Economics Dissertation

by admin | Mar 20, 2023 | Uncategorized

To what extent do FDI reduce exploitation of china’s workers? Dissertation
Introduction
Background of the Study
In recent time there has been an increase in the number and frequency of complaints concerning the poor treatment of workers in most industries in China over the past few decades as compared to other nations (Aitken, 1996). The issues that have been raised include poor working conditions, meagre pay, child labour and over exertion of the workers. Gills (2002, p. 157) suggest that in the 80’s, an estimated 80% of all workers in the local and multinational garment industries in China were experiencing some form of exploitation.

These employees were faced with various challenges such as sexual harassment, poor pay and pathetic working conditions. This situation has over the years escalated to serious levels due to the government’s neglect in imposing strict labour policies in industries. This is partly due to their need to protect the profit base that comes with inward FDI.

Consequently, increased interest has been developed by policy makers towards the transformation of the rules and regulations that govern the recruitment, sustenance and protection of these workers (Blalock, 2008). There is no doubt that FDI has significantly modified China’s industrial structure.

The industrial sector is the one that has received the maximum FDI in China, which also implies that this is the sector that has used maximum number of workers on employment terms that are almost at par with developed countries because multinational companies are regulated by their home countries in treating labour in the same manner as they would in their home country.

Statement of the Problem
Statistics provided by labour institutions in China reveal that most workers in the industrial sector are often subjected to poor working conditions. In a report made by a labour institution in China, four internationally renowned garment and textile industries in the Guangdong province were red flagged for severe exploitation of their workers.

Workers were expected to work an average of 12 to 15 hours a day with an average wage of 45 cents per hour. In addition to this, new employees were not provided with insurance cover for the first year of their contract. The living standards provided were also in bad shape and no safety training was offered to the employees. On the same note, there were workers aged below 18 years working in these industries and it was also noted that there was no freedom of speech in most industries (Hsu, 2003).

Some industries also deducted a mandatory fee on the wages of new employees for at least the first three months in order to cover for working uniforms and health examinations. Ironically, these industries claim to have maintained high levels of ethical and moral standards towards their workers and their operations.

According to Alon (2008, p. 128), FDI’s mostly present workers with opportunities for better pay, good working conditions and better technology, thus improving their motivation levels that result in increased productivity. This study sets out to investigate the extent to which this statement holds true with regard to the Chinese workers.

It is now well accepted that China’s ability to absorb foreign investment forms an important reason for the country’s fundamental principles of opening up its economy to the outside world. This strategy is in keeping with the theory of Deng Xiaoping that has greatly contributed to build a socialist economy with Chinese characteristics (Coughlin, 2000).

In 1978, the third session of the 11th Central Committee of the Communist Party had affirmed its ideologies in the context of emancipation and sought practical solutions in keeping with the global environment (Huang, 2006). During this time, the Chinese government also affirmed that historical transformation was key to the economic development of China in keeping with its long-term objectives of becoming a global power.

It was at this time that the People’s Republic of China took the decision in reforming itself and opening up its economy to the outside world. The law of the country in regard to Chinese foreign equity joint ventures was introduced by the National People’s Congress and subsequently steps were initiated to neutralise foreign capital as an important source for meeting this long-term objective (Lardy, 1993).

It was after 20 years of exhaustive efforts that the extent of absorption of foreign capital began to expand and the government took additional initiatives in perfecting the procedures for foreign investments. Such initiatives have attracted businesses from across the world and paved the way for a fast and healthy development of the Chinese economy (Li, 2007).

Reardon (2001) has revealed that China needed huge amounts of capital to build up its economy and FDI has made considerable contribution in this regard. During 1993-1999, the share of FDI in China in terms of fixed domestic assets investments was about 10 per cent. Although in other countries FDI is known to have exceeded domestic capital but this pattern is not prevailing in China.

The main driving force behind the spectacular growth of FDI in China has been the bright expectation of investors about the Chinese economy, which is in keeping with the fast growth rates that commenced from the early 1990s. Such expectations were further brightened when the Chinese government adopted friendly market policies.

Technical competence was raised and the quality of labour force was improved, because of which FDI has been steadily growing in the country in tandem with domestic investments (Reardon, 2001). There is now a marked pattern whereby in manufacturing sectors almost half the FDI has been directed in industries that are labour-intensive. Capital intensive and technology intensive investments comprised of the major bulk of FDI in China. The OECD has held in this regard that:

“Because of its size, China’s open door policy launched twenty years ago constitutes a unique and vast laboratory for the study of major structural changes in China and the world economy. It also provides an opportunity to test the benefits and the shortcomings of the economic policies which have been followed by the Chinese authorities and identify the improvements that could be brought about to increase the economic positive fall-outs of Chinese economic reforms” (OECD, 2000, p.3).

A visible pattern is indicative of the fact that FDI companies are paying higher wages. In following the patterns of other countries, in China also, FDI firms pay higher compensation to workers in terms of salaries, wages, bonuses and other monetary and non-monetary incentives, which is not the case with domestic companies that have been characterised with intense exploitation of labour.

In the light of these findings it is correct to say that FDI companies had significantly reduced the exploitation of labour in China. The higher wages for workers in FDI firms is applicable in all sectors except coking and petroleum refining.

Other than the disparities in distribution of the working environment in different wage sectors, most FDI companies have recorded higher productivity of labour and also used increased capital intensity as compared to domestic firms. There are some instances where higher level of productivity has also reflected a higher capital and labour ratio (Wang, 2003).

Status of Foreign Companies in China
FDI companies are much larger than domestic firms and mostly pay higher wages than the smaller domestic companies. Sometimes foreign companies may adopt policies in buying themselves in labour markets that are not familiar and may adopt practices of attracting workers from competing firms.

There have been very few cases of labour exploitation in multinational companies in China. The major structural weaknesses that have characterised China are mostly located in technology and capital intensive goods such as textile products, engines, machinery and plastics.

China has had a major competitive advantage in some specific sectors and the comparative advantages accounted for the bulk of its exports mostly in labour intensive products. China continues to reply on labour intensive methods of production in view of its large labour force, which has often been exploited by domestic industries in the past (Segal, 2004).

Research has revealed that provinces in China that have higher GDP, high levels of FDI stock, a strong transport infrastructure, better telecommunications and high per capita income have attracted maximum influence of FDI. In areas where labour costs are high, as approximated by wage efficiency and low quality of labour, FDI inflows have been comparatively less.

According to Li (2007), the entry of China into the WTO has resulted in the significant cut in tariffs imposed on industrial goods which have further reduced from 21 per cent in 1998 to 9.45 per cent in 2006. In addition, quantitative restrictions on industrial imports have also been phased out.

Presently, foreign firms as well as domestic firms had to face the tough competition from imported goods. It is evident from the present scenario that capital intensive industries such as machinery, electronic goods and vehicles will be adversely impacted by increasing import competition. The actual impact of liberalising imports upon different firms will depend on the specific sectors’ specialisations (Broadman, 2003).

The major types of FDI in China relate to equity joint ventures, wholly owned foreign enterprises and contractual joint ventures. Initially, contractual joint ventures were the most popular form of FDI into China since the late 1970s. But from the 1980s wholly owned foreign enterprises and equity joint ventures have become more popular resulting in the proliferation of foreign owned companies.

A popular entry mood is by way of equity joint ventures, which have become quite popular because of liberal policies followed by the Chinese government. The government in China believes that the Chinese objective of foreign capital management experiences and technology is best served by equity joint ventures (Dunning, 1999).

Additionally, foreign investors can engage in joint ventures by getting assistance from local partners in domestic markets. Economists have observed that the majority of the foreign investors opt for wholly owned foreign enterprises in order to avoid regulation issues related to equity joint ventures.

Multinational companies that were previously forming joint ventures with domestic companies have begun to establish wholly owned enterprises in order to strengthen their control over companies, to improve efficiencies and coordination in the context of corporate resources.

Yunshi and Jing (2005) have revealed that from 1984 to 2003 there was significant increase in the number of wholly owned foreign enterprises and during this period foreign investors were choosing to fund entirely almost 50 per cent of the foreign registered companies.

According to Tseng and Rodlauer (2003), the Chinese economic progress over the years has been remarkable with the country experiencing increased manufacturing and export. This has been the result of rapid technological advancement brought in by FDI, and the increased use of labour intensive techniques of production.

However, due to increased competition and high costs of production, there have been cases of workers exploitation in a bid to counter these limitations. The authors give examples of these tendencies and offers solutions and efforts that are in place to reduce the same.

Impact on Workers after 1979 Liberalization
Most of the labour intensive manufacturing facilities in China are located in Jiangsu, Zhejiang and Guangdong provinces. Most of the industrial establishments are located within the special economic zones and are largely in private hands although foreign investment is gradually becoming common.

For instance, in Guangdong province, almost 62 per cent of the factories are funded through FDI. In the Chinese textile industry alone there are about 15 million people employed and the workforce comprises mainly of women, most of them being migrant workers.

According to Oxfam, 80 per cent of workers in the garment sector are women under the age of 25 years against whom significant discrimination has been recorded by different agencies. In most industries in China, workers are employed on short term contracts between one and three years because of which labour turnover is very high (Casson, 2001).

China’s move towards a socialist market economy has considerably changed the ownership of industries from being state owned to privately or foreign owned, which has created a large number of laid off workers from the formerly state owned industries that has strongly impacted Social Security arrangements and labour relations.

The previous systems of state ownerships and controls have given way to a system of laws and regulations that have frequently weakened the condition of the labour force. For instance, the labour law in China now requires employers to give benefit of medical insurance, maternity, industrial injuries and to provide for old age, but this is usually not practised. It is understood that almost 90 per cent of Chinese companies do not comply with laws pertaining to labour (Buckley, 1999).

Changes that were introduced in the Chinese migration laws during the 1980s have prevented workers from shifting from one place to another in search of work. This resulted in higher level of poverty and under development in rural areas and created a class of migrant workers in the country.

Migrant workers in China now require a work visa and a permit before they move to a new city in search of work. In cities, workers are not entitled for welfare benefits and cannot own property or bring their families with them.

Workers have to return to their villages after the work contract is over with their employer. Such workers are more specifically exploited in view of their poverty status and their excessive dependence upon work permits. Such problems are further aggravated because of excessive supply of low skilled labour in China (Fu, 2004).

The China Labour Bulletin estimates that, by 2020 there will be about 15 million new entrants into the Chinese labour market every year, while only 8 million new jobs will be created at the present rate of growth in the country. It is thus likely that further pressures on jobs and employment will be created for Chinese workers in the coming future.

In major industrial centres such as the Guangdong province, working conditions are extremely poor and workers have started to migrate to other areas in the hope of getting better job options.

Freedom of association in China is no longer present although article 3 of China’s trade union laws provide for all workers to have the right to organise and to join trade unions. The All China Federation of Trade Unions (ACFTU) is the only trade union in the country that is officially recognized by the government but it has a great deal of monopoly in representation (Hsu, 2003).

Impact of Industrialization on Workers
Foreign owned and overseas Chinese affiliations are much bigger as compared to internal ownerships and are characterised with higher levels of capital labour intensity and are thus more capital intensive as compared to domestic industries in China. The plight of Chinese labour is evident from the fact that since 1998 there were more than 3.4 million jobs that were lost in the manufacturing sector.

Since 1999, more than 40,000 large and medium manufacturing industries have been forced to close down, which led to the loss of almost 90 per cent of jobs. Studies have confirmed an ongoing pattern of job losses in China. The International Trade Commission Model has revealed that almost 973,000 industrial jobs and 1,235,000 jobs as a whole have been displaced by way of repression of labour rights in China.

The Economic Policy Institute has estimated that about 410,000 industrial jobs were lost between 2002 and 2005 in China. Studies concluded by the US-China Economic and Security Review Commission (USCC) revealed that about 100,000 jobs are created in China every year and such numbers have been accelerating after 2001. Recent studies conducted by the Federal Reserve Bank of New York revealed that about 3.8 million jobs were displaced by US trade in the manufacturing sector in 2003 (Zhou, 2005).

China is known to have over 109 million workers in the industrial sector and most of them are migrants from rural areas and thus have no rights. The payment that they receive is very meagre and ranges between15 and $.50 per hour. Most of them are required to work many months for 70 hours per week and are not eligible for minimum wages and overtime, while safety and health and environmental laws are not made applicable for them.

A common characteristic in China pertains to the fact that child labour and forced prison labour continues to have a strong impact on Chinese industries. There are about 10 to 20 million child workers in the country, which forms1/8th to 1/4th, of the country’s factory workers.

This problem has been particularly aggravated after the AFL-CIO first petition was rejected by President Bush. It is estimated that there are between 1.75 million to more than 6 million prison labourers in the country.

In this regard, the Ministry of Justice in China has reported that there are about 1.5 million prisoners spread across the 700 prisons in the country that comprised of the official criminal justice system. However, it is also known that there are between 250,000 and 5 million prisoners that have been detained in Administration Detention Centres and under schemes relating to re-education through labour camps (RTL) (Yan, 2005).

Li (2007) has found that in 2006, China had surpassed Germany in becoming the third largest economy in the world after United States of America and Japan (Miller, 2004). About one third of China’s GDP comprises of exports and in 2005 the country’s exports had grown by 28.5 per cent.

The country has reported yearly growth rate of approximately 10% every year during the last 25 years although economists argue that the actual growth in China from 2005 has been about 15 per cent. During the 1990s, manufacturing output in China increased by 422 percent and the country’s manufacturing exports increased by 384 percent.

Starting from the late 1990s, China’s yearly growth rate in manufacturing outputs and exports has accelerated significantly. During 1999 manufacturing outputs in China had grown by 11.58%, while exports increased by 7.3%. During the last few years, manufacturing in China has grown by 91.4%, while exports pertaining to new and high-technology products have grown by 31.8% every year (Li, 2007).

China is now a world leader in manufacturing products such as computer cables, desktop computers, motorbikes, bicycles, cameras, refrigerators and televisions. It is also a leader in the manufacture of other components such as cotton textiles, cigarette lighters, cell phones, DVD players, microwave ovens and several other manufactured products (Wu, 2006).

China continues to maintain its lead at a very fast pace, which is evident from the fact that during 2005, productivity in mobile communication equipment increased by 108.2 per cent, computers by 48.9%, photocopiers by 38.5 per cent semiconductors by 36.5 per cent motor vehicles by 33 per cent, electrical instruments by 27.8%, chemical fibres by 33.8% fax machines by 33.9%, steel products by 17.4%, aluminium by 44.3% and television sets by 23% (Wu, 2006).

It is widely felt by several analysts that the creation of excess production capacity by China will continue to increase dramatically, thereby increasing competition both in global and local markets. According to Kynge (2006), capital expenditure in China is estimated at about 38% of GDP, which is almost twice the rate of countries such as Mexico, Brazil and India.

In 2003, when the AFL-CIO had filed its first petition, the overall capital spending in China had increased by 25 per cent to $660 billion. The new capital spending in 2005 in the manufacturing sector had increased by 37.6 per cent, which clearly indicates the high rate of acceleration in the country’s growth.

In 2006, capital spending in China had grown by 27.5 per cent in the metal industry, by 81% in general equipments, by 80 per cent in furniture production, by 44.8 per cent in electrical machineries, by 38 per cent in the textile industry, by 34 per cent in chemical products and by 47.4 per cent in apparels.

Foreign Direct Investment in China witnessed an increase by $20 billion in 2005. China has now become a global destination for FDI inflows and is the favourite and leading destination for the same. Almost 70 per cent of FDI into China goes into the manufacturing sector with maximum focus being made on advanced technology sectors and export oriented industries.

Future contractual FDI projections to China are expected to be more than double the present figures as more and more American multinational companies make a beeline to make investments in engineering and research and development. It is thus evident that FDI in China will not only increase the scope of employment for local people but can also set in motion the implementation of regulations that will deter exploitation of Labour.

There is a direct connection, in China between the cost of supply shocks and extreme exploitation of labour. This is because suppression of labour cost will attract new capital that will seek competitive advantages and enhance the shares of capital in permitting higher levels of weak investments by existing companies.

This becomes more pertinent in view of the fact that labour repression by the Chinese government reduces manufacturing wages by seven per cent to 85 per cent and also reduces the price levels of Chinese export goods by 10.5 to 43.5 per cent (Huang, 2006).

Technological, Financial and Physical Infrastructure
Major factors that determine the inflow of FDI into any country are the presence of interior transport waterways, railways and highways. Another important factor is the quality of telecommunications services because better telecommunication saves time and reduces the cost of information and communication gathering, thereby facilitating business activities.

Research as supported by empirical studies has confirmed that FDI will primarily flow into provinces that have good infrastructure. An export promotion and development strategy has been adopted by China which has proved to be a massive success and together with its export promotion policies, the Chinese government has introduced open door policies and economic reforms in promoting trade through adopting several unilateral actions and bilateral trade arrangements (Lankes, 2004).

Considerable success has been achieved by China in reducing tariff barriers whereby imports were reduced from 42 per cent in 1992, to 24 per cent in 1996 and further on to 17.6 per cent in 1998. China has also initiated and implemented a large number of preferential arrangements for encouraging international trade.

Tax exemptions on the intermediate products were provided in the production of export goods that played a major role in enhancing the country’s foreign trade (Lancaster, 2002). Such developments are very favourable for improving the working environment and will lead to the gradual removal of worker exploitation.

Literature review
Advantages of FDI for Labour
The impact of foreign ownership is increased by spreading of the knowledge base to locally owned firms by way of training that is imparted to suppliers or by initiating labour mobility. Moreover, FDI allows and encourages the flow of ideas across national borders. The possible roles of multinational companies in spreading of knowledge and thus enabling fast economic growth are very well researched by Owen et al (2003).

In addition to the paucity of conventional resources such as capital, most developing nations have to face hardships in terms of the gap in ideas that is relative with the descriptions of the use of productive processes across different nations.

By making use of cross country statistics and other supportive evidence, theorists have claimed that a nation’s performance and growth is considerably related with the use of ideas embodied in foreign direct investments instead of the accumulated capital and the level of education prevailing in the country (Blackman, 2001).

Multinational companies are known to impact domestic wages significantly. FDI enables the provision of knowledge and technology and knowledge to the host nation whereby the relative productivity of labour increases, thus allowing an upward push on wages. If such increases in wages are considerably higher, there will be a marked pattern whereby equilibrium wages will result in response to enhancement in FDI.

Moreover, in view of the wage gaps that prevail in developing nations, a number of studies have used organizational statistics that reveal higher level of wages in companies that are foreign owned in vast difference from domestically owned companies.

Aitken et al (1996) found from their studies in the context of wages and FDI that high level of foreign investments is directly associated with high wages even though unviable economic circumstances and levels of development were present. They revealed that FDI significantly raises wage levels in countries where new production facilities are set up with foreign capital.

Grossman and Helpman (1991) researched and analyzed the labour market behaviours of FDI companies and their impact by using different parameters in the context of the manufacturing sector. They found that there was considerable difference of 25 percent amongst blue collar and white collar jobs while comparing FDI and domestic companies.

It should however be kept in mind that the differences in the prices of labour pertains only to wage differentials instead of the entire compensation. Therefore in reality the differences may be greater because foreign owned companies usually pay higher levels of other compensation than local companies.

Secondly, there is need to analyse the impact of the labour market by examining if the greater number of foreign owned companies impact wages in local companies. Foreign ownership in industries or in an industry located within a region, impacts wages in local companies as also in all plants taken as a whole despite the absence of wage differentials amongst foreign and local companies (UNCTAD, 2004).

If there are large numbers of foreign owned companies in a given industry, there will be a marked pattern whereby wage levels in domestically owned companies will be higher for workers with good educational qualifications. This conclusion is made on the basis of the size of the form and the impact of energy and related inputs in the organization (Cason, 2001).

Additionally, there is a great deal of concern in regard to FDI and wage disparities amongst skilled and unskilled workers. As per the traditional trade theory, FDI in countries that are characterised with low skills raises the related demand for low skilled workers. Consequently, there is a reduction in the inequality amongst skilled and low skilled workers. But a few empirical studies conducted in different countries have revealed contradictory results.

The data of wages and employment by occupation as provided by the International Labour Organisation during the period 1985 and 1998 provides strong evidence about FDI actually resulting in reduced wage inequality in some developing countries. In some countries, FDI has resulted in enhanced wage inequality as a result of controlled domestic influences such as supply of skills and wage setting.

According to Owen and Yu (2003), in addition to provincial factors, the kind of FDI that is present impacts relative wages amongst skilled and low skilled workers. Different kinds of FDI companies such as export and import oriented foreign companies enhance the wages of low skilled workers and reduce the wages of skilled workers while lowering the skill premium at the same time. According to Ruth Domoney (2007), who researched the working condition of workers in the Chinese textile industry:

“The move towards a socialist market economy has changed garment sector ownership from mainly state owned to privately owned companies, creating high numbers of laid off workers from former State Owned Enterprises (SOEs) and impacting significantly on labour relations and social security arrangements in China.

A previous system of direct state ownership and control has been replaced by a system of laws and regulations that are currently only weakly enforced. For example, official Labour Law requires employers to provide old age, industrial injury, maternity and medical insurance, but this is not always provided in practice. It is estimated that 9 out of 10 Chinese companies do not meet national labour law standards” (Domoney, 2007, p.3).

In his article on reform and openness Gallagher (2002) asserts that the Chinese government is to blame to some extent for the increased abuse of workers in China. The government of China is seen to have effectively managed to maintain a strong grip over the workers while denying them their labour rights through polite demands and red tape measures. This has consequently resulted in exploitation of the present workers in most regions, causing suffering and distress to the workers (Bui, 2002).

However, it can still be contended that FDI has resulted in positive results as is illustrated by Blalock (2008) who asserts that the social welfare of the host country has much improved. This is mostly as a result of the technological transfer that is gained by the local suppliers which in turn improves productivity and quality all the while increasing the GDP of the host country and its ability to compete in the global scene (UNCTAD, 2004).

The exploitation of labour in China is seen as gradually diminishing after the entry of foreign companies through FDI in different phases. It was during the 1990s that FDI inflows were the maximum in China in sharp variance to the medium rate of growth during the 1980s, which is often referred to as the phase when growth began to increase significantly.

Although foreign companies had begun to take interest in China after 1979, large scale FDI inflows were not experienced during the initial phase due to poor infrastructures in the country (OECD, 2000). A steady growth and comparatively larger inflows were seen during the period 1983 to 1991, as the Chinese government began to lay specific focus upon special economic zones that began to expand into several cities because of FDI incentives that were provided for in the year 1986.

This enhanced pattern reached its zenith when the inflows reached over US$110 billion by 1993. By now China had become the largest host country in the context of FDI inflows amongst developing nations and occupied the second rank in this regard in the world.

From 1994 onwards there was an adjustment period in China whereby FDI inflows slowed down although the contracted amount of capital inflow was climbing consistently, because of which the total inflows by 2001 had increased by 15%, which showed a visible rend in deviating from global patterns (Chen et al, 2003).

From 2001 onwards, labour conditions showed significant signs of improvement after China became the single nation that witnessed a continuous increase in the amount of FDI inflows.

FDI growth in China does not appear to be a part of the normal strategy of global expansion as adopted by multinational companies across the globe because China had experienced considerable growth in FDI amongst developing nations as also amongst developed nations such as the USA that had begun to witness by this time a decline in the entry of foreign capital within its economy.

This is clearly suggestive of the fact that locations played a crucial role in the FDI growth pattern in China. In fact China enjoyed exclusive advantages in comparison with other nations that were canvassing to attract FDI inflows (UNCTAD, 2003).

Status of Foreign Companies in China
By creating corporate networks, foreign companies in China are able to reduce overall cost related to operations and can thus optimize their local presence by providing extra benefits to the local workforce that were mostly exploited before foreign companies began to enter China.

Given that many multinational companies have also built research and development departments in China, there are now indications that most of such companies are to stay in China for long and will thus cater to the interests of the workforce by giving them better working environment and incentives.

Most of such companies have established their research and development centres in major industrial areas such as Guangzhou, Shanghai and Beijing, thus allowing the labour force from urban centres to seek employment with them (Yunshi and Jing, 2005).

It is known that export oriented FDI is encouraged by the availability of cheap labour and market oriented FDI is encouraged by the access to foreign markets. According to Zhang (2000), export oriented FDI is considered better by most countries that have mortgages as compared to source countries.

Hence export oriented FDI was preferred by China because it was able to offer favourable incentives and the environment that allowed foreign companies to engage cheap Chinese labour for their production activities. There are many sectors in China that have attracted FDI on the basis of local markets because the huge market size allows large number of opportunities to be realized effectively in terms of economies of scale. It is in this context that researchers have held that:

“The FDI patterns in China show a great disparity among regions: For the period from 1983 to 1998, FDI in the eastern region took up 87.8 per cent while the central region attracted 8.9 per cent and the western region recorded only 3.3 per cent. This inequality stems from the FDI policies taken by the Chinese authority.

The open door has started with the creation of special economic zones (SEZs) and preferential regimes for fourteen coastal cities. This has resulted in an overwhelming concentration of FDI in the east. With the adoption of more broadly-based economic reforms and open door policies for FDI in the 1990s, FDI inflows into China have started to spread to other provinces” (OECD, 2000, p.8).

The easy availability of cheap labour is a specific advantage enjoyed by China in attracting FDI. Wei and Liu (2001), have held that the main determinants of inflow of foreign funds into China are decided by FDI theories, which they classified into three types; Micro, macro and strategic determinant.

These theories are considerably related to the movement and availability of the workforce. Micro factors relate to the ownership of firms in relation to specific advantages pertaining to size of the firm and product differentiation that are significantly impacted by the availability of labour.

Macro factors are related in the context of FDI focusing upon the growth of the host country and the size of the market that can be measured in terms of the gross domestic product, GNP, per capita GDP; as fast economic development creates larger domestic businesses and markets.

There are other macro issues such as exchange rates, political risks and taxes. Strategic determinants in the context of FDI are related to long term factors such as diversifying activities of firms, defending existing foreign markets, gaining or maintaining a stronghold in the host country and complementing other types of investments (Dunning, 2001).

Cost and Productivity of Labour
One of the most important factors that attracted FDI into China was the advantages that occurred in a complicated productive environment because of factors such as the labour force, natural resources and land. The extent of economic development in the host country is mostly considered a very strong determinant of FDI inflow because it is directly related to its local infrastructures, education levels and domestic entrepreneurship (Henley et al, 2003).

China has the world’s largest population and has a massive labour force with relatively low wage levels. In the last few decades China has given a lot of attention in educating its people through schemes such as the nine-year universal compulsory education. Thus, Chinese workers turn out to be comparatively of better quality and there are relatively higher numbers of technical personal now. However, in some areas there is short supply of technicians, engineers and managers (Hymer, 1996).

Analysts often argue that the cost of labour should be used in ascertaining FDI flows in terms of efficiency of wage rates that are adjusted in keeping with productivity instead of absolute wages, especially when FDI is export oriented (Porter, 1996). When considering efficiency wage rates it is evident that China enjoys good advantage, which has been confirmed by empirical research efforts.

China is known to have excellent energy reserves and its production of oil, which is the major source of energy, is amongst the highest in the world despite the fact that a major part of its consumption of oil is imported (Hood, 2001).

The advantages accruing from a cheap labour force appear to have become less attractive for foreign investors because of the liberalisation of international trade, globalisation of the world economy and the massive strides in technological innovations. It is quite apparent that because of the disadvantages by way of lack of qualified labour and technological gaps, some fields could lower the speed at which the country’s growing (Hill, 1998).

It has been observed that there has been a marked change in employment patterns in China because of the increasing number of foreign companies that have begun to establish production facilities in the country. The following data reveals the employment position in the country during 2008:

Annual Average Number of Employed Persons and Fully Employed Persons in Chinese Cities, 2008

Employed Persons Fully Employed Staff and Workers
City
Total State- Urban Other Total State- Urban Other
owned Collective- Types of owned Collective- Types of
Units owned Units Ownership Units owned Units Ownership
Guangzhou 225.96 82.16 11.13 132.67 218.12 78.29 10.72 129.11
Shenzhen 201.68 41.20 1.37 159.12 199.62 40.70 1.36 157.56
Zhuhai 57.90 9.15 4.05 44.70 57.08 8.79 4.01 44.28
Shantou 31.47 16.84 6.13 8.50 30.77 16.44 6.07 8.26
Foshan 54.45 18.91 3.00 32.54 53.59 18.56 2.98 32.05
Shaoguan 28.93 14.36 1.92 12.65 28.31 14.20 1.87 12.24
Heyuan 23.56 10.50 1.65 11.41 23.13 10.40 1.62 11.11
Meizhou 22.74 16.12 1.49 5.12 22.23 15.93 1.45 4.85
Huizhou 76.87 16.13 2.67 58.06 75.82 15.91 2.63 57.29
Shanwei 14.05 9.12 1.56 3.37 13.24 8.70 1.33 3.21
Dongguan 20.98 11.52 3.98 5.48 20.50 11.08 3.96 5.46
Zhongshan 25.18 7.49 1.48 16.21 24.66 7.25 1.47 15.94
Jiangmen 40.71 13.18 3.14 24.40 40.06 12.90 3.11 24.04
Yangjiang 17.08 10.26 3.79 3.04 16.67 10.00 3.64 3.02
Zhanjiang 38.83 27.08 3.10 8.65 37.97 26.60 3.02 8.34
Maoming 30.24 20.55 3.88 5.81 29.49 19.96 3.87 5.67
Zhaoqing 26.99 13.76 1.25 11.99 26.41 13.36 1.19 11.87
Qingyuan 25.77 11.79 0.92 13.05 25.49 11.62 0.92 12.96
Chaozhou 13.03 8.33 1.45 3.25 12.59 8.04 1.42 3.13
Jieyang 20.51 14.32 2.64 3.55 20.43 14.27 2.62 3.54
Yunfu 17.13 8.31 0.50 8.32 17.03 8.26 0.49 8.28
The data reveals that in given major cities, the employment pattern has significantly shifted from state owned enterprises to other types of ownerships, which are mainly foreign companies that have established through FDI. Although state owned enterprises continue to employ a significant percentage of the workforce but it appears very soon the number of workers employed with such other types of ownership will increase consistently.

Regulatory Framework
Another favourable impact for the workforce has been the fact that China has constantly been making efforts in introducing a transparent business environment and legal framework. It has streamlined its legal systems, especially in the context of FDI and a series of laws and regulations and provisions have been amended by introducing regulations such as Contract Law, and Joint-venture Law.

China has also relaxed some of the procedures that were restraining FDI and further liberalised policies in areas of restricted investments while placing greater focus on attracting FDI into areas that had encouraging potential. Starting from the mid-1990s, a series of programmes have been launched in the country in order to reduce and restructure state ownership in several sectors.

The government has declared that foreign participation is welcome in such a restructuring process that will introduce enhanced internal efficiencies, advanced managerial skills and global competitiveness. In understanding the need to transform the small-scale sector and while keeping in mind the weakness of the domestic capital market and the shortcomings in managerial capacities, the Chinese government has allowed FDI in the small-scale sector, which presently appears to be on right track.

However, it has to be seen how specific participation of foreign investors will be permitted. A major problem that continues to haunt the government is the poor conditions that the labour force has to go through in view of increasing unemployment and the lack of a social security net (Kamath, 2000).

Impact of FDI on China’s Economy
In view of its unique circumstances, research and the economic literature has attributed considerable economic effects on FDI. During the last two decades, the country has attracted large amounts of FDI and multinational companies have become wider elements in China’s economy.

The effect of FDI on firms and the manner in which FDI is impacting the Chinese internal economy has become a subject matter of analysis and discussion amongst analysts and policymakers as well as academic experts in China as well as in other developed countries. Several research efforts have concluded that FDI provides a very bright future for the Chinese economy, especially in view of the huge consumer market that can be tapped by multinational companies.

Additionally, the large numbers of FDI inflows provide a strong basis for such companies to employ local people and to introduce their organisational development policies in order to improve the quality of labour and to enhance the facilities available to them. Positive results in this regard had already begun to appear as more and more Chinese people are employed by these companies, resulting in better working conditions, higher wage levels and a virtual absence of labour exploitation (Krugman, 2001).

Impact of FDI on China’s International Trade
According to Swain (2003), although China has a greater structure of a developing country, its inter-sectoral trade specialisation appears to be more deeply entrenched than in any other developing nation in Asia.

This is primarily because of China’s huge natural resources and low cost labour that allow it to continue with expanding export of labour intensive products. It is true that China has considerably diversified its exports pertaining to labour intensive goods and established a competitive position in the fast expanding market, thus allowing it to have a sustained and rapid growth in exports (Sun, 2002).

FDI and Job Creation
It is also true that FDI in China has created a lot of jobs and virtually transformed the job market in the country. The most prominent impact of FDI on the Chinese economy has been to directly or indirectly create employment opportunities in the labour intensive environment, which is a major characteristic of most developing countries.

Employment in both FDI firms and urban employment have shown a marked increase. Foreign companies that have entered China through FDI employed over 5 million people in 1991 which was about 0.74 per cent of China’s total employment and 0.98% of urban employment in the same year.

Statistics have confirmed that by the year 1998 the number of people employed by FDI firms had increased by four times to 18.3 million and to 88 million workers respectively. This also implies that most of the job opportunities created by FDI were located in rural areas. This is also a strong indication that the introduction of FDI into the Chinese economy is gradually improving the condition of the workforce, not only in the urban areas but also in townships and village enterprises (Lai, 2006).

Most of the urban employment in FDI firms in China is concentrated in the eastern region that accounts for about 86 per cent of the labour force, more specifically in provinces such as Zhejiang, Liaoning, Shandong, Jiangsu, Fujian and Guangdong as also in the municipal areas of Tianjin, Beijing and Shanghai. The impact on employment of FDI in the urban areas of western and central regions has been significantly low.

Consequently, the FDI contribution in urban employment in the country has been quite low. Although FDI companies accounted for about 6.8 per cent of urban employment in the eastern region of China, they were responsible for only 1.15% and 0.64 per cent of urban employment in western and central regions respectively.

This clearly suggests that FDI has to some extent been responsible for increasing the gap in incomes between the east and the best regions of China. However this does not mean that FDI has not resulted in improvement of the working conditions of the labour force (Teece, 2003).

FDI companies in China have significantly increased the number of workers employed in the manufacturing sector. Presently FDI companies employ 9.3% of the total labour force in the manufacturing sector in China. The positive contribution of FDI has been the maximum in labour intensive industries such as fur and leather products, sports goods and fibre products (Wei et al. 2001).

FDI has significantly contributed in many technology intensive industries such as electrical equipment and machinery, instruments and meters and telecommunication equipments. The share of such industries in terms of quality of workforce has significantly improved because of the entry of FDI firms.

China needed huge amounts of capital to build up its economy and FDI has made considerable contribution in this regard. During 1993-1999, the share of FDI in China in terms of fixed domestic assets investments was about 10 per cent. Although in other countries FDI is known to have exceeded domestic capital but this pattern is not prevailing in China.

The main driving force behind the spectacular growth of FDI in China has been the bright expectation of investors about the Chinese economy, which is in keeping with the fast growth rates that commenced from the early 1990s. Such expectations were further brightened when the Chinese government adopted friendly market policies (Zhang, 2002).

FDI and Industrial performance in China
Most of the research conducted in the area of FDI has focused upon the changes that have occurred because of foreign funded companies in the competitive structure of the Chinese industrial setup. It is observed by researchers that domestic Chinese companies still occupy dominating positions in the Chinese markets, which will lead to improving labour conditions because domestic companies will have to adopt new regulation in the context of the workforce.

Such companies account for almost 85 per cent of the demand pertaining to industrial products in the country. The market share of goods produced by domestic firms was less than 70% only in sectors such as electronic equipment and instruments. It was below 80% in sectors such as machinery and transport equipment.

The entry of China into the WTO has resulted in the significant cut in tariffs imposed on industrial goods which have further reduced from 21 per cent in 1998 to 9.45 per cent in 2006. In addition, quantitative restrictions on industrial imports have also been phased out.

Presently, foreign firms as well as domestic firms had to face the tough competition from imported goods. It is evident from the present scenario that capital intensive industries such as machinery, electronic goods and vehicles will be adversely impacted by increasing import competition. The actual impact of liberalising imports upon different firms will depend on the specific sectors’ specialisations.

Methodology
The Research Method
The methodology is related to the working conditions faced by workers in Chinese industrial establishments. The National Labour Committee released a report in which harsh and illegal working conditions have been highlighted in the Jabil Circuit factory in Guangzhou.

The factory employs over 6000 workers that are mostly illegal migrant labourers that produce hi-tech products for companies such as Xerox, Siemens, Philips, Nokia, Lucent, IBM, HP and Cannon. Through evidence that comprises of photos, interviews and documents, the report highlights the inhuman conditions in which workers are made to work.

Workers have to work in twelve hour shifts throughout the week and assembly line workers are not permitted to sit during the entire shift because of which workers have frequently complained of swollen feet and stiff arms, shoulders and neck. They can use bathrooms only once during the regular eight hours shift.

Illegal workers are hired en-masse and pitted against regular workers. Security guards act as if they are policemen on the look out for indiscipline. About six workers are made to share one dorm and have to sleep on double level bunker beds. Majority of the workers revealed that the food is awful. They are given only nominal wages of 93 cents per hour, which is much below the subsistence level (Computer Weekly, 2010).

In this context it is pertinent to examine relevant data concerning the causes of disputes concerning labour that have arisen in China. The exploitation of labor in China is evident from the large number of labour disputes in the country, which are detailed in the following table:

Table I

Year Number of labor
Disputes
2003 12204
2004 10838
2005 14256
2006 15464
2007 19729
2008 24540
Source: Statistical yearbook of the republic of China, 2008.

It is evident that since 2003 the number of disputes concerning have been on the constant rise, which is indicative of the deplorable labour environment in the country. For instance amongst the 24540 labour disputes in 2008, 9186 pertained to disputes over wages and 8343 related to dismissals by employers. The total disputes concerning other labor rights related issues were 2486.

There is an increasing incidence of disability cases in the Chinese working environment which is evident from the following table:

Table II

Year Number of
Establishments Total Employees Number of Disability Cases Mean Frequency of Disability
2003 7424 1248227 5365 1.91
2004 8099 1396492 6047 1.96
2005 9058 1922821 10196 2.51
2006 12457 2559502 11466 2.14
2007 13107 2646609 12246 2.21
2008 13637 2723323 11920 2.09
Source: Statistical yearbook of the republic of China, 2008.

It can be seen that there is a vast increase in the number of organizations that have established production facilities since 2003 and the number of employees have significantly increased. The extent of injuries sustained by workers while at work has drastically increased from 5365 in 2003 to 11920 in 2008, which is also indicative from the mean frequency of disability cases that has increased from 1.91 to 2.09 during the same period. Such figures are clearly indicative of the unfavourable working environment in China.

The following data is depictive of the employment characteristics of the Chinese workforce:

Table III Indications of Employed People in China

Item 2005 2006 2007 2008
Number of employed people
(10,000 people) 904.27 954.44 1001.46 1007.87
Employed in State owned units 380.19 384.78 381.00 385.14
Employed in other units 455.38 502.41 554.97 562.09
Average earnings of urban employed
(Yuan) 24,122 26400 29658 33282
Source: Statistical yearbook of the republic of China, 2008.

The data clearly reveals that the number of urban employed in units that are not state owned has been increasing consistently since 2005. It is noteworthy that the wage levels have also been consistently increasing which is indicative of the improved emoluments that urban workers are getting after the entry of foreign companies.

In the light of the given working environment, the research team made efforts to conduct a sample survey and ascertain the conditions they are made to work in and what they feel about their circumstances. The most effective tool to use in the context of measuring responses relating to the impact of FDI is to make analysis of the correlations that exist in different aspects that are presented in this research (McGuire, 2008, pp.30).

As such, the study shall use the descriptive correlation research method. This is because it seeks to identify the relationship between two variables which in this case are the FDI and labor policies in China. The data collected will consist of testimonials from some selected workers and reports from various sources related to the labour policies governing foreign and local investments in the country.

The data collected shall then be compared to data generated by other related studies to evaluate the efficacy of FDI in China in relation to their contribution in reducing exploitation of Chinese workers. To answer the questions designed for this study, the key concerns shall be established to provide guidelines for the interviews and the criteria to be used in data collection.

Data Gathering Procedure
As earlier mentioned, an evaluation methodology shall be used to design the procedures through which the purpose of this study can be realized. The participants for the interviews shall preferably be selected from industries located in the Guangdong region. Questionnaires shall be distributed among the workers and employers from various regions in order to gauge whether the situations are similar in all FDI companies.

The proposed methods shall suffice in addressing all the questions posed in this study because they provide credible data from the one on one interviews and the answers posted on the questionnaires. In addition to this, the results obtained after compiling the data, shall provide accurate information regarding the topic and the correlation shall be used to identify the causes of problems that are in the Chinese industrial sector.

The methodology primarily pertains to a survey that was carried out amongst workers and employers in the Guangdong province. This province was chosen because it provides an ideal environment with all sections of employees being represented in different industrial organisations.

A questionnaire for workers was prepared that comprised of 15 questions and for employers the questionnaire included 10 questions. Fifteen respondents were chosen from the workforce while 10 respondents were chosen amongst employers. The following questions were placed before the workers:

What is your name
Which provinces are from
What is your age
Which company are you employed with
Is your employer a domestic company or a foreign company
How long have you been working in this company
Do you feel that your wages are at par with the qualification that you have
What are the benefits that you get from your employer in addition to the wages
How many hours you work in a day
Does your employer provide medical benefits and sick leave
Does your employer offer training facilities
Do you feel that the working environment is in keeping with health regulations
What are the kind of facilities that you get at work
How many hours are you made to work in a day
Does your employer provide adequate job security
The following questions were a part of the questionnaire that was given to the employers that were chosen as respondents for this survey.

What is your name
What is your role in the organisation
Is your organisation domestically owned or foreign owned
How many workers do you have
Do you provide wages as per regulations of the government
What are the extra benefits you provide workers other than wages
Do you provide health care and sick leave to your employees
How many hours are workers required to work in a day
Is your organisation technologically advanced and do you employ people with low skills.
Do you allow trade unions to exist in your organisation
Results
Responses from workers clearly indicated that there has been considerable change in conditions of workers after foreign owned companies began to establish production centres in different provinces in China. Workers in most of the foreign owned companies did not mention the existence of any kind of exploitation in the context of not being given the minimum wages.

Workers appear to be satisfied about the quality of working environment, the number of working hours, benefits such as healthcare, bonuses and sick leave. Most foreign owned companies provide a healthy working environment and allow workers to develop their skills and capabilities through a number of training and skills development programmes that are organised by most of such organisations.

Foreign firms were found to be complying with all the regulations in the context of welfare of workers who were given their due recognition and were allowed to have the status as provided by law. Some workers that were working with domestic companies responded in saying that although there is an overall improvement in the working conditions of workers, domestic companies continued to be slow in implementing the new rules and regulations that have been made applicable after the entry of foreign companies in China.

Such companies are still conservative and continue with their traditional approach of looking down upon workers instead of giving them recognition in adding to the performance of the organisation. A number of domestic companies in China that had not yet adapted to the changed liberal environment were found to be exploiting workers in a number of ways, such as low wages, lack of health care facilities and the absence of healthcare, sick leave and training.

Responses from the employers were different for foreign companies and domestic companies. Foreign companies that had entered China through FDI were represented by the top administrators such as general managers and directors that had chosen to respond to the questionnaire provided by the research team.

Respondents from foreign companies were quite positive in asserting that their basic objective was to enhance productivity and profitability of the company by making the best use of the available resources. The very purpose for them to enter China and to set up production facilities was to exploit the favourable circumstances in the country in terms of the huge natural resources and the vast availability of cheap labour.

They had no intention to exploit the local labour and have well defined goals in providing maximum facilities to skilled and unskilled labour in meeting their corporate objectives.

They asserted that their corporate policies required them to treat workers with dignity in keeping with the regulations they were bound with in their home countries. They said they were fully committed to abide by the Chinese regulations in the context of labour and were willing to take extra steps to enhance their skills and to provide them motivation to increase their productivity.

Representatives of domestic companies expressed some resentment about being able to entirely follow the provided regulations in the context of treating the workforce as per provided norms.

They felt that under the given circumstances they did not have the required resources to fully comply with providing benefits to the entire workforce in view of the paucity of growth opportunities for them. Over and above the hurdles that they face, domestic companies were found to be open in having attitudes to reduce the plight of workers employed with them.

Discussion
The analysis of FDI in China has revealed that labour skills have been upgraded, which is evident from the fact that the percentage share of skilled labour has increased as compared with the total number of employed workers by FDI firms. On the basis of this criterion the research has found that the structure of employment in FDI companies in the country is almost the same as observed in other developing nations.

Workers that were employed in direct manufacturing in the year 1998 accounted for 76.7 per cent of the total labour employed by FDI companies while professionals and technicians, accounted for about 8.25 per cent. The percentage of workers employed in direct production was found to be greater in FDI companies as compared to domestic companies.

Managerial staff, administrative staff and clerical staff accounted for more 10.8, 7.5 and 6.24 per cent respectively of the total labour force in FDI companies. It is evident from the data that managerial staff and professional employees form a significant increase in the context of employment by FDI firms.

Such figures also indicate that FDI companies adopt more liberal policies and utilise greater number of technically efficient workers in productive activities because they have a tendency to utilise a greater part of the labour force in production activities instead of in non-productive administrative functions, which is the criteria served in most domestic firms in China.

Researchers also concluded that FDI firms are more particular about having better quality of labour in their production activities as compared to domestic companies in China. FDI companies have contributed a great deal in employing workers at the university and higher degrees.

It is now recognized that China’s ability to absorb foreign investment forms an important reason for the country’s fundamental principles of opening up its economy to the outside world. The Chinese government has affirmed that historical transformation was key to the economic development of China in keeping with its long-term objectives of becoming a global power.

It was at this time that the government took the decision in reforming itself and opening up its economy to the outside world. The law of the country in regard to Chinese foreign equity joint ventures was introduced by the National People’s Congress and subsequently steps were initiated to neutralise foreign capital as an important source for meeting this long-term objective.

It was after 20 years of exhaustive efforts that the extent of absorption of foreign capital began to expand and the government took additional initiatives in perfecting the procedures for foreign investments. Such initiatives have attracted businesses from across the world and paved the way for a fast and healthy development of the Chinese economy.

The most common factors that attract FDI in China are labour costs, market size and growth, cost of capital, government policies, cultural differences and geographical distance. Theory has classified FDI into two different kinds; market-oriented and export oriented. In the case of market-oriented FDI, the most significant factors that encourage FDI is the size and economic development happening in the host country.

In terms of export oriented FDI, the major focus is on cost competitiveness (Calvet, 2001). There are several other factors that apply to both kinds of FDI that are said to be characterising the Chinese economy. In terms of the size and growth of the Chinese economy and the related prospects, market-oriented FDI primarily aimed at setting up production facilities for supplying goods and services in local markets.

This kind of FDI is mostly adopted for exploiting new markets in addition to the conventional reasons of avoiding size of market, tariff barriers and the prospect of market growth including the extent of development of the host country.

The normal implications pertain to the fact that countries that have bigger market size, faster rate of economic growth and higher levels of economic development will enable better and increasing opportunities for such industries to take maximum advantage of their ownership in further attracting additional market-oriented FDI.

In the case of export oriented FDI also, the host country’s market size plays a very important role in view of the fact that a bigger economy can allow higher levels of economies of scale and others spill over impacts (Coughlin, 2000).

China’s population is more than 1.2 billion and provides massive potential for consumption. Investors who plan to bring in FDI consider the Chinese market has been the last big opportunity in terms of a huge market that has not yet been developed up in the world. The level at which the Chinese economy has been expanding over the past few decades has allowed the purchasing power of people to strengthen the fast growing markets in becoming excellent business opportunities.

Although the per capita GDP in China is not yet high, the rapid rate of economic growth and constantly increasing purchasing power has allowed China to become a very attractive market that has become the target of multinational companies and pup in more and more FDI in areas such as pharmaceuticals, electronics, automobiles, household electronic goods, drinks and basic chemicals.

Although the economic growth in China had slowed down after 1996 because of adjustments made in the overall growth phase during the beginning of the 1990s, the rate of economic growth has now more or less become stable between seven and 8%, which too, is an excellent opportunity for global companies to invest and reap the profit potential of a huge consumer base that waits to be tapped (Kuhn, 2004).

A large empirical and theoretical literature exists in the context of impact of FDI.

Although the question relating to benefits of FDI in developing nations remains uncertain; the role of FDI has been largely accepted as contributing to economic growth in developing nations. A large number of empirical research efforts in different countries have revealed that FDI has a strong and positive impact upon the host country from the perspective of labour markets.

Firstly, on the job training is considered the most important perspective in this regard. Lucas (1993) has shown that on the job training is directly linked with fast economic growth when workers move quickly into additional productive job roles. This is referred to by theorists as the quality ladder model as argued by Grossman and Helpman (2001).

Their arguments are supported by different levels of evidence that look at the relationship amongst the formations of human capital, growth in productivity and on the job training resulting from the entry of foreign companies.

They presume that the entry of foreign multinational companies enables opportunities in the context of knowledge and technology as also of transfer of knowledge. In this manner the quality of domestic human capital is enhanced because of efforts pertaining to learning by doing in the context of the domestic workforce (Wei, 2002).

A marked pattern is observed whereby FDI companies have been found to be paying higher wages. In following the patterns of other countries, in China also, FDI firms pay higher compensation to workers in terms of salaries, wages, bonuses and other monetary and non-monetary incentives, which is not the case with domestic companies that have been characterised with intense exploitation of labour. In the light of these findings it is correct to say that FDI companies had significantly reduced the exploitation of labour in China.

The higher wages for workers in FDI firms is applicable in all sectors except coking and petroleum refining. Other than the disparities in distribution of the working environment in different wage sectors, most FDI companies have recorded higher productivity of labour and also used increased capital intensity as compared to domestic firms.

There are some instances where higher level of productivity has also reflected a higher capital and labour ratio. FDI companies are much larger than domestic firms and mostly pay higher wages than the smaller domestic companies. Sometimes foreign companies may adopt policies in buying themselves in labour markets that are not familiar and may adopt practices of attracting workers from competing firms. There have been very few cases of labour exploitation in multinational companies in China.

China’s transformation into a socialist market economy has considerably changed the ownership of industries from being state owned to privately or foreign owned, which has created a large number of laid off workers from the formerly state owned industries that has strongly impacted Social Security arrangements and labour relations.

The previous systems of state ownerships and controls have given way to a system of laws and regulations that have frequently weakened the condition of the labour force. For instance, the labour law in China now requires employers to give benefit of medical insurance, maternity, industrial injuries and to provide for old age, but this is usually not practised. It is understood that almost 90 per cent of Chinese companies do not comply with laws pertaining to labour.

Other than creating direct trade benefits for workers in China, FDI companies have raised factor productivity and enhanced transfer of technology. It is quite logical to assume that when the firm invests in a foreign country it does so because it is delivered with some kind of ownership benefits such as patents and blueprints or trademarks.

Other benefits would also include intangible assets and the availability of capabilities, in the context of information and technology, marketing and entrepreneurial skills, managerial, organisation systems and accessibility to find the goods or intermediary markets. Such benefits are strong motivators that allow such firms to meet no hurdles and disadvantages associated with doing business in a foreign country.

In the case of China, there is clear evidence that managerial skills and technology have been transferred by multinational companies that entered the country through FDI option. Such conclusions have been made after evidence was found in the context of capital and physical intensities introduced by FDI firms in China.

The major issues concerning FDI in China relate to the manufacturing sector, which comprised of about 60 per cent of the total FDI till the year 1998. Other sectors that had been tapped by FDI are real estate that had a share of about 25 per cent, while sectors such as retailing, wholesale and transport accounted for about 6%.

The construction sector accounts for about 3.1 per cent of the FDI that has entered the country. Primary industries comprising of fishing, forestry and agriculture account for about 1.8 per cent of FDI in China.

It is anticipated that in the future, telecommunications, service trade and wholesale commerce will comprise major part the FDI inflows into China in view of the large shares that will be commanded because of liberalisation and China’s accession to the WTO. Investment liberalisation is also expected to take place in conventional industries because expansion of FDI in the agricultural sector will be dependent upon the extent to which it will be open to the market circulation of agricultural products (Kynge, 2006).

The size of any company is measured by the total assets that it holds. The size of an FDI company in China is mostly found to be at least hundred per cent larger than domestic companies. FDI firms have been found to be labour intensive in excess of 170 per cent, 125 per cent bigger in terms of technology intensive industries and 40 per cent larger in terms of capital intensive industries as compared to domestic companies in China.

Such figures lead to the conclusion that FDI companies in China are more technically efficient in their production activities and get greater benefits by way of economies of scale. In terms of the ownership advantages such companies mostly make use of greater capital and labour ratios than domestic companies in China.

On an average basis, FDI firms have a capital to labour ratio that is 140% greater than domestic companies. The disparity in physical capital intensities is quite large and technology intensive companies are followed by capital intensive and then by labour intensive industries.

Such conditions imply that FDI companies have better ownership benefits and thus employed higher technology and better production techniques as compared to domestic firms in China. This also implies that workers employed with such companies are given better benefits and wages as compared to domestic firms.

It is interesting to note that ratios of skilled labour in China such as managerial personnel, professionals and technicians as compared to the total labour in FDI companies was only about one per cent higher as compared with domestic companies in the year 1998. Such issues are almost the same in labour intensive industries although in capital and technology intensive industries FDI companies demonstrated higher ratios in human capital intensities as compared to domestic firms.

This is suggestive of the fact that FDI firms make use of better technology and skills in their production processes. The moderate performance of labour intensive industries is because foreign investors in such sectors mainly operate in the final stages of production while maintaining their research and development activities in the home country.

There is no doubt that FDI has significantly modified China’s industrial structure. The industrial sector is the one that has received the maximum FDI in China, which also implies that this is the sector that has used maximum number of workers on employment terms that are almost at par with developed countries because multinational companies are regulated by their home countries in treating labour in the same manner as they would in their home country.

The services sector in China is characterised with a large number of barriers to entry, which explains the relatively low level of FDI in the sector. Nevertheless there is significant potential of FDI in this sector and it is anticipated that with China’s accession to WTO, the service sector will also be opened up in giving a strong boost to FDI in the country.

As per statistics provided by the Third National Industrial Census of China, the textile industry and the electronics and telecommunications sector have accounted for the maximum FDI in the country, which is to the extent of 8.6 and 11.3 per cent respectively of the total foreign funded assets.

Large amounts of foreign investments have also been made in the transport equipment sector, metallic and non metallic mineral products, electrical equipment and machinery, chemical industry and the fibre products industry. A steady growth and comparatively larger inflows were seen during the period 1983 to 1991, as the Chinese government began to lay specific focus upon special economic zones that began to expand into several cities because of FDI incentives that were provided for in the year 1986.

This enhanced pattern reached its zenith when the inflows reached over US$110 billion by 1993. By now China had become the largest host country in the context of FDI inflows amongst developing nations and occupied the second rank in this regard in the world.

From 1994 onwards there was an adjustment period in China whereby FDI inflows slowed down although the contracted amount of capital inflow was climbing consistently, because of which the total inflows by 2001 had increased by 15%, which showed a visible rend in deviating from global patterns.

Given that China has ratified the United Nations covenants on economic, social and cultural rights; although with reservations about extending right to organise trade unions, it is imperative for policymakers in the country to ensure that labour rights are protected and workers are not exploited.

China has not consented to the freedom of association and the right to collectively bargain as required by the International Labour Organisation.

However, sooner or later it will have to do so because the Declaration on Fundamental Principles and Rights at Work as provided by the International Labour Organisation requires all members to abide by its principles irrespective of whether they have ratified the convention, but China has ignored the same so far. The Labour Dispute Mechanism in China allows for disputes to be settled within the regulatory framework through mediation and arbitration.

Conclusion
The Chinese government understands that the competitiveness of its industry is greatly dependent upon its efficiency and its ability to provide solutions at short notice. In this context, the major knock out effects pertain to long working hours and workers being required to work overtime at short notice.

Research by Oxfam has reported that women have to often work more than 150 hours overtime every month although 60 per cent among them did not have any contract in writing and 90% did not have access to social insurance. For instance, the standard working hours in most domestic companies range between 10 and 12 hours and sometimes the working hours are known to cross 15 to 16 hours per day.

Many domestic firms do not make payment in time and workers are made to suffer in terms of adverse health and safety conditions that include exposure to toxic chemicals, high risk of industrial accidents and fire hazards. Many workers are not covered for maternity pay and wages can be held up for several months. Such issues usually give rise to disputes that are often not resolved for long periods. It is quite common in many domestic industries for wages being below the minimum levels.

Large numbers of migrant workers are unable to have a completed status in terms of their work permit because of which they become vulnerable to exploitation. Because such workers do not have complete residency permits in cities that they approach for employment, they are often denied the basic amenities that are due to them under the law.

Limited access to properties and limited income for these workers implies that most of them have to live in employer provided dorms where living conditions are bad. Because of high cost of job permits many employers pay for them in advance, implying that workers come under debt the moment they start with their employment contracts.

Many employers require that workers pay deposits and hand over their identity documents while commencing employment with them, which literally bonds them in further creating conditions for their exploitation. The creation of such economic bondage for many workers allows employers to exploit them in terms of excessive overtime and flexibility of working hours. Most of such workers do not have an understanding of the rights available to them and thus continue to work under such conditions.

It is also known that workers that organise and become prone to strikes and protests in China do so at immense personal risk and often face repression, violence and imprisonment. Labour activists have been known to be imprisoned after facing criminal trials that are not conducted as per international standards. Although such imprisonment cannot exceed three years, in practice it is extended at will by the authorities.

Labour disputes in China have been consistently increasing since the 1990s. During the last ten years, considerable amount of research has been done in the context of what could result in enhancing of awareness by social organisations that are interested in China. China is characterised by a restrictive legal system whereby worker issues relate to the implementation of rules of conduct and finding solutions in opening up laws towards labour organisation.

With the entry of foreign companies that have entered the country through FDI, many such organisations have begun to focus on training workers to enhance democracy at the workplace and to allow them access to legal rights. There are now a number of multi-stakeholder initiatives that are presently coordinating with businesses to create better ways of working. There has been considerable progress in this regard in most provinces in the country.

Reference List
Aitken, B., et al. (1996), Wages and Foreign Ownership: A Comparative Study of Mexico, Venezuela, and the United States, Journal of International Economics, Vol. 40, No. 3/4, pp. 345-371.

Alon, I & McIntyre, J. R 2008, Globalization of Chinese enterprises, Palgrave Macmillan McGuire.

Blackman Carolyn. (2001) China business: The rules of the game, Crows Nest: Allen & Unwin Pty Ltd.

Blalock, G., and Gertler, P. J. (2008), Welfare Gains from Foreign Direct Investment through Technology Transfer to Local Suppliers, Journal of International Economics.

Broadman H.G. and Sun, (2003) The distribution of foreign direct investment in China. The World Economy, Volume 20(4), pp.349-371.

Bui Tung, Yang David. (2002) China’s Economic Powerhouse: Economic Reform in Guangdong Province, Palgrave Macmillan.

Buckley P J. (1999) New theories of international business: Some unsolved issues, the Growth of International Businesses, Allen & Unwin, London.

Calvet A. (2001) A synthesis of foreign direct investment theories and theories of the multinational firm. Journal of International Business Studies, 12, pp.44-60.

Casson Mark. (2001) Foreign investment and the economic development of China. Evolution of International Business, Vol. 8, Routledge.

Cason M. and Zheng, J R. (2001) Western joint ventures in China. Journal of International Development, 3(3), pp.293-323.

Chen L B, Zhou, Z.Y. and Wan, G.H. (2003). Why is U.S. direct investment in China so small? Contemporary Economic Policy, 18(2), pp.96-106.

Computer Weekly, Chinese factory supplying HP, IBM and Cisco has ‘cruel and inhuman’ conditions. Web.

Coughlin C C and E SEGEV. (2000) Foreign Direct Investment in China: A Spatial Econometric Study, The World Economy, Volume, 23(1), pp.3-23.

Domoney Ruth, (2007). Briefing on the Chinese Garment Industry. Web.

Dunning J H. (1999) Explaining changing patterns of international production: In defence of the eclectic theory. Oxford Bulletin of Economics and Statistics, November, pp.267-295.

Dunning J H. (2001) Globalization and the Theory of MNE Activity, The Globalization of Multinational Enterprise Activity and Economic Development, St. Martin’s Press Inc., USA.

Fu Xiaolan. (2004) Exports, foreign direct investment and economic development in China. New York: Palgrave Macmillan.

Gallagher, M. E. (2002) Reform and openness posted on April retrieved from https://www.jstor.org/stable/25054191?seq=1#page_scan_tab_contents

Grossman, Gene and Elhanan Helpman. (2001) Quality Ladders and Product Cycles, Quarterly Journal of Economies. Volume 106, pp.558-586.

Grossman, Gene and Elhanan Helpman. (1991) Innovation and Growth in the Global Economy, Cambridge, MIT Press.

Henley J, Kirkpatrick C and Wilde G. (2003) Foreign Direct Investment in China: Recent Trends and Current Policy Issues, Blackwell publishers Ltd.

Hill CW and Kim WC. (1998) Searching for a dynamic theory of the multinational enterprise: A transaction cost model, Strategic Management Journal, 9, pp.94-104.

Hood N and Young S. (2001) Globalization, multinational enterprises and economic development, The Globalization of Multinational Enterprise Activity and Economic Development.

Hsu John C. (2003) China’s foreign trade reforms: impact on growth and stability. New York; Cambridge University Press.

Huang Yasheng. (2006) Selling China: foreign direct investment during the reform era. : Cambridge University Press.

Hymer S H. (1996) The International Operations of National Firms: A Study of Direct Foreign Investment, MIT Press.

Kamath S. (2000) Foreign direct investment in a centrally planned developing economy: The Chinese Case, Economic Development and Cultural Change, 38(2), pp.109-130.

Krugman P. (2001) Intraindustry Specialization and the Gains from Trade. Journal of Political Economy, Volume 88, pp.958-973.

Kuhn Robert Lawrence. (2004) Made in China: Voices of the new economic revolution. New York: TV Books.

Kynge James. (2006) China shakes the world: the rise of a hungry nation, London; Weidenfeld & Nicolson.

Lai Hongyi. (2006) Reform and the non-state economy in China: the political economy of liberalization strategies, New York Palgrave Macmillan.

Lancaster K. (2002). Intra-Industry Trade under Perfect Monopolistic Competition, Journal of International Economics, 11, pp.152-175.

Lankes Hans-Peter and Venables A J. (2004) Foreign direct investment in economic transition: the changing pattern of investments. Economic of Transition, 4(3) pp.332-347.

Lardy Nicholas R. (1993) Foreign trade and economic reform in China: 1978-1990. New York; Cambridge University Press.

Li Shoushuang. (2007) The legal environment and risks for foreign investment in China, Springer.

Lucas Robert. (1993) Making a Miracle Econometric, Economic of Transition, Vol 62 NO 3 April pp.251-273.

Miller R R. (2003) Determinants of US Manufacturing Investment Abroad. Finance & Development, March, pp16-18.

OECD, (2000) MAIN DETERMINANTS AND IMPACTS OF FOREIGN DIRECT INVESTMENT ON CHINA’S ECONOMY, OECD Co-operation Programme with the People’s Republic of China.

Owen A.L and Yu B.Y. (2003) Wage Inequality between Skilled and Unskilled Workers in China, Working Papers, Hamilton College.

Porter M.E. (1996) Changing patterns of international competition. California Management Review, 27, pp.9-40.

Reardon Lawrence C. (2001) The reluctant dragon: Crisis cycles in Chinese foreign economic policy. Studies of the East Asian Institute. Seattle: University of Washington Press.

Segal Gerald. (2004) China changes shape: regionalism and foreign policy: how will the outside world deal with a China re-shaped by the forces of decentralisation and internal reform, International Institute for Strategic Studies.

Sun Q W and Q. Yu. (2002). Determinants of Foreign Direct Investment across China. Journal of International Money and Finance, 21(2), pp.78-113.

Swain N J and Wang Z. (2003) Determinants of inflow of foreign direct investment in Hungary and China: time-series approach, Journal of International Development, 9(5), pp.693-723.

Teece D J. (2003) Technological and organizational factors in the theory of the multinational enterprise, The Growth of International Business.

Tseng, W & Rodlauer, M. (2003) China, competing in the global economy, International Monetary Fund.

UNCTAD. (2004) The Shift Towards Services. New York: United Nations.

UNCTAD. (2003) World Investment Report, Transnational Corporations and Competitiveness, New York: United Nations.

Wang Hongying. (2003) Weak state, strong networks: The institutional dynamics of foreign direct investment in China, New York; Oxford University Press.

Wei, Y. and Liu, X. (2001) Foreign Direct Investment in China: Determinants and Impact, Edward Elgar, UK.

Wei Shang-Jin. (2002) The globalization of the Chinese economy, Edward Elgar Pub.

Wei Y, Liu X and Song. (2001) Endogenous Innovation Growth Theory and Regional Income Convergence in China, Journal of International Development, 13(5), pp.141-158.

Wu Weiping. (2006) Pioneering economic reform in China’s special economic zones: The promotion of foreign investment and technology transfer in Shenzhen, Ashgate Publishing.

Yan Yanni. (2005) Foreign investment and corporate governance in China, New York: Palgrave Macmillan.

Yunshi, M and Jing, Y. (11 October, 2005) Overseas investment trends change with times. China Daily.

Zhang K H. (2000) Why is U.S. Direct Investment in China so Small? Contemporary Economic Policy, 19(2), pp.84-94.

Zhang K.H. (2002). Why does China receive so much foreign direct investment? China & World Economy 3, pp.49-56.

Zhou Zhongfei. (2005) Chinese banking law and foreign financial institutions, Kluwer Law International.

Law Dissertation

by admin | Mar 20, 2023 | Uncategorized

The Management of Police and Development of Law Essay
Introduction
Policy and law development is a multifaceted discipline that often requires a strong understanding of the contextual political, social and economic issues that affect it (Hill & Hupe 2014). Since many private organizations and government agencies often fail to understand this fact, they miss the opportunity to develop relevant policies and laws that would create a positive social change (Koontz & Newig 2014). This systemic problem affects different levels of public and private sector performance.

However, there are many lessons to learn from the business, psychology, and military spheres of governance (regarding the formulation and implementation of successful policies and laws) that could be used to remedy this problem. This paper draws on some of these lessons to present a case for the development of leadership and management capabilities in policy and law development. Using an inquiry-based approach, this paper presents a high-level business case for the use of leadership and management skills in policy formulation and implementation. Key tenets of this paper explain the drivers for policy change and explain the principles that must apply for inquiry-based research to produce effective management and leadership capabilities.

This analysis occurs within a firm understanding that the main aspects of leadership and management, such as teamwork, creativity, planning and decision-making, are central to the formulation and implementation of policies and laws. Key sections of this paper also highlight the need to nurture a culture of high performance that is centered on the need to use resources efficiently to implement useful policies and laws. These insights are relevant in explaining the management of policies and development of law. In the first section of this review, we explain how military doctrine could influence the development of laws and policies.

Infusing Military Doctrine in the Development of Law and Policies
There are different lessons we could learn from the use of military strategies in the development of policies and laws. This relationship comes from the application of military doctrines in the legal practice. Based on this finding, different researchers have explored how governments could use military doctrines to leverage the policy formulation process (Santos 2013; Pollitt 2015). Those that have done so have also investigated the doctrine as another influence of an organization’s strategic direction (Scott 2013). Others have compared such an influence, as any other that would affect a typical business or political decision (Pollitt 2015).

Here, it is important to point out that the definition of strategy and policy, as applied in the military, is the same as the definition of the two concepts in policy and law. Although different researchers have presented different arguments and definitions of strategy and policy in the military, their definitions all converge in portraying these two concepts as the effective use of military means in the accomplishment of a specific policy agenda (Scott 2013). The concept of strategy, as applied in the military sense, has a deeper meaning because it involves the deployment of military capabilities through long-term planning to increase the odds of success in a military confrontation.

The similarity between the definitions of strategy in the military is the same as that incorporated in law because the latter employs its strategies as an integration of specific actions with an anticipated event to achieve a specific legal outcome (Pollitt 2015). Indeed, when lawmakers develop policies or laws, they aim to achieve a specific outcome through the employment of state or organizational resources. Thus, the definition of strategy and policy, as used in the military and in the development of law, are the same. This finding is useful in improving the policy formulation process because there is a pool of resources from the military doctrine that policy formulators could use to enhance their performance.

The drivers for maintaining authority in military doctrine and in the government are also the same because they all stem from the same basis – protecting public interests. In military doctrine, authority is maintained through an assessment of political, economic, social, environmental and religious needs (Pollitt 2015). The same drivers are the sources of authority when developing government policies because the same guidelines are aimed at protecting the political, economic, social, environmental and religious interests of the people. Indeed, as Ahmed and Dantata (2016) point out, governments have to consider different social, environmental and religious interests when making policies that apply to specific groups of people, or to an entire national population. The findings of this analysis could be useful in developing a framework for formulating laws and policies.

Being part of an international community could help in the development of policy and law because it normalizes, or standardizes, different laws, thereby creating minimal room for conflicts and misinterpretations. Cross border enforcement of laws is also possible through the internationalization of laws. Therefore, countries that are part of a larger international community could benefit from judicial cooperation because their laws are enforceable beyond their borders (Bakhtyar 2013). The contrary situation is undesirable because it would be difficult for countries that are not part of any international agreement to have their laws enforced outside their borders. Comprehensively, being part of an international community helps in the development of policies and laws through the normalization and standardization of legal statues. These findings are useful in the integration of law across international borders.

Nonetheless, global players could experience significant limitations in enforcement when a legal issue is of an international nature. In this sphere of analysis, it is critical to point out a difference between a legal understanding and information because international agreements are often based on common understandings between multiple parties, while information is mostly based on a set of rules relied on by these entities (Ahmed & Dantata 2016). Sometimes, these definitions create a lot of confusion in the implementation of law. This is why many researchers have emphasized the need for effective leadership and management of policy and law (Ahmed & Dantata 2016). Nonetheless, understanding these lessons in international law development could help to avoid legal misinterpretations and misunderstandings in the global political space.

Some key diplomatic attributes that global leaders should have to avoid these problems include a meticulous attention to detail and an analytical temperament because the global legal space is more complex today than it was in the past. Indeed, leaders need to know how to navigate through the different tenets of international legal enforcement, with minimal distractions and with a laser focus in achieving the desired goals. The findings of this analysis could be useful in choosing the right leader to spearhead the policy formulation and interpretation processes.

Context for Change
To initiate change in a policy setting, it is important to create a context that would support it. Ideally, regulations should be redesigned to respond to the complexities of different societies. The main drivers of change in the regulation environment are globalization, economic conditions, changes in civil society, cultural changes, external pressures (treaty-driven regulations), technological advances, terrorism and environmental issues (Pollitt 2015). Many jurisdictions, especially in the UK, have taken proactive measures to change their laws to align with some of these drivers. While some of them are reactionary (such as responses to terrorism), others have benefitted from regulatory foresight and changed their laws to pre-empt some of the aforementioned drivers of change. These findings are useful in public education because people need to understand why change needs to occur.

Doing nothing has never been an option for many countries, whenever there is a need to change, because some of the drivers of change cannot be effectively ignored because of their adverse outcomes. For example, terrorism is a key driver of legal change and cannot be ignored because it is important for authorities to be a step ahead of the terrorists. Doing so requires them to use existing legal jurisdictions to get the information they need and deter the terrorists from causing harm to the public. Environmental change is also a key driver affecting the legal environment and cannot be ignored because of its possible devastating outcomes on human wellbeing.

Global warming and severe weather patterns are some of the issues that could arise from the failure of countries to effectively address such a problem. This is why many nations come together in global conferences to address the issue of climate change because they recognize that it cannot be ignored anymore. The Paris Climate Agreement, which is a legally binding document signed by hundreds of countries, is a product of such a conference. Comprehensively, based on the consequences attached to some drivers of change, doing nothing is not an option. This finding is useful in encouraging stakeholders to be part of policy change processes.

While “doing something” is a positive step towards addressing some of the issues highlighted above, changes to legislation do not always lead to policy changes, or reform. This problem often arises from several issues, including poor enforcement of legislations, lack of goodwill to “do the right thing” and sabotage by people or parties who may have conflicting interests (Pollitt 2015). This finding is essential in assessing the risks associated with policy implementation.

Based on the aforementioned issues, there is a need to undertake independent inquiry into legislative change. This function cannot be left to the government alone because some agencies could be compromised, or fail to be objective, when undertaking such inquiries. An independent inquiry would be free from such influences and promote an objective analysis of the legislative change process (Bakhtyar 2013). This analysis is useful in evaluating policy implementation processes.

Based on the above factors, there are supposed to be checks associated with the lawmaking process because there is a limit that lawmaking should extend to. Furthermore, there is a limit that lawmaking should stop. For example, law making should only extend to the protection of public interests and refrain from infringing on private ones (Bakhtyar 2013).

This provision explains why most jurisdictions protect certain freedoms, such as the freedom of worship, because they understand the need to protect private interests, while at the same time preserving public ones. Additionally, the process of making laws should stop at the point where there is a judicial process preventing the process, or if there are existing international statutes that prevent the same (Koontz & Newig 2014). These finding are essential in developing limitations of law.

My criteria for changing current law or initiating a new law would mostly be hinged on an evaluation of whether the laws deviate from the interests of the people, or parties, it is supposed to govern. For example, laws should be changed when they deviate from the interests of the people it is supposed to cater to. New laws should be initiated when existing laws fail to sufficiently address new issues emerging in the society.

For example, different jurisdictions have had to introduce new laws to prosecute cyber crime because this is a new type of problem affecting societies today. The same is true for countries that have withstood the worst of terrorist attacks because they have to introduce new laws to manage new threats. This observation was true for America after the 9/11 attacks because it had to introduce new laws on information access, which was a big political issue at the time. Comprehensively, these findings show that new laws should be introduced when new issues have to be addressed.

Understanding how to Assess and Benchmark Performance
There are different types of data that could be used to assess or benchmark performance. However, they are mostly dependent on the type of business one is engaged in, or the kind of services offered by an institution. Indeed, based on the type of work involved, different benchmarks of performance could be used to evaluate performance. For example, to assess the performance of a police service, we could use unique benchmarks, such as crime rates, arrests, clearances and response times. Although there is a big debate surrounding the role of creativity in law, the science behind the concept in human beings is straightforward.

Psychologists and biologists have often explained how the human brain is engaged in creative thinking by showing that the left and right sides of the brain serve different functions (Santos 2013). While the right side of the brain is mostly engaged with logic and reasoning, the left side of the brain is mostly responsible for creativity. This explanation is mostly contained in the left-brain right-brain theory, which presupposes that creativity is often associated with people who are right brained and they are more tuned to be intuitive, subjective and creative. These findings are useful in understanding the source of human creativity.

Although the use of creative thinking in law is considered relatively problematic, some researchers point out that there are specific instances when creative thinking may be valuable in the practice. According to Bullock and Sindall (2014), there are many opportunities for using creative thinking in law, most of which are concentrated in the area of problem solving. In fact, they say that effective lawyers are mostly creative thinkers. For example, creative lawyers often use infographics as a tool for presenting arguments. These findings are instrumental in understanding how to incorporate creativity in policy and law development.

Although there are unique situations for using creative thinking, as outlined above, the process is not often acceptable in some legal contexts. Part of the reason for this issue is the belief by some practitioners and the public that it may cause a travesty of justice (Bullock & Sindall 2014). Others believe that it may cause an injustice because it could involve people “twisting” the law to suit their arguments (Bakhtyar 2013). In this regard, some people believe that the spirit and letter of the law would not be followed if creativity were allowed. Those who hold this view assume a “black and white” view of justice. For example, they would argue that a person has either broken or the law or not. In other words, there are no special circumstances to “twist” the analogy to suit one version of an argument or another.

There are different risks associated with using creative thinking techniques. Most of them centre on the failure of the new ideas to work. For example, coming up with a creative legal maneuver may fail to achieve the desired goal and create resentment among all or some of the parties involved. Granted, creativity comes with its own set of risks because most creative ideas are novel ones. Nonetheless, the absence of a record of accomplishment to prove their success underlines the risk itself because there is always a possibility that the new ideas may fail to work. This is why many analysts often recommend the development of a counter strategy in case the creative idea fails (Pollitt 2015). These findings are instrumental in developing a risk framework for policy implementation.

Since research has proved that some people may be more creative than others are, people who are not creative may find themselves stuck in situations that demand such ingenuity. One solution for overcoming this problem is to develop a problem-solving team. Having a collaborative approach to problem solving will help people who are not creative to get assistance from other members of the team who are creative (Pollitt 2015). Alternatively, some researchers also propose the creation of relaxed workplace environments to stimulate creativity. For example, some have recommended taking a walk, or a stroll, to boost creativity for people who are not naturally this way (Bullock & Sindall 2014). These findings give a pointer on how non-creative people can be creative at work.

Although some people sometimes question the link between creativity and law, I have witnessed instances where the concept has been successfully practiced in the field. There is a case where a defendant was accused of stealing a bunch of notes that were presented in court and serialized to show that they were the missing notes. His lawyer creatively argued that such evidence could not be admissible in court because the law stated that someone who had knowledge of the contents should present evidence. In the aforementioned case, the court ruled that the evidence was inadmissible because the serial numbers of the notes were produced from a computer, which was incapable of knowing the contents of the case (Bullock & Sindall 2014). Although this ruling was a travesty of justice, it shows how creativity can be successfully used to win cases. From this example, I have learned that creativity and law can coexist perfectly so long as the creative element of an argument does not contravene the rights of any of the parties involved.

Comparatively, Chanin (2014) presents a different case where creativity has failed to work in the legal setting where in an electoral petition in Ghana one aggrieved party felt the he was cheated of a win and wanted the results nullified by the court. The defendants argued that the evidences of cheating could not be admissible because they were time barred (the application for nullification was made late). However, the court ruled in favor of the plaintiff. This case shows the limits of creativity.

Public Engagement
Engaging the public in assessing and benchmarking performance is a strategy recommended by Dawson and Stanko (2013) and Effiong (2013) to realize public buy-in in the implementation of public policies and laws. Policymakers could engage with the people using crowd sourcing because it has the ability to reach a large number of people within a short time and in a relatively inexpensive way (Dawson & Stanko 2013). Comparatively, the ideal way of involving the public via the ethnography approach is through focus groups (Scottish Parliament Justice Committee on Policing 2013).

The public could also be engaged in the policy making process through idea generation, which should typically happen through brainstorming (Dawson & Stanko 2013). Deliberative dialogues are often up-close and personal and should typically involve getting the views of experts or peers in the policy-making process. Lastly, getting the views of the public through social media platforms could be another way of engaging the public in the policy making process. However, this type of platform is often prone to abuse. Therefore, it should be consistently checked and monitored to make sure that only the useful views are included in the policy-making process. These findings explain the factors to consider when choosing the right engagement platform to use in the policy making process.

Policymakers could also use other techniques in their work to make or design policies that are beneficial to the society. For example, the use of change cards is an unconventional and sometime unpopular technique of policymaking that could be used by this group of professionals to formulate and implement policies. Policy makers often use change cards to give a different view of the process, usually by challenging conventional assumptions about the same (Dawson & Stanko 2013). This technique could be beneficial in developing new ideas about policy. Open-policy techniques are also alternative tools that could be used in the policy-making process. People who choose to use them are often curious, networked or digitally engaged. Collectively, these kinds of techniques would be instrumental in generating novel ideas in the policy-making process.

Nonetheless, using open policy-techniques comes with new challenges when applied in the workplace setting because it is prone to conflict and fierce debates, as noted in my workplace setting. The reaction I would get from using this type of technique in my workplace setting is unique because people would appreciate it because they are often governed by dictatorial management guidelines that rarely appreciate open discussions. Therefore, if management were to introduce an open-policy system that fosters transparency and values public opinion, many of my colleagues would embrace it. These findings are useful in highlighting the importance of transparency in the workplace and policy environments.

Importance of Communication in the Development of Policy or Law
One of the most important aspects of policy development is communication. In this regard, policy makers need to possess important communication skills because it would help them to engage effectively with the public, or the people who are subject to the policies in the first place. For example, these skills are essential in developing trust and cultivating positive relationships with the public because some members of the public often view some policies suspiciously. Areas that are often characterized with increased suspicion about law enforcement are key areas that require constant communication with the public about the policy making process.

Based on the inherent risks associated with poor communication, or the lack of it, it is important to align policy with the communication structure to achieve the intended goals because without doing so, the policy making process becomes irrelevant or problematic (De Sardan & Ridde, 2015). These findings are instrumental in highlighting the need for stakeholder involvement in the policy formulation process.

At the same time, it is pertinent to ensure that the right inputs are involved in the communications process because the right stakeholders need to be consulted, in the right way, for the best results to be realized. For example, it is important to have a sound communication strategy that aligns with the views of the target audience. Furthermore, it is important for policy-makers to be sensitive about the cultural or political issues that may cloud the communication process. These findings are important in developing the right message contents for each stakeholder group.

Although the communication structure needs to be thoughtful of the interests of all stakeholders involved, it is also essential for the actors and institutions involved in the process to manage their expectations well because the process is often complex. The possibility of policy failures, or disagreements, is often real as is the likelihood that specific policies may fail to achieve their intended goals.

The Supreme Court decision in Brown vs. the Board of Education highlights this fact because although a specific ruling was given, there was no reliable implementation framework to enforce the ruling (De Sardan & Ridde 2015). This example shows the possibility of failed expectations despite the existence of a meticulous process of policy formulation. This finding is important in preparing stakeholders for possible outcomes associated with policy implementation.

A critical component of managing expectations is setting realistic objectives. This is highlighted in literatures that have investigated why policies have failed to achieve their goals (Hill & Hupe 2014). They have shown that setting unrealistic goals is part of the problem. Policy-makers should make sure that the goals set in the policies are not only attainable but also realistic. Similarly, efforts should be made to understand the capacity of the stakeholders involved to formulate and implement policy guidelines as well as the resources available to implement specific policy guidelines. These findings are useful in developing the policy framework for the implementation of existing and new laws.

Options for a Communications Strategy
The elements of strategic communications that I can consider for communicating with internal and external stakeholders in my work include having the right team and knowing the target audience (Hill & Hupe 2014). These elements of strategic communication are important in communicating with the stakeholders because they complement each other in the sense that knowing the right target audience helps to assemble the right team to develop the right contents that would appeal to the audience. These findings are useful in understanding how to develop the right communication framework for policy development.

My former supervisor, Edward May is one person who has taught me how to develop effective communications strategies because I have seen him develop some of the most successful communication strategies responsible for the success of my former company. He developed a successful marketing campaign that saw the company’s sales increase by 50%. This strategy was hinged on developing the right communication content on the digital space. This finding is useful in demonstrating how the right selection of communication elements could yield unforeseen success in policy development.

Although other people have achieved tremendous success in communication, it is often difficult to know which communication strategy appeals to a specific workplace or institutional setting (Froestad, Grimwood & Herbstein 2015). This is the case in my organization because there are unique situational issues that require a specific communication strategy.

However, based on the recommendations of Fyfe (2014), people should always use past examples as reference points when formulating communication strategies. This is a solution to my organizational context because I can use past examples of successful communication strategies to understand how to design my communication plan to appeal to the target market. This finding helps in identifying the right elements of communication to include in the policy planning process.

Nonetheless, knowing what is right is not enough to guarantee the success of a communication plan. According to Fyfe and Scott (2013), there needs to be several things in place to implement a successful communications plan. One of them is a right team that would steer the entre communications process. This finding is useful in knowing the supportive structure to have when developing a communication plan.

The last step in developing a communications strategy is understanding how to evaluate it. To understand the effectiveness of the communication strategy, I would assess the feedback received from the other parties in the communication framework. A high volume of feedback could possibly signify the effectiveness of the communication strategy. Another strategy I could use to evaluate the communication strategy is testing the communication plan on a sample of people that have the same characteristics as the target audience. This process would create opportunities to tweak the strategy depending on how well the sample group responds to the overall plan (Fyfe & Scott 2013). These findings are useful in fine-tuning a policy plan.

Gaining an Insight into the Audience’s Views
As highlighted in the above section of this paper, developing an effective communication framework/strategy is important in the policy formulation process. However, implementing a seamless communication plan requires policymakers to gain an insight into the perspectives, or views, of the audience, which they target. An inquiry-based approach is an effective way of developing leadership and management expertise in this process (Fyfe & Scott 2013). This approach mostly works by asking the audience probing questions in an open and interactive way, as opposed to presenting a stream of arguments or information to be discussed.

The inquiry-based approach to seeking the views of the audience regarding their perception of policy-making is also justified in the context of this study because it helps to arouse curiosity of audiences that may not be interested in the policy-making process in the first place. This problem often affects the policy-making processes because even when organizers arrange for public discussions about critical issues, a significant percentage of people may fail to show up (Whitford 2014).

This kind of apathy is detrimental to the entire process because it denies the policy-makers an opportunity to get an accurate view of the views of the public. An inquiry-based approach helps to solve this problem by arousing the interests of the public regarding the policy-making process. Through the same process, audiences are likely to benefit from an increased understanding of the policy-making process because open discussions guide them on how to contribute and help them understand the critical areas that need their attention. In this regard, they are likely to develop a growth mindset that should be cultivated within a culture of public participation in civic affairs, or policy-making processes (Fyfe & Scott 2013).

Some literatures have shown that the benefits of using an inquiry-based approach in policy-making are much deeper because they help policy-makers to engage the audiences beyond the level of general curiosity, by allowing them to develop a critical and in-depth understanding of the policies discussed (Fyfe & Scott 2013). This approach has a proven record of accomplishment in education and business management because it has been proved to be successful in improving the competencies of teachers, managers and leaders in understanding the issues that affect their subjects (Fyfe 2014).

The same success could easily be replicated in the policy environment because managers and leaders are in a better position of understanding the views of their audiences by adopting this inquiry-based engagement approach. The findings of this analysis can be useful in understanding how best to engage audiences regarding policy issues. Since the context of discussion is of a public nature, the findings of this study are useful in increasing the participation of audiences in public forums.

Changes in Communication and their Effects on Policing
Globalization is one aspect of modern communication that I need to understand for policy safety and security. In other words, as Fyfe, Terpstra and Tops (2013) observe, people should understand that the audience today is no longer local but global. This aspect of communication is useful in designing messages for different stakeholders because policy-makers should understand that a global audience would spontaneously consume their messages (Barbosa & Brusca 2015).

In the context of policy formulation, speaking is the most important aspect of communication that I would use. It involves conveying information to receivers in ways that they understand. Speaking may occur in town hall meetings, public forums and the likes. Although this aspect of communication may be effective in getting instant responses from the public, it is still subject to changes in modern technology. This finding is important in identifying the right communication platform to use in policymaking.

The digital revolution is perhaps the most dominant force that could change speaking as an aspect of communication (Greasley & Hanretty 2016). The digital revolution is bound to affect public speaking by changing the entire format of communication in a way that people may not necessarily see the need to attend public meetings (because such engagements could happen in a virtual setting). These findings can be used in designing communication messages, or (broadly) in determining the best communication strategy to use.

I could be in touch with changes in communication by observing existing trends and seeing what industry leaders are doing (Barbosa & Brusca 2015). This strategy stems from the fact that industry leaders often dictate the new ways of communication and influence the kind of communication platforms that would be available in the future. Here, there needs to be a thoughtful communication structure, which allows people to understand their roles, and obligations in the entire communication framework (Fyfe 2014). This provision does not only include the communication team, but also the subjects of the communication plan because they need to understand who to consult whenever they have questions, or want to seek clarification about a specific issue. These findings are useful in the risk management process associated with policy formulation.

Lastly, I believe there is a gap between perception and reality, as is communicated in the political setting. The digital age has especially brought new challenges to the process of deciphering messages that are reliable and credible from those that are not. In this regard, I believe the line between perception and reality is increasingly blurred. Thus, it is becoming important for people to take extra care when consuming information available in the public domain because what may be presented as factual may not necessarily be so. These findings could be instrumental in evaluating what is important and what is not.

Developing Communications vs. Developing Policy and Law and Stakeholder Mapping in the Communication Process
As highlighted above, developments in communication happen all the time and affect how people conduct their business in the policy-making arena. However, it is important to point out that there are differences in communications development and the development of policies and law. One of the most significant differences between developments in communication and developments in policy and law is the context in which they both occur. Advances in communication are often non-contextualized, but developments in policy and law are often contextualized. For example, developments in policies and laws often happen within jurisdictional boundaries, but developments in communication are not limited this way (Greasley & Hanretty 2016).

Another difference between the development of policies and communications is the trajectory of developments that often occur in each segment (Ferlie & McGivern 2014). In policy implementation, it is difficult for any development to contradict an existing policy or law. However, the same is not true when developing communications because a new development could easily contradict a previous one and become acceptable. Comparatively, one notable similarity between policy and law development and developments in communication is that both advances are designed to improve public welfare. These findings are useful in understanding the limitations and delimitations of policy development.

According to Hill and Hupe (2014), stakeholder mapping important in the communications process because it helps policy-makers to understand their partners better. In this regard, the stakeholder mapping process will help policy-makers to develop their communications in a way that would avoid the risk of misunderstanding in the long-term. By understanding the stakeholders better, they would also be in a good position to tailor their messaging strategies and develop the contents of their communication to align with the needs of the stakeholders. These insights show that stakeholders are an important part of the policy-making process because they could “make or break” the process.

There are different ways through which policy-makers can get the agreements of their key stakeholders during the policy-formulation process. One way of doing so is to collaborate with them because collaboration is a form of partnership and a type of approval for the activity or policy in question (Hill & Hupe 2014). Indeed, it is difficult for stakeholders to agree to collaborate with policy-makers on an issue that they do not approve. Therefore, their willingness to collaborate is a form of agreement on the type of policy being developed.

Empowering the stakeholders is also another way of getting the agreements of the stakeholders in the policy-formulation process because the process is supposed to benefit the stakeholders. Often, when stakeholders are empowered, they approve of the process or policies that lead to this outcome (Ferlie & McGivern 2014). Conversely, if the policy-formulation process does not empower them, they are bound to feel frustrated and refuse to approve of the process. In this regard, empowerment stands out as a key step in getting stakeholders to agree on the policy-formulation process. These findings are useful improving the stakeholder engagement process.

Implementing and Delivering Policies
Having an over-ambitious timescale is at the top of the list of challenges associated with policy implementation because policy-makers sometimes create unrealistic targets for implementing different phases of a policy, thereby making it difficult to implement the project well (De Sardan & Ridde, 2015). The failure to properly plan for the implementation process is a key cause of this problem because having inadequate knowledge about the requirements of the implementation process could mislead policy planners to create the unrealistic timescales. In this regard, planners should conduct proper research and provide realistic guidelines for when specific policy implementation phases should be completed (De Sardan & Ridde, 2015).

At the same time, it is vital for policy planners to ensure that the people who are mandated to implement the said policies have the requisite skills and requirements needed for the job. As Holmberg (2014) points out, it is important for policy planners to train the policy implementers about the process. These findings are instrumental in the formulation and implementation of policy plans. More so, they are valuable in understanding the steps that need to be followed when implementing policy plans.

Poor project management is also a likely cause of the poor implementation of policies. Policy implementers need to protect themselves from this risk because poor project management often leads to missed deadlines and poor relationships between stakeholders (De Sardan & Ridde, 2015). To shield themselves from this mistake, the project managers need to ensure that there is sufficient communication among all the stakeholders involved so that they all understand what the implementation process entails. They also need to understand how each part of the implementation process works together because failing to do so often leads to the failure of some people involved in the implementation process to do their work on time (Holmberg 2014).

To shield themselves from most of the aforementioned perils, policy-makers also need to ensure they have a contingency plan to specify the necessary actions that need to be taken when the project fails. This plan should also specify the kind of risks that policy planners could face when implementing the policies (Holmberg 2014). Having this plan in place could salvage a bad situation where the implementation process has failed to achieve its goals. The policy planners would be able to get right back on track when they have this plan. This way, it would be easy for public institutions to protect their resources and minimize the inconveniencies that they would experience from the failure of their implementation plan.

A key part of the implementation plan is also the clarification of roles among all the actors involved in the implementation process. This process would save time and resources because the implementers would not waste a lot of time on undertaking projects that do not add value to the implementation goal. Nonetheless, at the center of the process of minimizing this risk is the need to make the right decisions surrounding the implementation plan. The section below outlines how to devise a map for designing the decision-making process.

Devising a Map for the Decision-Making Process
Before determining the need for a policy or law change, I would follow a specific step of action reviews that would clarify the process. One criterion of doing so is checking to see if the policy review process is due because in some organizations, policies and laws are reviewed periodically (Holmberg & Balvig 2013). If this is the case, the policy review process should occur without fail. These findings are useful in evaluating new policies before they are implemented.

When developing the decision-making map, there are limits to which a person could infer decisions based on environmental or personal factors. The minimum I could do before making any decision in this regard is to understand the existing decision alternatives. This is the only way that a person could know which decision to make because without doing so, it would be difficult to know which course of action to take. The maximum I could do is to start executing the idea as a preliminary test to understand how I would feel about its implementation. Doing so could lead to the development of new ideas, or a change of the initial decision, depending on the outcome of the testing phase.

Setting the objectives is also a central theme in the decision-making process. To do so, I would use the SMART framework as proposed by House (2013). This framework dictates that goals or objectives should be specific, measurable, attainable, realistic and timely (House 2013). Similarly, I would make sure that the objectives formulated fit within the overall vision of the institution because they should be relevant to the overall mission and vision of the organization. These alternatives are useful in developing a criterion for developing policy goals.

Although the options that would be generated using the SMART guidelines may be relevant to the overall vision and mission of the organizations, there is a need to refine them further to get only the ones that would be easy to implement with minimal resources. These two criteria would be used to refine the objectives. Sharing the ideas (of the objectives) with peers would also help to refine the objectives further to come up with those that are appropriate for implementation. A third party analysis could help to point out issues with specific objectives that the original formulator could not see (Tummers 2017). These findings are instrumental in developing a policy review guideline.

To make sure that I have selected the best business case for the policy review process, I would check to see if there are any inconsistencies in them. Particularly, inconsistencies with the overall goals of the institution, or of the policy framework, would be deemed unacceptable because it would mean that the objectives are counterproductive, or ineffective, in the accomplishment of institutional goals (Tummers 2017). Collectively, this process would make sure that the selected business case appeals to the overarching goals of the organization and complements it as opposed to contradicting it.

Building and Assessing Capabilities for Implementing Policies or a Piece of Legislation
Before implementing policies or pieces of legislation, it is important to make sure that there is adequate capacity to do so. Using an inquiry-based approach, it is possible to assess such capabilities by identifying and resolving barriers that would stand in the way of implementing the policies (Whitford 2014). To do so, it could be useful to undertake a pilot test to assess people’s response towards the policy or law. This test would provide a general overview of the barriers that may arise in the implementation of a policy. From their identification, it would be easier to address the problems that affect the implementation process by consulting with stakeholders who may not support the process.

Another criterion I would consider for reviewing existing policies is checking out whether they align with any changes in the policy environment. If they do not align with the institutional framework, the need for a review would be inevitable. The same is true if they fail to align with the institutional goals currently in place. Tweaks to the policy implementation process may occur as a result (Whitford 2014). These findings are important in developing contents to use in the policy formulation process.

In other words, based on the findings highlighted in this paper, we find that many facts about policy and law implementation and formulation could be borrowed from other disciplines, such as business and military strategic development. Broadly, we also find that the internationalization of law is beneficial for parties that ascribe to international legal agreements because they would easily implement or enforce their laws outside their borders through jurisdictional cooperation. However, the global space is complex, owing to the multiplicity of different interests from global players. Therefore, it is important for leaders to demonstrate good leadership acumen hinged on the execution of well thought out diplomatic strategies.

Policies that need to be implemented rapidly may come with increased risks of suspicion and poor implementation because there is not enough time to plan for their application. To manage these risks, it is important to undertake public education about the urgency of implementing such policies so that people are not suspicious about the process. If the stakeholders understand the reasons for implementing such policies quickly, they are bound to create less resistance to the process. This finding could be useful in reducing the barriers associated with implementing new policies.

To make sure that such policies are relevant for a long period and align with government policies, it is also important to design them to align with international best practice because this is what most policy formulation processes are striving to align with (Fyfe 2014). The main assumption here is that governments would not want to isolate themselves from the rest of the world. Therefore, they would want to align their laws and policies to align with international best practice. Although this strategy is not 100% guaranteed to align policies with future political interests, it is the best bet that policymakers could make if they want their policies to remain relevant over long periods (Fyfe 2014).

To achieve the above objective, it is pertinent to make sure that the policy implementation process is a part of the policy design phase. Doing so requires policy planners to involve actors or players who would be involved in the policy implementation phase to be part of the policy design team. In this regard, when the policy design phase is happening, they may give their input because they would want to make sure that the design phase does not interfere with the implementation phase. In fact, according to Hupe (2014), they would want to make the design phase work for them by giving in their input before the completion of this stage. This finding is useful in improving stakeholder buy-in.

One barrier that could possibly impede the implementation of a policy plan is the resistance to change by some stakeholders. This barrier could also affect the roles and responsibilities that are allocated to those who will spearhead the implementation process, or be a part of the team because it could make some of them hesitant to carry out their duties (Fyfe 2014).

Since some of the senior managers in organizations are also resistant to change, it may also be difficult getting all the resources needed in the implementation plan. The same group of people may also affect details of the finance, skills and infrastructure that are important in the implementation process. Therefore, having a culture of change is important in the implementation process because, as seen from the examples above, it may be difficult to control its effects on different aspects of the project plan.

Safeguarding the Trust of Partners and Stakeholders
One of the ways of building trust in the policy implementation process is communicating regularly with all stakeholders to inform them about what is happening in the policy-formulation process, as well as involving them in the same process as well. Such communication structures should be clear and open so that no player feels left out, or sidelined during the process of policy formulation. The underlying lesson here is that trust can only be fostered if the communication structure is clear, regular and open.

Another step that we could take to build trust among stakeholders is to allow relationships among stakeholders to develop incrementally, as opposed to one-offs. The key for doing this is to allow partners to develop deep-rooted relationships, which cannot occur without allowing the players to take their time to trust each other (Van Sluis, Cachet & Jochoms 2013). Particularly, if stakeholders are entering into a relatively under-researched policy area, they may encounter the challenge of not knowing how their policy recommendations would be received. One stakeholder may understand the strengths and weaknesses of the policy better than others do and teach the others on the same subject and create a stronger implementation team. However, if trust were developed in this kind of environment, it would be easier for the concerned parties to take their time to do so, as opposed to rushing to forge such relationships (Zhan, Lo & Tang 2014). This approach would be a key hallmark in my quest to foster stakeholder trust.

While developing trust is an essential part of the policy implementation phase, making sure that the stakeholders deliver on what they are supposed to, and within the right specifications, could be problematic for most policy planners (Ingold & Leifeld 2016). To mitigate this challenge, I would curb the problem by choosing carefully the stakeholders to work with. These findings are useful in improving stakeholder engagement.

Managing stakeholders could be a difficult process especially if there are many cases of lip service, as opposed to the actual aiding of the implementation process. Managing stakeholders therefore becomes an important task for policy formulators because doing so is the only sure way of pushing them to achieve their objectives (Fyfe & Scott 2013). Although some of them may not necessarily meet the specified level of performance, it is important to adopt the views of Koontz and Newig (2014) who say that not all stakeholders are the same.

Therefore, it is pertinent to define different levels of acceptable behavior for each group of stakeholder. Stated differently, each stakeholder should be evaluated differently to understand how his or her behaviors affect the overall implementation plan. If their failure to meet the desired objectives falls within the acceptable boundaries, I believe that nothing should be done. In worse situations, a warning may work to inform them about the effects of their behavior on the overall policy implementation process.

However, when such warnings are ignored, it is imperative for the policy implementers to reprimand such stakeholders by excluding them from future engagements (Koontz & Newig 2014). Having an implementation unit to enforce these guidelines is important. Such implementation teams help policy makers in different ways.

For example, their contribution, in this context, could be practical, in the sense that they could be the team on the ground to liaise with stakeholders and make sure that each one was doing what is required of them. Their contribution could also be advisory because they could provide informed advice to the top leadership of government agencies and the policy teams (Ulibarri 2015). The lesson we can learn here is that of proper stakeholder management because although they may understand what to do, they may not necessarily deliver. Therefore, the findings of this section are important in safeguarding the policy implementation success.

Based on the above assertion, one may question whether the actions or behaviors of others may be transferable to the managers of the policy implementation team. I believe that this is a fallacy because it is difficult to control the actions of other people, while keeping the core of the implementation process in place. In other words, one has to suffer. The main observation to be made in this context is the need to let all stakeholders do what is required of them. In other words, their actions and behaviors are not the responsibility of others.

Through an effective communication framework, they already know what they are supposed to do and should work towards such a goal without necessarily transferring blame for their inability to do so to other people. Typically, whenever they fail to deliver as expected, they should be reprimanded (as highlighted above) and possibly replaced with other representative groups who are willing to accomplish the policy implementation goals.

Addressing Implementation Problems
As demonstrated in this paper, implementing policies in the public space may be a difficult process because there are several obstacles that may be experienced, ranging from poor stakeholder cooperation, inadequate resources, and the likes. Solving most of these problems could be an issue for policy planners because getting to their root causes and understanding how to navigate through these challenges without necessarily affecting others aspects of the implementation plan could be problematic.

In this regard, it is important to use an issue tree, which, as defined by Ulibarri (2015), is a customized framework for understanding the root causes of implementation problems. Such a framework could be useful in identifying solutions to specific problems. These issue trees could also be useful in structuring the implementation process and developing solutions to issues affecting the implementation plan (Koontz & Newig 2014).

For example, they could help policy planners to analyze their problems by investigating the “why” and “how” questions of policy implementation. Using this framework, they could always breakdown a question and dissect it into different parts that would help them to identify where the main issues lie (Ulibarri 2015). These findings are useful in identifying workable techniques of problem solving in the policy environment.

After the identification of implementation problems and the subsequent identification of solutions using the issue tree, it is pertinent for policy makers to develop an implementation team that would spearhead the implementation of the policies. In some cases, government organizations often seek the services of an implementation unit to carry out this function. For example, in the UK, under the Tony Blair government, there was a Prime Minister’s Delivery Unit (PMDU), which was a de facto implementation team that would oversee the implementation of the government’s policies and drive its agenda through different cadres of social and political governance systems (Ulibarri 2015).

Recent governments have also had implementation units (IU) which carry out the same function. Unlike past implementation units, recent ones have developed the reputation of being more flexible and knowledgeable about how different government departments work (Koontz & Newig 2014). They have also demonstrated their knowledge on three government departments – crime reduction, health, and education (Koontz & Newig 2014). Similarly, as units that often consult with different government departments, they have a vast knowledge of interdepartmental issues that may affect the implementation agenda.

Therefore, unlike a situation where a government department may want to implement a policy by itself and run into problems associated with overstepping its mandate, the implementation units could step in and prevent such problems from happening because they understand how inter-departmental issues may arise and how they could be solved. Generally, these units are integral in increasing the capacity of policymakers to implement their policy plans. These findings can be used to simplify the process of policy implementation not only for government agencies, but also for organizations that want to implement new policies.

Developing a Culture of High-Level Performance
Developing a culture of high-level performance is important in making sure that organizations constantly meet the requirements of their customers. Using a customer journey map is one way of making sure that an organization maintains a culture of high performance because it helps them to stay focused to the main goal – customer satisfaction. Resource management processes could also be improved using this strategy because customer journey maps would help policy makers to allocate resources to the most important functions. These findings can help policymakers to improve the effectiveness of their policies.

Although having a customer journey map is integral in improving the effectiveness of new policies and laws, it is often difficult to determine the amount of resources organizations should allocate to this process. Nonetheless, according to studies by Lavertu and Moynihan (2013a), the amount of resources spent on customer mapping should correspond to the number of touch points on the customer journey map. This finding could be useful in improving resource-mapping processes associated with policy implementation processes.

Developing a customer journey map is often not important for some organizations because they deem the nature of their processes to be too small to warrant the use of such a management tool (Lavertu & Moynihan 2013a). However, this should not be the case because no matter how small a business is, they should understand their customer journey to improve the experience of their clients.

The above-mentioned benefits of the customer journey-mapping tool are important in the improvement of customer experience, but fundamentally differ from the process-mapping tool, which seeks to improve an organization’s processes, not from the customer’s point of view, but from the organization’s point of view (Greasley & Hanretty 2016). As a management tool, companies are bound to find customer journey maps to be more beneficial than process-mapping tools because they would help them to optimize their operational efficiencies and provide (almost) instant customer satisfaction by tweaking their products and services (Greasley & Hanretty 2016).

Customer-mapping tools also have a low probability of experiencing acceptability error compared to process-mapping tools because customers are used as the main measure of organizational process changes, as opposed to using what management thinks is right for the customers. The latter approach could backfire on companies because they do not understand what the customer wants (Lavertu & Moynihan 2013a). The findings are useful in identifying the target market.

Lastly, measuring customer satisfaction ratings would be an important part of the customer mapping process. To do so, undertaking a survey to assess the level of satisfaction customers have concerning a specific product or service would be a practical way of understanding their opinions (Terpstra & Fyfe 2014). Since surveys are scientific ways of assessing people’s views, the findings would be reliable in the policy implementation process because it will align it with existing customer needs and requirements.

How to Propose and obtain an Agreement for Policy or Legal Implementation
As observed by Lavertu and Moynihan (2013b), policy implementation could be a problem for many organizations and institutions. Being open-minded about this process is useful in minimizing some of the problems associated with the process because doing so could lead to the development of new and innovative ideas that would help policy implementers to overcome some of the hurdles associated with the process without using many resources (Greasley & Hanretty 2016). This finding stems from the understand that policy and law development is a multifaceted discipline that often requires a strong understanding of the contextual political, social and economic issues that affect it (Hill & Hupe 2014).

Since many private organizations and government agencies often fail to understand this fact, they miss the opportunity to develop relevant policies and laws that would create a positive social change (Koontz & Newig 2014). This systemic problem affects different levels of public and private sector performance. Therefore, it is important to be open to new ideas because it promotes the cohesiveness of the implementation team since this type of culture exemplifies the strengths of each stakeholder and accounts for any differences that may exist between them (Lavertu & Moynihan 2013b). This way, it creates an environment where people feel valued and more encouraged to participate in the implementation process.

Before undertaking significant changes in policy or regulatory framework, it is important to ask key questions such as

How would the policy change improve the lives of the subjects?
Who would implement the policy changes?
Are there adequate resources to undertake the policy change?
These questions are central in making sure that the implementation process goes on smoothly and the barriers that would prevent the realization of the implementation goals are eliminated. Only after answering these questions should the policy changes go on.

Weaknesses and costs associated with the implementation plan could significantly delay the process of implementing policy changes. Bringing these concerns to parties who initiated the policy changes in the first place could be problematic because it may create mistrust and suspicion regarding the commitment to implement the change (Lavertu & Moynihan 2013b). It is important to overcome this issue because securing the trust of all stakeholder groups is an important ingredient in the successful implementation of policy implementation plans. Trust would lead the stakeholders to invest in the implementation process because they would be committed and motivated to see the successful implementation of the process, as opposed to adopting a wait and see approach, or doing the “bare minimum” (Koontz & Newig 2014).

However, to get this trust, there needs to be careful and deliberate steps taken to improve stakeholder relations. To overcome the risk of poor stakeholder involvement, it is imperative to approach this issue in a sensitive way. For example, instead of saying cost issues could be a problem, one could say, “do you think that cost issues could be a problem?” Doing so presents a non-judgmental attitude to making stakeholders aware of possible problems associated with the implementation process. The lesson here is that policy change initiators should not feel they are being judged or “being put down;” instead, they should feel that they are being “made aware” of an issue.

In case there are risks that are classified as important, attention needs to be drawn to the fact that the policy implementation process could be significantly compromised without addressing these risks. Thus, it is important to address these issues first before the policy implementation process goes on. The first step I would take in such a situation is to mitigate the risk. For example, if it was discovered that the policy implementation team does not correctly understand the scope and nature of the policy change, it should be known that the implementation process could be significantly jeopardized because it would not be able to understand the scope of the implementation plan.

The risk mitigation plan I would undertake here would be to educate the team about the policy change and make sure they understand all its tenets. However, before undertaking such a drastic process, it would be prudent to consult the policy change initiator to make sure they also understand the severity of the risk and the importance of undertaking the risk mitigation strategy. The lesson we could learn here is the need to assess all types of risk before undertaking a policy change. These findings could be useful in evaluating the policy implementation process and in maintaining good stakeholder relations, because, as demonstrated in the above strategy, the policy change initiator needs to be involved in managing the risks associated with the policy change.

Risk Identification and Management
It is often difficult to understand all types of risks that may occur in the management of policies and the development of law because it is difficult to anticipate the actions of all actors or players in the policy implementation process. Similarly, it is difficult to predict the reactions of some stakeholders after a policy change is implemented. However, as mentioned in this paper, contextual factors need to be considered when communicating with different stakeholders in the policy-making process. Each context often demands a unique communications strategy.

As a policy initiator, it is important to have absolute control of the policy implementation process because there is a likelihood that the policy implementers may fail to understand the letter or spirit of the law. Indeed, it is common for people and policy implementers to misunderstand new policies and laws, thereby requiring an interpretation of the same in a court of law (Lavertu & Moynihan 2013b).

Without an absolute control of the process, such issues are bound to arise. Consequently, it is pertinent for the policy formulator to be present, as a point of reference, to minimize the possibility of such occurrences happening, especially in the implementation phase. The findings of this section could be useful in understanding who should steer the implementation process. Indeed, as highlighted above, the policy formulators should steer the policy implementation process. These findings could be useful in determining who should spearhead the policy implementation process.

Completing the project should be the last stage of the policy implementation process. However, it is often unclear when to do so because there are some specific indicators that should let the policy implementers know that their work is done. Some of the key points to monitor before the closure of the implementation phase are a sense of alignment with the overarching goals and laws governing a specific jurisdiction and the realization of quantifiable metrics that could be shared across different government departments (Lavertu & Moynihan 2013b).

The latter metric is important because it provides a framework for understanding the initial success or failures of a policy. It could also be used as a performance measurement tool that could provide a platform for evaluating future policy changes. Ensuring that the newly implemented policies or laws align with the overarching policy environment is equally as important because, as mentioned in earlier sections of this paper, new laws should not contravene existing ones.

For example, once the policy makers establish that their new laws align with existing ones, or complement them, they would know that their work is done (Fyfe & Scott 2013). Such alignments could be with existing laws, culture of the society, or even with existing international laws. When policy makers can establish that these criteria are met, they can initiate the closure of the implementation phase. The findings of this section are useful in helping policymakers to understand some of the key performance indicators they should watch out for during the policy implementation phase.

Policy Impact Evaluation
There are two main types of evaluation criteria for analyzing the impact of policies on affected populations. One of them is the outcome evaluation criteria which strives to understand the effect of the policy implementation process on a population by evaluating its progress on people’s social, economic, or political development (Teodoro 2014). The second evaluation criterion is impact assessment, which strives to understand the effectiveness of the policy on meeting its projected outcomes (Fyfe & Scott 2013).

It is important to control who is affected by a policy because the failure to do so could significantly jeopardize the ability of policymakers to evaluate their policies. To do so, it is important to specify the exclusion and inclusion criteria in the policy to define who is affected by it and who is not. Indeed, in many countries, the impact of laws is defined by different social, political and economic metrics. For instance, in Ireland, government’s policies are made after considering the interests of people with different religious beliefs, people of different political opinions, people of different racial groups, people of different ages, people of different marital status, and people of different sexual orientation (Ahmed & Dantata 2016).

This analysis shows that these considerations affect the government’s policymaking criteria. More importantly, they span across different religious, social, economic, and political circles, the same way as other countries do (Bakhtyar 2013). In this regard, we find that many countries use social, political and economic measures to define who is affected by a policy and who is not. This finding is useful in the policy design phase because it can help policy formulators to pre-empt some of the implementation challenges that may arise and correct them accordingly.

It is also important to stop control or comparison groups from getting any intervention because they would complicate the evaluation process (Situmorang 2015). To stop this from happening, it is important to design the evaluation criterion in a way that there is a disclaimer in the decision-making process about the possible interference of the evaluation process because of the control group. This disclaimer should be made through the process of establishing the decision-making criteria (Teodoro 2014). In this section of analysis, specific decision about how the evaluation would be conducted, including the exclusion of control groups would be made.

This way, stakeholders would understand the reasons for excluding the control group and its impact on the evaluation process. Nonetheless, many practitioners often experience difficult situations where they have to build a context for change to get the support they require to build commitment and support from stakeholders during the policy evaluation processes. Thus, to get the buy-in required for undertaking the evaluation, a right context should be created and fostered (Koontz & Newig 2014). This finding would be useful in making sure that the evaluation process is contextualized to the scope of evaluation.

To ensure that the policies or laws are applied to all target groups, it is also pertinent to involve all stakeholders from all the target groups and make sure they are involved in the policy formulation and implementation phases (Situmorang 2015). There are different ways of engaging the public during policy-making. As highlighted in this paper, some of the most common ways include crowd sourcing, ethnography (decision thinking), idea generation (design thinking), deliberative dialogue, and social media analysis (Dawson & Stanko 2013). In the context of this study, crowd sourcing involves getting the views of the public from a large number of people.

Based on the sheer number of views that could be received on this platform, it is more practical for policy makers to use the internet and web-based platforms to get their views. Doing so will create awareness regarding the process and encourage them to be part of the process. Comparatively, if such methods of engagement are not used and stakeholders feel excluded from the process, they are bound to be disengaged. In extreme situations, they are bound to oppose the policies under implementation. Consequently, the policies would not apply to them. This finding is useful to our analysis because it helps to explain how to gain stakeholder buy-in in the implementation process.

Benchmarking performance is an important step for organizations and public institutions to use in policy evaluation because they help to identify gaps in performance and provide a platform, or justification, for filling them. Additionally, assessing and benchmarking performance is important for organizations and public institutions because the process helps in providing a platform for quality controls and a basis for referencing organizational performance (Barbosa & Brusca 2015). There are five key steps for assessing or benchmarking performance. They include determining what to benchmark, defining the metrics, developing a data collection methodology, collecting data, and identifying performance gap (Barbosa & Brusca 2015).

Nonetheless, to understand the causal mechanisms that affect the policy formulation process, it is important to conduct a scientific study that is based on conditional probabilities to understand how one variable affects another (Storbjörk & Isaksson 2014). In this analysis, it would be easy to make statements such as “X causes Y,” if a specific variable is constant. This approach involves holding certain variables constant to focus on one specific relationship. The findings of this analysis are useful in developing the issue tree for problem solving and problem analysis.

Resource limitations could be an impediment to the evaluation process because they could limit the ability of policymakers to evaluate all aspects of the implementation process. However, to mitigate this concern, one could employ the use of advanced technology to undertake this process. Here, the use of technology involves employing software tools, data analysis techniques, and new communication techniques in the policy evaluation process (Storbjörk & Isaksson 2014). Depending on the selected technological tool, it would be easier to choose between the impact or outcome evaluation technique.

For example, the availability and use of data analysis software could make the policy implementers move towards using the outcome evaluation method, as opposed to the impact evaluation method. Often, the adoption of these techniques is inexpensive because they help to make the evaluation process easier and more efficient. Furthermore, the increased availability of new technology has made technology cheaper. The findings of this paper could be useful in making policymakers operate more efficiently when implementing their policies.

Having powerful stakeholders in the policy implementation process could prove to be problematic for many implementation teams because their inputs could “make or break” the implementation process. Extra effort needs to be made to make sure that this group of stakeholders understands the benefits of the policy change, or the introduction of the new policies, failure to which they would not support the process (Pettas & Giannikos 2014). A high level of openness should also be characteristic of the kind of communication made with this stakeholder group.

This is aimed at gaining their trust and cultivating relationships with them. Doing so would significantly improve the odds of success in policy implementation because such powerful stakeholders are responsible for resource allocation and the creation of a sound political environment to implement the policies (Storbjörk & Isaksson 2014). Although communication is an important aspect of policy-making process, it is important to understand that past communication strategies may not be as effective as they should be because of changes in the communication landscape.

Particularly, the digital revolution has changed how people communicate and similarly affected the efficacy of traditional communication techniques, such as print media and television. Based on these changes, we should understand many things regarding the modern communication landscape and its effects on policy, safety and security. The findings highlighted in this section could be useful in improving stakeholder engagement.

Lastly, within the evaluation design, there needs to be a plan to mitigate completion risks because the possibility that the implementation plan may fail to materialize is real. In such circumstances, it would be prudent to transfer the risk to a third party, such an insurance company, to manage such a risk because it may be difficult to control it within the institution or agency involved (Pettas & Giannikos 2014). Similarly, it could be prudent to shorten the time involved in the implementation phase to minimize the room for error.

This analysis occurs within a firm understanding that the main aspects of leadership and management, such as teamwork, creativity, planning and decision-making, are central to the formulation and implementation of policies and laws. Key sections of this analysis also highlight the need to nurture a culture of high performance that is centered on the need to use resources efficiently to implement useful policies and laws. These insights are relevant in explaining the management of policies and development of law and are useful in improving the outcomes of implementation processes because they would help policy implementers to reach their goals on time.

Considerations in Policy Implementation
According to Ferlie and McGivern (2014), there are different communication strategies, such as television communications, social media campaigns, public forums of engagement and the likes. This finding is useful in understanding the types of risks to consider in the overall policy implementation plan. There are several issues to consider during the policy implementation phase. For example, when identifying the criteria to choose for identifying a policy problem that needs to be tackled, it is critical to carry out an impact assessment test to evaluate the significance of the problem to the overall policy implementation process (Pettas & Giannikos 2014).

For example, only those policy problems that significantly influence organizational activities and human societies should be considered for review. Policymakers use this basis to develop policies that are relevant to human societies. In fact, Barbosa and Brusca (2015) say that courts often refrain from giving widely unpopular decisions because they know such rulings could be defied if they do not relate or resonate with the people they are intended for. When such issues happen, there is a risk of of people deeming them as irrelevant. Generally, policy problems that do not have a high level of materiality should not be given much attention. However, those that are material to the accomplishment of the policy goals should be managed with a lot of care. These findings are useful in making sure that policy makers understand which problems to focus on when implementing the policy plans.

The process of understanding which group of people the policy would mostly affect should inform the process of choosing a target audience for a new policy (Pettas & Giannikos 2014). Stated differently, those who are mostly affected by the policy would be the perfect target audience because there is no reason for other people to care about a policy that does not affect them (Scottish Parliament Justice Committee on Policing 2013).

The inquiry-based approach of gaining insight into the audience’s view is often justifiable when building the capacity for leadership to identify the target audience because it allows the managers to take ownership of the policy-making process, thereby increasing their odds of supporting the outcome of the process (Fyfe 2014). Through the same approach, not only will the audience’s voices be fortified, but also they would feel empowered to embrace the process and deem it their own (Whitford 2014).

The inquiry-based approach is also justifiable in this case because it would help to increase audience engagement in the policy-making process, thereby giving the policy-makers an opportunity to gain an insight into their views. This step is unlike other methods of seeking the public’s views, which could be limited by the audience’s unwillingness to participate in the process. The inquiry-based approach solves this problem by increasing the motivation for the audience to engage in such discussions. Through the process, the facilitator could observe and understand the views of the audience (Fyfe & Scott 2013). This finding is useful in designing communication plans, in the policy formulation phase, because the communication strategy should align with the needs of the audience.

Many government agencies use a payment for results method to run policies. However, this method is not effective in the public sector, and more so in the policy formulation and implementation arena, because the public space is often vulnerable to unforeseen changes, which could impede the process of policy implementation.

For example, propaganda could change people’s views about a policy and create public disapproval towards it (Scottish Parliament Justice Committee on Policing 2013). In fact, history is littered with many cases where noble ideas have been shelved because of bad politics and the unwillingness of some actors to do what they are supposed to do (Scottish Parliament Justice Committee on Policing 2013). In this regard, it is difficult to secure the success of policy implementation processes regardless of how much one actor may be committed to the process. The findings of this paper are useful in improving the evaluation of policy outcomes.

Lastly, although people may have a high level of commitment to implementing new policies, independent research may show that the policies have failed to meet their required objectives (Padurariu 2014). In such cases, the researchers should report such findings to relevant stakeholders, as opposed to shielding them from the public. The importance of doing so is to maintain good stakeholder relationships and possibly provide an environment where changes could be made to improve the problematic areas (Padurariu 2014). The findings of this analysis are useful in helping policy implementers to understand what to do when they encounter problems in the implementation process.

Independent Evaluation and Auditing
Since government spending may sometimes lack the clarity and transparency required of such an institution, it is important to undertake independent audits to investigate government spending (O’Toole 2017). There is a lot of value in carrying out independent audits because investors are likely to have confidence in the government and its spending habits because they could rely on an audit report that is objective and free from interference (Scottish Parliament Justice Committee on Policing 2013). Independent audits would also minimize the possibility of fraud, especially from errand government officials who may want to swindle public funds because they know that an audit would reveal their misgivings.

Based on these factors, it is important to point out that the findings of this analysis are central in increasing transparency in government spending. This is a critical component of the policy implementation process because the misuse of government funds could easily deprive policy implementers the resources meant for the policy implementation process (Scottish Parliament Justice Committee on Policing 2013). The main finding we get from this analysis is the need to train all employees to carry out their functions well to minimize the risk of fraud. In this step, the planners should avail all the important information pertaining to the policies to allow the trainees to understand what is required of them.

All concerned parties should also reiterate these policies regularly so that all stakeholders internalize them. Doing so will ensure that the implementers are equipped to manage most of the challenges associated with the policy implementation process. Similarly, to avoid such risks, there should be a clear definition of roles in the organization. This effort would help them to avoid unnecessary arguments about who needs to do what and where. Indeed, as Holmberg and Balvig (2013) points out, people tend to work better with each other when their roles are clearly defined. Conflicts between members of the implementation team would hereby reduce, thereby increasing the opportunity for successfully implementing policies. Comprehensively, most of the challenges defined above need to be mitigated to minimize the risk of fraud or a poor implementation of policies (Holmberg & Balvig 2013).

Although auditing is usually based on past performance, its findings could still be relied on to monitor what is happening in the present. This fact stems from the fact that past information could be used as a reliable measure of predicting the future, or understanding the present (De Sardan & Ridde, 2015). For example, an audit report that shows areas of pilferage of funds could be used as a reliable measure to predict areas of weakness in financial management. The same is true if I undertake extensive consultations with professionals who are knowledgeable about the field, and most importantly those who understand the organizational setting. These examples explain how to detect cases of financial impropriety in an organization, or institution. Such cases are likely to affect the quality of policy implementation. Comprehensively, the findings of this paper are useful in understanding how best to manage resources through early detection of risk areas.

Developing and Maintaining a Culture of Performance
Having a high-performance culture is useful in improving the probability of a successful implementation of policy objectives. For example, such a culture could help to make useful predictions about how people could respond to a new policy (De Sardan & Ridde, 2015). Some researchers often argue that it is not important to try and make predictions about new policies, but findings from Liu et al. (2015) show that doing so is important in designing policies so that they are able to overcome some of the challenges or impediments to policy implementation.

The failure to predict policies would make it difficult for policy makers to understand the kind of objections they may encounter in the policy implementation phase, thereby depriving them of their ability to plan for them. Particularly, large companies cannot afford to miss this strategy because they would fail to understand their customer requirements. Particularly, large multinationals or global companies that provide sensitive products or services should pay close attention to this strategy to develop a sound customer map because the failure to do so could lead to serious service delivery issues (Lavertu & Moynihan 2013a). These findings are useful in the risk management process because they would help policy planners to understand what to expect when implementing new policies.

Understanding human behavior is at the centre of this process because human beings and their actions could either impede the policy-making process, or support it. In this regard, the customer-centric approach is more reliable in the policy implementation process. Additionally, the customer mapping process would allow companies to point out which aspects of their operations are causing unnecessary delays and exclude them from their processes for the betterment of their customer relationships. Removing these impediments to the delivery of services or products would not only make the organizations more efficient, but more cost-effective as well in achieving their goals (Lavertu & Moynihan 2013a; Greasley & Hanretty 2016).

Having an efficient customer-mapping tool could equip companies with the skills of encouraging their customers to recommend their products or services to other people. Policy makers and their implementation teams can get better at understanding human behavior by investigating past behavioral patterns because as new research shows, human beings are often creatures of habit. In this regard, it would be useful for them to investigate past behavior to understand how they could exploit them for the benefit of improving the policy formulation and implementation processes. The findings of this paper are also useful in risk management processes because they would help policy makers to understand the kinds of objections or support they could encounter. In this regard, they could plan accordingly.

Linking Staff Appraisal to Organizational Performance
Linking employee appraisal to organizational performance could be a critical part of the evaluation culture. However, this evaluation culture should be action-oriented because the quest of the policy makers should always be to find solutions to pressing implementation problems (Murray 2014). At the same time, the evaluation culture should profess a teaching-oriented value in the sense that there should be a unity of formal evaluation through all cadres of the implementation team. Such evaluations should also not be limited to one individual or department in the organization because, as mentioned in earlier sections of this paper, the process should involve all stakeholders. The findings of this analysis could be useful in understanding the values to uphold in the policy implementation process because some government agencies often lack the direction to follow when undertaking this task.

Although it is important to evaluate policies and laws, it may not be practical to evaluate all of them because of their subjective nature. Indeed, as Moldogaziev & Resh (2016) observe, it is difficult to measure subjectivity because of the failure of a reliable index to do so. Additionally, some policies may not have an immediate impact that we could all observe. In other words, their impact could be felt in the long-term. Therefore, it would be difficult to holistically evaluate them because of time-frame limitations. Nonetheless, investigating what experts are saying about future communication strategies could also be a pointer in understanding how future strategies could be received (Greasley & Hanretty 2016).

However, this approach is not ideal because some of the information conveyed by the experts cannot be relied upon. Instead, we could use public platforms of engagement, or debate, where leaders initiative conversations surrounding a specific policy topic. Through spontaneous group discussions, policy makers could get the views of the public in any given policy area and incorporate the same in the process of policymaking. This type of format for engaging the public in the policy-making process is closely related to deliberative dialogue, which is often designed to get the best views regarding the policy making process (Effiong 2013).

For example, in the area of governance, the deliberative dialogue should seek to get the views of security experts, political scientists and the likes. Their input will add a professional touch to the policy-making process (Effiong 2013). Information could also be obtained using social media tools. However, this type of platform is often prone to abuse. Therefore, it should be consistently checked and monitored to make sure that only the useful views are included in the policy-making process. These findings are useful in understanding how to develop policy evaluation guidelines.

Comparatively, as explained by Moldogaziev and Resh (2016), evaluations are often easier done when they are simple because everyone could understand them. Based on the importance of communicating with internal and external stakeholders involved in the policy-making process, De Sardan and Ridde (2015) say the failure to engage stakeholders in the evaluation process could be disastrous for policy makers because there are several inherent risks attached to not doing so. For example, there is a high probability that community members would not cooperate with policymakers when they are not engaged in the policy evaluation process. Consequently, policymakers are likely to experience resistance to what they are doing, regardless of whether they have noble intentions, or not. However, organizations need to avail financial resources and the expertise needed to teach staff about evaluation if such processes are to be successful.

The policy implementation phase is among the most difficult ones after engaging stakeholders and evaluating their performance. There are different problems associated with the process, including the failure to have a team that understands the policies, using over-ambitious time-scales, poor project management, inadequate planning, and the failure to designate clear roles and objectives of each member of the implementation team. Consulting with professionals and understanding some of the political challenges that may impede the policy implementation process would ensure realistic targets are developed. Based on this need, I would say the best evaluation techniques are participatory because stakeholder engagement is a key part of the process.

To realize maximum stakeholder engagement, it important to work only with stakeholders that have a proven record of accomplishment in delivering what is expected of them, or those who have the capacity to do so. To make sure they meet agreed targets, it is also important to sign a performance contract with them that specifies the timelines of policy implementation. This document would be legally binding and would peg rewards to the realization of implementation targets. Such agreements have been used in several cases where government departments have tried to manage the performance of their employees, with relative success (Ingold & Leifeld 2016).

Its implementation in the policy environment is bound to be problematic because the success of the process partly depends on the sheer goodwill of the stakeholders, but it would be a start in specifying the kind of targets that are expected of each stakeholder, or partner. Another strategy of making sure that the stakeholders meet the required expectations and agreed targets is providing them with adequate resources to do so. This preposition stems from studies that have shown the willingness of some stakeholders to do their job, as is required, but the lack of resources may impede them from realizing the success they desire (Fyfe & Scott 2013). These findings are important in fostering engagement among stakeholders.

Lastly, I believe that the findings of policy evaluations should be used to suggest actions, as opposed to taking actions because a finding is a mere indication of an outcome and not necessarily a factor influencing the same. For example, in this paper, we have recommended that communications should be redesigned to fit the digital communication platform.

Indeed, based on the changes that the digital revolution brings to policy development, the process of designing messages to suit this platform and meet their intended objectives should be a top requirement in policy implementation because it is the only way of making sure that the messages conveyed reach their intended audiences and achieve the required goals. To get the information to include in these messages, policy makers could use focus groups. Nonetheless, focus groups are not only easy to work with, but also effective in getting the views of a large number of people because from a small sample of respondents, policymakers could understand the cultural views and norms that they need to consider in the communication plan. These findings are useful in policy implementation.

Comprehensively, based on the findings we present in this report, it is important to point out that laws are not static and neither is the process of making them. Laws should respond to different situations and issues, failure to which they would be deemed irrelevant. These findings are instrumental to our understanding of the need to foresee the regulatory framework and understand how it needs to change to appeal or address to current social, economic and political situations. While the process of law making is central to the change management process, it is critical to point out that there are limitations to law making because the process should not contravene any judicial limitation or international obligation that countries have in reference to the same. Generally, the findings of this paper are useful in creating a seamless policy formulation and implementation guideline that would work in both the private and public sector.

Conclusion
Generally, based on the findings highlighted in this paper, we find that many facts about policy and law implementation and formulation could be borrowed from other disciplines such as business and military strategic development. For example, we could draw comparisons between teamwork in business and stakeholder engagement in policy implementation. As highlighted in some sections of this paper, stakeholders are critical in the implementation of policies and laws. Involving their input in the communication process is similarly an important process in getting their support.

To do so, it is important to undertake a stakeholder mapping process because it has tremendous value in this regard. In this paper, we also find that the internationalization of law is beneficial for parties that ascribe to international legal agreements because they would easily implement or enforce their laws outside their borders through jurisdictional cooperation. However, the global space is complex because of the multiplicity of different interests from global players. Therefore, it is important for leaders to demonstrate good leadership acumen, hinged on the execution of well thought out policy implementation strategies.

Reference List
Ahmed, I & Dantata, B 2016, ‘Problems and challenges of policy implementation for national development’, Research on Humanities and Social Sciences, vol. 6, no. 15, pp. 5-16.

Bakhtyar, B 2013, ‘Potentials and challenges in implementing feed-in tariff policy in Indonesia and the Philippines’, Energy Policy, vol. 60, no. 1, pp. 418–423.

Barbosa, A & Brusca, I 2015, ‘Governance structures and their impact on tariff levels of Brazilian water and sanitation corporations’, Utilities Policy, vol. 34, no. 1, pp. 94–105.

Bullock, K & Sindall, K 2014, ‘Examining the nature and extent of public participation in neighbourhood policing’, Policing and Society, vol. 24, no. 4, pp. 385–404.

Chanin, J 2014, ‘On the Implementation of pattern or practice police reform’, Criminology, Criminal Justice, Law & Society, vol. 15, no. 3, pp. 38–56.

Dawson, P & Stanko, B 2013, ‘Implementation, implementation, implementation: insights from offender management evaluations’, Policing, vol. 7, no. 3, pp. 289-298.

De Sardan, J & Ridde, V 2015, ‘Public policies and health systems in Sahelian Africa: theoretical context and empirical specificity’, BMC Health Services Research, vol. 15, no. 1, pp. 3-7.

Effiong, A 2013, ‘Policy implementation and its challenges in Nigeria’, International Journal of Advanced Legal Studies and Governance, vol. 4, no. 3, pp. 26-31.

Ferlie, E & McGivern, G 2014, ‘Bringing anglo-governmentality into public management scholarship: the case of evidence-based medicine in UK health care’, J Public Adm Res Theory, vol. 24, no. 1, pp. 59-83.

Froestad, J, Grimwood, S & Herbstein, T 2015, ‘Clifford shearing, policy design and nodal governance: a comparative analysis of determinants of environmental policy change in a South African city’, Journal of Comparative Policy Analysis: Research and Practice, vol. 17, no. 2, p. 174.

Fyfe, NR 2014, A different and divergent trajectory? Reforming the structure, governance and narrative of policing in Scotland, Routledge, London.

Fyfe, NR & Scott, K.B 2013, In search of sustainable policing? Creating a national police force in Scotland, Eleven International Publishing, The Hague.

Fyfe, NR, Terpstra, J & Tops, P 2013, Centralizing forces? Comparative perspectives on contemporary police reform in Northern and Western Europe, Eleven International Publishing, The Hague.

Greasley, S & Hanretty, C 2016, ‘Credibility and agency termination under parliamentarism’, J Public Adm Res Theory, vol. 26, no. 1, pp. 159-173.

Hill, M & Hupe, P 2014, Implementing public policy: an introduction to the study of operational governance, SAGE, London.

Holmberg, L 2014, ‘Scandinavian police reforms: can you have your cake and eat it, too’, Police Practice and Research, vol. 15, no. 6, pp. 447–460.

Holmberg, L & Balvig, F 2013, Centralization in disguise. The Danish police reform 2007–2010, Eleven International Publishing, The Hague.

House, S 2013, Collaborative working and shrinking budgets: can we get better value by behaving smarter? Apex Scotland, Edinburgh.

Hupe, P 2014, ‘What happens on the ground: persistent issues in implementation research’, Public Policy and Administration, vol. 29, no. 2, pp. 164–182.

Ingold, K & Leifeld, P 2016, ‘Structural and institutional determinants of influence reputation: a comparison of collaborative and adversarial policy networks in decision-making and implementation’, J Public Adm Res Theory, vol. 26, no. 1, pp. 1-18.

Koontz, T & Newig, J 2014, ‘From planning to implementation: top-down and bottom-up approaches for collaborative watershed management’, Policy Studies Journal, vol. 42, no. 3, pp. 416 -420.

Lavertu, S & Moynihan, D 2013a, ‘The empirical implications of theoretical models: a description of the method and an application to the study of performance management implementation’, J Public Adm Res Theory, vol. 23, no. 2, pp. 333-360.

Lavertu, S & Moynihan, D 2013b, ‘Agency political ideology and reform implementation: performance management in the bush administration’, J Public Adm Res Theory, vol. 23, no. 3, pp. 521-549.

Liu, N, Tang, S, Zhan, X & Lo, C 2015, ‘Political commitment, policy ambiguity, and corporate environmental practices’, Policy Studies Journal, vol. 2, no. 1, pp. 5-15.

Moldogaziev, T & Resh, W 2016, ‘A systems theory approach to innovation implementation: why organizational location matters’, J Public Adm Res Theory, vol. 26, no. 4, pp. 677-692.

Murray, K 2014, Stop and search in Scotland: an evaluation, Scottish Centre for Crime and Justice Research, Glasgow.

O’Toole, L 2017, ‘Implementation for the real world’, J Public Adm Res Theory, vol. 27, no. 2, pp. 376-379.

Padurariu, A 2014, ‘The implementation of police reform in Bosnia and Herzegovina: analysing UN and EU efforts’, International Journal of Security and Development, vol. 3, no. 1, p. 4.

Pettas, N & Giannikos, I 2014, ‘Evaluating the delivery performance of public spending programs from an efficiency perspective’, Evaluation and Program Planning, vol. 45, no. 1, pp. 140-145.

Pollitt, C 2015, ‘Wickedness will not wait: climate change and public management research’, Public Money & Management, vol. 35, no. 3, p. 181.

Santos, R 2013, ‘Implementation of a police organizational model for crime reduction’, Policing: An International Journal of Police Strategies & Management, vol. 36, no. 2, pp. 295–311.

Scott, K 2013, ‘A single police force for Scotland: the legislative framework’, A Journal of Policy and Practice, vol. 7, no. 2, pp. 135–147.

Scottish Parliament Justice Committee on Policing 2013, Official report 31 October 2013, Scottish Parliament, Edinburgh.

Situmorang, A 2015, ‘The implementation of community policing in the deliberative democracy perspective’, International Journal of Applied Sociology, vol. 5, no. 4, pp. 171-174.

Storbjörk, S & Isaksson, K 2014, ‘Learning is our Achilles heel. Conditions for long-term environmental policy integration in Swedish regional development programming’, Journal of Environmental Planning and Management, vol. 57, no. 7, p. 1023.

Teodoro, M 2014, ‘When professionals lead: executive management, normative isomorphism, and policy implementation’, J Public Adm Res Theory, vol. 24, no. 4, pp. 983-1004.

Terpstra, J & Fyfe, N 2014, ‘Policy processes and police reform: examining similarities and differences between Scotland and the Netherlands’, International Journal of Law, Crime and Justice, vol. 42, no. 4, pp. 366–383.

Tummers, L 2017, ‘The relationship between coping and job performance’, J Public Adm Res Theory, vol. 27, no. 1, pp. 150-162.

Ulibarri, N 2015, ‘Tracing process to performance of collaborative governance: a comparative case study of federal hydropower licensing’, Policy Studies Journal, vol. 43, no. 2, p. 283.

Van Sluis, A, Cachet, L & Jochoms T 2013, Contested police systems: changes in the police systems in Belgium, Denmark, England & Wales, Germany and the Netherlands, Eleven International Publishing, The Hague.

Whitford, A 2014, ‘Information and uncertainty in policy implementation: evidence from the implementation of EPA waivers’, J Public Adm Res Theory, vol. 24, no. 2, pp. 267-288.

Zhan, X, Lo, C & Tang, S 2014, ‘Contextual changes and environmental policy implementation: a longitudinal study of street-level bureaucrats in Guangzhou China’, J Public Adm Res Theory, vol. 24, no. 4, pp. 1005-1035.

Medicine Dissertation

by admin | Mar 20, 2023 | Uncategorized

Chronic Kidney Disease: Body Mass Index and Haemoglobin Dissertation
Chapter one: Introduction
Introduction and Background Information
Across the globe, chronic kidney disease (CKD) is categorised as a critical health problem. It is defined as glomerular filtration rate (GFR)<60Ml/min/1.73m2 for >3 months irrespective of diagnosis, or kidney damage. The damage to the kidney is identified by abnormalities in the patients’ blood or urine. It is also identified through imaging tests kidney biopsy.

The prevalence of CKD is on the rise. It has reached pandemic levels across the globe.1 Chronic Kidney Disease affects approximately 7-10% of the adult population in the UK. According to the World Health Organisation, kidney disease leads to 850,000 deaths in the world annually. It also accounts for 15,010,167 in disability-adjusted life years. The consequences of the disease among children are far more devastating because it condemns the child to various levels of lifelong medical disabilities.

The dominant causes of CKD among adults are hypertension and diabetic nephropathy. However, irrespective of the factors that initiate the condition, the onset of the disease triggers a chain of occurrences. The events predictably describe a common final pathway where the condition progresses to kidney failure. It is observed that the condition is associated with increased risk to cardio-vascular disease, stroke, renal failure, and death.

The increase in the prevalence of CKD is attributed to different factors. For instance, various studies that have been undertaken to determine the various conditions associated with CKD have pointed out to the possible relationship between the disease, levels of haemoglobin concentration, and obesity.2 However, the findings have elicited debates, which have necessitated more epidemiological studies in the endeavour to conclusively establish the associations between obesity and haemoglobin levels among people with CKD.3 Even though there is a marked progress in the studies, there are arguments purporting that the relationships may vary based on different factors.

The current study was conducted against this background. The findings of the research will expand the knowledge regarding the relationship between BMI and haemoglobin among patients with CKD. The findings of the study will inform policy development.

Overweight and Obesity
Obesity and overweight have been on the rise. They have attained such global proportions as to be categorised as epidemics. Epidemiologists suggest that the two conditions can lead to the impairment of kidney functions.4 However, most studies carried out in relation to overweight and obesity are inconclusive. Nevertheless, some studies have pointed out to the existence of positive relationship between BMI and CKD. For instance, some researchers have tried to show that people with high BMI baseline have a high probability of future renal dysfunction.

Some studies indicate that there are different pathways in which weight may contribute to renal diseases. Some of the pathways include lipid disturbances, pro-inflammatory states, as well as hormonal and hemodynamic factors.5 The studies that point out to these pathways are established in general populations. However, it is worth noting that the researches are conflicting. As such, it is difficult to provide comparisons bearing in mind that different markers are used to quantify obesity. The markers include race and socio-economic factors. The variations highlight the need for specific studies to investigate the implications of BMI among people with CKD.

Haemoglobin
Concentration of haemoglobin indicates the presence of anaemia. Anaemia is common among patients suffering from CKD, which is a pointer to the crucial function that kidneys play in haemopoisesis, oxygenation, and stimulation of the precursors for haemopoietic in the bone marrow.6 Based on this perspective, the level of haemoglobin among people suffering from CKD oscillates above or below the recommended targets within short periods. As a result, anaemia develops as a possible complication associated with CKD.

Some studies indicate that the fluctuation of haemoglobin is associated with the severity of the renal dysfunction.7 The correlation between the renal function and the haemoglobin levels is the basis on which Erythropoietin-stimulating agents (ESA) are used in the management of CKD. It is, however, important to note that there are multifactor causes of anaemia. For instance, it may be caused by lack of iron in the diet, folate, vitamin B12, and Erythropoietin.8 In the case of CKD, the most significant cause of anaemia is Erythropoietin deficiency.

It is worth emphasising that CKD has become a global health problem whose prevalence has been on the rise both in the developed and developing nations. With the increase in obesity and cases of anaemia around the world, the two conditions can be categorised as major co-morbidities of CKD patients. The co-morbidity of anaemia gets more pronounced at the later stages of the kidney complications.9

Based on the varying evidence about BMI and haemoglobin implications in CKD, it is apparent that there is a need for a conclusive study to determine the relationship that exist and its impacts on the management of the condition. The recognition of the manifestation of the co-morbidities of CKD is a major milestone in the formulation of policies regarding the treatment and management of renal complications.

Objectives of the Study
The objective of the study was to establish the relationship between obesity, its subsequent influence on anaemia, and the effects of anaemia on CKD. Many studies have been carried out to enhance the understanding of CKD and to inform the design of possible intervention programs for both prevention and management of the condition.

However, the existing awareness of the causes of CKD is low among the healthcare policy formulators, caregivers, and the patients.10 As such, there is a need for the creation of adequate awareness about CKD and the multi-factorial causes associated with it. For instance, it is important to establish the relationship between haemoglobin levels and the BMI of patients with diabetes mellitus, which, according to researchers, is one of the major causes of kidney diseases. Such knowledge is critical in guiding the policy development and the implementation of intervention programs.11

To this end, the major objective of the current study was to evaluate the relationship between BMI and haemoglobin in a population with CKD. The objective will guide the collection of data that can be used to inform development of policies on the prevention and management of CKD.

Implications for Policy
The 21st century has witnessed an increased emphasis on the implementation of healthcare policies that are evidence-based. The move has created the need for health researchers to invest in studies aimed at understanding the various complications associated with CKD and how they can be managed to increase the quality of life for the patients.

Despite the many studies undertaken, the findings regarding the relationship between haemoglobin, BMI, and CKD are inconclusive. Some of the factors that have aggravated the nature of the inconclusive findings are variations based on gender, race, and socio-economic factors. The differences have been identified both in cross-sectional and longitudinal studies investigating the association between BMI and haemoglobin. For example, there is evidence of variations in the nutritional status of different populations, which may affect the BMI of the individuals.

In relation to haemoglobin levels, studies have shown that patients with defective kidneys, and who are put under human Erythropoietin treatment, reflect poor response to the drug.12 The poor response is brought about by the association between the condition and iron deficiency.13 The implication is that if the iron deficiency is corrected, response to therapy will be considerably increased as proper haemoglobin levels are restored. Similarly, some studies investigating the relationship between BMI and CKD have found that the prevalence of the condition is higher among people with high BMI. However, there are variations between men and women, especially among patients with diabetes and hypertension. To this end, women register high BMI compared to men.14

To improve cost effectiveness in the treatment of CKD, there is a need to have an in-depth understanding of the main co-morbidities associated with the condition. In addition, the establishment of the relationship between the co-morbidities presents the health providers with a basis for policy formulation, which ensures that therapists take into consideration the management of these elements. The studies should be patient-based as opposed to blanket application, which may render the policies ineffective. Such policies lead to inadequate treatments, which may later result in complications. The common problems include the progression of the condition to the final stages of renal dysfunction, cardiovascular complications, and poor quality of life for the patients.15

The general rationale for the screening of a medical condition is that the problem is sufficiently prevalent and has an association with adverse impacts as to be of significant public health concern. The condition should also be detectable in early clinical stages. In addition, the treatment should improve health outcomes. The screening for eGFR among obese people offers an opportunity for nationwide attention and intervention through sensitisation campaigns aimed at educating the general population on the risks of anemia and CKD. Consequently, the findings of the current study will inform the policymakers on the need for awareness campaigns and other systems, which act as mitigating factors in addressing the escalating problem of CKD among the population.

It is important for the policymakers and the health providers to understand the factors that aggravate the CKD in specific populations. Bearing this in mind, the following study provides an analysis of the relationship between BMI and haemoglobin in ICLDC population corrected for CKD. The study will provide important information for the formulation of policies for the management of the patients.

Rationale
It has been established that some of the debilitating conditions among patients with CKD include anaemia and obesity. Consequently, comprehensive awareness regarding the complications can enhance the quality of care accorded to the patients. It is worth noting that the high prevalence of obesity among women does not rule out the co-morbidity of this condition among the men with renal dysfunction. In fact a study conducted by the Obesity and Renal Cancer Association found that the risk of renal cell cancer was high among both men and women.16

In relation to anaemia, it has been found that people with CKD can suffer from anaemia due to different reasons. As such, in the treatment process, there is the need to carry out an in-depth analysis to establish the main causes of the complication. Anaemia occurs before the decline in renal function due to Erythropoietin deficiency. It is important to note that Erythropoietin has anti-inflammatory and anti-obesity effects. Consequently, an inflammation may have an implication on Erythropoietin. It has also been noted that there are other factors during inflammation that affect Erythropoietin.

They include, among others, Hepcidin. It must be understood that Erythropoietin deficiency is a major cause of anaemia among CKD patients. As such, the treatment of CKD should be preceded by the evaluation of the BMI status and the causes of the anaemia in the patient, which is followed by appropriate management. In addition, there should be a clear understanding of the association between BMI and haemoglobin. The understanding will help to avoid the use of CKD therapies that are rendered ineffective by the obesity and anaemia conditions.

Bearing in mind the implications of high BMI and anaemia, it is important to carry out an in-depth analysis to describe the association between the former and haemoglobin in populations with CKD. The information will be paramount in the formulation of health policies. In addition, it will help in the compilation of the right treatment and reduction of the morbidities and mortalities among populations with renal complications. The current health policies, however, do not take into account the association between BMI and anaemia.

Definition of Terms
Stages of Chronic Kidney Disease
In this study, CKD was defined based on the NKF-KD0QI guidelines. The guidelines rank the status of the kidney damage based on the creatinine clearance. As such, the eGFR cut-off levels were used to determine the five stages of CKD.

Anaemia
It is defined using levels of haemoglobin. The levels vary between men and women based on the health status of the patient. For men, concentration below 13.0 g/dl was used to define anaemia. For women, the level was less than 2.0 g/dl.

Erythropoietin
Erythropoietin is an essential hormone produced in the liver and the kidney to enhance the production of red blood cells. The study concentrated on Erythropoietin levels. For the purposes of the study, the normal response to Erythropoietin for patients with CKD formed the basis of discussion.

Chapter 2: Systematic Literature Review
Introduction
There are different studies that have been conducted to investigate the implications of CKD and the related co-morbidities. The studies have been in the form of case studies, cross-sectional studies, and longitudinal studies. In relation to BMI and haemoglobin, the studies have mainly studied the relationships between obesity and CKD. In relation to haemoglobin, the focus has been the investigation of prevalence of anaemia in patients with CKD. The following section is an overview of CKD and review of the studies that have been conducted in the past. The focus is on the researches that touch on BMI and haemoglobin in patients with CKD.

Overview of Chronic Kidney Disease
Chronic kidney disease is classified as one of the major public health problems in many parts of the world. This has been due the increase the incidence and prevalence of the CKD in both the developing and developed nations. There are different stages of CKD, which are based on the glomerular filtration rate. The extent of the kidney damage is determined by albumunuria.17 In addition to being used as markers of CKD, the estimated glomerular filtrate rate (eGFR) and the albuminuria are classified as signifiers of cardiovascular disease.

In England, the prevalence of CKD as reported by use of eGFR and albuminuria in 2009/2010 was 6% for men and 7% for women. Kidney damage is the pathological abnormalities that can be traced by use of blood, urine and other imaging tests.18 A renal dysfunction is rated as chronic when the eGFR is 60ml/min/1.73m2 for over three months.19 As stated, above, eGFR provides the basis for staging CKD. The following table is a guideline for the identification of stages of CKD. The stages are critical identifiers of the required therapeutic interventions for each stage.

Table 1: The five stages of CKD based on eGFR

Stage GFR (ml/min/1.73m2) Description
1. ≥90. Elevated GFR and renal damage.
2. 60-89. Damage of Renal with decrease in GFR.
3. 30-59. Mild to moderate decrease in GFR.
4. 15-29. Severe decrease in GFR.
5. <15. Kidney failure.
For patients between stages 1-3, the severity is classified as mild to moderate. The eGFR is >30mL/min per 1.73m2. At this stage, patients are supposed to undergo screening interventions for the risk factors of CKD. The screening is followed by the analysis of the causes and treatment of the conditions such as the metabolic abnormalities such as obesity and other conditions such as anaemia. After reaching stage 3, the disease progresses to stage 4.

Here, it is termed as severe impairment. At this stage, the eGFR reduces to between 30-15 ml/min per 1.73m2. At this juncture, the focus of the care providers is renal replacement. Finally, stage 5 has eGFR of less than 15 ml/min per 1.73m2. It is normally established as renal failure. The major signs at the stage include uraemia. The condition is marked by raised levels of urea in blood and other nitrogenous wastes excreted by the kidney. The management of the CKD at this level includes dialysis or transplantation of the renal.

It is important to note that prevalence of any disease plays an important role in the assessment of the trends, establishment of the underlying determinants and in implementation of the procedures to manage and prevent CKD. In developed countries such as the UK, the concerned health professionals have put in place different policy initiatives to identify and manage CKD. They include the establishment of a reporting system for all eGFR data from the biochemistry laboratories.

This policy initiative makes it easy for the authorities to determine the prevalence and incidence levels and hence, help in the budgeting for the medical care services.20 The policy measures taken by the UK health authorities present a great advancement in ensuring that quality of life is enhanced by ensuring that detected cases are treated before the CKD progresses to the final stages which are more expensive to treat.

However, it is worth noting that there is still need for a policy framework that puts into consideration the complications related to CKD which have a potential of lowering the treatment efficacy. Thus, a policy framework based on proper understanding of the co-morbidities will thus ensure a comprehensive awareness of the CKD.

Implications of Haemoglobin Levels among Patients with CKD
A study conducted by McClellan, Aronoff, and Bolton shows that the prevalence of anaemia is high among patients with renal dysfunctions.21 As such, anaemia is associated with increased chances of developing diabetes complications such as nephropathy and heart failure. In patients with diabetes, studies show that there are myriad of factors that contribute to the increased prevalence.

However, many studies have shown that majority of patients with renal impairment have functional Erythropoietin deficiency. It is also worth noting that the deficiency of Erythropoietin as a major cause of anaemia is not influenced by the severity of the renal dysfunction. This shows that despite the clear correlation of the anaemia and diabetes, there is the need for more studies to determine correction of the Erythropoietin. The situation results in the improved management of anaemia.

Kidney plays a great role hemopoiesis, oxygenation, and stimulation of haemopoeitic precursors found in the bone marrow. In many cases, the inability of the kidney to increase the release of Erythropoietin in order to counter the reduction in the haemoglobin level has been pointed out to be one of the causes for the development of renal anaemia. Therefore, there is evidence that functional Erythropoietin deficiency has a role in the diabetic nephropathy anaemia and thus the potential consequences for mortality and morbidity among the diabetic patients.

The definition of anaemia in relation to the haemoglobin level varies based on the gender age and the status of the individuals. For patients with CKD, the incidence of anaemia occurs when the haemoglobin levels are below 13.5 g/dl in males and 12.0g/dl in females (Appendix 2). The graph demonstrates the relationship between the haemoglobin and obesity. For example, many nations, the best practice guideline indicates that premenopausal women with haemoglobin level below 11.5 g/dl are anaemic, for adult males and post menopausal women it is 13.0 g/dl.

In relation to age, men aged above 70 years are said to be anaemic if the haemoglobin levels are less than 12.0 g/dl. Anaemia is manifested in all the five stages of CKD; however, its severity increases at the late stages of the kidney dysfunction. This necessitates the need for supplementation in order to correct the deficiencies. For instance, the prevalence of anaemia increases when the eGFR is 70ml/min or less for the adult males and less or equal to 50ml/min for the females. Many cross sectional studies have shown that anaemia is a major co-morbidity for CKD.

Deficiency of Erythropoietin
There are many factors responsible for the development of anaemia among patients with CKD. The main cause is the inability of the failing kidneys to synthesise EPO. In the body, the EPO is produced both in the liver and the kidney. The liver produces 10-15% of the EPO, while the rest is produced in the kidney. As such, the kidney is the main organ for providing the body with EPO.

The appropriate measure of the kidney function is the glomerular filtrate rate which varies depending on the sex, size of the body and age. For young adults, the GFR measures between 120 and 130 ml/min/ per 1.73 m2. The levels decline with age to adulthood in which the kidney function losses more than half GFR by adulthood.22

Anaemia presents adverse risk factors for patients with CKD. Among the patients with CKD, anaemia occurs at early stages more so for patients with diabetes compared to cases of CKD caused by other factors.23 To re-emphasise, diabetes is one of the leading causes of kidney diseases. In addition, kidney is also a risk factor for diseases such as coronary heart disease. As such people who suffer from both anaemia and diabetes are likely to have faster progression of the CKD from stage 1-5 if proper care is not given.

A study was conducted by Lucile, Marie and Nicole et al (2012) to measure the levels of EPO among patients with CKD.24 The patients constituted those with and without anaemia and the aim were to evaluate the concentration levels of haemoglobin in CKD patients. The study found that the response of EPO to the concentration of haemoglobin varied based on the average glomerular filtration. In most cases, the patients with anaemia but without CKD, had EPO was that was inversely correlated with haemoglobin concentration.

However, for patients with CKD, the correlation is deranged. In yet a similar study that examined the relationship between haemoglobin and the concentration of the serum EPO, a routine measurement of the parameters among 167 people without CKD and 333 CKD patients was conducted in a hospital in German.25

The findings established that there exist a strong correlation between anaemia severity and the increase in EPO for the 167 people without CKD. For the population with CKD, the research established that as the CKD stages progresses, the correlation between EPO and haemoglobin gradually attenuated till it disappears at the final stages of CKD (stage 4 and 5).

Inhibition of Erythropoietin
Studies investigating the prevalence of anaemia in CKD patients show that it remains high despite the high levels of EPO. The implication is that CKD decreases the sensitivity of the bone marrow. It inhibits Erythropoiesis. According to another study, inhibition of the Erythropoiesis is common in uremic patients.26 The cause is the uremic sera inhibitors, which is the mechanism for proliferation of hemosynthesis. As a result, it is common for health care providers to encounter progressive anaemia for patients who have not reached dialysis but have declining renal function. This is an attestation that the Erythropoietin tissues become less sensitive to the EPO for patients with CKD.

Body Mass Index and CKD
Studies have shown that the cause of death for people with the CKD is due to the combination of complications, such as cardiovascular diseases, diabetes, and anaemia. The cardiovascular complications are high among patients with high BMI.27 The other contributing factors include severe anaemia, the presentation of the cases for treatment at later stages of the CKD, poor awareness of the kidney disease, and lack of clear policies to guide the diagnosis and treatment. High BMI signifies high cases of overweight and obesity which have grown exponentially across the globe.28

These problems have reached pandemic levels. Studies have pointed out that obesity leads to increased mortality due to the consequent increase of cardiovascular diseases. Cumulative evidence suggests that there is an association between BMI and mortality. For instance, some studies have indicated that there is a low risk of death among patients with BMI of 20-27.5 kg/m2. This indicates that people with normal BMI have a survival advantage due to reduced risk of chronic disease such as diabetes and CVD.

In contrast to the findings from general populations, there are contradictory associations for BMI and mortality in patients suffering from CKD.29 This is in relation to past studies that have shown that a low BMI was related to increased risk of death for patients with CKD. The main reasons for the findings have been attached to the baseline where low BMI is due to nutritional deficiencies that aggravate the CKD situation.

The contradiction is extended by other studies that have shown that there is no association between BMI and adverse manifestations of CKD. Due to the morbidity associated with CKD, it appears as if there is a difference between general population and those with CKD in relation to co-morbidities and mortality. In addition, there are differences in the way men and women exhibit pathogenesis and clinical manifestation of diseases. For example, a study about CKD, women were associated with a slower renal function decline and better survival compared to the males.30

Even though the studies on the BMI in general population and patients with CKD are contradictory, they present the basis for further studies in order to understand the effects of BMI among the CKD patients. With regards to the relationship between obesity and anemia of inflammation, there have been several studies, some of which were inconclusive due to, perhaps their study design, for instance, the study on Mexican women showed that anemia is related to obesity and not nutritional iron deficiency.

The findings denote the crucial role of BMI plays in influencing the morbidity and mortality of renal diseases. The cross sectional study established that in dialysis patients, there is survival advantage for the patients with high BMI. The survival advantage can be attributed to the nutritional status of the patient.

The studies provide critical findings that can be useful when designing a comprehensive treatment therapy for the patients with CKD; however, they fail to look into the role of high BMI in obesity, CVD and other chronic diseases that may aggravate the condition of patients with CKD. The study contradict other cross-sectional studies that have pointed out that there are positive relationships between CKD and BMI, nevertheless there are longitudinal studies that have shown that higher BMI is a predictor of likelihood of renal dysfunction.

Relationship between Haemoglobin Concentration and BMI among CKD Patients
To inform the current research, the author carried out a review of other studies related to BMI, haemoglobin concentration, and CKD.31 For instance, there are extensive cross-sectional studies conducted to compare the relationship between obesity and CKD. A cross-sectional study in Norway by Hallan et al. evaluated 37,793 patients with a mean age of 50.2 years.32 EGFR was measured in which the results showed an association between people with a BMI of over 30kg/m2 and CKD. In the study, there were no significant differences in gender.

In another cross-sectional study carried out in Japan, Nomura et al which evaluated 1,978 people who had a mean age of 60.8 years, similarly, the eGFR was measured33 and The results showed that obesity was common in patients with CKD compared to those who did not have both among men and women. Another cross study was carried out by Shankar et al in Malay.34

The mean age for the study participants was 58.1 years in which 2,783 participants were incorporated in the study. eGFR was measured and in this study, the association between MBI and CKD was only found among the men cohort. A control study in Sweden which compared 926 patients aged between 18 and 74 years for the relationship between diabetes and chronic renal failure found that a high BMI of between 30 kg/m2 and 35 kg/m2 was associated with chronic renal failure.

The findings from the above cross sectional studies are supported by the past longitudinal studies that have shown an association between chronic renal failure and haemoglobin both in diabetic and non diabetic patients.35 As noted earlier, the variations established in the associations between BMI and chronic renal failures are attributed to different factors.

For instance, the racial differences and the sample sizes used. However, in a study in which 20,000 study participants were analysed in a cross-sectional study, it was established that there was positive correlation between BMI and CKD for both men and women.36 For the cases of women, increased risk of progression of CKD was noted for the patients who were severely obese regardless of the age factor.37 The findings show that the design of the intervention and management of the renal complications can be effective if there are programmes to reduce weight, treat hypertension and diabetes.

Summary of Literature Review
There are many studies that have suggested that anaemia leads to adverse outcomes in people with different health conditions. However, the presence of CKD has a modifying effect on anaemia. For example, anaemia can be an independent risk factor for chronic conditions such as CVD, however, the combination of anaemia and CKD leads to increased risk for development of coronary disease and stroke. The above literature review shows that both BMI and haemoglobin levels have a correlation with the progression of CKD.

From the review, it can be established that these factors play an important role in determining the progression of CKD. Even though there are no conclusive finding about the association between the BMI and CKD, the longitudinal studies have shown that high baseline BMI is a good predictor of future occurrence of renal dysfunction. On the other hand, cross-sectional studies concerning relationships between BMI and CKD have been contradictory. The contradictions have been attributed to variations based on gender and racial factors.

However, most of the studies have shown that high BMI is a precursor for faster progression of CKD. The rationale for the findings both in longitudinal and cross sectional studies mainly centre on the correlation of BMI and diabetes. Diabetes is one of the main factors that lead to various kidney problems. In addition, high BMI is associated with CVD and other chronic heart complications. The co-morbidities increase the severity of CKD. In relation to haemoglobin, the literature review has signified the role of Erythropoietin in CKD progression.

Suffice to say, the studies have provided a good basis for further investigation and understanding CKD. The knowledge from the studies can be primarily used in medical interventions for people with CKD. It is worth noting, however, that most of the studies were inconclusive in nature. In addition, the findings seem to be general and affected by variations such as gender and race. As such, there is the need for specific case studies that can be applied by policy makers in order to formulate policy-specific to some populations. Thus, the literature review lays ground for the current study that focuses on the relationship between haemoglobin and BMI for ICLD population with CKD.

Chapter 3: Research Methodology
Methodology
The phenomenon under investigation was the association between BMI and haemoglobin in a specified population with CKD. It was, therefore, essential for the researcher to devise a systematic way to understand the issue investigated. The procedure includes gathering information about the complications and how they affect the health status of the people with CKD.

The study aims at gaining scientific understanding on the correlations that exist between the CKD and the two co-morbidities associated with BMI and haemoglobin through the use of quantitative research methodology. The quantitative strategy uses measurable data to uncover patterns in a study. The data was obtained from the Imperial College, London spanning a period of 10 years. The data was extracted from the renal Diamond database.

Exclusion and Inclusion Criteria
Exclusion criteria
The initial data revealed a trend of a decrease of haemoglobin with increased BMI. However, the relation between decreased haemoglobin and BMI was not clearly noted with CKD IV and V reason being that with more advanced CKD there are other factors such as secondary or tertiary hyperthyroidism, mala-absorption of iron, or uraemia that have some effects on the bone marrow in addition, some the patients are on Erythropoietin stimulating agents.

Therefore, the study has excluded CKD IV and V from the analysis. The study has also excluded the population with low BMI with less than a count of 20 because the low BMI may have been influenced by nutritional deficiency.

Inclusion criteria
The criteria required that the study participants be patients with or without diabetes, male and female aged between 18 and 75 years who have a documented glomerular filtration, BMI, and haemoglobin measurements.

Study Design: Cross-Sectional Research
The commonly applied research designs in health setting include longitudinal and cross-sectional studies. It is important to note that other study designs can still be applied. However, for the current research, the study design is a cross-sectional study. In the health care setting, cross-sectional study it is viewed more as transversal study where the researchers observe certain trends in a population in a specific point in time. As a result, the data obtained provides a ‘snapshot’ of the situation as presented by the population under review.

In the current study, the researcher determined the stage of CKD by measuring the haemoglobin levels, the BMI and other parameters that pertain to the study. The subjects being studied may include the people with and those without CKD. The main advantage of using the cross-sectional study is because it provides the basis for comparing different populations at a specific point in time, i.e. providing a snapshot. For example, from the literature review, it was established that association between BMI or haemoglobin and CKD are sometimes influenced by factors such as age, nutrition and gender. Therefore, a cross-sectional study provides a way of looking at the different factors. Also, the design is descriptive at the same time and hence, the rationale for being applied in the current study.

Ethical Issues
The study did not require consideration of ethical issues. The reason is that all the data was obtained from the Diamond database.

The Sampling Procedure
The researcher realized that it was impossible to study the entire target population. As such, there was a need to acquire a section of population that is representative of the whole. The move forms the basis of sampling rationale. According to Denk, sampling is the process of selecting a subset of the target population.38

It denotes having specific area that is being investigated and tentative knowledge on where the required information can be obtained from. As a result, in a systematic study, there are different sampling designs that are used. For the current study, cross-sectional study design, in which data was extracted from ICDLC, was applied.

The relevant data from the institution was obtained through non-probability sampling procedures. The aim of the current study was to establish the relationship between haemoglobin and BMI in patients suffering from CKD. It necessitated a large sample to ensure that the differences pointed out in the past studies are addressed. As such, the researcher settled for an institution that specialises in care delivery to people with diabetes and related complications, such as renal failure.

Rationale for Inclusion and Exclusion Criteria
The sample data was extracted from the ICDLC data base. The data covers all the patients who have attended the clinic for diabetic care since its inception; thus, the cross sectional data for a 10 year period. Even though the technique allows all the potential subjects to have an equal chance of being included in the final sample, there is the need to set parameters in order to ensure that subjects included are in line with the study objective the inclusion criteria entail all adult patients aged above 18 years, i.e. both males and females.

In addition, the study participant should be type 2 diabetes patients (diabetes mellitus), they should have a BMI of 20kg/m2 or above, and the CKD should be between stages 1 to 3. The exclusion criteria are patients in stages 4 and 5 of CKD, those who are already on dialysis or patients who require dialysis. The CKD 4 and 5 were excluded because they are on exogenous EPO and IV iron therefore, to include them would mean to stop treating their anemia which is unethical. The patients on iron infusion, Erythropoietin supplementation and replacement therapy were as well be excluded, as those with BMI below 20 kg/m2. The rationale for exclusion of the patients with low BMI was that they are likely to have nutritional deficiencies.

Sample Size
For the purposes of the current study, the researcher used a total of 64000 patients. The participants were drawn from ICLDC, a centre that provides specialised care for people living with diabetes. The sample was drawn from patients who had sought care in the centre and their diabetes and CKD related data was captured. There was, as a result, a large sampling frame. It is the reason why the researcher settled for the cohort of 64,000 patients. Out of these participants, only the non-insulin-dependent were included in the cohort population.

Methods of Data Collection
The application of the right data collection instruments is important. There are several data collection methods just as there are different sampling methods. The method of data collection is normally influenced by the research strategies, the point of collection, and the person to carry out the research. The use of the proper technique ensures that data is collected in scientific manner, minimises bias, and ensures consistency.

As a result, proper techniques of data collection enhance the accuracy, reliability, and validity of the study findings. In the current cross-sectional study, the data collection method entailed the review of the recorded data on patients with CKD in the ICLDC. The data captured a specific point in time for all the patients. The information collected included the last reading for each patient who visited the centre. The use of the last reading for each of the patients served as a major limitation to the data collection. The reason is that past measures of the study parameters were not captured in the data.

Criteria for Data Analysis
After the collection of the data, it was important to synthesise it in order to capture the useful information. This is obtained through data analysis. Data analysis is defined by Dixon as the process of cleaning, transforming and modelling data in order to establish the useful information that can be used to draw inferences.39 There are different tools for analysing data.

The tools of data analysis entail software applications used to synthesise the extracted data and present it in a manner that allow easy drawing of correlations. Examples of software for the data analysis includes the use of excel functions or advanced tools such as SPSS. The present study relied on the statistical analysis using STATA 14.0., Multivariate analysis, and statistical test to determine correlation. For example, the correlation between the decreasing haemoglobin and increasing BMI, in which statistical significance was tested.

Overview of ICLDC
The Imperial College London Diabetes Centre (ICLDC) is a facility that offers outpatient services to people who are in need diabetes treatment. The state of the art centre is involved in training, research and creation of public health awareness. ICLDC has several centres, one in United Arab Emirate, the other in Abu Dhabi and the last one in Al Ain.

The centre was established in 2006 and since its inception; it has continued to offer important diabetes care services to patients. It boasts of having received over 800,000 patients since 2006. The centre operates in partnership with the Imperial College London in the UK. In general, the main mandate of ICLDC is to provide specialised care for patients with diabetes and related complications through diagnosis and management of the related conditions including kidney disease.

Chapter 4: Results And Analysis
Introduction
From the literature review it was established that the studies on the relationship between haemoglobin levels and anaemia have not been conclusive. Some of the past studies sought to investigate the relationship between anaemia and CKD or BMI and CKD. However, the aim of this study was to investigate how variation in haemoglobin affects BMI in patients with CKD.

The reduction in haemoglobin levels is used to determine the anaemic state of a patient. The study found that an increase on the BMI has different implications on the health of individuals both with and without CKD. The results and analysis section presents an analysis of the extracted data regarding the changes in haemoglobin levels and how such changes relate to obesity. Obesity is presented by increase in BMI above the normal.

Results
Overview
Data was obtained from 64,000 patients from the Imperial College Diabetes Centre who attended the clinics and their haemoglobin, BMI, blood pressure systolic, blood pressure diastolic, eGFR and other health parameters were tested. As outlined in the study objective, the main concern for this study was the relationship between haemoglobin levels and the BMI and the influences of gender and age. Even though 64,000 patients were involved in the study, the BMI and haemoglobin was not captured for all the patients. Table 2 is a summary of relationship between BMI and haemoglobin levels for the patients with CKD.

Table 2: Variation in haemoglobin levels with respect to BMI category and CKD groups

BMI Group No. of Patients (N=51730) Mean Haemoglobin
20-30. 28063. 132.61±16.80.
30-40. 20094. 130.78±16.86.
40-50. 3204. 128.25±16.54.
50-60. 369. 126.16±16.36.
Table 2 above shows detailed result of relationship between BMI and haemoglobin. The total numbers of the patients were 51,730, in which four clusters of BMI were obtained based on the ascending order. In each cluster the mean haemoglobin was computed. The first cluster included the patients with BMI of between 20 and 30; the patients in the cluster were 28,063 while the mean haemoglobin was 132.61.

The second cluster ranged from 30 to 40 in which 20,094 patients were involved, with mean haemoglobin of 130.78. It is worth noting that in these BMI clusters, the age and gender factors were not analysed. The relationship established in table 2 is presented in figure 1. From the analysis, it can be demonstrated that as the haemoglobin level decreased the BMI were seen as increasing.

This table shows the mean and standard deviation of haemoglobin with the approximate number of patients within each BMI grouping.

Mean and Standard Deviation
Mean and standard deviation.
Table 3: Mean and standard deviation
BMI; body-mass index: kg/m2

The table above excludes BMI of less than 20. The reason is that such individuals are likely to have nutritional deficiencies. The total number of patients is over 50,000. The majority have a BMI of between 20 and 30 (n=28063) and 30 to 40 (n= 20094).

Association between BMI and Haemoglobin

Direct association between BMI and haemoglobin.
Table 4: Direct association between BMI and haemoglobin
The table above demonstrates the direct Association between body-mass index and haemoglobin. There are 54,027 observations. The p value of the model is highly significant.

The r2 shows the amount of variance of haemoglobin explained by body-mass index. In this case, the body-mass index explains a 0.15% of the variance in haemoglobin. The two-tailed p value tests the hypothesis that each coefficient is different from zero. In this case, the body-mass indexes are statistically significant in explaining the relationship between BMI and haemoglobin. The coefficient shows that for each one point increase in body-mass index, the haemoglobin decreases by 0.105.

Graphical representation of the correlation between BMI and haemoglobin.
Table 5: Graphical representation of the correlation between BMI and haemoglobin
The figure above depicts how patients with high BMI are associated with decreased levels of haemoglobin.

Variation between haemoglobin and BMI based on CKD stages
In addition to the analysis between BMI and haemoglobin, further assessment was done to determine how the various stages of CKD related to the two parameters. The CKD stages analysed were 1, 2, and 3. The four clusters of BMI were maintained in order to ensure consistency of the results and enhance understanding of the variations. In this category, 40,640 patients were analysed.

The results showed that the mean haemoglobin decreased as the CKD progressed from one stage to the next. This was the case for the four BMI clusters as analysed and presented in figure 1. However, comparisons based on the BMI clusters did not show linear regression. For example, for BMI group between 20 and 30, the mean haemoglobin was 13136.42±16.95 for CKD stage 1, 131.73±15.91 for CKD stage 2 and 123.4±16.63 for CKD stage 3. For the BMI group 30-40, the mean haemoglobin for CKD 1, 2, and 3 was 132.73±17.24, 128.09±15.00 and 121.72±15.70 respectively.

Regression analysis of various factors.
Table 6: Regression analysis of various factors
Table 6 above is a Multiple Regression analysis of various factors contributing to a drop in levels of haemoglobin among patients. There is a statistically significant regression observed within the haemoglobin and glomerular filtration rate (ml/min/m2) BMI (kg/m2), glycosylated haemoglobin (HBA1c), and urinary microalbumin (MG).

Table 7: Variations in haemoglobin levels within BMI and CKD groups

BMI Group No. of Patients (n) Mean Hb (SD), gm/dL
20-30 CKD 1 9567 136.42±16.95
CKD 2 10369 131.73±15.91
CKD 3 1581 123.4±16.63
30-40 CKD 1 10285 132.73±17.24
CKD 2 5306 128.09±15.00
CKD 3 888 121.72±15.70
40-50 CKD 1 1826 127.67±16.17
CKD 2 469 125.45±14.05
CKD 3 112 117.27±14.13
50-60 CKD 1 180 124.77±15.43
CKD 2 47 121.34±15.50
CKD 3 10 115.2±12.69
Table 7 above illustrates the variations in levels of haemoglobin within BMI and CKD groups

Mean haemoglobin
Table 8: Mean haemoglobin
Table 8 above shows the mean of haemoglobin levels.

The graph shows that an increase in BMI is associated with reduced levels of haemoglobin for each CKD stage. Figure 2 show that there is a significant drop in haemoglobin as the BMI increases. Furthermore, there is a decrease in the haemoglobin levels as the severity of CKD increases. For example, as the BMI for patients in CKD stage 1 increased, there was a noticeable drop in the haemoglobin levels. Table 9 below is an extraction of the changes.

Table 9: Changes in haemoglobin in haemoglobin and BMI for the three stages of CKD

> 90ml/min 60-90 ml/min 30-60 ml/min
20-30 13.6±17 13.2±16 12.3±17
(9567) (10369) (1581)
30-40 13.3±17 12.8±15 12.1±15.7
(10285) (5306) (888)
The table represents the changes in haemoglobin in haemoglobin and BMI for the three stages of CKD. As pointed out, the measurements for haemoglobin levels were not obtained for all 64,000 CKD patients. As a result, the data was analysed for specific measurements based on the subjects who met the required parameters. For example, the PTH, ferritin and vitamin D2 level values are reasonable for clinical data obtained. However, only 3642 patients were recorded for ferritin.

Other measures with substantial readings included the eGFR with 45,201 patients, vitamin D measurements with a cohort of 50,739 patients, and micro-albumin measurements that had a cohort of 22,068 patients. Throughout the data analysis and subsequent discussion, the variations in the number of subjects were taken into considerations. Table 5 below is a summary of the analysed data. It is important to note that this is the synthesised data which has also taken into consideration the missing measurements for some parameters among the subjects.

Summary of Synthesised Data
Table 10: Summary of data.

Table 10 shows that an increase in BMI was related to a significant decrease in haemoglobin. In order to establish the correlation for the subjects that had the measurements for haemoglobin and BMI, a regression analysis was carried. Table 6 is a summary of the association between the BMI and levels of haemoglobin for 54027 patients.

Correlation between BMI and haemoglobin based on linear regression
Table 11: Correlation between body-mass index and haemoglobin.

As presented above, the linear regression helps in the determination of the correlation. For example, from the analysis, the p value of the association is highly significant while there is variance based on the haemoglobin levels as influenced by the changes in BMI. In addition to the linear regression, a multivariate analysis was undertaken to investigate the BMI and the glomerular filtration rate. The glomerular filtration rate was determined by the modified MDRD equation.

Regression analysis for relationship between BMI and glomerular filtration
Table 12: Regression analysis for relationship between BMI and glomerular filtration

Variable Model 2
Bmi4 -0.450***
(0.0140)
gfr4 0.184***
(0.00375)
Constant 128.3***
(0.471)
Observations 41,949
R-squared 0.062
*** p<0.01, ** p<0.05, * p<0.1

The table above is an indication that there is a relationship between the predictor variables as established by the association between the BMI and eGFR at 6.2%. The coefficient shows that with an increase in BMI there is a decrease on haemoglobin levels by 0.450 while an increase in GFR increased the haemoglobin level by 0.184.

The two-tailed P value test shows that there is a significant effect of glomerular filtrate and BMI on the level of haemoglobin. In addition to the haemoglobin, BMI, and glomerular filtration, a multivariate regression analysis was carried out to examine the relationships of vitamin D2, PTH and glycosylated haemoglobin. Table 13 is a summary of the multivariate regression.

4.3.3. Multivariate regression analysis of vitamin D2, PTH, and glycosylated haemoglobin

Table 13: multivariate regression analysis of vitamin D2, PTH and glycosylated haemoglobin

(1)
VARIABLES Model 6
bmi4 -0.536***
(0.0160)
gfr4 0.206***
(0.00426)
Vitamin D -0.00329
(0.00335)
PTH -0.190***
(0.0375)
Syst bp 0.0677***
(0.00521)
hba1c 0.566***
(0.0521)
Constant 117.4***
(0.915)
Observations 32,931
R-squared 0.087
Robust standard errors in parentheses

*** p<0.01, ** p<0.05, * p<0.1

The multivariate regression analysis shows that R squared of 0.087 which is equivalent to an 8% of the variation of haemoglobin with the changes in BMI, GFR, vitamin D, PTH and systolic blood pressure and glycosylated haemoglobin. The two-tailed T value reveals that the vitamin D2 level is not significantly related to a haemoglobin reduction. However, the other parameters are statistically significant at (P< 0.05).

From the table it can be established that the significant single tailed T value reveal that the most important variables in haemoglobin are glomerular filtration and body-mass index at 48.29 and -33.44 respectively, the other parameters PTH, systolic blood pressure and HbA1c are -5.05, 12.98 and 10.85 respectively suggesting that they are weaker correlating factors. However, this is statistically significant. The glycosylated haemoglobin shows that an increase leads to a subsequent increase in the haemoglobin concentration.

An increase in the glycosylated haemoglobin results in an increase of the iron concentration. This is due to the fact that the function of glycosylated haemoglobin is dependent on the concentration of the serum haemoglobin hence the association is established. Also, the results point a possible relationship between albuminuria and vitamin D, i.e. an increase in albuminuria being related to a drop in levels of vitamin D for the 25,015 patients is observed.

Levels of serum EPO
It is noted that EPO is a critical factor that is produced by the kidney. Studies conducted by various researchers indicate that most patients had a reduced production of EPO as the renal damage progressed.40 However, at a given haemoglobin concentration, the response of EPO was normal. For example, the results showed that at the initial stages of EPO production was 66.7%. The results indicated that a change in CKD from stage 1 to two and then three showed a positive correlation with the decreasing EPO. For the present study, the analysis for EPO was not carried out. However, based on the past clinical tests, it could be presumed that EPO levels for the patients with the first three stages of CKD would remain the same. However, based on the findings that increase in BMI was related to reduction in haemoglobin, there is high likelihood of EPO resistance due the renal damage. In order to avoid the presumptions, there is the need for future studies to carry out the EPO measurement.

Chapter 5: Analysis And Discussion
Introduction
The findings presented in chapter four shows the various factors related to CKD. In the cross-study, the relationship between BMI with respect to the BMI clusters was analysed. Low haemoglobin levels and increased BMI were found to be the factors that present the complications faced by majority of patients with CKD.41 The low haemoglobin is a pointer of increased prevalence of anaemia while an increasing BMI signifies severity of obesity. Evidence shows that obesity mediates complications of CKD, cardiovascular diseases, and obesity.

The early detection of the possible complication due to low haemoglobin levels can lead to lifestyle changes that could improve the chances of diabetes early interventions and the initiation of the management programmes that can improve the quality of life for the diabetic patients. This is also important in reducing the burden of care which is normally very expensive for patients who manifest the complications. Based on the correlations presented in the results section, the following is a detailed explanation of the implications in the management of CKD. Also, the findings are critical in the design and implementation of policy framework for the treatment of people with CKD.

Characteristics of the Study Subjects
The study participants included CKD patients between the age ranges of 18 to 75 years. The total number of patients included in the study was 64,000 which included both sexes. Even though the data was obtained from ICLDL, the patients hailed from different places and hence, represented different ethnic and racial groups.

The fact that over 64,000 subjects were studied proves that the study sample was considerably large; and, therefore had the ability to draw generalisations that can be used within general population. The presence of people with varying age and from different ethnic groups ensured that the study was comprehensive and inclusive. The diversity captured in the sample helped in reducing shortcomings related to inferences drawn from homogenous populations.

Haemoglobin Variability
The variability of the haemoglobin can be evaluated within a patient and sometimes between clients in a group. Within the clinical practice context, the variability importance is within the patient. There are several methods that are applied to quantify the degree of variability which may include the coefficient of variation which focuses on the ratio of conventional SD to the mean. However, the data studied showed a simple characteristic of the relationship between the haemoglobin and obesity.

The higher the BMI, the lower the level of haemoglobin registered for a particular patient in the cohort used. It therefore, means that high body mass has a direct influence of the levels of haemoglobin, a finding that is significant for the study because it is suggesting the obesity interferes with the growth of haemoglobin. It can be deduced from the results of the analysis that the variability of the haemoglobin can be associated with the mortality.

For instance, among the analysed results show that mortality risk is low among clients who maintain consistent haemoglobin levels between 11.0 to 12.5 g/dl. However, should the haemoglobin maintenance level oscillated towards 11.0, the longer that level was maintained it predicated a risk of mortality (table 3). It should be Bourne in mind that in the study, the patient characteristics did not account for much in the variation of the haemoglobin variability metric.

According to the analysis above, haemoglobin variability is closely associated with morbidity and mortality, it is, therefore, assumed that both high and low levels are also associated with elevated death risks. It is, therefore, evident that obesity or high body mass correlates positively with mortality arising from either high or low haemoglobin activities.

In the cohort of 58,058 that was used in the study, it can be observed that the maintenance of haemodialysis patients showed an inverse J-curve in the association between haemoglobin levels and possible adverse outcomes and conversely, the maintenance of haemoglobin levels in the 11.5 and 13.0 g/dl represented the lowest mortality risk.

Relationship between EPO, Haemoglobin, and CKD Stages
The extracted data shows that that there was a trend of decreasing haemoglobin as the stages of CKD progressed. Similarly, the EPO for the patients with CKD was found to reduce as the disease progressed from stage 1 to 3. As pointed out in the results section, as the haemoglobin levels reduced as the disease moved from stage 1 to 3, the EPO also reduced. As a result, majority of the study subjects had low EPO which is predictive of possible mortality (Table 4). This can be attributed to the mechanism which is used for the production of the EPO.

For instance, as the renal failure increased, the kidney mechanism responsible for the production of EPO was negatively affected. As such, only a small percentage of less than 5% of the patients included in the study sample had the normal levels of EPO production based on given level of haemoglobin. The findings are an indication of the contribution of EPO in increasing the prevalence of the anaemia among the patients with CKD. From the results, it was evidenced that as the disease moved from stage 1 to 3, there was low level of EPO. These findings relate to earlier clinical studies that have explained these findings based on the general renal function.

A case example is a study conducted by McClellan, Aronoff and Bolton which showed that the prevalence of anaemia is high among patients with renal dysfunctions.42 As such, anaemia is associated with increased chances of developing diabetes complications such as nephropathy and heart failure. Similarly, in patients with diabetes, studies show that there are many factors that contribute to the increased prevalence of the anaemia. As the severity of the renal disease increases, the cells responsible for the production of EPO are partially or completely damaged.43

The result is that the production of EPO is inhibited and hence, compares to the reduction in the haemoglobin levels. Earlier studies have pointed to the evidence that as the disease CKD condition progresses, the correlation between haemoglobin and EPO becomes deranged. In the present case, the correlation was not established due to the fact that the analysis concentrated on the initial stages of CKD, i.e. stage 1 to 3. The deranged relationship can be explained by reviewing the physiological processes that result in the production of EPO in the body.

The two organs that produce EPO are the liver and the kidney. Kidney is the main producer, responsible for over 85-90% of the EPO generated in the body. Therefore, as the kidney gets damaged, the EPO production reduces. In case of complete damage of the cells responsible for the production, the body is left to remain with less than 15% of the EPO synthesised in the liver. Thus, the deranged correlation that has been found in studies that have analysed the correlation in stages 4 and 5 of CKD.

It is also worth noting that the deficiency of Erythropoietin, as a major cause of anaemia, is not influenced by the severity of the renal dysfunction. The findings depicted in the present study are similar to those by Lucile which showed that the response of EPO to the concentration of haemoglobin varied based on the glomerular filtrate. The cytokine Erythropoietin (EPO) plays an essential role in the synthesis of the red blood cells in the human body.

The main function of EPO is to stimulate the production of the cells in order to compensate the destroyed red blood cells which results due to their short lifespan. It can also be explained by an evaluation of the role the kidney plays in the control of Haematopoiesis, oxygenation and in the simulation of haemopoietic precursors that are found in the bone marrow. In many cases the inability of the kidney to increase the release of Erythropoietin in order to counter the reduction in the haemoglobin level has been pointed out to be one of the causes for the development of renal anaemia.

The glomerular filtrate is the standard measure used to determine the stage of CKD in the present study. The cross-sectional study by Lucile, established that for patients with anaemia but have are free from CKD, the EPO was inversely correlated with the concentration of haemoglobin. On the other hand, for patients with CKD, the correlation became deranged as the disease progressed from stage 1 to the final stages due to the fact that majority of patients with CKD are likely to suffer from anaemia.

The findings are further supported by a research carried out in a German hospital which established that as the kidney damage progressed, relationship between EPO and haemoglobin attenuated till it disappeared in the final stages of the disease. Therefore, the correlation established in the current study is because the study focussed on the early stages of the disease, thus, if the analysis could have covered the final two stages of the CKD, there is likelihood that the findings would mirror the studies that have established the deranged correlation.

Similarly, James, Post, and Wilkes noted that the inhibition of erythropoiesis due to decreased sensitivity of the bone marrow makes the Erythropoietin tissues to be less sensitive to EPO for the patients in the advanced stages of CKD.44 It can, therefore, be deduced that functional Erythropoietin deficiency has a role in the diabetic nephropathy anaemia and thus the potential consequences for mortality and morbidity among the diabetic patients.

Therefore, it is arguable that the relationship established in the study, as depicted in the scatter diagram, was only for the first three stages. As the condition moves to the severe state, this is likely to change. In order, to ascertain the correlation of EPO and haemoglobin levels at the advanced stages of CKD, there is need to analysis the data for the patients in the fourth and fifth stages. Similarly, there are studies which have pointed out that the main cause is the failure of the diseased kidneys to synthesise EPO.

For example, the EPO is produced both in the liver and the kidney; however, the liver produces 10-15% of the EPO while the rest is produced in the kidney.45 This makes kidney to be the main organ that provides the body with EPO. The appropriate measure of the kidney function is the glomerular filtrate rate which varies depending on the sex, size of the body and age.

For young adults, the GFR measures between 120 and 130 ml/min/ per 1.73 m2. The levels decline with age and the kidney function losses more than half GFR by adulthood.46 It is important to note that prevalence of any disease plays an important role in the assessment of the trends, establishment of the underlying determinants and in implementation of the interventions to manage and prevent CKD.

Clinical investigations have shown that patients suffering from diabetes have a higher degree of anemia in relation to the extent of renal dysfunction compared to the patients with other causes of renal impairment. There are myriad of factors that have been given as responsible for the onset of anemia in patients with diabetes mellitus. Some of the factors include autonomic neuropathy which adversely affects production of Erythropoietin (EPO). The condition also damages renal interstitial and, therefore, causes systematic inflammation of the kidney.

The end result is the inhibition of the production of EPO. Studies that have examined hematologic and hematinic parameters among diabetes patients have established how diabetes contributes to increased cases of anaemia. For example, in a retrospective analysis of hematologic parameters of type 2 diabetes patients showed that there was sustained decrease in hemoglobin for the patients in which a negative correlation was demonstrated between the levels of EPO and hemoglobin. As a result, it was concluded that anemia is a complication of chronic disease and is more severe in patients with diabetic nephropathy compared to patients suffering from other kidney diseases. EPO deficiency is therefore, associated with nephropathy.

Role of Vitamin D in Patients with CKD
One of the key parameters captured in the extracted data were the varying levels of vitamin D among the patients. For instance, the results showed that there was remarkable reduction in the level of vitamin D in the blood for CKD patients. Vitamin D deficiency is defined by levels less than 12 mg/ml. In the current study, the data extract from ICDLC showed that majority of the CKD patients suffered from Vitamin D deficiency.

The depiction can be explained by earlier studies that established that patients with kidney disease are found to have reduced activity of the 1- α hydroxylase in the kidneys; this enzyme is responsible for the activation of 25-hydroxyvitamin D to the active form of 1, 25-dihydroxyvitamin D.47 The active form plays a critical role in the pancreatic function and hence its importance in management of diabetic patients and other conditions that depend on the healthy functioning of the kidney. There are different mechanisms through which Vitamin D is made available to the body; they include eating foods that are rich in the vitamin, through the ultraviolet B radiation from the sun or by taking supplements.

As the CKD progresses, there is evidence of the reduction of the active forms of the vitamin, which are the 1, 25 dihydroxy vitamin D and calcium. In general clinical manifestations, the situation is followed by the increase in serum phosphate levels which result in secondary hyperthyroidism as signified by the elevation of parathyroid hormones (PTH). This condition is responsible for bone disease that is known as the renal osteodystrophy. As a result, the CKD patients suffer a low vitamin D level which negatively affects the outcome of the dialysis.

The low levels of vitamin D observed in the study are supported by past studies. For instance, the review of the literature indicated that CKD leads to complications such as hypertension, albuminuria, and diastolic dysfunction. Vitamin D has a role in remedying the complications; thus, a deficiency in vitamin D can impair the treatment.

Clinical trials and laboratory experiments have shown that vitamin D helps in reducing albuminuria in animal models treated for kidney diseases.48 For humans, there are different stages of CKD, which are based on the glomerular filtration rates. Studies also show that the extent of the kidney damage is determined by albumunuria.49 In addition to being used as markers of CKD, the estimated glomerular filtrate rate (eGFR) and the albuminuria are classified as signifiers of cardiovascular disease.

In this relation, the kidney damage has been viewed as the pathological abnormalities that can be traced by blood tests, urine and other imaging tests.50 The definition forms the foundation for understanding the current findings. As such, the renal dysfunction is described as chronic when the eGFR is 60ml/min/1.73m2 for over three months.51 As stated, above, eGFR provides the basis for staging CKD. Thus, based on the findings it is worth emphasising that vitamin D plays a critical role in enhancing the function of the kidney. Similarly, the kidney has a role in enhancing the absorption of the micro-nutrient.

This is supported by various studies which have demonstrated that vitamin D has a supporting role in the pancreatic function. Consequently, the supporting role gives it a special function in patients with diabetes type 2 which is caused by the intolerance of glucose.52 Vitamin D has an exclusive effect on how insulin responds to glucose stimulation; consequently, among the individuals without CKD, the function of vitamin D is depicted by variation in glycaemic control based on the seasons of the year. For example, the glycaemic control for patients with diabetes type 2 is worse during the winter, a phenomenon that is attributed to the prevalent of the hypovitaminosis D during the cold season.

Research has also established that diabetes is one of the major causes of kidney diseases. Consequently, the level of vitamin D indirectly affects the CKD status. Due to the cross-sectional nature of the study, the trend of vitamin D that exists among patients with CKD was not established. The snapshots data provided the levels of vitamin D for the patients in the last day of visit; thus, the data cannot be entirely relied on to form conclusive argument about depictions of vitamin D among the patients.

As such, there is need for future studies to investigate the 25-OHD concentration and its effects on the development or lack of CKD. Nevertheless, from the snapshot data obtained in the current study, it can be inferred that many patients had low levels of vitamin D, and it was viewed as a possible predictor of the relationship between the eGFR and vitamin D. Putting into consideration the fact that active vitamin D plays a role in improving the status of patients with chronic diseases, such as CVD and renal dysfunction; there is a need for health policies makers to ensure that therapies for people with CKD should include vitamin D supplements.53

Haemoglobin and CKD
The present data analysis showed that the haemoglobin levels reduced as the BMI increased. Similarly, the levels decreased as the CKD progressed from stage 1 to 3. These variations are an attestation of the past studies that found that the severity of anaemia increases as the renal dysfunction becomes worse. The increase in severity increases the mortality of the patients if care is not given on time. The findings of this study are supported by several studies that have examined the status of haemoglobin in populations with and without CKD.

The graph (App. 3) offers a clear demonstration that haemoglobin levels fluctuate among the patients with CKD; they can be below or above the recommended concentration levels.54 Based on the past studies that have been conducted to examine the levels of haemoglobin in patients with CKD, it has been shown that the fluctuation of haemoglobin relates with the degree of the renal dysfunction. In clinical settings, haemoglobin is used to determine the anaemic status of the CKD patients. The different factors that contribute to anaemia include the deficiency of vitamin B12, iron, foliate and the inability of the body to produce enough Erythropoietin.

The variation in haemoglobin levels is also affected by different factors. For instance, haemoglobin levels below 13.5 g/dl among men qualifies the person to be termed as anaemic, while for women, levels below 12g/dl are termed as anaemic. Studies have demonstrated that low haemoglobin levels are evidenced in all stages of CKD. However, the haemoglobin levels are seen to vary based on the race, age and gender. For instance, past clinical studies have observed that as people age, the haemoglobin levels decrease.

This is more evident among women compared to men. Similar studies that have examined the status of haemoglobin levels have also pointed out that black patients have low haemoglobin compared to whites.55 Despite the differences, the studies investigating the phenomenon have not shown significant variations in the ESA response based on the age, race or gender. Thus, in the treatment of the patients with CKD, there is the need to individualise the treatment. This is important in order to take care of the individual needs of the patient. In addition, the inconclusive nature of most of the clinical investigation necessitates the individualised treatment.

As observed earlier, low haemoglobin levels are used to determine the anaemic status of people. For the patients with CKD, there are underlying similarities in the mechanisms for the development of anaemia. However, there is also evidence that show that there exist differential responses to anaemia between men and women. In the current analysis of the data from the ICDLC, the differences between the haemoglobin levels between the women and men was very small for the patients whose haemoglobin levels were captured and analysed.

The contributing factors of death for CKP patients include severe anaemia, presentation for the cases for treatment at late stages of the CKD, poor awareness of the kidney disease, and lack of clear policies to guide the diagnosis and treatment. High BMI is a reflection of high cases of overweight and obesity.56 As pointed out, anaemia is more prevalent for patients with diabetes. Besides, both obesity and anaemia have been categorised as risk factors for mortality for diabetes patients In relation to prevalence, anemia is 2-3 times more prevalent in people with diabetes mellitus compared to those without the diabetes type 2.

The analysis of the data indicated that there is an inverse association between the CKD and haemoglobin. However, the studies concentrated on levels of CKD where the renal replacement therapy had not started. Due to the cross-sectional nature of the current study, the risk of mortality due to reduced levels of haemoglobin, as identified in longitudinal studies, was not established in the study.

The longitudinal studies have also analysed the association of haemoglobin levels and mortality based on gender, a factor which was not examined in the present study. For example, it has been suggested that the risk of mortality due to CKD decreased among women with an increase of haemoglobin levels of up to 13 g/dl.57 The implication for the findings is that women who have started renal replacement therapy are more likely to experience the effects of anaemia due to the low haemoglobin levels recorded for people whose renal system has failed.

To re-emphasise the situation of the current study, these findings could not be ascertained as the analysis was limited to patients who have not reached the stage of renal replacement therapy. Furthermore, the cross-sectional observational study did not examine the mortality associated with CKD. It is worth noting that there are very few studies that have investigated the haemoglobin variance in women compared to men. There is need, therefore, for further researches that could specifically evaluate the gender-specific effects by application of longitudinal data instead of cross-sectionals data which only provided the situation at a given time.

CKD and Risk Factors Associated with Lifestyle
There are different risk factors associated with CKD. As shown in the results, an increase in BMI was related to the increased risk of CKD progression to the next stage, which points to obesity as one of the key risk factors for kidney disease complications. In addition to obesity, another risk factor that was captured in the data was effects of smoking. The results showed that exposure to smoking increased the risk of CKD.58 The findings are in line with previous studies that have pointed out that there is evidence that smoking has adverse effects on the kidney just as obesity acts as a risk factor.

For example, a research conducted by Hallan et al.59 showed that a BMI higher than 35kg/m2 was a significant risk factor for CKD.60 This shows that many patients are exposed to combined risk factors of CKD such as obesity, smoking and physical inactivity. Bearing in mind that more men are likely to be involved in smoking than women, this may place men at higher risk of CKD. In addition, there is evidence that there are biological interactions between obesity and smoking because they are seen as influencing each other. There is, thus, the probability of gender differences due the variations in the risks related to lifestyle. This phenomenon was not analysed in the current study as the main focus was to examine the relationship between haemoglobin and BMI in patients with CKD.

Relationship between BMI and Progression of CKD
The analysis of the data extract showed that as the BMI increased, the severity of CKD also increased. These findings mirrors past studies that have explored the relationship between BMI and CKD. In other words, an increase in BMI is related to a reduction in the mean rate of glomerular filtrate. Due to the findings, it is important to explore the implication of increased BMI on CKD. As stated, CKD is a risk factor for cardiovascular diseases.

The relationship is mediated by an association that exists between diabetes and CKD, obesity, smoking and hypertension. As pointed out, obesity has become a great concern for health care providers due its increased prevalence and its role in preceding CVD and diabetes. As a result, high BMI denotes overweight and obesity and plays a role in mediating the association of other risk factors with CKD. Clinical studies have categorised BMI as continuous exposure for people with CKD. Hence, an increase in a unit of BMI is likely to increase the probability of CKD worsening.

In a longitudinal study, a follow up of the study subjects for 10 years showed that obesity increased the risk developing stage 3 CKD.61 In addition, overweight and obesity were found to contribute to the development of CKD stage three. An analysis of data from more than 300,000 people by HSU et al showed that there was a relative risk of renal dysfunction in obese and overweight people.62

The relative risk was evidenced in class 1, 2 as well as extreme obesity. The relative risk increased as the obesity moved from one stage to the next. For example, in class 1 obesity, relative risk was 2.98; in class 2 obesity, relative risk rose to 4.68; while in extreme obesity, the relative reached 4.99; this was in comparison with people with normal BMI and with varying degrees of kidney dysfunction.

As shown in the study, an increase in BMI is related with a decrease in haemoglobin. This is an important finding that the health care provider and policy makers can capitalise on by putting in place policies to ensure that there is a coordinated monitoring of haemoglobin in relation to haemoglobin for patients presenting with renal complications.

In addition, the findings can form the basis for further investigation to explore the effect of EPO deficiency as well as establishing whether it precedes eGFR decline. It has also been pointed out that low haemoglobin is associated with anaemia morbidity which increases the cost of treating the patients with CKD. Therefore, there should be policies that advocate for preventive care such as interventions to reduce obesity and supplementation and prior treatment of infections that are likely to aggravate the haemoglobin levels.

Impacts of Anaemia Levels on CKD
Overview
Anaemia is one of the factors associated with decreased function of the kidney. The main symptoms of anaemia include depression, dyspnoea and fatigue. Anaemia also has other adverse consequences that lead to left ventricular hypertrophy and left ventricular systolic dysfunction.63 These adverse effects accelerate progression of CKD to the final stages of the renal dysfunction and stroke; hence, the implication that patients with anaemia caused by CKD have high likelihood of being hospitalised.

Furthermore, the length of stay in hospital is prolonged for the patients, an implication of high cost of treatment. In general, anaemia reduces the quality of life ad increases mortality related to CKD. Anaemia is found in all stages of CKD which qualifies it as a major co-morbidity. It increases towards the final stages of the kidney failure while the prevalence of anaemia sets in if the creatinine clearance reduces to levels of below 70ml/min.

The findings of the current study did not show a great difference from other related studies that have examined the prevalence of anaemia among the CKD patients. This is true for both the developed and developing nations. A study carried out by Cnunwuba, Uchenna and Ngozi in Nigeria found out that there was progressive rise in the anaemia severity from 26.7% among the patients studied to 75.5% in stages 3 to 5 respectively.64

The mean haemoglobin of the study subjects decreased with decline in the eGFR for the five stages of CKD. The results, thus, relate to the current findings that have indicated that the degree of anaemia is proportional to the extent of the renal damage. However, it is important to bear in mind that the current stage did not analyse the correlation past stage three of the disease.

The major mechanisms of anaemia related to CKD are the reduction in the response of EPO. For instance, the patients who have no CKD, the correlation between EPO and haemoglobin is negative. This negative correlation is reversed in the patients with CKD. For patients in the latter stages of CKD, the feedback regulation mechanism is blunted but may be maintained after haemorrhage and in patients in high attitudes. This is explained by the functions of bone marrow in case of blood transfusion in high attitude areas. The patients with CKD, the EPO levels are normally below the expected quantity for the degree of anaemia.65

In the current study, EPO varied based on the mean GFR level. The results showed that levels of haemoglobin and EPO were negatively correlated. After testing the significance of correlation, r was -0.2 and p=0.04 for the study subjects that had an mGFR of above 30ml/min per 1.73m2. However, there was no negative correlation for the patients with the mGFR less than 30ml/min per 1.73m2. Further analysis showed that there lacked correlation for the patients that did not have or had anaemia.

In addition to anaemia, EPO was found to vary based on the age, BMI and iron status of the patients. For example, EPO was found to be higher in patients aged between 60 and 69 years, and had a BMI above the normal. In relation to gender, there was no relationship established. The findings confirm that there is a significant interaction between EPO, GFR and haemoglobin in the CKD stages 1 to 3. The findings also show that there are other factors that are responsible for stimulation of EPO other than GFR and haemoglobin.

Hepcidin and its effects
The systematic iron metabolism is regulated is regulated by Hepcidin. The enzyme is a small peptide hormone. It regulates homeostatic operations of systemic iron metabolism. It also mediates between the defence of the host and inflammation. The hormone is measured in human urine, plasma, and serum.66 Thus, the Hepcidin controls the flux of iron into the plasma. The levels of Hepcidin in the body are influenced by the level of body iron.

For example, when the levels of iron are high, the Hepcidin increases in order to block the absorption of the iron from the diet. The expression of Hepcidin is low when the levels of iron are low. In addition, in case of anaemia or hypoxia, the Hepcidin is also found to be low. As a result, for people with iron deficiency, the Hepcidin is normally suppressed to very low levels.

Anemia resulting from the progression of CKD is non-inflammatory; because the pathogenesis of the anaemia in CKD is normally caused by the impaired production of EPO. However, in case of infection that results in inflammation, the inflammation may adversely affect the Erythropoiesis and lead to resistance of the Erythropoietin treatment. To advance the understanding of anaemia in patients with CKD, there are studies that have been conducted to measure the levels of Hepcidin among the patients.

The rationale was to find out its role in anaemia. The Hepcidin studies have been mainly been on the relation to the Ferritin levels.67 For patients with CKD and not on hemodialysis, there is evidence of suppression of Hepcidin. For the CKD patients who are on Erythropoietin therapy, the levels of Hepcidin drop slightly, a depiction that there is negative correlation between Hepcidin and the Erythropoietin dose.

Chapter 6: Conclusion
Strengths and Limitations of the Study
The major strength of the study is the large population sample of study, a sample size of 64,000 patients with CKD. The study main focus was on the diabetic patients with chronic kidney disease. This ensured that the parameters observed provided the relationship that was being sought without being influenced by other factors.

In addition the data was obtained from a leading diabetes centre which has been receiving and keeping the patients data over time. As such, there were no cases of bias as only data recorded by professionals was used; hence, the use of complete data sets. Moreover, the data used covered patients from diverse origins, sex, and age, critical factors that ensured that inferences drawn from the study could be generalised.

Despite these unique strengths, the study had its limitations. One of the major limitations was the study design. The use of the cross-sectional study design meant that only a snapshot of data at a given time was analysed. This implied that trends that could be observed in case of longitudinal study were not captured.

Thus, it can be argued that static data was used which does not show clinical changes that the patients with CKD undergo. The reliance on data from one diabetes centre may also be limiting, an occurrence that could be associated with the selection bias and data capture failures. However, the fact that ICDLC is run by medical professionals helps to eliminate the selection bias.

Discussion and Analysis
The major focus of the study was the analysis of the association between haemoglobin and BMI in patients with CKD. The study has established important correlations that affect the health status of the patients with CKD. One of the key to the findings included the establishment that haemoglobin levels declined as the renal disease progressed from one stage to the next. The study also found that there was a relationship between the BMI and haemoglobin levels in which increase in BMI was associated with decline in haemoglobin (Appendix 1).

The findings formed the basis for determining the co-morbidities of CKD including anaemia, obesity, hypertension, and other renal dysfunctions. In general, the study established that there was an association between haemoglobin levels, BMI and CKD. The increased severity of CKD in obese patients was found to increase as the BMI increased. Besides, the BMI factor, the study did not conclusively establish whether there was a statistical significance for the relationship between the haemoglobin levels and sex. However, the normal fluctuations which are found in patients with CKD were noted among sexes but correlations could not be established.

Additionally, the study established that the main co-morbidities among CKD patients were anaemia and obesity and they mediate in the development of other chronic complications such as cardiovascular diseases and diabetes mellitus. It was also found that the level of haemoglobin varied among the CKD stages. Similarly, as the obesity increased, the level of haemoglobin was also found to decrease in the studied obesity clusters.

Endogenous EPO was also noted to be inadequate, a state attributed to the diminishing kidney function which is the major organ that has the function of producing EPO. Other crucial factors established in the study were the role of active vitamin D and calcium in enhancing the kidney function. The findings may point to the EPO insufficiency which is an early occurrence of the decline in CKD.

From the findings of the study, it is evident that there are many factors that can lead to complications for people with CKD. Some of the factors included individuals’ lifestyles and social behaviour including smoking, inactivity, and poor diet that increase the chances of being obese. The associations established are critical in promoting the understanding the CKD progression.

Therefore, comprehensive awareness and knowledge about the management measures for the debilitating conditions such as anaemia and obesity can enhance the quality care accorded to the patients. This is based on the fact that that obesity has been on the rise across the globe and, therefore, a significant risk for the development of the CKD.

Implications on Health Policy
To sum up, all the associations established in the study have clinical implications because they can be applied in the formulation of policies that ensure that there are comprehensive intervention programs for patients with CKD. Due to the variations established and possible differentiation based on age and gender, the policy should capture the need for individualised preventive and curative therapies that take into consideration the findings. It will enhance the quality of life for the patients with CKD and also reduce the cost burden associated with increased hospital stay due to the co-morbidities.

The findings of the study have a wide range of implications on policy formulation and implementation. Having established that the haemoglobin, obesity, and CKD have a relationship, the study findings will add to the body-knowledge of the effects of these factors and inform on policy and interventions programs in the management of the CKD.

The prevalence of the chronic condition can be alleviated by appropriate education and the development of interventions programs that would be focused on addressing the obesity as a way of preventing the escalation of the CKD. According to the study finding, the management and maintenance of the haemoglobin within the standard level can also be a way of managing the chronic disease outcomes.

Suffice to say, the three health conditions are interrelated and their combined management can have improved heal care and well being for the CKD. However, the most significant implication is that the policy makers can address themselves to the management of obesity and the maintenance of appropriate levels of haemoglobin as a preventive measure among populations at risk of CKD and other allied complications.

References
Caldararu CD, Tarta D, Pop R, Gliga M, Carasca E, Dogaru G. Body Mass Index and the Relationship with Chronic Kidney Disease in a Tertiary Care Hospital in Romania. Acta Medica Marisiensis. 2016; 62 (2): 225-9.
El-Achkar TM, Ohmit SE, Mccullough PA, D CROOK ER, Brown WW, Grimm R, Bakris GL, Keane WF, Flack JM. Higher prevalence of anemia with diabetes mellitus in moderate kidney insufficiency: The Kidney Early Evaluation Program. Kidney International. 2005; 67(4): 1483-8.
Arogundade FA, Barsoum.RS. CKD prevention in Sub-Saharan Africa: a call for governmental, nongovernmental and community support. Am J Kidney Dis, 2008; 51(1):515-23.
Cohen E, Fraser A, Goldberg E, Milo G, Garty M, Krause I. Association between the body mass index and chronic kidney disease in men and women. A population-based study from Israel. Nephrology Dialysis Transplantation. 2013 ; 28 (4): 130-5.
Ginawi IA, Ahmed HG, Al-hazimi AM. Assessment of risk factors for chronic kidney disease in Saudi Arabia. Hypertension. 2014;1 (2):1-4.
Gotloib L, Silverberg D, Fudin R et al. Iron deficiency is a common cause of anemia in Chronic Kidney Disease and can often is corrected with intravenous iron. Journal of Nephrology. 2006; 19 (1):161 -7.
Kalantar-Zadeh K, Aronoff GR. Hemoglobin variability in anemia of chronic kidney disease. Journal of the American Society of Nephrology. 2009; 20 (3):479-87.
Boudville NC, Djurdjev O, Macdougall IC, de Francisco AL, Deray G, Besarab A, Stevens PE, Walker RG, Ureña P, Iñigo P, Minutolo R. Hemoglobin variability in nondialysis chronic kidney disease: examining the association with mortality. Clinical Journal of the American Society of Nephrology. 2009; 4 (7):1176-82.
Mehdi U, Toto RD. Anemia, diabetes, and chronic kidney disease. Diabetes Care. 2009; 32 (7):1320-6.
Plantinga LC, Tuot DS, Powe NR. Awareness of chronic kidney disease among patients and providers. Advances in Chronic Kidney Disease. 2010; 17(3):225-36.
Sevitt L.H, Hoff brand A.V, Serum folate and Vitamin B12 levels in acute and chronic renal disease. Effect on peritoneal dialysis. British Medical Journal. 2009;2(1):18-21
James B. Post, B.M., Wilkes Michael F, Iron deficiency in patients with chronic kidney disease: potential role for intravenous iron therapy independent of Erythropoietin. International Urology and Nephrology. 2006, 38(1):719-23.
Foster MC, Hwang SJ, Larson MG, Lichtman JH, Parikh NI, Vasan RS, Levy D, Fox CS. Overweight, obesity, and the development of stage 3 CKD: the Framingham Heart Study. American Journal of Kidney Diseases. 2008; 52(1):39-48.
Garty M, Krause I. Association between the body mass index and chronic kidney disease in men and women. A population-based study from Israel. Nephrology Dialysis Transplantation. 2014; 28(2):11-15.
Descombes E,Hanck AB,Fellay G,Water soluble vitamins in chronic hemodialysis patients and need for supplementation. Kidney International Journal. 2013; 43:1319-1328.
Anaemia management in chronic kidney disease: National clinical guideline for management in adults and children. London: Royal College of Physicians [Internet] 2006 [cited 2016 July 4] Available: www.guideline.gov/content.aspx?id=9817.
Roderick PJ, Fraser S, Mindell JS, O’Donoghue D, Day J, Moon G. Change in prevalence of chronic kidney disease in England over time: comparison of nationally representative cross-sectional surveys from 2003 to 2010. BMJ open. 2014; 4(9):1-15.
Berhane AM, Weil EJ, Knowler WC et al. Albuminuria and estimated glomerular filtration rate as predictors of diabetic end-stage renal disease and death. Clinical Journal of The American Society of Nephrology: CJASN. 2011; 6: 2444-51
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. American Journal of Kidney Disease. 2002; 39:1-266.
Aitken GR, Roderick PJ, Fraser S, Mindell JS, O’Donoghue D, Day J, Moon G. Change in prevalence of chronic kidney disease in England over time: comparison of nationally representative cross-sectional surveys from 2003 to 2010. BMJ open. 2014; 4(9):1-15.
McClellan W, Aronoff SL, Bolton WK. The prevalence of anemia in patients with chronic kidney disease. Current Medical Research and Opinion. 2004; 20 (1):1501–10.
Cohen E, Fraser A, Goldberg E, Milo G, Garty M, Krause I. Association between the body mass index and chronic kidney disease in men and women. A population-based study from Israel. Nephrology Dialysis Transplantation. 2013; 28(4)130-5.
Jonathan O. Cullis. Diagnosis and management of anaemia of chronic disease: current status. British Journal of Haematology. 2011; 154(3):289-300.
Lucile M, Marie M, Nicole C et al. Timing and determinants of Erythropoietin deficiency in Chronic Kidney Disease. Clinical Journal of American Society Nephrology. 2012;7(2):35-42.
Ferrh A, Teut R: Serum Erythropoietin concentrations in response to anemia in patients with Chronic Kidney Disease. Nephrology Dialysis Transplantation. 2007;22: 2900-2908.
McGonigle RJ, Shadduck RK, Fisher JW: Erythropoietin deficiency and inhibition of erythropoiesis in renal insufficiency. Kidney International. 2004;25:437- 444.
Kambham N, Markowitz GS, Valeri AM, Lin J, D’Agati VD. Obesity–related glomerulopathy: an emerging epidemic. Kidney International. 2011;59(4):1498–1509.
Valeri AM, Lin J, D’Agati VD. Obesity–related glomerulopathy: an emerging epidemic. Kidney International. 2007;9(1): 98–109.
Huang JC, Lin HY, Lim LM, Chen SC, Chang JM, Hwang SJ, Tsai JC, Hung CC, Chen HC. Body mass index, mortality, and gender difference in advanced chronic kidney disease. PloS one. 2015;10(5).
Chen SC, Chang JM, Hwang SJ, Tsai JC, Hung CC, Chen HC. Body mass index, and gender difference in advanced chronic kidney disease. PloS one. 2014;1(5).
Tanaka H, Shiohira Y, Uezu Y, Higa A, Iseki K. Metabolic syndrome and chronic kidney disease in Okinawa, Japan. Kidney International. 2006;69(2):369-74
Hallan S, de Mutsert R, Carlsen S, Dekker FW, Aasarød K, Holmen J. Obesity, smoking, and physical inactivity as risk factors for CKD: are men more vulnerable?. American Journal of Kidney Diseases. 2006;47(3):396-405.
Mura I, Kato J, Kitamura K. Association between body mass index and chronic kidney disease: a population-based, cross-sectional study of a Japanese Community. Journal of Vascular Health and Risk Management. 2009;5(1):315-320.
Shankar A, Leng C, Chia KS, et al. Association between body mass index and chronic kidney disease in men and women: population-based study of Malay adults in Singapore. Nephrology Dialysis Transplantation. 2008; 23(1):1910-1918.
Ohashi Y, Sakai K, Tanaka Y et al. Reappraisal of proteinuria and estimated GFR to predict progression to ESRD or death for hospitalized chronic kidney disease patients. Renal Failure. 2011;33(2): 31-9.
Cohen E, Fraser A, Goldberg E, Milo G, Garty M, Krause I. Association between the body mass index and chronic kidney disease in men and women. A population-based study from Israel. Nephrology Dialysis Transplantation. 2013;28(4):130-5.
Boulware LE, Troll MU, Jaar BG, Myers DI, Powe NR. Identification and referral of patients with progressive CKD: a national study. American Journal of Kidney Disease. 2006;48(2):192-204.
Denk T. Comparative multilevel analysis: proposal for a methodology. International Journal of Social Research Methodology. 2010;13(1):29-39.
Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A. Synthesizing qualitative and quantitative evidence: a review of possible methods. Journal of Health Services Research & Policy. 2005;10(1):45-53.
Lucile M, Marie M, Nicole C et al. Timing and determinants of Erythropoietin deficiency in Chronic Kidney Disease.Clinical Journal of the American Society of Nephrology. 2012;7(2):35-42
Mai E, Horio M, Iseki K, et al. Prevalence of chronic kidney disease (CKD) in the Japanese general population predicted by the MDRD equation modified by a Japanese coefficient. Clinical and Experimental Nephrology. 2007;11(2):156–163.
McClellan W, Aronoff SL, Bolton WK. The prevalence of anemia in patients with chronic kidney disease. Current Medical Research and Opinion. 2004;20:1501–10.
Malyszko J, Malyszko JS, Pawlak K,Mysliwiec M, Hepcidin, iron status, and renal Function in chronic renal failure, kidney transplantation, and hemodialysis. American Journal of Hematology. 2006; 81(2):832-7.
James B. Post, B.M., Wilkes Michael F, Iron deficiency in patients with chronic kidneydisease: potential role for intravenous iron therapy independent of Erythropoietin. International Urology and Nephrology 2006; 38(2):719-723.
Jonathan O. Cullis. Diagnosis and management of anaemia of chronic disease: current status. British Journal of Hematology, 2011; 154 (1):289-300.
Cohen E, Fraser A, Goldberg E, Milo G, Garty M, Krause I. Association between the body mass index and chronic kidney disease in men and women. A population-based study from Israel. Nephrology Dialysis Transplantation. 2013;28( 4)130-5.
Melamed ML, Thadhani RI. Vitamin D therapy in chronic kidney disease and end stage renal disease. Clinical Journal of the American Society of Nephrology. 2012 Feb 1;7(2):358-65.
Dhiman RK, Duseja A, Chawla Y. Asians need different criteria for defining overweight and obesity. Archives of Internal Medicine Journal. 2005;165(9):1069–1070.
Roderick PJ, Fraser S, Mindell JS, O’Donoghue D, Day J, Moon G. Change in prevalence of chronic kidney disease in England over time: comparison of nationally representative cross-sectional surveys from 2003 to 2010. BMJ open. 2014;4(9):1-15.
Berhane AM, Weil EJ, Knowler WC et al. Albuminuria and estimated glomerular filtration rate as predictors of diabetic end-stage renal disease and death. Clinical Journal of The American Society of Nephrology. 2011; 6(1): 2444-51
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. American Journal of Kidney Disease. 2002; 39:1-266.
Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism. 2007;92(6):2017-29.
Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism. 2007;92(6):2017-29.
Gelber RP, Kurth T, Kausz AT et al. Association between body mass index and CKD in apparently healthy men. American Journal of Kidney Disease. 2005; 46: 871–880.
Kalantar-Zadeh K, Aronoff GR. Hemoglobin variability in anemia of chronic kidney disease. Journal of the American Society of Nephrology. 2009;20(3):479-87.
Kambham N, Markowitz GS, Valeri AM, Lin J, D’Agati VD. Obesity–related glomerulopathy: an emerging epidemic. Kidney International. 2001;59(4):1498–1509.
Sturm G, Lamina C, Zitt E, Lhotta K, Lins F, Freistätter O, Neyer U, Kronenberg F. Sex-specific association of time-varying haemoglobin values with mortality in incident dialysis patients. Nephrology Dialysis Transplantation. 2010;25(8):2715-22.
Carlsen S, Dekker FW, Aasarød K, Holmen J. Obesity, smoking, and physical inactivity as risk factors for CKD: are men more vulnerable? American Journal of Kidney Disease. 2006;47(3):396–405.
Hallan S, de Mutsert R, Carlsen S, Dekker FW, Aasarød K, Holmen J. Obesity, smoking, and physical inactivity as risk factors for CKD: are men more vulnerable?. American Journal of Kidney Diseases. 2006 Mar 31;47(3):396-405.
Hallan S, de Mutsert R, Carlsen S, Dekker FW, Aasarød K, Holmen J. Obesity, smoking, and physical inactivity as risk factors for CKD: are men more vulnerable?. American Journal of Kidney Diseases. 2006;47(3):396-405.
Yamagata K, Ishida K, Sairenchi T, et al. Risk factors for chronic kidney disease in a community–based population: a 10–year follow–up study. Kidney International. 2007;71 (2):159–166.
Hsu CY, McCulloch CE, Iribarren C et al. Body mass index and risk for end-stage renal disease. Ann Intern Med. 2006;144(1): 21–28
Reza Afshar, Suzan Sanavi, Javad Salimi, Mahnaz Ahmadzaheh. H. Hematological profile of Chronic Kidney disease in Iran, in Predialysis stages and after initiation of Haemodialysis. Saudi Journal Kidney Disease Transplant. 2009; 20(2):368-371.
Chinwuba I, Uchenna I, Ngozi I. High prevalence of anemia in predialysis patients in Enugu, Nigeria. Nephrology Reviews. 2010; 2(1):14-9.
Shadduck RK, Fisher JW: Erythropoietin deficiency and inhibition of erythropoiesis in renal insufficiency. Kidney Intinational. 2004; 25(3):437-444.
Tussing-Humphreys L, Pustacioglu C, Nemeth E, Braunschweig C. Rethinking iron regulation and assessment in iron deficiency, anemia of chronic disease, and obesity: introducing Hepcidin. Journal of the Academy of Nutrition and Dietetics. 2012;112(3):391-400.
Mercadel L, Metzger M, Haymann JP, Thervet E, Boffa JJ, Flamant M, Vrtovsnik F, Houillier P, Froissart M, Stengel B. The relation of Hepcidin to iron disorders, inflammation and hemoglobin in chronic kidney disease. PloS one. 2014;9(6):e99781.

Business Dissertation

by admin | Mar 20, 2023 | Uncategorized

McDonald’s Ethical Issues: Examples of Unethical Marketing Practices
Abstract
Unethical marketing practices are a significant issue affecting firms’ operations. The fast-food industry is one of the most affected sectors of the economy when it comes to unethical marketing practices. A case in point is when a company promotes a product without indicating its implications on the consumer’s health. Ethical standards in business focus on ensuring that the organization attains its core objectives in a manner that adheres to the laid down requirements.

The process of developing a marketing plan may tempt the business entity to violate the ethical principles put in place. Therefore, the case study of McDonald’s ethical issues is an outstanding opportunity to learn about the violations of a big corporation. There is a need to examine some ethical practices businesses must comply with. Every industry has its unique set of guidelines to which the players are expected to adhere. However, several standards apply to all companies operating in the modern global market. In this study, the author analyzed the case of unethical practices of McDonald’s UAE.

Chapter I. Background Information
In marketing, ethical considerations play a vital role in advancing the objectives of an organisation. In the world of business, ethics is all about developing trust between the various parties involved in trade. According to Murphy and Laczniak (2012), a number of ethical practices are evident in the process of carrying out business activities. They include, among others, honesty and integrity on the part of the producer. Unfortunately, many organisations flout the ethical principles put in place. Ethical violations have a devastating effect on both the business concerned and the consumer.

The current study intends to shed more light on this issue of ethical business practices in the contemporary market. It is a case study of McDonalds and how the international company disregards the ethical considerations of business in the fast food industry. The discussions in this paper focus on the ethical issues that emerge in the process of implementing a marketing plan. In this regard, the study uses the McDonalds’ chain of stores in the United Arab Emirates (UAE). Hundekar (2010) argues that competition among companies is one of the factors that lead to the violation of ethical standards. The organisations carry out such violations in a bid to endear themselves to the consumer.

One of the primary ethical practices relate to the need for professional conduct. According to Sirgy and Lee (2008), businesses are expected to market their products in a professional manner. Such an undertaking should be reflected in the interactions between a business and its stakeholders. The parties referred to in this case include consumers, competitors, and the regulatory authorities put in place. Such an ethical practice is said to occur when a company is non-discriminatory and portrays its products in an honest manner to the consumers. On their part, Smith (2012) suggests that ethical standards should be factored in when planning on how to deal with the competitive nature of a business environment. To this end, the ethical practices include the accurate representation of a product in the market. Other common codes of conduct fall within the category of pricing and labelling of the products.

In spite of the fact that the ethical practices are obvious and clear, some business organisations still flout them. As already mentioned, the procedures are often abused by companies during the development of a marketing plan. Murphy and Laczniak (2012) point out that there are many ethical standards violated by contemporary business entities. Four of these codes of conduct are commonly cited in literature and studies conducted in this field. All of them relate to the development of a marketing plan. They touch on pricing, labelling, inaccurate representation of information, and disregard for professionalism.

There are serious ramifications associated with the violation of the laid down ethical guidelines. Hundekar (2010) observes that the most affected party is the consumer. In the case of the fast food industry, companies that misrepresent the health implications of their products put the health of their consumers at risk. It is noted that fast food has serious consequences on the health of the people. In light of this, it is important for food related companies to elaborate on the impacts of their products so that the consumers can make informed choices. Other effects of flouting ethical issues in business relate to the performance of the industry at large. For example, negative publicity associated with a given sector in relation to violation of ethical standards may affect the success of organisations of businesses operating therein.

McDonalds is a good reference point when it comes to the analysis of ethical issues in business. The company has a history of violating codes of conduct in a bid to gain a competitive advantage against its rivals in the fast food market. It is one of the reasons why the current study focuses on McDonalds stores in the UAE. Smith (2012) argues that most companies in the fast food industry tend to hide information relating to the ingredients of their products from the consumers. For instance, there are several allegations made against McDonalds on matters touching on the labelling of its products. In addition, the company has in the past been accused of using sports icons to create the impression that its products are healthy. Such form of unethical conduct jeopardises the health of the consumers.

The current study is developed against this background of business ethics in relation to the various marketing plans that companies develop in efforts to remain competitive in their respective sectors. In the opinion of Sirgy and Lee (2008), competition cannot be wished away in the business environment. However, Sirgy and Lee (2008) point out that it is possible for companies to gain a competitive edge in their industry without having to engage in unethical practices. The current study seeks to develop a framework through which organisations can achieve this objective. The strategies through which entities in the fast food industry can succeed by adhering to the codes of conduct will be discussed.

In the literature review, some insights into the UAE fast food market will be highlighted. For instance, there are various regulations around marketing that are meant to be followed by firms operating in this market. The same is discussed alongside the larger UAE fast food industry. To this end, a comprehensive insight into the fast food industry is outlined. Furthermore, the study intends to use the UAE as a model region to showcase how ethics are violated in today’s global market. In addition, the country is used to show how solutions to this problem can be dealt with in an effective manner.

Problem Statement
The current study is an integral aspect of marketing and, in extension, formulation of a marketing plan. To this end, the researcher makes use of a functional organisation that is associated with rampant unethical practices. McDonalds UAE is selected as an ideal company for the purposes of this study. It will act as a reference point owing to the sheer magnitude of consumers associated with the brand. Sirgy and Lee (2008) suggest that the evaluation of ethical issues in business is effectively done when an analysis is carried out on the market leaders.

Thesis statement
The current study was guided by one thesis statement, which is stated as follows:

Unethical practices reduce the credibility and image of a brand in the fast food industry.

Based on the thesis statement developed for the current study, the problem that will be addressed at McDonald’s is its unethical practices that ought to be addressed to curb the rising food related diseases in the modern society. The World Health Organisation (as cited in Smith 2012) recognises the link between poor diet and illnesses like diabetes and heart failure. An organisation like McDonald’s should not exploit its customers by marketing its products as healthy when this is not true. The current study identifies the said marketing plan that illustrates the company as an entity that relies on false information to gain competitive advantage.

Companies operating in the UAE are subject to Islamic laws used in the country. The same is particularly observed in the food industry with emphasis on Halal branded items. Marinov (2007) points out that promotion of products in the Islamic market should be gender specific. Other issues that should be factored into the marketing process include emphasis on the quality and value of the commodity offered. There are a number of regulations that should be adhered to with respect to entities operating in the food industry in the UAE. The literature review will expound on these issues.

Objectives of the Study
Major objective
The current study is guided by one major objective, which entails relating ethical issues to business operations, specifically in the fast food industry.

Specific objectives
The study has four specific objectives, which support the major one. They include the following:

To establish the ethical standards related to the process of marketing a product
In this regard, the author will analyse literature on ethical practices. According to Murphy and Laczniak (2012), common ethical considerations include reasonable pricing, adhering to professionalism, accurate labelling, and proper representation of information in the market. The current study identifies the ethical standards that relate to the mentioned practices.

To illustrate the common ethical violations committed by businesses in the modern market.
Violations of the ethical requirements of business are common in the food industry. The current study illustrates how businesses can mislead the consumers of their products. Specifically, the research undertaking outlines how McDonald’s misleads its customers through the use of sports icons in its marketing plan. In addition, the study addresses the manner through which McDonald’s conceals vital information from consumers in the labelling of its products.

To outline the effects of non-adherence to ethical standards during marketing.
Whenever businesses fail to adhere to the laid down ethical practices, the stakeholders involved are affected in different ways. According to Hundekar (2010), marketing plans and strategies have a direct impact on the consumer. To this end, the current study establishes the affected parties with respect to unethical business practices. Consequently, the research undertaking outlines the respective effects of unethical business practices to the parties. The same will enable the development of a suitable marketing strategy that respects ethics of business.

To propose ethical marketing plans
McDonalds is used in the current study to outline the numerous unethical practices in the fast food industry around the world. According to Smith (2012), it is possible to achieve competitive advantage in the market without necessarily having to flout the various ethical requirements put in place. To this end, the current study makes recommendations on the necessary measures that industry stakeholders can implement to achieve the objective. Such measures will help to minimise the unethical practices presently being carried out in the fast food sector. The same will illustrate how to make these products suitable to sell in the market without harming the health of the consumers.

Rationale of the Current Study
Studies are often carried out to ascertain or verify the existence of a number of phenomena. In addition, Saunders, Lewis, and Thornhill (2003) recommend the need for research undertakings to provide solutions to the problems identified in a given field. For example, a study can be carried out to explore a challenge facing a particular market segment and the possible solutions. In light of this, the findings made in the current study are expected to be quite beneficial to the marketing sector. It is based on the need to observe ethical issues.

As such, the study provides the phenomenal aspects behind ethical practices in the industry. The findings can be applied in other industries apart from the fast food. They can also be applied in other countries apart from the UAE. Considering the market size served by McDonald’s, the study illustrates how industry players can retain their leadership positions without having to engage in unethical practices (Saunders et al. 2003).

The study is developed with the intention to promote a culture of ethical practices in businesses. Smith (2012) points out that the best way to promote a given culture is to have key industry players adopt the concept. To this end, the food industry will start paying more attention to ethical work practices if a key player like McDonald’s adopts the recommendations proposed. Murphy and Laczniak (2012) argue that most consumers prefer identifying with brands that have integrity. Courtesy of the survey carried out, it is established that organisations can make the most the market which supports ethical practices by heeding to the consumers’ call (Murphy & Laczniak 2012). Consequently, the current study plays a huge role in ensuring that other companies get to appreciate this growing concern from the consumers.

The discussion in this paper carried out in partial fulfilment for the requirement of a degree. To this end, the research might not be conclusive in certain areas. However, Saunders et al. (2003) suggest that the inconclusive nature of any research is bound to reveal more information that will require future study. In the same light, the current study outlines the many areas that need expounding upon. For instance, to what extent should the law address ethical practices in business? The same will help to address the several cases where businesses exploit legal loopholes to navigate around the ethical requirements.

Research Questions
The research carried out in this study is centred on the subject of ethical issues in business. Based on the objectives, discussed, the study has seven main research questions. In point form they include the following:

What is meant by, ‘ethical standards in business/?
What are the respective ethical practices demanded for in business?
Why was McDonald’s selected for the study?
What are the impacts of unethical practices in the food industry
How are ethics of standards applied in a marketing plan?
What are the opinions of the consumers regarding adherence to ethical practices in businesses?
What is the motivation behind undertaking unethical work practices?
Assumptions, Limitations, and Delimitations
Assumptions
The current study is developed under the assumption that fast food consumers will continue to indulge in the commodities even with comprehensive labelling. According to Saunders et al. (2003), the assumptions made in a study prompt the researcher to delve deeper into the specifics of the subject matter. To this end, the study relies on the assumption in reference to develop a marketing plan that will open up the information sharing between McDonald’s and the consumers. The same will advice on the need for honest labelling and representation of the ingredients involved in the preparation of the foodstuff (Saunders et al. 2003).

Limitations of the study
In point form, the following is a list of the limitations faced in the execution of the current study:

The time required for the research was quite small
The current study is limited to the unethical practices in only one business industry (the food industry). Other sectors like logistics, banking and insurance are areas where unethical practices are carried out. However, their role is not examined
Within the food industry, the researcher is restricted to fast foods, and by extension McDonald’s. The same was carried out with the awareness of diversity within the industry.
Delimitations of the study
Initially, the researcher planned to use primary data by interviewing employees and dedicated customers of McDonald’s from 4 cities over various outlets. However, it was not possible to access all the participants due to the short time. To this end, the survey was carried out across 15 McDonald’s outlets in the United Arab Emirates.
The study focused on the food industry owing to the increased interest in healthy products from consumers. The findings of this study are aspects that can be generalised to other sectors as well.
The researcher settled on fast foods owing to the market size. Fast food industries across the world have larger consumers and the same implies easy access for participants to such a study.
Definition of Marketing Ethics
Ethics is a concept that is understood from the perspective of human conduct. In previous studies and existing literature, ethics has been defined variedly. According to Murphy (2006) ethics is a philosophy that evaluates human conduct. Murphy and Laczniak (2012) point out that ethics evaluates how individuals can make a distinction between right and wrong. In the field of marketing, ethics are viewed as the principles that govern the decision making.

The standards and principles associated with marketing ethics are meant to enhance an acceptable conduct in this field of business. Murphy and Laczniak (2012) suggest that marketing ethics are determined by various stakeholders. In most cases, the stakeholders include the company marketing its products alongside its customers. Given the integral role of marketing in business the respective principles and standards are incorporated several regulations. Murphy and Laczniak (2012) point out that a code of ethics on matters pertaining to marketing is very important to realise the acceptability of this field.

The code of ethics allows marketers to conform to the expectations from the various stakeholders and the society at large. However, marketing ethics transcends the legal and regulatory issues contained in the code of conduct. Ethical marketing practices and principles constitute the necessary elements required in establishing trust. Kotler (2000) suggest that trust is an essential ingredient in fostering long-term marketing relationships. To this end, ethical principles are necessary to ensure that marketing strategies endear a company to its clients.

In the field of marketing, the practitioners and scholars have a divergent approach to the subject. Churchill and Lacobucci (2002) cite an example of scholars who perceive ethics as being associated with an individual’s morality. Separately, Kotler (2000) argues that virtues such as honesty, fairness, responsibility can be acquired, notwithstanding an individual’s personal character. Practitioners who approach ethics from an organisational perspective focus on the cost of a marketing strategy. Kotler (2000), suggests that the cost implication results in the training of personnel on adherence to the code of ethics. Consequently, practitioners have a secondary view of ethics in the context of marketing.

Chapter Summary
The current chapter lays the foundation for the entire study with respect to unethical marketing practices in business. A background on the subject is outlined. The foundation of this study is based on the thesis statement that unethical practices destroy the image of an organisation. In this regard, McDonald’s franchise based in the UAE is used as the basis of researching up on the thesis statement. The rationale and research technique, employed are all outlined in this chapter. The subsequent chapter offers an insight into the existing literature on the issue of ethical standards in marketing.

Literature Review
Historical perspectives of ethical marketing
Matters relating to ethics, with respect to marketing, are not a new phenomenon in business. According to Smith (2012), some of the earliest literature on the subject dates back more than half a century ago. For instance, as early as 1957 Packard (as cited in Smith 2012) discussed some of the negative elements of marketing.

Packard (as cited in Smith 2012) makes a claim that marketing is a completely manipulative area of business. In chapter 15 of the book, Packard (as cited in Smith 2012) argues that, “The large-scale efforts being made, often with impressive success to channel our unthinking habits, our purchasing decisions, and our thought processes by the use of insights gleaned from psychiatry and the social sciences” (Smith 2012, p. 7)

Notwithstanding the claim of marketing as a manipulative technique, the idea was advanced for several years. However, there were other schools of thought which did not buy into the whole manipulative idea. Smith (2012) point out that whereas the idea was advanced, other scholars associated the sentiments to how best to understand a consumer. Packard (as cited in Smith 2012) was seen to suggest that consumers should not be seen as being gullible.

The subject of marketing ethics is also associated with the element of social responsibility to the consumers. To this effect, Levitt (as cited in Saucier 2008) wrote a series of papers reflecting on his sentiments regarding social responsibility. Levitt (as cited in Smith 2012) was against business ethics that violated the civil nature of a people’s daily activities. The arguments were developed from the idea that businesses have no obligation to the welfare and social responsibility. The underlying aspect of business is to realise profits. To this extent Levitt (as cited in Smith 2012) associated marketing with the core principles which scarcely make reference to ethics in business.

The elements of marketing ethics have, for a long time now, been published in a number of peer reviewed articles. However, Saucier (2008) cites the Journal of Marketing as the most notable journal with respect to the subject. Saucier (2008) points out that the journal has gained the necessary reputation owing to its publication of articles that touch on advertising practices. Specifically, marketing ethics have been discussed from the perspective of advertising practices, deceptive marketing techniques and promotional aspects in a marketing campaign.

The Journal of Marketing has acted as a platform for notable scholars who have discussed marketing ethics at length. According to Lazo, Petit, and Zakon (as cited in Smith 2012), issues like promotion of questionable values and ethical dilemmas in marketing are very significant to companies. On their part, Bogart 1962 and Twedt 1663 (as cited in Smith 2012) outline the numerous ethical concerns in marketing. Their publication over the years has continued to assert the importance of the subject in the broader spectrum of business.

Based on the review outlined, so far, the foundation of ethics in business is pointed out as having taken roots several decades ago. Smith (2012) helps to illustrate that scholars and marketing experts have placed the subject on a high pedestal. However, critical aspects of marketing ethics lie in understanding the suitable and unethical marketing techniques. The same are reviewed in the subsequent sections as a means of developing on the historical foundations laid out (Smith 2012).

Marketing in the UAE
The UAE is considered one of the fastest growing market regions in the world. To this end, the region has attracted a wide array of companies, cutting across all industries. Marinov (2007) argues that the UAE is part of the affluent markets of the world. The same explains why big brand names like McDonald’s are found in the region. Notwithstanding the presence of Islamic laws, affluent markets have a lot in common with similar ones in Europe and America. Marinov (2007) points out that there is an appetite for western commodities in the UAE region. However, the same calls for marketing strategies which ought to conform to the regulations in the UAE market.

Corporate governance and business ethics are market specific. While carrying out a study on the same, Obay (2009) uses Dubai as an illustration of this phenomenon. The marketing guidelines in the region require that an advertisement campaign should be gender specific. A similar perspective has been discussed by Marinov (2007). Marinov (2007) argues that the message in such marketing strategies should either target men or women. In addition, Marinov (2007) points out that the UAE still has gender inequalities. To this end, the message for women should be subtle.

As already mentioned, Islamic law is applicable in the larger context of the UAE. Consequently, marketing campaigns are required to involve some religious words. This aspect has been discussed previously in literature. For instance, Marinov (2007) points out that the use of religious words and phrases should be used where appropriate. Separately, Obay (2009) argues that the same is essential in endearing the religious community to the product. There are cases when such words are inappropriately used, bringing about ethical concerns.

The Islamic religion emphasises on a modest lifestyle. The implication for companies is such that marketing should ensure that simplicity is at the heart of the message (Marinov 2007). In addition, in the UAE, marketing techniques where the message emphasises on price-cuts are not allowed. Such marketing tactics suggest that the price was intentionally raised high. To this end, marketing in the UAE is required to closely align itself with the requirements of the Islamic law.

Suitable Marketing Ethics
As illustrated in the previous sections, there are several instances where marketing is seen as suitable and unsuitable. According to Coldwell and Herbst (2004), suitable marketing ethics can sometimes be referred to as positive. The positivity is seen in the sense that marketing is carried out in a manner that conforms to morally neutral aspects of a society.

To this end, studies in the field advance the understanding that ideal marketing ethics are the kinds that are developed on moral principles (Smith 2012). While discussing the subject, Nill and Schibrowsky (as cited in Chaar & Lee 2012), positive marketing ethics can be considered as suitable. However, relying on morality introduces the aspects of normative ethics. The difference between the two lies in the ideal ethics and what is actually applied in the field.

With respect to the suitable marketing ethics, a number of variables have been identified. For instance, Chonko and Hunt (as cited in Palmer 2000) initially carried out a study to identify suitable ethics in marketing. Their study found a number of ethical issues which hinder the realisation of suitable practices in marketing. Some of the issues include bribery, fairness and honesty. However, in a separate study, Smith (2012) found that pricing and product related issues add to the ethical concerns that inhibit stable ethics to be adhered to in marketing. To this end, suitable marketing ethics present a dilemma to the stakeholders whereby the demands of a company and the consumers have to be met.

The importance of ethics in marketing has resulted in several studies sprouting up to establish the actual ethical concerns that marketing experts face. For instance, Hunt, Chonko and Wilcox (as cited in Clemes & Burn 2000) carried out a survey which would identify key ethical concerns in marketing. The study by Hunt et al. (as cited in Clemes & Burn 2000) involved a total of 460 participants, all of whom were marketing researchers. Hunt et al. (as cited in Clemes & Burn 2000) identified a number of ethical concerns, which included research integrity and the treatment of consumers. On their part Smith (2012), found that most marketing executives engage in unethical behaviours when it comes to the marketing of certain products. However, when such managers were reprimanded, the vices stopped.

Understanding suitable marketing ethics requires insight on ethical judgments that marketers have to make. The same was the subject of a study by Akaas and Riodan (as cited in Davidson 2003) where marketing researchers’ opinions were sought regarding the ethical judgments they make. In the study, ethical issues like labelling of products and hyped branding as the borderlines for ethical issues. Smith (2012), on their part, found that ethical judgments are brought about by such issues as the information given to clients and the pricing of commodities. In both cases the judgments result in outlining the suitable marketing techniques. To this end, suitable marketing ethics are only realised when the marketers can make the necessary judgments from the issues raised.

Labelling is seen as a suitable marketing technique with respect to ethics. Alserhan (2011) argue that businesses that deal with goods require adherence to certain standards of labelling. Smith (2012) argues that labelling is particularly important in the food industry. For instance, companies that manufacture processed foods are required to adhere to certain safety standards. To this end, issues like the ingredients used in the products ought to be outlined. Hunt et al. (as cited in Clemes & Burn 2000), Smith (2012), and Saucier (2008) argue that proper labelling of products like food and commodities ensure that the safety concerns of the consumers are catered for. Proper labelling is, as a result, considered as one of the suitable marketing ethics.

As already mentioned, marketing executives are faced with a dilemma when it comes to making profits at the expense of honesty to their customer. The subject has been an issue of debate as outlined by Saucier (2008). Saucier (2008) found that most marketing professionals tend to distort certain information while describing their product. Smith (2012) found that misinformation and misinterpretation are ethical concerns that most marketers face. The dilemma results from the claim by Packard (as cited in Smith 2012) that consumers can be gullible and the need to increase sales.

Several studies outline the possibility of realising profits by avoiding the ethical issues surrounding misinformation and misrepresentation. Hunt et al. (as cited in Clemes & Burn 2000) initially advocated that companies avoid overhyping their products but, instead, focus on the actual benefits. Gilbert and Churchill (2001) recently pointed out that companies can market their product by outlining the actual benefits of their products. The same calls for intensive research on the said benefits. Saucier (2008) found that marketing a product based on well researched issues by credible authorities increases the allure of a product.

Pricing, on its part, is one of the thorny ethical issues that most marketing executives face. The subject was an issue of research in the study carried out by Smith (2012). According to Packard (as cited in Smith 2012), marketing is seen as deceptive in the manner that a particular commodity is priced. Packard (as cited in Smith 2012) found that marketers tend to associate a product with high values when in fact the same is not true. Under such circumstances, the idea advanced by Levitt (and cited in Smith 2012) argues that consumers are not as gullible as imagined, emerges.

Marketers tend to price their products under an illusionary value in order to attract their customers. However, Smith (2012) point out that such a move is seen as exploiting the consumers. To this end, reform is necessary to ensure the dignity of the consumer is safeguarded.

Common Ethical Issues in Marketing
Good marketing ethics have a direct impact on the operations of a company, with respect to meeting its core objectives. Ethics are the viewed as the principles a person or an organisation relies on, to meet its objectives. In a study carried out my Gulls (and cited in Brenkert 2008), decisions made by a company can be clear cut right and wrong. However, with respect to marketing there are exists ambiguity resulting in ethical dilemmas.

In the field of marketing, there are a set of uncertain problems pertaining to product development and pricing policy. Gulls (and cited in Brenkert 2008) made an observation that when it comes to distribution activities and promotion ethical dilemmas present themselves. In this section, of the review, ethical issues in marketing are highlighted. To that extent a code of ethics, is outlined, to point out the areas where business ethics must be employed.

The first ethical issue, commonly associated with marketing is the misleading of clients. The issue was subject of the study by Gilbert and Churchill (2001) and Davidson (2003). In the studies, the production of a misleading advertisement was viewed as a common ethical dilemma. Gilbert and Churchill (2001) suggest that regulation creates the boundaries for what can be said in a marketing campaign. Consequently, marketers are required to consider the ethical boundaries. Davidson (2003) evaluated a number of claims with respect to how clients get misled through marketing campaigns. Consequently, to establish when a claim is taken too far companies are required to adhere to a code of conduct on matters relating to ethics.

The ethics related to direct marketing is another concern facing a number of companies in the present times. According to Davidson (2003), direct e-mails and telemarketing amounts to the invasion of privacy. However, direct marketing should not be misconstrued to imply that it is not an ideal marketing strategy. Davidson (2003) suggests that the same is another example of the ethical dilemmas which present themselves when developing an ideal marketing strategy. To this end, the use of promotion avenues, to market a product should be governed by sound ethical principles.

The safety of consumers is an important concern that should be considered in the development of a marketing plan. Hermit (as cited in Murphy 2006) carried out a study to evaluate the safety measures taken in protecting consumers from harmful products. According to Saucier (2008), companies, particularly in the cosmetic and food sectors, fall prey t the temptations of marketing of harmful products. Saucier (2008) went on further to point out that, industries like tobacco and fast foods are culprits in the production of products that are wholly harmful to their consumers. To this end, marketers ought to evaluate the degree of responsibility they take due to the harm caused by the products.

Although the consumers also have a responsibility, the same should be clearly delegated in the form of disclaimer alerts on the harm caused by the products. Brenkert (2008) argues that the right choice is not always clear. The same calls for adherence to ethics. Marketers can also take their own initiative to set out ethical practices. Saucier (2008) refers to the fast food industry pointing out that, while enjoying the profits made by the easy-to-make foods they should take personal initiatives to advance ethical standards.

In the field of marketing, adherence to pricing ethics is an important component in enhancing the relationship between the seller and the consumer. Davidson (2003) evaluated the same and mentions predatory pricing as a common practice used by marketers. According to Davidson (2003), predatory pricing is practice used to drive out competition. The same is done in a manner that the competition cannot possibly compete. Such a trend can be harmful to consumers and marketers are advised to tread carefully. Policy designed to foster a healthy marketing environment must ensure that there is a balance between the profits and the welfare of the consumers.

Cause-related marketing is an emergent ethical issue in the field. Davidson (2003) argues that cause-related marketing becomes an ethical dilemma based on how it is managed. The society develops a perception of a company based on the of cause impact on customers. To this end, marketing departments responsible for the relationship with a cause are required to manage the same with transparency.

In the current business arena, companies are increasingly forced to adhere to the environmental concerns. According to Davidson (2003) marketers are developing marketing strategies based on how their product affects the environment. The so called ‘Green’ practices can improve the good standing of a company since the society will attach such practices to the care and protection of the environment. Environmentally-friendly choices can be a costly affair (Saucier 2008). However, marketers must consider their responsibility to society and the environment, as they come up with strategies to sell their products

Marketing executives are often confronted by a number of ethical issues. Graham (as cited in Clemes & Burn 2000) argues that the ethical issues often revolve around the costing of development of a marketing strategy. Consumers ought to be informed of price or size changes and the same has huge cost implications. However, marketers are also required to consider the ethics behind their policies. To this end, issues of cost result since certain ethical requirements are a costly affair. An example of cost implications on ethical demands of marketing is in the distribution of products. Fresh foods, for instance, require healthy transport conditions like refrigerators. However, marketing executives opt to ignore the requirement just to minimise on the operating costs of their company.

Ultimately, ethics relates to organisational performance in generating goodwill for a particular company. Davidson (2003) argues that such goodwill often translates into sales. Adhering to the laid down ethical concerns, of marketing, by a company turns an organisation into a more attractive place to work. Davidson (2003) argues that the company’s good reputation is passed on to the staff. Motivated, proud employees tend to improve on their performance. Companies that don’t conform to the required marketing ethics destroy their good reputations with their consumer base. A good reputation is arguably much harder to build compared to sales numbers.

Stereotyping is also another ethical issue of concern in business. Advertisements are known to cast particular groups in stereotypical roles. Davidson (2003) examined washing powder advertisements across the world. Such marketing campaigns often portray women as housewives preoccupied with their laundry. Another angle used in similar advertisements is the ‘do-it-yourself’ marketing. According to Rodwin (2010) such advertisements depict only men as being “handy.” The stereotypical impression created by a number of advertisements is that having an abundance of possessions translates into fulfilment and happiness. Such campaigns create an opposing message that the consumer will not be part of the happy group unless they purchase the product.

Most marketing campaigns insert a hidden message meant to manipulate clients. Smith (2012) cites the George Bush 2000 Presidential Campaign. In that campaign, there was an advertisement where the word “rats” was used for a split second (Smith 2012). The same was one as criticism to his opponents’ medical plan. Such tactics appeal to the metal faculties of a consumer to a associating certain aspects (good or bad) in relation to their product.

Marketing can come out as offensive, especially when it appears to create some cultural and ethnic sensitivity. Waller (2012) conducted a survey on motor vehicle advertisements. According to Waller (2012), advertisements about luxury cars depict men as womanisers. Such a marketing tactic depicts women as objects that can easily be acquired through material objects. Waller (2012) suggest that depicting a woman as dependent on financial success is offensive. Marketing campaigns of that nature ruin relationships between organisations and their clients.

Racial stereotypes are the most common when it comes to marketing strategies. Waller (2012) found that it is possible to exclude a certain group of people in a multi ethnic society. In a separate study Palmer (2000) found that marketers in the fast food industry often target children with the juicy images created. The ethical concern in this case is the assumption that children don’t need to be informed on the dangers of fast food Waller (2012). Consequently, the children are exposed to such diseases as obesity.

Marketers tend to manipulate consumer into buying a certain commodity, when in fact it is not the actual product. Waller (2012) discussed the same and refers to such a trend as post-purchase dissonance. According to Waller (2012), post-purchase dissonance often occurs when a consumer makes a mail order. Such a scenario occurs when a client gets an inferior quality or quantity of the goods they ordered. Although the buyer may claim a refund, such tactics usually deter prospective buyers.

The Domain of Marketing Ethics
As already mentioned, trust and good faith are integral aspects of developing a rapport between the consumer and the seller. The implied good faith, due to marketing ethics is essential for the mutual benefit of both parties to trade. To this end, the study by Kotler (2000) established that the performance of an organisation transcends the discretion of its executives. Marketing ethics opens up the process to include all the stakeholders in trade. The same ensures maximum benefits out of the trading endeavour. Waller (2012) suggests that marketing ethics have been legislated in certain states in America.

The implied covenant of good faith and fair dealing “is meant to enforce the contract or transaction in a manner consistent with the parties’ reasonable expectations” (1998 WL 1991608 Mich. App.). Gundlach and Murphy (as cited in Murphy 2006) argue that courts may ensure the good faith is incorporated in any form of marketing exchange. To this end, legal institutions like courts and tribunals are expected to embody the spirit of good will.

Ultimately, marketers are required to make decision but ought to be guided by the principles of ethics. In the study by Fry and Polonsky (and cited in Rodwin 2010) must ensure that all the stakeholders are satisfied by the decisions made. The input from all stakeholders is required, coupled with their specific interests to ensure that a middle ground is reached. Homburg, Krohmer, and Workman (and cited in Grewal & Levy 2010) carried out a survey to establish marketing orientation and how it relates to marketing. Homburg et al. (and cited in Grewal & Levy 2010) arrived at the conclusion that a marketing orientation results in the success of possible marketing strategies employed by a company. A disclaimer is necessary to point out that. At times, the marketing strategy may not be 100% satisfactory t all stakeholders but their involvement enhances ethics.

The domain of marketing ethics has a locus in the element of pricing. Customers at Wal-Mart customers often get low prices. However, Palmer (2000) points out that the company has several critics. The critics include “organised labour, feminists, human rights activists, environmentalists, local businesses, and anti-sprawl activists…resulting in a growing negative consumer perception of Wal-Mart’s corporate citizenship” (Palmer 2000). Unfortunately, most approaches to market orientation often opt to elevate the interests of individual stakeholders.

According to Coldwell and Herbst (2004), Wal-Mart is an example of a company that focuses on the consumer as its individual stakeholder while at the same time disregarding the plight of its workforce. Wal-Mart disregards the workforce but lays emphasis on profits and the consumer numbers. Failure to incorporate their employees in the decision making process, gives Wal-Mart a bad image. Such a move is seen as a failure for a marketing strategy.

In recent times companies are facing immense pressure to focus on all their stakeholders. The incorporation of all stakeholders ensures that an organisation is accountable for its actions. Vargo and Lusch (and cited in Coldwell & Herbst 2004) add that the consideration of all the interests is a step towards satisfying all the stakeholders. Marketing exists to provide both social and economic progress (Coldwell & Herbst 2004). The logic behind such an understanding is captured in the one of the many definitions of marketing.

The American Marketing Association defines marketing as follows, “marketing is an organisational function and a set of processes for creating, communicating, and delivering value to customers and for managing customer relationships in ways that benefit the organisation and its stakeholders” (Coldwell & Herbst 2004, p. 34).

The definition places emphasis, on marketing, with respect to ethics. The American Marketing Association (as cited in Coldwell and Herbst 2004) introduces the importance of delivering value while marketing. To this end, it is the responsibility of marketers to come up with meaningful relationships that provide benefits to all relevant stakeholders. Based in the study by Saucier (2008), marketing ethics was, for the first time, defined to include all the necessary parties. The same is seen as a move in the right direction with respect to the development of marketing ethics.

Marketing executives can make an ordinary decision or one that is bound by ethics. Saucier (2008) uses their study to point out the difference between the two decisions. An ordinary marketing decision disregards the code of ethics while an ethical one sticks to the laid down regulations. Consequently, Saucier (2008) advices marketers to settle on a decision that satisfies all the parties. An individual’s values also contribute towards a marketing decision. At this point, ethical dilemmas present themselves on the decision to be selected. Ethical decision making requires that marketers make decisions informed by their personal morality, laid down rules and the conviction to enhance the concept.

Theoretical Frameworks of Ethics in Marketing
Ethical decision making, in marketing, is not any different from other similar functions of an organisation. Gilbert and Churchill (2001) argue that marketing ethics overlap with those of general business practices. The argument relies on the assumption that all activities in an organisation are geared at ensuring the products reach the consumer. To this end an ethical component to business decisions, regardless of whether it is marketing or some other functional area component is important in the functionality of the organisation.

There is a high possibility to generalise the average behaviour patterns in any company. Waller (2012) points out that marketing identifies the importance of stakeholders, their related issues. Marketing also enhances information gathering. The same is meant to respond to the constituent elements of the marketing domain. Secondly, in the decision-making process, marketers are required to settle on the most important issues. Based on this argument, Waller (2012) suggests that marketers should focus on the intensity of the issues at hand.

The fast food industry, in the US, is under immense pressure by government agencies, consumers, and special interest groups to develop menu options that consider the health of their consumers. While discussing the same, Smith (2012) makes reference to children as the main interest group. Children, as already mentioned, are not in a position to make informed health choices.

Upon the release of the movie Super Size Me McDonald’s restaurants became the focus of negative publicity associated with fast food. McDonald’s responded by introducing healthier portions, like salads, to their menu. The evaluation and resolution of ethical dilemmas in marketing requires an ideal theoretical framework as a point of reference. Churchill and Lacobucci (2002) point out that moral philosophy is an ideal point of reference in the development of a theoretical framework.

An ideal theoretical framework is one which encourages internal discipline. Research has indicates that companies are lenient on the top sales performers compared to the ones who perform poorly (Churchill & Lacobucci 2002). Such lenience allows top sales performers to further unethical practices without fear of the repercussions.

The process of advancing a theory of marketing ethics has been the subject of numerous studies. The following agencies are an example of how the US intends to enhance an ideal theoretical framework due to policy making:

American Marketing Association
Direct Selling Association
Direct Marketing Association
Marketing Research Association
American Federation of Advertising
National Advertising Division of the Council of Better Business Bureaus.
The agencies mentioned above have come up with comprehensive codes of conduct meant to tackle the ethical risk in marketing. According to Baragona (2010), the recent regulatory changes in America require marketing executive to take the onus of implementing ethics in the field. A theoretical framework that promotes the culture of ethics in an industry will ensure marketing becomes a respectable entity. The General Theory of marketing lays the ground for a more comprehensive framework.

Emergent Ethical Issues in Marketing
Increasing trends in the field of business support new trends of ethical issues in marketing. According to Smith (2012), most emergent ethical concerns arise from consumer psychology. In this section, of the review, some fundamental consumer behaviours are outlined.

Ethical consumerism
Marketing strategies, and ultimately, marketing strategies are developed with the understanding that consumers perceive certain ethical concerns. The study by Smith was able to outline that “consumers are influenced in purchase and consumption due to certain ethical considerations” (2012, p. 43). Whereas such an understanding was seen as a definition of ethical consumerism, there is distinction from consumerism as defined by Kotler (and cited in Smith 2012).

Based on the definition, given, it is possible to have a negative ethical consumerism. In a separate study Gilbert and Churchill (2001) point out that, consumers develop an attitude towards a product, based on the ethical connotations associated in its marketing. To this end, Smith (2012) found that certain customers make a decision to purchase a product based on the ethics of its production and marketing. There are cases when a product is associated with a company that is reputed for unethical practices Waller (2012). Similarly, consumer decisions have been developed based on the ethical perceptions.

Understanding ethical consumerism is largely focused on the consumer decisions with respect to purchases. According to Smith (2012), when a consumer refuses to make a purchase, the same can be considered as an ethical boycott. In a separate study Bellizzi and Hasty (and cited in Smith 2012) found that organised consumer boycott often results from a negative perceptions to the ethical concerns of marketing a commodity. The same applies for cases when there is a positive ethical consumerism.

Chapter Summary
The current chapter highlights the previous studies on the issue of ethics in marketing. Some of the areas of interest include a historical outlook on the subject followed by an overview of some of the unethical perspectives of marketing. In this chapter theoretical perspectives on the subject of ethical marketing standards are outlined. The review of literature highlights the general thoughts on the subject from various scholars. The next chapter provides the results from the actual research undertaking carried out through the administration of questionnaires.

Results
Overview
In this section of the study, the outcome of the interview is illustrated. The participants were administered with questionnaires, randomly. The questions in the questionnaire are closed. Participants are only required to respond with a No or a Yes as the case may be. The questions on ethical marketing practices are posed in a fast food industry setting. The results, outlined, give a general bearing of the objectives of the study. The results act as responses to the questions raised in the introductory section. Based on the results outlined, a suitable discussion on the ethics of marketing in the fast food industry suffices.

Demographics
The study involved a total of 250 participants based in the United Arab Emirates’ city of Dubai. In terms of gender, 140 of the participants were female while 110 were male. The females were mostly between the ages of 19 to 25. On the other hand, the males were selected between the ages of 20 to 27. The participants were randomly selected from various McDonald’s outlets in the city of Dubai. 154 of the participants were customers while 96 were employees. Prior to the study all the participants filled out the consent forms.

Familiarity to ethical standards
Participants to a study are required to exhibit an understanding of the subject intended for evaluation. According to Creswell (2003), the credibility of a study is determined by the participant’s ability to understand the subject matter. In this regard a series of questions were posed to the participants to establish their understanding of ethical standards. Participants were required to respond with a ‘Yes’ or ‘No’ depending on the question posed.

Have you encountered the word ethics in your career?
All the participants were given the questionnaires to fill out. Table 1 is an illustration of how the participants responded.

Table 1: Have you encountered the word, ‘ethics’ in your career?

Response Yes No No response
Number of participants 223 0 27
Based on the figures represented in Table 1, a total of 27 participants failed to respond to the question posed. However, an overwhelming 223 responded in the affirmative. It is unclear whether the 27 had no clue or the question was skipped accidentally. That notwithstanding, there is a general view that a majority of the participants have a general idea of the concept.

2. What are ethical standards?

The need to establish whether the participants truly understood the subject was followed up by this question. Table 2 illustrates the responses based on the proposed set of answers.

Table 2: What are ethical standards?

Response Adherence to the rules of business practice Practices that promote the integrity of a business Genuine business practices
Number of Participants 59 138 53
Responses to the question posed, in this section were varied. 138 of the participants were of the view that ethical standards are the practices that promote integrity of a business. 59 of the participants view ethical standards as the adherence to the rules of business practice. On the other hand, 53 view the subject as genuine business practices. In general, the participants have an idea of the entails of business ethics.

Ethical Practices
Ethical standards in the field of business are coupled by a series of practices. The participants were given a number of options to select from in regard to their view on the ethical practices demanded by a business. Table 3 outlines the responses given.

Table 3: Ethical Practices

Opinion surveyed Mean Standard Deviation Sum Part
Ethical principles should be represented in the management 5.60 1.08 248 2.2
Ethical issues call for quality assurance 5.17 1.30 246 2.2
Accreditation process should be incorporated in organisations 5.07 1.19 240 2.1
Ethical auditing is called for to improve an organisation’s ratings 4.86 1.07 236 1.9
The development of ethical plans in an organisation 4.77 1.31 234 1.8
Competence should be a core principle 4.44 1.16 197 1.6
Total 4.99 1401 9.72
There are a number of practices that a company can carry out to conform to ethical practices. In this study a total of 6 different opinions were surveyed regarding ethical practices of an organisation. Table 3 illustrates the results of the study in which the representation of ethical principles was the most common opinion among the participants. The least popular view was that competence should be a core principle in organisation. That notwithstanding, the responses given illustrate a general willingness among the participants for ethical practices.

Reasons for selecting McDonald’s
As already mentioned, the current study was focused on McDonald’s, the fast food outlet. However, ethical practices cut across various business organisations. In this regard, the participants were asked to indicate why think McDonald’s fits the profile of a suitable company for the study. Table 4 outlines the results of this survey.

Table 4: Why was McDonald selected for the study?

Reason It is a common brand Unethical practices are common in the fast food industry McDonald’s has a huge client base It was the easiest company to evaluate
NumberofParticipants 65 103 67 15
McDonald’s is an international brand in the fast food industry. According to Brubaker (2007), the fast food industry is laced with several instances of unethical practices. To this end, the study decided to involve a well known brand in the industry. The information in table 4 suggests that 103 participants viewed that McDonald’s was selected owing to the unethical practices common in the industry. On the other hand, 67 of the participants were of the view that the company was selected owing to its huge client base while 65 suggested that the company was a common brand. A paltry 15 supported the view that it was an easy company to evaluate.

Common Unethical Practices
In the fast food industry, there are a number of issues which constitute unethical practices. In this regard a number of those issues were posed as questions to the participants. Figure 1 is a representation of the unethical practices and the percentages of their occurrence, according to the participants.

Figure 1: Unethical marketing issues

Unethical marketing issues
Figure 1: Unethical marketing issues
Participants in this study were provided with 8 different issues related to unethical practices in marketing. Misrepresentation recorded a whopping 35% of the responses from the participants. According to the results in figure 1, consumer safety and hidden messages follow suit at a joint 16%. The participants perceived pricing as another unethical practice associated with McDonald’s with the subject recording 15% response from the participants. Other unethical issues associated with the fast food franchise include, Cause-related marketing (5%), employee motivation (7%), Post-purchase dissonance (5%) and cultural sensitivities (1%).

Misrepresentation
Misrepresentation, as already discussed in the literature review, is the most common unethical practice in the food industry. Participants were asked of the degree at which misrepresentation occurs. Figure 2 is an illustration of the responses given.

Misrepresentation
Figure 2 illustrates that the participants view that misrepresentation is an often occurrence in the fast food industry. However, the results also indicate that more than 50% of the participants perceive the misrepresentation occurs once in a while. A significant percentage of the participants perceive that the same rarely occurs. The disparity in the responses can be attributed to the various issues of misrepresentation.

There are a number of instances where marketing makes use of misrepresentation. In the current study, participants were provided with three options that would suggest misrepresentation. In this regard, figure 3 illustrates how the participants responded.

Issues of misrepresentation
Figure 3: Issues of misrepresentation
The participants perceive that the misrepresentation commonly occurs when fast food companies associate their products with celebrities. More than 70% of the participants surveyed hold this opinion. An equally overwhelming number of participants perceive that fast food companies create the impression that their products are healthy. In addition, more than 505 of the participants are of the opinion that an inaccurate representation of ingredients is a common occurrence in the fast food industry. Figure 3 is a clear indicator that misrepresentation is a common occurrence in the fast food industry.

Consumer safety
From the literature review section, it was clear that fast food companies do not necessarily come up with safe products. In this regard, the consumers were surveyed on their opinions regarding consumer safety in the marketing strategies used by fast food companies. Figure 4 is an illustration of the responses. Participants were polled on their opinion regarding prioritisation of consumer safety in marketing strategies.

Consumer safety priority
Figure 4: Consumer safety priority
Based on the results outlined in figure 4 it is clear that there is little priority given to safety standards. For instance, more than 50% of the participants perceive that fast food companies rarely make consumer safety a high priority. The opinions on the moderate priority found that 44% of the participants are of the opinion that companies do so once in a while. An equal number suggest that the same is rarely a consideration. Collectively an average of 40% of the participants view that consumer safety is not a priority based on the results of the once in a while and rarely responses.

Application of Ethical Standards
Marketing practices, like any other business operations, can be executed based on certain standards. The participants were asked as to whether they were familiar with this premise. To this end, the participants were required to outline the various instances through which ethical standards can be applied in marketing. The scope of the responses was limited to the fast food industry. Figure 5 is an illustration of the responses.

Application of ethical standards in marketing
Figure 5: Application of ethical standards in marketing
The participants were provided with four options to which they would select their preferred application of ethics in marketing of fast foods. Based on figure 5, 35% of the participants were of the opinion that health considerations should be a top priority in the marketing of fast food products. On the other hand, 15% were of the view that marketing campaigns should have a full disclosure of the ingredients. 30% percent of the participants were supported the adherence to set out marketing strategies. Given the option to avoid the use of misleading information, 20% of the participants perceive the same as an ethical application.

In this part of the questionnaire, the participants were asked to illustrate the degree of application of the respective options of ethical applications in marketing. Based on the respective option, participants were asked to outline the degree of priority and frequency. The figures 6, 7, 8 and 9 are an illustration of the responses given.

Health consideration
Figure 6: Health consideration
From the results obtained, 75% of the participants perceive health consideration as a high priority in ethical marketing. Within this percentage, 55% view health considerations to be applied often while 9% suggest that the same should be applied moderately. A paltry 1% of the respondents suggest that whereas health considerations should be a high priority, they should rarely be applied in marketing.

24% of the participants support a moderate application of ethical practices. A whopping 14% of this percentage support an often approach to a moderate application of health considerations. Based on figure 5, 10% of the moderate proponents support a ‘once in a while approach’, while 1% suggest that the same should not be applied altogether. Finally, 9% of the participants support the premise that health considerations should not be a priority in ethical marketing practices in fast food companies.

Adherence to set out standards
Figure 7: Adherence to set out standards
Figure 6 indicates results from the participants regarding their opinions on the issue of adherence to the laid out standards of ethics in the fast food industry. 83% of the participants support the idea that adherence to industry regulations on ethics should be treated as a high priority. Within this set of participants 57% argue that the same should be carried out often while 26% are for once in a while application. Interestingly, none of the participants supported the view to rarely apply standards of ethics in marketing.

In the case of full disclosure and the misleading campaigns, the participants were asked to give a cumulative response. Both premises were seen as having a similar effect in the sense that they point to the nature of a marketing strategy. Marketing campaigns tend to be deceptive. In this regard, the participants were sought for their opinion regarding misleading advertisements. Figure 7 is an illustration of their responses.

Nature of advertisements in a marketing campaign
Figure 8: Nature of advertisements in a marketing campaign
Figure 8 points to four main aspects of a misleading advertisement campaign. The participants were asked to voice their opinion on the main aspect they would have likes addressed in the nature of a marketing strategy. With respect to the fill disclosure of the ingredients, a paltry 5% were in support. On the other hand, 43% were in support of an enticing but not deceptive marketing strategy. 35% would like marketing campaigns to point out the effects of using the product in reference. All this while, 17% percent of the participants support the need for a partial outline of the ingredients of a product.

Opinion of Consumers Regarding Ethical Practices in Marketing
The study was cognisant to the idea that ethical practices can be practiced across various industries without having to diminish the quality of the product. To this end, the study allowed the participants to voice their opinions regarding ethical practices in marketing. Figure 8 is an illustration of the results of this survey.

Consumer opinions on ethical practices in marketing
Figure 9: Consumer opinions on ethical practices in marketing
Figure 9 outlines the five main opinions of consumers regarding marketing ethics. 15% of the participants relate ethical marketing to a vote of confidence on the product. 17% perceive the ethical practices can be profitable to a business venture. 24% of the participants suggest that ethical marketing techniques, in the fast food industry, promote healthy eating. On the other hand, 23% view ethical marketing as an ideal method of reducing lifestyle related diseases. Finally, 21% of the participants view ethical marketing practices as a means to terminating the tradition of deception in advertisements.

Motivation for Unethical Practices
In the previous chapter, it was established that unethical practices are driven by the need to make profit. However, the current study went on further to outline a number of reasons as to why fast food outlets end up violating ethical standards in marketing. The major motivation has been making profits. However, demand from consumers and the high cost of alternative foods have made the fast food industry violate ethics in marketing.

To a certain extent the lack of a tough legal framework to enforce the ethical practices motivates said unethical techniques. In this regard the participants were sought after to provide an opinion on what they feel is the main reason as to why fast food companies engage in unethical practices. The results are outlined in figure 9 below.

Motivation for unethical practices
Figure 10: Motivation for unethical practices
According to the results displayed, in figure 9, it is apparent that quick profits coupled by a weak legal framework act as the major motivation for unethical practices. 51% of the participants perceive quick profits as the main motivator, followed by 31% in favour of a weak legal framework. 11% find the high cost of fast food alternatives as another driver. On the other hand 8% of the participants cite high demands of fast foods as a motivating factor for unethical practices. That notwithstanding, all four options provided to the participants checked out as possible motivators for unethical marketing practices in the fast food industry.

Chapter Summary
The current chapter outlines the results of the study carried out. The study involved administering questionnaires to participants. The results are a reflection of the participant’s opinions on ethical marketing standards in the fast food industry. The responses shed more light on the questions raised by the objectives of this study. In the subsequent chapter a comprehensive discussion on the findings is provided. Chapter four compares the findings of this study to the opinions raised by previous studies on the subject.

Discussion
Overview
The previous chapter was an illustration of the responses obtained from the participants who took part in the study. In light of this, a discussion on the implications suffices. The first chapter mentions four specific objectives of this study. Primarily, the study is meant to establish the standards of ethics in the fast food industry. Secondly, some of the common ethical violations made by companies are outlined. The effect of not adhering to ethical standards during also features in the discussion. The discussions are meant to open the way for an ideal marketing technique for fast food companies.

Understanding Ethical Standards of Marketing
As previously mentioned, ethics is associated with the human conduct of a people engaged in a specific trade. In There is no universal definition for the subject. However, Kotler (2000) looks at ethics from a philosophical point of view. Kotler (2000) argues that ethics is akin to the evaluation of human conduct. Kotler (2000) further describes ethics as an attribute that business persons exhibit when it comes to making a choice between what is right and what is wrong. Ethical marketing techniques enable the consumer to make rational decisions regarding the product.

From the survey conducted, comprehension of the subject was quite vital. For instance, table 1 points out that out of the 250 participants, only 27 of them failed to give an affirmative response. That notwithstanding, a whopping 223 participants responded in the affirmative. The results are an indicator that both consumers and producers of products have the knowledge of the idea of ethics in business.

At this juncture, a question would be posed as to the importance of being familiar with ethical standards of marketing. Churchill and Lacobucci (2002) made it clear that marketing ethics are meant to enhance an acceptable conduct in this field of business. In this regard, the credibility of an organisation depends on good marketing ethics. Churchill and Lacobucci (2002) standards in the field are supposed to be developed by the necessary stakeholders depending on the industry. Some of the stakeholders include the company, its customers and marketing professionals. Churchill and Lacobucci (2002) point out that a code of ethics on matters pertaining to marketing is very important to realise the acceptability of a particular industry to the market. To this end, an industry developed code of conduct becomes necessary.

The issue of a code of conduct was also part of the issues presented to the participants. Participants were asked what their idea of ethical standards entails. There were three responses presented as options to the participants. From table 2, it is clear that 138 of the participants were of the view that ethical standards are the practices that promote integrity of a business. With respect to the rules of business practice (industry code of conduct) only 59 of the participants associated the same to the meaning of ethical. On the other hand, 53 view the subject as genuine business practices. Based on the first two responses, industry practices are essential in understanding the subject of ethical standards.

Codes of ethics in various industries allow marketers to adhere to certain agreed upon rules of practice. However, marketing ethics transcends the legal and regulatory issues contained in the code of conduct (Abbarno 2001). Ethical marketing practices and principles should encompass the necessary elements required in establishing trust. Kotler (2000) points out that a number of long-term marketing relationships (between producers and consumers) largely depend on trust. To this end, ethical principles are necessary to ensure that marketing strategies endear a company to its clients.

The divergent approach to the subject of ethical standards is evident. The results, in tables 1 and 2, help to support this argument. Ethical standards of practices have been associated with morality where virtues such as honesty, fairness and responsibility are necessary (Borgerson & Schroeder 2002). Since the subject boils down to individual characteristics such traits can be acquired by an individual and applied on a corporate level. The study found that McDonald’s staff had the awareness of ethical standards of marketing but failed to adhere to most of them.

Expected Ethical Marketing Practices
Companies rely on their marketing techniques to ensure the market is well informed about the product. However, based on the discussions in this study it is important to evaluate of the ethical concerns that should be factored in the marketing process (Brinkman 2002). In this study a total of 6 different opinions were surveyed regarding ethical practices of an organisation. Participants’ opinions were sought regarding McDonald’s keenness to apply ethical practices.

Quality assurance, accreditation and ethical auditing also featured as the necessary practices that companies should undertake. From the results displayed in table 3 the representation of ethical principles was the most common opinion among the participants. The least popular view was that competence is disregarded during marketing in fast food industries. The participants are aware that ethical practices are necessary in an organisation (Ellerbach 2004).

In light of the ethical awareness of the participants it is important to answer the question on the entails of ethical practices in a given organisation. Ellerbach (2004) looks at ethical marketing as a philosophy. Ellerbach (2004) argues that the philosophy of ethical marketing is meant to encourage responsibility when it comes to advertising. The idea of what is ‘right’ and what is ‘wrong’ makes the ethical practices rather abstract.

Based on the abstract nature of what is regarded as ethical, certain practices which are unethical tend to surface when discussing about the subject. Hsu (2012) points out that, unethical practices per se are not illegal. It all boils down to winning psychological battle of impressing the consumer. A look at figure 1 points out that McDonald’s UAE is characterised by 8 different unethical marketing practices.

Misrepresentation recorded a whopping 35% of the responses from the participants. In a joint second position, consumer safety and hidden messages follow suit given the 16% response rate. Pricing was also another unethical practice associated with McDonald’s with the subject recording 15% response from the participants. Other unethical issues associated with the fast food franchise include, Cause-related marketing (5%), employee motivation (7%), post-purchase dissonance (5%) and cultural sensitivities (1%).

The results in figure 1 point to a dark and sneaky trend being developed by the McDonald’s franchise in the UAE. According to Bronstein (2012), companies that engage in unethical practices given the loopholes of the system, tend to destroy customer relationships. The same can be reflected from the study given that 103 participants perceive McDonalds’s UAE as having unethical marketing techniques (see table 4). Such an opinion dents the brand’s image.

Ethical marketing practices are an ideal way through which a brand’s image is improved. Herbst, Sean, and Allan (2013) suggest that shunning unethical marketing techniques help promote long-term relationships with the consumers. In this regards, companies should ensure their advertisement campaigns are honest. The consumer is meant to get what is advertised and not anything less. In this regard the issue of regular ethical auditing comes into play.

The marketing team requires a mechanism that can evaluate their adherence to ethical marketing. Lurie (2009) argues that regular ethical auditing will help reduce cases where companies overlook grey areas in the marketing techniques being applied in various advertisement campaigns. For instance, the respondents in this case were asked about what they believe to be the most unethical marketing technique used by McDonalds. To this end, 35% of the participants mentioned misrepresentation. The findings are represented in figure 1. However, internal ethical auditing will ensure that such unclear areas are not exploited.

Most companies tend to develop their own marketing strategies to use in promoting their products. In addition, some organisations use benchmarking to develop their marketing techniques (Moshe & Yaov 2004). What this means is that the firm compares its operations with those of other companies regarded to be leaders in the industry. The marketing strategies developed are in line with those of the leaders. Table 3 points out that an average of 4.77 of the participants perceives McDonald’s UAE as one of the companies that engage in the benchmarking practices. The ethical element of this technique is that benchmarking can be done against a company that has a strict policy on ethical marketing. As such, the developed strategies are also likely to be ethical.

Benchmarking can help an organisation to adhere to industry regulations. However, Chaar and Lee (2012) argue that companies may also copy marketing practices that are unethical from their peers in the industry. To avoid this situation, the management should engage in quality assurance. The strategy is described in table 3. Quality assurance enables an organisation to verify whether their content meets the necessary ethical standards of the market. The numerous gray areas become illuminated and help a company avoid engaging in unethical marketing practices without their knowledge (Clemes & Burn 2000).

Quality assurance was once seen as a necessary undertaking in a marketing campaign for Dove soap. According to Rodwin (2010), the company had an advertisement that allegedly involved actual models. Such a marketing strategy was as a result of benchmarking from other high end cosmetic brands. The idea was to give the market segment the impression that the product would provide them with the ‘supermodel’ look they were looking for. The marketing campaign was found to have misled the consumers. The reason is that it did not involve real models. In addition, it was found that the company had altered the images of the individuals used in the campaign to suit the needs in the market (Waller 2012). The absence of quality assurance meant that Dove would engage in an unethical marketing technique, which would have been avoided.

Ethical practices in marketing demand a strict adherence to the principles laid down in a particular field. According to Waller (2012), marketing communication is needed to enhance uniformity in the ethical standards used. In this regard, the language used in an advertisement campaign should less deceptive but more convincing. The misrepresentation cited by McDonald’s involves advertisement campaigns which involve a sports personality. Given the high health demands for sporting action the advertisement creates the impression that fast foods for McDonald’s are healthy enough. Such a claim is definitely flawed considering the ingredients used in production of fast foods.

Ethical marketing strategies are developed by professionals who have a firm knowledge of the subject. Professionalism has some principles which apply almost universally (Ayers 2011). Ethical practices are realised when the marketers adhere to the demands of professionalism. One of the reasons McDonald’s appears to be failing is their disregard for competence. To this end, non-professionals end up developing a marketing strategy which disregards most if not all the requirements of ethics.

Ethical marketing demands that an advertisement should be developed as an individual content. Brinkman (2002) argues that sneaking an advertisement alongside news or other forms of entertainment is unethical. Viewers of such content tend to associate the product with the content being broadcast. Most of the consumers are unable to differentiate between the product and the content being aired. McDonald’s have run into some problems with that subject by targeting children’s programs to advertise their products. Such a move is unethical owing to the intense deception. However, this is one of the gray areas since such advertisement usually don’t mention association with the entertainment. They merely create an impression of association.

Fair treatment, on the part of the consumer, is an important principle of marketing. In this regard, the exploitation of children is a common practice in the fast food industry (Hodge et al. 2013). Such instances of exploitation result in a disregard of consumer safety as pointed out in figure 1.

Fast food companies are known to compromise on the healthiness of their products. The study sought the participants’ opinions regarding consumer safety in the marketing strategies used by fast food companies. Figure 4 points out that there is little priority given to safety standards in the marketing process. From the results 50% of the participants perceive that fast food companies rarely make consumer safety a high priority. 44% of the participants argue that consumer safety is a seasonal concern to McDonald’s. An equal number suggest that the same is rarely a consideration. On average, 40% of the participants are of the opinion that consumer safety is not a priority to McDonald’s franchise in the UAE (Ellerbach 2004).

Companies are expected to have some ethical practices. Table 4 points out that McDonald’s fairs poorly in implementing the ethical marketing practices. However, adherence to the principles of marketing, as outlined, helps companies to avoid treading into gray areas that will compromise the ethical integrity of their marketing techniques. When a company fails to adhere to such principles, they find themselves in a situation similar to that of McDonald’s (Grewal & Levy 2010).

Unethical Practices Associated with McDonald’s
In the literature review section, a number of unethical marketing practices were outlined. Most organisations were found guilty of misleading clients. The same was reflected in the current study as illustrated by the 35% opinion from the participants. Gilbert and Churchill (2001), together with Davidson (2003), argue that misrepresentation is a gray area in the ethical concerns of marketing. Gilbert and Churchill (2001) suggest the absence of strict wordings forbidding misrepresentation and hiding of information encourages the practice. Consequently, marketing stakeholders should clearly define ethical boundaries.

There are a number of ways through which consumers are misled during a marketing campaign. Davidson (2003) argues that marketing in the fast food industry involves deceptive techniques like associating the brand with icons. A similar opinion is shared in the current study given that more than 705 of the participants hold the opinion that McDonald’s tends to associate its products with celebrities. Such misleading marketing gimmicks are not forbidden in most codes of conducts (Palmer 2000). The same explains why companies like McDonalds will engage in such practices (Clemes & Burn 2000).

Many companies tend to carry out direct marketing. According to Davidson (2003), direct e-mails and telemarketing amounts to the invasion of privacy. However, direct marketing also involves making campaigns that target vulnerable groups like the young and elderly. The toy strategy used in McDonald’s Happy Meal campaign is one such avenue. The company lures children to buy extremely unhealthy foods through toys. It is unfair that such a campaign ignores the parents of such children. Davidson (2003) suggests that the same is another example of the ethical dilemmas which present themselves when developing an ideal marketing strategy.

Marketing plans become unethical when there is a clear violation of consumer safety demands. The study by Saucier (2008) found that fast food companies are the main culprits. In the current study it is clear that there is little priority given to safety standards. Figure 4 illustrates that more than 50% of the participants hold the opinion that fast food companies rarely make consumer safety a high priority. 44% of the participants are of the view that fast food related companies regard consumer safety once in a while. An equal number suggest that the same is rarely a consideration. On average 40% of the participants view fast food companies do not take consumer safety seriously. Marketers ought to evaluate the degree of responsibility they take due to the harm caused by the products (Saucier 2008).

Consumers also have a role to play regarding the safety of the products purchased. Saucier (2008) argues the shortcoming, in this regard, is the absence of clarity in making a choice in the market. The misrepresentation and hidden messages pointed out in figure 1 are contributors to the lack of clarity on the part of the consumer. However, marketers can also take their own initiative to set ensure consumers can easily make out a decision on a product by adequately providing the necessary information. Saucier (2008) makes reference to the fast food industry pointing out that, while enjoying the profits made by the easy-to-make such companies should ensure consumer safety is given a top priority.

In the field of marketing, adherence to pricing ethics is an important component in enhancing the relationship between the seller and the consumer. According to Davidson (2003) most marketers come up with predatory pricing which is meant to drive out competition. In certain cases the prices of commodities are set so low to a point that other brands cannot penetrate the market with their high prices. Such a trend can be harmful to the market (Hsu 2012). A healthy market must strike a balance between the profits and the welfare of the consumers. Such a balance is needed to enhance ethical conduct in the field.

In the literature review section, cause-related marketing was cited an emergent ethical concern. Davidson (2003) describes cause-related marketing as one of the numerous ethical dilemmas brought about by the gray areas. In this regard, a society develops a perception of a company based on the of cause impact on customers. To this end, marketing departments responsible for the relationship with a cause are required to manage the same with transparency (Davidson 2003).

Ethical concerns in business are driven by the cost of coming up with a marketing strategy. Lurie (2009) supports the idea of informing the consumers of price fluctuations. That notwithstanding marketer should always consider the ethics behind their policies. Cost implications affect the quality of a product. For instance a company that promotes fresh foods must incorporate storage facilities in their transport. The cost implications, in this regard, spills over to the consumer.

Fast food companies tend to develop stereotypes in their marketing campaigns. In the UAE, Halal products rake in the most sales. McDonald’s is known to sell products which are not Halal assuming that their market is gullible just by the display of the word ‘Halal’. Stereotypical campaigns create an opposing message that the consumer will not be part of the happy group unless they purchase the product. McDonald’s relies on this technique to capture the children’s market by using toys (Ellerbach 2004).

Most marketing campaigns insert a hidden message meant to manipulate clients. Smith (2012) argues that such tactics appeal to the metal faculties of a consumer to regarding certain aspects (good or bad) of their product. For instance, when McDonald’s makes an advertisement with a footballer like Lionnel Messi, an impression is created that such foods boost the performance in sport. However, given the calorie levels of fast foods the same couldn’t be any further from the truth.

In 2010, an article appearing on the Voice of America website pointed out to unethical practices of McDonald’s which prompted legal action. According to Baragona (2010), McDonald’s was being sued by a nutritional lobby group for the former’s action of luring children to buy their products using toys. The Centre for Science in the Public Interest (as cited in Baragona 2010) suggests that the toys are a ploy to lure the children into unhealthy eating habits. Such acts are unethical.

The Happy Meal is a children’s special by McDonald’s which dates back to 1979. Baragona (2010) argues that this technique makes use of popular toys, like action figures from television shows. The Centre for Science in the Public Interest (as cited by Baragona 2010) cites a study carried out in 2005 by the Centres for Disease Control and Prevention. The study found that one in every five American child was obese. Unhealthy eating habits contribute to children acquiring diabetes and heart problems. The Centre for Science in the Public Interest (as cited in Baragona 2010) perceives the idea of enticing children with toys as unethical given the health repercussions. In this regard, the misrepresentation outlined in figure 1 becomes clear.

From the results, displayed in figure 3, misrepresentation is common when fast food companies associate their products with celebrities given the 70% response to this opinion. An equally high percentage of the participants create the impression that their products are healthy. The same would explain why McDonald’s would continue to encourage the ‘Happy Meal’ giving the impression that it is okay for children. Also, more than 50% of the participants are of the opinion that an inaccurate representation of ingredients is a common occurrence in the fast food industry. The arguments raised by the Centre for Science in the Public Interest (CSPI) are a reflection of the instances of misrepresentation pointed out in the results section.

The grounds of the Centre for Science in the Public Interest vs. McDonald’s suit are largely due to the nutritional content of the product. According to Baragona (2010), the Happy Meals were found to have an excess of a child’s recommended calorie dose by up to 67%. The contents of this meal include a cheeseburger, French fries and a carbonated drink (soda). Baragona (2010) is quick to add that the soda contains “multiple levels calories and saturated fat. The drink is also found to have day’s worth of sodium coupled by two day’s worth of sugar”.

As already mentioned, the ethical concerns in marketing require an element of fairness. In this regard, Baragona (2010) cites the question raised by CSPI as to the fairness of the company to overlook the parent’s of the children and engage in a direct marketing campaign to the gullible children. A similar perspective is shared by the participants of the current study. 50% of the participants perceive that fast food companies rarely make consumer safety a high priority.

Another question raised touches of the tricks employed in the marketing campaign. To this end, CSPI (as cited in Baragona 2010) raise the question as to the correctness of using deceptive techniques to attract the children’s market. The effects of this toy promotion would also be discussed if the case were to be presented before a jury. In most cases, giant corporations tend to deflect response to such accusations by pointing out the good they engage in. For instance, Baragona (2010) suggest that McDonald’s responded to the claims with the numerous health products they have sold.

McDonald’s are notorious for unethical marketing techniques based on the pricing of their commodity. Based on the study, 15 % of the participants believe that McDonald’s does not adhere to ideal pricing techniques when it comes to the pricing of their commodities. The results are illustrated in figure 1. Borgerson and Schroeder (2002) reiterate that markets in the Middle East demand modesty based on the Islamic teachings. However, McDonald’s pricing disregarded the element of simplicity as demanded for in an Islamic market. The company tends to come up with advertisements, which suggest a he price cut on their products such a move create the impression that the price was place high intentionally.

In general, McDonald’s is seen as one of the major corporations whose ethical concerns, with respect to marketing, demand a review. Rinallo et al. (2013) argue that a shift from unethical marketing practices should be led by the industry leaders. In the fast food industry McDonald’s is a household name. Continued unethical marketing practices tarnish the brand’s name. The effects of such practices are devastating. Rinallo et al. (2013) argue that since there are a lot of gray areas in ethical marketing, mechanisms should be established to prevent further engagement in the practices.

Ultimately, ethical marketing techniques relates to how a company will generate enough goodwill from the market. According to Davidson (2003), the goodwill of a company in a given market is translated into sales. When a company adheres to ethical concerns, the work environment becomes conducive. In this regard, an organisation’s good reputation is passed on to its workforce. Employees with the necessary motivation tend to improve on their performance. Companies that don’t conform to the required marketing ethics destroy their good reputations with their consumer base. It is easier to boost sales numbers than it is to build an organisation’s reputation.

The Impact of Unethical Marketing Practices
When companies engage in unethical marketing practices there is a ripple effect. According to Abbarno (2001), unethical marketing practices have resulted in easy profits for many companies. Companies engage in deceptive advertisement campaigns to lure consumers to their products. Increased volumes of consumers result in high sales. Consequently, companies tend to make profits in the process (Abbarno 2001).

On the flip side, unethical marketing techniques have the potential to ruin a market. When companies resort to low pricing in a market they shut out competition. According to Ayers (2011), markets require competition to ensure consumers experience diversity. In cases where consumer safety is concerned, the lack adherence towards the same contributes to health concerns.

A suitable example is the health risk associated with the ingredient quantities given to children in the Happy Meal product. Some of the health risks associated with unhealthy fast food includes heart disease, diabetes and even cancer. Fast food companies can avoid such situations by making sure that they provide their consumers with adequate information pertaining to the product in reference. The burden of responsibility now shifts to the consumer (Ayers 2011).

The Application of Ethical Theories by McDonald’s
Marketing techniques are informed by a number of theories. According to Ellerbach (2004), some of the theories of ethical marketing include individualism, virtue, Kantian and the utilitarian theories. The absence of a universal code of conduct implies that the ethical actions of an organisation are best evaluated courtesy of the theories of the subject. The theories are essential to the study as they justify whether or not McDonald’s is in violation of expected ethical concerns.

Theory of individualism
The theory of individualism was developed by Friedman. According to Brinkman (2002), an organisation is intended to have returns to its profits. The actions of McDonald’s, based on the marketing strategy, appear to be in line with this theory. The direct marketing to children forces parent to make purchases of the products being advertised. McDonald’s capitalises on this idea because, the parent will buy a product while having taken their child to get the Happy Meal. In this regard, the company has realised double sales at a go. At the heart of the theory of individualism, the business venture must yield profits to itself and the stockholders. Brinkman (2002) suggests that increased sales translate to high profits. Based on this theory, McDonalds is well within the ethical demands of individualism.

The utilitarian theory
The utilitarian theory envisions satisfactions from industry stakeholders. Drawing understanding from the discussion at hand the industry stakeholders include the staff, management and customers of McDonald’s. Hodge et al. (2013) suggest that happiness from all the stakeholders implies that a company is within its ethical demands. In the case of the misrepresentation of the Happy Meal the complainant is not a direct stakeholder. In this regard, an assumption is made that all the direct stakeholders are content with the product. That being the case, then McDonald’s is seen as having adhered to ethical marketing demands.

Evidently, when the children go to a McDonald’s outlet they can acquire toys. Parents love the idea of seeing their children in a fun mood. Consequently, the entire experience translates into sales for the company. High profits suggest that employees get to be given a better pay (Hodge et al. 2013). The same also translates into plenty of other employment opportunities. The net results are stakeholders who are happy with their organisation. Again such results indicate that the company was squarely within the ethical demands.

The virtue theory
The virtue theory calls for a good character on the part of a marketer. To this end, issues like honesty and justice become an integral part of the theory (Borgerson & Schroeder 2002). The trends of McDonald’s and with respect to this theory can be seen as unethical. The company is deceptive in the manner through which they advertise their products. A common example is the now famous Happy Meal where the direct marketing to kids is done without an explanation of the health ramification.

In terms of the nutritional content of their products, McDonald’s is honest in pointing out the ingredients of the Happy Meal. The argument as to low nature of the nutritional value of the food places the responsibility on the parents. A parent has a responsibility to evaluate the nutritional value of whatever they are purchasing. To this end, the power to determine what is good for a child is the sole responsibility of their parents (Waller 2012). In this regard, the company is ethical in the sense that honesty, as to the nature of their product, is evident.

Kantian theory
The Kantian theory is advanced under the premise that people should engage in activities for the right reasons. According to Hsu (2012), the Kantian theory compels marketers to examine their customers more as people and not just statistics. Most marketers operate under the principle where the end justifies the means. However, the Kantian theory is a departure from such an ideology. The theory compels marketers to develop strategies based on some sense of rationality. The theory advances the element of consistency in the execution of organisational objectives.

In terms of consistency, the company is in line with this theory. According to Baragona (2010), the company has consistently maintained their concept of providing toys and play grounds to children who are a huge market segment. However, the company fails when it comes to ensuring that rational decisions are arrived at by the consumer. One way through which this can be achieved is by ensuring all their products outline the respective nutritional information. In so doing, the consumer is allowed to make an informed decision based on the information provided to them.

The Kantian theory demands that a marketing strategy should be respectful. Based on the study and literature review there is no record of McDonald’s engaging in a marketing campaign that is vulgar and disrespectful. All the advertisements, carried out for the company, are always respectful and mindful of foul language. Respects transcends to cultural demands of a certain people (Chaar & Lee 2012). In the UAE, the McDonald’s chain is mindful of religious holidays like Ramadhan by not exposing the locals to temptation of food during the day.

Based on the information outlining the demands of the Kantian theory, McDonald’s appears to fair well in all of them. However, the motivating factor behind luring children using toys is not out of the goodwill of the company. The desire is to ensure that maximum profits are realised from the sales. Hsu (2012) suggests that the techniques used in marketing may fail the ethics text due to the numerous gray areas.

Chapter Summary
The chapter provides a discussion into the various ethical and unethical aspects of marketing in the fast food industry. The crux of this chapter relies on the results obtained from the questionnaires administered to the participants of the study. Additional information is drawn from the literature review. To this end, the discussions respond to the research questions mentioned in chapter one. The next chapter provides a summary of the entire study. Chapter five provides recommendations to McDonald’s and at the same time concludes the study by pointing out areas that require further research.

Recommendations and Conclusion
Overview
In this chapter, a review of the problem statement is provided. In this regard, a suitable marketing technique for McDonald’s is provided. According to Rodwin (2010), ethical marketing strategies are real. Companies do not have to border on the gray areas but can develop marketing techniques based on sound practices. The recommendations provided are an indicator that other companies in the fast food industry can also carry out the same to avoid losing credibility.

Developing an Ethical Marketing Plan
Ethical marketing is all about the tools used to develop a strategy for use in the present and times to come. The first step to ethical marketing is to decide the objective of the strategy sought after (Hsu 2012). The tools of ethical marketing are essential in revising the already existing techniques to ensure that the brand image is maintained at the expense of making profits.

The first recommendation is an analysis of the company, its customers and the market segment. Based on the results of this study, McDonald’s does not appear to have a comprehensive analysis of the three parameters. According to Waller (2012), there are plenty of advantages in engaging in an ethical marketing campaign. However, companies like McDonald’s shun such methods since profitability is usually at stake.

The study further recommends that McDonald’s engages in an extensive market research. Rinallo et al. (2013) suggest to a possibility of ethical marketing resulting in profitability. However, this result is only attainable with intensive market research. For instance, McDonald’s can try to penetrate the organic food market by developing suitable packages like salads. Such a move will attract consumers who prefer healthy food but lack any in menus of fast food outlets.

The study recommends that McDonalds should always use ethical marketing features. Ethical marketing is determined by the features which an organisation intends to utilise in its campaign (Alserhan 2011). The abstraction of ethics calls for reliance on professionalism and the necessary competence. In this regard, McDonald’s should engage the services of professional marketers to develop ideal marketing features. Marketing gaffes like associating sports personalities with unhealthy food products will be avoided if ideal marketing features are employed by a company.

McDonald’s can achieve this objective by avoiding direct marketing, to children, products with high sugar and calorie content. According to Ellerbach (2004), children don’t eat a lot of food to this end, fast food outlets have the advantage of coming up with portions of food that don’t have inflated content of unhealthy ingredients. Ethical marketing features therefore call for a delicate balance between that which is true and the persuasion of the consumer.

As already mentioned, McDonald’s is a market leader in the fast food industry. In light of this, ethical marketing should not be something they should straggle over. Lurie (2009) points out that, market leaders have the advantage of pick up ethical techniques and incorporate them in their strategies. The issue of cost should not be an impediment given the financial muscle that such companies possess. In light of this, the study recommends that McDonald’s should develop marketing strategies that acts like a benchmark for emulation in the fast food industry. The recommendations made in this section are a response to the research questions raised at the preliminary phase of the study.

Conclusion
As mentioned earlier, the study is a holistic overview of marketing and by extension market plan development. The adoption of McDonald’s as a reference point worked in favour of the thesis statement suggested. The results of the study point out that the consumers respect for the brand is dwindling. The thesis statement sought to establish whether unethical practices are a threat to a brand’s image and credibility. Sirgy and Lee (2008) suggest that the evaluation of ethical issues in business is easier done when an analysis is carried out on the market leaders. The unethical practices, unearthed in this study contribute to a degradation of the credibility and image of McDonald’s.

The image of an organisation is smeared when the brand is found to be engaging in activities that do not promote integrity and honour (Smith 2012). For instance, when McDonald’s, an industry leader, misrepresents the facts about their products such is seen as preying on the gullibility of their consumers. Although the fine print of required ethics might be faint, the same calls for a judgment call on the part of the marketers. Prior to the development of a marketing plan, marketers should weigh on the ripple effect of such an action with respect to the image of their organisation.

The discussions in this paper suggest that the subject of ethics in marketing is not easy to crack. According to Ayers (2011), what might appear ethical to one party might be unethical to the other. For instance, the theories of ethical marketing suggest that McDonald’s (in the Happy Meal suit) were largely engaged in ethical practices. However, the same was not reflected in the response given by the participants to this study.

The study found that misrepresentation was a common phenomenon in the marketing strategy of McDonalds. Marketing techniques of such a nature tend to destroy the trust levels between an organisation and its customers (Rodwin 2010). From the theory of individualism profitability is seen as the motivating force behind what appear to be unethical practices. However, the loss of trust from consumers poses a threat to the intended profits. To this end, organisations need to develop a hybrid of marketing techniques. Such techniques should ensure that the marketing strategies will not interfere with customer relations.

In conclusion, acts like misrepresentation and withholding information tend to erode the trust between a company and its customers. The same supports the view, of the thesis statement, that unethical marketing practices destroy a brand’s image and further reduce its credibility. The same is due to the loss of trust from the unethical practices (Hodge et al. 2013). Further research is called for to examine the gray areas of ethics. The same would set the stage for a universal code of conduct. Such a move will protect brands from unknowingly engaging in unethical practices.

Chapter Summary
The chapter evaluates the problem statement with regards to unethical marketing practices at McDonald’s. Necessary recommendations for the development of ethical marketing strategies are outlined in this chapter. According to Rodwin (2010), ethical marketing strategies are real. Companies do not have to border on the gray areas but can develop marketing techniques based on sound practices. The recommendations suggest that fast food companies can engage in ethical marketing practices without compromising on their brand image.

Reference
Abbarno, M 2001, ‘Huckstering in the classroom: limits to corporate social responsibility’, Journal of Business Ethics, vol. 32 no. 2, pp. 179-189.

Alserhan, B 2011, The principles of Islamic marketing, Farnham, Gower.

Ayers, A 2011, ‘The evolutions of Kotex advertising and the introduction of the ‘Negro market’, Constellations, vol. 2 no. 2, pp. 52-65.

Baragona, S 2010, McDonald’s faces possible lawsuit over marketing to kids, Web.

Borgerson, J & Schroeder, J 2002, ‘Ethical issues in global marketing: avoiding bad faith in visual representation’, European Journal of Marketing, vol. 36 no. 56, pp. 570-594.

Brenkert, G 2008, Marketing ethics. Blackwell Publishers, Malden.

Brinkman, J 2002, ‘Business and marketing ethics as professional ethics: concepts, approaches and typologies’, Journal of Business Ethics, vol. 41 no. 1-2, pp. 159-177.

Bronstein, C 2012, ‘Advertising in the corporate conscience’, Journal of Mass Media Ethics, vol. 27 no. 2, pp. 152-154.

Brubaker, S 2007, ‘Ethics and regulation in direct marketing’, Direct Marketing: An International Journal, vol. 1 no. 1, pp. 55-58.

Chaar, B & Lee, J 2012, ‘Role of socioeconomic status on consumers’ attitudes towards DTCA of prescription medicines in Australia’, Journal of Business Ethics, vol. 105 no. 4, pp. 447-450.

Churchill, A & Lacobucci, D 2002, Marketing research, methodological foundations, Harcourt College Publishers, Orlando.

Clemes, M & Burn, D 2000, ‘An investigation of marketing problems across service typologies’, The Journal of Service Marketing, vol. 14 no. 2, pp. 573-594.

Coldwell, D & Herbst, F 2004, Business research, Juta, Durban.

Creswell, J 2003, Research design: qualitative, quantitative, and mixed method approaches, Sage Publications, Thousand Oaks, California.

Davidson, D 2003, Selling sin the marketing of socially unacceptable products, Praeger, Connecticut.

Ellerbach, J 2004, ‘The advertorial as information pollution’, Journal of Information Ethics, vol. 13 no. 1, pp. 61-75.

Gilbert, A & Churchill, G 2001, Basic marketing research, Dryden Press, Michigan.

Grewal, D & Levy, M 2010, Marketing, McGraw-Hill Irwin, Boston.

Herbst, K, Sean, H & Allan, D 2013, ‘Advertisement disclaimer, speed and corporate social responsibility: ‘costs’ to consumer comprehension and effects on brand trust and purchase intention’, Journal of Business Ethics, vol. 117 no. 2, pp. 297-311.

Hodge, J, Collmer, V, Orenstein, D, Millea, C, & Buren, L. 2013. ‘Reconsidering the legality of cigarette smoking advertisements on television public health and the law’, Journal of Law, Medicine and Ethics, vol. 41 no. 1, pp. 369-373.

Hsu, K 2012, ‘The advertising effect of corporate social responsibility on corporate reputation and brand equity’, Journal of Business Ethics, vol. 109 no. 2, pp. 189-201.

Hundekar, S 2010, Principles of marketing, Himalaya Publishing House, Mumbai.

Kotler, P 2000, Marketing management, Prentice Hall, New Jersey.

Lurie, P 2009, ‘DTC advertising harms patients and should be tightly regulated’, Journal of Law, Medicine and Ethics, vol. 37 no. 3, pp. 444-450.

Marinov, M 2007, Marketing in the emerging markets of Islamic countries, Palgrave Macmillan, London.

Moshe, C & Yaov, H 2004, ‘Advertisements, stereotypes and freedom of expression’, Journal of Social Philosophy, vol. 35 no. 2, pp. 165-187.

Murphy, P & Laczniak, E 2012, Ethics in marketing: international cases and perspectives, Routledge, Abingdon.

Murphy, P 2006, Marketing ethics: cases and readings, Pearson Prentice Hall, New Jersey.

Obay, L 2009, ‘Corporate governance & business ethics: a Dubai based survey’, Journal of Legal, Ethical and Regulatory Issues, vol. 12 no. 2, pp. 29-33.

Palmer, A 2000, Principles of marketing, Oxford University Press, Oxford.

Rinallo, D, Bauroy, S, Wu, R, & Jeon, H. 2013. ‘The media and their advertisers: exploring ethical dilemmas in product coverage decisions’, Journal of Business Ethics, vol. 114 no. 3, pp. 425-441.

Rodwin, M 2010, ‘Drug advertising, continuing medical education and physician prescribing: a historical review and reform proposal’, Journal of Law, Medicine and Ethics, vol. 38 no. 4, pp. 807-815.

Saucier, R 2008, Marketing ethics, Edwin Mellen Press, Lewiston.

Saunders, M, Lewis, P & Thornhill, A 2003, Research methods for business students, 3rd edn, Prentice Hall, Harlow.

Sirgy, M & Lee, D 2008, ‘Well-being marketing: an ethical business philosophy for consumer goods firms’, Journal of Business Ethics, vol. 79 no. 4, pp. 377-403.

Smith, N 2012, Marketing ethics, SAGE, Los Angeles.

Waller, D 2012, ‘Truth in advertising: the beginning of advertising ethics in Australia’, Journal of Mass Media Ethics, vol. 27 no. 1, pp. 46-56.

History Essay

by admin | Mar 20, 2023 | Uncategorized

The History of Great Depression Research Paper
The collapse happening was influenced by the consequences of World War I and other factors that combined at that time. The Great Depression was a highly significant and destructive event caused by multiple factors, ending in a shift in the whole world and every structure and changing Americans’ attitude toward the government. The Great Depression was the most severe recession of the past centuries. It affected the whole world and lasted for approximately 12 years.

Main body
Field claims that gross domestic production fell by 30%, almost half of the banks in the United States collapsed, and about 25% of the population became jobless during the Great Depression (para 1). Unemployment insurance did not exist at that time, and no one was prepared for these events, and it became a disaster for millions of people. Kiger states that the Great Depression affected everyone, from investors who became bankrupt overnight to clerks and factory workers who became unemployed (para 1).

The event influenced every person despite their status or profession.

Thus, the Great Depression was a devastating event that affected everyone.

It is believed that the reason for the recession was the market collapse in 1929; however, it is not. There was no one exact reason for the collapse happening.

Field claims that the genuine reason for the event was a combination of different factors, such as ill-timed tariffs and misguided moves (para 2).

Thus, the Great Depression had predispositions and was provoked by many factors.

Moreover, Segal, Cheng. et al. affirm that “inactivity followed by overaction by the Fed also contributed to the Great Depression” (para 6).

After the eight-year inactivity, Fed, the central US banking system, drastically increased the money supply, which influenced the economy and became a predisposition for the collapse. Thus, there were several factors that contributed to the Great Depression happening. Furthermore, it is believed that the consequences of World War I also caused the Great Depression. The world experienced a crisis and tried to stabilize the economy.

Kiger states that after the war, the level of consumption increased, which brought wealth to many businesses (para 9). However, this also made them vulnerable to any changes in consumers’ preferences.

Kiger adds that the economy throughout the world was unstable and many connections were broken, and cooperation between many countries stopped (para 9).
This led to exaggerating the problem with the economy and made all the businesses unstable and at constant risk of bankruptcy. Thus, World War I impacted the collapse severely and destroyed the ability of cooperation among many countries.

The consequences of the Great Depression were deplorable and, meanwhile, significant: it affected people’s lives and their attitudes toward the government.
It is hard to determine the exact number of human casualties during that time.

However, Amadeo, Kelly et al. state that the rate of committing suicide increased by 22.8% at that time (para 25). His means that the recession severely affected people’s mental health. Amadeo, Kelly. et al. affirm that in the 1930s, the level of trust in the government reached its peak and was never higher (para 26). Americans believed in the New Deal that was formed after the Great Depression and its decisions. Thus, the collapse changed the population on different levels and shaped its relations with the government.

Conclusion
In conclusion, the Great Depression was a meaningful and devastating event of the 20th century that led to a significant shift in the world and changed the attitude of the US people toward their government. It was caused by a combination of varied factors, such as the consequences of World War I, the Fed overaction, lack of cooperation of many countries, and others. The event made many humans suffer; however, it led to stabilizing the economy and evoked trust and cooperation between the residents and the government.

Works Cited
Amadeo, Kimberly. Kelly, Robert. Jonson, Arron. “Great Depression: What Happened, Causes, How it Ended.” 2022.

Field, Anne. “The Main Causes of the Great Depression, and how the Road to Recovery Transformed the US Economy.” Insider. 2020

Kiger, Patrick. “5 Causes of the Great Depression.” History. 2022

Segal, Troy. Cheng, Marguerita. Kvilhaug, Suzanne. “What Was the Great Depression?” Investopedia. 2022