Modern Global Epidemic Of Obesity

Modern Global Epidemic Of Obesity In his Annual report of 2002, the UK Chief Medical Officer has described it as a health time bomb. Overweight and obese children are likely to stay obese into adulthood with increased risk of associated major chronic diseases. Consequently, socioeconomic disparities observed in obesity supplement socioeconomic inequalities in health (Law et al., 2007). Prevention of childhood obesity therefore is critical. In this paper, the author will examine the complex interaction of social, economic, biological and environmental determinants of health that may explain the recent explosion, shifts in demographic trends of this worldwide problem, and briefly explore lifestyle and behavioural factors that may create particular risks. A discussion about causes, complications and treatment options of childhood obesity will follow. The author will review and analyse determinants and health policy initiatives, critically appraise various global, national and local strategies, initiatives and interventions, which aim to prevent obesity in childhood and examine their link to conventional health promotion models and theories. By critically examining the range of interactions and existing initiatives, the author seeks to propose appropriate interventions to tackle the growing challenge of childhood obesity. Key words: childhood obesity, inequalities, policy, strategy, prevention, health promotion DEFINITION Obesity/Adiposity is defined as a condition characterised by excessive body fat. Body fat can either be stored predominantly around the waist or around the hips. Body Mass Index (BMI) is used to measure obesity and defined as: Bodyweight (Kg) (Keys et al., 1972) Height (m) 2 BMI is useful in clinical practice and epidemiologic studies, but has limitations. Freedman et al. (2004) reported that although BMI is a good measure of fat mass in children with high BMIs, it is not a reliable indicator in thinner children. Two international datasets that are widely used to define overweight and obesity in pre-school children are International Obesity Task Force (IOTF) reference and World Health Organisation (WHO) Child Growth Standards (2006). None is superior to the other and both tend to underestimate or overestimate the prevalence when used on the same population (Monasta et al. 2010). Thresholds for obesity in children in UK (and Scotland) are measured by referring to UK National BMI classification system that uses reference curves based on data from several British studies between 1978 and 1990 (Cole et al, 2000). Children are classified as overweight or obese using the 85th and 95th percentiles as cut points. PREVALENCE, trends and costs Obesity has become an epidemic in many parts of the world and surveys over the last decade have documented the rapidly increasing prevalence of obesity and overweight among children along with rising socioeconomic inequalities (Wang and Lobstein, 2006; Lobstein, Baur and Uauy, 2004). The latest WHO report (Mercedes, Monika and Elaine, 2010) based on surveys from 144 countries estimates that globally, 43 million children (including 35 million in developing countries) are overweight and obese and another 92 million are at risk of overweight. This corresponds to a prevalence increase from 4.2% in 1990 to 6.7% in 2010. In England, 2008 figures showed 16.8% of boys aged 2 to 15, and 15.2% of girls were classed as obese, an increase from 11.1% and 12.2% respectively in 1995 (The Health and Social Care Information Centre, 2010). Amongst Organisation for Economic Cooperation and Development (OECD) countries, only USA and Mexico having higher levels of obesity than Scotland and this is expected to get worse even with current intervention practices. Scottish Govt. report (2010) states that in 2008, 15.1% children were obese and 31.7% were overweight. Amidst this doom and gloom scenario are recent reports (Stamatakis, Wardle and Cole, 2010) showing trends in overweight and obesity prevalence have stabilized or reversed in pre-teens and early teenage years in France, Switzerland and Sweden. In the US too, the obesity epidemic may be stabilising (Ogden et al.,2010) but it is too early to know whether the data do reflect a true plateau (Cali and Caprio, 2008). Similarly, in England, trends in overweight and obesity prevalence have levelled off after 2002 (Stamatakis, Wardle and Cole, 2010); however, socioeconomic inequalities have deepened. Healthcare (direct) costs of obesity are only a fraction of overall (indirect) costs to society (McCormick, 2007) which are due to loss of employment, production levels and premature pensions and deaths. Obesity is responsible for 2-8% of total health costs in Europe and other developed countries (WHO, 2007). Direct costs of obesity in Scotland were about  £175 million in 2007/8 and expected to double by 2030. The indirect costs were much higher (about  £457 million) and expected rise to  £0.9 billion- £3 billion by 2030 (Scottish Govt. report, 2010). In England, recent estimate of direct obesity-related costs to NHS is  £4.2 billion and this may double by 2050. Cost to the wider economy is in the region of  £16 billion, and will rise to  £50 billion per year by 2050 if left unchecked (Department of Health (DH) report, 2010). INEQUALITIES Although no clear relationship between socio-economic status (SES) in early life and childhood obesity (but confirmed a strong relationship with increased fatness in adulthood) was reported by Parsons et al.,(1999); a more recent systematic review by Shrewsbury and Wardle (2008) supports the view that overweight and obesity tend to be more prevalent among socio-economically disadvantaged children in developed countries. Similar patterns are shown in data from England (Stamatakis, Wardle and Cole, 2010; Law, 2007) and Scotland (Scottish Govt. report, 2010). However, trends vary within different ethnic populations as highlighted by Wang and Zhang (2006); a review by Caprio et al. (2008) who studied the influence of race, ethnicity and culture on obesity trends concluded higher prevalence in non-Caucasian populations in US. Although earlier reports (Wang, 2001) revealed that the burden of this problem was mainly in wealthier sections of the population in developing nations, recent reports (Lobstein, Baur and Uauy, 2004; Wang and Lobstein, 2006) indicate that prevalence is rising among the urban poor in these countries, possibly due to their exposure to Westernized diets overlapping with a history of undernutrition. The reasons for the differences in prevalence of childhood obesity among population groups are complex, involving race, ethnicity, genetics, physiology, culture, SES including parental education, environment, as well as interactions among these variables (Law et al.,2007; Caprio and Cali, 2008; Townsend and Ridler, 2009). ETIOPATHOGENESIS and COMPLICATIONS Kirk, Penney and McHugh (2010) argue the complexity of the obesogenic environment, which comprises of personal (e.g. diet and physical activity preferences; disability), physiological (e.g. genetics, race and ethnic, psychological, metabolic) and environmental factors (home, school, and community). Other contributory factors are influences in society (e.g., social and peer influences, food advertisements) and availability of and access to optimal health care. Although genetic factors can have an effect on individual predisposition (Wardle et al., 2008), perinatal and maternal factors explain rapidly rising global prevalence rates. Key perinatal factors for childhood obesity (Wojcik and Mayer-Davis (2010), cited in Freemark, 2010) are maternal overweight before, during and after pregnancy, smoking and bottle-feeding. The mothers dietary habits and level of physical activity are also significant. Decreased physical activity levels associated with sedentary recreation (video and computer games), mechanised transportation (less walking), and increasing urbanization (limited opportunity to physical activity) are all associated with increased risk of obesity (Trost et al. 2001; Gordon-Larsen, McMurray and Popkin, 2000). Children with disability are at a greater risk to develop obesity (Reinehr et al.,2010); factors include health concerns and restricted access to physical activity. Epstein et al. (2008) propose that television viewing encourages weight gain not only by decreasing physical activity, but also by increasing energy intake. In addition, television advertising could adversely affect dietary patterns throughout the day (Lewis and Hill, 1998). Psychosocial factors can influence dietary and physical activity behaviours that define energy balance. Children who suffer from neglect and depression are at increased risk for obesity during childhood and later in life (Johnson GJ et al.,2002; Pine DS et al.,2001).In contrast, social support from parents and others increases participation in physical activity of children and adolescents (Sallis, Prochaska, Taylor, 2000). There is evidence that breast milk in infancy may protect against overweight in childhood (Harder et al.,2005) while intake of foods with high glycemic index, sugary soft drinks and fast foods are associated with increased risk and prevalence of childhood obesity (Ludwig et al.,2001; French, 2001); however, long term trials are needed to corroborate this association. Also, eating out (Zoumas-Morse et al.,2001) appears to be an important contributory life style factor. Excessive fat in the diet is believed to cause weight gain (Jequier, 2001); though, this association is not consistently shown in epidemiological studies (Atkin L-M Davies, 2000; Troiano,2000). Lustig (2006) proposes that the relationship between changes in the environment and neuroendocrinology of human energy balance is complex. The author explains that behaviours of increased caloric intake and decreased energy expenditure are secondary to obligate weight gain that is due to associated hyperinsulinemia, leptin antagonism and interference with normal satiety. Childhood obesity is a multisystem disease with potentially serious complications. Several studies suggest that childhood overweight/obesity is associated with increased risk of mortality in adult life (Gunnell,1998; Dietz,1998). Young-Hyman et al. (2001) have documented cardiovascular risk factors along with insulin resistance in children as young as five years old. The rising prevalence of type 2 diabetes in obese children is worrying in view of the vascular complications (heart disease, stroke, limb amputation, kidney failure, blindness) (Ludwig and Ebbeling,2001). These risks appear to be higher in non-Caucasians (Goran, Ball and Cruz,2000). According to Strauss, (2000) adverse psychosocial effects are more severe in white girls. Treatment Effective intervention is essential because obese children are likely to face substantial health risks as they mature (Cali and Caprio, 2008). Further, as healthcare costs of this problem are rising (Wang and Dietz, 2002); intervention is required to prevent morbidity in adulthood while effective tools for primary prevention are developed. Spear et al. (2007) reviewed the evidence about the treatment options in primary care, community, and tertiary care settings and proposed a comprehensive 4-step approach for weight management. Uli, Sundarajan and Cuttler (2008) support a similar strategy. Several reviews of lifestyle (i.e. dietary, physical activity and/or behavioural therapy) interventions for treating childhood obesity (Oude- Luttikhuis et al.,2008; Wilfley et al., 2007) have concluded that family based combined behavioural and lifestyle interventions can produce significant reduction in overweight in children and adolescents. Although Golan and Crow (2004) suggested that targeting exclusively parents for change was superior to targeting only children for change, behavioural approaches involving both parents and children in the framework of a combined lifestyle intervention appear to be more effective (Wilfley et al. 2007; Epstein 1994; Bronwell, Kelman and Stunkard 1983). Moreover, intensive lifestyle intervention (with daily exercise, mandatory caloric restriction, multiple clinic visits and counselling sessions) appears to be more successful (Nemet at al. 2005) than standard lifestyle intervention (Epstein and Wing 1980). There is no consistent evidence to show that decreasing sedentary behaviour by reducing television viewing is effective in weight reduction (Dennison et al. 2004; Gortmaker et al. 1999). However, limiting TV food advertising to children appears to be a useful cost-effective population-based intervention (Magnus et al. 2009). In obese adolescents, treatment with orlistat or sibutramine as adjunct to lifestyle intervention is prescribed sometimes. However, these drugs can have significant side effects and this approach needs close monitoring and follow-up (Freemark, 2007). Morbidly obese adolescents can benefit from sizeable weight loss following bariatric surgery but with potential serious complications (Lawson et al., 2006; Uli et al.,2008). This necessitates close follow-up and dedication to a specialized dietary regimen (Shen, Dugay and Rajaram, 2004) for successful results. Evidence base of school-based interventions: Systematic reviews of random controlled trials (RCT) by Reilly and McDowell (2003) and Bluford, Sherry and Scanlon (2007) did not find sufficient evidence base for interventions to prevent childhood obesity and recommended further research. In contrast, Thomas et al. (2004) put forward a more positive conclusion in their review. Similarly, Flynn et al. (2006) and Doak et al. (2006) reported favourable outcomes in nearly all trials they reviewed. Interestingly, in an analysis of school-based programs, authors from National Institute for Health and Clinical Excellence (NICE), UK (2006) indicated that the evidence does not convincingly support the multidisciplinary whole school approach promoted by UK National Healthy Schools Program. Nonetheless, Connelly, Duaso and Butler (2007) in their review of RCTs have supported a decisive role for obligatory provision of aerobic physical activity in schools coupled with nutritional education and skills training. Finally, Kropski, Keckley and Jensens review (2008) concludes that although evidence is limited, schools play an important role in prevention strategies and directing different techniques at boys and girls may have more impact. HEALTH PROMOTION MODELS RELATED TO PREVENTION OF CHILDHOOD OBESITY Knowledge-Attitude-Behaviour model proposes that as knowledge accumulates, changes in attitude are set off resulting in gradual change in behaviour (Baranowski 1999). The model assumes that a person is logical by instinct. However, evidence shows that generally people in a variety of circumstances do not act logically (Shafir and LeBeouf, 2002). A common application of this model to promote change is providing health and nutritional information within school syllabi. Gaining knowledge may help to set goals and boost self-confidence but has not been shown to cause change in behaviour (Schnoll and Zimmermann, 2001) or to change in physical activity behaviour (Rimal, 2001) except perhaps in specific right people (Wang and Biddle 2001). Besides, there is no evidence that interventions based only on education strategies will change behaviour (Contento et al.,1995). According to Behaviour Learning Theory (BLT), when a specific stimulus elicits a desired behaviour, there is increased likelihood of that behaviour recurring if that behaviour is reinforced (Skinner,1938 as cited in Baranowski et al.,2003). A modern version of BLT, the Behavioural Economics model (Epstein and Salaens,1999) suggests behaviour is the result of benefits and costs where benefits are reinforcers. Obese people find food more reinforcing than others do whereas physical activity has greater reinforcing value among non-obese people. In addition, preference for a specific physical activity declines when the distance to that activity increases which reduces the reinforcing value of that activity (Raynor, Coleman and Epstein, 1998). Thus, obese people are more likely to find behaviours that lead to obesity more reinforcing. Saelens and Epstein (1998) applied the model successfully in obtaining increased physical activity. However, application of reinforcers on controlling behaviour is challenging and can be beyond the ability of many parents. The Health Belief Model explains the utility of health services. It has been widely applied to health-related behaviours (Janz, Champion and Strecher, 2002). The model describes health actions through the interaction of sets of beliefs: perceived susceptibility, perceived seriousness perceived benefits and disadvantages and cues to action. A meta-analysis study by Witte and Allan (2000) of fear-based communications revealed that they could induce behavioural change by affecting individuals perception of threat. However, children and adolescents often tend to perceive themselves as invincible, thus the concept of fear, threat and perceived risk and susceptibility are not useful in this age group. HBM may become more relevant if people perceive obesity as a serious threat waiting to happen to them (Baranowski, 2003). Social Cognitive Theory (SCT) proposes (Bandura 1999) that behaviour is a function of continuous mutual interaction between the environment and the person. The theory assumes that people generally strive for positive outcomes and evade negative ones by changing their behaviours by using self-control. Programs based on SCT have resulted in some changes as reported in a review by Sharma (2006) of school-based interventions for preventing childhood obesity where SCT was the most popular intervention tool. However, the theory lacks predictability for understanding childrens behaviour that is related to food and activityit could be that the concepts are too complex for children (Baranowski, Cullen and Baranowski,1999). Furthermore, children may not be expected to or capable of sufficient self-control over their diet and physical activity. Environmental variables like parenting and availability of food and physical equipment may be more beneficial (Cullen et al.,2003). Theory of Reasoned Action (TRA) and Theory of Planned Behaviour (TPB): To explain the relation between attitudes and behaviour (Ajzen and Fishbein,1975 in Baranowski et al.,2003) proposed TRA and said that people are more prone to perform a specific behaviour when they have the intention to perform it. The theory has many limitations one is that presence or absence of choice can influence behaviour e.g. unable to perform the intention to buy healthy food due to its unavailability in the local store. Ajzen and Madden (1986) modified TRA to TPB, which emphasises that perceived behavioural control influences intention. Goding and Koks review (1996) argued that the efficiency of the theory varies between health-related behaviour categories. TPB model has been applied to childhood obesity prevention programs with results showing both good (Andrews, Silk and Eneli, 2010) and mixed (Fila and Smith, 2006) predictability. The Transtheoretical model (T) proposes that health behaviour change progresses through six stages of change: pre-contemplation, contemplation, preparation, action, maintenance, and termination and describes 10 processes that enable this change (Prochaska et al.,1992). The model has been successfully applied in addictive disorders but has limitations when applied in the treatment of eating and weight disorders (Wilson and Schlam, 2004). T has been applied to obesity with studies reporting both good (Sarkin et al., 2001) and poor predictability (Macqueen, Brynes and Frost, 2002 in Wilson and Schlam, 2004). The complex etio-pathogenesis of childhood obesity suggests that Social Ecological (SE) Models may generate creative and lasting solutions (Huang and Glass, 2008). The SE model initiated by Bronfenbrenner (1977) and subsequently developed for understanding obesity by Davison and Birch (2001) and Story et al., (2008) proposes that individuals contribute their cognitions, skills and behaviours, lifestyle, biology and demographics, while surrounded in other circles representing the social, physical and macro-level environments to which they are exposed. Swinburn, Egger and Raza (1999) have described the ANGELO (analysis grid for environments linked to obesity) framework which is an ecological model for understanding environments that are obesogenic. Figure 1. The IOTF model is a SE model and describes societal policies and processes with direct and indirect influences on body weight (Kumanyika et al.,2002) as shown here in Figure 1(above). An ecological approach is also the basis of the Canadian model, Child Health Ecological Surveillance System (CHESS). As illustrated in Appendix 4, it demonstrates a local approach to tackle childhood obesity and has possible global implications (Plotnikoff, 2010). Global, regional and national prevention strategies As part of the response to fight the childhood obesity epidemic, WHO (2004) developed the Global Strategy for Diet, Physical Activity and Health (DPAS) and produced a range of tools to assist Member States and stakeholders to implement DPAS. It emphasised that National plans should have achievable short-term and intermediate goals. A schematic model developed for WHO by Sacks, Swinburn and Lawrence (2009) for implementation and monitoring of DPAS provides the basis for a framework for action and explains how supportive environments, policies and programmes can influence behaviour change in a population and have lasting environmental, social, health and economic benefits. The monitoring and evaluation component provides the foundation for promotion, policy development and action. Figure 2: Implementation framework for the Global Strategy on Diet, Physical Activity and Health. The model emphasises the need of right mix of upstream (socio-ecological) approaches to shape the economic, social and physical (built and natural) environments, midstream ( lifestyle) approaches to directly influence behaviour (reducing energy intake and increasing physical activity), and downstream (health services) approaches to support health services and clinical interventions (Sacks, Swinburn and Lawrence, 2008 in WHO report, 2009). According to WHO (2009), population-based prevention strategies developed in the context of a social determinants-of-health approach and implemented both at the national level and locally in school and community-based programmes will help to change the social norm by encouraging healthy behaviours. Furthermore, transferring the responsibility of tackling health risks from the individual to decision-makers will help to combat associated socio-economic inequalities. In addition, strategies will need coordinated action by multiple stakeholders and effective leadership for success. Surveillance tools for growth assessment recommended by WHO are Child Growth Standards (WHO Reference, 2007) and the Global School-based Student Health Survey (GSHS) (WHO, 2009). Key challenges of population based strategies identified by WHO are increasing globalization of food systems that have created economic and social drivers of obesity through changes in food supply and peoples diets, worsening socioeconomic inequalities and tackling obesity in children with physical and/ or mental disabilities. Other important hurdles are poorly designed urbanisation and achieving cost-effectiveness. In this regard, combined approaches that address multiple determinants can improve efficiency of intervention programmes according to a model-based analysis by OECD and WHO (Sassi 2009 in WHO report 2009). The Ottawa Charter for Health Promotion (WHO 1986) recommends that global prevention strategies should work at multiple settings (e.g. schools, after-school programmes, homes and communities and clinical settings) and use the correct mix of approaches for a given situation along with concern for country- and community-specific factors, such as availability of resources and/or socioeconomic disparities. It emphasises that such strategies must identify and include at-risk groups, set priorities and realistic targets and engage with all stakeholders in a transparent manner. The public should have access to information on partnerships including potential conflicts of interest. Successful implementation and sustenance of such strategies depends on long-term planning, budgeting and identifying cost-effective interventions such as the ACE-Obesity project (Carter et al., 2009). It is also important to dissociate private sector funding from projects that set direction and techniques of such programs by adopting novel funding strategies. The IOTF (2007) have developed in consultation with WHO a set of (Sydney) principles that define the commercial promotions of foods and beverages to children and guide action on changing marketing practices them. The principles aim to ensure a degree of protection for children against obesogenic foods and beverages. The European Union (EU) Member States have adopted the European Charter on Counteracting Obesity (2006), which defines WHO policies and action areas at the local, regional, national and international levels for all interested parties in government and private sectors (e.g. food manufacturers, advertisers and traders) and also organizations of professionals (providers) and consumers (users). Policy strategies emphasise the need to identify and focus on at-risk population groups, set realistic goals, and use efficiently coordinated multiple settings and approaches. They also stress the need for research into all aspects of treatment and prevention methods and develop creative sustainable funding (WHO Europe, 2007). In UK (England), to encourage individual behavioural change, the strategy Healthy Weight, Healthy Lives: A Cross-Government Strategy (DH, 2008) has been developed with emphasis on healthy growth and development of children, promotion of healthier food choices and bringing physical activity into peoples lives by building healthy towns on the EPODE model ( Borys 2006). It also aims to provide personalised advice and support and create incentives to be healthy. Policy drivers include national policy changes (e.g. increased support for monitoring of growth, promotion of breast feeding, bans on unhealthy food advertisements, social marketing campaigns) and changes to the food supply (e.g. development of a healthy food code, front-of-pack labelling, limits on fast-food restaurants near schools and parks, increased supply of fresh fruit and vegetables to stores in deprived areas). Change4Life is the marketing arm of the Governments strategy to stress on prevention through healthier habits from early life (DH, 2009). Other strategies are development of a national physical activity plan in part tied to the 2012 Olympics with the purpose of improving built environments and support more weight management services. The national Government leads the project and provides resources for local authorities, National Health Service (NHS), and community care partnerships. Government agencies and their partners coordinate to raise funds and integrate projects into existing strategies and programmes for cost-effectiveness. Long-term goals include developing a national dialogue on societys response to the epidemic of obesity, provide more support and guidance for PCTs and local authorities and build up skills and capabilities of staff, set aside extra resources and while demonstrating good governance and clear accountability. In Scotland, the Government and Convention of Scottish Local Authorities (COSLA) have developed a Route Map for decision-makers in government to work with their partners, NHS and businesses to develop and deliver lasting solutions to prevent overweight and obesity (Scottish 2010). The Government has targets to reduce the rate of increase in the proportion of children with unhealthy BMI by 2018 but none yet for obesity or weight management. The aim is to reduce energy consumption, increase physical activity, minimise sedentary behaviour, and create positive health behaviour through early life interventions and building healthier work place environments. Policy drivers to manage obesity include HEAT (health, efficiency, access and access target) which measures achievement rates for intervention programmes, Counterweight which is a second-level program to support people who need management of their weight, and Scottish Enhanced Services that provides childhood obesity services in primary and community care settings. To prevent obesity, the Government has developed several initiatives in a framework Lets Make Scotland More Active which is for promoting increased physical activity. Policies to help build healthier lifestyle are the National Food and Drink Policy Recipe for Success, eight Healthy Weight Communities programmes nation-wide, and Seven Smarter Choices Smarter Places to study travel behaviours of communities and their potential to adopt healthier choices. Take Life On is a national social marketing drive that aims to improve diet and fitness of communities and Beyond the School Gate and Scotlands Healthy Weight Outcomes Framework will provide guidance to help create health-promoting communities. In addition, there are several national programs directed to a Greener, Healthier, Smarter, Safer and Stronger Scotland which are likely to have indirect contribution to tackle overweight and obesity. CONCLUSION: The essay emphasises the rapidly increasing burden of childhood obesity with associated population profile changes and increasing social inequalities. It explains the complex multifaceted and interlinked causal pathways that form the obesogenic environment. The author has described community and school-based obesity intervention and prevention programmes and explored the role of research protocols in gathering evidence for such interventions and their usefulness. Various prevention strategies and interventions (singly and in combination) that are in practice and the settings and conditions in which they may be effective are reviewed and compared. Existing global, regional and national prevention and implementation strategies and their need to tackle upstream influences to fight childhood obesity are explained. The present evidence for effective treatment and prevention of childhood obesity is not consistent. It is very difficult to attain significant weight on a long term basis in spite of strenuous efforts it could be that present prescriptions for diet and exercise are not as effective as they need to be; in addition, the adversities in the environment can overwhelm the beneficial effects of techniques used in current intervention techniques. Further research is required to identify realistic options for treatment and best practice procedures for public health policies that are cost-effective, culturally sensitive, deal with upstream influences and address population inequalities. Although numerous school and community based programs are having an impact, there is a need for evidence to evaluate effective social interventions so that social policies direct healthy lifestyle approaches. From the review of available evidence, the author has learnt that policymakers and professiona

The Stoics and Socrates :: essays research papers

The Stoics and Socrates The question of the reality of the soul and its distinction from the body is among the most important problems of philosophy, for with it is bound up the doctrine of a future life. The soul may be defined as the ultimate internal principle by which we think, feel, and will, and by which our bodies are animated. The term "mind" usually denotes this principle as the subject of our conscious states, while "soul" denotes the source of our vegetative activities as well. If there is life after death, the agent of our vital activities must be capable of an existence separate from the body. The belief in an active principle in some sense distinct from the body is inference from the observed facts of life. The lowest savages arrive at the concept of the soul almost without reflection, certainly without any severe mental effort. The mysteries of birth and death, the lapse of conscious life during sleep, even the most common operations of imagination and memory, which abstract a man from his bodily presence even while awake; all such facts suggest the existence of something besides the visible organism. An existence not entirely defined by the material and to a large extent independent of it, leading a life of its own. In the psychology of the savage, the soul is often represented as actually migrating to and fro during dreams and trances, and after death haunting the neighborhood of its body. Nearly always it is figured as something extremely volatile, a perfume or a breath. In Greece, the heartland of our ancient philosophers, the first essays of philosophy took a positive and somewhat materialistic direction, inherited from the pre-philosophic age, from Homer and the early Greek religion. In Homer, while the distinction of soul and body is recognized, the soul is hardly conceived as possessing a substantial existence of its own. Severed from the body, it is a mere shadow, incapable of energetic life. Other philosophers described the soul's nature in terms of substance. Anaximander gives it an aeriform constitution, Heraclitus describes it as a fire. The fundamental thought is the same. The soul is the nourishing agent which imparts heat, life, sense, and intelligence to all things in their several degrees and kinds. The Pythagoreans taught that the soul is a harmony, its essence consisting in those perfect mathematical ratios which are the law of the universe and the music of the heavenly spheres. All these early theories were cosmological rather than psychological in character. Theology, physics, and mental science were not as yet distinguished. In the "Timaeus" (p.

Julius Ceasar Essay -- essays research papers

Character Counts   Ã‚  Ã‚  Ã‚  Ã‚  William Wordsworth once said that â€Å"The best portion of a good man’s life is his little, nameless, unremembered acts of kindness and love† (Health Communications, Inc. 213). In William Shakespeare’s play Julius Caesar, Marc Antony exhibits the character counts pillars respect, responsibility, and also caring. Marc Antony shows his respect when everyone was against Caesar, but he still was tolerant of the difference. He displayed responsibility when after Caesar’s death, and Brutus’s speech, he told the people of Rome that Caesar was not ambitious, but true to Rome and then continued on to read Caesar’s will. Lastly, Marc Antony displays caring when he grieves from Caesar’s death.   Ã‚  Ã‚  Ã‚  Ã‚  Marc Antony displayed respect when everyone was against Caesar, but he was tolerant of the difference. â€Å"Friends am I with you all, and love you all, / Upon this hope, that you shall give me reasons / Why and wherein Caesar was dangerous†(McDougal. 642). During the time when all of Rome was against Caesar, and chaos was everywhere in Rome, Marc Antony respected the citizens opinions, and was capable of dealing peacefully with his anger, the insults, and disagreements. Even though Antony was being badgered for sticking by Caesar, he took to thought the feelings and opinions of the citizens at that time, and was able to discuss them calmly with the people while others might have turned against Caesar. Therefore, Antony was not ...

Target Corporation’s Supply Chain Management

Target Corporation Supply Chain Assignment Target’s Supply Chain Unit 2 Assignment GB570 Managing the Value Chain Dr. Rita Gunzelman Kaplan University December 12, 2011 Target’s Supply Chain The purpose of this paper is to show evidence of cohesive knowledge of the supply chain and how it works by the exploration of Target Corporation’s supply chain.Target, one of the nations largest retail chains, first opened in 1962 in Minnesota as key leadership were looking for new ways to move from a family-run (The Dayton Family) department store to a mass market national chain strengthening customer relationships by appealing to value-oriented shoppers in quest of a higher-quality experience. Today, Target operates approximately 1750 stores (including nearly 240 SuperTarget stores) in 49 states with Gregg Steinhafel as their CEO. We will review the effectiveness of Target’s supply chain and analyze if it meets the necessary expectations of their demand chain. Targe t, 2011) Overview of Target’s Supply Chain Target, the 2nd largest discount-retailer in the U. S. has focused on their slogan, â€Å"Expect More Pay Less† and strategizes to increase optimal value and growth for global networking, an exclusive upscale and trendy product line, and value added service that creates a distinctive niche throughout the world. This multi-billion dollar company set out to change how consumers thought about discount shopping by offering a more upscale shopping experience.In 1998, Target purchased Associated Merchandising Corporation (AMC) as part of the development of their global service network in efforts to offer products at more competitive prices and survive one of their biggest competitors, Walmart. Target and its founders have always focused on constantly reducing costs, improving sales, adopting efficient and competent distribution and logistics management systems while using sophisticated and cutting-edge information technology (IT) sy stems—thus creating the makings for an efficient supply chain management system.Components of Target’s supply chain that will be evaluated include product and service specs, order processing and management, evaluation of delivery options, procurement, inventory management, processing/manufacturing, and transportation (Target, 2011; Walters and Rainbird, 2007). Product and Service Specification Target believes in a differentiated approach to set them apart from their direct competitors and provide products and services based on what their customer needs and wants.They begin by offering customers a more upscale shopping experience that makes shopping easier in stores that are always clean and attractive with more trend-forward merchandising at lower costs. For added value and convenience for the customers the development of new store prototypes birthed where they are offering more than just a general merchandise store with pharmacy, photo processing center, Food Avenue r estaurants, but a grocery store with fresh produce and quality food items, Target. om website, an optical department, their own credit card, more exclusive deals with various name brands and designers, and sell more gift cards than any other retailer in the country. Also, unlike Walmart, Target does not sell firearms (real or toy firearms that look real) or tobacco products. As well, Target does not promote services or items on their public address system or use music in its stores.All of this, with a highly contemporary design, signage, and graphics enhances the attractiveness and appeal of the store along with knowledgeable and well-dressed employees (who are referred to as Team Members) attract a different type of customer or â€Å"Guests† than that of Target’s direct competitors. Target tends to attract a younger, affluent, educated, and fashion-forward customer. Order Processing and Management To further deliver on Target’s Brand Promise and optimize their supply chain network, leveraging cutting-edge logistics technologies to drive service and meet the needs of the guests cost-effectively and efficiently is critical.With great leadership and effective management, Target prepares, plans, and delivers the guests what they want, where they want it, and when they want it (whether customer purchases online or in store) via analyzing, developing, and implementing successful supply chain strategies and initiatives. This is done by coordinating activities from Finance, Merchandising, Distribution, transportation, and stores. Senior leadership will be addressed with additional opportunities, alternative solutions, and anticipated benefits via the internal systems, company infrastructure, and streamlining.Value Delivery Options In efforts to enable Target to deliver more value to their customers and shareholders, Target, a Partners Online Website is utilized as a vehicle to communicate to Target’s Partners business- critical information that ultimately elevate performance, speed, and accuracy while maximizing profitability within the supply chain. Due to the ability of cutting expenses, Target provides customers with high-quality merchandise at low margins.In addition, with over 1700 stores globally and more than 300,000 employees, Target offers continued customer relations improvement and greater guest experiences through their product life-cycle whether receiving assistance in stores or online. (Target, 2011; Walters and Rainbird, 2007) Procurement Target takes seriously the need to provide efficiency and opportunity in this area with the use of internal consultants who ensures performance improvements of safety and quality, driving service, and strong financials.For example, due to the high costs of fuel in today’s challenging economy, Target and their Logistics Management Team across the country to re-calculate and strategize the impact and develop alternatives to continue low costs that are passed on t o their customers. As a result, Target will keep goods moving on the cheapest forms of transportation whether via all-water, railroad, or transload methods for as long as possible to minimize exposure to high-fuel expenses (Target, 2011; Tirschwell, 2008). Inventory ManagementTarget has developed and caters to the needs of each individual store through their sophisticated technology and Online IT systems. In-stock improvements are supported for efficiency, speed, and profitability with excellent tracking and communication systems (Target, 2011). Processing Target focuses on continued improvements of their customer’s product life-cycle starting at set-up to the delivery of the product by managing process improvements, organizational support, consistent measurement, and technology updates.This global focus helps the Distribution Centers maintain the grounds, equipment and systems, and buildings as well as as providing the leadership and facility operations processes it requires . Transportation To ensure Target meets the needs of their guests effectively and cost efficiently, they manage their overall supply chain to provide the fastest and shortest routes and create a team that has a direct and vital connection between internal purchasing, distribution centers and stores, and their import warehouses. Assessment of Supply Chain EfficiencyMy assessment of the efficiency of Target’s supply chain based upon your review above and the reference materials provided in this unit is that Target has a very effective supply chain. They provide a high value proposition as it pertains to their products, suppliers, distribution, and manufacturing and service systems. The focus of value, quality, cost reduction, network optimization, and profitability was delivered in a cost and time efficient manner and re-strategized their plan if it did not. (Target, 2011; Walters and Rainbird, 2007). Relationship of Supply Chain to Demand ChainI believe Target’s supply chain successfully supports its demand chain. Target focuses on their customer’s needs and wants and let their market knowledge determine working relationships with suppliers, employees, and customers. Therefore, the focus is primarily on customers and product service and offering, exclusivity, quality, and affordability while increasing performance and adding value. This differentiation is an integral factor in seeking a competitive advantage. Target provides efficiency in their processes to ensure customer satisfaction by having state of the art technology that’s fast and efficient.Target supports partnership and flexibility in efforts to foster growth and sustainability. Target has great customer relations management as well supplier relationship management, which overlaps and makes for a more efficient and effective management (Target, 2011; Walters and Rainbird, 2007). Conclusion Target’s supply chain management practices effectively met the needs of their demand chain. This resulted in increased efficiency in customer value, offering of quality products and services, and optimal effectiveness in operations and customer service.The use of excellent strategies with customer and value focus will ensure Target will continue to create sustainable competitive advantage that separates it from the evident competitive activities of their direct competitor. This will guarantee Target has a strong market position, increased profitability, and contribute to their ongoing success. References Misra, H. , & Choudhary, K. (2010). Opportunities and challenges for ICT mediated innovations in a development oriented value chain: The case of Jaipur Rugs Company.Vilakshan: The XIMB Journal of Management, 7(2), 21-48. Target. (2011). Retrieved on December 13, 2011 from http://sites. target. com/site/en/company/page. jsp? contentId=WCMP04-031316. Tirschwell, P. (2008). The Journal of Commerce: Target reconsiders supply-chain strategy. Retrieved on December 13, 2011 from http://www. ittc. com/uploadedfiles/News/07_14_08_target_reconsiders_supply_strategy. pdf. Walters, D. , & Rainbird, M. (2007). Strategic operations: A value chain approach. New York: Palgrave Macmillan.

Todays World

The Income Break The income inequality is just the deflexion in the salaries of the antithetical class of volume and/or jobs. In The Rise of the seminal Class, Ric solid Florida takes a look at fight all across the U. S in order to comp atomic number 18 and contrast wages. He does a breakdown of the 3 classes that he chatters about earlier in the book and from there compargon the wages. In atomic number 53 chart that is displayed he specifys that computed axial tomo graphy has the highest income but then he has some other graph that shows otherwise. I dont believe this could be halted because people of variant jobs feel as if they deserve different levels of compensate, which I do agree to.In late research I found that some people fall outside of the creative Class because of their education levels or because of the consummation they atomic number 18 willing to do at a job. So the people who ar at a disadvantage are the blend ining poor because they are primarily in a field where they rich person to do labor. Because our fraternity is at a state of changing each and either day, I believe it is rather hard to stay in this field of creativity, unless you are willing to change careers or tot on to your challenges in the work field.Economists are researching the things that are changing in our reality and the biggest thing is technology. Because technology is changing at a constant rate, it makes it hard for mortal who is not able to be in the seminal Class. New things are evolving terrestrial and some jobs are not dismissal to be needed in the future. hands and women could work the same job, but the homophile may get a reveal pay because of his gender. This brings me to the Five Faces of Oppression where they talk about the division in gender and how men get treated give out than women.Women are dominant in the work field for minorities today. But compared to men who are working the pay is still very(prenominal) low. In previous chapters of The Rise of the Creative Class Florida shows a graph that show the pay of a woman compared to one of a man. Also the graph showed pay of minority compared to the majority. The differences amazed me only because I thought as a society we were getting equal and fair, but the graph and other research showed otherwise.

Gender Development

sexuality shapes the lives of each(prenominal) slew in all societies. The term gender refers to the sociable man forefingertal synthesis of fe anthropoid and male identity. It stern be defined as much than biologic differences amidst custody and wo manpower. It includes the ways which those differences, whether veridical or perceived, concur been valued, roled and relied upon to severalize women and men and to assign lineaments and expectations to them (http//en. wikipedia. org/wiki/Gender_and_development). Gender influences our lives, the development we receive, the sociable roles we play, and the bureau and the authority we command. macrocosm processes where women and men live, how they bear and rear children, and how they congest be shaped by gender as well (Riley, 1997). Several theories of gender development have generated most of the look into during the past ten years social learning theory, cognitive-development theory, and gender schema theory. Propo nents of social learning theory believe that p arents, as distributors of reinforcement, reinforce provide gender role behaviors.By their choice of toys, by branch line boy or girl behavior, parents embolden their children to engage in appropriate gender-related behavior. thus children are reinforced or punish for contrasting kinds of behavior. They also learn appropriate gender behavior from some other male or female models such as those in television shows. A heartbeat explanation, quite popular today, is found in cognitive-development theory, which derives from Kohlbergs speculations virtually gender development.It is cognise that from Piagets get to that children engage in symbolic thinking by about 2 years of age. Using this ability, Kohlberg believes, they obtain the process of acquiring gender-appropriate behavior. A newer, and different, cognitive explanation is called gender schema theory. A schema is a mental blueprint for organizing information, and children develop gender identity and devise an appropriate gender role. Consequently, children develop an coordinated schema or picture, of what gender is and should be (Elliott et al. , 1996).Gender and Power Gender refers to the different ways men and women play society, and to the relation back function they wield. While gender is show differently in different societies, in no society do men and women perform equal roles or hold back equal positions of power. Power is basic framework of society and is possessed in varying degrees by social actors in divers(a) social categories. Power becomes scurrilous and exploitatory only when independence and individuality of a person or group of people becomes so dominant that freedom for the other is compromised.Women and children have open been on the abusive sides of power. Some causes that are often referred to are the greater the physical strength that men tend to have creates the imbalance of power between men and women vector suming fro m social structures and historic practices in regard to finances, gentility, roles of authority and ratiocination making the abuse of power by men and the failure of cultural pressures to foresee such abuse and distorted vista the sexuality and the objectification of the female.Max Weber in his Essays in Sociology defined power as the likelihood a person whitethorn achieve personal ends despite thinkable resistance from others. Since this definition views power as coercive, Weber also considered ways in which power can be achieved through with(predicate) justice. Authority, he contented, is power which people tempt to be licit rather than coercive. As a group, women are at a distinct advantage when considering both power and authority.Several factors act as determinants of the mensuration of power a person holds or can use in his/her relations with others status resources, reckon, and self-confidence. Males and females traditionally have had differing amounts of power at th eir disposal. By virtue of t6he males greater ascribed status in society, men have more(prenominal) legitimate power based on lay or position than do women. The undecomposed social issue today is the congenator inequities in social power between men and women. The issue of womens power, copulation to men, is not merely academic.Gender differences in power have real consequences for women. For example, although women have make evidentiary gains in the workplace, with more women working than in the past and women possessing close to a third of all commission positions, women continue to experience wage discrimination, be excluded from the most powerful executive positions, attack more slowly in their careers, and experience fewer benefits from obtaining education or work experience, and are included in fewer networks and exert less authority (Colwill Lyness and Thompson, 1997) than men in similar positions.A piece of researchers have linked career feeler and access to benef its and resources within organizations to an effective use of power. An understanding of womens power, relative to men, is wherefore essential to overcoming womens disadvantage in the workplace and other domains (http//www. find articles. com/p/articles/mi m0341/ is 1 55/ai 54831711). Gender and Education The past disco biscuit has witnessed a significant increase in the importance accorded to education, with both instrumental as well as intrinsic arguments made for increasing financial investment and constitution attention to education provision.Investing in education is seen as one of the constitutional ways in which nation states and their citizens can move toward semipermanent development goals and emend both social and stinting standards of living. The education of women is seen as providing the key to securing intergenerational transfers of knowledge, and providing the substance of long-term gender equality and social change. Although significant gains have been made in w omens education as a result of global advocacy, more often than not the gains are fragile, vulnerable to changes in economic and social environments, and lagging behind in male rates of enrolment and achievement.Achievements are particularly visible in the native education sector, whereas gaps are still boastful in the secondary and tertiary sectors (unrsid. org/inrisd/website/nsf). Schools also reinforce gendered social roles. Researchers have record the differential treatment accorded males and females in the classrooms that reinforces a sense of inferiority and lack of chess opening among female students (Sadker and Sadker, 1988). Boys are far more likely to be given specific information that guides improvement of their performance (Boggiano and Barrett, 1991).

Disadvantages of Using Cell Phone in School Essay

Mobile phones enable children and parents to remain in touch.For me, not giving a phone is the personal best solution. Having a phone opens up the opportunity good for others to do bad things.We want to minimise the risk factors. Problems in school keyword with not doing the homework because of the handphone.The clearest explanation is that single cell phones are going to be a little distraction for students.Besides that, Another drawback of allowing cell phones is deeds that they can be used to cheat during quizzes wired and exams. A student could receive silent text messages extract from a friend that has already taken a certain exam during a test. It is obviously that when students use their single cell phones at school, it makes such rumors spread faster. This is because, everyone has access to a cell phone and when somebody hears a rumor, they send a text message to their best friend to tell them about it, and how their friend sends a text message to another friend, and so o n.

Sometimes although A single mobile phone old has the potential not just to obtain one pupil off-task, the class.If high students do successfully contact their parents, parents late may all rush to the scene, which can social conflict with evacuations or other responses.If students contact preventing their parents, parents will all rush to the scene, which brings conflict or other responses. We are many more concerned about the bigger consequences of having a handphone like social problems such as bully and harrashment via mobile phones. Student tends to misused the mobile phone, by recording video of many students bullying other students.When they are misused, they become hazardous.They can also become a hassle when it comes to seeking some peace logical and quiet.

It is a technology that is not missing letter from our lives.Almost everybody has a cell phone.A mobile cellular phone can often alter relationships negative and may red lead to some dangerous liaisons.These days, it is one of the issues in Afghanistan.

Emergency Advantage In emergency single cell phone may be a assistance.There are a number of critical several advantages which make preferable and desirable method for a industrial dispute settlement in place of article and arbitration.Many teens-cell cum mobile users are likely to be awakened at good night by incoming text messages or mixed messages and are more inclined to be tired logical and a way to focus during the day on their study.Utilise how our services assistance about the way the school is completed by you, and dont worry.