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World Health Organization
Chair: Amma Prempeh
World Health Organization PMUNC 2016
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Contents
Contents .......................................................................................................................................... 2
Letter from the Chair .................................................................................................................... 3
Committee Description ................................................................................................................ 4
Topic A: Emergency Response and Humanitarian Action ..................................................... 5
Introduction ............................................................................................................................... 6
History of the Topic ................................................................................................................. 7
Current Situation ....................................................................................................................... 9
Country Policy ......................................................................................................................... 14
Questions to Consider: ........................................................................................................... 16
Keywords: ................................................................................................................................ 16
Topic B: Global Health and Bioethics ..................................................................................... 17
Introduction ........................................................................ Error! Bookmark not defined.
History of the Topic ............................................................................................................... 17
Current Situation ..................................................................................................................... 20
Country Policy ......................................................................................................................... 25
Key Terminology .................................................................................................................... 29
Questions to Consider ............................................................................................................ 30
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Letter from the Chair
Dear Delegates, Hello and welcome to the 2016 Princeton Model United Nations Conference! My name
is Amma Prempeh, and this year, I will be serving as your Chair for the World Health Organization Committee. I am a sophomore here at Princeton University, currently deciding between majoring in Politics, with an international relations focus, or Anthropology. In complement to either major, I am pursuing specialized certificates in African Studies and Global Health Policy- all of which brought me to this WHO committee! I’m excited to staff my second PMUNC and chair my first committee!
The topics of discussion for WHO are: A. Emergency Response and Humanitarian Action
B. Global Health & Bioethics
Since its inception in 1945, WHO has worked closely with the United Nations to direct
international efforts and support national goals. Their work encompasses both intergovernmental policy within the UN system and specific regional, country-level assistance in issues ranging from mental health to viral epidemics.
At PMUNC, we will recreate the experience of the WHO in terms of size and subject.
However, delegates do not have to adhere to its administrative or budgetary limitations during the conference, while we do believe it is important to consider these facets when coming up with solutions. Rather, PMUNC will be an educational and exciting opportunity to make policy programs and health decisions along the lines of the WHO mission and constitution.
As you are likely aware, this background guide is not meant to replace further research,
and I encourage you to take this background guide as a jumping-off point for further in-depth into your countries’ policies and stances. I hope to cover the most salient points of the topics at hand, and provide a fundamental understanding of the issues. If you should have any questions concerning your preparation for either Committee or the Conference, you are welcome to contact myself at: [email protected].
All my best during your preparation, and I will see you in Committee!
Sincerely, Amma Prempeh Chair, World Health Organization
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Committee Description
The World Health Organization (WHO) was founded on April 7th, 1948, not
long after the creation of the then-nascent United Nations, and served as one of the
preliminary specialized agencies of the same body. The organization was conceived of as
early as 1945,1 during the founding of the United Nations. The UN conceived of
organization alike to predecessors such as the 1913 Rockefeller Foundation International
Health Division,2 and the League of Nation’s Health Organization.3 Under its incarnation as
the Health Organization, there was little power to take on the ground action or dictate
policy.
Still, since the creation of the WHO, it has had a major role in the global eradication
of smallpox, and in efforts to mitigate the rates and effects communicable diseases, including
HIV/AIDS, malaria, Ebola, and most recently, Zika. Over 7000 people from over 150
nations work for WHO across 150 Organization offices, 6 regional offices, and the Global
Service Center in Kuala Lumpur, Malaysia, and the headquarters in Geneva, Switzerland.4
The WHO provides many services to the global community including: publication of the
World Health Report, conduction of the World Health survey, and celebration of World
Health Day, April 7th annually.
It was tasked with monitoring, managing, and ultimately improving the state of human
health around the world (in order to fulfill its mandated goal, “the attainment by all people
of the highest possible level of health”), and its early efforts helped culminate in the effective
1 “Origins and development of health cooperation.” World Health Organization. accessed 26 Aug 2016. http://www.who.int/global_health_histories/background/en/. 2 “100 Years: Health.” The Rockefeller Foundation. Accessed 22 Aug 2016. http://rockefeller100.org/exhibits/show/health. 3 “Origins and development of health cooperation,” World Health Organization. 4 “Who We Are.” World Health Organization. Accessed 22 Aug 2016. http://www.who.int/employment/about_who/en/.
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eradication of smallpox. Its sixty-one original member states have since grown in number to
over one hundred and ninety-four, and its reach has expanded from its headquarters in
Geneva to regional offices that employ over 7000 full time personnel in 150 countries.
The WHO is one member of the United Nations Development Group, and is
currently headed by Director General Margaret Chan. Among other recurring activities, the
WHO publishes the annual World Health Report and hosts the World Health Day. In
2014/2015, WHO proposed a budget of approximately US$4 billion.5 Its members provide a
cumulative amount of 930 million USD per year, and an additional 3 billion USD are usually
provided by voluntary contributions and public donations.6 Among its leading financial
sponsors are the US, followed by Japan, Germany, and the UK.7
The WHO is split into regional subsections, consisting of Africa the Americas, the
eastern Mediterranean, Europe, Southeast Asia, and the Western Pacific. The WHO
normally meets once a year to discus regular and recurring agenda items and topics,
including eradication of communicable disease, mitigation of non-communicable disease,
nutrition, and more. Among its various rules of procedure, the WHO must convene when a
majority of its members posit a request to hold council, particularly in light of time-specific
crises that may arise.
Within its powers, the WHO can deploy its resources to combat health threats,
educate the populace on better health standards, and provide resources and guidance for the
development of improved health programs and regimens among municipal, local, state, or
country levels. The World Health Organization’s objective has been to direct international
health cooperation.
5 “Programme budget 2014-2015,” WHO International. Published 2015. Accessed 21 Sep 2016. http://www.who.int/about/finances-accountability/budget/PB201617_en.pdf?ua=1 6 Ibid. 7 Ibid.
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Topic A: Emergency Response and Humanitarian
Action
Introduction
It is the responsibility of the World Health Organization to respond to emergencies
in an efficient manner that not only addresses the immediate safety and medical concerns
that arise, but also respects the community it is aiding, while managing a limited number of
resources. In one decade (2001-2010), the world witnessed approximately seven thousand
natural and technological emergencies that cost over 1 million lives, and affected hundreds
of millions more.8 The WHO also has to contend with emergencies as a result of global
conflicts, which, according to the World Bank, affect a quarter of the world’s population9.
Living in a disaster zone or an area of conflict not only disrupts health and security, but also
has deeper societal consequences that might extend for generations. These include
disruptions in education, politics, economic development, civil rights, and much more.
Also, the effects of developing technologies at some points push us forward, but can
also make the task at hand more burdensome. For instance, medicine has advanced and new,
cheaper drugs are available. Also, improved communications has also streamlined the
process immensely. That being said, there are also several negative effects. Globalization and
faster modes of transportation has made the spread of disease much harder to control. And
improved communications have also made the control of the flow of information much less
manageable.
8 WHO's Emergency Response Framework. Report. World Health Organization. 2013. http://www.who.int/hac/about/erf_.pdf. 9 World Disaster Report 2011. Geneva, International Federation of the Red Cross and Red Crescent Societies, 2011.
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The other overwhelming issue is that these global issues do not affect all people involved
homogeneously. Lower classes, minority populations, and at-risk groups inevitably bear the
brunt of these accidents. Recovering from an emergency situation (be it a natural disaster, an
epidemic, or something else) might set back a country by decades. Any action taken must
always take into account the specific circumstances of any particular country. Emergency
intervention should never be an infringement of sovereignty. As the number of recorded
disasters has doubled in the past decade (from about 200 to 400 every year), what actions
can this body take in order to deal with the increased number of attacks?10
History of the Topic
Developing frameworks for emergency responses is never a straightforward path.
The World Health Organization has learned a lot through their experiences over the past
forty or so years. Delegates should consider past responses (e.g. Haiti in 2010 or Syria in
2012) to gauge the amount of change that would need to take place in the current
frameworks.
One significant step forward was the adoption, in 2005 the Inter-Agency Standing
Committee (IASC), an accountability organization which the WHO is a member, set up
many significant new reforms. One such measure was the adoption of the Cluster Approach.
This is aimed at organizing resources and divides the labor of many organizations that are on
the ground during a humanitarian crisis. The IASC set up the WHO as the lead of the
10 Disaster Preparedness for Effective Response Guidance and Indicator Package for Implementing Priority Five of the Hyogo Framework. Report. United Nations. 2008. http://www.unisdr.org/files/2909_Disasterpreparednessforeffectiveresponse.pdf.
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Global Health Cluster.11 However, the IASC recognized in 2011 that there are many areas
for additional reforms, such as:
1. Experienced humanitarian leadership deployed in a timely and predictable way
2. More rapid and more effective cluster leadership and coordination
3. Accountability at the head of country office level
4. Better national and international preparedness for humanitarian response
5. More effective advocacy, and communications reporting, especially with donors.
Other reforms that were taken were in 2007, when the International Red Cross Red
Crescent Movement adopted “Guidelines for the domestic facilitation and regulation of
international disaster relief and initial recovery assistance.” These were also referred to as the
IDRL Guidelines and were implemented through the states parties to the Geneva
Conventions.12 Nevertheless, even the Red Cross accepts that this framework is “quite
dispersed, internally contradictory and under-utilized.”13 On three separate occasions,
through resolutions 63/139, 63/141, and 63/137, the UN urged countries to make use of
these regulations, but they are still not in widespread use.
The guiding document for the World Health Organization is its Emergency Response
Framework (ERF), which promises to be a central part of the debate throughout this
committee. In order to develop these guidelines, the WHO created a Global Emergency
11 “WHO's Emergency Response Framework.” World Health Organization. Published 2013. Accessed 11 Aug 2016, http://www.who.int/hac/about/erf_.pdf. 12 "IDRL Guidelines." IFRC. 9 Mar 2013. http://www.ifrc.org/en/what-we-do/disaster-law/about-disaster-law/international-disaster-response-laws-rules-and-principles/idrl-guidelines/. 13 "International Disaster Response Laws, Rules and Principles (IDRL)." IFRC. 9 Mar 2013. http://www.ifrc.org/what-we-do/disaster-law/about-disaster-law/international-disaster-response-laws-rules-and-principles/.
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Management Team (GEMT) to overview and guide the process for the WHO14. The
specifics of these guidelines will be discussed in the following section.
Current Situation
The role of the World Health Organization is to provide critical services to areas of
need. The four main types of critical functions are as follows:15
Leadership: to be a leader in the health sector/cluster response and provide support
to local and national health authorities.
Information: organize the distribution and analysis of information related to health
warnings, needs of the local governments/health sector, etc.
Technical expertise: Where the need it presented, provide technical expertise to
combat the emergency scenario. These include, but are not limited to: health policy
recommendations, information on health standards and protocols, early disease
warning systems, and surveillance on the spread of the disease. In most cases, the
WHO depends on the available health services through partners or local resources.
However, as a last resort, they will set up their own measures to address critical gaps
(e.g. such as setting up mobile clinics).
Core services: coordinate the logistics of the emergency response, such as the
establishment of the local office, the human resources available, financial and grant
resources, and the supply of resources (or the procurement of such).
15 WHO's Emergency Response Framework.
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Furthermore, there are specific structures under the Emergency Response Framework
(ERF) that help the WHO operate under different scenarios. They organize themselves by
grade definitions as follows:16
Ungraded: an event that should be monitored closely, but that requires no
immediate action.
Grade 1: an event (involving one or multiple countries) that requires minimal local
or international response and that has minimal public health consequences. Most
organization coordinated by the WHO Country Office (WCO).
Grade 2: an event (involving one or multiple countries) that requires a moderate
response from the WCO and/or an international WHO response. The event has
moderate public health consequences. The regional office will run an Emergency
Support Team to coordinate any support the WCO requires.
Grade 3: an event (involving one or multiple countries) that requires an extensive
response from the WCO and/or an international WHO response. The event has
significant public health consequences. The regional office will run an Emergency
Support Team to coordinate any support the WCO requires.
The grades are determined by the Head of the WHO Country Office in question and the
regional offices if they are classified as “Ungraded” or as “Grade 1”. In order to classify
something as a Grade 2 or Grade 3, the Head of the WCO must refer to the Global
Emergency Management Team (GEMT). The four main things considered when
16 Note: all information from the EFR come from the following source: WHO's Emergency Response Framework. Report. World Health Organization. 2013. http://www.who.int/hac/about/erf_.pdf
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determining a Grade are scale, urgency, complexity, and context. Once the emergency has
passed, then the GEMT will be responsible for removing the Grade classification.
Once the grade is determined, the World Health Organization acts in the following
manner:
Figure 1. Table on Types of Support. WHO Emergency Response Framework. 2013.
When set up in charts, like the above (Figure 1), the decision-making process seems
clear-cut. However, when looking at how aid is effective in the real world, there are many
other complex issues to contend with. These include economic restrictions, political
inefficiencies, conflict zones, and religious disputes, among others. For instance, in South
Sudan, the government restricted aid access because of a fear that it would aid rebel
groups.1718 On the other hand, often aid cannot be efficiently distributed by governments, if
17 "South Sudan Backgrounder - United to End Genocide." United to End Genocide. Accessed September 22, 2016. http://endgenocide.org/conflict-areas/south-sudan-backgrounder/.
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there are too many corrupt officials or if non-governmental militias are strong and can seize
supplies and material. Examples like these are prevalent throughout the world and cannot be
ignored by this committee.
Most of the above has referred to health related at a more general level. However,
nine out of ten disasters have been climate related.19 Therefore, another major concern for
this committee are the responses to natural disasters, as climate change is predicted to cause
natural disasters to continue to become more frequent and more volatile.20 Many issues arise
when dealing with climate change, because there are many conflicting interests involved.
This committee will be less interested in fighting the economic front, as preventative
measures are sometimes accused of hindering economic development. Instead, we should
think about disaster prevention and response. One measure that has been taken
internationally is the Hyogo Framework of 2005, which was implemented through the UN
resolution 60/195 after the World Disaster Reduction Conference. This is a 10-year plan to
make the world more resilient to disasters, which includes improving risk information and
early warning, reducing risks wherever possible, and improving response time21.
However, one thing that has remained constant, is that some people are affected
more by these disasters than others. For instance, the 2014 World Disasters Report
presented the graph below (Figure 2), shows how in countries with very high human
development have much lower numbers of people killed by disasters than those with low
18 "Sudan, An Endless War." WWW.OPPRESSION.ORG / AFRICA / Sudan, An Endless War. Accessed September 22, 2016. http://www.oppression.org/africa/sudan_endless_war.html. 19 “Disaster Preparedness for Effective Response Guidance and Indicator Package for Implementing Priority Five of the Hyogo Framework.” United Nations. Published 2008. Accessed 11 Sep 2016. http://www.unisdr.org/files/2909_Disasterpreparednessforeffectiveresponse.pdf. 20 Ibid. 21 "Hyogo Framework for Action (HFA)." UNISDR News. Accessed September 23, 2016. https://www.unisdr.org/we/coordinate/hfa.
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human development.22 This discrepancy is evident and one that must be seriously addressed
by the WHO.
Figure 2. Source: EM-DAT, Cred, University of Louvain, Belgium
Natural disasters affect people all over the world every single day. But in order to
tackle them it is helpful to understand which types of disasters affect different people. The
greatest threats, currently, are floods, windstorms, earthquakes and extreme temperatures.
How can we address, as a committee, these pressing risks to populations around the world?
How can we enhance the World Health Organization’s response, promote cooperation with
NGOs, and save lives?
22 "World Disasters Report 2014 – Data." World Disasters Report 2014. Accessed September 27, 2016. http://www.ifrc.org/world-disasters-report-2014/data.
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Figure 3: Source: EM-DAT, Cred, University of Louvain, Belgium
Country Policy
Figure 4. Source: Source: EM-DAT, Cred, University of Louvain, Belgium
The graph above gives an overview of the regions around the world that are affected
by natural disasters. This should help guide you in terms of priorities moving forward. The
following also outline more specific country positions.
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Middle East /African Countries: As less economically developed countries in general, they
are in dire need of emergency aid. Conflicts throughout the region make it more difficult to
address emergency situations and often put aid personnel at risk. Corruption in many
governments throughout the region also limit their ability to effectively aid their populations.
Therefore, there is the unfortunate combination of those who need the most aid, also have
the hardest time getting it.
The Middle East region is similar to Africa in many respects, in the demand for, but
difficulty in acquiring aid. Many conflicts make securing of effective emergency response
difficult. Moreover, they face security threats as an additional avenue of humanitarian need,
and human-caused destruction as an additional disaster. There is also an increased wariness
towards intervention from Western Counties. However, there are very developed countries
in this region, such as Saudi Arabia, who should not be considered part of this bloc. They are
much more alike the Western nations, though they face elevated threats of terror.
Developed Western Nations: these countries are often willing and able to provide aid to
countries around the world. Some of these nations (like Scandinavian countries for instance)
have a strong interest in tackling climate change. Some other nations may have economic or
military powers that might have hidden political agendas when providing aid. This is a fear
of many less developed nations around the world, who want to defend their sovereignty.
Asia: Asia has been consistently affected by the highest number of natural disasters,
which make them highly concerned with these situations in their countries. Some of them
(such as India and China) are rapidly developing and are likely to be both givers and takers
of emergency aid.
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Questions to Consider:
With these considerations in mind, how might the WHO better formulate plans and
contingencies for its emergency response?
Are there any situations, crises, or specific high-risk countries whose needs should be
prioritized over the needs of others? And if so, how might this hierarchy be
established?
How can we bridge the resource gap between more economically developed and less
economically developed countries?
What kind of emergency situations should be prioritized above others?
How to provide emergency response aid in conflict regions?
How to balance economic concerns with the needs of the affected populations?
Keywords:
Hyogo Framework
Global Emergency Management Team (GEMT)
Emergency Response Framework
WHO Country Office (WCO)
Emergency Response Grades
IDRL Guidelines
International Red Cross Red Crescent Movement
Inter-Agency Standing Committee (IASC)
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Topic B: Global Health and Bioethics
History of the Topic
Neither global health nor bioethics is a new concept. However, given the
unprecedented speed and quantity of technological innovation and scientific discovery, the
question of just how to conduct ourselves with this knowledge is imperative to consider.
From organ transplants between those with communicable disease23 to early- and late- term
abortions,24 post-contraceptive genetic editing25 and climate change-exacerbated food
scarcity,26 ethical issues affect all parts of global health care, often in deeply controversial and
divisive ways. Because nuance is important, we will delve a little deeper into the history of
both the WHO and of bioethics.
Global health has been defined as “the area of study, research and practice that
places a priority on improving health and achieving equity in health for all people
worldwide.”27 It aims to address problems that cross national borders, and take on
geopolitical and socioeconomic importance. Global health utilizes perspectives in medicine,
pathology, prevention and practice; population-scale public health; epidemiology and
demography to provide data on risk factors and policy, and a number of other social sciences
to better understand and direct health in an international context.28 As with any social
occurrence of this scale, organizations working in this field face many quandaries regarding
human rights and bioethics.
23 Matt Terrell, “HIV-Positive Organ Donors Are Now Able to Save Lives,” VICE. http://www.vice.com/read/hiv-positive-organ-donors-are-now-able-to-save-lives. 24 “Hyde Amendment,” Planned Parenthood. 25 Margarite Nathe, “10 global health issues to follow in 2016.” Humanosphere. Accessed 21 Sep 2016. http://www.humanosphere.org/global-health/2016/01/guest-post-10-global-health-issues-to-follow-in-2016/. 26 Ibid. 27 JP Koplan et al, “Towards a common definition of global health,” Lancet 373/9679: 1993-1995. 28 Robert Beaglehole and Ruth Bonita, “What is global health?,” Global Health Action, 2010/3, http://www.globalhealthaction.net/index.php/gha/article/view/5142.
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Bioethics is the study and practice of the philosophy of ethical discernment and
moral considerations as applied to the fields of medicine, health care, and policy.29 Its
invocation is regularly brought about by the emergence of novel advancements in biological
science and human medicine. Bioethics concerns itself with topics ranging from the
boundaries of life determination to the scarcity and allocation of resources.
Global health became a field, though very different than its current state, following
the magnitude of public health action during the 1800s.30 The identification of the
microorganisms behind the interregional and international diseases malaria and tuberculosis
came about in the early 1880s. The 1920s heralded the development of both preventative
and curative vaccines that lengthened life spans globally. The eradication of smallpox, a
campaign started and taken beyond US borers by the private Rockefeller Foundation
International Health Division,31 officially occurred in 1977. A cholera epidemic in Egypt that
claimed more than 200,000 lives between 1947 and 1948 provided necessary fire for the
international community to formulate an intergovernmental body focused on human health
development that was capable of more than simply surveying and census taking.32
With the growth and globalization, and multiculturization of a global health agenda,
came the rise of bioethics discourse. Bioethics was emphasized by the health community as
the global health agenda was formulated and staffed in large part by economically-
advantaged nations of the global north. Even as global interventions relating to vaccination,
diversified nutrition, gender based violence and a milieu of other campaigns continued and
grew, objections arrived as well. These arose in opposition to practices and processes that
29 “What is Bioethics?,” Adelaide Centre for Bioethics and Culture, accessed 21 Sep 2016, http://www.bioethics.org.au/Resources/Bioethical%20Issues.html. 30 “Global Health Timeline,” Global Health Hub, accessed 21 Sep 2016, http://www.globalhealthhub.org/timeline/. 31 “100 Years: Health,” The Rockefeller Foundation. 32 “History of WHO,” World Health Organization.
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could be perceived as offensive, oppressive, obstructive or neocolonial depending on the
culture of the place receiving enforcement and direction.
Therefore bioethics, a term first coined in 1971 by University of Wisconsin professor
Van Rensselaer Potter,33 began to encompass the rising tide of practice and philosophy
related questions. Since its formalized inception, bioethics has proved a powerful force in
practical matters such as science and technology legislation and public health policy.
Bioethics is a recognized arena of academic discipline, with a number of international and
internationally well-regarded literature, burgeoning with innovate and cutting publishers and
journals, including IRB: Ethics and Human Research, American Journal of Bioethics, Indian
Journal of Medical Ethics, and Developing World Bioethics.34
One of the primary concerns to engage modern bioethicist thinkers was that of the
principles and applications of living human experimentation. In 1974, the National
Commission for the Protection of Human Subjects of Biomedical and Behavioral Research
was established to create basic ethical principles that would ideally underlie biomedical and
behavioral conduct as it concerned living human subjects.35 Nations that constituted the
United Nations and thus were board members of the nascent World Health Organization
included the United States and Western European nations. These were nations tainted with
human subject abuses such as the 40 year Tuskegee Study of Untreated Syphilis in the Negro
Male and complicity in World War II Era human medical experiments. In the wake of these
violations of fundamental principles concerning bioethics, the ideas of autonomy, justice,
33 “What is Bioethics?.” 34 “Former Bioethics Commissions,” The Bioethics Research Library at Georgetown University, accessed 21 Sep 2016, https://bioethicsarchive.georgetown.edu/pcbe/reports/past_commissions/. 35 Ibid.
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and betterment serve as the cornerstones of this area, with moral values such as human
dignity and the preservation of life being added by other scholars over time.
Current Situation
In recent years, enormous attention has been directed to resolving ethical issues
that inevitably arise following advancements in medical science and global health policy.
With the emergence of global health rather than international health that aims for
unilateral standards, there are increasing discussions centered on the ethics of
implementation in diverse societies. There remains a number of imperative issues within
the fields.
There is an array of popularly discussed problems within the joint fields of global
health and bioethics. Once such dilemma arises from bioethics and its intersection with
ruling law. Sovereign nations may create rulings and guidelines on concerns related to
health, science, and medicine. However, these legislations, subject to demography,
culture, and socioeconomics, maybe not be in line with the goals perceived by
supranational organizations such as the WHO and those challenged or found
controversial. There is a necessity to create specified guidelines to protect human rights in
health-care settings.
Culture
Another problem arises from the immutability of national culture and progressive
care. It takes only an examination of the indelible spread of Ebola due to differences in
funeral rite and rituals,36 or consideration of the Hyde Amendment as passed by the
36 Margarite Nathe, “As Ebola Transmissions End in Guinea, What about the Heroes Left Behind?” Intrahealth. Published 29 Dec 2015. Accessed 26 Sep 2016, http://www.intrahealth.org/blog/ebola-transmissions-end-guinea-what-about-heroes-left-behind.
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United States Congress in 1976,37 and its impact on pregnancy termination accessibility in
developing nations for it to become clear that “culture clashes” are central to the
contemporary global health experience. As WHO moves beyond disease treatment and
prevention into an active agenda of lifestyle promotion seen as “healthy and safe,”
including but not limited to contraception, gender equity, and tobacco and alcohol
consumption limitation,38 just the depth and breath of the Organization’s influence on
nations and its citizens maybe be examined and challenged.
Supervision of Funding
Global health is a multibillion dollar industrial undertaking, and as such, the
sources of its funding can become areas of contention. Though global health initiatives
such as the Rockefeller Foundation’s campaigns against hookworm, smallpox, and yellow
fever were privately funded operations of varying success.39 The investment put forth by
individual, sovereign nations into international wellbeing though, deserves to garner
closer inspection and deliberation. In fiscal year 2016, the United States is slated to
contribute nearly US$38 billion in foreign aid, and transparency in this spending,
especially in the health care sector laced with questions of culture, rights, and coercion is
of unsold importance. For the 193 member nations of WHO, preventing disease can be
viewed as moral, socially benevolent cause, as well as a concrete investment. National
economies and their productivity suffer greatly when premature deaths or work disability
occur due to disease epidemics or non-communicable complications, whether it is US$9
billion lost in India due to obesity or US$3 billion lost in Brazil due to diabetes.40
37 “Hyde Amendment,” Planned Parenthood. 38 Katherine Schulz Richard, “World Health Organization,” About Geography. Accessed 21 Sep 2016, http://geography.about.com/od/culturalgeography/a/world-health-organization.htm. 39 “100 Years: Health,” The Rockefeller Foundation. 40 “Preventing Chronic Disease is a Vital Investment,” World Health Organization. Accessed 20 Sep 2016. http://www.who.int/chp/chronic_disease_report/en/.
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Distribution of Health Workers
Another, pertinent to 2016, is a reversal in the global health-care worker shortage.
As per WHO surveillance, there is a worldwide shortage of 7.2 million doctors, nurses,
midwives, and other heath-care providing personnel. As member nations embrace the
advent year of the new Sustainable Development Goals and their own national health-
targets, in large part by building equitable health workforces, they must grapple with ways
to distribute community workers, as well as access to technology and resources.41 An
important piece of global strategy concerning this is the Human Resources for Health:
Workforce 2030, which outlines goals for the development of a more accessible and
experienced health-care workforce across the globe.42 The issue of health workers means
that we must enhance the capacity for underdeveloped regions at a global scale as well, as
developed nations hold a near monopoly on high-technology, cutting edge health.
Balancing Responses and Allocating Resources
Yet another issue is directing attention to or from emerging and waning disease
threats. Communicable diseases such as HIV/AIDS and polio have devastated human
populations but in our present time are waning, and in the especial case of polio- near
eradication. However periodically, new threats will emerge and pose challenges to the
global health agenda and public health safety, including Ebola, and the recent vector-
borne Zika virus.43 These recent illnesses the attention they garner, and the fear they
stoke prove powerful forces in influencing health policy and action direction. It is
contentious just how to balance responses to chronic disease and action against nascent
41 Margarite Nathe. “10 global health issues to follow in 2016.” 42 “Transforming our world: the 2030 Agenda for Sustainable Development,” United Nations General Assembly, Published 2015. Accessed 20 Sep 2016. https://sustainabledevelopment.un.org/post2015/transformingourworld. 43 “Zika Virus.” The New York Times. Published 2016. Accessed 20 Sep 2016. http://www.nytimes.com/news-event/zika-virus.
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emergencies of indeterminate scale, scope, and severity. As member nations of WHO, it
is your responsibility to consider this compromise.
Diseases from Changing Lifestyles
Alongside the pressures to address historical, communicable diseases is the rise of
epidemic level “lifestyle” or non-communicable diseases; these were formerly limited to
wealthy nations but increasingly appear in developing nations due to globalization.44
These are putting immense pressure on unaccustomed health-care systems.45 Type 2
diabetes, the preventable condition of obesity, and its related complications including
cardiovascular issues, stroke, and respiratory illness in South Asian and sub-Saharan
nations formerly associated with endemic hunger are illustrative of this new
phenomenon.46 While it is hard to assign blame for these conditions, it is important to
remember that global nature of health, and how changes in the world culturally have
influenced health issues as well.
Outcome Gap
But beyond the issues specifically, is a universal problem of the “outcome gap.”47
The gap is characterized as the division between members of a population, whether local
or national, that have aces to essential medical treatment and those that do not. Often
this gap is widest and found in its most dire incarnation in countries which lack
sustainable infrastructure, workforces, or economies.48 This gap should be regarded as
referring not only to basic inability to find or receive treatment but also to chronic
44 “Non-Communicable Disease Deemed Development Challenge of ‘Epidemic Proportions’ in Political Declaration Adopted During Landmark General Assemly Summit,” United Nations. Published 19 Sep 2011. Accessed 20 Sep 2016. http://www.un.org/press/en/2011/ga11138.doc.htm. 45 P Hossain et co, “Obesity and diabetes in the developing world- a growing challenge,” New England Journal of Medicine, 3:213-215. 46 Ibid. 47 Farmer, P. “The major infectious diseases in the world- to treat or not to treat?” New England Journal of Medicine, 3:208-210. 48 Ibid.
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shortages of basic medicines and operations. This gap is especially important to keep in
mind as a dollar of spending in a developing country will not translate results seen in a
country where infrastructure is well-built and resources are ample. Moreover, it means
that there are amplified detrimental effects of disease, as countries least equipped to deal
with health crises also face an uphill battle.
We have listed a litany of issues. There has been much literature describing the
priorities of global health and what ought to be done. The World Health Organization
Constitution is a seminal document adopted in 1946 that articulates Notable works of
legislation concerning global health and its intersection with bioethics are major international
law documents such as the United Nations Universal Declaration on Bioethics and Human
Rights and UNESCO declarations on human cloning and the human genome. 49 To Save
Humanity is a 2015 collection of essays on the topic of global health that asks, “What is the
single most important thing for the future of global health over the next fifty years?,” and
garnering responses as diverse as leadership on climate change, accelerating access to
vaccines, pharmaceutical efficacy, and balanced diets. 50 The WHO Model List of Essential
Medicines is updated biannually since its publication in 1977.51 This list is remarkable and its
size and thus adapted to regional and national standards. Its categorization of assigning
essentialness brings up an ethical dilemma in the realm of drug creation, disruption, and
49 “Constitution of WHO,” World Health Organization. Accessed 20 Sep 2016. http://www.who.int/about/mission/en/. 50 “To Save Humanity Book Launch Julio Frenk,” Vimeo. Accessed 20 Sep 2016. https://vimeo.com/137492688. 51 “19th WHO Model List of Essential Medicines (April 2015),” World Health Organization. Last modified Nov 2015. Published Apr 2015. Accessed 21 Sep 2016. http://www.who.int/medicines/publications/essentialmedicines/EML_2015_FINAL_amended_NOV2015.pdf?ua=1.
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economics. The Alma Ata declaration of 1978 expresses the urgent need for primary health
care, firstly in developing nations but also with application in the Global North.52
Halting the spread of diseases and malaise is essential to the human future. Yet, there
is no singular single policy that will be adequate to address all governance or all emergencies.
However, solutions are regularly posed and amended to make progress on the front. The
Sustainable Development Goals, also know by its official title of Transforming our world:
the 2030 Agenda for Sustainable Development, is a 2015 set of seventeen “Global Goals” in
sequel to the UN Millennium Development Goals.53
Country Policy
Although WHO’s mission is that of a coherent global health policy, differences
divide its member states in 6 recognized, distinct blocs: African Region, Region of the
Americas, South-East Asia Region, European Region, Eastern Mediterranean Region, and
Western Pacific Region. These regional distinctions are derived from the Global Burden of
Disease classification system,54 for the purposes of reporting, analysis and administration.
Delegates should recognize which region their state belongs and formulate appropriate
solutions and approaches to modern global health and bioethics accordingly.
The African bloc, composed of 46 countries, is the second largest administrative
region, including the nations of Benin, Cameroon, Eritrea, the Gambia, Kenya, Nigeria,
South Africa, and Uganda. Global health is a particular topic of concern in sub-Saharan
Africa’s economically challenged nation, which see financial hardship translate directly in
52 “Declaration of Alma-Ata,” World Health Organization. Published Sep 1978. Accessed 21 Sep 2016. http://www.who.int/publications/almaata_declaration_en.pdf. 53 “Transforming our world: the 2030 Agenda for Sustainable Development.” 54 “Global Burden of Disease Regions used for WHO-CHOICE Analyses,” World Health Organization. Accessed 21 Sep 2016. http://www.who.int/choice/demography/regions/en/.
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decreased life expectancy. To illustrate, WHO classifies 25 of 46 nations as having “high
child, high adult” mortality, and the remaining 21 as having “high child, very high adult”
mortality.55 The African region is also tasked with responding to severe humanitarian
emergencies in Nigeria and South Sudan, and infectious epidemics including, Ebola virus,
and Lassa and yellow fevers.56
Eastern Mediterranean region recognizes Afghanistan, Egypt, the Islamic Republican
of Iran, Oman, and the United Arab Emirates as members, who in the scheme of Global
Disease Burden as starkly either nations with “low child, low adult” mortality or “high child,
high adult” mortality.57 As this region contains both African and Middle Eastern nations of
high population density and comparatively disparate economic statuses, there are many
issues to contend with in the public health mission. A unique campaign is that to ensure
health amongst refugee populations in Jordan and Turkey, and the protection of health care
workers in the midst of Syria’s civil war and the ongoing Israeli-Palestinian conflict.58
The European bloc is one of the most economically advantaged, as well as the
largest, hosting 53 member nations including Belgium, Denmark, Lithuania, Poland, Spain,
the United Kingdom, and the Ukraine.59 As an economically dominant region, these nations
experience “very low child, very low adult” to “low child, high adult” mortality. This region
has upwards of 60 years of healthy life expectancy at birth, with over 70 years of healthy life
55 “African Region,” World Health Organization. Accessed 21 Sep 2016. http://www.who.int/choice/demography/african_region/en/. 56 “Regional Office for Africa,” WHO Regional Office for Africa. Accessed 21 Sep 2016. http://www.afro.who.int/. 57 “Eastern Mediterranean Region,” World Health Organization. Accessed 21 Sep 2016. http://www.who.int/about/regions/emro/en/. 58 “#ProtectHealthWorkers: stop the attacks on health care in Syria,” WHO Regional Office for the Eastern Mediterranean. Accessed 21 Sep 2016. http://www.emro.who.int/eha/news/protecthealthworkers-stop-the-attacks-on-health-care-in-syria.html. 59 “European Health Information Gateway,” WHO Regional Office for Europe. http://portal.euro.who.int/en/
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being the norm.60 With this distinction, the European regional office of Who regularly
engages in hosting conferences and formulating policy, delivering essentials to regions in
strife,61 and addressing industrial-related health concerns such as workplace injury, obesity,
and mental health treatment.62
The Regions of the Americas is diverse in the sense of strategic planning as it
features nations with “very low child, very low adult” mortality including the United States
of America and Canada, as well as “high child, high adult” ranked nations such as Bolivia,
Ecuador, and Peru.63 A pertinent issue for this regions is the emergence of pervasive Zika
virus, especially in south America.64 This is a singular, but substantial example of how global
health and bioethics can stress the Organization’s effectiveness, as Zika-preventative
measures such as contraception, or responses such as abortion, are problematic and
contentious through North and South America.
South-East Asia region features major nations such as Bangladesh, Democratic
People’s Republic of Korea, India, Indonesia, Myanmar, Nepal, and Thailand. As a region
featuring nations of vastly differentiated populations and wealth statuses, the South-East
Asia office faces unique challenges, including finding and focusing of funding to combat the
60 “Healthy life expectancy (HALE) at birth, both sexes, 2015,” UN Data, accessed 21 Sep 2016, http://data.un.org/Data.aspx?q=hale&d=WHO&f=MEASURE_CODE%3AWHOSIS_000002. 61 “WHO and partners deliver essential medicines and supplies to 900 000 patients in northern Syria,” WHO Regional Office for Europe. Accessed 21 Sep 2016. http://www.euro.who.int/en/health-topics/emergencies/pages/news/news/2016/08/who-and-partners-deliver-essential-medicines-and-supplies-to-900-000-patients-in-northern-syria. 62 “12th World Conference on Injury Prevention and Safety Promotion (Safety 2016),” WHO Regional Office for Europe. http://www.euro.who.int/en/media-centre/events/events/2016/09/12th-world-conference-on-injury-prevention-and-safety-promotion-safety-2016. 63 “Regions of the Americas,” World Health Organization. Accessed 21 Sep 2016. http://www.who.int/choice/demography/american_region/en/. 64 “Case control study shows causal relationship between Zika infection in pregnancy and microcephaly in newborns,” WHO Pan American Health Organization. Accessed 23 Sep 2016. http://www.paho.org/hq/index.php?option=com_content&view=article&id=12490%3Acase-control-study-causal-relationship-zika-pregnancy-microcephaly-newborns&Itemid=135&lang=fr.
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burden of communicable disease.65 Nations in this region have need, in times of global
recession, of careful analysis of behavioral, environmental, and systematic factors that
contribute to the expansion of communicable diseases including Japanese encephalitis,
leprosy, dengue fever, and cluster diseases.66 Additionally, a decrease in the growth rate of
gross domestic product (GDP) by three percentage points in Asia and the Pacific, perhaps
due to the global economic crisis of 2008, has the potential to translate into 10 million more
undernourished people, 56,000 more deaths among children below 5 years old, and 2000
birthing bed mortalities. The economic decline also plays part to delay the achievement of
Millennium Development Goals targets relating to infant mortality and hunger.67
The Western Pacific region is widespread, containing a number of comparatively tiny
nations that, as a composite, create the healthiest region. Their WHO Global Disease
Burden classifications range between “very low child, very low adult” to “low child, low
adult” mortality. It includes Australia, China, Japan, the Philippines, Singapore, and Viet
Nam. A highly diverse region, the health related challenges are numerous and complex. The
Western Pacific Region has one third of the world's smokers and two people die every
minute from tobacco-related diseases.68 The range of nations is processing sexual and
reproductive health legislation related to antibiotic resistance to treatment for sexually
65 Indrani Gupta and Pradeep Guin, “Communicable diseases in the South-East asia Region of the World Health Organization: towards a more effective response.” Bulletin of the World Health Organization. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828785/ 66 Ibid. 67 Ibid. 68 “Member States call for stronger tobacco control measures to end tobacco industry interference,” WHO Western Pacific Region. Accessed 22 Sep 2016. http://www.wpro.who.int/mediacentre/releases/2016/20160916/en/.
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transmitted diseases,69 as well as debating the ethical right for women to breastfeed in public
places- an issue of contention in socio-culturally and religiously different nations.70
Some issues are bloc-crossing and unilateral in their effect, including efforts to
address the global threat of antimicrobial resistance,71 and thorough family planning and
reproductive health72, amongst others.
Key Terminology
In the view of the World Health Organization, health is a state of complete physical,
mental and social well-being and not merely the absence of disease or infirmity, and the
enjoyment of the highest attainable standard of health is one of the fundamental rights of
every human being, without distinction. The health of all peoples is fundamental to the
attainment of peace and security and is dependent on the fullest co-operation of both
individuals and countries.73
Bioethics is a relatively new term used to describe the investigation of ways in which
decisions in medicine and science touch upon our health and lives and upon our societies.
Bioethics is concerned with questions about basic human values such as the rights to life and
health, and the rightness or wrongness of certain developments in healthcare institutions, life
technology, medicine, the health professions and about society's responsibility for the health
69 “Growing antibiotic resistance forces updates to recommended treatment for sexually transmitted infections,” WHO. Accessed 21 Sep 2016. http://www.who.int/mediacentre/news/releases/2016/antibiotics-sexual-infections/en/. 70 “Member States call for stronger tobacco control measures to end tobacco industry interference.” 71 “U.N. Official Calls For Cross-Sector Efforts To Address Global Threat Of Antimicrobial Resistance,” Kaiser Family Foundation. Accessed 21 Sep 2016. http://kff.org/news-summary/u-n-official-calls-for-cross-sector-efforts-to-address-global-threat-of-antimicrobial-resistance/ 72 “U.S. Funding for International Family Planning & Reproductive Health,” Kaiser Family Foundation. Accessed 21 Sep 2016. http://kff.org/global-health-policy/issue-brief/u-s-funding-for-international-family-planning-reproductive-health/. 73 “WHO definition of Health”, World Health Organization. Accessed 21 Sep 2016. http://www.who.int/about/definition/en/print.html.
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of its members. Bioethics is a branch of "applied ethics" and requires the expertise of people
working in a wide range. Bioethics is full of difficult ethical questions for everybody: families,
hospitals, governments and civilization, as fundamental values are at stake.74
Affected people are those adversely affected by a crisis or a disaster and who are in
need of urgent humanitarian assistance. A crisis is any situation that is perceived as difficult
but more so carries the possibility of an insidious process of undeterminable time, layers, and
intensity. An emergency, by turn, demand decision and follow-up of super-ordinary
measures. It requires a response with a degree of effectiveness, the process through which
activities are undertaken at the most appropriate level and with the most valuable execution.
Responses can be conducted through the collaboration of communities of practice, which
develop naturally as people with common ideas and interests congregate or come together.75
Questions to Consider
1. What is your nation’s involvement in the international global health agenda?
2. What are your nation’s views on the role of supranational organization on its public
health?
3. Has your nation’s views and involvement in global health changed in the past 15
years?
4. How can differences in bioethical conduct between nations be addressed?
5. What are the most pressingly ethical considerations for your population’s wellbeing?
74 “What is Bioethics?,” Adelaide Centre for Bioethics and Culture. 75 “Humanitarian Health Action: Definitions,” World Health Organization. Accessed 21 Sep 2016. http://www.who.int/hac/about/definitions/en/.