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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/.

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