Community developmentnursing: Theory and practice - Essay Example

Unit 2: Historical Context of Public Health in Australia: Health and Illness in Australia Activity I There was a dramatic increase in life expectancy between 1840 and 1940 in developed countries such as Australia. Why did this occur? This occurred because of a major health revolution in developed countries; marked by a significant change in basic approach towards health and hygiene, bathing, cleaning, cooking and overall living conditions followed by improvement in socio-economic conditions, and the invention of antibiotics during this period. Since 1940 this increase in life expectancy has slowed significantly. Why has this occurred? Post 1940 there was an increase in cardiovascular diseases and deaths due to lung cancer, leading to a reduction in life expectancy, especially among males (Mathers & Douglas 1998). How cost effective do you think secondary and tertiary hospital based health care in improving the health and life expectancy of Australians? The cost effectiveness of Australian health care be better understood by comparing it with international performance. The same is mentioned in the table below: Annual Cost of Health Care per capita (Visual Economics, 2010) Country Amount ($) Australia 2886 Canada 2998 France 3048 UK 2317 Japan 2249 U.S. 5711 On the basis of the above table, it can be stated that the health care provision in Australia is relatively cost effective as compared to other nations of the world. Why are there differences in morbidity and mortality between different social classes? The differences in morbidity and mortality between different social classes can be mainly attributed to the significant differences in lifestyle, food consumption patterns, and access to health care facilities. The incidence of which diseases are higher among Australian Aboriginal peoples than the non-Aboriginal population? Australian Aboriginals are known to suffer from cardiovascular diseases, diabetes (type II), high blood pressure, and stress as compared to non-aboriginals (MMHR, 2010). Why do our Aboriginal peoples experience these diseases at a higher rate? Various factors such as genetic susceptibility, diet, lack of physical activity, poor standards of living and reduced access to medical care are responsible for the presence of such diseases among Australian Aboriginals (Better Health Channel, 2010). What are the possible implications for preventative strategies when there are class and racial differences in the incidence of disease? People belonging to certain race / ethnicity are known to suffer more from certain diseases as compared to others. Such knowledge can lead to early proactive and preventive measures, such as early detection and / or treatment strategies specially designed for them; provision of better health care facilities; increased and improved access to cost effective medical aids and programs directed towards raising awareness regarding the type of disease and measures to prevent its’ occurrence. In Hong Kong there has been an overall decrease in cigarette smoking since 2004; however, the rate for males has decreased while the rate for females has increased. Why do you think this is? This is because females had lower confidence in quitting as compared to males. Furthermore, smoking which is associated with impaired quality of life, which was far worse for women as compared to men (Chan, 2004; Wilson et al, 2004). Please write your own personal reflections on what this information has provided for you and whether it has met the objectives of the tutorial. Australia is a culturally diverse nation. The diversity in population in terms of social classes as well as race and ethnicity entails individualized health care programs to suit the needs of each section of the population and to uphold their preferences which are based on factors such as genetics, social beliefs and culture, lifestyle, standards of living etc. With the increase in cultural diversity, the nature and complexity of provision of palliative care also increases simultaneously. Thus in order to ensure optimum health and well-being across all sections of the population, an integrated health promotion program must be implemented, taking into consideration the rich cultural diversity and the epidemiology of all sections of the society. This unit, helped in understanding the role played by social factors on health and well being of individuals and thus successfully met the objectives laid down in the study module. UNIT 3: Funding of and the Strategic Directions of Public Health in Australia: Activity 1: Identify the main factors that have contributed to the emergence of the new public health in Australia, and what roles have international trends played in its development. The key factors which have contributed to the emergence of new public health in Australia include: growing awareness about the fact that physical, social, psychological as well as biological influences have a significant impact on health outcomes; emergence of various national and international advocacy groups such as WHO; greater emphasis on improving public health and development of laws by international policy makers etc. Furthermore international laws such as the Alma-Ata declaration of 1978; The Ottawa Charter of 1986; The Jakarta Declaration 1997; etc among others which emphasized on improving public health through provision of better primary health care facilities to one and all regardless of any class, ethnic, religious or racial differences, acted as a guide to other nations to achieve better public health. What is your definition of health? Health, in my view, is the complete mental, physical, emotional and social well-being of an individual. What are the key points from the seminal documents and conferences you were asked to read? The Alma-Ata declaration emphasized on providing uniform health care facilities to all sections of the society and eliminating the differences which existed, especially between developed and developing nations. The Ottawa charter focused on the needs and requirements of industrialized nations and aimed at improving overall conditions of living by improving political, economic, social, cultural, environmental factors. The Jakarta Declaration re-emphasized the issue of health promotion and aimed at addressing the threats caused by new and re-emergence of infectious diseases. It recognized poverty as a major health hazard. The Bangkok Charter on Health Promotion (2005) aimed at developing strategies to build a healthier world The Mexico Conference stressed on promoting social responsibility for health; expanding partnerships for health; increasing investment for health development; and securing an improved infrastructure for promoting better health. Do these documents show an evolutionary process in the development of the primary health care on a global basis? Yes, all the documents studied provide a clear road map of the manner in which health care developed at a global level. Do you think primary health care has benefited our society? How? Yes. Primary health care has immensely benefited our society in the form of improved worker efficiency; increased productivity; improvement in socio-economic conditions; improvement in standard of living; as well as an overall improvement in social, economic, political, and environmental aspects of our everyday life. What are the future challenges for health promotion on a global basis? Equitable distribution of resources Improving accessibility and ensuring affordability Tackling complex issues such as urban crowding to ensure smooth functioning of health promotion programs Establishing a clear understanding by the policy makers in terms of the association between health and environmental sustainability What are the possible implications for health promotion when there are class and racial differences in the incidence of disease? Enabling a better understanding of the various disparities prior to developing and implementing health promotion programs; developing segment specific activities directed at people belonging to various categories depending on their age, sex, race, or ethnicity; improving resource allocation and ensuring better accessibility across all sections of the society. Please write your own personal reflections on what this information has provided for you and whether it has met the objectives of the tutorial. This unit helped in gaining immense insight into the various factors and events that led to the development of global public health. The international initiatives aimed at enhancing and improving public health, spearheaded by the Alma- Ata declaration of 1978 paved way for other nations to acknowledge and recognize the significance of public health and its consequent impact on social, economic, political, and environmental factors. It not only helped in improving health of people in the industrialized nations but also helped in providing quality health care facilities in developing nations. UNIT 4: Epidemiology in the Australian Health Care Context Activity 2 What is epidemiology? Epidemiology is that branch of medical science which explores a range of factors that establishes the presence or lack thereof, of diseases and disorders. It studies the occurrence and causes of diseases as well as the frequency with which they occur (Hales, Lauzon, 2009). What are the three (3) main uses of epidemiology? The three main uses of epidemiology are: Community Assessment Screening and Program Evaluation What is the difference between population and clinical epidemiology? Population health is the study of disparities in health among various sections of the population while epidemiology focuses on the causes and frequency of occurrence of certain diseases among a given set of population. What are the limits to epidemiology? inability to identify major risk factors associated with chronic diseases does not take into consideration biological factors leading from exposure to diseases as opposed to toxicology Mainly deals with a heterogeneous population which may raise serious questions regarding the validity of its results (Ahrens, Pigeot, 2005) How do you define prevalence and incidence of disease? Prevalence refers to the total number of people affected by a given disease at a particular point in time, while incidence refers to the frequency of occurrence of that particular disease during a given period of time. Outline how the following may impact on the individual’s and community’s health status: I. Social and economic factors Individuals and communities which enjoy a higher socio-economic status have better access to health care facilities as well as affordability, compared to those who are not socially or economically well-off, hence they enjoy better health than the other sub groups. These factors have the capability and power to influence health related decisions and may lead to positive or negative health outcomes depending on their status. II. Employment status Those individuals who are employed tend to enjoy better health status than those who are unemployed. They are mentally secure and since they feel valued and have ample opportunities for advancement and personal growth, as compared to those who are unemployed, since the unemployed often suffer from stress, insecurity, hypertension, low self esteem which further leads to various health related problems. III. Ethnicity Ethnicity plays a vital role in the manner in which health related issues are dealt with. The beliefs, practices, attitudes and approaches towards health vary largely between various ethnic groups. This influences their decisions to access and avail health care facilities as well as the type of health care provider sought by them. IV. Gender The presence of gender inequality may lead to poor health status among females. This is largely observed in developing countries and among racial / ethnic minorities in developed countries. V. Age Infant mortality rates are relatively higher among populations with lower economic status. The young or adolescent health among economically backward sections of the society or those belonging to ethnic minorities is also relatively poor owing to lifestyle differences and alcohol or drug abuse. VI. Geographical Location The type of neighbourhood plays a major role in determining individual or community health. The accessibility as well as affordability of health care facilities and the overall awareness about the health programs offered by local, or national authorities also varies and is largely dependent on the geographical location. Activity 3 Case Study Hong Kong offers universal health care system wherein all individuals seeking and in need of health care are offered maximum possible support. Social and economic factors Social and economic factors can have a significant impact on the individuals health. Over and above the physical health the emotional and social environment is also largely responsible for shaping an individuals health. Factors such as social care, housing, education, transport as well as economic development significantly influence peoples health and hence must be taken into consideration in order to ensure better health. The public health nurse can assist this family in availing better housing facilities to such homeless and vulnerable groups as a preventive health measure. Employment Status Since this family does not have an employed member, and have no source of employment, the public health nurse may recommend them to appropriate communities to engage them in active employment. Lack of employment affects mental health significantly and leads to activities which may harm an individual’s health – such as alcohol abuse, gambling, drug abuse, etc. Ethnicity Ethnic differences play a major role in health conditions of individuals. People belonging to certain race or ethnicity are relatively more prone to certain diseases as compared to others mainly on account of their genetic factors. Public health nurses must hence take into consideration such factors while prescribing treatment for people belonging to diverse ethnic backgrounds. Gender Mrs. Soweto has urinary problems related to genital mutilation is also 12 weeks pregnant. Furthermore both Mr. and Mrs. Soweto have very little understanding of the hygiene practices and general cleanliness. This could create further problems and endanger the life of both the mother as well as her unborn child. Furthermore they have little knowledge about the language spoken in Hong Kong. This could adversely affect their health causing further complications. The public health nurse can assist this family by recommending the services of a translator to better understand and assess their health needs, and provide good quality health care facilities. Age This family has 3 young children between the age group of six months and three years. Their living conditions are unhealthy (since they live in a small unit with barely any furniture). This could severely affect their health and cause potential damage to their physical and mental wellbeing. The nurse can provide paediatric care to the three children and provide better and safer housing to ensure that the children are brought up in a safe and healthy environment. Education is also considered as a preventive health measure by the Hong Kong government, hence arrangements can be made to accommodate the oldest child in school. Geographical location The Soweto family are unemployed immigrants to Hong Kong and the place they live in – a small unit, could be highly unhygienic and unhealthy. The fact that they speak very little English and no Mandarin could complicate matters, especially in terms of communicating their health needs to the nurse. Their economic condition may further act as a deterrent and they may suffer from low self-esteem and hence avoid contacting the health authorities for help. Hong Kong offers universal health services and even free of charge medicines to people from poor families. A public health nurse can help them in availing these services and ensure their better health. Please write your own personal reflections on what this information has provided for you and whether it has met the objectives of the tutorial This unit helped in understanding the basic concept of health – which is far more than the mere absence of illness, and includes an overall wellbeing of an individual. The discussion about the health facilities offered at a global level and especially in countries such as Hong Kong which has the highest life expectancy rates in the world, and is known for the high quality health care facilities, broadens ones views about the need and impact of provision of such services on the public health and the betterment of the community as a whole. One of the most significant observations made during this study is the fact that there many countries today are culturally diverse and hence there is an urgent need to develop and implement an integrated health promotion approach which aims at satisfying the needs of its culturally diverse population. This can be done through establishment of community support services at local and regional levels which work in co-ordination with the national and international health organizations. UNIT 6: Health Inequities Activity 1: What are three (3) ways in which English control of Hong Kong impacted on the health of the Hong Kong people? Provision of subsidised medical facilities ensuring affordable health care to all sections of population regardless of their socio-economic backgrounds The establishment of government health care policy that aimed at ensuring that no one is denied access to health care facilities due to lack of means A strong public health care infrastructure which aims at disease prevention and control How do social factors impact on the health of Chinese people? The indigenous population in China are marked by chronic underdevelopment owing to lack of social support. Hence they are more likely to attract health risks - especially on account of malnutrition and poverty. Many minority groups follow outdated social customs, which may be unhealthy and hence cause potential health risks. The risk of attracting sexually transmitted diseases is also relatively higher, since awareness and knowledge related to such diseases is low. How the provision of health care changed since Hong Kong has returned to central Chinese Government? In the mid nineteenth century public health in Hong Kong, was not considered as a part of government responsibility. However, this changed drastically post nineteenth century and Hong Kong emerged as the world’s best health care provider. During the British rule, the hospitals in Hong Kong mostly provided western style treatments however after its accession to the central Chinese government, the use of Traditional Chinese Medicine increased significantly. The number of hospitals was limited initially, but now they have increased and provision of good quality and affordable health care services to one and all has become an integral part of the government’s agenda. There is a significant change in government’s commitment to health sector prior to and post British rule. Non-governmental organizations sponsored by government grants, were established to provide health care services and the Hong Kong hospital authority was revamped. Today Hong Kong is one of the few nations in the world which offers universal health care facilities and subsidised and even free of charge medical aids to the needy (Gauld & Gould, 2002). Many communities are reported as having many disadvantages. Explain briefly how vulnerable groups in Hong Kong (e.g. immigrants – both legal and illegal) people may be disadvantaged in relation to the following factors, and how these disadvantages may impact their health. Education: Lack of education leads to lack of general awareness about the health issues and thus leading to ill health especially among the vulnerable groups. Since the vulnerable groups are among the most disadvantaged groups, in terms of economic wellbeing, access to services, discriminatory attitudes towards them by the system, etc., such factors have a direct impact on their health. Furthermore, lack of education also leads to lack of knowledge about basic hygiene, the ill effects of consumption of contaminated food / water, preventive measures to be taken to avoid spread of contagious diseases etc. The risk of ill health is relatively higher among the vulnerable sections of the society such as illegal immigrants, or legal citizens who are poor or belonging to economically backward strata of society, because, they lack adequate access to health services either on account of lack of knowledge regarding the same or lack of resources at their disposal to avail services provided to them. Employment Status The employment status has a direct correlation with health of the population at large. Unemployment invariably leads to mental health problems, such as stress, depression and loss of self-esteem among the individuals, leading to a gradual deterioration of health. The crisis is even more acute among vulnerable groups such as – illegal immigrants and those from poor economic backgrounds, as well as the racial / ethnic minorities. Lack of employment leads to poorer conditions, and gives rise to problems such as lack of availability of food, clothing and shelter. Issues such as these, adversely impact the health of these individuals as well as their families and access to medical care becomes all the more difficult leading to ill health among such vulnerable groups. Economic Status There is a very strong relationship between an individual’s economic status and health. The lack of availability of adequate funds at one’s disposal leads to poor housing conditions, affects hygiene, leads to lack of education which in turn leads to adequate knowledge regarding conditions affecting health. Lack of availability of adequate funds forces such families to live in adverse situations and environments which are hazardous to their health. Lack of adequate finances is known to affect both physical as well as mental health of such vulnerable groups. Housing Poor economic status often forces families of illegal immigrants to live in adverse situations and localities with inadequate facilities for sewage and waste disposal. Poor illegal immigrants as well as other disadvantaged groups in Hong Kong are often found living on the streets or in dingy apartments or units with lack of proper furniture and other basic necessities. Such factors adversely affect the health of people especially women and children, who are among the most vulnerable of such groups. Lack of appropriate environmental infrastructure Environmental infrastructure or the lack of it plays a significant role in affecting the health of the general population and hence great care must be taken to ensure that it is safe and conducive to the surrounding neighbourhood. Vulnerable social groups are likely to fall prey to the adverse effects of an inadequate environmental infrastructure such as lack of access to safe and pure drinking water, sanitation facilities, inadequate waste management system, poor drainage systems, air and water pollution in their neighbourhoods, etc. which take a toll on their health. The risk of attracting diseases is relatively high among the vulnerable social groups especially on account of their choice of settlements or lack of proper housing facilities. They tend to live in urban slums or congested areas which are known for inadequate environmental infrastructure which is unsafe for their health. The availability of a sound environmental infrastructure has a sound bearing on the quality of life led by individuals and hence must be taken into consideration by the responsible authorities in order to ensure the safety and well being of such groups. Why was the Northern Territory Emergency Response (NTER) instigated by the Howard Australian Liberal Government in 2007? The NTER was announced by the former Australian Government in 2007 as a response to a recommendation of the Little Children are Sacred report, which was brought into national focus, highlighting a serious issue of child abuse among indigenous communities in that territory. It sought to conduct an independent review of the whole issue and investigate into areas such as health, education and child welfare (FAHCSIA, 2010). What were the three (3) broad objectives of the NTER? The three broad objectives of NTER include: - Stabilization to protect children and secure their communities; - Normalisation of services and infrastructure; and - In the longer term, sustainability, bringing Indigenous Australians fully into line with the choices other Australians enjoy (MJA, 2007). What do the health checks for children involve? The health checks for children involves compulsory childhood immunization, a comprehensive history of the child along with the circumstances in which they are brought up; tests on heart, lungs, eyesight, hearing, dental checkups, and other tests such as blood sugar etc; and a follow up on these tests to reveal histories and development of the child. What were the major findings of these health checks? The health checks revealed that a majority of the aboriginal children (approx. 80 percent) suffered from middle-ear diseases, intestinal parasites and skin infections. The skin diseases were found to be common among these children largely owing to lack of availability of clean water for washing, and drinking as well as an inadequate sewage disposal system. This was also responsible for the high prevalance of renal and heart diseases, followed by rheumatic fever. Type 2 diabetes was also found to be common among such children. Part of the NTER was to improve the nutritional status of children with a School Nutrition Program. What are the benefits of the School Nutrition Program? The main aim of the School nutrition program was to improve school attendance among the aboriginal children who were enrolled in schools but were not attending classes regularly. The major benefits of this program encouraged the children to not only attend the school but remain in classes all day. It helped in teaching the children the importance of healthy eating. The program also provided ample opportunities to the parents to remain actively involved in their childs school activities and participate in their development. It offered real job opportunities for local indigenous people, helped the children to concentrate and engage actively in school activities and ensured that the parents took adequate care of their children in terms of feeding them healthy food. How is the School Nutrition Program being implemented? The program is introduced to communities through a well planned activity whereby the Department of Education, Science and Training, contributes by providing adequate funding to organizations in order to enable them to carry out this program successfully in the designated areas. What sort of food is provided and where will it come from? The meals under this program would be provided in accordance with the nutritional guidelines set out by the Northern Territory School Canteen. The meals will be prepared by local indigenous people who in turn will be employed by local organizations in charge of supplying such meals. Can parents contribute for one meal a day instead of both breakfast and lunch? No. The parents need not provide any meals since the both the breakfast as well as lunch will be provided under the program. How is the School Nutrition Program funded? The cost of meals provided under this program will be borne by the parents. They can contribute to the Income Management or through Centerpay or directly through cash contributions. They can also assist in funding the infrastructure costs. The cost of salaries payable to the employees working under this program will however, be borne by the Australian Government and shall be provided to them through the Department of Education Science and Training. Please write your own personal reflections on what this information has provided for you and whether it has met the objectives of the tutorial. This unit helped in understanding the vast differences that exist between various sections of the population and especially between the aboriginal and non aboriginal population; the various reasons for such differences; and the steps initiated by the government in order to bridge this divide. The comparison to Hong Kong also helps in highlighting the fact that such differences among various social, economic and ethnic groups exist across the globe and that it is possible as well as essential to bridge such divide, through proper programs in order to ensure a better public health. The facts related to the establishment of the Northern Territory Emergency Response helped in gaining a broader understanding of health issues faced by children of indigenous groups, and how the government initiated robust programs to elevate their health and wellbeing. UNIT 7: Healthy Living: Activity 1 What are the basic nutrients which are needed in our diets on a daily basis? The four basic nutrients required in our daily diets are: water, carbohydrates, proteins and fats (Balch, 2006, Pp. 7). Why do we need these nutrients? Water is required for transporting nutrients in and out of cells; helps in digestion, absorption, circulation as well as excretory functions; and utilization of water-soluble vitamins. It helps in maintaining appropriate body temperature. Carbohydrates act as fuel for cells which helps in muscle building. It helps in curing digestive disorders and prevents colon cancer. Proteins are required for the overall growth and development of the body. It provides energy and helps in manufacturing hormones, antibodies, enzymes and tissues as well as maintaining proper acid-alkali balance in the body. Fats is required for normal brain development during childhood and small amounts of fats is required for providing adequate energy and enable normal growth and support during adulthood, although excessive intake may prove to be injurious to health (Balch, 2006, Pp.5). Briefly explain the following terms: Metabolism: Metabolism refers to the physical and chemical changes which occur in a human body which are extremely inevitable for sustaining life (Nath, 2005, Pp. 35). Anabolism: Anabolism refers to the process by which the enzyme pathways build up cellular components. It produces all the necessary components which help in operating and reproduction of cells in our body (Ronzio, 2003, Pp. 434). Catabolism Catabolism is the system whereby the enzymes oxidize fuel nutrients such as carbohydrates, amino acids and fat, into energy and to waste products, carbon dioxide and water (Ronzio, 2003, Pp. 434). How much fluid per day is recommended for an average adult? A healthy adult requires one and half to three liters of water per day (BBC Health, 2010). What is Body Mass Index (BMI)? The Body Mass Index alternatively known as BMI is an approach by which an individuals weight is calculated against a given height. It calculates the ration between weight and height of an individual. It is considered to appropriately indicate body adiposity and it does not include body fat (Gropper et al, 2008, Pp. 280). What is the normal BMI for an average adult? The normal BMI for a healthy adult is between 20 and 25 (Better Health, 2010). How do you assess a child’s growth (i.e. children < 5 years of age)? There are various ways with which a childs growth can be assessed. Some of the most common ways to measure such growth include basic anthropometry - which entails measuring the height, weight and head circumference of young children; body composition i.e. body fat or muscle; and BMI (Department of Health, 2010). How is ‘energy’ intake related to weight? When the amount of energy intake is less than the amount of energy used, it indicates a negative energy balance and the body uses energy stores, and thus loses weight in the process. On the contrary, when the energy intake is more than the energy amount of energy used there is positive energy balance, this excess energy is stored in the body in the form of fat. Since more energy is available in the body than what is required, it tends to add weight (Brown, 2008, Pp. 8-9). What factors influence the potential for healthy eating? There are various factors which may influence the potential of healthy eating among individuals. These include: physical, psychological, socio-cultural, environmental as well as politico-economic factors. What are the Physical Activity Guidelines for the following age groups? a) Average Adult: A total of four steps are recommended for adults whereby steps 1 - 3 describe the minimum amount of physical activity recommended for improving health while the last step is for those wishing to achieve greater health and fitness. Step 1 - Any form of physical movement of the body is recommended and is considered as a step forward, towards improving health rather than a time-wasting inconvenience. Step 2 - Activities like walking, cycling or doing things yourself, are recommended as opposed to using cars, or other machinery. Step 3 - Dedicate a minimum of thirty minutes of your life per day, in shorter sessions of activity Step 4 - Indulge in some regular, vigorous activity to achieve greater health and fitness (Department of Health, 2010). b) A child < 13 years: For a child less than 13 years of age, a combination of moderate and rigorous activities for a minimum of sixty minutes per day is highly recommended. These activities may include brisk walking, bike riding, or any other sort of activity or play. These activities may include organized sports such as football or netball or ballet, running, as well as swimming. Furthermore it is highly advisable that children should be abstained from using electronic media such as TV, internet or computer games for prolonged period of time - i.e. more than two hours per day, and especially during day light (Department of Health, 2010). c) An Adult who had a diagnosis of diabetes mellitus Type 2 with no other co morbidities: An adult diagnosed with type 2 diabetes must continue with moderate physical activities after consulting with a physician. What considerations should be made when advising an aged person (>65 years) to increase their level of physical activity? There are total five key recommendations for older Australians. These include: 1. Older people must engage in some form of physical activity, regardless of their age, weight, health problems or abilities 2. They should remain active each day in as many ways as possible and indulge in various activities which help them incorporate fitness, strength, balance and maintain flexibility 3. They should devote a minimum of thirty minutes each day for moderate physcial activities 4. Those who have completely stopped all kinds of physical activities, or starting a new physical activity, must start at a level which is easily manageable and then gradually build up on the recommended amount, type and frequency of activity and 5. Those who continue to enjoy a lifetime of vigorous physical activity should continue doing so in a manner which is most suitable for them considering their health status and capability, provided they adhere to the safety procedures recommended for them (Department of Health, 2010). Hong Kong has had an increase in obesity since 2004. Why do you think this has occurred? Hong Kong underwent tremendous socio-cultural changes during the past decade. Rapid economic development was observed in Asian countries during the past couple of years. This was followed by an increased availability of rich nutrient availability and improved access to rich food. This led to the increase in consumption of fatty foods and food rich in sugar. The consumption of saturated fat also increased significantly thus leading to obesity among the population. Undertake a little research into the health children who are in Afghanistan and Iraq (i.e. in a war zone), and outline issues related to their nutritional status. Compare your findings with the nutritional health of Hong Kong children. Most of the children in war torn countries suffer from malnutrition, due to lack of availability of adequate food. According to UN 54 per cent of the children surveyed in Afghanistan during the year 2009 were found to be stunted and at high risk of malnutrition (RAW news, 2009). The infant mortality rates are relatively higher in such countries. In Afghanistan for instance, approximately 200,000 children die each year and the major causes of death include deaths due to: neonatal causes (41%), pneumonia (21%), and diarrhea (14%) and measles (4%). The underlying cause of all deaths among children is malnutrition and micronutrient deficiencies (NCAHP, 2009). The results for children in Iraq were strikingly similar to the plight of children in Afghanistan. The Iraqi children were also found to be severely malnourished with a majority of children suffering from acute malnutrition (UNICEF, 2003). On the contrary, the children in Hong Kong were found to be overweight and problems of obesity among children are also higher, due to consumption of unhealthy food or unbalanced diet. Nutritional problems in Hong Kong were mostly related to over nutrition and high protein consumption. The cholesterol and fat levels of these children were also found to be higher as compared to children from war torn countries such as Iraq or Afghanistan where the availability of adequate nutritious food is a rarity (Hui, Nelson, 2006). Activity 2: case study What questions would you ask this lady and her daughter in relation to Mrs. Sheppard’s eating and drinking? Since this woman lives alone it is highly likely that she has no source of social interaction which has made her withdrawn and lonely, and hence has lost her appetite. Thus questions should be asked to enquire about her daily routine to find out about her daily chores and whether she has any social interaction with the outside world. After exchange of greetings and general inquiry about her health, the following questions can be asked: Q1. How do you spend your day? Q2. What kind of activities do you indulge in? Q3. Do you go out for a walk? If yes, How often? Q4. Do you go out / socialize with your peers / friends / neighbors? Q5. Are you in touch with your family / friends? These questions would provide answers to her social life, and whether or not she engages in any sort of physical activity. It is highly likely for an aged individual living alone to feel isolated and ignored, because of which they may lose all interest in life, and tend to react negatively. Loss of appetite is one such outcome of loneliness and boredom. Thus it is highly recommended that she participate in outdoor activities such as walking and engage in moderate physical activity on a daily basis. This will keep her healthy, improve her appetite and keep her engaged with her peers thus reinforcing in the will to live her life to the fullest. Inactivity often leads to boredom and feelings of depression among the elderly. Engaging in physical activity will help in boosting her spirits and enhance her quality of life. Please write your own personal reflections on what this information has provided for you and whether it has met the objectives of the tutorial This unit provided a broader understanding of the fact that nutritional needs of people across different age groups vary and they are largely associated with the type of health enjoyed by each individual. The nutritional requirements of individuals suffering from certain illnesses are different from a perfectly healthy individual. Furthermore, this unit helped in understanding the significance of daily physical activity for different age groups and how it helps in maintaining proper health. Reference List Ahrens, W., Pigeot, I., 2005. Handbook of Epidemiology, Birkhauser Publication, Pp. 14 - 17 Balch, P. A., 2006. Prescription for nutritional healing, Avery Publication, CA BBC Health, 2010. Why do we need water? 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