger, V. L., Ransom, J. E., Bailer, K. R., Edwards, W. D., Leibson, C. L. (2008) Recent Trends in the Prevalence of Coronary Disease: A Population-Based Autopsy Study of Non-natural Deaths Archival of Internal Medicine Vol. 168, No. 3, pp. 264-270. NHS East Lancashire (2010) SMYL If you want to live longer [Online] last accessed 2nd December 2009 at http://www.smyl.eastlancspct.nhs.uk/welcome/ NHS Networks (2010) East Lancashire Public Health Network [Online] last accessed 2nd December 2009 at http://www.networks.nhs.uk/networks.php?pid=727 Smoke Free (2007) Smoke-free Legislation Compliance Data [Online] last accessed 2nd December 2009 at http://www.smokefreeengland.co.uk/files/dhs01_03-smokefree_report_final.pdf Wells, A. J. (1999) Passive Smoking and Coronary Heart Disease New England Journal of Medicine Vol. 341, No. 9, pp.697-698. World Health Organisation (WHO) (2004) Causes of Death (part 2). The Global Burden of Disease: 2004 Update [Online] last accessed 2nd December 2009 at http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part2.pdf World Health Organisation (WHO) (2010a) Cardiovascular Diseases: Key messages to protect heart health [Online] last accessed 2nd December 2009 at http://www.who.int/cardiovascular_diseases/en/ World Health Organisation (WHO) (2002) Global Burden of Disease in 2002: Data Sources, Methods and Results [Online] last accessed 2nd December 2009 at https://apps.who.int/infobase/compare.aspx?dm=10countries=818%2c250%2c414%2c484%2c554%2c566%2c643%2c710%2c826%2c840year=2002sf1=mo.cg.059sex=all World Health Organisation (WHO) (2010d) Global Information System on Tobacco Control [Online] last accessed 2nd December 2009 at http://www.who.int/tobacco/global_data/en/index.html World Health Organisation (WHO) (2010e) Global Network [Online] last accessed 2nd December 2009 at http://www.who.int/tobacco/global_interaction/en/ World Health Organisation (WHO) (2010c) Regional Activities to the Global CVD Strategy [Online] last accessed 2nd December 2009 at http://www.who.int/cardiovascular_diseases/region/en/ World Health Organisation (WHO) (2010b) Research and Global Partnership Initiatives [Online] last accessed 2nd December 2009 at http://www.who.int/cardiovascular_diseases/research/en/ World Health Organisation (WHO) (2008) Tobacco Use: Infobase [Online] last accessed 2nd December 2009 at https://apps.who.int/infobase/report.aspx?rid=116dm=8 Bibliography American Heart Association (2010) Risk Factors and Coronary Heart Disease [Online] last accessed 2nd December 2009 at http://www.americanheart.org/presenter.jhtml?identifier=4726 Ash (2007) Ash facts at a glance: Smoking and Diseases [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_94.pdf ASH (2009) Ash facts at a glance: Implementation of the Smoke-free Law in England, Wales and Northern Ireland [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_594.pdf Ash (2009) Ash facts at a glance: Tobacco Regulations [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_96.pdf Ash (2010) Ash facts at a glance: Smoking Statistics [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_93.pdf Ash (2010) Ash facts at a glance: Tobacco Economics [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_95.pdf British Heart Foundation Statistics Website (2009) Mortality [Online] last accessed 2nd December 2009 at http://www.heartstats.org/topic.asp?id=17 Bullen, C. (July, 2008). Impact of Tobacco Smoking and Smoking Cessation on Cardiovascular Risk and Disease. Expert Review of Cardiovascular Therapy, Vol. 6, No. 6, pp. 883-895. Chime Communications Plc (2008) East Lancashire PCT Enlists BMT to Develop a Campaign to Tackle the Region s Biggest Killer [Online] last accessed 2nd December 2009 at http://www.chime.plc.uk/press-releases/bmt-launches-east-lancashire-pct-campaign-could-it-be-you Department of Health (DoH) (2004) The National Service Framework for Coronary Heart Disease: Wining the War on Heart Disease [Online] last accessed 2nd December 2009 at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4077154 Department of Health (DoH) (2010) Public Health [Online] last accessed 2nd December 2009 at http://www.dh.gov.uk/en/Publichealth/index.htm Ewles L, Simnett I. (2003). Promoting Health: A Practical Guide. London: Balliere Tindall. Ford, E. S. Capewell, S. (2007) Coronary Heart Disease Mortality Among Young Adults in the U.S. from 1980 Through 2002. Concealed Levelling of Mortality Rates Journal of the American College of Cardiology Vol. 50, pp. 2128-2132. Hill, S. Blakely, T., Kawachi, I., Woodward, A. (2004) Mortality Among Never Smokers Living with Smokers: Two Cohort Studies British Medical Journal Vol. 328, No. 7446, pp. 988-989. Improvement and Development Agency (IDeA) (2007) Smoke-free Legislation [Online] last accessed 2nd December 2009 at http://www.idea.gov.uk/idk/core/page.do?pageId=6166044 Improvement and Development Agency (IDeA) (2009) Smoking [Online] last accessed 2nd December 2009 at http://www.idea.gov.uk/idk/core/page.do?pageId=5889940 Jiang, H.E., Vupputuri, S., Allen, K., Prerost, M. R., Hughes, J., Whelton, P. K. (1999) Passive Smoking and the Risk of Coronary Heart Disease A Meta Analysis of Epidemiological Studies New England Journal of Medicine Vol. 340, No. 12, pp. 920-926. Kaur, S., Cohen, A., Dolor, R., Coffman, C.J., Bastian, L.A. (2004) The Impact of Environmental Tobacco Smoke on Women s Risk of Dying from Heart Disease: A Meta Analysis Journal of Women s Health Vol. 13, No. 8, pp. 888-897. National Health Service (NHS) (2008) Rates of Heart Disease in the Young [Online] last accessed 2nd December 2009 at http://www.nhs.uk/news/2007/January08/Pages/Ratesofheartdiseaseintheyoung.asp National Health Service (NHS) (2009) Health A-Z: Coronary Heart Disease [Online] last accessed 2nd December 2009 at http://www.nhs.uk/conditions/Coronary-heart-disease/Pages/Introduction.aspx National Heart Forum (2006) Economic Cost of Heart Disease [Online] last accessed 2nd December 2009 at http://www.heartforum.org.uk/AboutCHD_Economicburden.aspx Nemetz, P. N., Roger, V. L., Ransom, J. E., Bailer, K. R., Edwards, W. D., Leibson, C. L. (2008) Recent Trends in the Prevalence of Coronary Disease: A Population-Based Autopsy Study of Non-natural Deaths Archival of Internal Medicine Vol. 168, No. 3, pp. 264-270. NHS East Lancashire (2010) SMYL If you want to live longer [Online] last accessed 2nd December 2009 at http://www.smyl.eastlancspct.nhs.uk/welcome/ NHS Networks (2010) East Lancashire Public Health Network [Online] last accessed 2nd December 2009 at http://www.networks.nhs.uk/networks.php?pid=727 Smoke Free (2007) Smoke-free Legislation Compliance Data [Online] last accessed 2nd December 2009 at http://www.smokefreeengland.co.uk/files/dhs01_03-smokefree_report_final.pdf Wells, A. J. (1999) Passive Smoking and Coronary Heart Disease New England Journal of Medicine Vol. 341, No. 9, pp.697-698. Whincup, P. H., Gilg, J. A., Emberson, J. R., Jarvis, M. J., Feyerabend, C., Bryant, A., Wakler, M., Cook, D. G. ( 2004) Passive Smoking and Risk of Coronary Disease and Stroke: Prospective Study with Cotinine Measurement British Medical Journal Vol. 329, No. 7459, pp. 200-205. World Health Organisation (WHO) (2002) Global Burden of Disease in 2002: Data Sources, Methods and Results [Online] last accessed 2nd December 2009 at https://apps.who.int/infobase/compare.aspx?dm=10countries=818%2c250%2c414%2c484%2c554%2c566%2c643%2c710%2c826%2c840year=2002sf1=mo.cg.059sex=all World Health Organisation (WHO) (2004) Causes of Death (part 2). The Global Burden of Disease: 2004 Update [Online] last accessed 2nd December 2009 at http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part2.pdf World Health Organisation (WHO) (2008)Tobacco Use: Infobase [Online] last accessed 2nd December 2009 at https://apps.who.int/infobase/report.aspx?rid=116dm=8 World Health Organisation (WHO) (2010a) Cardiovascular Diseases: Key messages to protect heart health [Online] last accessed 2nd December 2009 at http://www.who.int/cardiovascular_diseases/en/ World Health Organisation (WHO) (2010b) Research and Global Partnership Initiatives [Online] last accessed 2nd December 2009 at http://www.who.int/cardiovascular_diseases/research/en/ World Health Organisation (WHO) (2010c) Regional Activities to the Global CVD Strategy [Online] last accessed 2nd December 2009 at http://www.who.int/cardiovascular_diseases/region/en/ World Health Organisation (WHO) (2010d) Global Information System on Tobacco Control [Online] last accessed 2nd December 2009 at http://www.who.int/tobacco/global_data/en/index.html World Health Organisation (WHO) (2010e) Global Network [Online] last accessed 2nd December 2009 at http://www.who.int/tobacco/global_interaction/en/ Smoking and Coronary Heart Disease Impact Smoking and Coronary Heart Disease Impact Introduction Medical innovations and rapidly evolving technology has led to a decrease in the rate of mortality from diseases. However, the fast and constantly changing hectic lifestyle of today has led to the introduction of new diseases, unhealthy lifestyle and early, premature deaths. Todays technology has provided us with the benefits of early detection and preventive treatments and answers to some of the previously incurable diseases. But it has brought in increased stress and unhealthy eating and other habits that have in some ways caused more harm than benefit. This report titled Smoking: The Heart Breaker is a look at the current situation of coronary heart diseases caused by smoking, relevant legislations, policies and practices, strategies to deal with the situation and future of the disease at local, national and global levels. The report will start by discussing the smoking and coronary heart disease as a public health issue and the reasons for concern. It will provide a background to help better understand the present situation along with an epidemiology of the disease and its causes, with special reference to smoking. It will then go on to report about the legislative policies and strategies that are being currently undertaken in the region of Burnley, East Lancashire to counter this particular health issue. The report will also discuss the policies and initiatives and the status of the health issue at national and global level, so as to provide a complete and holistic picture of the seriousness of the health issue. Finally the report will discuss the current strategies being employed by the government as well as non-government agencies to tackle the health issue. Recommendations will also be made to help make an improvement in the current situation. Public Health Issue: Coronary Heart Disease due to Smoking The term Coronary heart disease is used to describe a condition of blockage or interruption of blood supply to the heart due to build-up of fatty substances in the coronary arteries (NHS, 2009). This build-up (called atheroma) can lead to insufficient supply of blood to the heart causing pain in the chest known as angina. A completely blocked artery can lead to a heart attack (called myocardial infarction) (NHS, 2009). There are various mild to critical impacts of this condition that even result in death. According to the British Heart Foundation Statistics (2009), diseases related to the heart and circulatory issues are the biggest cause of deaths in the UK, resulting in over 90,000 deaths in the UK in a year. This has resulted in not only raised concerns about the disease but also growing efforts to increase the awareness about the disease, its causes, and preventive as well as precautionary measures that can help to avoid the disease. The situation isn t any brighter in other par ts of the world. According to the World Health Organisation (WHO), the majority of countries around the world are affected by coronary heart disease and the disease is a major killer, especially in developing and transitional countries of the world. In a WHO report, cardiovascular diseases including coronary heart disease is considered to be the leading cause of death and is projected to increase from 17.1 million in 2004 to 23.4 million in 2030 (WHO, 2004). Among the various causes of coronary heart disease, smoking is regarded to be one of the primary causes. According to the WHO report, tobacco-related deaths are expected to rise from 5.4 million in 2004 to 8.3 million in 2030, representing 10% of all global deaths; and smoking has been associated to cardiovascular diseases and subsequent deaths (WHO, 2004). According to a study conducted in 2008, smoking is the leading cause of cardiovascular diseases including coronary heart disease (Bullen, 2008). Though increasing age has been thought as a cau se of coronary heart disease, two studies have found that improper lifestyle, stress, etc are increasing the mortality rates due to coronary heart disease among the young population in the UK, USA and Australia (Nemetz, Roger Ransom, 2008) (Ford Capewell, 2007). Therefore, the growing concern for this disease and its preventable yet common cause is the choice of topic for this report. Background and Epidemiology Cardiovascular diseases including coronary heart disease have been found to be an unbiased killer that can create havoc in any society irrespective of its economic, political, cultural, religious, regional or racial identity. Similarly, tobacco smoking (either active or passive) is known to be a major cause of many diseases including the coronary heart disease. Given the stressful lifestyle in today s world, many people take up smoking to tackle the stress levels and in the process get addicted. They not only harm themselves but also people around them. The region of Burnley in East Lancashire, is no exception to this trend. Being witness to many friends and family members taking up smoking in the name of relieving stress and then getting addicted and finally ending up suffering from diseases, especially coronary heart disease inspired the choice of topic for this report. There are several causes that can result in coronary heart disease. The NHS lists smoking as the major cause of the disease (NHS, 2009). The various other causes of coronary heart disease have been listed as high blood pressure, high level of cholesterol in blood, presence of thrombosis and / or diabetes unhealthy lifestyle with no regular exercise, obesity and a family history of angina and / or heart attack (which are hereditary) (Nemetz et al, 2008). The risk factors associated with coronary heart diseases which cannot be treated, modified or changed include age, gender and heredity (or race). Increasing age increases the risks of coronary heart disease and fatality from it. Men are found to be at a greater risk of suffering from coronary heart disease in comparison to women (Wells, 1999). Heredity of coronary disease or its causes such as diabetes, high blood pressure, and cholesterol are also known to create risks of coronary heart conditions. The causes such as smoking, high le vel of cholesterol in blood, high blood pressure, physical inactivity, being overweight and / or obesity and diabetes (diabetes mellitus) are some of the risk factors of coronary heart disease that can be modified, changed and controlled by taking medication and / or by adopting a healthy lifestyle. Other risk factors and causes of the disease include stress and alcohol addiction and can in certain circumstances prove to be fatal causes of the coronary heart disease (Ewles Simnet, 2003). Comparative data of the effects of coronary heart disease in different countries do not provide a very positive picture (see appendix 1). According to a World Health Organisation survey report, the mortality from cardiovascular diseases in 2002 for the developed nations like the United Kingdom and the United States was higher than many other developing nations like China, India, even Nigeria (WHO, 2002). It is clear from the data, that developing countries have a much higher mortality rate from cardiovascular and consequently coronary heart diseases in the developed countries like UK, USA, Germany; and an important fact to notice is that the death rate is higher in the European region in comparison to other regions of the world. This most probably can be attributed to the excessive use of tobacco, alcohol, improper lifestyle that increases stress levels, improper eating habits that leads to blood sugar and cholesterol in the blood. The tobacco usage in different countries around the world also points towards the grimness and enormity of the situation, through which one can appreciate the risk of tobacco causing further deaths due to coronary heart disease (WHO, 2008). The WHO report on tobacco consumption in different countries show that despite government initiatives and regulations, the tobacco consumption has mostly increased and has led to increased mortality especially in the age groups between 25-45 years. Though coronary heart disease is of global nature without any kind of boundary, various specific groups of people are in greater risk of having the disease in comparison to others. The affinity to having coronary heart disease is dependent on factors such as geography, heredity, age and gender. Men are at an increased risk of suffering from coronary heart conditions as compared to women (Wells, 1999). Increase in age increases the chances of suffering from coronary heart disease (DoH, 2004). Coronary heart conditions are also known to be prevalent among Mexican Americans, some Asian Americans, American Indians, and Native Hawaiians (American Heart Association, 2010). England is one of the most vulnerable nations in Europe when it comes to coronary heart diseases (NHS, 2009). Populations in developing and underdeveloped nations of the world too are at a higher risk of suffering from coronary heart disease and related fatalities (American Heart Association, 2010). Smokers, obese people and people with high blood cholesterol are also included in the high risk group for coronary heart disease. Female smokers are more susceptible to the disease especially with increased age since females are more susceptible to the dangers of smoking in comparison to men (WHO, 2002). With increased impact of aggressive and unhealthy lifestyle and stress, the young population across the developed nations of the world too are increasingly coming under the risk of coronary heart disease (NHS, 2008). Therefore, these risk factors result in the coronary heart disease taking on a pandemic nature if certain precautionary and preventive measures are not taken to control the risk factors that can be influenced. Strategies, Policies and Initiatives Given the growing concern about coronary heart diseases, deaths due to the disease and the impact on the younger population, government agencies around the world are taking steps to combat the growing menace. Non-governmental and private agencies too are joining the efforts to promote a healthy lifestyle and awareness about preventive techniques that can help to bring down the risks associated with the disease and the rising cases of fatalities. This section of the report looks at the strategies, agenda, policies, that are being undertaken at the local (NHS East Lancashire, 2010), national and global levels to combat coronary heart disease. Local Public Health In East Lancashire, several workshops and other programmes have been undertaken to increase awareness, educate and help the residents of the area give up smoking and adopt a healthy lifestyle that will help prevent and fight coronary heart disease. The MPs in the region are encouraging antismoking legislations and policies being adopted by the authorities. The NHS has introduced the concept of smoke free zones. The SMYL programme is promoting healthy lifestyle and eating habits (NHS East Lancashire, 2010). Another campaign called Could it be you was also started in 2008 to help people fight coronary heart disease and adopt healthy and preventive lifestyle (Chime Communications Plc, 2008). The authorities in East Lancashire have also collaborated with different agencies to start networks that can promote anti tobacco campaign and raise awareness on coronary heart disease (NHS Networks, 2010). This involvement of the government as well as non-government agencies in the area, one can b e hopeful that headway will be made into the matter. However, it is important that the public realise the criticality of the situation and take advantages of the programmes being undertaken to have a long, healthy and disease free life. Implications at the National Level The National Heart Forum (2006) indicated that heart diseases cost the UK around  £29 billion per year and was termed as economic burden . There are several programmes that have been taken up by the health care authorities and the government in collaboration with non-government agencies to promote anti smoking habits in the country. Several regional programmes such as Bolsover Teenage Smoking Programme, Corby Smoking Cessation Programme, Halton Smoke-Free Programme, London Borough of Tower Hamlets Tobacco Control Alliance, Pendle Smoke-free Council, Heartbeat Awards, the GO Smokefree Campaign, etc have been launched in an earnest to curb the growing effect of smoking in the country (IDeA, 2009). Several governmental legislations have also been put into place (IDeA, 2007). The Department of Health has also started programmes such as Start4Life, 5 A Day, National Support Teams and Let s Get Moving to promote healthy lifestyle that can help to prevent coronary heart disease (DoH, 201 0). Therefore the various government and nongovernment agencies in UK are making effort to control smoking habit and improve lifestyle of the citizens of the country thereby ensuring a brighter future free from smoking and coronary heart disease. Global Health The fight against smoking and coronary heart disease has taken enormous proportions with the growing realisation that these are two of the most important killers in the world today. Especially, the understanding that smoking causes diseases such as the coronary heart disease not only in the smoker but also in non-smokers who have been in the presence of smokers, has led major organisations and developed nations of the world to taking a stand against smoking. The Work with Heart project by WHO is helping to spread the message of preventive actions that can help in prohibiting coronary heart disease and other cardiovascular diseases (WHO, 2010a). WHO has also taken up research and global partnership initiatives to help the developing countries of the world fight cardiovascular diseases (WHO, 2010b). Furthermore, WHO has aligned with several countries in the world to promote regional activities under the global strategy to counter cardiovascular diseases which includes America, Eastern Mediterranean, Africa, South-East Asia, European region and Western Pacific (WHO, 2010c). To help fight the smoking addiction growing among countries, WHO has set up the Global Tobacco Surveillance System (GTSS) (WHO, 2010d) and is also collaborating with different international organisations such as the United Nations and the governments of various countries to help campaign against sale and use of tobacco among different nations (WHO, 2010e). Recommendations and Conclusion Upon analysing the current situation on a local, national and global basis, the following recommendations can be made: Initiatives to prevent coronary heart disease and promote anti smoking habits need to be undertaken at the grass root level, i.e. at local level. This will make the initiatives and campaigns more effective. The developing nations such as India, Brazil and China need to be targeted with confidence. Further researches into preventive and curative medicines and technologies for coronary heart diseases need to be promoted. Healthy lifestyle needs to be promoted at every level since preventive practices are more beneficial than curative ones. It is important to realise that despite several initiatives being taken by local, national and global agencies and governments, smoking trends are increasing around the world and has started to affect the young population. Coronary heart disease too has started to take its toll on the population around the world due to the hectic and unhealthy lifestyles that have come to permeate people s lives. It is highly essential that for the success of the initiatives and programmes, people must be involved in them and everyone across the globe has to realise that simple changes to their lifestyle, eating habits and anti smoking measures will help to fight and prevent coronary heart disease. The changes in lifestyle will also bring down coronary heart disease caused due to other factors such as stress, alcohol, blood sugar and cholesterol. To conclude, it can be stated that prevention is better than cure and quitting smoking and leading a healthy lifestyle can protect everyone from the silent killer, the coronary heart disease (Ewles Simnet, 2003). References American Heart Association (2010) Risk Factors and Coronary Heart Disease [Online] last accessed 2nd December 2009 at http://www.americanheart.org/presenter.jhtml?identifier=4726 ASH (2009) Ash facts at a glance: Implementation of the Smoke-free Law in England, Wales and Northern Ireland [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_594.pdf Ash (2007) Ash facts at a glance: Smoking and Diseases [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_94.pdf Ash (2010) Ash facts at a glance: Smoking Statistics [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_93.pdf Ash (2010) Ash facts at a glance: Tobacco Economics [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_95.pdf Ash (2009) Ash facts at a glance: Tobacco Regulations [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_96.pdf British Heart Foundation Statistics Website (2009) Mortality [Online] last accessed 2nd December 2009 at http://www.heartstats.org/topic.asp?id=17 Bullen, C. (July, 2008). Impact of Tobacco Smoking and Smoking Cessation on Cardiovascular Risk and Disease. Expert Review of Cardiovascular Therapy, Vol. 6, No. 6, pp. 883-895. Chime Communications Plc (2008) East Lancashire PCT Enlists BMT to Develop a Campaign to Tackle the Region s Biggest Killer [Online] last accessed 2nd December 2009 at http://www.chime.plc.uk/press-releases/bmt-launches-east-lancashire-pct-campaign-could-it-be-you Department of Health (DoH) (2010) Public Health [Online] last accessed 2nd December 2009 at http://www.dh.gov.uk/en/Publichealth/index.htm Department of Health (DoH) (2004) The National Service Framework for Coronary Heart Disease: Wining the War on Heart Disease [Online] last accessed 2nd December 2009 at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4077154 Ewles L, Simnett I. (2003). Promoting Health: A Practical Guide. London: Balliere Tindall. Ford, E. S. Capewell, S. (2007) Coronary Heart Disease Mortality Among Young Adults in the U.S. from 1980 Through 2002. Concealed Levelling of Mortality Rates Journal of the American College of Cardiology Vol. 50, pp. 2128-2132. Improvement and Development Agency (IDeA) (2009) Smoking [Online] last accessed 2nd December 2009 at http://www.idea.gov.uk/idk/core/page.do?pageId=5889940 Improvement and Development Agency (IDeA) (2007) Smoke-free Legislation [Online] last accessed 2nd December 2009 at http://www.idea.gov.uk/idk/core/page.do?pageId=6166044 National Health Service (NHS) (2009) Health A-Z: Coronary Heart Disease [Online] last accessed 2nd December 2009 at http://www.nhs.uk/conditions/Coronary-heart-disease/Pages/Introduction.aspx National Health Service (NHS) (2008) Rates of Heart Disease in the Young [Online] last accessed 2nd December 2009 at http://www.nhs.uk/news/2007/January08/Pages/Ratesofheartdiseaseintheyoung.asp National Heart Forum (2006) Economic Cost of Heart Disease [Online] last accessed 2nd December 2009 at http://www.heartforum.org.uk/AboutCHD_Economicburden.aspx Nemetz, P. N., Roger, V. L., Ransom, J. E., Bailer, K. R., Edwards, W. D., Leibson, C. L. (2008) Recent Trends in the Prevalence of Coronary Disease: A Population-Based Autopsy Study of Non-natural Deaths Archival of Internal Medicine Vol. 168, No. 3, pp. 264-270. NHS East Lancashire (2010) SMYL If you want to live longer [Online] last accessed 2nd December 2009 at http://www.smyl.eastlancspct.nhs.uk/welcome/ NHS Networks (2010) East Lancashire Public Health Network [Online] last accessed 2nd December 2009 at http://www.networks.nhs.uk/networks.php?pid=727 Smoke Free (2007) Smoke-free Legislation Compliance Data [Online] last accessed 2nd December 2009 at http://www.smokefreeengland.co.uk/files/dhs01_03-smokefree_report_final.pdf Wells, A. J. (1999) Passive Smoking and Coronary Heart Disease New England Journal of Medicine Vol. 341, No. 9, pp.697-698. World Health Organisation (WHO) (2004) Causes of Death (part 2). The Global Burden of Disease: 2004 Update [Online] last accessed 2nd December 2009 at http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part2.pdf World Health Organisation (WHO) (2010a) Cardiovascular Diseases: Key messages to protect heart health [Online] last accessed 2nd December 2009 at http://www.who.int/cardiovascular_diseases/en/ World Health Organisation (WHO) (2002) Global Burden of Disease in 2002: Data Sources, Methods and Results [Online] last accessed 2nd December 2009 at https://apps.who.int/infobase/compare.aspx?dm=10countries=818%2c250%2c414%2c484%2c554%2c566%2c643%2c710%2c826%2c840year=2002sf1=mo.cg.059sex=all World Health Organisation (WHO) (2010d) Global Information System on Tobacco Control [Online] last accessed 2nd December 2009 at http://www.who.int/tobacco/global_data/en/index.html World Health Organisation (WHO) (2010e) Global Network [Online] last accessed 2nd December 2009 at http://www.who.int/tobacco/global_interaction/en/ World Health Organisation (WHO) (2010c) Regional Activities to the Global CVD Strategy [Online] last accessed 2nd December 2009 at http://www.who.int/cardiovascular_diseases/region/en/ World Health Organisation (WHO) (2010b) Research and Global Partnership Initiatives [Online] last accessed 2nd December 2009 at http://www.who.int/cardiovascular_diseases/research/en/ World Health Organisation (WHO) (2008) Tobacco Use: Infobase [Online] last accessed 2nd December 2009 at https://apps.who.int/infobase/report.aspx?rid=116dm=8 Bibliography American Heart Association (2010) Risk Factors and Coronary Heart Disease [Online] last accessed 2nd December 2009 at http://www.americanheart.org/presenter.jhtml?identifier=4726 Ash (2007) Ash facts at a glance: Smoking and Diseases [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_94.pdf ASH (2009) Ash facts at a glance: Implementation of the Smoke-free Law in England, Wales and Northern Ireland [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_594.pdf Ash (2009) Ash facts at a glance: Tobacco Regulations [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_96.pdf Ash (2010) Ash facts at a glance: Smoking Statistics [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_93.pdf Ash (2010) Ash facts at a glance: Tobacco Economics [Online] last accessed 2nd December 2009 at http://www.ash.org.uk/files/documents/ASH_95.pdf British Heart Foundation Statistics Website (2009) Mortality [Online] last accessed 2nd December 2009 at http://www.heartstats.org/topic.asp?id=17 Bullen, C. (July, 2008). Impact of Tobacco Smoking and Smoking Cessation on Cardiovascular Risk and Disease. Expert Review of Cardiovascular Therapy, Vol. 6, No. 6, pp. 883-895. Chime Communications Plc (2008) East Lancashire PCT Enlists BMT to Develop a Campaign to Tackle the Region s Biggest Killer [Online] last accessed 2nd December 2009 at http://www.chime.plc.uk/press-releases/bmt-launches-east-lancashire-pct-campaign-could-it-be-you Department of Health (DoH) (2004) The National Service Framework for Coronary Heart Disease: Wining the War on Heart Disease [Online] last accessed 2nd December 2009 at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4077154 Department of Health (DoH) (2010) Public Health [Online] last accessed 2nd December 2009 at http://www.dh.gov.uk/en/Publichealth/index.htm Ewles L, Simnett I. (2003). Promoting Health: A Practical Guide. London: Balliere Tindall. Ford, E. S. Capewell, S. (2007) Coronary Heart Disease Mortality Among Young Adults in the U.S. from 1980 Through 2002. Concealed Levelling of Mortality Rates Journal of the American College of Cardiology Vol. 50, pp. 2128-2132. Hill, S. Blakely, T., Kawachi, I., Woodward, A. (2004) Mortality Among Never Smokers Living with Smokers: Two Cohort Studies British Medical Journal Vol. 328, No. 7446, pp. 988-989. Improvement and Development Agency (IDeA) (2007) Smoke-free Legislation [Online] last accessed 2nd December 2009 at http://www.idea.gov.uk/idk/core/page.do?pageId=6166044 Improvement and Development Agency (IDeA) (2009) Smoking [Online] last accessed 2nd December 2009 at http://www.idea.gov.uk/idk/core/page.do?pageId=5889940 Jiang, H.E., Vupputuri, S., Allen, K., Prerost, M. R., Hughes, J., Whelton, P. K. (1999) Passive Smoking and the Risk of Coronary Heart Disease A Meta Analysis of Epidemiological Studies New England Journal of Medicine Vol. 340, No. 12, pp. 920-926. Kaur, S., Cohen, A., Dolor, R., Coffman, C.J., Bastian, L.A. (2004) The Impact of Environmental Tobacco Smoke on Women s Risk of Dying from Heart Disease: A Meta Analysis Journal of Women s Health Vol. 13, No. 8, pp. 888-897. National Health Service (NHS) (2008) Rates of Heart Disease in the Young [Online] last accessed 2nd December 2009 at http://www.nhs.uk/news/2007/January08/Pages/Ratesofheartdiseaseintheyoung.asp National Health Service (NHS) (2009) Health A-Z: Coronary Heart Disease [Online] last accessed 2nd December 2009 at http://www.nhs.uk/conditions/Coronary-heart-disease/Pages/Introduction.aspx National Heart Forum (2006) Economic Cost of Heart Disease [Online] last accessed 2nd December 2009 at http://www.heartforum.org.uk/AboutCHD_Economicburden.aspx Nemetz, P. N., Roger, V. L., Ransom, J. E., Bailer, K. R., Edwards, W. D., Leibson, C. L. (2008) Recent Trends in the Prevalence of Coronary Disease: A Population-Based Autopsy Study of Non-natural Deaths Archival of Internal Medicine Vol. 168, No. 3, pp. 264-270. NHS East Lancashire (2010) SMYL If you want to live longer [Online] last accessed 2nd December 2009 at http://www.smyl.eastlancspct.nhs.uk/welcome/ NHS Networks (2010) East Lancashire Public Health Network [Online] last accessed 2nd December 2009 at http://www.networks.nhs.uk/networks.php?pid=727 Smoke Free (2007) Smoke-free Legislation Compliance Data [Online] last accessed 2nd December 2009 at http://www.smokefreeengland.co.uk/files/dhs01_03-smokefree_report_final.pdf Wells, A. J. (1999) Passive Smoking and Coronary Heart Disease New England Journal of Medicine Vol. 341, No. 9, pp.697-698. Whincup, P. H., Gilg, J. A., Emberson, J. R., Jarvis, M. J., Feyerabend, C., Bryant, A., Wakler, M., Cook, D. G. ( 2004) Passive Smoking and Risk of Coronary Disease and Stroke: Prospective Study with Cotinine Measurement British Medical Journal Vol. 329, No. 7459, pp. 200-205. World Health Organisation (WHO) (2002) Global Burden of Disease in 2002: Data Sources, Methods and Results [Online] last accessed 2nd December 2009 at https://apps.who.int/infobase/compare.aspx?dm=10countries=818%2c250%2c414%2c484%2c554%2c566%2c643%2c710%2c826%2c840year=2002sf1=mo.cg.059sex=all World Health Organisation (WHO) (2004) Causes of Death (part 2). 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Language and Cognition Essay

For years, I have witnessed how the art of teaching had evolved and it keeps on evolving. Every year, the teaching practice is revised; old techniques are changed with new approaches suiting the new generation. Unknowingly, teachers are pressured to cope with all these changes yet with their dedication, they find means to give quality education to us students. With this article, teachers are given a new way to teach young minds. I strongly believe that a child’s first steps to learn language and literacy are the most crucial ones. His first learning and experiences in school will serve as his foundation throughout his life. I could see the importance of teachers in this stage. Thus, teachers should be competent enough to develop the child. The new approach discussed in the article promotes interactive teaching and interactive learning and as a student, I agree with this approach. By using this approach, students are encouraged to talk and participate and as a result given more chance to express their thoughts and ideas in class well making it easy for learning. As I see it for the teachers’ side, it would be more convenient for them to listen to their students’ responses and so they could understand their knowledge and thinking, as well as correct some misunderstandings and misconceptions. On the other hand, it was stated in the article that other teachers might be hesitant to apply this new approach with their fear of losing classroom control, and I understand that since some students, when given freedom to speak, misuse it. Nevertheless, as a learner, I am very open to this approach and I appreciate this article for helping teachers in acquiring new techniques for their profession and also for helping students learn language better which is their foremost step to literacy and quality education.

The Effect of Outsourcing on Public Sector Organizations

The Effect of Outsourcing on Public Sector Organizations JOHN H HANNAH III UNIVERSITY OF PHOENIX The Effect of Outsourcing on Public Sector Organizations This paper will examine the particular issues associated with the impact of outsourcing on public sector organization’s performance and employee commitment. As the move to outsourcing is part of a wider phenonom for flexibility in the organizational, structure, development and change paradigms of public sector organizations.This paper begins by examining the problems associated with an outsourcing strategy in public sector organization. Many counties within the US, have chosen to outsource the investment and operation of non-competitive public services, such as water and waste management, public transports, mail services, information and communication technology services, facilities management and road infrastructures. Outsourcing today has become an essential revenue and growth strategy for almost every existing corporation. It creates flexibility in the company, ensuring the maximum utilization of available resources within the company. It also offers corporations cost advantages and help free up their management resources. Orange county government-anywhere USA, requested the services of a Home Land Security Specialist to assist in the collaborative, assessment, development and strategic enhancement of it municipality’s Information Technology (IT) and Critical Facilities’ (CF) upgrades and security.Upon the completion of plan, expectations and deliverables, a series of introductions with Directors, Managers and Supervisors, it was apparent the federal dollars associated with the project was indeed the motive for the invitation. In my initial general assessment and development of a strategy, the organization handbook was the first critical reading which uncovered a mission statement, values, ethical guidelines and the organizational cultural premise. â€Å"The Mayor’s outline the v ision, values and mission as simple – to serve. You have an important job to do as we work to meet the needs of our citizens.We ensure that roads are built and maintained; we protect environmental resources; we respond to crisis and emergency situations; we staff facilities that care for people; and we ensure that the quality of life of our citizens is protected our challenge is to build on the strengths of our diverse community so that everyone can enjoy the very best Orange County has to offer. We are committed to maintaining an organization where citizens are engaged in civic affairs, take ownership in their government and have input in the decision making process†.The following core values serve as our foundation: 1. FAIRNESS, 2. WORK ETHIC 3. INTEGRITY AND CHARACTER 4. EXCELLENCE AND INNOVATION: 5. PROFESSIONALISM AND ACCOUNTABILITY (Orange County Government, 2012) . The role of the Security Specialist in this public sector organization is to examine the particular issues associated with the impact of outsourcing on public sector organization’s performance and employee commitment and develop a strategy to move this organization toward outsourcing initially in the areas of IT and CF.Provide an assessment and evaluation of the organizational readiness for change in the area of outsourcing. This paper begins by examining the problems associated with an outsourcing strategy in public sector organization in the form of an assessment. As public sector moves to outsourcing as part of a wider strategy to increase flexibility in the organizational, structure, development and change paradigms of public sector organization. Outsourcing helps organizations to be focused.Since the most valuable resource within management is time, once a process is successfully outsourced, the management gets more and effective time to explore new revenue streams, time to accelerate other projects and time to focus on customers. Traditionally executives spend 80 per cent of their time managing details, and only 20 percent on planning and customer relations, in other words, a successful outsourcing process can help reverse this ratio.Outsourcing can also help companies to have access to new technologies that might not be used in their company. This is mainly because the outsourcers use the latest state-of-the art technologies to serve their private sector clients. And this might also increase the change paradigm shift and rapid migration of these companies to new technology. Outsourcing also helps multi functional areas and department of a public sector providing the benefit of 24-hour operational cycles and providing necessary services to their customer.The ever- growing pressure for increased productivity and profitability of city, county and state governments thus, the pressures to reduce costs and improve productivity are the main factors that influenced the beginning of offshore outsourcing. For example, the main advantages to move producti on to private contracting of products and services to reduce in-house human resources management cost. Hence, today outsourcing has become an attractive and powerful strategy for companies to reduce cost and improve performance.These models provide theoretical guidelines upon which valid and reliable organizational assessments should be based. All of these models provide value to management and human resource organizational leaders performing organizational assessments based on a internal aspects or a system theory evaluation approach (Erwin & Garman, 2010). The McKinsey 7S Framework model is used as a tool to assess and monitor changes in the internal situation of an organization closed system assessment. The model is based on the theory that, for an organization to perform well, these seven elements need to be aligned and mutually reinforcing.So, the model can be used to help identify what needs to be realigned to improve performance, or to maintain alignment (and performance) dur ing other types of change. The basic premise of the model is that there are seven internal aspects of an organization that need to be aligned if it is to be successful evaluation and assessment tool. The Seven Interdependent Elements of the 7s model are Hard elements (strategy, structure and systems) and the Soft Elements (shared values, skills, style and staff) (Waterman, Peters, & Phillips, 1980)Burke & Litwin Model (The Casual Model of Organizational Performance & Change) – The Burke & Litwin Model, suggests linkages that hypothesize how performance is affected by internal and external factors. It provides a framework to assess organizational and environmental dimensions that are keys to successful change and it demonstrates how these dimensions should be linked causally to achieve a change in performance. According to Burke-Litwin’s model, an organization may conduct a change intervention in stages as they relate to a specific focus in two stages â€Å"First order and Second order† changes.If an OD intervention is directed toward structure, systems, and management practice result, it can be considered a first order change, if interventions are directed toward mission, strategy, leadership, and organizational culture then result in second order change (Burke & Litwin, 1992). The Marvin Weisbord-Six-Box Model (Weisbord’s Model) is designed to assess the functioning of organizations based mainly on the techniques and assumptions of the field of organizational development. The model represents a particular way of looking at organizational structure and design.It gives attention to issues such as planning, incentives and rewards, the role of support functions such as personnel, internal competitions among organizational units, standards for remuneration, partnerships, hierarchies and the delegation of authority, organizational control, accountability and performance assessment. The model also follows the basic ‘systems' approac h to organizational functioning including the well-known inputs and ‘outputs' categories. The six-box model is comprised of the following components (boxes): (1). Purposes, (2). Structure, (3) relationships; (4). Rewards, (5). Leadership, (6).Coordinating technologies. The only disadvantage to this model is it s design to only address internal environments (Weisbord, 1978). An open system organizational development theory and (Burke & Litwin) model will be utilized to conduct a diagnosis analysis planned change assessment to the organization. These changes are usually designed to address an organization problem or to help an organization prepare for future. It is the one method of quickly bringing change, which focus on human and social aspects of the organization as a way to improve organization’s ability to adapt and solve problems.The best theory is developed from practice; the best practice should be grounded in theory (Seeger, 2006; Brown, 2011). The Burke & Litwin Model hypothesizes’ how performance is affected by internal and external factors. Public sector management occurs within a complex, dynamic system involving stakeholders, coupled with informational and resource material flows and behaviour that is characterized by interactions related to internal and external environments. According to Burke-Litwin’s model, an organization may conduct a change intervention in stages as they relate to a specific focus in two stages â€Å"First order and Second order† changes.If an OD intervention is directed toward structure, systems, and management practice result, it can be considered a first order change, if interventions are directed toward mission, strategy, leadership, and organizational culture then result in second order change (Burke & Litwin, 1992). The theory of Organizational readiness for change is considered a multi-level, multi-faceted construct. From and organization-level construct, readiness for change refers t o organizational members' shared resolve to implement a change (change commitment) and shared belief in their collective capability to do so (change efficacy).Organizational readiness for change varies as a function of how much organizational member’s value the change and how favorably they appraise three key determinants of implementation capability: task demands, resource availability, and situational factors. When organizational readiness for change is high, organizational members are more likely to initiate change, exert greater effort, exhibit greater persistence, and display more cooperative behavior (Weiner, 2009). References Bateman, T. S. , & Snell, S. A. (2007). Management: Leading & collaboratiing in a competitive world (7th ed. . New York, NY: McGraw Hill – Irwin. Boland, T. , & Fowler, A. (2000). A systems perspective of performance management in public sector management. The International Journal of Public Sector organizations, 13(5), 417-446. doi:10. 110 8/09513550010350832 Brown, D. R. (2011). An experiential approach to organization development (8th ed. ). Boston, MA: Prentice Hall. Burke, W. W. , & Litwin, G. H. (1992). Causal model of organization performance and change’. Journal Management, 18(3), 523-545. doi:10. 1177/014920639201800306 Erwin, D. G. , & Garman, A. N. (2010).Resistance to organizational change: Linking research and practice,. Leadership & Organization Development Journal, 31(1), 39-56. doi:10. 1108/01437731011010371 Harrison, M. I. , & Shirom, A. (1999). Organizational diagnosis and assessment: Bridging theory and practice. Thousand Oaks, CA: Sage. Kotter, J. (1995). Leading change: Why transformation efforts fail. Harvard Business Review, 59-67. Retrieved from http://89. 248. 0. 102/upload/Topplederprogrammet/Kotter. pdf Lewin, K. (1951). Field Theory in Social Science. London, England: Harper Row. 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The Historical Development Of Painting Media Essay

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