Supremacy of the US Dollar

Supremacy of the US Dollar ABSTRACT This assignment briefly discusses the supremacy of US Dollar. It includes suggestions and recommendations to its near future position, internationally. The proponents of the assignment are divided into the history of the US Dollar and its role as the dominating currency in the world. Ever since other currencies began to take part actively in the foreign exchange markets, they began to challenge the role of US Dollar. Arguments were put forward that the US Dollar would have to compete with the various emerging currencies to maintain its position as the most influential money dominator. The paper intends to discuss the currency contenders, which are the Euro, Japanese Yen Chinese Renminbi and the Russian Rouble and why are they the nearest competitors to challenge the US Dollar. Chapter 1 HISTORY The United States emerged from World War II not only as military victor but as an economic victor as well. It was by far the strongest economic power in the world. Under the Dollar standard, the Dollar standard, agreed to make the Dollar â€Å" as good as gold† redeemable on demand by any central bank at the rate of $35 an ounce in 1933. This meant that the dollar became the accepted medium of exchange for international transactions. This seemingly routine event was to have far reaching implications for the international financial system, certainly beyond what anyone would have imagined. According to James Grant the US dollar is the greatest monetary achievement in the history of the world. In year 1792 the first US dollar issued by the United States Mint which same in size and composition to the Spanish dollar. The US dollar was created and defined by the Coinage Act of 1972. The Coinage Act 1792 set the value of at 10 dollars, and the dollar at 1/10th eagle. It also called for 90% silver alloy coins in denominations of 1,  ½,  ¼, and 1/10. The timeline of US dollar currency will be discussed which as follows: I. Colonial Bills 1690 The Massachusetts Bay Colony, one of the Thirteen Original Colonies, issued the first paper money to cover costs of military expeditions. The practice of issuing paper bills spread to the other Colonies. II. Franklins Unique Counterfeit Deterrent 1739 Benjamin Franklins printing firm in Philadelphia printed colonial bills with nature printsunique raised impressions of patterns cast from actual leaves. This process added an innovative and effective counterfeit deterrent to bills, not completely understood until centuries later. III. British Ban 1764 Following years of restrictions on colonial paper currency, Britain finally ordered a complete ban on the issuance of paper money by the Colonies. IV. Continental Currency 1775 The Continental Congress issued paper currency to finance the Revolutionary War. Continental currency was denominated in Spanish milled dollars. Without solid backing and easily counterfeited, the bills quickly lost their value, giving rise to the phrase not worth a Continental. V. The Bank of North America 1781 Congress chartered the Bank of North America in Philadelphia as the first national bank, creating it to support the financial operations of the fledgling government. VI. The Dollar 1785 Congress adopted the dollar as the money unit of the United States. VII. First Central Bank 1791 Congress chartered the Bank of the United States for a 20-year period to serve as the U.S. Treasurys fiscal agent. The bank was the first to perform central bank functions for the government and operated until 1811, when Congress declined to renew the banks charter. Recognizing that a central banking system was still necessary to meet the nations financial needs, Congress chartered a second Bank of the United States in 1816 for another 20-year period. VIII. Monetary System 1792 The Coinage Act of 1792 created the U.S. Mint and established a federal monetary system, set denominations for coins, and specified the value of each coin in gold, silver, or copper. IX. Greenbacks 1861 The first general circulation of paper money by the federal government occurred in 1861.Pressed to finance the Civil War, Congress authorized the U.S. Treasury to issue non-interest-bearing Demand Bills. These bills acquired the nickname greenback because of their color. Today all U.S currency issued since 1861 remains valid and redeemable at full face value. X. First $10 Bills 1861 The first $10 bills were Demand Bills, issued in 1861 by the Treasury Department. A portrait of President Abraham Lincoln appeared on the face of the bills. XI. The Design 1862 By 1862, the design of U.S. currency incorporated fine-line engraving, intricate geometric lathe work patterns, a Treasury seal, and engraved signatures to aid in counterfeit deterrence. Since that time, the U.S. Treasury has continued to add features to thwart counterfeiting. XII. National Banking System 1863 Congress established a national banking system and authorized the U.S. Treasury to oversee the issuance of National Banknotes. This system established Federal guidelines for chartering and regulating national banks and authorized those banks to issue national currency secured by the purchase of United States bonds. XIII. Secret Service 1865 The United States Secret Service was established as a bureau of the Treasury for the purpose of controlling the counterfeiters whose activities were destroying the publics confidence in the nations currency. XIV. Bureau of Engraving and Printing 1877 The Department of the Treasurys Bureau of Engraving and Printing began printing all United States currency. XV. Paper Currency with Background Color 1905 The last United States paper money printed with background color was the $20 Gold Certificate, Series 1905, which had a golden tint and a red seal and serial number. XVI. Federal Reserve Act 1913 The Federal Reserve Act of 1913 created the Federal Reserve as the nations central bank and provided for a national banking system that was more responsive to the fluctuating financial needs of the country. The Federal Reserve Board issued new currency called Federal Reserve Notes. XVII. The first $10 Federal Reserve Notes 1914 The first $10 Federal Reserve notes were issued. These bills were larger than todays bills and featured a portrait of President Andrew Jackson on the face. XVIII. Standardized Design 1929 The first sweeping change to affect the appearance of all paper money occurred in 1929. In an effort to lower manufacturing costs, all currency was reduced in size by about 30 percent. In addition, standardized designs were instituted for each denomination across all classes of currency, decreasing the number of different designs in circulation. This standardization made it easier for the public to distinguish between genuine and counterfeit bills. XIX. In God We Trust 1957 The use of the National Motto In God We Trust on all currency has been required by law since 1955. It first appeared on paper money with the issuance of the $1 Silver Certificates, Series 1957, and began appearing on Federal Reserve Notes with the 1963 Series. Chapter 2 Characteristic of US Dollar Currency Introduction The U.S. dollar is the currency most used in international transactions. It is also used as the standard unit of currency in international markets for commodities such as gold and petroleum. There are also some Non-U.S. companies dealing in globalized markets, such as Airbus, list their prices in dollars cause of the international acceptance and the value of the dollar. At the present time, the U.S dollar remains the worlds foremost reserve currency. In addition to holdings by central banks and other institutions there are many private holdings which are believed to be mostly in $100 denominations. The majority of U.S. notes are actually held outside the United States. All holdings of US dollar bank deposits held by non-residents of the US are known as Eurodollars (not to be confused with the euro) regardless of the location of the bank holding the deposit (which may be inside or outside the US). Economist opinion said that demand for dollars allows the United States to maintain pers istent trade deficits without causing the value of the currency to depreciate and the flow of trade to readjust. Strong arguments do exist for why the dollar remains strong and still remain for world currency. There are (at least) three sources of demand for dollars that exert an exogenous force on normal balance of trade dynamics: * A demand for dollar liquidity for transaction needs; * A foreign desire for asset security found in the dollars role as a reserve currency; and * Developing country attempts to accelerate economic growth through an export dominated economy. To date all three factors have increased the incentive for foreigners to collect dollars (by selling goods and services in exchange for dollars) and decreased the incentive to dishoard dollars (by buying goods and services with the dollars). If these dynamics were to reverse, they would exert pressure to devalue the dollar above and beyond pressures exerted by the balance of trade dynamics. Before discuss further about the characteristics of US Dollar that makes it the worlds foremost reserve currency, a better understanding regarding the basic function of money is crucial. The main basic functions of money are: a) Medium of exchange When money is used to intermediate the exchange of goods and services, it is performing a function as a medium of exchange. It thereby avoids the inefficiencies of a barter system, such as the double coincidence of wants problem. b) Unit of account A unit of account is a standard numerical unit of measurement of the market value of goods, services, and other transactions. Also known as a measure or standard of relative worth and deferred payment, a unit of account is a necessary prerequisite for the formulation of commercial agreements that involve debt. c) Store of value To act as a store of value, money must be able to be reliably saved, stored, and retrieved. The value of the money must also remain stable over time. In that sense, inflation by reducing the value of money diminishes the ability of the money to function as a store of value. d) Standard of deferred payment Standard of deferred payment is distinguished as an accepted way to settle a debt a unit in which debts are denominated, and the status of money as legal tender, in those jurisdictions which have this concept, states that it may function for the discharge of debts. When debts are denominated in money, the real value of debts may change due to inflation and deflation, and for sovereign and international debts via debasement and devaluation. Based on the explanation above, there are some main characteristic of the currency shall have to be the main player. In this paper, we will discuss from the various aspects. a) Currency and asset substitution Currency and asset substitution are typically induced by past inflations, devaluations, currency confiscations and the growth of underground economies. The effective money supply is much larger than the domestic money supply and is, moreover, less easily controlled by the monetary authority because of the publics propensity to substitute foreign for domestic currency. To peg the exchange rate to the US dollar, authorities have to intervene and purchase foreign exchange, hence the accumulation of holdings of US foreign exchange reserves, US currency has many desirable properties. It has a reputation as a stable currency, and is therefore a reliable store of value. It is available in many countries, is widely accepted as a medium of exchange, and protects foreign users against the threat of domestic bank failures, devaluation and inflation. Cash usage preserves anonymity because it leaves no paper trail of the transaction for which it serves as the means of payment and is therefore the preferred medium of exchange in underground transactions. Indeed the very characteristics that make the US dollar a popular medium of exchange also makes it difficult to determine the exact amount and location of US notes circulating abroad. Nevertheless, there is a direct source of information that can be used to determine the approximate amounts of US cash in circulation in different countries. Currency substitution also has fiscal consequences that are particularly salient for transition countries. Foreign cash transactions reduce the costs of tax evasion and facilitate participation in the unreported or â€Å"underground† economy. This weakens the governments ability to command real resources from the private sector and deepens fiscal deficits. The shifting of economic activity toward the underground economy distorts macroeconomic information systems (Feige, 1990, 1997), thereby adding to the difficulty of formulating macroeconomic policy. b) International Reserve Currency Furthermore, another characteristic of US dollar as world currency is because of the international reserve currency. Over the past three decades, academic and financial analysis that argued the US would suffer dollar devaluation due to national consumption exceeding national production has been largely wrong. That such an intuitive argument has been so consistently wrong is the source of much frustration and consternation. What has become clear is that when discussing exchange rates and determinants of exchange rates, there is a necessary delineation between the dollar and the rest of the world currencies. Because the dollar is the world reserve currency, special dynamics exist for it in addition to the normal trade and monetary dynamics one would expect. The euro inherited this status from the German mark, and since its introduction, has increased its standing considerably, mostly at the expense of the dollar. Despite the dollars recent losses to the Euro, it is still by far the major international reserve currency; with an accumulation more than double that of the euro. In August 2007, two scholars affiliated with the government of the Peoples Republic of China threatened to sell its substantial reserves in American dollars in response to American legislative discussion of trade sanctions designed to revalue the Chinese yuan. The Chinese government denied that selling dollar-denominated assets would be an official policy in the foreseeable future. c) Usage of the US Dollar Other characteristic of US Dollar as a main currency is when there are a few nations besides the United States use the US Dollar as their official currency. For example, Ecuador, El Salvador and East Timor all adopted the currency independently; former members of the US-administered Trust Territory of the Pacific Islands (namely Palau, the Federated States of Micronesia and the Marshall Islands) decided that, despite their independence, they wanted to keep the U.S. dollar as their official currency. Additionally, local currencies of several states such as Bermuda, the Bahamas, Panama and a few other states can be freely exchanged at a 1:1 ratio for the U.S. dollar. d) Secure the Safety Trade As the so-called â€Å"safety trade† turn into dollars that occurred in the second half of 2008, made ironic event in two ways. The dollar represents security to foreign entities is partly due to historical good behaviour and partly due to wishful thinking on the part of foreign entities. Certainly through 1960, the US had a virtually unblemished record in paying its debts and honouring its obligations. This historical precedent combined with geopolitical considerations and force of habit has created the foreign perception that exists to this day that the US dollar is â€Å"as good as gold.† Thus, historically when a country suffered from a balance of payment crisis, the most common alternative to the home currency was the dollar. The list of countries whose private citizens hoard dollars as an alternative to the home currency is long. The reason for this hoarding is fairly easy to understand. If a country pegs its currency to the dollar and the peg is kept too high, citizens of the country will consume more than they produce and the country will run a current account deficit. Mirroring this current account deficit, a country will run a financial account surplus which decreases its supply of dollars. As the supply of dollars approaches a critical point, citizens will speculate that the peg cannot be maintained and will â€Å"make a run† on the currency, trading all of their domestic currency for dollars in anticipation of the devaluation. This is referred to as a balance of payments crisis, and results in a devaluation of the national currency. Examples of recent balance of payment crises include the Argentine economic crisis (2001-2002) and the Asian financial crisis (1997). Citizens in countries who have suffered balance of payment crises will often hold a portion or even a majority of their wealth in dollars in anticipation of currency devaluation. As an additional demand, it is commonly considered good practice for a developing country to carry reserves in excess of what is necessary for transactions as a preventative measure against balance of payments crises. Thus, there is actually an incentive to peg a currency too low, as a method for accumulating a protective supply of dollars to prevent balance of payment crises. e) Exchange Rate Dynamics While all other countries have two primary mechanisms that determine their exchange rate, the US dollar has five. The two mechanisms present for all currencies are: the relative supply of the currency (determined by the central bank); and the terms and attractiveness to foreigners of domestically produced goods and services. All else equal, the greater the supply of currency the higher the exchange rate (depreciated), and the more attractive the terms of domestically produced goods the lower the exchange rate (appreciated). Both of these mechanisms are reflected in the current account: if a country devalues its currency through an increase in money supply, it will have higher interest payments on foreign denominated assets. In this circumstance, a net debtor will generally see a deterioration in the current account, and a net creditor will see an improvement. If a country increases the attractiveness of terms on its production to foreigners, it will improve the current account. f) US Role As Most Develop Country In The World Financial and currency news are not just the only stories of news but interests to all. As for example, Foreign exchange (Forex) traders also have a lot of interest in political news that may have an impact on different countries currencies. Political events, such as the U.S. presidential election cycle has substantial consequences on the valuation of currency. The essence of money is purchasing power and power is at the heart of politics. Power goes to those who create money, those who receive it, those who spend it, and most of all, those who control it. Money, in other words, is anything but neutral. Money can be controlled or governed in very different ways; these systems of governance are described as monetary regimes. Chapter 3 BENCHMARKING THE US DOLLAR In order to understand the current international monetary system and its problems, one must realize that, for practical purposes, all international financial transactions are inextricably linked to the US Dollar. As the dollar goes, so goes the international financial system. Recently, as been mentioned earlier, the US Dollar remains the worlds foremost reserve currency. The US Dollar has been referred as the standard unit of currency in international markets for commodities such as gold and oil. Some non-U.S. companies dealing in globalized markets, such as Airbus, list their prices in US dollars. US Dollar has a value based on supply and demand of the market. As demand of US Dollar increase and more people willing to pay more to buy the US Dollar, then US Dollar will increase the value. We can also know the performance/value of US Dollar by using the benchmark in US Dollar. Benchmarking of the US Dollar means that we measure or evaluate the performance/value of US Dollar with another similar item in an impartial scientific manner. The US Dollar Index (US Dollar X) is type of index used as a benchmark in US Dollar. US Dollar Index is an index (or measure) of the value of the United States Dollar relative to a basket of foreign currencies. It is a weighted geometric mean of the dollars value compared only with Euro (EUR), 57.6% weight Japanese yen (JPY), 13.6% weight Pound sterling (GBP), 11.9% weight Canadian dollar (CAD), 9.1% weight Swedish krona (SEK), 4.2% weight and Swiss franc (CHF), 3.6% weight. (Source: Wikipedia) Like declining real estate or stock prices, the diminishing dollar is neither uniformly beneficial nor harmful. In an article written by Karen (2008), the author provided an example of Accor North America, Inc., a division of Paris-based Accor, a global hotel operator. She added that when the company needs extra funds, perhaps to make an acquisition, the declining dollar comes in handy. Taking advantage of the dollar devaluation means that its cheaper to borrow from our parent than a bank, says Stephen Manthey, senior vice president and treasurer with the Carrollton, Texas-based firm. This is because the parent companys Euros now are more valuable than they were a year or two ago (Karen, 2008). Animesh Ghoshal, a Professor of Economics at DePaul University, Chicago, once mentioned that exporters typically do well when their currency drops, as their products become more competitive outside their home markets. Conversely, importers take a hit, as the costs of their goods or materials rise. Karen (2008) also quoted a statement from Dean Baker, a co-director of the Center for Economic and Policy Reseach, an independent research group in Washington, D.C. Dean mentioned that people think of a strong dollar like a strong body, but, theres no particular virtue in having a strong dollar. In November 2007, prices for imports from the European Union rose for the seventh consecutive month, increasing 0.2 percent, while prices for goods coming from Canada jumped 4.7 percent. For the year ending in November, the prices of imports from Canada were up 12.9 percent, while imports from the EU were up 3.3 percent. The rises can be attributed to higher fuel prices and the declining dollar, rep orts the Bureau of Labor Statistics. From 4 below, we can see that the US Dollars relative strength compared to Euro had been declining over the 2007. The declining US Dollar may bring more harm than benefits to the US importers. Chapter 4 Factors Affecting US Dollar Currency a) Trade Deficit A trade deficit occurs when a country imports more than the exports. This leads to a net outflow of a countrys currency. Countries on the other side of the transaction will typically sell the importing countrys currency on the open market. As supply of the countrys currency increases in the global market the currency depreciates. As a net importer, the US has seen its trade deficit grow rapidly over the last decade. In last year (2008), the United States had a record of trade deficit of $816 billion dollars. This trade deficit weakens the US dollar relative to other currencies since foreign goods are denominated in foreign currency. Thus raising of demand for foreign goods increases the demand for foreign currency and decreases the demand for US dollars. This causes the US dollar to depreciate. b) Budget Deficit Chart below show that US Public debt has grown substantially over time. When a countrys government spends more than it earns from taxes or other sources of revenues, it is forced to borrow from its citizens and/or from foreign entities. As a countrys debt load increases, the value of its currency may decrease as result of fears within the international community over its ability to repay the debt. In addition, by borrowing money from foreign countries, the US increases the demand for foreign currency in exchange for US Bonds. The US is the worlds largest debtor with approximately $12 trillion dollars in debt in total debt. Over half of this debt is owned by foreign countries and lenders. (Source: Wikipedia) c) China, Japan, and India may stop holding large US Dollar Reserves Japan ($349B) and China ($643B) are two of the largest purchasers of US debt. China in particular has exhibited a voracious appetite for US debt. Its rapidly growing economy is heavily dependent on exports, and the US is one of its largest trading partners. In any given year, the US imports much more from China than it exports to China. As a result there is a net flow of dollars to China. Normally, one might expect China to sell these dollars on the global market, causing the dollar to weaken. Instead China reinvests its dollars in US debt. In doing so, China strengthens the US dollar and limits the appreciation of its own currency. Chinese exports remain cheap to American consumers. However, due to large deficits many countries, China and India in particular, have begun to reconsider diversifying their reserves to protect themselves from a devaluation of the US Dollar. In November 2009, the Indian Central Bank announced that it would purchase $6.7B worth of Gold to diversify its reserves. China, which is the single largest purchaser of US Securities, has similarly increased its reserves of gold by 76% since 2003 and has hinted at further purchases. The decision of these large countries to shift increasingly towards Gold as a reserve currency greatly decreases the demand for US Dollars and weakens the US Dollar. d) Monetary Policy Inflation Demand for a countrys currency is highly dependent on the relative value of holding it, ie. the real, relative return of U.S. government bonds. Fear over higher inflation erodes the real value of bonds, which in turn decreases demand for US dollars. Similarly, tighter monetary policy raises the real interest rate on U.S. Gov. bonds, at which demand for US dollars increases until the relative, risk adjusted return on those bonds is equivalent to the return on bonds for another country. e) The Federal Reserve Rate The Federal Open Market Committee, comprising of the Chairman, Vice Chairman, and three other members, along with the chiefs of the regional branches of the Federal Reserve System, come together regularly to determine the Federal Funds Rate, which is the rate at which financial institutions with deposits at the Federal Reserve lend to each other. The release of the decision is usually accompanied by much media fanfare, analysis and commentary, and with good reason. Lending at the federal funds rate is the normal channel for banks with financing needs, and it represents the wholesale market for large financial institutions. The Federal Reserve Rate also determines the Dollar Libor rate which is the basis of many different types of financial transactions from complex derivative contracts, to credit card and mortgage interest rates. Libor is the cost of short-term unsecured interbank lending (where theres no collateral exchanged between counterparties). As such, it is one of the building blocks of the modern financial system. Although most transaction in the unsecured market are limited to a single month at most, the benchmarks themselves are regularly quoted and taken as a basis for contracts and agreements. f) Equity Market The equity market can impact the currency market in many different ways. For example, if a strong stock market rally happens in the U.S., with the Dow Jone and the Nasdaq registering impressive gains, we are likely to see a large influx of foreign money into the U.S., as international investors rush in to join the party. This influx of money would be very positive for the US DOLLAR, because in order to participate in the equity market rally, foreign investors would have to sell their own domestic currency and purchase U.S. dollars. The opposite also holds true: if the stock market in the U.S. is doing poorly, foreign investors will most likely rush to sell their U.S. Equity holdings and then reconvert the U.S. dollars into their domestic currency which would have a substantially negative impact on the greenback. Chapter 5 The impact of US Dollar a) Dollar Hegemony (Domination of the Dollar) The Bretton Woods negotiations at the end of the Second World War paved the way for establishing the dominance of the dollar as international money. This role was sustained by the confidence that the United States with its vast reserves of gold would honor the commitment to provide gold to foreign central banks in exchange for dollars at a fixed rate of $35 per ounce. By the end of the sixties, the growing trade deficit and the burdens of its military interventions in Vietnam created a huge dollar overhang abroad. In the face of increased demands for gold in exchange for dollars the United States unilaterally abandoned gold convertibility. This, however, did not lead to the dismantling of dollar hegemony. Instead, the refashioning of the international monetary system into a â€Å"floating dollar standard† in the post-Bretton Woods period was associated with the aggressive pursuit of liberalized financial markets in order to encourage private international capital flows denomin ated in dollars. In the 1970s the Eurodollar markets served as the principal means of recycling oil surpluses from the oil exporters to developing economies, particularly in Latin America. This process became a tool of resurgent U.S. political dominance. The 1970s military dictatorships in Chile, Indonesia, and Argentina, and the â€Å"Chicago School† free market regimes that followed, were bolstered by repression and supported by the readily available loans from U.S. banks flush with oil funds. Once this cheap bonanza of credit came to an end with the debt crisis in 1982, a new wave of neoliberal reforms and financial liberalization was imposed through the IMF-World Bank rescue packages. The crisis was deployed to further entrench the dominance of the dollar and U.S. imperialist agenda. In country after country the IMF and World Bank imposed â€Å"structural adjustment† policies during the crisis phase that destroyed all attempts at independent economic development while engulfing thei r financial systems in the ambit of dollar hegemony. This set in motion another surge of dollar denominated private capital flows to emerging markets and a fresh round of crisis in the 1990s when capital flowed back to the United States From 1973, up until about 2003 (the run-up to the present crisis) the periods when flows to emerging markets surged were also periods with a net efflux from the United States. As the surge comes to an end in the wake of capital flight and crisis, as in the Latin American debt crisis in 1982-83 and the Asian crisis in 1997-98, private capital flows are sucked back into the United States (see chart 2). The privileged role of the dollar provided the United States with an international line of credit that helped fuel a consumption binge. Cheap imports allowed consumption to be sustained despite stagnant or declining real wages. The export-led economies of Asia (first Japan, later East Asia and China) in turn depended on mass consumption in the United States to drive their economies. But the dependence on cheap imports precipitated growing trade de

Limitations From Suffering Chronic Asthma

One of the major public health problems facing Australia today is Asthma. It is disturbing that there has been an apparent increase in its prevalence and severity, and increased rates of hospital admissions. (E.J.Comino, 1996) For the diagnosed patient, the degree to which he or she suffers is related to severity of the condition, compliance with recommendations by medical experts, the immediate environment and the effectiveness of education programs. Like other major health problems, asthma has varying degrees of symptoms. As such, the degree and frequency of the symptoms limits many aspects of the asthmatics life. To describe the main limitations suffered by those with chronic asthma, asthma must be defined. Asthma is a condition whereby the sufferer has difficulty breathing due to widespread narrowing of the airways of the lungs. This narrowing can be caused by a local inflammation of the air-ways, muscle contraction or the production of excess mucus with in bronchi. (R.Roberts, 1996) Most common is bronchial asthma. Medical definitions of asthma suggest that environmental triggers can substantially contribute to the occurrence of an asthma attack. The review of asthma in Victoria (1988) by the Asthma Foundation of Victoria outlined infection, exercise, climatic conditions, exposure to airborne irritants and emotional upsets as the main trigger factors. However, doctors use a general classification to identify a patients pattern of asthma†¦classifying people who experience some symptoms of asthma on most days as having a chronic asthma condition. The classification system also extends to the categories of children, occupational asthma and asthma in later life. Usually regular medication is required to keep the lungs functioning as normally as possible. Some chronic asthmatics have severe symptoms over a long period of time and may require long term or indefinite medication to be able to lead a normal life. (Lane, 1996) The most obvious limitations suffered relate to the asthmatics physiological dysfunction. However, physiological dysfunction can in turn contribute to greater social and psychological limitations. This area is related more specifically to quality of life and morbidity and will be discussed further on. The main physiological limitation is related to the presence of the bronchial narrowing slowing the movement of air into and out of the lungs. Thus, there is difficulty both breathing in and out. Asthmatics commonly describe the feeling – tightness of the chest, congestion and wheezing. Although these symptoms can commonly occur in other chest diseases, in asthma it is a characteristic that can occur in an aggravated attack. This may be either brief episodes of chest tightness lasting a matter of minutes or a prolonged episode of wheezing lasting up to and hour, which can merge into a full blown attack of asthma. (D.J.Lane, 1996) Other physiological limitations relate to the sufferers sensitivity to known triggers factors and the consequential effect on their daily functioning. The Global Strategy for Asthma Management and Prevention (1995) states that triggers are risk factors that cause asthma exacerbation†s by inducing inflammation or provoking bronchio-constriction. This report also describes the main triggers as allergens, air pollutants, respiratory infections, exercise and hyperventilation, weather changes, allergies to foods, additives and drugs, and emotional stress. For example it is well established that viral respiratory infections can exacerbate asthma, especially in children under the age of 10. (Busse, 1993) Because the triggers may vary from person to person and from time to time, it is important to take the sufferers natural history into account and identify each individuals triggers. Therefore, an individuals identified trigger can restrict the sufferers ability to function normally. For example – an asthmatic child may try to avoid exercise for fear that it may trigger an asthmatic attack. This may in turn limit the sufferers physiological development over the long term and hence further contribute to the problem. (Global Strategy, 1995) Some psychological and social problems can also be considered as a consequence of the interaction with physiological limitations. The Global Strategy for Asthma Management and Prevention (1995) states that â€Å"asthma is a chronic disorder that can place considerable restrictions on the physical, emotional, and social aspects of the lives of patients and may have an impact on their careers†. Chronic asthma sufferers have to live with the need for treatment and with the limitations that having asthma places on their everyday lives. It is in this context that the asthmatics life area†s are most likely to be handicapped. In general, the chronic asthmatics activity choices are particularly handicapped. †¦. especially physical education. Exercise incites airflow limitation in most children and young adults who have asthma. Exercise appears to be a specific stimulus for people with asthma because it seldom leads to airflow limitation in people without asthma. (Global Strategy, 1995) More specifically sports where sustained effort is needed over a considerable period (eg long distance running) are not recommended. From a psychological point of view, the development of a positive sense of self (ie self-esteem) can be adversely affected by asthma. In one study, nearly 41 percent of parents of children with asthma said that asthma caused their children to feel self-pity. These children also were found to have low self-esteem as well as poor relationships with their peers. (Charmaz, 1983) For an adult, occupation and social life may be handicapped. A comparative study from Edinburgh (1996) between asthmatics and people with other forms of physical disability were found to have similar levels of anxiety or neuroticism. It was found most asthmatics exhibited varying levels of anxiety in relation to their beliefs and, in particular, their constant fear of another attack and anxiety over school and work prospects. (Lane, 1996). Similarly, fear also plays a predominant role in children who suffer from asthma†¦. with one in four Victorian children fearing not being able to breathe as a result of asthma (King, 1988). Furthermore, the relationship between asthma and emotional andor severe behavior problems is documented in a 1995 study by R,Bussing et al. In particular they tend to suffer from limited school functioning, inability to attend school and need for special school or special classes. In Australia, school loss caused by asthma accounted for approximately 965,000 days annually. (Aust Bureau Statistics, 1991) In particular poor academic performance and greater risk to learning difficulties were found to be the greatest negative consequences. (Fowler, 1992) The asthma sufferer can have a limited choice of occupations, because they are exposed to an increasingly large number of potential irritants in their working lives. In particular if specific allergies are known to exist then an occupation that exposes them to the allergens must be avoided. For instance, those sensitive to pollen should not become gardeners or those who have recurrent shortness of breath, should not become marine biologists. (Lane, 1996) 3. What can an individual do to prevent the occurrence of unnecessary as asthma attacks, or to minimize the seriousness of those that do occur? In 1989 an Australian Asthma management (AMP) plan was set up as a guideline for health professionals. The guideline was set up as a common consensus among health experts to help tackle the irregular diagnosis and treatment of asthma. More particularly, to help combat the increase of asthma induced admissions to hospitals due the occurrence of unnecessary asthma attacks. This report outlined 6 important steps to aid the doctor and the sufferer as to the basis of good asthma management. They include (1) Assess the severity of asthma; (2) achieve best lung function (3) maintain best lung function by identifying and avoiding triggers; (4) maintain best lung function with optimal medication; (5) develop an action plan; and (6) educate and review regularly. (Woolcock, 1989) Current research by Beilby (1997) highlighted that having an action plan can play a vital role in preventing hospital admissions and death from asthma. An asthma action plan is a co-ordinated method of management that covers all aspects a persons asthma – medication, triggers factors, lung function measurements, etc. To ensure greater adherence, both the patient and the doctor should fill out an asthma management chart together. It encourages self management and focuses on the importance of identifying the main trigger factors and monitoring the warning signs of an asthma attack. Essentially this involves a regular check on airway function by the use of a peak flow meter and the additional measurement of lung capacity twice a day those with severe asthma. Use of symptomatic (quick working) medication such the bronchodilator ventolin aerosol type to maintain best lung function, is recommended to reduce the seriousness of an acute attack. Doctors prescribe preventative medication such as Intal (sodium cromogylcate), anti-allergy injections and inhaled steroids for people who have severe asthma. Long term use of preventative medicine is used in conjunction with bronchodilators. After several months on preventative medicine, asthmatics find they are able to reduce their use of bronchodilators dramati cally. (Prendergast, 1991) Identifying trigger factors such as allergens, infection, exercise, weather changes and emotional stress is also important. The use of a bronchodilator or Intal, before being exposed to an identified trigger factor, can reduce the likelihood of an asthmatic reaction. The asthma management chart also describes what to do if following warning signs are observed : (1) the bronchodilator doesn†t bring expected relief, (2) a decrease in the peak expiratory flow, (3) Increased breathlessness and variation in peak flow rates during the day, (4) more frequent wheezing and a persistent dry cough and (4) disturbed sleep. (Prendergast, 1991) Asthmatics who live in highly polluted areas and are surrounded by electrical appliances, high tech equipment and power lines can benefit from air ionisers and a purifiers. Individuals can also prescribe to alternative treatment (for instance the Buteyko method), various breathing exercises, physical exercise (such as swimming), a healthy diet, and natural remedies such a homeopathic and acupuncture. It has been found that these treatments should complement orthodox medication and also help reduce the reliance on it. Roberts (1996) suggest that there is evidence that the Buteyko method is effective in treating chronic asthma. Devised by professor Beteyko of Siberia, this program consists of specific relaxation techniques and shallow breathing to correct breathlessness and wheezing. For those who are prone to exercise induced asthma choosing the right type of exercise is important †¦ particularly choosing a sport that requires longer and slower breathing and/or short bursts of effort. Examples include gymnastics, cricket and basketball. Swimming with its controlled breathing pattern is also recommended as it promotes chest development, flexibility and, therefore better breathing. (Roberts, 1996) There has been extensive research into new drug treatments of asthma by pharmaceutical companies and universities over the last 20 years. One such new effective drug to emerge is a Leukotiene receptor antagonists (LTRA). It was recently introduced into Australia this year and the USA 3 years ago. In people with asthma, leukotrienes play a key role in causing the inflammation, bronchoconstriction, and mucous production that lead to coughing, wheezing, and shortness of breath. LTRA†s prevent leukotrienes from attaching to the proinflammatory receptors on circulating and lung cells, which contribute to asthma symptoms. Leukotriene research is the direct result of a Nobel Prize-winning discovery made by scientist Beng Samuelsson in 1979. (Lipworth, 1999) However, there needs to be further research into the efficacy and its side effects. 4. How effective are the educational programs undertaken by organizations such as Asthma Victoria? Current statistics indicate that there has been a reduction of asthma mortality and morbidity in Australia over the past 10 years. The fall in deaths from 964 in 1989 to 715 in 1997 may indicate that some of Australia†s strategies for asthma management have been successful. (NAC, 1998) The Australian Asthma Management Program provides a systematic and methodical approach to asthma care. Nevertheless, it was not formulated as an evidence based document. This means that its recommendations (devised in 1989) were not based on systematic reviews or had been ranked according to the strength supporting them. However, today there have been a number of studies reviewing the effectiveness of the AMP. One such report by the National Asthma Campaign (1999), commented on the crucial role of education in improving the management of asthma rather than the token gesture of handing over a leaflet at the end of a patient consultation. This was in relation to the 6th step – educate and review regularly and highlights the importance of education programs undertaken by organizations such as the Australian National Asthma Campaign, Asthma Victoria, the Thoracic society of Australia and New Zealand and other relevant educators. The 1990 and 1993 national surveys of 22,000 adults and 16,000 children conducted by the National Asthma Campaign (NAC) showed improved asthma management practices in the three year period. Although the changes are not necessary the direct result of the National Asthma Campaign, it is considered to be consistent with the campaign and other agencies having been successful in promoting awareness and optimal management of asthma. (Comino, 1996) One of the goals of the NAC was to reduce the reliance on daily medication and hence increase the use of preventative therapy (such as inhaled corcosteroids) for patients with moderate or severe asthma; together with written action plans based on symptom severity and measurements of lung function. Use of preventative medication was found to have increased among both children and adults. The study highlighted also that there was a significant decline in the use of daily inhaled bronchodilator drugs among children and also inappropriate medications such as antibiotics and oral prescriptions. In addition this study also showed that in 1993 survey, doctors measured lung function significantly more often than in 1990; with similar increases observed in the use of peak flow meters and written action plans. (Comino, 1996) These results suggest that the Australian Asthma Management Programs are relatively effective. However, the study also points to the fact that limitations still exist. In particular there is a lack of communication and joint management strategies between specialists and GP†s, hospitals and the community; whilst the use of action plans still has considerable room for further improvement. Nonetheless, not all studies on education programs show positive conclusions. A British research paper ‘Greenwich Asthma Study† of 1291 asthmatics conducted in 1993 and 1996 found that their model of service delivery was not effective in improving the outcome of asthma in the community. The intervention program used was based on the British Thoracic Society†s guidelines and was conducted by specialist nurses in community based settings. There were similarities in the methodology and intervention measurement. However, they concluded that no evidence was found for an improvement in asthma related quality of life among newly surveyed patients in intervention practices compared with control practices. (Premaratne, 1999) Altogether this highlights that the variability of the asthma educational programs undertaken by various major organisations make it difficult to comparatively evaluate. A comprehensive world wide study, ‘Objectives, methods and content of patient education programs for adults with asthma: systematic review of studies published between 1979 and 1998†³ found that there was great difficulty in identifying the most effective components of asthma educational programs. The main reason cited was that education programs for adults with asthma vary widely. Most reports did not specify the general (56%) and educational objectives (60%) of the intervention. Important training characteristics were often not available: duration of education (45%) and number of sessions (22%), who delivered education (15%), whether training was conducted in groups or was individualised (28%). (Sudre, 1999) Such variability suggests a lack of consensus on what educational components actually work. With insufficient documentation of asthma education programs for adults, replication is limited. In conclusion there is some evidence to suggest that written treatment management plans are most effective in improving the quality of life for people with asthma. In the Australian context the National Asthma Campaign has clearly documented program goals. However, the limitations lie in its lack of empirical evidence. In addition the reliability of the research documents in general has been brought into question by the Sudre (1999) study. Therefore it is difficult to demonstrate the most effective management plan for asthma sufferers. This issue is currently being addressed by the National Asthma Campaign and the Asthma Foundation of Victoria. The Asthma foundation is currently conducting a study into the effectiveness of their schools based program. Hopefully, this and other studies will help fill the gap associated with the effectiveness of asthma education programs. And hence secure the continuation and development of asthma education in the community. Limitations From Suffering Chronic Asthma One of the major public health problems facing Australia today is Asthma. It is disturbing that there has been an apparent increase in its prevalence and severity, and increased rates of hospital admissions. (E.J.Comino, 1996) For the diagnosed patient, the degree to which he or she suffers is related to severity of the condition, compliance with recommendations by medical experts, the immediate environment and the effectiveness of education programs. Like other major health problems, asthma has varying degrees of symptoms. As such, the degree and frequency of the symptoms limits many aspects of the asthmatics life. To describe the main limitations suffered by those with chronic asthma, asthma must be defined. Asthma is a condition whereby the sufferer has difficulty breathing due to widespread narrowing of the airways of the lungs. This narrowing can be caused by a local inflammation of the air-ways, muscle contraction or the production of excess mucus with in bronchi. (R.Roberts, 1996) Most common is bronchial asthma. Medical definitions of asthma suggest that environmental triggers can substantially contribute to the occurrence of an asthma attack. The review of asthma in Victoria (1988) by the Asthma Foundation of Victoria outlined infection, exercise, climatic conditions, exposure to airborne irritants and emotional upsets as the main trigger factors. However, doctors use a general classification to identify a patients pattern of asthma†¦classifying people who experience some symptoms of asthma on most days as having a chronic asthma condition. The classification system also extends to the categories of children, occupational asthma and asthma in later life. Usually regular medication is required to keep the lungs functioning as normally as possible. Some chronic asthmatics have severe symptoms over a long period of time and may require long term or indefinite medication to be able to lead a normal life. (Lane, 1996) The most obvious limitations suffered relate to the asthmatics physiological dysfunction. However, physiological dysfunction can in turn contribute to greater social and psychological limitations. This area is related more specifically to quality of life and morbidity and will be discussed further on. The main physiological limitation is related to the presence of the bronchial narrowing slowing the movement of air into and out of the lungs. Thus, there is difficulty both breathing in and out. Asthmatics commonly describe the feeling – tightness of the chest, congestion and wheezing. Although these symptoms can commonly occur in other chest diseases, in asthma it is a characteristic that can occur in an aggravated attack. This may be either brief episodes of chest tightness lasting a matter of minutes or a prolonged episode of wheezing lasting up to and hour, which can merge into a full blown attack of asthma. (D.J.Lane, 1996) Other physiological limitations relate to the sufferers sensitivity to known triggers factors and the consequential effect on their daily functioning. The Global Strategy for Asthma Management and Prevention (1995) states that triggers are risk factors that cause asthma exacerbation†s by inducing inflammation or provoking bronchio-constriction. This report also describes the main triggers as allergens, air pollutants, respiratory infections, exercise and hyperventilation, weather changes, allergies to foods, additives and drugs, and emotional stress. For example it is well established that viral respiratory infections can exacerbate asthma, especially in children under the age of 10. (Busse, 1993) Because the triggers may vary from person to person and from time to time, it is important to take the sufferers natural history into account and identify each individuals triggers. Therefore, an individuals identified trigger can restrict the sufferers ability to function normally. For example – an asthmatic child may try to avoid exercise for fear that it may trigger an asthmatic attack. This may in turn limit the sufferers physiological development over the long term and hence further contribute to the problem. (Global Strategy, 1995) Some psychological and social problems can also be considered as a consequence of the interaction with physiological limitations. The Global Strategy for Asthma Management and Prevention (1995) states that â€Å"asthma is a chronic disorder that can place considerable restrictions on the physical, emotional, and social aspects of the lives of patients and may have an impact on their careers†. Chronic asthma sufferers have to live with the need for treatment and with the limitations that having asthma places on their everyday lives. It is in this context that the asthmatics life area†s are most likely to be handicapped. In general, the chronic asthmatics activity choices are particularly handicapped. †¦. especially physical education. Exercise incites airflow limitation in most children and young adults who have asthma. Exercise appears to be a specific stimulus for people with asthma because it seldom leads to airflow limitation in people without asthma. (Global Strategy, 1995) More specifically sports where sustained effort is needed over a considerable period (eg long distance running) are not recommended. From a psychological point of view, the development of a positive sense of self (ie self-esteem) can be adversely affected by asthma. In one study, nearly 41 percent of parents of children with asthma said that asthma caused their children to feel self-pity. These children also were found to have low self-esteem as well as poor relationships with their peers. (Charmaz, 1983) For an adult, occupation and social life may be handicapped. A comparative study from Edinburgh (1996) between asthmatics and people with other forms of physical disability were found to have similar levels of anxiety or neuroticism. It was found most asthmatics exhibited varying levels of anxiety in relation to their beliefs and, in particular, their constant fear of another attack and anxiety over school and work prospects. (Lane, 1996). Similarly, fear also plays a predominant role in children who suffer from asthma†¦. with one in four Victorian children fearing not being able to breathe as a result of asthma (King, 1988). Furthermore, the relationship between asthma and emotional andor severe behavior problems is documented in a 1995 study by R,Bussing et al. In particular they tend to suffer from limited school functioning, inability to attend school and need for special school or special classes. In Australia, school loss caused by asthma accounted for approximately 965,000 days annually. (Aust Bureau Statistics, 1991) In particular poor academic performance and greater risk to learning difficulties were found to be the greatest negative consequences. (Fowler, 1992) The asthma sufferer can have a limited choice of occupations, because they are exposed to an increasingly large number of potential irritants in their working lives. In particular if specific allergies are known to exist then an occupation that exposes them to the allergens must be avoided. For instance, those sensitive to pollen should not become gardeners or those who have recurrent shortness of breath, should not become marine biologists. (Lane, 1996) 3. What can an individual do to prevent the occurrence of unnecessary as asthma attacks, or to minimize the seriousness of those that do occur? In 1989 an Australian Asthma management (AMP) plan was set up as a guideline for health professionals. The guideline was set up as a common consensus among health experts to help tackle the irregular diagnosis and treatment of asthma. More particularly, to help combat the increase of asthma induced admissions to hospitals due the occurrence of unnecessary asthma attacks. This report outlined 6 important steps to aid the doctor and the sufferer as to the basis of good asthma management. They include (1) Assess the severity of asthma; (2) achieve best lung function (3) maintain best lung function by identifying and avoiding triggers; (4) maintain best lung function with optimal medication; (5) develop an action plan; and (6) educate and review regularly. (Woolcock, 1989) Current research by Beilby (1997) highlighted that having an action plan can play a vital role in preventing hospital admissions and death from asthma. An asthma action plan is a co-ordinated method of management that covers all aspects a persons asthma – medication, triggers factors, lung function measurements, etc. To ensure greater adherence, both the patient and the doctor should fill out an asthma management chart together. It encourages self management and focuses on the importance of identifying the main trigger factors and monitoring the warning signs of an asthma attack. Essentially this involves a regular check on airway function by the use of a peak flow meter and the additional measurement of lung capacity twice a day those with severe asthma. Use of symptomatic (quick working) medication such the bronchodilator ventolin aerosol type to maintain best lung function, is recommended to reduce the seriousness of an acute attack. Doctors prescribe preventative medication such as Intal (sodium cromogylcate), anti-allergy injections and inhaled steroids for people who have severe asthma. Long term use of preventative medicine is used in conjunction with bronchodilators. After several months on preventative medicine, asthmatics find they are able to reduce their use of bronchodilators dramati cally. (Prendergast, 1991) Identifying trigger factors such as allergens, infection, exercise, weather changes and emotional stress is also important. The use of a bronchodilator or Intal, before being exposed to an identified trigger factor, can reduce the likelihood of an asthmatic reaction. The asthma management chart also describes what to do if following warning signs are observed : (1) the bronchodilator doesn†t bring expected relief, (2) a decrease in the peak expiratory flow, (3) Increased breathlessness and variation in peak flow rates during the day, (4) more frequent wheezing and a persistent dry cough and (4) disturbed sleep. (Prendergast, 1991) Asthmatics who live in highly polluted areas and are surrounded by electrical appliances, high tech equipment and power lines can benefit from air ionisers and a purifiers. Individuals can also prescribe to alternative treatment (for instance the Buteyko method), various breathing exercises, physical exercise (such as swimming), a healthy diet, and natural remedies such a homeopathic and acupuncture. It has been found that these treatments should complement orthodox medication and also help reduce the reliance on it. Roberts (1996) suggest that there is evidence that the Buteyko method is effective in treating chronic asthma. Devised by professor Beteyko of Siberia, this program consists of specific relaxation techniques and shallow breathing to correct breathlessness and wheezing. For those who are prone to exercise induced asthma choosing the right type of exercise is important †¦ particularly choosing a sport that requires longer and slower breathing and/or short bursts of effort. Examples include gymnastics, cricket and basketball. Swimming with its controlled breathing pattern is also recommended as it promotes chest development, flexibility and, therefore better breathing. (Roberts, 1996) There has been extensive research into new drug treatments of asthma by pharmaceutical companies and universities over the last 20 years. One such new effective drug to emerge is a Leukotiene receptor antagonists (LTRA). It was recently introduced into Australia this year and the USA 3 years ago. In people with asthma, leukotrienes play a key role in causing the inflammation, bronchoconstriction, and mucous production that lead to coughing, wheezing, and shortness of breath. LTRA†s prevent leukotrienes from attaching to the proinflammatory receptors on circulating and lung cells, which contribute to asthma symptoms. Leukotriene research is the direct result of a Nobel Prize-winning discovery made by scientist Beng Samuelsson in 1979. (Lipworth, 1999) However, there needs to be further research into the efficacy and its side effects. 4. How effective are the educational programs undertaken by organizations such as Asthma Victoria? Current statistics indicate that there has been a reduction of asthma mortality and morbidity in Australia over the past 10 years. The fall in deaths from 964 in 1989 to 715 in 1997 may indicate that some of Australia†s strategies for asthma management have been successful. (NAC, 1998) The Australian Asthma Management Program provides a systematic and methodical approach to asthma care. Nevertheless, it was not formulated as an evidence based document. This means that its recommendations (devised in 1989) were not based on systematic reviews or had been ranked according to the strength supporting them. However, today there have been a number of studies reviewing the effectiveness of the AMP. One such report by the National Asthma Campaign (1999), commented on the crucial role of education in improving the management of asthma rather than the token gesture of handing over a leaflet at the end of a patient consultation. This was in relation to the 6th step – educate and review regularly and highlights the importance of education programs undertaken by organizations such as the Australian National Asthma Campaign, Asthma Victoria, the Thoracic society of Australia and New Zealand and other relevant educators. The 1990 and 1993 national surveys of 22,000 adults and 16,000 children conducted by the National Asthma Campaign (NAC) showed improved asthma management practices in the three year period. Although the changes are not necessary the direct result of the National Asthma Campaign, it is considered to be consistent with the campaign and other agencies having been successful in promoting awareness and optimal management of asthma. (Comino, 1996) One of the goals of the NAC was to reduce the reliance on daily medication and hence increase the use of preventative therapy (such as inhaled corcosteroids) for patients with moderate or severe asthma; together with written action plans based on symptom severity and measurements of lung function. Use of preventative medication was found to have increased among both children and adults. The study highlighted also that there was a significant decline in the use of daily inhaled bronchodilator drugs among children and also inappropriate medications such as antibiotics and oral prescriptions. In addition this study also showed that in 1993 survey, doctors measured lung function significantly more often than in 1990; with similar increases observed in the use of peak flow meters and written action plans. (Comino, 1996) These results suggest that the Australian Asthma Management Programs are relatively effective. However, the study also points to the fact that limitations still exist. In particular there is a lack of communication and joint management strategies between specialists and GP†s, hospitals and the community; whilst the use of action plans still has considerable room for further improvement. Nonetheless, not all studies on education programs show positive conclusions. A British research paper ‘Greenwich Asthma Study† of 1291 asthmatics conducted in 1993 and 1996 found that their model of service delivery was not effective in improving the outcome of asthma in the community. The intervention program used was based on the British Thoracic Society†s guidelines and was conducted by specialist nurses in community based settings. There were similarities in the methodology and intervention measurement. However, they concluded that no evidence was found for an improvement in asthma related quality of life among newly surveyed patients in intervention practices compared with control practices. (Premaratne, 1999) Altogether this highlights that the variability of the asthma educational programs undertaken by various major organisations make it difficult to comparatively evaluate. A comprehensive world wide study, ‘Objectives, methods and content of patient education programs for adults with asthma: systematic review of studies published between 1979 and 1998†³ found that there was great difficulty in identifying the most effective components of asthma educational programs. The main reason cited was that education programs for adults with asthma vary widely. Most reports did not specify the general (56%) and educational objectives (60%) of the intervention. Important training characteristics were often not available: duration of education (45%) and number of sessions (22%), who delivered education (15%), whether training was conducted in groups or was individualised (28%). (Sudre, 1999) Such variability suggests a lack of consensus on what educational components actually work. With insufficient documentation of asthma education programs for adults, replication is limited. In conclusion there is some evidence to suggest that written treatment management plans are most effective in improving the quality of life for people with asthma. In the Australian context the National Asthma Campaign has clearly documented program goals. However, the limitations lie in its lack of empirical evidence. In addition the reliability of the research documents in general has been brought into question by the Sudre (1999) study. Therefore it is difficult to demonstrate the most effective management plan for asthma sufferers. This issue is currently being addressed by the National Asthma Campaign and the Asthma Foundation of Victoria. The Asthma foundation is currently conducting a study into the effectiveness of their schools based program. Hopefully, this and other studies will help fill the gap associated with the effectiveness of asthma education programs. And hence secure the continuation and development of asthma education in the community.

Compensation and Benefits Strategies Essay

Employees are worth more than their hourly wage, even though, that is typically all that is considered by an employee while looking for a new job or considering a move to a different job or employer. Employers see employees as much more than the hourly or salary that they are offered to do a specific job. The benefits package that employers offer to employees is worth a substantial amount of money. Health insurance, life insurance, disability insurance and other benefits, and even some discount programs are part of the entire compensation and benefits package. Employers, and employees alike, need to understand and educate themselves on the added value they have by looking at the entire compensation and benefits package and comparing it to other companies before taking a position for a higher hourly or salaried rate. Centura Health is evaluated throughout this paper regarding their compensation and benefits strategies. Market Evaluation Companies in competing markets need to know what their competitors are offering in terms of compensation and benefits packages so that they are able to stay current with what other organizations are offering their employees. Researching and understanding the compensation and benefits of competitors is a vital process in hiring and recruiting new employees from the regular job market of employees and when trying to recruit employees away from their current employer. Understanding the compensation structure of your own company, and of your competitors, will make evaluating the current structure easier and then making it more appealing to employees wanting to be employed by the organization will be a more informed decision making process. Centura Health, Kaiser Permanente, and the University of Colorado Hospital will be reviewed. Centura Health Centura Health is one of the largest employers in Colorado. Centura Health’s website states, â€Å"Centura Health takes pride in providing a comprehensive benefits package that’s designed to inspire health† (Centura Health, n.d., p. 1). Centura Health is looking for talented employees that will help them continue their mission and support their key values. Centura Health offers competitive wages, health insurance, prescription coverage, vision, and dental through their health benefits package. Centura Health offers short-term and long-term disability packages along with life insurance and accidental death insurance for an additional low fee. Centura Health offers a paid time-off (PTO) that accrues during each pay period and 401k and other retirement programs. An employee assistance program is offered by Centura Health for employees who may need counseling or a referral to a counselor to help them cope with issues in their work or home life. Centura Health also has an associate discount program that offers discounts on many services such as cell phone carriers, life, and car insurance among many other discounts. Kaiser Permanente Kaiser Permanente (KP) is another one of Colorado’s largest employers and a dominate player in hiring talented health care employees. Kaiser Permanente’s website states, â€Å"we understand that providing excellent service to our employees enables you to provide excellent service to our members. As a result, we offer a total compensation package designed to enhance the lives of you and your family member† (Kaiser Permanente, 2015, p. 1). Kaiser Permanente offers a wide range of benefits to their employees with enrollment into the KP health insurance being at the top of their list. Kaiser Permanente also offers â€Å"flexible spending accounts (FSA), health savings account (HSA), supplemental life insurance, occupational accident insurance, mental health, care, accidental death and dismemberment insurance, dental insurance, vision insurance, life insurance, disability insurance, health care on-site, and retiree health and medical† (Kaiser Permanente, 2015, p. 1). Kaiser Permanente also has other benefits under the following categories for employees, financial and retirement, family and parenting, vacation and time off, perks and discounts, and professional support. All of these categories expand into additional areas of benefits  to employees. The University of Colorado Hospital The University of Colorado Hospital is also one of Colorado largest employers in healthcare. The University of Colorado Hospitals (UCH) website states, â€Å"We are proud to provide competitive and comprehensive health and welfare benefits as part of our Total Rewards program† (University of Colorado Health, 2014, p. 3). The University of Colorado Hospital, like the previous employers, offer a medical health plan, life insurance, accidental death and dismemberment insurance, short and long-term disability insurances, and dental and vision plans. The UCH offers a dependent day care spending account (DCSA) to their employees to help pay the cost of day care with tax-free dollars. The UCH also offers their employees the ability to sign up for a group legal plan. The University of Colorado Hospitals benefit enrollment guide states that their UltimateAdvisor program, â€Å"offers you a wide range of legal services to help you prevent and resolve everyday legal issues† (University of Colorado Health, 2014, p. 17). The daycare and legal programs offered by the UCH are not offered by their competitors and make them more desirable when comparing compensation and benefits packages. Compensation Structure Centura Health uses an annual employee review system called Performance, Feedback, and Development (PFD) to review employees to determine if they are eligible for a yearly raise. This process involves the employee rating themselves on how they are meeting their job performance in accordance with Centura’s seven core values. The seven core values are compassion, respect, integrity, spirituality, stewardship, imagination, and excellence (Centura Health, n.d., p. 1). This process is time intensive and cumbersome for employees and managers to sit down and write scenarios and narratives for these values. Employees skip the self-assessment section by doing the bare minimum of just checking the auto-populated response available to meet their required timeline for turning in the assessment. Market Position Centura Health’s market position falls into the large-sized companies. Centura Health employs â€Å"17,100 employees and associates† (Draper, 2014, p. 1). Centura Health is expanding into a new health campus and new physician  buildings in the northern Denver Metropolitan area. Centura Health had a net income of $61.5 million â€Å"(Sealover, 2013, p. 1). Centura Health operates 15 hospitals throughout Colorado after the recent expansion into the St. Anthony North Health Campus. Compensation and Benefits Centura Health needs to stay competitive when offering their compensation and benefits package to new employees. The existing compensation package that Centura Health offers is solid and market comparable to their competitors. As Centura Health continues to expand their locations and the need for employees continues to grow it would be advised that Centura Health looks at daycare benefits to their employees with children and, to include, elderly family members who may need assistance of daycare programs as well. Centura Health promotes health and wellness throughout their system and has recently stopped hiring any employee that smokes. Employing healthier employees does several things for Centura Health. Sick time will be reduced by hiring healthier employees, reduced profit loss by having more employees at work than on sick time and reduced health insurance costs for both Centura Health and the employee. Work-life balance is important for Centura Health to review in their compensation and benefits packages. Centura Health can benefit from telecommuting for many administrative jobs and to support more flexible work schedules for employees who need to start earlier or later and can stay for the full shift amount of time because of their home life requirements. Work-life balance is important to employee’s health and wellness and offering additional options into the preconceived mold of being a healthcare worker will make Centura Health a more desirable employer for the talented employees they want to employ. Performance Incentives and Merit Pay Centura Health would benefit from a reward-based program that would include bonuses, for employees who are doing the non-management and non-executive jobs. Incentive Compensation for employees creates a work environment of higher performance and competition between employees. Employees and lower level management can give each other a pat on the back for a job well done, cost savings identification or a heroic moment with a patient, but those moments are short-lived. Rewarding employees speaks volumes when trying to  create a positive work-life balance in an organization. Creating an incentive-based program that management can reward on-the-spot accomplishments creates the need to do better with the other employees in the organization. Recognizing employees for a job well done with an incentivized program using gift cards, bonuses, or additional PTO motivates others to try and receive these awards. Creating a positive competitive work environment encourages employees to strive to wo rk better, do better, and be better. Laws The Employee Retirement Income Security Act (ERISA) was originally created to address issues with pension plans and did not address health, life, disability, or medical benefits. ERISA has been modified, for the most part, to address pension plans, but the medical coverage area was modified with the creation of the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). COBRA was created â€Å"to provide continuation of group health coverage that otherwise might be terminated† (United States Department of Labor [USDOL], n.d., para. 1). COBRA COBRA is offered to employees who have been terminated, either voluntarily or involuntarily, without any gross misconduct or because of the reduction of work hours by the employer. COBRA is paid for out-of-pocket by the employee and at higher rate than offered through their plan when they were employed. The qualified employee must be offered identical coverage to the plan they had while employed. COBRA is usually an overly expensive option for employees that have been released from their jobs. HIPAA HIPAA is a federal law that â€Å"limits pre-existing condition exclusions, permits special enrollment when certain life or work events occur, prohibits discrimination against employees and dependents based on their health status, and guarantees availability and renewability of health coverage to certain employees and individuals† (United States Department of Labor [USDOL], n.d., para. 3). Special enrollment examples are exhaustion of COBRA benefits, marriage, and new child by birth or adoption. The employee is to be given a 30-day period to request the special enrollment option regardless of the plan’s set enrollment dates as provided by the employer. Conclusion Centura Health is one of Colorado’s largest providers of healthcare services and largest employers. Centura Health has invested in understanding the health care market so that they can provide a competitive and attractive compensation and benefits package to entice talented employees. There is a benefit to Centura Health and the employee regarding understanding the package presented to them during the hiring process so that both parties understand the worth they are gaining with employment. The compensation and benefits process for an employer is worth an in-depth review of their competitors and the market the organization is in. References Centura Health. (n.d.). Compensation, Benefits and Tuition Reimbursement. Retrieved from http://www.centura.org/careers-and-education/compensation-benefits-and-tuition-reimbursement/ Centura Health. (n.d.). Mission & Values. Retrieved from http://www.centura.org/about-us/mission-and-values/ Draper, E. (2014). Colorado hospital giant Centura Health to stop hiring tobacco users. Retrieved from http://www.denverpost.com/news/ci_26977759/colorado-hospital-giant-centura-health-stop-hiring-tobacco Kaiser Permanente. (2015). Benefits, pay, and enrollment. Retrieved from http://www.kaiserpermanentejobs.org/employee-benefits.aspx Kaiser Permanente. (2015). Kaiser Permanente Benefits. Retrieved from http://www.glassdoor.com/Benefits/Kaiser-Permanente-US-Benefits-EI_IE19466.0,17_IL.18,20_IN1.htm Sealover, E. (2013). Denver hospitals post healthy profits. Retrieved from http://www.bizjournals.com/denver/news/2013/05/30/denver-hospitals-post-healthy-profits.html United States Department of Labor. (n.d.). Applicable Laws, Regulations, Publications and Related Links. Retrieved from http://www.dol.gov/elaws/ebsa/health/7.asp United States Department of Labor. (n.d.). Frequently Asked Questions COBRA Continuation Health Coverage. Retrieved from http://www.dol.gov/ebsa/faqs/faq_compliance_cobra.html University of

Organ Donation And Organ Organs Essay - 1308 Words

Organ donations have encountered organ donor and organ supply rejections. Organ donation challenges and demands increase as the organ shortages increase over the years. Organ donation’s mission is to save many terminally ill recipients at the end stages of their lives. The significance of the organ donation is to give back to restore one’s quality of life. The ongoing issues may present an idealistic portrait of how these issues may be resolved. As a result, the mission of organ donations are to restore organs for their patients and to promote, education, empower altruism and quality ethics as a resource for existing and potential donors Organ donations has been perceived by potential organ donors to be inhumane activity, a dishonor to the humanized process, circulation of illegal revenue, and conceptual grounds needs to be consistent with altruism as the empowered outcome. Inhumane activity is the overall reason why this proposal is for increasing organ donations which are frequently rejected by incongruities with solidarity motivation as donor’s measures. It differentiates ethical principal amongst altruism and solidarity motivations for organ donations. The first issue being the grounds is a limited form of additional problems limited to supporters (Saunders, 2012), which may be independent or of individual groups, awaiting for the scarcity of organs to receive the next available transplantation. Individuals are practicing degrading behaviors, illegal activity, andShow MoreRelatedOrgan Donation : Organ Organs1054 Words   |  5 PagesOrgan Donation Organ donation occurs when a failing or damaged organ, is replaced with a new organ, through a surgical operation. The two sources of organs for donation come from a deceased person and a living person. The organs that are received from a deceased person are called cadaveric organs. A person can indicate on his or her driver’s license if they want to be an organ donor after they die. There are some states that allow for family consent for organ removal, regardless if the deceasedRead MoreOrgan Donation : Organ Donations Essay1323 Words   |  6 PagesPreviously organ donation has encountered organ donors and organ supply rejections. Organ donation challenges and demands decreased as the organ shortages increase over the years. Organ donation mission is to save many terminally ill recipients at the end stages of their lives, the significance of the organ donation is to give back to restore one’s quality of life. The ongoing issues may present an idealistic portrai t of how these issues may be resolved. As a result organ donation mission is toRead MoreOrgan Donation : An Organ Donor1068 Words   |  5 Pagesshould become organ donors. Choosing to become an organ donor provides the opportunity to save up to eight lives and improve the quality of life for many others with tissue donation. An organ donor can also provide comfort to the grieving family: the loss of the loved one will be helping others to live. Becoming an organ donor is much easier than many think. The decision can literally be done in just minutes. Web MD states, an organ transplant is the surgical removal of a healthy organ from one personRead MoreOrgan Donation. â€Å"Organ Donation Is Not A Tragedy, But It1112 Words   |  5 PagesOrgan Donation â€Å"Organ donation is not a tragedy, but it can be a beautiful light, in the midst of one† (Unknown). There has been many disbeliefs about donating your organs over the years. The organ demand drastically exceeds the available supply, which is why more people need to be organ donors. People should become organ donors because of the limited availability of organs and the chance to save many lives. Although many people think that if you are an organ donor doctors won’t try as hard toRead MoreOrgan Donation1237 Words   |  5 PagesSpecific Purpose: To persuade my audience to donate their organs and tissues when they die and to act upon their decision to donate. Thesis Statement: The need is constantly growing for organ donors and it is very simple to be an organ donor when you die. I. INTRODUCTION A. Attention material/Credibility Material: How do you feel when you have to wait for something you really, really want? What if it was something you couldn’t live without? Well, my cousin was five years old whenRead MoreOrgan Donation2096 Words   |  9 Pages stat! After applying yourself to be a recipient for a donation, you will be added to the waiting list for that organ. This can take months, if not years. Receiving an organ can be sudden whenever an organ match has been found for you. 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Most look upon people who donate organ/s as generous. Others even applaud them for being a lifesaver. The question that lingers on many: Is it proper to charge for the organ donations or not? According to the Mayo Clinic, in United States alone, over 100,000 individuals are in the offing for an organ donation. Regrettably, several individuals may at no time procure the bid that a fit benefactor of an organ matches his or her— one more wagerRead MoreOrgan Of Organ And Tissue Donation1771 Words   |  8 PagesOrgan and tissue donation can be defined as the removal of organs and tissues from either a living donor s body or body of a patient who has recently died and transplanting the anatomical gifts into the body of the recipient (Frey and Waun n.p.). Donation has continuously verified itself in the science world as an exemplary form of medical treatment. Based on the advancements in donation over the years, one can expect further amendments to be made to the life-saving treatment in such high demandRead MoreOrgan Donation For An Organ Transplant1811 Words   |  8 Pageswaiting for an organ transplant. They also state that one organ donor can save up to eight live s. Those are significant numbers that should make us very much aware of the monumental impact organ donation can have on the lives of so many critically ill patients and their families. Although the tragedy of an accident or horrifying event is sometimes unbearable for the patient and the patient’s family, it may result in what some may call a â€Å"new hope† for those who are awaiting organ transplantation