Disadvantages of Using Technology in the Classroom Essay

In most cases, technology is a true blessing to the modern-day classroom, making access to information faster and easier to understand than ever before. But just like all new innovations, it is not without drawbacks. Here are some of them One of the first cons of classroom technology is the financial aspect. Not every school can afford the numerous pieces of electronics needed for even a single classroom to be fully equipped. At best some schools can only afford a limited number of these items.But it’s not only this. Once technology is purchased for a school, the cost of upkeep and maintenance can be too expensive for the school to maintain. Outdated software and hardware components can have compability issues with available programs. Unless the teacher is well trained in technology and can support the hardware in the classroom, an IT will be needed to troubleshoot problems whicj means even more scpenses for the school. Also, the cost of repairing broken equipment may be too expensive for school budgets. In order for a school to successfully integrate technology, there must be a replacement or updating plan in place to keep technology updated and useful. Because of connection problems, downloading issues, illegal software and other difficulties, teachers can sometimes stop using it simply because the lack of time. To lose the 10 minutes period just because of connectivity issues is not fair, and it’s one of the main reasons for the failure of technology integration in schools To sum up, technology can be powerful learning and educating tool, but schools must first ask themselves if they have the resources, not only the material but also human resources, to afford and maintain such expensive equipment . This can lead to students and teachers competing for such resources, which can only affect badly to the school environment. While technology can be a great addition to the classroom, it also can be a source of frustration for both teachers and students. Unless the teacher is well trained in technology and can support the hardware in the classroom, an IT will be needed to troubleshoot problems.. Additionally, technology often needs frequent maintenance to keep it in good condition for use. Once technology is purchased for a school, the cost of upkeep and maintenance can be too expensive for the school to maintain. Outdated software and hardware components can have compability issues with available programs. Also, the cost of repairing broken equipment may be too expensive for school budgets. In order for a school to successfully integrate technology, there must be a replacement or updating plan in place to keep technology updated and useful.

Marketing Plan Phase III Essay

Marketing Plan Phase III MKT 421 Marketing Plan Phase III In-N-Out Burgers basic values and philosophy is simple: make the highest quality product, prepare the product in a clean environment, and serve the product in a warm and friendly manner. Introducing a new product to In-N-Out Burgers traditional menu will challenge the products success with both existing customers as well as new customers. The introduction of the salad with a desirable zest to In-N-Out Burgers menu will bring a healthier choice to improve the menu and escalate customer satisfaction. The new product will be entering the market during the very competitive and less profitable maturity stage of the product life cycle. The target market for the new product will be families that want a choice in the fast food restaurant industry. The new salads with their flavorful attributes will give In-N-Out Burgers a competitive advantage because of their positioning and differentiation strategies at the right price. Product Attributes Maintaining the tradition of quality, In-N-Out will only use quality salad dressings on their salads. In-N-Out’s competition uses Newman’s popular brand name salad dressing that has an established fan base, and another competitor uses Ken’s salad dressing that are ranked the most popular salad dressing brands. They tend to be higher in calorie count so In-N-Out will be challenging the competition to provide a healthier salad option by using Annie’s Organic Salad dressings. Cost will be low because only three dressings will be needed to launch the salads; Caesar, ranch, and vinaigrette. This will allow for the growth of the salad line in the future. Mixed greens in the salads will allow for aesthetics’ as well as added nutrition, especially with an array of dark green leafy lettuce such as romaine. Cherry tomatoes will be added for color and fresh shredded carrots for variety. A colorful description of the salads has been added to demonstrate the qua lity of each. Side Salad. In N Out’s side salad is a fresh garden salad with a blend of premium lettuces. The generous salad serving is accented with blended cheeses, shredded carrots, and cherry tomatoes fresh from local farmers. This salad comes with three choices of  dressings; organic ranch or vinaigrette and In-N-Out’s signature special sauce. Caesar Salad. In addition to the variety of greens and cherry tomatoes the Caesar salad is topped with parmesan cheese. The salad is then tossed in a light, flavorful Caesar dressing. Avocado Chicken Salad. In- N- Out’s Avocado salad appeals to the Californian in us all. This salad is a hearty salad meant to satisfy. The mixed greens are combined with cherry tomatoes, blended cheese, red onion, ripe avocado, and grilled chicken. This salad will also come with the choice of ranch, vinaigrette, or special sauce. Product Life Cycle In-N-Out will be entering the salad foray behind the eight-ball in terms of the fast food salad product life cycle. Other fast food restaurants have had salads as an option on their menus for years prior to In-N-Out; they may already have a hold on much of the salad eating market. In-N-Out is entering the salad fast food market during its maturity stage. This means that In-N-Out may not be able to enjoy the large profit margins that early salad pioneers experienced, however, In-N-Out is confident that those smaller margins will be helped by regular increases in salad sales volume in addition to increased sales of the core menu items. In order to maximize salad sales volume, In-N-Out must recognize the maturity of the salad market and promote accordingly. Doing this will require In-N-Out to differentiate its salad offering from the competition and reposition its standing in the minds of consumers who do not feel that In-N-Out has an adequate assortment of food options. Customers who seek out salad offerings no doubt are interested in health benefits, freshness, availability, and price. In-N-Out is already known for their freshness and taste; their competition, on the other hand, many times, is not. In-N-Out must emphasize through their marketing mix that the same crisp freshness that customers expect from ingredients on their burgers is the same crisp freshness they can expect in their salads. The simple, low calorie nature of In-N-Out salads should be made clear because competitor salads often are not very in calories or sodium content. The simple and fresh nature of In-N-Out products will be an advantage of health conscious consumers. In-N-Out has an opportunity to win with quality but also due to the nature of competitor pricing, In-N-Out has an opportunity to match or beat their competitors in that arena as well. In-N-Out would do well to indicate the price advantage of their fresh options compared to the competitions heavier and pricier salad menus. Finally, In-N-Out must make it a priority to reposition its lack of choice perception in the fast food market. They must make it clear to customers that they now have an option beyond burgers and fries at In-N-Out. Couples and groups of people can eat at our restaurants even if one or more of the individuals is vegetarian or seeking a healthier options. Positioning and Differentiation Strategies Product differentiation strategy is part of the marketing strategy of a company that will establish a strong identity within a specific target market for that product. The goal is to have the intended consumer perceive the product desirable and different. With the introduction of salads to the In-N-Out Burgers menu, the company will need to establish a product differentiation strategy as other competitors also have salads on their menu. The difference that In-N-Out Burgers brings with their salads is the quality of the food. No pre-packaged, frozen or over processed vegetables will be used. Product positioning strategy is also part of the marketing strategy of a company, but the goal is focused on the consumer instead of the product and where that product fits in relationship to their competitors. ‘Positioning refers to how customers think about proposed or present brands in a market. Without a realistic view of how customers think about offerings in the market, it is hard for the marketing manager to differentiate.’ (Perreault, Cannon, McCarthy, 2011) In-N-Out Burgers has already positioned itself in the market regarding their burgers and has established a loyal base on customers. In-N-Out Burgers has ‘a famously devoted customer base that inspires envy throughout the industry—and brand recognition well beyond its geographic reach.’(Pearman, 2009) The product positioning strategy currently used for their burgers should be extended to their new salad products. Pricing Strategy The price strategy that In-n-Out will be using for their new salads is to target those price-conscious customers looking for healthy options along with the current menu options being offered. As a company In-N-Out is aware that there is a need in consumers who want to keep a healthy lifestyle while  still being able to have selections with reasonable pricing. In addition to appealing to those consumers wanting a healthier choice when ordering, In-N-Out is conscious that the competition will have similar selections with similar pricing as well. In this instance because the company doesn’t use intermediaries to promote or sell products, they will add to the marketing strategies by increasing the advertising on radio and TV commercials with the new salad options that have been added to the traditional menu that has been around since the company began. The advertising efforts will also add to the value that In-N-Out has had from day one, and that is freshness of their products. In-N-Out is confident that by using previous marketing strategies to offer the menu to consumers and offering the salads to the traditional menu with similar pricing will not only continue to keep existing customers but will also bring in new customers. Conclusion The new salad with its flavorful attributes will give In-N-Out Burgers a competitive advantage because of their positioning and differentiation strategies at the right price. The attributes of the three new salads being introduced to the menu are healthier, colorful, great tasting choices. The product is entering the market in the maturity stage of the product life cycle but In-N-Out Burgers can maintain this stage with its commitment to quality, and freshness, which gives it a competitive advantage. The success of the product will come from the firms positioning and differentiation strategies of quality while focusing on customer interests. In-N-Out Burgers price strategy will be competitive in the industry so as to draw new customers as well as satisfy the needs of the existing customers. In-N-Out Burgers is about quality, competitiveness, customer satisfaction, and a healthy diet. References Pearman, S. (2009). In-N-Out Burger’s Marketing Magic. Retrieved from http://www.businessweek.com/smallbiz/content/apr2009/sb20090424_877655.htm Perreault, W., Cannon, J., & McCarthy, E. (2011). Basic Marketing: A Marketing Strategy Planning Approach (8th ed.). New York, NY: McGraw Hill/Irwin.

Critical Review of the Literature of the role that Dietary Factors Play in Preventing Type 2 Diabetes Essay

Critical Review of the Literature of the role that Dietary Factors Play in Preventing Type 2 Diabetes’ Introduction Type 2 Diabetes (T2D) is a rapidly growing international public health issue. It has been reported that 285 million 20–79 year olds had the disease in 2010 worldwide and this is estimated to grow to 439 million by 2030. (19) T2D has been associated with a variety of other health problems such as cardiovascular disease, blindness and shortened life expectancy. (4,40) The prevalence of the disease is associated with obesity and overweight as well as a ‘Western’ dietary pattern and lack of exercise. (17) It has been reported that approximately 80% of people who develop T2D are obese or overweight prior to diagnosis.(8) Diabetes is a preventable disease, (19) with weight loss being identified as one of the most powerful interventions. (4) Diet and physical activity (PA) are effective interventions in attaining this (25) and have also been linked with reduction in risk independently. (40) The primary focus of this paper will look at diet and review the evidence on whether diet alone can help to prevent T2D. As a secondary theme it will also look at the evidence that diet can help to prevent the development of and help to control symptoms after T2D has been diagnosed. 8 papers will reviewed, (26-33) with a purpose of identifying some practical, evidence based dietary guidelines. Dietary guidelines are easier to follow when they indicate specific foods and patterns rather than nutrients and properties of foods and greater compliance can be achieved . (29,31) For this reason the studies reviewed focus on specific foods and diet styles rather than macronutrients and or micronutrients which do not translate into dietary guidelines as easily. Literature Search A literature review using the following databases was carried out; Pubmed, Web of Science, Embase, CINAHL, British Nursing Index and Medline. The following keywords were used in various combinations; Diet, prevention, food, T2D, interventions, dietary, fruit, vegetables, nutrition. Other resources such as ‘Google scholar’ and NHS Choices ‘behind the headlines’ were also utilised. Because T2D is an international issue, papers from around the world were considered. The criteria for inclusion was less than 10 years old, the intervention had to be a specific food group or diet style, measuring new incidents of T2D, or changes is symptoms associated with T2D and adults as the sample group. Diet as a tool to prevent T2D 6 Studies looked at whether diet can prevent T2D. Please refer to Table 1 for details of all the studies. Villegas et al (26) and Bazzano et al (27) looked at fruit, vegetable and fruit juices consumption and fruit and vegetable consumption respectively. Both of the studies used women only in their sample groups, limiting the generalizability of the findings to the wider population. (5) Dietary assessment was achieved through Food Frequency Questionnaires (FFQ) in both studies. Villegas et al (26) provided evidence of their FFQ having been validated, (21) however reported using it only 3 times within a 4.6 year timeframe, questioning the accuracy of their collected data. Bazzano et al (27) data collection was retrospective in that the FFQ was designed in 1984 and followed up at 4 year intervals. The concern with such a dated questionnaire is that it has not accounted for different trends that have occurred over time, affecting the accuracy of the results. Villegas et al (26) confirmed incidence of T2D through subjects meeting the criteria set out by the American Diabetic Association.(2) Bazzano et al (27) used criteria set out by National Diabetes Data Group for all participants up to and including 1997.(16) The Criteria for participants after 1998 was set out by the American Diabetic Association. The reason for this was due to new criteria being published at this time. (2) The main difference being the plasma glucose reading changing from 7.8mmol/l or more to 7.0mmol/l or more. (9) The Criteria Set out by the World Health Organisation in 1985, (24) could have been used to confirm incidence of T2D in the Bazzano et al (27) study . It was published 1 year after baseline data was taken and would have resulted in a higher percentage of participants being diagnosed with the same criteria, increasing consistency and reliability in the results. Villegas et al (26) reported that a higher consumption of vegetables was associated with a reduced risk of T2D. Participants who had a higher vegetable intake were also less likely to smoke and have higher levels of PA, both factors that can reduce the risk of T2D questioning the causality of the reduction in risk. (4) Participants with a higher fruit intake were also less likely to smoke and have higher levels of PA. There was no association made between fruit intake and risk of T2D therefore it is possible to consider that confounders like PA and smoking may not have effected the level of risk to T2D in this study. Bazzano et al (27) reported an inverse association between whole fruit and green leafy vegetable intake. Women who had a higher intake of fruit and vegetables were older, less likely to smoke and more likely to have higher levels of PA. Fruit Juice was positively associated with incidence of T2D which could be due to high sugar content.. (22) Also participants who had the highest fruit juice intake had the lowest levels of PA which is associated with increased risk of T2D. (20)Salas-Salvado et al (28) and Martinez-Gonzalez et al (29) both studied the risk of T2D and adherence to the Mediterranean diet (MedDiet). A MedDiet is characterised by high consumption of fruit, vegetables, whole grains, olive oil, nuts, pulses, fish and reduced consumption of red and processed meats, high fat dairy refined gains and foods high in sugar and starch. (11) Salas-Salvado et al (28) compared adherence to a MedDiet supplemented with either olive oil or nuts with a low fat diet (control group). The supplemented items in the MedDiets were given to participants. Participants in the control group were given non dietary gifts to encourage adherence. There are concerns about the ethics of using incentives and gifts in research. (6)Within this study the use of gifts appears innocuous, the concern lies with how adherence to the diet is reliably measured. When participants are given vital ingredients, this will influence their dietary intake, making it difficult generalize the results. (13) The sample population in this study were older and had at least 3 risk factors relating to cardiovascular disease again making it more difficult to generalise results. Participants were given 7 goals, including;  increasing vegetable and fruit consumption, reducing red and processed meat and increasing the consumption of either olive oils or nuts. The control group were asked to reduce all types of fat. Results showed that participants in the MedDiet groups had a greater reduced risk of T2D. Risk was reduced by 51% in the olive oil group and 52% in the nut group. These findings are backed up by other studies. (38-39) Diabetes incidence was lower in those who attained ≠¥ 4 of the 7 goals. PA levels and changes in weight did not differ through all 3 groups, although the participants in the both the MedDiet groups were associated with higher levels of PA. This study was carried out on Spanish participants, who traditionally follow a MedDiet. The control group may have had a strong adherence to a MedDiet naturally, which could impact on the reliability of the results. Martinez-Gonzalez et al (29) used participants who were nurses and university graduates. Prevalence in T2D is associated with lower socioeconomic status, (1) so by using the participants from a higher socioeconomic group may bias the findings. (13) Participants were not excluded if they had Diabetes at baseline. Data was collected via FFQ which consisted of 136 items with 9 responses ranging from never to more than 6 times a day. Points were allocated to determine a score indicating level of adherence. Questions covered areas such as cooking methods, supplements and fats and oils. This FFQ goes into a lot of detail to obtain the most information it can about participants diets, increasing the validity of the data. However reliability is compromised as participants are asked to recall food intake from the previous year decreasing the accuracy of data collected. (5) The results indicated a significant reduction in risk of developing T2D in those who with strong adherence to the MedDiet after adjustment for age and sex. Participants with a score of ≠¥ 6 had an 83% reduction. Although participants in this group had the highest levels of physical activity, which is a known factor in decreasing the risk of T2D, they also had a higher baseline prevalence for increased risk factors for Diabetes such as age higher BMI and higher blood pressure. This adds weight to the findings the MedDiet can reduce the risk of developing T2D. Fung et al (30) and VanDam et al (31) looked at more generalised dietary  patterns. VanDam et al (31) used a 131 item FFQ specifying specific foods, portion sizes and frequency of intake. Over a space of 12 years data on food intake was collected 3 times. In order to make these results more reliable data collection should have occurred more frequently. The participants were all male health professionals making the sample group quite specific reducing the ability to generalise the findings to the wider population. (13) Foods were classified into groups based on nutritional profiles. Factor analysis was then applied in order to identify food patterns. Two dietary patterns were identified ‘Prudent’ and ‘Western’. Prudent was characterised by high consumption of vegetables, fish and whole grains and Western by high consumption of red and processed meat, high-fat dairy and eggs. Men with higher Western patterns were younger, more likely to smoke and did less PA. Men with higher Prudent diet patterns were older less likely to smoke and engaged in more PA. The Prudent diet was associated with a modest reduction in risk in developing T2D with wholegrain foods having the highest inverse association. Fruit and vegetables were not considerably associated with reduced risk. The Western diet was associated with considerably higher risk of developing T2D. Processed meat, other processed foods and refined grains indicating the most significant association. This could indicate that cutting out specific foods could me more beneficial in reducing the risk of T2D than increasing intake of other foods. Fung et al (30) used participants from the Nurses Health Study which was established in 1976. This is the same study from which Bazzano et al (27) took their participants. The same FFQ was used in this study with baseline also being the 1984 FFQ as this was the expanded 116 item version. The information obtained was then used and classified in the same way as the VanDam et al (31) study producing the same Prudent and Western dietary patterns. The results from this study focus mainly on the Western diet pattern. Similarly to the men in the VanDam et al (31) study, women who scored high in the Western diet pattern were more likely to smoke. The results also mirrored that of the VanDam et al (31) study in that it reported an increased risk of developing T2D and a Western diet pattern. This study investigated the characteristics of the Western dietary pattern further and found positive associations between red and processed meats and  the development of T2D. This could also add weight to the previous comment that cutting out specific foods, such as red and processed meats could be more beneficial than adding other food groups in preventing T2D. A replica study using the same FFQ and Prudent and Western diet pattern and using a sample group that consisted of both men and women could add strength to the finds of both of these studies.(5) Diet as a tool in preventing the development of and giving greater control over the symptoms of T2D Elhayany et al (32) compared a low carbohydrate Mediterranean diet (LCM) a traditional Mediterranean diet (TM) and the 2003 American Diabetic Association diet (ADA) on health parameters. Glycemic control for people with T2D diagnosis was one of the outcome measures. Participants were randomly assigned to 1 of the 3 groups, given recommendations for daily intake on nutritional elements such as calories and protein and advised to engage in 30-45 minutes of PA a week. The LCM and TM diets included only low glycemic index carbohydrates, with LCM having a lower %. The TM and ADA diets had the same % of carbohydrates but the ADA also included mixed glycemic index carbohydrates. FFQ were used asking the participants to recall the last 24hour food intake. It is felt this data will be more accurate than those studies asking participants to recall food intake from the previous year, making results more reliable. Data was collected 3 times over a 12 month period. Results showed all groups had reduced weight and BMI with no significant difference. All 3 dietary interventions reduced factors that increase glycemic control such as HbA1c and triglyceride levels. The LCM diet was the most effective in increasing glycemic control. Esposito et al (33) compared a LCM and a low fat calorie restricted diet (LFD) on glycemic control and the delay on needing to commence antihyperglycemic medication in people newly diagnosed with T2D. The LCM diet was rich in fruit vegetables and whole grains and low in red meat. There was also a requirement that no more than 50% of calories was from  carbohydrates. Complex carbohydrates rather than low GI carbohydrates were stipulated. Some complex carbohydrates can have high GI levels, which are associated with increased risk of Diabetes. (10) The LFD was based on American Heart Association guidelines. (12) Participants were randomized into 1 of 2 groups asked to keep food diaries and given guidelines on increasing physical activity. Data was collected through reviews of the diary. Food diaries could provide more reliable information than FFQ if they are filled out daily. There is still a risk that they could be filled out inaccurately, and that participants may modifies their intake as a result of keeping a diary. The study reported that both groups lost weight, but reduction was greater in the LCM. Overall there was a significant difference in the need to commence antihyperglycemic medication between the LCM and the LFD; 44% and 70% respectively. Potentially this result could have shown more significance if low GI carbohydrates were stipulated instead of complex carbohydrates. Discussion The findings coming out of this review indicate that certain dietary interventions maybe helpful in reducing the risk of developing T2D and may also help with glycemic control after diagnosis.(26-33) Some food groups and dietary patterns provide more consistent evidence than others. The results regarding fruit intake and risk of T2D are inconsistent within this review with Villegas et al (26) reporting no association between fruit and risk reduction, where as Bazzano et al (27) did. High consumption of fruit and vegetables are a major component in the Mediterranean diet and the Prudent dietary pattern, both of which were associated with an inverse association. Vegetables are more consistently associated with a reduced risk, in this review and a recent meta-analysis, (3) particularly green leafy vegetables. (27) More research studying the effects of fruit and vegetables separately is needed. This inconsistency is reflected in other studies and systematic reviews. (7) High intake of fr uit and vegetables has often been associated with higher PA levels within this review, (26-29,31) which is a risk reducing factor in itself. Part of the problem could be that many studies that look at dietary interventions are prospective cohort studies and  although they can provide an association they can not prove whether the cause is due to the dietary item or another factor such as PA or weight loss. More experimental designed research is needed so that a direct cause between diet and the reduction of T2D can be established. (13) While it is unclear the exact role that fruit and vegetables play in reducing the risk of T2D there is an abundance of evidence that a diet rich in fruit and vegetables is beneficial in overall health (34-35) and weight reduction, (23) so including them as part of a healthy diet may indirectly help to reduce the risk of T2D. Red and processed meat has been more consistent in its positive association to developing T2D. Fung et al (28) and VanDam et al (29) found strong associations between consumption and increased risk of T2D. One of the characteristics of The Mediterranean diet is the absence or reduction of red and processed meats, and this diet has been associated with reduced risk. These findings were backed up in a recent meta-analysis paper (18) studying 3 cohorts who’s conclusion suggests that red meat consumption, particularly processed red meat is linked to higher risk of developing T2D. Meta-analysis produces level 1 evidence, providing increased confidence in the conclusions and good grounding for providing evidence based information such as dietary guidelines.(13) Diets high in red and processed meats are linked to high cholesterol (14) which is one of the leading causes of death in people with T2D (15) and other serious health conditions such as cancer and cardiovascular disease. (36) So while increasing fruit and vegetable intake may have a more beneficial and holistic effect on health, the same could be said for reducing the intake of red and processed. Salas-Salvado et al (28) produced higher level evidence being a randomised control trial giving more weight to their findings;(5) following a MedDiet can reduce the risk of T2D. One of the studies that looked at the effect of diet after diagnosis, (32) was also a randomised control trial providing the same level of evidence and weight to their findings that LCM can delay the need for hyperglycaemic medication therefore having a positive beneficial effect on T2D. Although these two studies looked at the effect of diet after diagnosis it could be reasonable to suggest that following the dietary  patterns associated with these findings, prior to diagnosis could help prevent T2D as they are similar dietary patterns to two of the other studies.(28-29) While the findings from this review indicate that making changes to ones diet may help to reduce the risk of Diabetes occurring, it also suggests that implementing the same kind of dietary changes may help with glucose control after Diabetes has been diagnosed, preventing the further development of the disease and the need for antihyperglycemic medication. (32-33) One study has implied that dietary changes in the form of energy restriction can actually reverse beta cell failure and insulin resistance, symptoms found in T2D. (37) It is a very small study and the dietary intervention is severe energy restriction making it difficult to generalise to the wider population, but it is a controlled study and could provide interesting findings that further research could be built upon, that dietary interventions may be able to reverse the symptoms of T2D. Collating this information together it seems reasonable to suggest that making positive changes to dietary habits could have benefits pre and post T2D diagnosis. Dietary Guidelines The findings from the 8 studies in this review can not all be discussed in detail due to word limitation. However recurring themes seem to be occurring, providing information on which to base a set of guidelines. Going by these findings the following guidelines are recommended: Reduce intake of red meat and processed meat (all colours) Substitute these with white meats and fish Reduce intake of other processed foods Reduce intake of refined grains Reduce intake of high sugar foods and drinks including fruit juices Carbohydrate intake should be based on items with a low GI score Increase intake of olive oil Increase nut intake Increase intake of pulses Increase wholegrain intake Increase vegetable intake especially green leafy vegetables Increase fruit intake A Mediterranean style diet is characterised by much of this advise and is therefore a recommended diet style to follow. Conclusion The prevalence of T2D is growing around the world. It has been associated with many other health problems and reduces quality of life and life expectancy. It is a preventable disease and diet is one of the ways in which this disease can be combated. Dietary guidelines have been recommended from the findings of this review, based on following a Mediterranean diet, reducing intake of red and processed meats and other processed foods and increasing intake of foods such as fruit and vegetables, wholegrains and olive oils and nuts. While it has been acknowledged that more research needs to be carried out to further examine the cause and effect between diet and T2D, it is reasonable to suggest that one may find these dietary changes beneficial in helping to reduce the risk of T2D and other areas of health, possibly helping to indirectly reduce risk of T2D. It is also reasonable to suggest that a change in diet may bring beneficial changes once diagnosis has been given. Table 1 Reference list 1. Agardh E, Allenbeck P, Hallqvist J, Moadi T and Sidorchuk A. Type 2 Diabetes and Socioeconomic Position: A Systematic Review and Meta-analysis. International Journal of Epidemiology. 2011: 40(3) 804-818 2. 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European Journal of Clinical Nutrition. 2004:58:17–23 22. Shulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MD, Willet WC, and Hu FB. Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes in Young and Middle-Aged Women. The Journal of the American Medical Association. 2004: 292(8):927-934 23. Tohill B, Seymour J, Serdula M, Kettle-Khan L, and Rolls BJ. What Epidemiological Studies Tell Us about the Relationship between Fruit and Vegetable Consumption and Body Weight. Nutrition Reviews. 2004: 365 -374 24. WHO Study Group on Diabetes Mellitus. Diabetes Mellitus: Report of a WHO Study Group. Geneva: World Health Organisation: 1985 25. NICE Public Health Guidance. Preventing Type 2 Diabetes: Population and Community Interventions. National Institute for Health and Clinical Excellence. 2011: Issue 35 26. Villagers R, Shu OX, Gao YT, Yang G, Elasy T, Li H and Zheng W. Vegetable but Not Fruit Consumption Reduces the Risk of Type 2 Diabetes in Chinese Women. 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History Essay Example | Topics and Well Written Essays - 2000 words - 4

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HR Management in McDonald Essay Example | Topics and Well Written Essays - 1750 words

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Violations of the Code of Ethics Research Paper Example | Topics and Well Written Essays - 750 words

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Software Usability Case Study Example | Topics and Well Written Essays - 500 words

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Magazines,just like all of their mass media counterparts have been Essay

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Personal development Essay Example | Topics and Well Written Essays - 2000 words

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Enid Lee, Incorporating Antiracism Essay Example for Free

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Essay On Parliamentary Sovereignty

Essay On Parliamentary Sovereignty Tesco was founded in 1924 by John Edward Cohen in the East End of London. The name Tesco, was first used on tea, and was derived from the initials of Cohens tea supplier, T E Stockwell, combined with the first two letters of Cohen. Tesco Stores Limited was incorporated in 1932. In 1935, Jack Cohen visited the U S A and was impressed by the supermarkets self-service system which enabled more people to be served faster, with lower labour costs. In 1947, the Tesco branch in St Albans, a small shop by 21st century standards (200 square metres) was the first Tesco to be converted to self service, although it didnt immediately catch the publics imagination. See appendix 1 for details. Tescos Mission Statement Tescos mission statement is to Retain Loyal People. To make sure Tesco achieve their mission statement, they need to know who their loyal customers are. That is why Tesco has got a club card service, through which they can award people by giving them special vouchers and extra points. Vision A business aim is an organisations long-term goal. In 2005, the two core values of Tesco are: No-one tries harder for customers and Treat people as we like to be treated. In 2006, Tescos mission and vision shows that this company is really for quality service and values their customers:  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Be the leader in Quality Service provided to everyone in the retailing industry  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Understand the needs of their client and respond with urgency.  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Meet customers demands and exceeds their expectations  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Maintain highly trained and motivated employees.  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Continuously improve their skills, service and achieve excellence in all of the companys endeavours. Objective Objectives are goals that a firm sets itself for the next three or five years. They have a timescale, they must be measurable and they must contribute to the business achieving its aims. The core objective of Tesco is to establish value for customers in order to gain their lifetime loyalty.  Tescos success depends on their valued customers. These customers shop and work with the company. Tescos principle is, if the customer likes what they offer, surely these people will come back and purchase again. Industry Stage Life Cycle The stage life cycle of the retail industry is no doubt to be mature  because of the profits they are gaining every year. The retail industrys profit is increasing and profiting from their cash cows. Tesco is the largest UK retailer and the 3rd largest global retailer. Tesco controlled 30.8% of the UK grocery market as of May 2009 and ~9% of the UK non-food retail market. The majority of its sales and profits are generated in its 2,282 UK stores, which are segmented into the following formats: Tesco Express neighbourhood convenience store that focuses on fresh products, 961 stores Tesco Metro city centre convenience store,174 stores Tesco Superstore conventional supermarket, 448 stores Tesco Extra hypermarket that serves an entire community, 177 stores Tesco Homeplus and One-Stop account for its remaining stores The company also sells general merchandise through Tesco Direct, its online and catalogue businesses. Tescos management focuses on customer satisfaction by giving customers more choices where to shop and by offering them attractive prices on its products. In the fourth quarter of 2008, Tesco began selling new discount range of products to compete more aggressively on price against discounters. Its prices are generally perceived to be at a small premium to Asda and a small discount to Sainsbury and Morrison. Tescos primary supermarket competitors in the UK include Asda (17.3% share of UK grocery market), Sainsbury (16.3% share), WM Morrison Supermarkets (11.2% share), Waitrose (3.7% share), Aldi (2.9% share) and Lidl (2.3% share). In recent years, some of its major competitors have turned around their struggling stores, which will make it more challenging for Tesco to gain significant share in the UK market going forward. Tesco uses its customer information to target and segment communications to the millions of its loyalty program members by almost infinite demographic, purchase, and lifestyle profiles. Several hundred million in-store purchases per day are being tracked by the loyalty-card program. The company developed 5,000 customer needs segments, with each segment receiving personalized coupons. Source: www.tesco.com Income Statement Summary Sources: Companies, www.DeutscheBank.com Tescos UK sales grew 4.3% last year (3% ex gasoline) and its net new stores contributed 2.7% to growth. Its UK sales also benefited from a 53rd week that represented 2.1% of sales and the first time contribution from the consolidation of Tesco Personal Finance. International sales grew 30.6% (including FX benefits) and 13.6% at constant exchange rates benefiting from square footage growth and strong sales growth in Asia. The companys operating margin was flat at 5.9% in fiscal 2009 as unfavourable sales mix was offset by increased productivity and good expense control. Its EPS growth was only 2.6% last year, hurt by 26.7% tax rate vs. 24% in fiscal 2008 when it benefited from tax reimbursement and lower UK corporate tax rate. Introduction: The organisations of choice are within the Retails sector TESCO and ASDA as the elective firm both are UK based companies. 1.1 Tesco objectives blend in with each other All of Tescos objectives blend in with each other. None of the objectives will work without each other. For example; the business will not have any customers if the business is not operating well. Share holders will not invest money in the business, if the business hasnt got any customers. The company will not be able to afford to have any employees working for them if they havent got money being invested in the business. 1.2. Stakeholders Tesco Stakeholders are a certain group of people that have an interest in Tesco group businesses. Each group have their own interests in the business. The service-profit chain attempts to show the interrelationship of a companys internal and external communities, stakeholders and highlights how customer loyalty that translates into revenue growth and profits might be achieved; developed by Heskett et al. (1994). It does this by establishing relationships between profitability, customer loyalty, stakeholders and employees satisfaction. Tesco has many stakeholders. They are as follows: * Shareholders * Customers * Employees * Government and Non-Governmental * Local Community * Suppliers * Financials * Pressure Groups Customers: Generally a customer wants quality goods at a low cost. They would also want a variety of products to choose from. All customers want these things and by Tesco providing them Tesco will attract more customers because of people talking about it (Word-of-Mouth). Tesco like most business need their customers because they are the business income as the customers are the people who buy Tescos products. Tesco staffs hear customers views on everything from how we are serving them in our stores to our role in the community. The customers are a bit like a pressure group because they apply pressure to Tesco to meet their needs. Meeting the customers needs can be things such as expanding their stores. Staff Tesco employees give management their feedback through the Viewpoint staff survey, Staff Question Time sessions and Tesco Staff Forum process. Suppliers Tesco group core value is treat people how we like to be treated, and its something Tesco organisation applied firmly to enhance their suppliers relationships. Investors Capital Investor Relations team regularly meet analysts from the financial institutions which invest in Tesco group or represent their shareholders. All the above defined stakeholders are Tesco group influencers. They affect the outcome of the decision making process through their influence on others. Influence could stem formally from expertise, such as the advice of an accountant on return on investment. 2. Nature of the Retail (Tesco) Marketing Environment The definition that the module assignment work with is that Tesco organisations marketing environment is made up of those forces that lie outside the Tesco group organisation and that exert some degree of influence upon the ways in which marketing management develops relationship with the firms target markets. Two distinct components within Tesco environment are: Micro-environment and the macro-environment. See figure 1 below. Social and cultural factors Legislation Economic Factor Political Issues Technological changes Supply chain Customers Competitors Suppliers Distributors The Tesco Organisation Figure 1. The Tesco Organisations marketing environment It is recognised that regardless of which approach Tesco group adopts; the environment is a significant determinant both of strategy and organisational performance. Baker (1985, pg. 85) described it as the ultimate constraint upon the firms strategy; Drucker (1969), referred to the environment of the 1960 and 1970s as age of discontinuity; and Toffler (1970, pg. 28), who look ahead, referred to it as a time of future shock. 2.1. MARKETING AUDIT The marketing audit is really the launching pad for the Tesco marking plan, because it encourages Tesco management to reflect systematically on the environment and the organisations ability to respond, given its actual and planned capabilities. Similar to financial audit, marketing audit is first and critical about developing a shared, agreed and objective understanding of Tesco organisation. The audit is has suggested by McDonald (1995, p.28): The means by which a company can identify its own strengths and weakness as they relate to external opportunities and threats; It is thus a way of helping management to select a position in that environment based on known factors. Three major elements and potential benefits of the marketing audit can be seen to be: The detailed analysis of the external environment and internal situation The objective evaluation of past performance and present activities. The clearer identification of future opportunities and threats. These three above factors can be viewed against the background of comments made by Ansoff (1968 1984), who has suggested that irrespective of the size of the organisation, corporate decisions have to be made within the constraint of a limited total resource. Marketing audit have a place the overall management audit that incorporate financial audit together with audits of other functional areas as illustrated in figure 2 below. Marketing audit in terms of structure consists of three major and detailed diagnostic steps. That involved a review of: Tesco organisations environment (opportunities and threats) designed to establish the various dimensions of the marketing environment, change and probable impact of these change upon the organisation; its marketing systems (strengths and weakness) an assessment of the extent to which Tescos marketing systems are capable of dealing with the demands of the environment and its marketing activities review of the individual components of the marketing mix. There are the environmental variables and operational variables with distinction in terms of the macro-environmental forces (political / legal, economic / demographic, social / cultural, and technological) that affect the business. Micro-environmental actors (customers, competitors, distributors and suppliers) who subsequently influence Tesco organisations ability to operate profitably in the market-place Macro environment is the most general external audit of the environment, that consist of broad environmental factors, aimed at identifying key variable that offer actionable responses that would benefit Tesco and threats that must be avoided. These key external forces can be divided into five broad categories. Economic forces Social, Cultural, Demographic and Environmental forces Political, Governmental and Legal forces Technological forces Competitive Force Financial audit Personnel audit Production audit The Management audit Marketing audit EXTERNAL (Opportunities and threats) Macro The business and economic environments (political, economic, social/cultural, technological, legal and environmental factors PESTLE) Market Competition INTERNAL (Strengths and weaknesses) Micro Organisational performance and structure Operations and resources Marketing objectives Marketing strategy Information systems Planning systems Control systems Functional efficiency Inter-functional efficiency Profitability analysis Cost-effective analysis Figure 2. The place of the marketing audit in the overall management audit 2.2. SWOT Analysis The strengths and weaknesses of a SWOT analysis focus on the current market position of Tesco in retails business in relation to its: Customers is the business meeting the needs of its target markets Competitors- is the business offering a better way of meeting customer needs compared with its competitors Internal resources- is the business making effective use of its internal resources to meet customer needs and deal with competition The opportunities and threats of a SWOT analysis focus on the future market position of Tesco in retails business. Tesco organisation used their strengths and limits the weaknesses to plan for future development, marketing strategies and activities. Tescos opportunities and threats grew out of objectives, consideration of the real strengths and weaknesses of their business. Specific information were collated (such as data captured and analysed from CRM programs) before the process begins and personnel working to a joint solutions, adopted a truly objective positioning for the processes to be successful and worthwhile. 2.2.1. The main purpose of a SWOT analysis: Identify market opportunities To avoid complacency about market position a self evaluating organization As a safety check before embarking on major new project As a response to change change of director might initiate a SWOT analysis to gauge the strength of the team. There is no set procedure for carrying out a SWOT analysis but care must be taken to identify weaknesses if the process is to serve its purpose. A weakness may purely be lack of information, or lack of suitably qualified staff. SWOT analysis of TESCO Strengths Weaknesses To provide high level customer service Presence in multiple retail markets For Tesco to create unique products Increasing market share Wide knowledge of retail industry Competent top management and rank file for operation and maintenance Existing customer base Financial investment backing. Strong IT returns through internet shopping Good advertising Used iconic models to attract core target group. Tesco Online Brand value Insurance Secured commercial standing within the global market place winning Retailer of the Year 2008 at the World Retail Awards. This can be used for marketing campaigns to drive advantage towards the demographic base for future growth and sustainability Product diversification home and furniture Turnaround in sales and growth As a business looking for continued expansion TESCO have reserve funds of credit coupled with income derived from property portfolio development funds. In an environment where global retail sales are showing decline or level performance on a like for like basis TESCO Group have published sales gain of 13% for UK markets and 26% growth in international markets. As a business looking for continued expansion TESCO have reserve funds of credit coupled with income derived from property portfolio development funds. Tescos position as a price leader in UK markets can lead to reduced profit margins in order to retain the key price points on must have commercial items. Grocer outlets are not set up to operate as specialist retailers in specific areas of product which can be capitalised on by other smaller bespoke retailers. Low supervision on international market Considerably late exploitation of the Internet. Whilst current economic conditions suggest Tescos key value message will succeed there is a weakness in non-essential, mid to high ticket price items which will suffer from the rising cost of living and lower disposable incomes. Reliance upon the UK market Comparing Tesco with British Airways might get you thinking about how dependent Tesco is on the UK market (73.8% of 2003 revenues.) Comparing Tesco with Amazon might reveal flaws in its attempts to move into new markets. TESCO Finance profit levels were impacted through bad debt, credit card arrears and household insurance claims. Grocer outlets are not set up to operate as specialist retailers in specific areas of product which can be capitalised on by other smaller bespoke retailers Opportunities Threats Statistics suggest TESCO is the third largest global grocer which indicates a level of buying power to ensure mainstream economies of scale. Further international growth Expansion of target market Healthy market environment Increasing detraction of small retail businesses in UK Use younger more contemporary models to attract younger generation. The acquisition of Homever provides the opportunity to develop the brand through Asia, specifically South Korea and further grow International markets for the group. The development of Tesco Direct through online and catalogue shopping will grow the use of technology, providing the launch pad for larger non food based products with moderate to high margin returns and less focus on sales and margin per foot return to space. TESCO mobile have grown  ¼ million customers in 2008 and moved into profitable status suggesting further growth and development within this technological area can be developed. Tesco Homeplus stores offer all of Tescos ranges except food in warehouse-style units in retail parks. Introducing wider ranges such as Tesco (Value, Brand, Finest, Wholefoods, Bakery Kids), Healthy Living, Organic, Best Of British, World Foods, Cherokee, Free From, Tesco Christmas, Tescos own clothing label F+F to mention few Other services e.g. banking, insurance, savings to mention few. UK structural change could spark a price war Rising raw material costs from both food and non food will impact profit margins overall International expansion Economic restructuring Intensified competition Government regulation UK and American markets have been affected by economic concerns through the credit crunch. Lower available income will impact and strategic focus may need to change to lower priced basic products with less focus on higher priced brands suggesting a switch in price architecture. Sourcing changes to Far East locations with regards exporting restrictions on some non food product areas will reduce margin rates on products with already low margins. Changes to consumer buying behaviours require further analysis as technology develops consumer buying patterns change which will result in product areas requiring evaluation. For TESCO there is a persistent threat of takeover from the market leader Wal-Mart who has both means and motive to pursue such action. Lower available income will impact and strategic focus may need to change to lower priced basic products with less focus on higher priced brands suggesting a switch in price architecture. Overconfident of Tesco management Figure. 3. Tesco Micro and Macro-Environmental SWOT analysis 3. Tescos Strategic Options 3.1. Generic Strategies Generic Strategies are characterised by an individual retailers response to the industry structure. For a giant retailer, such as Tesco, to obtain a sustainable competitive advantage they may have followed either one of three generic strategies, developed by Porter (1985). The first strategy of cost leadership is one in which Tesco can strive to have the lowest costs in the industry and offer its products and services to a broad market at the lowest prices. This strategy will be based on the Tescos ability to control their operating costs so well that they are able to price their products competitively and be able to generate high profit margins, thus having a significant competitive advantage. Tesco used another strategy of differentiation that it has to try to offer services and products with unique features that customers value; Tesco was able to create brand loyalty for their offerings, and thus, price inelasticity on the part of buyers. Tescos breadths of product offerings, technology, special features, or customer service are popular approaches to differentiation The last strategy of focus can be either a cost leadership or differentiation strategy aimed toward a narrow, focused market. In pursuing a cost leadership strategy Tesco focuses on the creation of internal efficiencies that will help them withstand external pressures. Therefore, it appears reasonable to think that Tesco will have frequent interactions with the governmental/regulatory and supplier sectors of the environment. In accordance to this framework, while both overall cost leadership and differentiation strategies are aimed at the broad market, Tesco may also choose to confine their product to specific market areas or may choose to offer a smaller line of products to the broad market, thus pursuing a strategy of focus or niche (Porter, 1980). In other words, Tesco pursues a strategy of cost leadership or differentiation either in a specific market or with specific products. 3.2. Core Competence and Corporate strategy Superior performance, according to Johnson and Scholes (2003), has to be determined by the way in which companys resources are deployed to create competence in the organisational activities. Core competencies are activities or processes that critically underpin the companys competitive advantage. Core competences may be embedded deep in Tesco at an operational level in the work routines. The framework developed by Prahalad and Hamel in the 1990s suggests that over time companies may develop key areas of expertise which are distinctive to that company and critical to the companys long term growth (Drejer, 2000; De Toni, and Tonchia, 2003). In the case of Tesco the areas of expertise are most likely to develop in the critical, central areas of the organisation where the most value is added to its service and its delivery The phrase used by Tesco to describe its aspiration to appeal to upper, medium and low income customers is inclusive offer in the same stores. Tesco pulled off an idea that other retailers were not aware. That appealed to all segments of the market. One plank of this inclusively has been Tescos use of its own-brand products, including the upmarket Finest and low-price Value. Tesco implemented CRM programme launched the Clubcard rewards program to gather necessary customer information, which it then used to cater to specific customer needs and potential wants. When shoppers signed up for the card, they automatically submitted their age, gender, and income. Tesco was able to segment their shoppers based on these factors. As soon as the shopper used the card when shopping online or in-store, purchased product information was automatically uploaded into Tesco database. Product information was used to cross-sell additional products and services such as grocery delivery services. Beginning in 1997 when Terry Leahy took over as CEO, Tesco began marketing itself using the phrase The Tesco Way to describe the companys core purposes, values, principles, and goals This phrase became the standard marketing speak for Tesco as it expanded domestically and internationally under Leahys leadership, implying a shift by the company to focus on people, both customers and employees. 3.3. Partnership with Tesco Tesco respond to changes in marketing by partnering with other businesses; Tesco then added a travel service through a partnership with Lunn Poly, giving discounts off high-street prices. It also combined its card with Visa through the Royal Bank of Scotland, and offered discounts on DIY goods through well-known home improvement chain BQ. In 1997 it added a full range of financial services, and the Tesco Direct service. Adding value was mandatory to these functional items so, for example, expectant mothers were given priority parking outside the store, changing facilities, and personal shopping assistants to help them. In 1998, after the U.K.s deregulation of utilities, Tesco began to offer electricity and telecommunications products and services. Also in that year, clothing was added to the range through Next. By this time, Tesco had identified 108 customer market segments. This year, 2000, a joint undertaking with General Motors allows customers to buy cars from Tesco. 3.4. Enhancing Quality Everyday, top managers of Tesco stores gather for an hour-and-a-half customer advocacy meeting to pore over that weeks performance statistics. à ¢Ã¢â€š ¬Ã‚ ¦a strategy which is concerned with changing the fundamental beliefs, values and culture of an organisation, harnessing the enthusiasm and participation of everyoneà ¢Ã¢â€š ¬Ã‚ ¦.towards an overall idea of right first time by Atkinson and Naden (1989, pg 6). What makes this unusual is that every performance measure under scrutiny relates to customer satisfaction, and this meeting is the most important one on the corporate schedule. See Appendix 2 for On-Time-Delivery Tesco competitive strategy. 4. Industry Attractiveness   Inherent within the notion of strategy is the issue of competitiveness, analyzing industry attractiveness, and Porters (1979) five forces model is used. The attractiveness of the retail industry depends on the situation of competition. The competition in the retail industry is based on its economic structure Porters Five Forces Model implies that business are being influenced by five forces namely supplier power, threat of substitutes, buyer power, barriers to entry and rivalry. This model also implies that business must be able to understand the industry context in which they operate. 4.1. Porter five forces analysis: A Porters five forces analysis can complement other techniques, like a SWOT analysis. A SWOT analysis focuses on the company, while a Porters five forces analysis looks at the external factors impacting on a company Porters five forces framework as shown in figure 4, helps identify the sources of competition in the retail sector, and as a way of assessing the attractiveness that profit Tescos retails market. The underlying force in the macro-environment driven competitive forces are:- The bargaining power of supplier The bargaining power of buyers The threat of potential new entrants The threat of substitutes The extent of competitive rivalry The above five forces are not independent of each other, connection between competitive forces and the key driver in macro-environment is essential. Pressures from one direction can trigger off changes in another in a dynamic process of shifting sources of competition. Industry Competitors Rivalry among Existing firms Potential Entrants Buyers Suppliers Substitutes Bargaining power of suppliers Bargaining power of buyers Threat of substitude products or services Threat of new entrants Figure 4, Porters Five Forces Model The objectives of such an analysis investigated how Tesco organisation formed its strategy in other to develop opportunities and protect itself against competition and other threats. This must be done in order to better design the strategy that the business will use to be able to compete with rivals within the same industry. It is important for businesses to determine the level of competition present within the industry. This will allow them to address potential risks before they even strike. 4.2. Cost advantage and differentiation According to Baker (1985), a business positions itself based on its strengths and strength are categorized into two cost advantage and differentiation. Furthermore, when these strengths are applied in either a narrow or a broad sense, it will result to three generic strategies focus, differentiation and cost leadership strategy. Cost leadership strategy means that the company is the low cost producer or provider of a certain quality item in a given industry. This kind of strategy is being implemented for two reasons and achieved through two ways. The first method and reason is to sale items at average industry price so that the company will be able to be more profitable compared to rivals. The second method and reason is to sale the products at below average industry price in order to gain market share. According to Baker (1985), a company that has the ability to produce or offer less costly products will be able to remain profitable for a longer period. It is important to note that this strategy targets a broad market. 4.3. BCG Matrix Tesco can be considered as a cash cow because it distributes quality and extra services to its consumers and equipped with new innovative products and services in United Kingdom. At the same time the company can also be considered as Stars because they put a lot of efforts to increase the awareness of their consumers to the benefits of e-commerce and retailing 5. Market Objectives and Strategies Implementation Strategy frameworks and structuring tools are keys to assessing the business situation. Risk and value trade-offs are made explicit, leading to concrete proposals to add value and reduce risk. Explicit plans for action, including effective planning need to be developed by Tesco as the strategic alternative. Piercy and Morgan (1990, pg. 2) state: In short, the à ¢Ã¢â€š ¬Ã‚ ¦..reality the marketing executive faces is that implementing plans and strategies successfully is often d

UK Health Policies on Obesity

UK Health Policies on Obesity Social, economic and industrial changes have changed the patterns of life globally. Changes in diet and physical activity patterns have been central to the rise of obesity among many of the worlds population. Obesity was traditionally seen as a disease of high-income countries only, but it is now replacing malnutrition and infectious diseases as a problem transcending social divides. Obesity carries a higher incidence of chronic illness including diabetes, heart disease and cancer. This paper will critically evaluate the current UK and NI policies aimed at addressing the obesity epidemic. There will also be a discussion around definition of policies, role of government in healthcare, previous and current healthcare policies regarding obesity in both Britain and Northern Ireland. The official calculation for defining obesity was set by the World Health Organisation (WHO) where adults are registered overweight and obese using a formula of Body Mass Index or (BMI), that is a persons weight in kilograms divided by the height in metres squared (DWP, 2012). The main restraint with using body mass index as an indicator is that it does not distinguish fat mass from lean mass; so a person could be healthy and have a low body fat, but be clinically overweight if they have a high enough BMI. A person is thought to be overweight if they have a BMI of 25.0 or more and obese if the BMI is 30.0 or more. Obesity has three classifications: à ¢Ã¢â€š ¬Ã‚ ¢ Class 1 BMI 30 to 34.9 (waist perimeter 102cm plus for males and 88cm plus for females). Person is categorised as overweight à ¢Ã¢â€š ¬Ã‚ ¢ Class 2 BMI 35 to 39.9. Person is classed as obese à ¢Ã¢â€š ¬Ã‚ ¢ Class 3 BMI 40 and over. Is when a person with a BMI of 40+ is said to be morbidly obese (WHO, 2012). Policy originates from the government that are in power, who are also the legal authority and have a status and guidance over all policy whether they be private or public (Crinson, 2009). According to Crinson 2009 Health policy is hypothesised in terms of macro and micro social developments, with the macro level reading the working of social and formal structures, such as the economic context of the state and the market, and the National Health Service (NHS). The micro side focuses on the influence of policy from the level of the healthcare professionals and the experience of the users (Crinson, 2009). Policy making, according to a White Paper published by the Labour Government in 1999 states that it is a method in which a government interpret their political vision into programmes and actions in order to make changes that are required and wanted by the population (Cabinet Office, 1999). It was also focused on modernising the government schema (Cabinet Office, 1999a) and the need for more inclusive and reactive policys linked to peoples demands. It planned to guarantee that policy making was to become more forward thinking and evidence-based, as well as correctly assessed and based on best practice. It went on to note the need for improved evidence when addressing policy making and to ensure a more joined-up approach across government departments and agencies (Cabinet Office, 1999). According to the World Health Organisation health policy signifies decisions, plans and actions that are started in order to reach detailed health care goals within a society. It goes on to note that and clear and string policy can outline an idea for the future whilst helps to establish objectives and points of orientation. A health policy can also help to design a framework and build agreement in addition to informing people (WHO, 2006). There are three key policies areas within the Department of Health and they are National Health (NH), Public Health (PH), and Social Care (SC) (Kouvonen, 2012). The current theory has two dissimilar backgrounds; the first is a public policy analysis that is favoured by the United States and Northern Ireland. The second is favoured in the United Kingdom and is a social policy theoretical structure (Kouvonen, 2012). Policies are intended to improve on current provisions in health and social care in the UK and aim to guarantee services that are funded or supported by the Department of Health are delivered in an open and patient-centred way (www.dh.gov.uk). This was not always the case, as according to Crinson governments were indifferent to the type of care delivered within the healthcare service; that was the concern of the doctor. This was to change in the 1970s when the economy declined and tax revenue was reduced (Crinson, 2009). The roll of the state in providing health and welfare to the public according to Crinson 2009 takes the view that there are five diverse conceptualisations and they echo differences between political and conceptual actions of the role that the state should play when delivering health and welfare services (Crinson, 2009). The writer goes on to give examples of these conceptualisations one of which is the neoliberal prospective that influenced the change in the health and social welfare policies of the Thatcher Government in the 1980s (Crinson, 2009). In the Political-Economic Critique, according to OConnor et al welfarism serves to build consent for capitalism through the process of dividing the population into groups with specific needs. This he notes had the effect of individualising what are widespread social and health problems associates with living in a capitalists society (Gough, 1979). In a paper by David Berreby in which he asks the question, why do people get fat and risk major health problem?, He believes the answer to this question is capitalism and sites it as the main cause of global obesity (Berreby, 2012). Conversely in a programme series aired on the BBC on the 11th July 2012 the reporter Jacques Peretti reports that our eating habits were changed by a decision made in America 40 years ago. Peretti travelled to America to examine the story of high-fructose corn syrup (HFCS) a calorie-providing sweetener used to sweeten foods and drinks, chiefly processed and shop-bought foods. The sweetener was backed in America in the 1970s by Richard Nixons farming administrator Earl Butz to use additional corn grown by farmers. Inexpensive and sweeter than sugar, it rapidly found its way into nearly all convenience foods and soft drinks. HFCS is not only sweeter than sugar; it also inhibits leptin, the hormone that controls hunger, resulting in the inability to stop eat ing (BBC, 2012). This was backed up by evidence from Robert Lustrig an endocrinologist, who according to this report, was the first to identify the dangers of high-fructose corn syrup (HFCS). His findings however, were discredited at the time. and a US Congress report sited fat, not sugar, for the alarming rise in cardio-vascular illness and the food industry responded with a series of low fat and heart healthy foods in which the fat was removed. (BBC, 2012). Policy makers encouraged farmers to overproduce corn and soy with the promise of foreign trade (Philpott, 2008). It was also in the 1970s that Britains food manufactures used advertising drives to encourage the idea of snacking between meals. A fast food culture also developed and fast food chains offered tempting foods and customers served themselves, and according to Ritzer this was the beginning of McDonaldization of Society. He goes on to write how fast food restaurant contribute to the development of obesity and it emphasis on supersizing its portions (Ritzer, 2004). Conversely poverty increased in the 1970s under Thatcher Government and according to the Institute for Fiscal Studies in 1979 13.40% of people in Britain lived below 60% on median income before housing costs. With this came a big rise in inequality and under the gini score for Britain was up to 0.339 from 0.253 (Crib, et al 2012). Due to the comorbidities associated with obesity and their increasing cost to the NHS, the consequences of obesity are currently and will continue to be important public health challenges globally and in the UK. It impacts through society and across all life courses, and can increase the risk of life threatening disease (Kouvonen, 2012).Appendix 1. Currently there is a framework in Northern Ireland titled A Fitter Future for All, this agenda spans from 2012 to 2022. Within this paper it explains that in Northern Ireland 59% of adults are either overweight (36%) or obese (23%) (DHSSPSNI, 2012). This policy addresses the need to act from childhood based on evidence from the Foresight Report 2007, and is now a cross sectorial cohesive life course agenda that will address obesity over the next 10 years (Foresight Review, 2012). The Department of Health has published a follow-on document to the Public Health White Paper called Healthy lives, healthy people: A call to action on obesity in England, which sets new national drives for a descending trend in excess weight by 2020. The Tackling Obesities: Future Choices project presented its findings on 17 October 2007 and the Project aims to deliver a feasible response to obesity in the UK over the next 40 years. It also sets out examples of what is intended on a national level to help ch allenge obesity, one of these is called Change4life programme. In this programme it states it will help consumers make healthier food choices (www.dh.gov.uk). This could be linked to Professor Marmot point, when he discussed behavioural choices as individuals such as where to shop for food, and how these decisions are dictated by the individuals socio-economic circumstance, and if they can afford the recommended good food (UCL Institute of Health Equity, 2012). A fitter Future for All and Healthy Lives, healthy people are policies that both the British and Northern Ireland government support, but there are wider determinants of poor health such as poverty and inequalities that play an important role in obesity (HM Government, 2010). It could be argued that while policies such as these are targeting the causes of obesity, they are not actively seeking out realistic solutions to the problem; people may know they need to eat healthier, but simply cannot afford to buy the better food. In developing countries rates of obesity are inclined to rise, and this is associated with growing social disadvantage; addressing social deprivation and material disadvantage is likely to reduce obesity (Kouvonen. 2012). Socio-economic class as a factor in health is not a new phoneme in the United Kingdom, as it has a history of many hundreds of years. According to Edwin Chadwicks report on sanitary conditions of the labouring population in Britain in 1842 showed that in Liverpool the average age of mortality for people in the upper classes was 35 years, and 15 years for labours and servants (Richardson, 2008). Inequalities still exist today, but have improved and in the Black report published in 1980 it states that there are still inequalities with regard to life expectancy and the use of medical services (Whitehead et al, 1992). According to the Foresight report (2007) a government science think tank reported that most adults are already overweight. It goes on to note that modern living will ensure that upcoming generations will be heavier than the last, and by 2050, 60% of men and 50% of women maybe clinically obese. The report also states the obesity is a multifarious and there is no evidence anywhere in the world where obesity has reversed. Social policy frameworks are paramount according to this report (Foresight Review, 2012). The Marmot Report the third such officially approved analysis in as many decades probing the link between health and wealth. The findings confirmed an alarming social incline, the poor not only die seven years earlier than the rich, but they can expect to become disabled 17 years sooner. Professor Marmot continues to discuss behavioural choices we make as individuals are part of our social and economic settings. He believes that people born into more affluent milieu tend to adopt a healthy lifestyle, resulting in healthcare differences between the social classes (UCL Institute of Health Equity, 2012). In 2011 the Chief medical Officers (CMOs) from across the UK published new strategies for physical activity, and they addressed a life course methodology, and included guidelines for early years (www.ic.nhs.uk). It could be argued this is a blanket policy and it is widely known that poorer people have limited choices with regards to lifestyle choices such as gym memberships. Also the report appears to place the responsibility of exercise on the individual. People from poorer socio-economic backgrounds have poorer housing and environments that dont encourage physical exercise which could be due to social culture of where these people live and lack of resources (UCL Institute of Health Equity, 2012). Addressing overweight children that become obese in later life was issue raised by Dr Hilary Jones on Good Morning Britain, when he stated that obesity begins in childhood. He went on to say that the National Health Service and the Government know causes of obesity but actively preventing it in childhood needs to be addressed (www.gm.tv). Prevention of obesity is more achievable goal than addressing obesity when it becomes established, as some health problems that are acquired through obesity remain an issue even after weight loss. Therefore government policies are mostly directed at primary prevention of obesity such as eating well, exercise and no smoking (Kouvonen, 2012). Social determinants of health are also a key factor in obesity in both children and adults. According to the World Health Organisation the social conditions in which people live are paramount to their health. It goes on to note that lack of income, poor housing and lack of access to healthcare facilities are just some of the factors leading to inequalities (www.who.int). Medical care on its own cannot adequately improve individuals health and addressing where people live and work is also important The social determinants of health are the upstream social, economic, and environmental factors that affect the health of individuals and populations, including income, social support, education and literacy, employment and working conditions. Downstream determinants, which include physical activity, clean air and water and healthy housing. These factors can influence health inequalities difference between social groups that can result in obesity in poorer areas (Kouvonen, 2012). Incidents of Childhood obesity are higher in areas with a lower socioeconomic population according to National Health Service Information Centre report on obesity. It also states that obesity is more widespread in schools in disadvantaged areas. It also noted that with Reception children (children in the primary school age group) 6.9% of those in least deprived areas were obese, in comparison to 12.1 percent of children in most deprived areas (www.ic.nhs.uk). In Northern Ireland statistics show that 8 percent of children ages between 2 and 15 years are obese, according to the Health Minister Edwin Poots. The health Minister went on to say that the likelihood of obese children become obese adults was probable; this would put greater strain on the health and social care services due to the comorbidities associated with the condition (Northern Ireland Executive, 2012). Governments state that health policies are micro driven, but in reality it could be argued that they are macro driven as ultimately obesity will cost more in the long run due to obesity related illness such as diabetes and heat disease, and according to NHS website the cost will be  £4.20 billion per year (HM Government). Tackling obesity is a challenge for not only the UK, but globally and according to the Department of Health and Social Services Northern Ireland website, overweight and obesity will overtake malnutrition and infectious disease in terms of their cost to the health services and people suffering from the condition (www.dhsspsni.gov.uk). Appendix 2. It was not until 1999 that obesity was declared an epidemic in America and was considered to affect all racial groups and across all ages in United States (National Medical Association, 1999). According to the information published there was an increase from 12% to 18% over a seven year period using a body mass index (BMI) that was greater than 30 (National Medical Association, 1999). Historically obesity rates were low and unaffected until 1970s and 80s, and the obesogentic environment (an environment that encourages and leads to obesity in individuals that relates to the influence that contribute towards obesity such as food, physical activity and environment. Many broader determinants of poor health such as health inequalities, poverty and deprivation play a significant role, and these factors have not swayed over the years. In pre-war Britain large differences in mortality and morbidity levels between rich and poor were recognised as the norm by policy makers. It was the introduc tion of the National Health Service in the 1940s that brought with it hope that the social class differences affecting health would decline. It wasnt until the 1970s that the Marmot Report stated peoples lifestyle and circumstances have a direct effect on their health (Crinson, 2009). The health implications from obesity are immense and can ultimately result in a premature death. Although obesity is caused by intake of more energy through food and drink than needed and the resulting excess stored in fat in the body, the view that obesogenic environment also plays a part in obesity is becoming widely accepted. Social and economic circumstances are also evaluated in this paper as are the role of governments and policy makers, both in the United Kingdom and Northern Ireland. The overall view of this paper would be that policies are made by individuals that have no insight into what part of society they are directed at such as deprived and socio-economic areas that lack the means and facilities whereby individuals feel that their contribution to society is valued and important enough for them to care about their own wellbeing. Policies are not directed at one specific group such and the one size fits all doesnt appear to be working as obesity is now a global epidemic. 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