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Introduction

A policy is a statement, principle, rule or a set of rules which are generated by a ruling body, such as a government, which are used as guidance for decision making and to achieve a planned intention through their implementation. A health policy includes a set of authoritative decisions, plans and activities that are carried out in order to improve or prevent a health care pandemic in a community so as to ensure that the wellness and health of individuals living in that community is achieved. As any other policies, a health policy is developed by an authoritative body such as a government that has power to enforce its implementation so that the policy can yield the expected results. Policies such as health policies have tremendous effects on political, social and economic factors in a country. Policies also have an effect on the professional practice of the particular field that they are targeted at, for example, health policies affect the professional practice of doctors, nurses and other stakeholders who are either directly or indirectly involved in the health sector. This research paper is intended to explore how health policies are developed, who affect, their impacts on political and socio-economic factors, how they are put into action through implementation, their effects on health and the community and how enforcement of implementation takes place. The study of policies in this paper will be based on an example, the smoking policies in Malaysia, to demonstrate the effects of policies on the environmental, socio-economic factors and on health professional practice particularly the nursing profession.This research paper seeks to examine health policies and their impact on the nursing professional practice as well as their impact on the social economic developments. The main objective is to demonstrate that if policies are well implemented they can cause tremendous effects on the socio-economic factors as well as on professional practice. These arguments will be supported with evidence from policy documents and written journals.

The term nursing means the inclusion of both the collaborative and autonomous care offered to individuals of all ages, family background, whether sick or in any kind of physical state that may require a special attention. The definition offered by the International Council of Nurses describes the nursing profession as that which involves the taking care of both the sick and the physically challenged by well trained professionals who offer support services to them and also medical services. Those in this category include the sick, the mentally and physically challenged, and also the aged in the society. The work of these nurses therefore extends to the environment where they help shape the health policies and systems that ultimately improve the health system in their respective countries.

Policy

Policies have an impact on the economic, social and cultural developments of countries and they can be used to predict a future epidemic and when implemented they can help to avert a looming future calamity According to the World Health Organization, an implementable policy is one that has a realistic vision, a measurable mission and activities and duties of the different health stake holders such as the government, media, health practitioners and individuals in the community. Health care policies may be divided into various sub-policies such as those dealing with personal health, drug policies and those dealing with public health such as smoking control policies, and those encouraging vaccination and breastfeeding. Health policies are important in any community as they help to plan and mitigate any looming epidemic that might occur in future as a result of current activities, for example the policy that has been developed in the United States to curb and prevent childhood obesity among children and the youth. The policy outlines the short term and long term dangers of obesity in kids as it leads to loss of self-esteem and increasing exposure to other diseases such as heart diseases, cancer and blood pressure. The policy then outlines how the health stakeholders such as parents, children, and the government as well as food suppliers will collaborate to eliminate the risk of obesity in young children (Crispin 2006).

The policy was developed by the congress in collaboration with the health care policy in the wake of the increased increasing child obesity which is now threatening the population of America and posing potential public health threat. The impact and consequences of child obesity were being felt across all health sectors such as the nursing sector as the nurses had a difficult time having to care for the bedridden children who were suffering from chronic illnesses mainly propagated by them being obese. According to a report presented at the second National Childhood Obesity Congress, the impact of obesity is also taking a toll at the public health fund and the health care system as more than $127 million were spent between 1997 and 1999 to cover hospital charges relating to obesity and to run campaigns to curb overweight and chronic diseases such as hypertension in children. This problem has challenged health practitioners such as doctors and nurses and the general public prompting actions in the various levels such as media, health professionals and the education sector. The implementation of such a health policy is going to benefit the whole country and is going to impact heavily on all sectors. For example the economic situation may improve as fewer funds will be directed toward obesity cases and those funds can be used to perform other economic functions. The community is generally going to be healthier and child mortality caused by chronic illnesses will decrease and also reduce chances of contracting other diseases such as high blood pressure and depression. The successes’ of the implementation of this policy will also have tremendous outcomes to the care givers such as having fewer patients to attend to hence reducing the work load since currently they are being overwhelmed by the increasing cases of bedridden obese children (Daniels, 2006).

Policy played a big role in Malaysia health dimension with the introduction and the continued implementation of the smoking policy. Cigarette smoking is very dangerous to the human health and causes various chronic complications in the human body. Prolonged smoking has been found to be a main cause of lethal forms of cancer such as lung and throat cancer. It also causes serious respiratory complications and heart diseases in adults as well as children. Excessive smoking can also lead to death as these diseases are difficult to treat. Smoking not only affects the smoker alone but also the people around him/her. Pregnant women who smoke or are around people who smoke expose the unborn child to risks of getting affected and even risk of a miscarriage. More than half of the born children are also exposed to cigarette fumes which could cause early respiratory problems and complications. Other burdens associated with smoking include direct and indirect medical costs that take a toll on the economic resources.

Policy development

Legislation on smoking were first introduced in Malaysia in 1976 that required that every cigarette packet made in and for Malaysia was supposed to have a warning message to alert the consumers on the dangers of smoking cigarette. Smoking was also banned from all public areas such as schools and hospitals from the year 1980 and legislations were also put in place to deal with those who broke these regulations. The restriction to sale of cigarette to persons under the age of 18 came in May 1994 and retailers were not allowed to sell cigarettes to minors. The next part of the policy was enforced in 2003 with the legislation of anti-tobacco advertisement and it was required that no cigarette advertisement was to air on radio or television. This was an improvement to the already existing law that restricted the showing of cigarette packaging in advertisement and the restriction on print media to ensure that cigarette advertisements did not exceed one page.

Heavy fines and imprisonments were also put in place for the offenders of these legislations. According to the International Tobacco Control Policy evaluation project carried out in March 2012 the government of Malaysia has carried out various campaigns to implement its smoking policy for example it has put in place bans and restrictions of smoking zones, forcing manufacturers to include warning messages on their packets and prohibiting the advertisement of cigarette products on television and radio. Other measures taken by the government of Malaysia include taxing tobacco products heavily in an attempt to raising their prices and consequently discourage their consumption (Desai 2003).

Scope of policy

According to the International Journal of Environmental Research and Public Health, the smoking and tobacco policy affected various stakeholders both in the business sector and health sectors. It enforced that any cigarette manufacturer should not release specified amounts of tan and other harmful gases from their manufacturing factories. This definitely restricted the bulk of cigarettes that manufacturers would produce and hence reduced the number of cigarettes available in the Malaysian market. It also required all cigarette producers to ensure that their packets contained a warning message as well as clear pictorial warnings of effects of smoking. Traders were also not spared by the policy as they were restricted from selling cigarettes to people of not more than eighteen years. This ban was meant to protect children and teenagers from the consumption of cigarettes especially at a young age which would be detrimental to their health. Smokers were also required to smoke only in the specified smoking zones and smoking in public areas such as public toilets, public vehicles, schools, hospitals, petrol stations and restaurants. Those who were caught breaking this rule were immediately fined a heavy penalty that included jail term.  

Policy in action and policy analysis

There has been vigorous promotion of health sensitizing messages to the general public especially in the densely populated areas. One such campaign is the ‘Tak Nak Merokot’ or the No smoking media campaign. This campaign became very popular and it was aired across all media stations as well as on print media and it was very effective as the message was able to reach a large number of people. The message is also on social media such as Facebook as well as other internet advertising sites. There was also the enforcement of the requirement by the government that all cigarette packets should have pictorial health warnings. These are scary and very gross pictures that show the consumer the effects of smoking and what smoking can do on the body. The government has as implemented control of prices on cigarettes by imposing the minimum cigarette prices on each packet. Extra taxes have also imposed on all tobacco products ranging from the tobacco harvest to the finished products. Manufacturers pass on some of these extra costs to consumers which burden the consumers and hence discourage them from excessive consumption of cigarettes. The government has also succeeded in the implementation of the legislation that bars traders from selling cigarettes to minors and those caught committing the offence are put in jail. Other legislations that have been successfully implemented include the ban of sale of cigarettes to minors, ban on misleading advertisements, ban on excessive release of nicotine and tar emissions and the designation of smoking zones.

Effects on health

According to a survey carried out by the poison and drug committee of Malaysia, the policy on smoking has had various benefits and effects especially on the general health on the community. Through the various awareness campaigns such as the Tak Nak campaign, the public became more aware of health risks associated with excessive smoking of cigarettes. The participants were asked to name some of the health risks associated with smoking and a good number of them could identify a number of health risks. These risks include causing stroke in smokers, impotence and infertility, blood clots especially in the brain, lung cancer, the rotting and wasting away of lungs, stained teeth leading to low self-esteem, diabetes, bronchial asthma especially in children, miscarriages, poisoning from the toxic substances found in cigarettes, peripheral vascular diseases among others. The creation of health risk awareness is very vital since people became more aware of the dangers of smoking.

The ministry of health in conjunction with the Institute of Public Health Malaysia has filled a report after a series of surveys carried out in intervals of ten years between year 1986 to 2006 shows that hospitals received fewer cases of smoke related complications, decline of smoke related deaths and a slight upward movement in the life expectancy. The health sector workers and professionals have also benefitted by having a smoke free work environment. Through the ban on smoking in public places such as hospitals, doctors and nurses are now able to attend to patients more properly as the hospitals are now smoke free.

Barriers and challenges facing the policy

Through the implementations of the various activities under the Malaysian Tobacco free policy, the government has had various successes such as the restriction of tobacco advertisements, restrictions of smoking in public places, the implementation of the directive to have pictorial warnings on all cigarette packets, control of prices and taxation on tobacco products and an effective ‘Tak Nak’ campaign. However the implementation of the policy faces various hindrances and barriers. These include inadequacy of health staffs making it difficult to get the message to everyone especially those in the rural areas. Medical and health professionals are greatly overwhelmed because according to the private health report of 2008 the number of nurses to the population was an overwhelming one to one thousand. This made it difficult for the health professionals to divide their time between attending to patients and travelling to the rural areas to speaking to people about the dangers of cigarette smoking. The other barrier is lack of communication channels to rural areas which leave out the rural dwellers from the Tak Nak campaign which is run through the media. The Tak Nak was very successive especially in urban areas where people had access to media and information channels such as radio and television. However it did not perform as well in rural area where electricity and communication were inaccessible. Teenagers and youth are also not quitting smoking as planned due to their lack of awareness and peer pressure. Smoking has been a culture in Malaysia and it is difficult for people to quit smoking so easily because they have been brought up with the practice. The other main barrier is the lack of support from all stakeholders, for example there are still a few media houses still airing advertisements about cigarettes. Some hotels as well as public vehicle operators are still allowing smokers to smoke at their premises which go against the government legislations. Another major hindrance is the trade on smuggled cigarettes that is spoiling the gains made so far. The government’s efforts to have all cigarettes manufactured in and for Malaysia are being watered down the drain due to the cigarette smuggling trade that brings to the market cigarette that do not conform to the set rules and legislations ( Moore2002).

Cigarette companies have also invested heavily in Malaysia and they carry out strong promotion activities that seem to counteract the effect of the government efforts of curbing excessive smoking. These companies invest billions of cash into advertisement and promotion activities such as the putting up of out-door media such as banners, posters and huge bill boards that try to compensate for the restriction to advertise through electronic media.

Conclusion

Policies are important because they assist an authoritative institute such as the government to achieve targeted measures and goals in order to avoid a looming epidemic and improve people’s lives. A good policy must be developed by an authoritative force that enforces its implementation by backing it up with legislations since an unimplemented policy is not useful at all.  The implementation of health policies has tremendous benefits as it improves socio-economic factors and improves health profession practice by improving the environment where the health professionals work from. The government has also been relieved of the extra burden of financing for the treatment of smoke related ailments among its citizens and purchase of medicine to cure them. Policies are therefore necessary for planning and development.

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