United States's role in outsourcing Essay Example | Topics and Well Written Essays - 750 words

United States's role in outsourcing - Essay Example Outsourcing presents both direct and indirect advantages and disadvantages. Several unfavorable conditions in the country make American companies outsource foreign employees and overseas locations. This paper explores United States role in outsourcing and its impact. The current  U.S. corporate tax code encourages companies to move their operations to foreign locations. It results in the offshoring of jobs that could currently be located in the United States. The government condemns the outsourcing of jobs out of the country by U.S. multinational corporations because it fails to solve issues the employment crisis in the country. In addition, outsourcing weakens the U.S. competitiveness in the international economy. The government tries to attract multinational companies in the country through tax incentives and formulation of policies that provide a favorable work environment. An increase in taxes for multinational business triggers an exodus of business, investments, and work opportunities (Wolverson 1). Multinationals often shift to low-tax countries in which they can maximize their profits. Commonly referred to as ‘tax havens’, such countries offer small corporate tax rates to persuade multinational corporations to transfer inc ome abroad. Production and labor costs are a cause for outsourcing. Other countries offer cheaper sources of labor as compared to American workers who demand high wages. China, for example, has an unrivaled large and reliable labor base that accepts lower pays. While unemployment is rampant in the U.S., it is worse in developing countries such as China, Singapore and Malaysia (Wolverson 1). As companies outsource to China, Americans remain unemployed because of limited job opportunities at home. The companies benefit because they reduce their capital and operating costs. Regrettably, the country loses its productivity and competitiveness in the global economy. Outsourcing

Arthur Miller Essay Example for Free

Arthur Miller Essay In this essay I will explain how Arthur Miller creates a dramatically effective opening by writing about the initial perceptions of the Carbone family. The tone is created through the characters before the two cousins arrive and the outcome of their onset is the transformation in atmosphere of the Carbone family. I will explain the effect of the historical context, knowing that Marco and Rudolfo are illegal immigrants, and what outcome this has on the audience. The role of Alfieri is also clearly explained, how he is portrayed and how he creates a tense, anxious atmosphere with his narrative, to the audience. Additionally I will explain why the majority of citizens immigrated to America initially and how knowing that, affects the audience. Furthermore how the concluding dramatic scene affects ALL the characters, the atmosphere and the effect on the audience at the end of Act One. Immigrants left Italy, Russia and Germany in 1955 because they thought America was rich had political, economic and religious freedom and a lot of space for growth. Education was of a higher standard and there was supposed to be full employment. They also believed that America was a very wealthy country and glamorous because of the ideas and images portrayed in the Hollywood movies. The reality of this was somewhat different. There was a lot of exploitation and conflict, the accommodation was over-crowded, people were intolerant, and there was mass unemployment and poverty. Knowing what peoples perception were, created suspense and tension, as the audience insight is of the cousins being sent back or getting found out, explained by the quote from Eddie: if everyone just keeps his mouth shut nothin can happen. This also creates dramatic suspense as the audience does not yet know how Eddie will react and whether he will turn Rudolfo and Marco in to the Authorities. Also there is tension as to whether Rudolfo is using Catherine to obtain American passport and American citizenship, if he marries you, he has got a right to an American citizen. Arthur Miller creates a dramatically effective beginning in Act1 of A View from the Bridge by firstly introducing an introductory speech by Alfieri. We know that Alfieri is the Narrator as he is the first to speak and introduce the main character. He links the scenes in the play and he prepares the audience for what is going to happen. An example of this is where he suggests in the quote, and watch it run its bloody course that a dreadful tragedy is clearly going to occur further on in the play. This tells the audience that blood may be shed or its something so terrible its unbearable. The audience know the main character is Eddie Carbone and he has something to do with an incident that will soon occur, this ones name was Eddie Carbone. Alfieri creates suspense and tension through this. We know the key theme in this play is justice referred in Alifieris first speech, justice is very important here which suggests a crime will be committed, creating a dramatic effective making you wan t to continue on with the play. The perceptions that we obtain from the Carbone family are that Beatrice is quite nervous about the cousins coming to stay, no, im just nervous thats all but happy, Catherine: laughing. We observed that Eddie is very protective especially over Catherine, responsible, Katie, I promised your mother on her deathbed. I am responsible or you, and caring, listen you been givin me the willies the way you walk down the street, I mean it! but obstinate and controlling, what job? Shes going to finish school. This indicates that Eddie is a good father figure for Catherine. They seem like a very warm-hearted, affectionate and hospitable, go baby, and set the table. We know Catherine is the best student out of her class mates, best in her class, which shows she is a very talented and educated young women. a very talented and educated person the best in her class. When the two cousins who are illegal immigrants, Marco and Rudulfo arrive, there is a transformation in atmosphere. The relationship between Catherine and Eddie also begins to change because Eddie is jealous of Rudolfos and Catherines relationship, Embarrassed now, angered. There is also a problem with Eddie and Beatrices marriage, when am I gonna be a wife again, Eddie? Eddie tries to avoid a discussion about this while on the other hand Beatrice wants to discuss the situation. This suggests a breakdown of communication. The family also seem to show more strain and anxiety, if everybody keeps his mouth shut, nothin can happen, said by Eddie. When Rudolfo and Catherine announce that they are now an item, Eddies protectiveness over her kicks in. He has now gone further than protective. He is now controlling and manipulative, I just dont want her hangin around., his patience warring. Rudolfo is seen as a lady figure. He sings, hes blond and self-centred, and then I want to go back to Italy when I am rich, and I will buy a motorcycle. While on the other hand Marco is the opposite hes darker and more reserved, Marco comes with a certain formal stiffness. He is also more responsible, my wife, I want to send it right away, maybe twenty dollars. Eddie is the only person to have a problem with Rudolfo. Mike and Louis tell Eddie that Rudolfo has a good sense of humour, which Eddie could perceive in one of several ways. This could make Eddie feel unfavourable as they see Rudolfo in a positive way on the other hand it could confirm Eddies view that hes right and that Rudolfo is insensible and defiantly not mature. This could also confirm eddies view that Rudolfo is a figure to laugh at Mike: Louis and he explode in laughter, you take one look at him everybodys happy Eddie: troubled. Also there are a lot more problems in Eddies and Beatrices relationship; it is rapidly deteriorating now after their row. Beatrice is now feeling furious and frightened Beatrice: suddenly with open fright and fury this shows conflict and a tense atmosphere. The final dramatic scene starts with tension, when Eddie and Rudolfo are arguing or disagreeing through conversation, Eddie: resenting his instruction, for Christ sakes. Eddie is being rude and insulting towards Marco, they count the kids and theres a couple extra than when they left? suggesting that Marcos wife may be committing adultery. The atmosphere becomes extremely tense, now Eddie is frustrated and unsettled with Rudolfo Eddie: (rises, paces up and down). Eddie tries to perceive the others by caring for Rudolfo, the more you run around like that the more chance youre takin', by doing this he can guide Catherine into breaking up with him. We know Eddies is alone on his argument, (holding back a voice full of anger) we know he is doing this through his actions, this builds tension, is he going to explode? Whats going to happen next? We know he feels this way because the rest of his family are on Catherine and Rudolfos side which could make Eddie very frustrated as he cant get his views across. By this he could also be very angry, tense and stressed. Eddie starts to be very intimidating towards Rudolfo, feeling Eddies eyes on his back which shows he is jealous and angry as if hes sending a personal warning to Rudolfo. Beatrice tries to distract Eddie be nice to go all over in one of those fishin boats which would help ease the tension. We know at this point that Eddie despises Rudolfo and starts to act in an immature and childish way he could make dresses he is ridiculing Rudolfo. Eddie invites Marco to a boxing match, you ever seen a fight, did you? he is know trying to act tough and to show that hes strong and masculine, like hes better or more of a manly figure. He also shows this through his actions as if hes getting ready to fight, rubbing his fists into his palms this shows he is very tense at this point and very unhappy or maybe he has a plan, still being nice and generous on the outside. The atmosphere seems to ease down a little at this point and becomes more relaxed and laid-back, (Rudolfo laughs) but the author is demonstrating an example of dramatic irony as this is false. As we know this is fake so dramatic irony is being used. Not forgetting the audience knows more about what is happening and has a more truthful perception of the characters than they do themselves. This makes the audience very suspicious and concerned as if something is about to happen, this causes tension and suspense for the audience, that a manly event of some sort is stirring. Eddie tries to teach Rudolfo how to fight, is it a trap? He boosts Rudolfos confidence by handing him compliments, hes terrific then Eddie hits him, watch out, here I come this is portrayed like a threat or a warning as if to say, stay away from Catherine. Marco, getting his revenge in some way challenges Eddie, Can you lift this chair?. But as Eddie soon realises its more than that. Eddie was only ale to lift it 1inch above the ground whereas Marco raised the chair over his head. This was to let Eddie know that he is stronger than him and that he understands what he is up to, protecting his brother and giving him a warning. He laughs this off, appear like a glare of warning into a smile of triumph which shows the others he is not threatening him but Eddie obviously knows what he meant. The atmosphere is now tense and formal.  Therefore Arthur Miller creates a dramatically effective beginning through out the play. He creates tone; suspense, tense atmosphere and historical context which make the audiences want to continue to watch the play and keep them guessing the whole way through.

Reflective Practice in Nursing Communication

Reflective Practice in Nursing Communication This assignment looks at the study of theoretical reflection in conjunction with how effective communication skills can be developed to expand our knowledge. To achieve this I will explain what reflection practice is using models of reflection; evaluate theories of personal development what they are and how they are used. Discuss how reflective practice benefits communication skills and in turn influence our knowledge of nursing care. What is reflection? In scientific terms reflection is seen as light, heat or sound striking a surface to give off a reflection (Darlene 2006). Reflection is also seen as philosophical understanding of how one can gain knowledge through experience and use different approaches to the same scenario (ref). Reflection can be described as; meditation, deep thinking and or giving careful considerations to possibilities and opinions of a given situation (Mcferran and Martin 2008). The novel idea of reflection rose from a theorist John Dewey (1859-1952); his proposed view on reflection is described as persistent, active thinking and taking into consideration the supporting evidence that forms knowledge to the given situation. This theorist suggests that the person uses their mind and emotions to facilitate reflection (Bulman and Schutz 2008). This suggests that John Dewey describes reflective individuals has being open-minded, responsible and wholehearted (Vaugn and Leblanc 2011). Deweys perception of reflection was a platform for many authors to elaborate on in terms of understanding reflective practice. Johns and Freshwater (2005) propose that health professionals should find the meaning of reflection through description rather than definition because to define reflection is to suggest the author has authority over its meaning. This in turn allows reflections models and frameworks to be used intuitively giving a more holistic approach, it can be subjective and purpose driven (Johns and Freshwater 2005). Mann et al (2007) describes Schons (1983) view that reflection can happen in two ways: reflecting upon activities whilst they are happening called reflection in action (present reflection) and reflecting upon activities once they have happened (reflecting on the past). Reflection can also be seen as the engine that facilitates superficial learning into finding a deeper understanding that enables the practitioner to transform what is known to knowledge in action (Boud et al 1985 cited in Rolfe et al 2011). Reflection (Broad overview) Describe some of the different theories and models of reflection that are available and how they are used. Explain how reflection can aid personal development. Schon, reflection on and in action Models of reflection, Driscolls, Atkins and Murphy, Gibbs, Johns, Kolb. 750 words Reflection Model and frameworks There are many different models of reflection which seem to have similar philosophical theories attached to each approach. Rolfe et al (2011) asserts models are methodologies and frameworks are methods used to understand and give guidance on how use the chosen reflective model and models therefore are ontological this mean they have formal specifications for representing ideas and concepts that aim to improve personal growth and development. Models of reflection developed by Schon and Argyris (1992) involves three elements: (1) knowing-in-action (2) reflection-in-action and (3) reflection-on-practice (Ghaye and Lillyman 2010). Ghaye and Lillyman (2010) have extrapolated Schons work to include knowing-in-action; they propose that practitioners customise and tailor their own knowledge or theories to the situation presented. Knowing in action is described further by Carper (1978) who identifies five approaches to knowing in action; empirical, personal, ethical and aesthetic knowing ( Newton and McKenna 2009). Empirical knowing is the formation of knowledge organised into general laws and theories for the describing and predicting phenomena pertaining to nursing practice (Averill and Clements 2007). Empirical means of knowledge tends to seek out theoretical explanation which can be replicated and be publicly verifiable (Newton and McKenna 2009). Newton and McKenna (2009) further suggest that empirical knowledge can only be effective when it is interpreted within the context of given clinical situation and how it is assimilated into practitioners personal knowledge. Personal knowing described by Carper (1978) is about finding out how much we know about ourselves when faced with clinical challenges and that health care professionals may not necessarily know about the self but do strive to know about the self. Newton and McKenna (2009) state that Caper (1978) does reiterate that it is difficult to master however it is an essential in understanding nursing care. Newton and McKenna (2009) suggest that personal knowing demands a deeper level of understanding and awareness to communicate and interact with ourselves and others. This type of knowing requires the nurse to be empathic, nurse attempt to do this by developing a personal yet professional relationship between the patients as opposed to viewing a patient as an object (Newton and McKenna 2009). Moral actions and ethical choices are intertwined with personal knowing to which Carper (1978) suggests presupposes personal maturity and freedom. Ethical knowing is about the moral aspect of nursing that is concerned with making choices, making justifiable actions and judging outcomes (Newton and McKenna 2009). The main focus of ethical knowing is trained towards issues of obligations that would require rationalisation and deliberate reasoning (Carper 1992). Chinn and Kramer (2004) suggest that rational can be expressed through codes, moral rules and decision-making. Newton and McKenna (2009) assert that having knowledge of moral issues is not isolated to ethical codes of nursing disciplines for example the Code of Conduct written by the NMC (2010). Newton and McKenna (2009) assert that ethical knowing is only partly learnt through applying codes and moral rules but is more through experiencing situations that initiate reflection upon what is or has happened and how this affects patient care. Gibbs( date) Driscoll(dates)and Kolb ( date)all conjured reflective models which are each similar to one another; they are all cyclical reveals that learning through reflection about what is or what has happened is continuous cycle. Gibbs et al (1988) model please see appendix 1 (a) Do you know of any other models that perhaps dont take on such a cyclical approach†¦ consider the work of Chris Johns, Mezirow, Boud et al also†¦. How do they compare and contrast with each other? Why might one model of reflection suit one situation or context better than another?Think about which models promote single loop or double loop learning if you can. Reflective practice (Specific) Give an overview of how reflection is used in nursing. Explain its relevance to nursing and how and when it is used. Explore the concepts of reflective practice and critical incident analysis. Introduce use of reflection for personal development. CPD, self regulation. Identify the different situations where reflection can be used. Skills V critical Incidents what is a critical incident. 750 words Reflective practice is seen has using reflective techniques to improve, maintain change in clinical procedures and influence guidelines to encourage greater safety of patients in all areas of health organisations (Bulman and Schutz 2008). Health care organisations in the UK have undergone and still continue to undergo changes to how it is regulated (Rolfe et al 2011). The emphasis is largely associated with increasing patient safety and risk reduction (Rolfe et al 2011). The four main bodies in the UK; Royal College of Nursing (RCN), Nursing Midwifery Council (NMC) and General Social Care Council (GSCC) and General Medical Council (GMC) which are concerned with the controlling, training and regulating of the healthcare system in UK (Rolfe et al 2011). Evidence-based studies have taught the NHS and regulatory bodies how to change practices and procedures to create better outcomes for patients, they have also encompassed further development for staff to promote a better use of resources through continuing professional development CPD (Ghaye and Lillyman 2010). An example of this could be the pressure sore nurses taking on the responsibility of giving guidance to non-specialist nurses to take care of patients with such conditions. This could not have been achieved if it was not for reflective thinking being part of the learning process (ref). How do we use reflective practice within our day to day practice? Consider the approaches that mentors take when supporting students, look at the principles involved in preceptorship and clinical supervision†¦ Communication skills (Application) Discuss and analyse how reflection can be utilised to improve your communication skills in practice. Explore how and when you would use it. What practical steps would you take and what resources would you utilise and why. Link reflection in and on action to communication situations giving information (in), breaking bad news (on), then use of journals, models, writing, peer support. 750 words Conclusion Sum up 500 words You have made a solid start at this assignment so far and have introduced many ideas which are relevant to the topic. These themes now need to be explored in greater detail . You have a slight tendency to introduce theoretical concepts ( not all of which are uncomplicated) without fully explaining their meaning†¦. Take care to avoid this as just mentioning them does not mean that you understand them and we will be looking for evidence of understanding. You also need to pay attention to your sentence construction as there are several poorly constructed sentences noted so far†¦. Make sure that when you lift them from the text you have referred to , that you do adapt them to make sense in the context that you are trying to use them. I would like to have a look at this piece when it has been developed a bit more. You are definitely heading in the right direction though and overall have made an effective start.

Professional Sports Teams Move - Cities Fight To Keep Them Essay

Professional Sports Teams Move - Cities Fight To Keep Them   Ã‚  Ã‚  Ã‚  Ã‚  Professional sports, like most of our popular culture, can be understood only partly by through its exiting plays and tremendous athletes. Baseball and football most of all are not only games anymore but also hardcore businesses. As businesses, sports leagues can be as conniving, deceitful, and manipulative as any other businesses in the world. No matter what the circumstances are, it seems that Politicians are always some how right around the corner from the world of sports. These Politicians look to exploit both the cultural and the economic dimensions of the sports for their own purposes. This is what is known in the sports industry as â€Å"playing the field†.   Ã‚  Ã‚  Ã‚  Ã‚  In the last decade, almost all the big cities in the United States, and a few small cities as well, have battled with each other for the right to host big league franchises. Cities spend hundreds of millions of dollars to build new stadiums and offer enticements to private franchise owners. Politicians often push for stadiums and other favors to teams despite not having support from neighborhoods and general opposition across the whole city, especially where these high dollar stadiums would be built.   Ã‚  Ã‚  Ã‚  Ã‚  Some of the most prolific franchises in sports, like the Oakland Raiders and Baltimore Colts of the National Football League, have moved to other cities breaking off their loyalty to the hometown fans. More important than the actual moves are the more frequent threatened moves. When teams â€Å"play the field† and explore the option of playing in other cities they are able to lure interested cities into giving them just about any royalty they want. New stadiums are only the beginning. The willingness to threaten departure has secured for teams a variety of land deals, lower taxes, more revenues from parking and concessions, control of stadium operations, guaranteed ticket sales, renovation of stadiums with luxury seating, control over neighborhoods and transportation systems, and that’s only the beginning of the list.   Ã‚  Ã‚  Ã‚  Ã‚  Franchises are able to control their own destinies and have major advantages over city officials. This is what as known in the sports industry as the â€Å"uneven playing field†. City officials react to the offensive stra... ...s left Baltimore to play in Indianapolis, where they haven’t had a championship season since they left.   Ã‚  Ã‚  Ã‚  Ã‚  Ironically, the Cleveland Browns of the NFL who were a playoff caliber team every year, who had loyal fans and good attendance, lost their team to the city of Baltimore. Owner Art Modell moved his Cleveland Browns team to the city of Baltimore, with the promise of a cost free state of the art stadium, built by tax payers, and a larger market for their team to play in. The city of Baltimore welcomed the team wholeheartedly, after going through the same loss of a team, the Colts. The team is know called the Baltimore Ravens and play in a beautiful stadium complex in downtown Baltimore, Maryland. They have great fan support and Baltimore is once again a football town. The city of Cleveland on the other hand has been in shock after losing a team they loved and supported and are not very fond of Art Modell. The city of Cleveland will once again become a football town, with the expansion Cleveland Browns preparing for their inaugural season, beginning in the fall 1999. The city is once again very excited about the NFL and the â€Å"Dog Pound† will live again.

Doing Business in Countries with Totalitarian Goverments Essay

The ethics of doing business in countries with totalitarian governments has many pros and cons involved with it. But for this debate I will show the cons of doing business in a country with a totalitarian government with an example. The term totalitarian government can be defined as in political science a system of government and ideology in which all social, political, economic, intellectual, cultural, and spiritual activities are subordinated to the purposes of the rulers of a state. (http://encarta.msn.com/encyclopedia) Totalitarian dictatorship strives to be in the control of all the aspects of the private and public behavior by the government influencing all of society toward all their common goals and policies. When I began thinking of a totalitarian government a good example came to mind is the totalitarian states of Nazi Germany which was under the leadership of Adolf Hitler at that time. It was the first examples of decentralized or popular totalitarianism in which the state achieved an overwhelming popular support for its country’s leadership. The support from its individuals was not spontaneous but it genesis depended on its charismatic leader. It also was made possible only by the modern developments in its communication and transportation. According to the Britannica Encyclopedia under totalitarian rules, the traditional social institutions and organizational are discouraged and suppressed. Thus saying that the social fabric is weakened and the people became more amenable to absorption into a single unified movement. With all said me I believe that with doing business in a country that has a totalitarian government would not be a chose one bit. A totalitarian government will tell you as a business owner how you should run your business. They will also make themselves involved in every big or little aspects of how your business is operated. With being in a totalitarian government you would have to be very caution of what and how you sell your goods and services. I also believe that with a totalitarian government that if you make one wrong move you business could be taken over by the government. By doing business with a country that lives under the  totalitarian rules you as a business owner are inadvertently supporting the regime of the dictators. References: â€Å"Definition of totalitarianism† Microsoft Encarta Encyclopedia (2008). Retrieved May 5, 2008 from http://encarta.msn.com/encyclopedia_761574819/totalitarianism.html†Totalitarianism† (2008). In Encyclopedia Britannica. Retrieved May 5, 2008 from Encyclopedia Britannica Online: http://www.brigannica.com/EBchecked/topic/600435/totalitarianism

Alcoholic Beverage and Personal Communication Essay

Introduction The use of a range of drug types, including alcohol, are part of the traditions of many, if not all, communities in Fiji. The Fijian and Indo-Fijian communities have long traditions of psycho-active drug use in the context of ritual and ceremony. 1,2 It has been noted that seafarers, together with indentured labourers, brought cannabis or Indian hemp traditions to Fiji, with the sugar cane plantations providing fertile ground for cultivation. 2,3 Meanwhile, kava was widely cultivated and consumed by ethnic Fijians. The Indo-Fijian community slowly adopted kava drinking rituals and gradually others began to increase their consumption. In addition, marijuana use emerged and spread with increasing popularity amongst youth, especially males. 2-5 This literature review explores the current licit and illicit drug situation in Fiji. It considers peer-reviewed articles identi? ed using Pub Med, Health Internet Work Access to Research Initiative (HINARI) searches and ‘grey’ literature, including published and unpublished reports, and web based resources (e.g. UNDOC, WHO). The review found that there is limited data available to assist in understanding the current situation and associated harms in Fiji, but notes more studies and reports have examined alcohol consumption patterns and associated social problems when compared with studies on illicit drug use. 1, 5-15 Alcohol use in Fiji According to the WHO Global Status Report on Alcohol, data from the 1993 National Nutrition Survey indicate that consumption of alcoholic home brew use is widespread in Fiji, as in other Paci? c nations. These beverages usually contain up to three times the alcohol content of commercially produced beer and are mostly drunk by younger men. 16 After 1995, unrecorded alcohol consumption in Fiji was estimated to be 1. 0 litre of pure alcohol per capita for the population older than 15 years (estimated by a group of key alcohol experts). 17 Although there are no recently published statistics on the number of drinkers and abstainers, the same survey found daily drinkers to be 1. 4% among males and 0. 8% among females aged 12 years and over. 18 Estimates from alcohol experts show that the proportion of adult males and females who had been abstaining (in the year prior to the survey) was 74% (males) and 98% (females). 17 Research shows that single drinking sessions with a high rate of alcohol intake (common practice among Fijian youth) can cause abrupt mood swings resulting in violence, accidents and ? ghts, exaggerated emotions, uncharacteristic behaviour, memory loss, impaired judgement, communication problems, sleepiness, coma, stupor and death (at very high intake) and suicide attempts. Binge drinking has also been implicated in schizophrenic and other psychiatric episodes. 19 165 REVIEW PACIFIC HEALTH DIALOG MARCH 201 1, VOL. 17, NO. 1 While there is limited current information on the rate and consumption patterns of alcohol, cannabis and kava among young people,1,6,9 several studies2,3,8,11 were conducted to analyse the extent of tobacco and alcohol use among young people in Fiji in the 1990s and early 2000s. One of the studies4 found that alcohol is widely consumed in one form or another among young people, with about 2 in 5 of the young people surveyed having tasted it. The percentage of young people classi? ed as current drinkers ranged from a high of 26% among males to 9% among females. 4 Of concern was the high proportion of binge drinkers: about 3 in 5 young people reported having had 5 or more alcoholic drinks in one session. The study4 indicated that the high prevalence among 13-15 year olds poses a serious concern, and highlights the need for law enforcement and intervention programs to create an environment that promotes responsible drinking. Interestingly, the study found that when compared to smoking, alcohol and kava use, the proportion of young people using cannabis was relatively low. 4 A follow up survey of 2147 students in 2004 by the National Substance Abuse Advisory Council (NSAAC) found a general increase in substance use among secondary students (see table 1). Table 1: Youth Substance Use in Fiji (Comparison of the results for Fiji in the 1999 Global Youth Tobacco Survey by UNICEF and WHO and 2004 follow up survey by NSAAC). Substance Tobacco Alcohol Kava Marijuana GYT Survey (1999) 32. 3 40. 3 51. 9 12. 8 NSAAC (2004) 43 51 61 13 Signi? cant variations exist in the drinking habits of males and females in Fiji; there are many more male drinkers than there are female drinkers. 11 Ordinarily males consume the bulk of the alcohol in the company of other males, usually during drinking sessions with no special occasion, while most women drink alcohol during social functions or in night club settings in the company of men and other women. While women occasionally participate in drinking sessions, typically it is an exclusively male activity. 11,13 It is at these drinking parties where the most copious amounts of alcohol are reportedly consumed. Thus, when males drink, they tend to drink larger amounts of alcohol in one sitting than women do. Illicit drug use in Fiji Border Security and Drug Control Limited data exist to aid in understanding illicit drug use and the associated harms across the Paci? c. In addition, there are no surveillance systems. 20 However, Fiji by virtue of its geographical position is faced with the twin problems of illicit drug traf? cking and increasing use. 21,22 These are further aggravated by the rapid transitional and social changes arising from urbanization. These developments create an atmosphere which exposes entire communities to greater risk associated with drug use (Personal communication – Fiji Police Department, 2008). Minimal use of drugs such as heroin, morphine, cocaine and hallucinogens occur, but this review found that Fiji is considered a transit area for smuggling. [20-23]. Drugs such as heroin, methamphetamines and 166 PACIFIC HEALTH DIALOG MARCH 201 1, VOL. 17, NO. 1 REVIEW cocaine are not commonly used due to their high cost when compared to the average income. Raw cocaine has reportedly been found in Fiji and three Chinese men and a Fijian security guard were murdered in what was thought to be an organized crime execution linked to drugs. 22 National enforcement agencies have responded to curb traf? cking as is re? ected by the large seizures of illicit drugs. 24,25 In spite of this response, a drug laboratory found in Fiji in 200625 supports the view that organized crime groups could escalate their activities in the Paci? c islands. 21,25 A raid at an industrial estate in Suva, involving police from Australia and New Zealand and Fijian Customs Of? cer followed a major heroin seizure in 2000. 21,25] The lab identi? cation also suggests a transition of Fiji (and possibly other Paci? c Nations) from a transhipment point to a production base. According to the New Zealand Police, to succeed in future operations similar to the Suva bust, interested agencies need to work towards having â€Å"robust communication systems† across organisations to keep them connected and informed on crime in the region. 21 It is reported that there are about 5000 vessels transiting in the Paci? c on any given day. 21,24 Large shipments may be unloaded from a mother ship to smaller vessels, and can subsequently go in hiding at the many small, uninhibited islets and atolls, waiting for the next step. 21 Fiji has recently established a Transnational Crime Unit (TCU) with the Fiji Islands Revenue and Customs Authority (FIRCA) as one of the key law enforcement agencies involved. This unit has been vigilant in promoting the cooperation between border organizations in order to assist the TCU in controlling the borders. 24 The Unit also compiles data for intelligence risk assessments throughout the year. It supports a Case Management Intelligence System (CMIS), whereby relevant information from the Police Department, Immigration Department, Local Government Authorities, Financial Intelligence Unit, and other Law Enforcement Agencies24 are automatically linked in the system. A number of cases which the TCU have been investigating include a Tongan syndicate smuggling drugs from Fiji to Tonga. In a recent example of program cooperation a number of TCU surveillance targets were arrested during a Police roadblock in Sigatoka (personal communication, FIRCA, 2008). Domestic Issues Cannabis is by far the most common and widespread illicit drug used in Fiji. 11 Like many other countries in the region, anecdotal evidence suggests there has been a considerable increase in drug use among young people4 despite the relatively small increase suggested by the 2004 NSAAC study (see table 1). However, it is not clear if the two studies they reported were directly comparable. Data collected by the St Giles Hospital and the Fijian Police Department support the view there has been an increase in use. Admissions data for St Giles Hospital reports on cannabis induced psychosis and other disorders. In 1987, ? ve young men were admitted to St Giles Hospital with cannabis related mental disorders. In 1988, the number rose to ? fteen with many more unreported cases. 26 The 2005 hospital data revealed that a total of 612 patients were seen at outpatients department diagnosed with a substance abuse disorder. These included 386 (63%) patients for marijuana, 59 (10%) alcohol, 99 (16%) kava and 99 (16%) tobacco use issues. In 2006, 272 admissions to St Giles Hospital were reported as drug related, consisting of 66% Fijians, 20% Indo-Fijian and 14% belong to other ethnic groups. It is probable that the political troubles in 2006 impacted on the number of admissions, but no data were available to con? rm or reject this view. Police arrest data report possession (see Table 2). 8,13,26 Statistics provided by Fiji Police showed 259 drugrelated crimes were committed in 2008. There was a 21 per cent drop from 2007 which had 329 drug-related 167 REVIEW PACIFIC HEALTH DIALOG MARCH 201 1, VOL. 17, NO. 1 crimes. 27 There are also reports of increasing cannabis cultivation as a form of inter-seasonal cash crop substitution among farmers. It is estimated that Fiji has between 500 to 1000 cannabis producers, some of them citing the country’s worsening economy as the motivator for production (personal communication, Police Drug Unit, November 2008). For generations, the villagers of Navosa have travelled for hours across rugged terrain to reach a road to the market to sell their produce with no guarantee their produce will be sold. Facing the same hardships as their ancestors, many of these villagers report having no choice but to resort to marijuana growing because â€Å"The product is lighter, it has a steady market and is economically viable† (Personal communication with growers, December, 2008). Production is predominantly for local consumption. Table 2: Recent Crime Data ( Drug offences recorded by the Fiji Police Forces from 2000 to 2006). Year Drug offences 2001 433 2002 417 2003 417 2004 312 2005 312 2006 333 The Save the Children Fund in Fiji reports that the continuing political and economic instability in the country has also led to a lot more children working as drug traf? ckers or prostitutes. [28] Concern over the increasing number of children involved in drug traf? cking was sparked by the recent arrest of three school children caught selling drugs in an amusement centre in Labasa. The Fiji Women’s Crisis Centre reported an increase in young Indo-Fijian girls working as prostitutes in urban centres. Furthermore, the National Manager for Save the Children Fund in Fiji, says there is a growing trend among poor families to send their children out onto the streets. 28 Drug and alcohol legislation and policy According to the literature, there is no regional-based illicit drug policy for the Paci? c and few treatment programs. 20,29 Information from the Paci? c Island Forum Secretariat (PIFS) indicates that Fiji’s Illicit Drugs Control Act is an adaptation of the Regional Model Law on the Control of Illicit Drugs which was developed by the Secretariat. There was no formal committee, but it was endorsed by a Cabinet sub-Committee on legislation which was chaired by the then Attorney-General. Both the Fijian Government and PIFS are advocating for a regional legislative framework to respond to the increase in illicit drugs in the region (personal communication, PIFS, 2008). Amphetamines are a key drug of concern with the region’s geographical vulnerability highlighted as a key factor in the rationale for this approach. At the time of writing, Kiribati and Fiji are the only two PIFS member countries to have adapted and enacted the model law. Furthermore, a Code of Practice has been developed by PIFS to assist stakeholders such as law enforcement agencies and pharmacies to classify, register and dispose of illicit drugs (personal communication, PIFS, 2008). It may be adapted by Forum member countries with modi? cations to suit national legal and administrative arrangements. Legislative control on the consumption and sale of alcohol to minors has not been widely and effectively implemented. While minors are legally barred from consuming alcohol, the sale of alcohol beverages to under-age drinkers is common throughout the country. 11 For the minor who is unable to gain access to commercial alcohol beverages, homebrew is an easily obtained alternative. Anecdotal evidence suggests that minors make up a large and undetected percentage of consumers of alcohol beverages. 168 PACIFIC HEALTH DIALOG MARCH 201 1, VOL. 17, NO. 1 REVIEW Sexually Transmitted Infections Sexually Transmitted Infections, including HIV, are emerging public health problems in Fiji. 13 A recent WHO report indicated that the rise in the number of HIV cases, in addition to increasing number of patients accessing STI clinics, in an ongoing concern. In 2006, MOH statistics indicated30 that Fijians comprised 83% of con? rmed HIV diagnoses, Indo-Fijian 13% and ‘others’ 4%. Since 2004, Fijian males had replaced females as having the highest number of cases. Overall, males comprised 59% and heterosexual transmission accounted for 85% of all cases. By the end of 2004 a total of 182 HIV infections had been reported in Fiji13 and the number of new cases reported each year has increased for the last ? ve years. In Fiji, reported cases of syphilis and gonorrhea have ? uctuated between 1998 and 2004. In 2004 there were 852 reports of syphilis and 1182 gonorrhea. The number of cases reported for 2008 were 1004 for syphilis, 1064 gonorrhea and 283 HIV cases. 27 Recent statistics from Fiji’s Health Ministry on Sexually Transmitted Infections are a cause for concern with the high rate of STIs among people aged 20 to 29 increasing the risk for HIV infection. 31,32 Fiji’s Director of Public Health notes that statistics gathered over the past eight years by the Ministry show that gonorrhoea and syphilis are the most frequently reported STIs in the country, which â€Å"highlights the underlying concern of unsafe sexual behaviour among young people† and the â€Å"same high-risk behaviour for the transmission of HIV. † He also said that â€Å"sex is serious business† and that â€Å"anyone, especially young people, who participates does so at their risk, in view of the sad consequences of infection from so many STIs including HIV, pelvic in? ammatory disease and infertility. †32 Risk/Protective Factors Some religious groups in Fiji, such as Islam, strictly forbid the use of alcohol. Christian denominations such as the Assemblies of God, Jehovah’s Witnesses and the Seventh Day Adventist Mission also prohibit the consumption of alcohol. Individual members of these religious groups vary in the degree to which they adhere to these principles. Any negative effects of combining tobacco or alcohol with kava use are currently conjecture, with relatively little work done to explore the nature of the relationship between these substances in the Paci? c. 1,6,9,26,33 However, anecdotal evidence suggests an inter-relationship exists with social and health consequences. 1, 4-6, 9, 13, 26, 33, 34 Reports of kava drinking followed by a beer chaser, known as ‘washdown’, are not uncommon and suggests the need for further exploration of potentially harmful consumption patterns. Excessive drinking, drinking too frequently and too much, often re? ects the drinking pro? le of the majority of young people in countries like Fiji. 5, 11, 14 Excessive drinking is reported as a signi? cant contributor to motor vehicle accidents, violence and aggressive behaviour, unwanted pregnancy, sexually transmitted infections, and criminal activities. 3, 14, 15, 18, 26 It has been suggested that the alcohol consumption pattern of young Indigenous Fijian males follows the traditional kava ritual of drinking until there is nothing left in the kava bowl. In many instances, young people often end their kava drinking session by consuming alcohol (‘wash down’). [3, 5] It is reported that most youths drink excessively to manage their problems, but it may result in new problems like unsafe sex, crime and violence and even suicide. 5, 14, 15, 34, 35 A study in Fiji10, 11 revealed that alcohol was a factor in 58% of all homicide between 1982 and 1992 and approximately 80% of the crime in the country is alcohol-related. 10, 18 169 REVIEW PACIFIC HEALTH DIALOG MARCH 201 1, VOL. 17, NO. 1 Furthermore, the effects of alcohol on the physical, mental and social health of Fiji’s citizens have in recent years been the subject of considerable concern amongst health-care professionals and social scientists, as well as the ordinary citizens. 2, 3, 8, 10, 11, 23, 26, 33 At present there is suf? cient evidence from a variety of research ? ndings1, 6, 10, 11, 34 to suggest that the heavy consumption of alcohol contributes other health problems in Fiji, such as diabetes, heart problems, obesity and hypertension. Among the social consequences of excessive alcohol consumption in the country,10, 11 violent crime, domestic violence, and road fatalities have been identi? ed as the most serious. 8, 23, 34 While alcohol and home brew drinking are more common, marijuana cultivation, sales and distribution has become pervasive in some Paci? c Island countries. It has been seen as a good source of income. A further emerging substance abuse issue is glue snif? ng among school age children, mostly in their early teens. In addition, unemployment in youths is a major problem in the Paci? c. In Fiji it has been estimated that out of nearly 10,000 youths seeking employment, only 1500 can be employed. 2, 3, 13 Studies and observations in some urban areas of Paci? c countries point to an increasing numbers of people between the ages of 15-19 engaging in commercial sex worker with some aged even younger. 2, 3, 11, 15, 35, 36 Conclusions There is a range of evidence and data suggesting the potential for increased risk of HIV infection associated with substance use in Fiji, but there is a need to explore this issue further with social behavioural and qualitative research. While harmful substance use patterns and sexual health risk factors are increasingly reported, there is little current analysis regarding the interaction of the two. Of particular concern is the current environment of rapidly changing substance use patterns with little in the way of structural responses to protect the people of Fiji from the range of social and health-related harms. In addition, dif? cult economic conditions and the tangible bene? ts of cannabis growing and distribution (and potential for amphetamine production) lend urgency to the need to investigate these issues further and to develop viable interventions that are informed by robust data and research information. References 1. Goundar R, Kava consumption and its health effects. Journal of Community Health and Clinical Medicine for the Paci? c 2006. 13(3): p. 131-5. 2. Plange, N. K. , Social Aspects of Drug and Alcohol Abuse: An overview of the situation in Fiji. Fiji Medical Journal, 1991. 17(3): p. 5-12. 3. Plange, N. K. , Alcoholism and Crime among Urban Youth in Fiji. 1991, University of the South Paci? c. 4. UNICEF. , Substance use among adolescents in Fiji: A surveillance Report from the Fiji Global Tobacco Survey. 1999. 5. Rokosawa, M. Alcohol problems in Fiji. 1986 [cited. 6. Moulds RFW, M. J. , Kava: herbal panacea or liver poison? [For Debate]. Medical Journal of Australia, 2003(178): p. 451-3. 7. Morrison F, H. F. , Gaylord J, Leigh B, Rainey D. , Adolescent drinking and sex: ? ndings from a daily diary study. Perspective on Sexual Reproductive Health, 2003. 35(4): p. 162-8. 8. Adinkrah, M. , Homicide-Suicides in Fiji: Offence patterns, situational factors & socio-cultural contexts. Suicide and Life Threatening Behavior, 2003. 33: p. 65-73. 170 PACIFIC HEALTH DIALOG MARCH 201 1, VOL. 17, NO. 1 REVIEW 9. Kava, R. , The adverse effects of Kava. Paci? c Health Dialog, 2001. 8: p. 115-18. 10. Adinkrah, M., Violent encounters: A study of homicide patterns in Fiji society. 1996, Fiji Council of Social Services. : Suva, Fiji. 11. Adinkrah, M. , Crime, deviance & delinquency in Fiji. 1995, Suva, Fiji: Fiji Council of Social Services. 12. Plange, N. K. , Social aspects of drug and alcohol abuse: An overview of the situation in Fiji. Fiji Medical Journal, 1991. 17(3): p. 4-12. 13. WHO, National Workshop on Alcohol Related Problems in Fiji. 1986. 14. Naiveli, B. , Alcohol and Crime. 1986, Royal Fiji Police. p. 34,35 15. Kippax, D. D. , The Genesis of Alcohol -Related Problems. 1986, Fiji School of Medicine. p. 24-28. 16. Na tabili kavoro: The place of alcohol in the lives of Fijian people living in Aotearoa New Zealand. ALAC Research Monograph series: No. 4. Wellington, Sector Analysis, Ministry of Health for the Alcohol Advisory Council of New Zealand, 1997. 17. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001. 7(3): p. 155-157. 18. http://www. who. int/substance_abuse/publications/en/? ji. pdf, WHO Global Status Report on Alcohol 2004: Geneva. 19. Recommendations for policy to support health promotion. A report to the Minister of Health., N. C. f. H. Promotion, Editor. March 1998. 20. Devanney M, R. G. , Baldwin S, Crofts N, Power, R, Illicit drug use and responses in six Paci? c Island countries. Drug and Alcohol Review, 2006. 25: p. 387-900. 21. Drug Enforcement Administration – Intelligence Division, Drugs Intelligence Brief: the paci? c islands region, v. Alexandra, Editor. 2004, Drug Enforcement Administration. 22. United States Of? ce on Drugs & Crime, Paci? c Islands: UNODC – Regional Centre for East Asia and the Paci? c. 2003. 23. Ratinisiva M, Drug Traf? cking, Prevention and Control in Fiji. Fiji Medical Journal, 1991. 17(3): p. 5-12. 24. Fiji Islands Revenue and Customs Authority, Annual Report. 2006. p. 17. 25. Louisa, C. , Paci? c ripe for drug ring boom, in NZ Herald. 2004: Auckland. 26. Abusah, P. Y. , The Drug Scene in Fiji. Fiji Medical Journal, 1991. 17(3): p. 21-25. 27. http://www. stats? ji. gov. fj/Key%20Stats/Miscellaneous/15. 7%20crime%20cases%20recorded. pdf. 2008. 28. http://tvnz. co. nz/view/page/425822/37544, More Fijian youth in drugs, prostitution 2001. 29. Illicit Drugs Control Bill Draft. Fiji: Paci? c Islands Forum Secretariat. 2002. 30. Ministry of Health, Annual Report – Shaping Fiji’s Health.2007. 31. http://www. health. gov. fj/index. html. 2008. 32. http://www. stats? ji. gov. fj/Social/health_cdeath. htm. 2008 [cited. 33. Council out to Fight Drug Abuse, in The Fiji Times. 34. Caswell, S. , Alcohol in Oceania. 1986, Alcohol Research Unit, Dept of Community Health and General Practice, School of Medicine, University of Auckland, New Zealand. p. 25. 35. Kippax D, O. M. J. , Alcohol-Related Problems in Fiji. 1986, Suva: Suva. 36. Ali, S. , Family Life Education. 1986, Ministry of Education. p. 36-39. 171 REVIEW PACIFIC HEALTH DIALOG MARCH 201 1, VOL. 17, NO. 1 172.