Health Promotion and Statistics Research Paper

This assignment proposes to discuss the role of the nurse in health promotion.  To facilitate the discussion in the delivery of primary, secondary and tertiary levels of health promotion, the health risk of tobacco smoking in relation to Lung Cancer has been chosen.  National policies will be explored in relation to smoking and how these influence the delivery of health promotion by the nurse.  The barriers to health promotion will be identified along with ways in which these may be overcome.Health Promotion and Statistics Research Paper 

The intention of the World Health Organist (WHO) to achieve “Health for All” by the year 2000 was published in their Ottawa Charter, the outcome of which was to build healthy public policy, create supportive environments, strengthen communities, develop personal skills and reorient health services.  They identified key factors which can hinder or be conducive to health; political, economic, social, cultural, environmental, behavioral, and biological (WHO 1986).Health Promotion and Statistics Research Paper

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The current health agenda for the UK aims to improve the health of the population and reduce inequalities with particular emphasis on prevention and targeting the number of people who smoke (DH 2010).

Inequalities in health have been extensively researched and although attempts have been made to overcome these, there is evidence to support that the divide between the rich and the poor still exists in society.  Marmot (2010) highlighted the lower social classes had the poorest health and identified social factors such as low income and deprivation as the root causes which affect health and well being.   Increased smoking levels were found to be more prevalent in this cohort.  Bilton et al (2002) suggests the environment an individual lives in can have an adverse effect on health in that it can influence patterns of behaviour.  For example, families living in poor housing conditions, in poverty or in an environment away from a social support network can suffer psychological stress; which in turn can prompt coping behaviors such as tobacco smoking (Blackburn 1991, Denny & Earle 2005).Health Promotion and Statistics Research Paper

Smoking is a modifiable risk factor to chronic disease such as Cancer of the Lung, with 90% of these cases being the result of smoking (Cancer Research UK 2009) it   is the single biggest preventable cause of premature death and illness and is more detrimental to the poorer in society.  Responsible for 80,000 lives per year, the huge financial burden on the NHS to treat illness associated with smoking is estimated at £2.7 billion each year (DH 2010).  This illustrates the huge opportunity for public health to address the wider issues associated with inequalities and to target people who smoke.  Various White papers have demonstrated the Government’s commitment in reducing smoking figures and preventing uptake, both at individual and population levels, through health promotion activity, empowering individuals and enabling them to make healthier lifestyle choices (DH 2004, DH 2006, DH 2010).

Health promotion is a complex activity and is difficult to define.  Davies and MacDonald (2006) describe health promotion as “any strategy or intervention that is designed to improve the health of individuals and its population”.   However perhaps one of the most recognized  definitions is that of the World Health Organizations who describes health promotion as “a process of enabling people to increase control over their health and its determinants, and thereby improve their health (WHO 1986).

If we look at this in relation to the nurse’s role in smoking cessation and giving advice to a patient, this can be seen as a positive concept in that with the availability of information together with support, the patient is then able to make an informed decision, thus creating empowerment and an element of self control.  Bright (1997) supports this notion suggesting that empowerment is created when accurate information and knowledgeable advice is given, thus aiding the development of personal skills and self esteem.

A vital component of health promotion is health education which aims to change behaviour by providing people with the knowledge and skills they require to make healthier decisions and enable them to fulfill their potential.   Healthy Lives Healthy People (2010) highlight the vital role nurses play in the delivery of health promotion with particular attention on prevention at primary and secondary levels.   Nurses have a wealth of skills and knowledge and use this knowledge to empower people to make lifestyle changes and choices.  This encourages people to take charge of their own health and to increase feelings of personal autonomy (Christensen 2006).   Smoking is one of the biggest threats to public health, therefore nurses are in a prime position to help people to quit by offering encouragement, provide information and refer to smoking cessation services.

There are various approaches to health promotion, each approach has a different aim but all share the same desired goal, to promote good health and prevent or avoid ill health (Peate 2006).  The medical approach contains three levels of prevention as highlighted by Naidoo and Wills (2000), primary, secondary and tertiary prevention.Health Promotion and Statistics Research Paper

Primary health promotion aims to reduce the exposure to the causes and risk factors of illness in order to prevent the onset of disease (Tones & Green 2004).  In this respect it is the abstinence of smoking and preventing the uptake through health education and preventative measures.  One such model of prevention is that of Tannahill’s (1990) which consists of three overlapping circles; health education for example a nurse may be involved in the distribution of leaflets educating individuals or a wider community regarding health risks of smoking, prevention, aimed at reducing the exposure to children, for example, in 2007 the legal age for tobacco sales increased from age 16 to 18 years in an attempt to reduce the availability to young people and prevent them from starting to smoke (DH 2008),  health protection such as lobbying for a ban on smoking in public places.

If we look at this in relation to the role of the school nurse, this is a positive step when implementing school policies such as no smoking on school premises for staff and visitors, as this legislation supports the nurse’s role when providing information regarding the legal aspects of smoking.   Research demonstrates that interventions are most effective when combined with strategies such as mass media and government legislation (Edwards 2010).   Having an awareness of such campaigns and legislation is essential to aid best practice and the nurse must ensure that knowledge and skills are regularly updated, a standard set by the Nursing and Midwifery Council (NMC 2008).

Croghan & Voogd (2009) identify the school nurse’s role as essential in the health and well-being of children in preventing smoking.    Many people begin to smoke as children, the earlier smoking is initiated, the harder the habit is to break (ASH) and this unhealthy behaviour can advance into adulthood.   Current statistics illustrate that in 2009 6% of children aged 11-15 years were regular smokers (Office for National Statistics 2009).  These figures demonstrate the importance of prevention and intervention at an early stage as identified by the National Service Framework (NSF) for Children, Young People and Maternity Services (DH 2004).  Smith (2009) highlights the school nurse as being in an advantageous position to address issues such as smoking and suggests that by empowering children by providing support and advice, this will enable them to adopt healthy lifestyles.

NICE (2010) suggest school based interventions to prevent children smoking aimed at improving self esteem and resisting peer pressure, with information on the legal, economic and social aspects of smoking and the harmful effects to health.   Walker et al (2006) argue self esteem is determined by childhood experiences and people with a low self esteem are more likely to conform to behaviors of other people.   This can be a potential barrier in the successful delivery of health promotion at this level, with young children exposed to pressure to conform; they are more likely to take up unhealthy behaviors such as smoking (Parrott 2004).   The nurse can overcome this by working in partnership with teachers and other staff members to promote self-esteem by ensuring an environment conducive to learning, free from disruptive behaviour which promotes autonomy, motivation, problem solving skills and encourages self-worth (NICE 2009).Health Promotion and Statistics Research Paper

Despite the well known health risks to tobacco smoking, unfortunately 1 in 5 individuals continue to smoke (DH 2010).  Whitehead (2001) cited in Davies (2006) argues the nurse must recognize and understand health related behaviour in order to promote health.  Therefore, when delivering health promotion the nurse needs to be aware of all the factors which can affect health, some of which can be beyond individual control.  Smoking cessation is one of the most important steps a person can make to improve their health and increase life expectancy, as smokers live on average 8 years less than non smokers (Roddy & Ross 2007).

Secondary prevention intends to shorten episodes of illness and prevent the progression of ill health through early diagnosis and treatment (Naidoo & Wills 2000).  This can be directed towards the role of the practice nurse in a Primary Care setting, where patients attend for treatment and advice that have symptoms of illness or disease as a result of smoking, such as Bronchitis.  Nice guidelines (2006) recommend that all individuals who come into contact with health professionals should be advised to cease smoking, unless there are exceptional circumstances where this would not be appropriate, and for those who do not wish to stop, smoking status should be recorded and reviewed once a year.  It is therefore essential the nurse maintains accurate and up to date record keeping.Health Promotion and Statistics Research Paper

Smoking cessation advice can be tailored to the specific individual and therefore it is important that the nurse has the knowledge and counseling skills for this to be effective.  The process of any nursing intervention is ultimately assessment, planning, implementing and evaluating (Yura & Walsh 1978), this applies to all nurses in any given situation including health promotion.  One such method of smoking cessation which can be used as an assessment tool is known as the 5 ‘A’s approach, ‘ask, assess, advise, assist, arrange (Britton 2004).  “Ask” about tobacco use, for example how many cigarettes are smoked each day, and “assess” willingness and motivation to quit, taking a detailed history to assess addiction.   Objective data can be obtained using a Smoker which measures Carbon Monoxide levels in expired air (Wells & Lusignan 2003).  These simple devices can be used as a motivational tool to encourage cessation and abstinence.    Castledine (2007) suggests the principle of a good health promoter is to motivate people to enable them to make healthier choices; this is made possible by the ability to engage with individuals at all levels.  Individuals who are not motivated are unlikely to succeed (Naidoo & Wills 2000).   “Advise” patients to stop smoking and reinforce the health benefits to quitting, “assist” the patient to stop, setting a quit date and discussing ways in which nicotine withdrawal can be overcome.  Being unable to cope with the physical symptoms of withdrawal can cause relapse and be a barrier to success, therefore it is essential the nurse possesses a good knowledge base of the products available to assist in reducing these symptoms if she is to persuade people to comply with treatment, such as the use of nicotine replacement therapy (NRT).    NRT is useful in assisting people to stop smoking and has proved, in some instances to double the success rate (Upton & Thirlaway 2010).  NRT products are continually changed and updated; therefore the nurse must ensure she has the knowledge and skills to identify which products are available, the suitability, how it works and any potential side effects.  Identifying triggers and developing coping strategies is useful for maintenance of a new behaviour, measures such as substituting cigarettes for chewing gum and changing habits and routines are just some of the ways in which self control can be achieved (Ewles & Simnett 1999).  Finally “arrange” a follow up, providing continual support and engagement. For patients who do not wish to stop smoking, advice should be given with encouragement to seek early medical treatment on detection of any signs and symptoms of disease.  Good communication skills are essential to the therapeutic relationship between the nurse and a patient and these must be used effectively by providing clear, accurate and up to date information.  The nurse should be an active listener and encourage the patient to talk, using open-ended questions helps demonstrate a willingness to listen, listening and showing concern for a patient’s condition demonstrates respect (Peate 2006).  The use of medical jargon and unfamiliar words can be a barrier to communication and should be avoided as these can affect a patients understanding.  Leaflets can reinforce information provided by the nurse and increase patient knowledge, however the nurse must ensure these are in a format and language the patient can understand.  Lack of literacy skills can prevent a patient reading and understanding the content of a leaflet, the nurse can assist with this by reading and explaining to them.Health Promotion and Statistics Research Paper

To assist in the assessment process the nurse may utilize a model of behaviour such as Prochaska & DiClemente’s stages of change model (1984).  This works on the assumption that individuals go through a number of stages in order to change behaviour, from pre -contemplation where a person has not considered a behaviour change, to maintenance, when a healthier lifestyle has been adopted by the new behaviour.   The stage a person is at will determine the intervention given by the nurse; therefore it is essential that an effective assessment takes place.  Walsh (2002) highlights patient motivation as central to success using this model, in that a patient will have more motivation; the more involved they are in planning the change.

Despite the health promoting activities mentioned and the increasing public awareness of the health risks to smoking, there are people who continue to smoke and some further develop illness as a consequence.  Lung cancer has one of the lowest survival rates, and as little as 7% of men and 9% of women in England and Wales will live five years after diagnosis (Cancer Research UK 2011).  Acknowledging this, the governments “Cancer Plan” aimed to tackle and reform cancer care in England by raising awareness of the signs and symptoms of cancer by investing in staff and extending the nurses role (DH 2000).  This involves further training and education for nurses to develop their skills and knowledge to enable them to provide the treatment and/or advice required.  This was succeeded by “Improving outcomes: a strategy for cancer” the aim being to enable patients living with cancer a “healthy life as possible”.   The government pledged £10.75 million into advertising a “signs and symptoms” campaign to raise awareness of the three cancers accounting for the most deaths, breast, bowel and lung, to encourage the public to seek early help on detection of any symptoms (DH 2011).  Currently no results are available on the effectiveness of this intervention due to its recent publication, however, one national policy that has had a positive effect on the health of individuals and the population is that of the “smoke-free England” policy implemented in 2007 prohibiting smoking in workplaces and enclosed public places.  Primarily this policy was enforced to protect the public from second hand smoke; however, on introduction of the law smoking cessation services saw an increase in demand by 20%, as smokers felt the environment was conducive to them being able to quit (DH 2008).  This policy also extended to hospital grounds, and the nurse must ensure a patient who smokes is aware of this on admission and use every opportunity possible to promote health.Health Promotion and Statistics Research Paper

Tertiary prevention aims to halt the progression, or reduce the complications, of established disease by effective treatment or rehabilitation (Tones & Green 2004).  A diagnosis of cancer can cause great distress and a patient may go through a whole host of emotions.  Naidoo and Wills (2000) suggest the aim of tertiary prevention is to reduce suffering and concerns helping people to cope with their illness.   The community nurses role has been identified as pivotal in providing support for patients and families living with cancer (DH 2000).  The World Health Organization describe Palliative care as treatment to relieve, rather than cure, the symptoms caused by cancer,  and suggest palliative care can provide relief from physical, psycho social and spiritual problems in over 90% of cancer patients (WHO 2011).

Assessment and the provision of health education and information at this stage remains the same as that in secondary prevention, and it is not uncommon for the two to overlap.  Providing advice and education on symptom control may alleviate some of the symptoms the patient experiences,  for example breathlessness is a symptom of lung cancer (Lakasing & Tester 2006), and relaxation techniques may reduce this (Cancer Research UK 2011), therefore the nurse may be involved in teaching these techniques to the patient and family members.  Continual smoking despite a lung cancer diagnosis can exacerbate shortness of breath and reduce survival rate (Roddy & Ross 2007), therefore the nurse can use this opportunity to reinforce the risks of smoking.  However, the nurse must use her judgement effectively and be sensitive to the patient’s condition, as the willingness to learn and respond to teaching can be affected by emotional state (Walsh 2002).  Establishing effective pain control is essential in the care of a cancer patient and this may involve discussion with the patients GP if medication needs adjusting.  A referral to specialist help lines such as those provided by Macmillan cancer support may be useful in assisting a patient and/or family to cope with cancer, these services can be accessed in person or by telephone.  These are just two examples of collaborative working and demonstrate the importance of inter-professional working.

In conclusion, with the emphasis of health promotion concerning prevention of illness and disease, the role of the nurse is essential in raising awareness and providing education and advice to individuals to facilitate behaviour change. The complexities of health promotion indicate the extensive competences a nurse must possess to empower and motivate individuals.  However, governments also have a responsibility to promote and protect health and are pivotal in introducing national policy to build “healthy public's” and environments conducive to health.

Health promotion is not a new concept. The fact that health is determined by factors not only within the health sector but also by factors outside was recognized long back. During the 19^th century, when the germ theory of disease had not yet been established, the specific cause of most diseases was considered to be ‘miasma’ but there was an acceptance that as poverty, destitution, poor living conditions, lack of education, etc., contributed to disease and death. William Alison's reports (1827-28) on epidemic typhus and relapsing fever, Louis Rene Villerme's report (1840) on Survey of the physical and moral conditions of the workers employed in the cotton, wool and silk factories John Snow's classic studies of cholera (1854), etc., stand testimony to this increasing realization on the web of disease causation.Health Promotion and Statistics Research Paper

The term ‘Health Promotion was coined in 1945 by Henry E. Sigerist, the great medical historian, who defined the four major tasks of medicine as promotion of health, prevention of illness, restoration of the sick and rehabilitation. His statement that health was promoted by providing a decent standard of living, good labor conditions, education, physical culture, means of rest and recreation and required the co-ordinate d efforts of statesmen, labor, industry, educators and physicians. It found reflections 40 years later in the Ottawa Charter for health promotion. Sigerist's observation that “the promotion of health obviously tends to prevent illness, yet effective prevention calls for special protective measures” highlighted the consideration given to the general causes in disease causation along with specific causes as also the role of health promotion in addressing these general causes. Around the same time, the twin causality of diseases was also acknowledged by J.A.Ryle, the first Professor of Social Medicine in Great Britain, who also drew attention to its applicability to non communicable diseases.(7)

Health education and health promotion are two terms which are sometimes used interchangeably. Health education is about providing health information and knowledge to individuals and communities and providing skills to enable individuals to adopt healthy behaviors voluntarily. It is a combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes, whereas health promotion takes a more comprehensive approach to promoting health by involving various players and focusing on multiculturalism approaches. Health promotion has a much broader perspective and it is tuned to respond to developments which have a direct or indirect bearing on health such as inequities, changes in the patterns of consumption, environments, cultural beliefs, etc.(3)

The ‘New Perspective on the Health of Canadians’ Report known as the Lalonde report, published by the Government of Canada in 1974, challenged the conventional ‘biomedical concept of health, paving way for an international debate on the role of non medical determinants of health, including individual risk behavior. The report argued that cancers, cardiovascular diseases, respiratory illnesses and road traffic accidents were not preventable by the medical model and sought to replace the biomedical concept with ‘Health Field concept which consisted of four “health fields”-lifestyle, environment, health care organization, human biology as the determinants of health and disease. The Health Field concept spelt out five strategies for health promotion, regulatory mechanisms, research, efficient health care and goal setting and 23 possible courses of action. Lalonde report was criticized by skeptics as a ploy to stem in the governments rising health care costs by adopting health promotion policies and shifting responsibility of health to local governments and individuals. However, the report was lapped up internationally by countries such as USA, UK, Sweden, etc., who published similar reports. The landmark concept also set the tone for public health discourse and practice in the decades to come.(7–10) Health promotion received a major impetus in 1978, when the Alma Ata declaration acknowledged that the promotion and protection of the health of the people was essential to sustained economic and social development and contributed to a better quality of life and to world peace.(5)Health Promotion and Statistics Research Paper

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To investigate how interventions may work we will look at the effects of alcohol consumption on individuals and populations, and draw attention to the search for policies that protect health, prevent health problems such as liver cirrhosis, cardiovascular disease and disability, and address the social problems associated with the misuse of alcohol consumption. What alcohol policy is why it is needed, which interventions are effective, how policy is made, and how scientific evidence can inform the policy-making process? Also looking at why the higher the average amount of alcohol consumed in a society, the greater the incidence of problems experienced by that society.

We will access the policy responses that are considered to reduce alcohol consumption: alcohol taxation, legislative controls on alcohol availability, and age restrictions on alcohol purchasing, media information campaigns, school-based education, community action programs, and treatment interventions. Considering the influence of environments that people live in, effects of cultures and social norms that define the appropriate uses of alcohol.

The value of population thinking in alcohol policy, and its ability to identify health risks and suggest appropriate interventions comparing different intervention strategies in terms of their effectiveness, and the ever-changing process that needs to constantly adapt to the evidence of new research results and tested intervention if it is to serve the interests of public health. One of the biggest determinants to alcohol consumption is the advertising and marketing of alcohol products by the drinks industry.

The extent and the nature of alcohol marketing will be examined to illustrate its effects on consumption, cultures and social norms. We will show that more evidence is needed to progress education as a viable intervention. Showing evidence that the majority of the population, alter their damaging drinking through the phenomenon of spontaneous remission, maturing out or self change.Health Promotion and Statistics Research Paper

It is good practice to learn from the past to plan for the future, the control of alcohol production, distribution, and consumption, has been around for thousands of years, such as requiring that all wine be diluted with water before being sold, these were devised by monarchs, governments, and the clergy to prevent alcohol-related problems.

But it was not until the rise of modern medicine and the emergence of the world Temperance Movement in the 19th century that alcohol policy was first seen as a potential instrument of public health. Between 1914 and 1921, laws prohibiting the manufacture and sale of all or most forms of beverage alcohol were adopted in the United States, Canada, Norway, Iceland, Finland, and Russia (Paulson 1973). Most of these laws were repealed during the 1920s and 1930s, and replaced by less extreme regulatory policies.

To view alcohol policies through the narrowly focused perspective of prohibition, however, is to ignore the fact that most policy-making during the past century has been incremental, deliberate, and respectful of people’s right to drink in moderation.: Alcohol control policies in public health perspective (Bruun et al. 1975), Sponsored by the World Health Organization (WHO), the monograph drew attention to the preventable nature of alcohol problems and to the role of national governments and international agencies in the formulation of rational and effective alcohol policies.

Alcohol control policies stimulated a heated debate not just among academics, but also among policy-makers. The most significant aspect of the book was its main thesis: the higher the average amount of alcohol consumed in a society, the greater the incidence of problems experienced by that society. Consequently, one way to prevent alcohol problems is through policies directed at the reduction of average alcohol consumption, particularly those policies that limit the availability of alcohol.

In the early 1990s, a new project was commissioned by WHO to review the development of the world literature pertaining to alcohol policy. The new study produced Alcohol policy and the public good, a book that proved to be as thought-provoking as its predecessor (Edwards et al. 1994). The book concluded that public health policies on alcohol had come of age because of the strong evidential underpinnings derived from the scientific research that had grown in breadth and sophistication since 1975.

After reviewing the evidence on taxation of alcohol, restrictions on alcohol availability, drinking and driving countermeasures, school-based education, community action programs, and treatment interventions, it was concluded that: The research establishes beyond doubt that public health measures of proven effectiveness are available to serve the public good by reducing the widespread costs and pain related to alcohol use.

To that end, it is appropriate to deploy responses that influence both the total amount of alcohol consumed by a population and the high-risk contexts and drinking behaviors that are so often associated with alcohol-related problems. During the past decade there have been major improvements in the way alcohol problems are studied in relation to alcohol policies. With the growth of the knowledge base and the maturation of alcohol science, there is now a real opportunity to invest in evidence-based alcohol policies as an instrument of public health.Health Promotion and Statistics Research Paper

In 1994, Edwards and his colleagues provided a broader view of alcohol policy, considering it as a public health response dictated in part by national and historical concerns. Though there was not an explicit definition of the nature of alcohol policy, its meaning could be inferred from the wealth of policy responses that were considered: alcohol taxation, legislative controls on alcohol availability, and age restrictions on alcohol purchasing, media information campaigns, and school-based education, to name a few.

Public policies are authoritative decisions made by governments through laws, rules, and regulations (Longest 1998). The word ‘authoritative’ indicates that the decisions come from the legitimate scope of legislators and other public interest group officials, not from private industry or related advocacy groups. Based on their nature and purpose, alcohol polices can be classified into two categories: allocative and regulatory (Longest 1998).Health Promotion and Statistics Research Paper

Allocative policies are intended to provide a net benefit to a distinct group or type of organization (sometimes at the expense of other groups or organizations) in order to achieve some public objective. The provision of treatment for alcohol-dependent persons is an example of a policy that seeks to reduce the harm caused by alcohol or to increase access to services for certain population groups.

In contrast to allocative policies, regulatory policies seek to influence the actions, behaviors, and decisions of others through direct control of individuals or organizations. Economic regulation through price controls and taxation is often applied to alcoholic beverages to reduce demand and to generate tax revenues. Laws that impose a minimum purchasing age and limit hours of sale have long been used to restrict access to alcohol for reasons of health and safety.

From the perspective of this paper, the central purpose of alcohol interventions is to serve the interests of public health and social well-being through their impact on health and social determinants, such as drinking patterns, the drinking environment, and the health services available to treat problem drinkers. Drinking patterns and behaviors that lead to intoxication, which leads to accidents, injuries, and violence.

Similarly, drinking patterns that promote frequent and heavy alcohol consumption are associated with chronic health problems such as liver cirrhosis, cardiovascular disease, and depression. Alcohol is causally related to more than 60 International Classification of Diseases codes (Rehm, Room, Graham, and others 2003); disease outcomes are among the most important alcohol-related problems.

4 percent of the global burden of disease is attributable to alcohol, or about as much death and disability globally as is attributable to tobacco and hypertension (Ezzati and others 2002; WHO 2002). The conclusions for alcohol policy are the same, whether alcohol is the sole causal factor for or consequence, a causal factor among many others or a factor mediating the influence of another causal factor.

In all cases alcohol contributes to social burden, and public policy must strive to reduce this burden, as well as the alcohol-related burden of disease. While there may be some offsetting psychological benefits from drinking (Peele and Brodsky 2000), from the point of view of minimizing the social harm from drinking, the general conclusion is that the lower the consumption, the better.

The environmental determinants of alcohol-related harm include the physical availability of the product, the social norms that define the appropriate uses of alcohol (e.g., as a beverage, as an intoxicant, as a medicine), and the economic incentives that promote its use. Health and social policies that influence the availability of alcohol, the social circumstances of its use, and its retail price are likely to reduce the harm caused by alcohol in a society.

Overall, the conclusion must be that alcohol consumption levels affect the health of a population as a whole. In addition to this, the predominant pattern of drinking in a population can have a major influence on the extent of damage from alcohol consumption. Patterns that seem to add to the damage are drinking to intoxication, and recurrent binge drinking. Another important determinant of health in relation to alcohol is the availability of and access to health services, particularly those designed to deal with alcohol dependence and alcohol-related disabilities.Health Promotion and Statistics Research Paper

Alcohol-related health services can be preventive, acute, and rehabilitative, and can be either voluntary or coercive. Health policies have a major impact on the alcohol treatment and preventive services available in people within a country through health care financing and the organization of the health care system. Bondy S.J. (1996) Public health is concerned with the management and prevention of diseases and injuries in human populations. Unlike clinical medicine, which focuses on the care and cure of disease in individual cases, public health deals with groups of individuals, called populations.

The value of population thinking in alcohol policy is in its ability to identify health risks and suggest appropriate interventions that are most likely to benefit the greatest number of people. The concept of ‘population is based on the assumption that groups of individuals exhibit certain commonalities by virtue of their shared characteristics (e.g., gender), shared environment (e.g., towns, countries) or shared occupations (e.g., alcoholic beverage service workers) that increase their risk of disease and disability, including alcohol-related problems (Fos and Fine 2000).

They also provide epidemiological data to monitor trends, design better interventions, and evaluate programs and services. In the context of the “public good” served by effective alcohol policy refers to those things that benefit most for a given society. One such public good would be effective intervention that would reduce alcohol related harm. Just as the eradication of malaria or (HIV) infections globally are seen as “global public goods” (Smith et al 2003).Health Promotion and Statistics Research Paper

By locating alcohol policy within the realm of public health and social policy, rather than economics, criminal justice, or social welfare, Authorities tend to approach alcohol as a major determinant of ill health. Health is viewed not only as the absence of disease and injury, but also as a state in which the biological, psychological, and social functioning of a person are maximized in everyday life (Brook and McGlynn 1991).

The way in which health is defined and valued within a society has important implications for alcohol policy. If it is defined narrowly as the absence of disease, then the focus is often placed on the treatment of alcohol dependence and the clinical management of alcohol-related disabilities, such as cirrhosis of the liver and traumatic injuries. If health is defined more broadly, then alcohol policy can be directed at proactive interventions that help many more people attain optimal levels of health.

Health is influenced by a variety of factors, including the physical, social, and economic environments that people live in, and by their genetic make-up, their personal lifestyles, and the health services that they have access to. An attempt is made to synthesize what is known about evidence-based interventions that can be translated into policy. By comparing different intervention strategies in terms of their effectiveness, scientific support, general ism, and cost, it becomes possible to evaluate the relative appropriateness of different strategies, both alone and in combination, to present problems and future needs.Health Promotion and Statistics Research Paper

As the scientific basis for alcohol policy begins to take shape, it is becoming apparent that there is no single definitive, much less politically acceptable, approach to the prevention of alcohol problems; a combination of strategies and policies is needed. If this realization is sobering, so too is the conviction, argued in this paper, that alcohol policy is an ever-changing process that needs to constantly adapt to the evidence of new research results and tested intervention if it is to serve the interests of public health. It will require extraordinary measures, some of them relatively painless to implement, others more demanding in terms of resources, ingenuity, and public support.

Another important factor is the “social norms” of a society where there are important differences in the cultural meaning of drinking for men and women. Societies normative expectations regarding the use of alcohol vary across age groups and between men and women. In some societies, drinking has been almost exclusively a province of men (Roizen 1981), In many societies, abstention rates increase in the later stages of life for both men and woman (Demers et al. 2001; Taylor et al. 2007).

This reflects social norms as older people are not suppose to get intoxicated and party as is common among st young people. Most societies use taxation of alcoholic beverages to bring in revenue in larger or smaller quantities to relevant budgets. Alcoholic beverages are, by any reckoning, important, economically.

The benefits connected with the production, sale, and use of alcohol come at an enormous cost to society. Public health specialists and policy-makers who forget this fact do so only at their peril (Edwards and Holder 2000). Also social customs and economic interests should not blind us to the fact that alcohol is a toxic substance. It has the potential to adversely affect nearly every organ and system of the body. No other commodity sold for ingestion, not even tobacco, has such wide-ranging adverse physical effects.

Taking account of alcohol’s potential for toxicity is therefore an important task for public health policy. Especially the past decade, it can be said that remarkable progress was made in the scientific understanding of alcohol’s harmful effects, as scientists discovered biological, chemical, and psychological explanations for humans propensity to consume what has been called ‘the ambiguous molecule (Edwards 2000).

One of the biggest determinants to alcohol consumption is the advertising and marketing of alcohol products by the drinks industry. The extent and the nature of alcohol marketing have changed globally in the last decade, and the research has also expanded considerably to better understand its effects. Most of the new research is directed to the measurement of the impact of marketing on youth.Health Promotion and Statistics Research Paper

More is now known about the effects of marketing on younger people’s beliefs and intentions to drink as well as on their drinking behaviour. Research has investigated the impact of marketing other than the broadcast and print media advertising, although some of the new media and marketing approaches being used by the alcohol industry remain unmeasured and under-researched.

The first examination is the current state of alcohol marketing and what is known about the way in which marketing has its impact. Second, two different policy approaches codes of content and restrictions to reduce exposure are assessed for their likely impact on consumption and harm. Interventions that change exposure to advertising have often been limited and evaluations have mixed findings.

More effort has gone into the establishment of codes aimed to affect the content of the advertising. Conclusions regarding the likely effects of these approaches can be made based on theoretical understanding and empirical evidence about the way in which marketing has its effects and its measured impacts. Conclusions may also be informed by research on tobacco advertising where the impacts are established and widely accepted (Lovato et al. 2004; Henriksen et al. 2008).

The alcohol industry insists that they only advertise to promote their own particular brands, and that the advertising does not affect any rise in the consumption of alcoholic beverages. Research and evidence shows that the commodity chain analysis highlights the importance of advertising, sponsorship and other forms of marketing to a globalized alcohol industry (Jernigan 2006). The marketing of the products and brand(s) produced is essential for the profit-making enterprise.Health Promotion and Statistics Research Paper

Marketing now involves much more than advertising using traditional media outlets such as print, television, and radio. Marketing exploits the possibilities provided by the design of products. New products and packaging have been developed to meet the needs and wants of different sectors of the market (Brain 2000). Pr-mixed drinks in which spirits or beer are made more palatable by the addition of a soft drink base or fruit flavorings have expanded in sales very rapidly and have become associated in some contexts, but not all, with heavier consumption (Huckle et al. 2008b).

Packaging has increased acceptability and palatability of alcoholic beverages among young people (Copeland et al. 2007; Gates et al. 2007). It utilizes a range of new media opportunities including electronic means, and a key element is the sponsorship of sporting and cultural events. The measured media (usually broadcast and print) is known to be an underestimation of the marketing effort by a factor of two to four (Anderson et al. 2009b). Marketing at the place of sale has become increasingly important with an expansion of alcohol sales into more retail outlets.

This often goes hand in hand with pricing promotions. For example buy-some-get-some-free (Jones and Lynch 2007). Promotion of alcohol brands in electronic media is a major part of marketing. Advertising is also shown in cinemas and this is increasingly supplemented by product placement in movies and television. Newer forms of electronic communication such as internet networking sites e-mail and cell phones have also provided new opportunities for alcohol promotion which are popular with young people (Jernigan and O’Hara 2004).

Sports and cultural events, particularly those with appeal to young people, are widely sponsored by alcohol brands. They also provide opportunities for direct marketing through free gifts and exclusive ‘pourage’ rights (Hill and Casswell 2004). Carlsberg’s sponsorship of the EURO 2004 football/soccer championship was reported to grow the brand by about 6% worldwide; Carlsberg told shareholders that its signage had appeared in the background of television sport coverage for an average of 16 minutes per game (Carlsberg 2006).

Much of marketing, including that based on sponsorship, crosses national boundaries. (Breen 2008). The theology is that the first stage is liking alcohol advertisements, followed by a desire to emulate the featured characters (including those that depict the lifestyle of young adults), and then the belief expressed that acting this way will result in positive benefits (Austin et al. 2006). Much of the marketing that targets young people is driven by an understanding of the importance of alcohol consumption for identity formation.Health Promotion and Statistics Research Paper

The advertising is designed to provide humor, attractive ideas, images, phrases, and other resources that are used in the process of peer-to-peer interaction as identity is formed and communicated (McCreanor et al. 2005). The longitudinal studies have been subjected to systematic reviews. The strength of the association, the consistency of the findings, the temporal relationship, the dose-response relationship and the theoretical plausibility of the effect have led to the conclusion that alcohol advertising increases the likelihood that young people will start to use alcohol and will drink more if they are already using alcohol (Jernigan 2006; Smith and Foxcroft 2009; Anderson et al 2009b).

Experience with policies to restrict the negative impacts of marketing is less well developed than with other areas of alcohol policy. In part this reflects the rapid developments and financial investment in marketing and media over the last four decades and a failure of policy developments to keep abreast of marketing practices. Research has suggested that voluntary codes are subject to under-interpretation and under-enforcement (Rearck Research 1991; Saunders and Yap 1991; Sheldon 2000; Dring and Hope 2001; Jones et al. 2008); including a bias in favor of the corporations represented on the decision-making board (Marin Institute 2008a).

There are also documented cases of the instability of such voluntary codes in response to changing market conditions (Martin et al. 2002; Hill and Casswell 2004). Following the introduction of a ‘co-regulatory approach in the UK, in which a government agency was delegated the handling of broadcast complaints to the Advertising Standards Authority (funded by the Alcohol industry), a code change was introduced.

Research demonstrated that advertisements continued to contain attributes that appealed to young people and the data showed a link between exposure to advertisements and consumption of specific beverages (Gunter et al. 2008). This substantial body of research has shown that, even if alcohol marketing remains in line with codes on alcohol advertising content, it nevertheless encourages drinking and has an impact on younger people’s beliefs and alcohol consumption levels.

A recent analysis of self-regulation by the alcohol industry in the UK concluded it was not an effective driver of change towards good practice (KPMG 2008b). Overall there is no evidence to support the effectiveness of industry self-regulatory codes, either as a means of limiting advertisements deemed unacceptable or as a way of limiting alcohol consumption (Booth et al 2008). Research has also suggested that the effects of marketing on beliefs about alcohol counteract any possible effect from health promotion activities (Wallack 1983; Center on Alcohol Marketing and Youth 2003).Health Promotion and Statistics Research Paper

Recipients, who bring their own cultural and social experiences to their interpretation of the marketing, may perceive heavy drinking or intoxication as represented within the advertising even when it is not shown directly (Duff 2003; McCreanor et al 2008). This is particularly likely to have an impact on efforts to reduce heavier drinking as a cultural norm.

To investigate how interventions may work we will look at the effects of alcohol consumption on individuals and populations, and draw attention to the search for policies that protect health, prevent health problems such as liver cirrhosis, cardiovascular disease and disability, and address the social problems associated with the misuse of alcohol consumption. What alcohol policy is why it is needed, which interventions are effective, how policy is made, and how scientific evidence can inform the policy-making process? Also looking at why the higher the average amount of alcohol consumed in a society, the greater the incidence of problems experienced by that society.

We will access the policy responses that are considered to reduce alcohol consumption: alcohol taxation, legislative controls on alcohol availability, and age restrictions on alcohol purchasing, media information campaigns, school-based education, community action programs, and treatment interventions. Considering the influence of environments that people live in, effects of cultures and social norms that define the appropriate uses of alcohol.

The value of population thinking in alcohol policy, and its ability to identify health risks and suggest appropriate interventions comparing different intervention strategies in terms of their effectiveness, and the ever-changing process that needs to constantly adapt to the evidence of new research results and tested intervention if it is to serve the interests of public health. One of the biggest determinants to alcohol consumption is the advertising and marketing of alcohol products by the drinks industry.Health Promotion and Statistics Research Paper

The extent and the nature of alcohol marketing will be examined to illustrate its effects on consumption, cultures and social norms. We will show that more evidence is needed to progress education as a viable intervention. Showing evidence that the majority of the population, alter their damaging drinking through the phenomenon of spontaneous remission, maturing out or self change.

It is good practice to learn from the past to plan for the future, the control of alcohol production, distribution, and consumption, has been around for thousands of years, such as requiring that all wine be diluted with water before being sold, these were devised by monarchs, governments, and the clergy to prevent alcohol-related problems.

But it was not until the rise of modern medicine and the emergence of the world Temperance Movement in the 19th century that alcohol policy was first seen as a potential instrument of public health. Between 1914 and 1921, laws prohibiting the manufacture and sale of all or most forms of beverage alcohol were adopted in the United States, Canada, Norway, Iceland, Finland, and Russia (Paulson 1973). Most of these laws were repealed during the 1920s and 1930s, and replaced by less extreme regulatory policies.

To view alcohol policies through the narrowly focused perspective of prohibition, however, is to ignore the fact that most policy-making during the past century has been incremental, deliberate, and respectful of people’s right to drink in moderation.: Alcohol control policies in public health perspective (Bruun et al. 1975), Sponsored by the World Health Organization (WHO), the monograph drew attention to the preventable nature of alcohol problems and to the role of national governments and international agencies in the formulation of rational and effective alcohol policies.

Alcohol control policies stimulated a heated debate not just among academics, but also among policy-makers. The most significant aspect of the book was its main thesis: the higher the average amount of alcohol consumed in a society, the greater the incidence of problems experienced by that society. Consequently, one way to prevent alcohol problems is through policies directed at the reduction of average alcohol consumption, particularly those policies that limit the availability of alcohol.Health Promotion and Statistics Research Paper

In the early 1990s, a new project was commissioned by WHO to review the development of the world literature pertaining to alcohol policy. The new study produced Alcohol policy and the public good, a book that proved to be as thought-provoking as its predecessor (Edwards et al. 1994). The book concluded that public health policies on alcohol had come of age because of the strong evidential underpinnings derived from the scientific research that had grown in breadth and sophistication since 1975.

After reviewing the evidence on taxation of alcohol, restrictions on alcohol availability, drinking and driving countermeasures, school-based education, community action programs, and treatment interventions, it was concluded that: The research establishes beyond doubt that public health measures of proven effectiveness are available to serve the public good by reducing the widespread costs and pain related to alcohol use.

To that end, it is appropriate to deploy responses that influence both the total amount of alcohol consumed by a population and the high-risk contexts and drinking behaviours that are so often associated with alcohol-related problems. During the past decade there have been major improvements in the way alcohol problems are studied in relation to alcohol policies. With the growth of the knowledge base and the maturation of alcohol science, there is now a real opportunity to invest in evidence-based alcohol policies as an instrument of public health.

In 1994, Edwards and his colleagues provided a broader view of alcohol policy, considering it as a public health response dictated in part by national and historical concerns. Though there was not an explicit definition of the nature of alcohol policy, its meaning could be inferred from the wealth of policy responses that were considered: alcohol taxation, legislative controls on alcohol availability, and age restrictions on alcohol purchasing, media information campaigns, and school-based education, to name a few.Health Promotion and Statistics Research Paper

Public policies are authoritative decisions made by governments through laws, rules, and regulations (Longest 1998). The word ‘authoritative’ indicates that the decisions come from the legitimate scope of legislators and other public interest group officials, not from private industry or related advocacy groups. Based on their nature and purpose, alcohol polices can be classified into two categories: allocative and regulatory (Longest 1998).

Allocative policies are intended to provide a net benefit to a distinct group or type of organization (sometimes at the expense of other groups or organizations) in order to achieve some public objective. The provision of treatment for alcohol-dependent persons is an example of a policy that seeks to reduce the harm caused by alcohol or to increase access to services for certain population groups.

In contrast to allocative policies, regulatory policies seek to influence the actions, behaviors, and decisions of others through direct control of individuals or organizations. Economic regulation through price controls and taxation is often applied to alcoholic beverages to reduce demand and to generate tax revenues. Laws that impose a minimum purchasing age and limit hours of sale have long been used to restrict access to alcohol for reasons of health and safety.

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From the perspective of this paper, the central purpose of alcohol interventions is to serve the interests of public health and social well-being through their impact on health and social determinants, such as drinking patterns, the drinking environment, and the health services available to treat problem drinkers. Drinking patterns and behaviors that lead to intoxication, which leads to accidents, injuries, and violence.

Similarly, drinking patterns that promote frequent and heavy alcohol consumption are associated with chronic health problems such as liver cirrhosis, cardiovascular disease, and depression. Alcohol is causally related to more than 60 International Classification of Diseases codes (Rehm, Room, Graham, and others 2003); disease outcomes are among the most important alcohol-related problems.

4 percent of the global burden of disease is attributable to alcohol, or about as much death and disability globally as is attributable to tobacco and hypertension (Ezzati and others 2002; WHO 2002). The conclusions for alcohol policy are the same, whether alcohol is the sole causal factor for or consequence, a causal factor among many others or a factor mediating the influence of another causal factor.Health Promotion and Statistics Research Paper

In all cases alcohol contributes to social burden, and public policy must strive to reduce this burden, as well as the alcohol-related burden of disease. While there may be some offsetting psychological benefits from drinking (Peele and Brodsky 2000), from the point of view of minimizing the social harm from drinking, the general conclusion is that the lower the consumption, the better.

The environmental determinants of alcohol-related harm include the physical availability of the product, the social norms that define the appropriate uses of alcohol (e.g., as a beverage, as an intoxicant, as a medicine), and the economic incentives that promote its use. Health and social policies that influence the availability of alcohol, the social circumstances of its use, and its retail price are likely to reduce the harm caused by alcohol in a society.

Overall, the conclusion must be that alcohol consumption levels affect the health of a population as a whole. In addition to this, the predominant pattern of drinking in a population can have a major influence on the extent of damage from alcohol consumption. Patterns that seem to add to the damage are drinking to intoxication, and recurrent binge drinking. Another important determinant of health in relation to alcohol is the availability of and access to health services, particularly those designed to deal with alcohol dependence and alcohol-related disabilities.

Alcohol-related health services can be preventive, acute, and rehabilitative, and can be either voluntary or coercive. Health policies have a major impact on the alcohol treatment and preventive services available in people within a country through health care financing and the organization of the health care system. Bondy S.J. (1996) Public health is concerned with the management and prevention of diseases and injuries in human populations. Unlike clinical medicine, which focuses on the care and cure of disease in individual cases, public health deals with groups of individuals, called populations.Health Promotion and Statistics Research Paper

The value of population thinking in alcohol policy is in its ability to identify health risks and suggest appropriate interventions that are most likely to benefit the greatest number of people. The concept of ‘population’ is based on the assumption that groups of individuals exhibit certain commonalities by virtue of their shared characteristics (e.g., gender), shared environment (e.g., towns, countries) or shared occupations (e.g., alcoholic beverage service workers) that increase their risk of disease and disability, including alcohol-related problems (Fos and Fine 2000).

They also provide epidemiological data to monitor trends, design better interventions, and evaluate programs and services. In the context of the “public good” served by effective alcohol policy refers to those things that benefit most for a given society. One such public good would be effective intervention that would reduce alcohol related harm. Just as the eradication of malaria or (HIV) infections globally are seen as “global public goods” (Smith et al 2003).

By locating alcohol policy within the realm of public health and social policy, rather than economics, criminal justice, or social welfare, Authorities tend to approach alcohol as a major determinant of ill health. Health is viewed not only as the absence of disease and injury, but also as a state in which the biological, psychological, and social functioning of a person are maximized in everyday life (Brook and McGlynn 1991).

The way in which health is defined and valued within a society has important implications for alcohol policy. If it is defined narrowly as the absence of disease, then the focus is often placed on the treatment of alcohol dependence and the clinical management of alcohol-related disabilities, such as cirrhosis of the liver and traumatic injuries. If health is defined more broadly, then alcohol policy can be directed at proactive interventions that help many more people attain optimal levels of health.

Health is influenced by a variety of factors, including the physical, social, and economic environments that people live in, and by their genetic make-up, their personal lifestyles, and the health services that they have access to. An attempt is made to synthesize what is known about evidence-based interventions that can be translated into policy. By comparing different intervention strategies in terms of their effectiveness, scientific support, general ism, and cost, it becomes possible to evaluate the relative appropriateness of different strategies, both alone and in combination, to present problems and future needs.

As the scientific basis for alcohol policy begins to take shape, it is becoming apparent that there is no single definitive, much less politically acceptable, approach to the prevention of alcohol problems; a combination of strategies and policies is needed. If this realization is sobering, so too is the conviction, argued in this paper, that alcohol policy is an ever-changing process that needs to constantly adapt to the evidence of new research results and tested intervention if it is to serve the interests of public health. It will require extraordinary measures, some of them relatively painless to implement, others more demanding in terms of resources, ingenuity, and public support.Health Promotion and Statistics Research Paper

Another important factor is the “social norms” of a society where there are important differences in the cultural meaning of drinking for men and women. Societies normative expectations regarding the use of alcohol vary across age groups and between men and women. In some societies, drinking has been almost exclusively a province of men (Roizen 1981), In many societies, abstention rates increase in the later stages of life for both men and woman (Demers et al. 2001; Taylor et al. 2007).

This reflects social norms as older people are not suppose to get intoxicated and party as is common among st young people. Most societies use taxation of alcoholic beverages to bring in revenue in larger or smaller quantities to relevant budgets. Alcoholic beverages are, by any reckoning, important, economically.

The benefits connected with the production, sale, and use of alcohol come at an enormous cost to society. Public health specialists and policy-makers who forget this fact do so only at their peril (Edwards and Holder 2000). Also social customs and economic interests should not blind us to the fact that alcohol is a toxic substance. It has the potential to adversely affect nearly every organ and system of the body. No other commodity sold for ingestion, not even tobacco, has such wide-ranging adverse physical effects.Health Promotion and Statistics Research Paper

Taking account of alcohol’s potential for toxicity is therefore an important task for public health policy. Especially the past decade, it can be said that remarkable progress was made in the scientific understanding of alcohol’s harmful effects, as scientists discovered biological, chemical, and psychological explanations for humans’ propensity to consume what has been called ‘the ambiguous molecule’ (Edwards 2000).

One of the biggest determinants to alcohol consumption is the advertising and marketing of alcohol products by the drinks industry. The extent and the nature of alcohol marketing have changed globally in the last decade, and the research has also expanded considerably to better understand its effects. Most of the new research is directed to the measurement of the impact of marketing on youth.

More is now known about the effects of marketing on younger people’s beliefs and intentions to drink as well as on their drinking behaviour. Research has investigated the impact of marketing other than the broadcast and print media advertising, although some of the new media and marketing approaches being used by the alcohol industry remain unmeasured and under-researched.

The first examination is the current state of alcohol marketing and what is known about the way in which marketing has its impact. Second, two different policy approaches codes of content and restrictions to reduce exposure are assessed for their likely impact on consumption and harm. Interventions that change exposure to advertising have often been limited and evaluations have mixed findings.

More effort has gone into the establishment of codes aimed to affect the content of the advertising. Conclusions regarding the likely effects of these approaches can be made based on theoretical understanding and empirical evidence about the way in which marketing has its effects and its measured impacts. Conclusions may also be informed by research on tobacco advertising where the impacts are established and widely accepted (Lovato et al. 2004; Henriksen et al. 2008).Health Promotion and Statistics Research Paper

The alcohol industry insists that they only advertise to promote their own particular brands, and that the advertising does not affect any rise in the consumption of alcoholic beverages. Research and evidence shows that the commodity chain analysis highlights the importance of advertising, sponsorship and other forms of marketing to a globalized alcohol industry (Jernigan 2006). The marketing of the products and brand(s) produced is essential for the profit-making enterprise.

Marketing now involves much more than advertising using traditional media outlets such as print, television, and radio. Marketing exploits the possibilities provided by the design of products. New products and packaging have been developed to meet the needs and wants of different sectors of the market (Brain 2000). Pre-mixed drinks in which spirits or beer are made more palatable by the addition of a soft drink base or fruit flavourings have expanded in sales very rapidly and have become associated in some contexts, but not all, with heavier consumption (Huckle et al. 2008b).