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Discuss the critical analysis of the Canada’s Tobacco Strategy.

Key messages

  • Smoking, both active and passive is detrimental to life
  • Active approach from the government through adequate funding and framing of the reforms will be instrumental in reducing the ill-effects of smoking
  • The government must critically analyse the gaps in the healthcare needs in order to devise the reforms and special focus must be given for the indigenous population and LGBT community

Under the Smoking Prevention policy reform, the government of Canada as proposed 5% reduction in smoking of tobacco by the end of 2035 in order to decrease the rate of staggering death arising out of increase in the burden of tobacco use. According to the Government of Canada (2018), reaching this target will help to save millions of live and billions of dollars. The smoking prevention policy reform also provides legislative along with regulatory efforts in order to protect non-smokers and youth. In order to give proper coverage to the youth, Tobacco and Vaping Products Act is taken under enforcement. Thus it can be said that the Canada’s Tobacco Strategy represents a shift towards more comprehensive and integrated approach of addressing the use of tobacco. The tobacco prevention strategy mainly includes cessation support, protection of young tobacco users and non-tobacco users, encouragement behind the use of vapping products and proper surveillance and research1.

Tobacco use in Canada continues to be a leading yet preventable problem underlying the premature death. While the use of tobacco has decreased, a significant percentage of the Canadian population still use tobacco. Smoking of cigarette results premature death of 45,000 Canadian per year 1. According to the statistics published by the Government of Canada, each year there are 23, 000 deaths of Canadian adults for smoking. Each day 100 Canadians die due to smoking related illness. Exposure to second hand smoke causes smoking-related deaths arising from cancer, cardiovascular diseases and respiratory diseases 1. One of the Canadian Territory Province which counts for high toll of smoking related deaths is British Columbia. In British Columbia (Canadian Territory Province) the rate of incidence of lung cancer is high and the main reason behind this is smoking.

Figure: Lung Cancer Statistics in British Columbia

Projected Mortality Rate of Lung Cancer (2)

Diagnosis Year

Male

Female

2000

51.7

33.8

2005

49.3

35.3

2010

39.9

33.3

2015

35.5

30.3

Incidence of Lung Cancer in British Columbia (2)

Diagnosis Year

Male

Female

2000

1273

1101

2005

1398

1275

2010

1447

1357

2015

1576

1645

2020 (projected)

1645

1896

2025 (projected)

1698

2171


Thus under the context of the increased chances of premature death in Canada with a special mention to the Canadian Territory Provinces, the Government of Canada has come forward with a smoking prevention policy reform. Effective prevention of smoking of tobacco will help in the reduction of the diseases associated with smoking like lung cancer3.

The main goals of the Tobacco Control Strategy of Canada are to reduce the use of tobacco by an ambitious target of 5%, by the end of 2035. The goal will be achieved through broad and population based approaches.

Kingdon model

In order to discuss the factors which have promoted the development of the policy reform, Kingdon (2003) model will be used. This model mainly describes three different windows (policy stream that are used for the policy development).

Figure: Diagram of Kingdon Model (2003) 

Under the policy stream, the main literature support which can be highlighted behind designing of the policy include smoking as one of the preventable cause of premature death arising out of respiratory disease, cardiovascular disease and lung cancer (Islami, Torre & Jemal, 2015). However, there is absence of screening about the incidence of smoking related deaths and the projected outcome of these consequences in the future. For example, Symbol of Statistics Canada. (2018) has a detailed review of the Cannabis intake in the territory province of Canada, but there are no detailed study of the death occurring due to use of tobacco or tobacco smoking and its impending risk. This has created a political agenda in order to ensure the health and the quality of life of the people residing in Canada. There are numerous other reasons, which have lead to the development of the policy reforms in smoking prevention in Canada 5. These reasons are described under the policy stream of the Kingdon model (2003). The local initiatives, which are taken in order to reduce the chances of smoking include smoking include awareness of smoking and its harmful effects and decreasing in the rate of smoking in public in order to reduce the harmful effects associated with passive smoking. However, implementation of the local initiatives is not helpful in the long run keeping into consideration of the financial investments. The reports published by the Government of Canada (2015) highlighted that health risks of the second hand smoke is high in Canada with a special mention to the Canadian provincial territory. This has caused increase in premature birth and stillbirth. Moreover, exposure to second hand smoking has also increased the level of incidence of leukemia, lymphomas and brain tumours. According to the excerpts of Dr. Brett Thombs, chairman of the four-member tobacco working group within the smoking prevention task force, “Rates of smoking have decreased over the last couple of decades, but they seem to have plateaued and they're still much too high”. Dr. Thombs also highlighted that “Among Canadian youth, by the time children and adolescents are in 12th grade, 36 per cent have tried smoking………….. And that's simply way too high given the massive burden of smoking on health [and] on our economy”. Thus increase in the ill-effects of active and passive smoke have highlighted that the local initiatives are not optimally effective and is also not feasible. There exists lack of co-ordination among the stakeholders leading to the development of the government initiatives for the prevention of smoking and ensuring subsequent funding against it 6,1.

The 3-i framework for understanding of the policy development and choices mainly deals with interests, ideas and institutions.

Figure: Model of 3-i framework 

Interests

The main interest behind the policy development is reduction in the rate of smoking or the use of tobacco will help to improve the health-related quality of life of the people residing in Canada. This healthy approach will help to decrease the premature deaths arising from active and passive smoking and reduction in the rate of smoking-related illness like respiratory disease or lung cancer. Other smoking related diseases which are taken into consideration include cardio-vascular disease and other form of cancers. Other external factors that influence the development of the policy is influences coming from the United states towards reducing the rate of smoking in order to lead a healthy life ahead. The United States of American has already implemented tobacco prevention reforms and has achieved success. It not only helped to reduce the premature deaths but have also increase the overall economic structure of the province 3

Ideas

The ideas that influenced the development of the policy is the reduction in the ill-effects of tobacco in order to improve the health-related quality of life of the people residing in Canada. The Canadian territory province was taken under special consideration as there were no specific data about rates of smoking and its projected outcome. Other systematic review and research which are conducted in this domain were also used as ideas for the development of the policy

Institutions

The main institution which is involved in framing and then implementation of the policy is Public Health Agency of Canada under the health department of Canadian Government. The Public Health Agency of Canada has tie up their hands with Canadian Paediatric Society (2016) in order to reduce to implement smoking prevention reform among the young adults and children. The main funding authority of government f Canada10. The budget announced in 2018 has released $80.5M funding for the strategy building with existing resources. It also aims to bring the total investment to $330M during the coming five years. Other institutions which are acting in collaboration include The Medical Psychiatry Alliance (MPA) and Centre for Addiction and Mental Health.

Policy Instruments

The main policy instruments towards the cessation of the tobacco use proper government support in provinces and territories. Government is also taking active initiatives in protecting the youth from developing the smoking habits and protection of children, pregnant women from becoming victim of second hand smoking and proper enforcement of laws. Detailed survey is used as instrument in order to reveal the challenges in addressing commercial tobacco use among the indigenous population and LGBTQ communities. Other policy instruments include support programs like “Picking Up the PACE” that help to reduce tobacco addiction as highlighted by Robert Oliphant, Member of Parliament and Dr. Theresa Tam, Canada’s Chief Public Health Officer 1.

The proper implementation plans includes use of proper advertisements to increase the level of awareness against the use of tobacco. The advertisement will mainly be featured in television, social media, and posters. Other policy instruments include set-up of community based approaches for the prevention of smoking. In order to give proper assistance for the prevention of smoking to the young and older adults’ promotion of the nicotine replacement therapy is undertaken along with the use of the vapping instruments 1. According to the reports published by the Globe and Mail (2017), the Government of Canada is coming forward and taking active initiatives (Canadian Task Force on Preventive Healthcare) for the prevention or reduction in the smoking tendency among the Canadian youth who are aged between five to eighteen years. The Government of Canada (2018), in order to implement the tobacco policy reforms is promoting smoke-free lifestyles by joining hands with Centre for Addiction and Mental Health’s work. According to The Honourable Ginette Petitpas Taylor, Minister of Health, “Promoting healthy living habits goes hand-in-hand with decreasing the number of Canadians using tobacco and will help us achieve our goal of reducing tobacco use in Canada to less than 5% by 2035” 8.

The main communication plans that are being implemented for the prevention of smoking includes community based health promotion approach with effective communication for the development of therapeutic relationships with the service users. The Centre for Addiction and Mental Health and Public Health Agency of Canada is working in collaboration to communicate and to increase the awareness of tobacco harm 9.

Process of evaluation

The process of evaluation will be done by conducting the survey in the healthcare organisation in order to evaluate the rate of hospital admissions and subsequent deaths arising out of tobacco. This will help in analysing whether the reform was successful in achieving the target of 5% reduction 1.

The following is the SWOT analysis of the chosen healthcare reform in Canada done from the perspective of the Canadian population over whom the policy will be implemented.

Helpful (in achieving the target)

Harmful (in achieving the target)

Internal origin

Strength (S)

The main strength of the policy is its funding. Proper funding in smoking prevention and use of vapping technique will help in the proper and optimal implementation of the program along with achieving the desired objectives.

Another strength of the policy is its specific target towards the aboriginal populations towards reducing smoking

Weakness (W)

The main weakness of the policy is it has no specific evaluation methods in order to detect the success of the reform in the long run (2035)

External origin

Opportunities (O)

It will help in reducing the ill-effects of the second-hand smoking and decreasing the effect of smoking over the youths and the children. This will help to promote a healthy future

Threats (T)

Planning of the proper use of the effective funding is not highlighted and this might lead to misuse of funding

References

  1. Government of Canada. (2018). Overview of Canada’s Tobacco Strategy. Access date: 21stNovember, 2018. Retrieved from: https://www.canada.ca/en/health-canada/services/publications/healthy-living/canada-tobacco-strategy/overview-canada-tobacco-strategy.html
  2. Provincial Health Services Authority in British Columbia. (2018). Tumour Site/ Type Demographics. Access date: 21stNovember, 2018. Retrieved from:  https://www.bccancer.bc.ca/health-professionals/clinical-resources/cancer-management-guidelines/lung/lung
  3. Islami, F., Torre, L. A., & Jemal, A. (2015). Global trends of lung cancer mortality and smoking prevalence. Translational lung cancer research, 4(4), 327.
  4. Brook, D. R., Felton, N. V., Clem, C. M., Strickland, D. C. H., Griffiths, I. H., Kingdon, R. D., ... & Hargrave, J. M. (2003). Validation of the urban dispersion model (UDM). International journal of environment and pollution, 20(1-6), 11-21.
  5. Symbol of Statistics Canada. (2018). Provincial and Territorial Cannabis Economic Accounts, 2017.Access date: 21st November, 2018. Retrieved from:  https://www150.statcan.gc.ca/n1/daily-quotidien/180430/dq180430b-eng.htm
  6. Government of Canada. (2015). Dangers of second-hand smoke. Access date: 21stNovember, 2018. Retrieved from: https://www.canada.ca/en/health-canada/services/smoking-tobacco/avoid-second-hand-smoke/second-hand-smoke/dangers-second-hand-smoke.html
  7. Lavis JN, Røttingen JA, Bosch-Capblanch X, Atun R, El-Jardali F, Gilson L, Lewin S, Oliver S, Ongolo-Zogo P, & Haines A. (2012). Guidance for evidence-informed policies about health systems: 2. Linking guidance development to policy development. PLoS Medicine9 (3):e1001186. https://doi.org/10.1371/journal.pmed.1001186.
  8. The Globe and Mail. (2018). Health officials urged to help prevent Canadian youth from smoking. Access date: 22ndNovember, 2018. Retrieved from:  https://www.theglobeandmail.com/news/national/health-officials-urged-to-help-prevent-canadian-youth-from-smoking/article34156250/
  9. Government of Canada. (2017). Smoking and Mortality. Access date: 21stNovember, 2018. Retrieved from: https://www.canada.ca/en/health-canada/services/health-concerns/tobacco/legislation/tobacco-product-labelling/smoking-mortality.html
  10. Canadian Paediatric Society. (2016). Preventing smoking in children and adolescents: Recommendations for practice and policy. Access date: 21stNovember, 2018. Retrieved from: https://www.cps.ca/en/documents/position/preventing-smoking
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