World Health Organization

Transcription

1 World Health Organization

2 Dear Delegates, Welcome to the World Health Organization Committee of UMMUN 2006! My name is Alexis Xu and I will serve as your director this year. I am currently a junior majoring in biology, and plan to attend dental school after I graduate. This is also my third year of involvement in UMMUN. I ve had wonderful experiences with the UNCHR and SOCHUM committees in past years, and look forward to an even better conference this year with all of you. I am extremely excited to be working with this year s assistant director, Jennifer Mahn. Jennifer is from Troy, Michigan; she is currently a pre-medicine student majoring in political science. This will be her second year in UMMUN, having had previous experience with the WHO last year. She brings a wealth of knowledge to our committee, and will be a considerable resource. Please feel free to contact either of us with any questions you may have regarding UMMUN, Ann Arbor, and the University of Michigan. We are more than happy to answer them. Our topics this year include two very pressing issues in the global community: the growing obesity epidemic and malaria in children. Obesity has quickly become a health crisis in developed and developing countries, while malarial rates in children, especially in African countries, remain unacceptably high. The WHO has the important task of helping affected countries overcome these diseases while at the same time preventing them from worsening in other regions. To prepare for the conference, the background guides we have provided should be used as a starting point for gathering additional information on the topics, especially that which is specific to the nation-state you represent. Although preprepared resolutions are not allowed at the conference, it is in the delegate s best interest to come with specific ideas for how they hope to approach the problems presented. We are very excited to each one of you, and look forward to an exciting and energetic conference in January. We wish you the best of luck in your preparations. Sincerely, Alexis Xu, WHO Director Jennifer Mahn, WHO Assistant Director World Health Organization 2

3 DAIS STAFF Director - Alexis Xu Assistant Director - Jennifer Mahn COMMITTEE MISSION Known as the Public Health Arm of the United Nations, the World Health Organization (WHO) was first proposed in 1945 at the UN Conference on International Organization held in San Francisco, California. Following several planning sessions, the WHO charter was approved on April 7th, Initially, the WHO s projects were aimed at fighting diseases such as smallpox, yellow fever, cholera and malaria. Additional focus was on the development of immunizations for measles, diphtheria, tetanus and polio. The relatively narrow focus of the WHO s preliminary stages has evolved dramatically since its inception to a far more complex and coordinated set of objectives and efforts. The WHO has made its main objective the achievement of the highest possible level of total health physical, mental and social well-being for all people. In this capacity, health and well-being are defined by more than just the absence of disease. The WHO advocates the belief that the health of all individuals is essential to the achievement of peace and security in the global community. Moreover, this level of well-being can only be attained through the coordination of efforts between individual states and their people, and between various states. The WHO acknowledges that there exist vast inequalities in the availability of healthcare and disease control among various nations, and it is through this lens that the organization approaches situations and formulates policy. The WHO advocates equal access to healthcare and the maintenance of well-being across all racial, economic and social divides, emphasizing the healthy development of children regardless of their environment. TOPICS Topic A: The Global Obesity Epidemic Topic B: Malaria in Children World Health Organization 3

4 TOPIC A The Global Obesity Epidemic Introduction Obesity has reached epidemic proportions globally. Not only are adults becoming increasingly overweight, obese, and morbidly obese, but children are quickly following suit. In addition to endangering the physical health of hundreds of millions of people, this relatively new health crisis also has the ability to fracture the social, cultural, and economic stability of both developed and underdeveloped countries. Defined as having a Body Mass Index (BMI) of 30 or more, obesity affects more than 300 million worldwide, excluding the additional 1 billion adults who are overweight. Obesity increases the risks of many serious and chronic medical conditions, including heart disease, type 2 diabetes, hypertension, stroke, arthritis, some forms of cancer, asthma, reproductive complications, and psychological disorders such as depression. Obesity affects people of both sexes, all ages, and all socioeconomic demographics. Especially alarming rates of development are appearing in children. The World Health Assembly endorsed the Global Strategy on Diet, Physical Activity, and Health in May However, global obesity rates are still increasing at alarming rates. Despite international efforts, little effective action has been taken against this disease. Historical Description There are many causes of obesity. On a basic level, weight gain occurs when energy intake (calories consumed) exceeds energy output (calories lost due to metabolic function and physical activity). Yet, for each individual, body weight is also the result of a combination of genetic, metabolic, behavioral, environmental, cultural, and socioeconomic influences. Because of the sharp increase in obesity in the past twenty-five years, genetic factors alone fail to explain the obesity epidemic. Societal changes and worldwide nutrition transitions are driving this epidemic. The main contributing forces are: economic World Health Organization 4

5 growth, modernization, urbanization, and the globalization of food markets. With rising incomes and urbanizing populations, diets increasingly shift to include higher fat foods, saturated fats, and sugars. Concurrently, large shifts towards less physically demanding jobs worldwide in part due to automated transport, home technology, and more passive leisure pursuits leads to decreased physical activity. Current Situation Obesity has become a public health crisis not only because of its physically harmful effects, but also because of the rising costs of obesity-related health care spending. With the rise of westernization and the adoption of Western culture, obesity has now spread to the rest of the world, and has become a global public health crisis, especially in industrialized countries. While a negative correlation between socioeconomic class and obesity prevalence exists in most developed countries, a distinct reversal in this correlation exists in many less-developed areas, including China, Malaysia, parts of South America, and sub-saharan Africa. Childhood obesity is already epidemic in some regions and on the rise in others. An estimated 22 million children under five years of age are overweight worldwide. Overweight is now the most common medical condition of childhood. This problem is not limited to developed countries, as it is global and increasingly extends into the developing world. Bloc Positions Obesity is relatively uncommon in African and Asian developing countries, although when present, it is more prevalent in urban than in rural populations. It reaches approximately 5% in China, Japan, and certain African nations. However, even in relatively low prevalence countries such as China, rates are almost 20 percent in some cities. Obesity has risen by 100 percent among Japanese men since In South Africa, its levels equal those of the US, World Health Organization 5

6 with one in three men and more than one in two adult women exhibiting obesity. It has created a double burden of disease in parts of Africa still struggling to overcome malnutrition. In the Americas, obesity rates for men and women are increasing in both developed and developing countries. Estimates suggest that 100 million adults in the United States alone are overweight or obese (35 percent of women and 31 percent of men). The prevalence of obesity in children is increasing markedly, as approximately 20 to 25 percent of children are either overweight or obese. According to the US Surgeon General, the number of overweight children in the USA has doubled and the number of overweight adolescents has tripled since Overall obesity costs to the US in the year 2003 were estimated to be $100 billion. In South America, where malnutrition and underweight were once predominant, the percentage of overweight children is now close to 5 percent. The frequency of obesity has increased by about 10 percent to 40 percent in the majority of European countries over the past 10 years. Europe has one of the highest average BMI (26.5) of all WHO regions. Overweight affects 25 to 75 percent of the adult population (400 million people) while the prevalence of obesity ranges from 5 to 20 percent in men and up to 30 percent in women (130 million adults). Research shows there is a rapid closing of the gap in obesity prevalence between western and eastern Europe. According to WHO estimates, more than 75 percent of women over the age of 30 are now overweight in countries as diverse as Barbados, Egypt, Malta, Mexico, and Turkey. Estimates are similar for men, with over 75 percent now overweight in, Argentina, Germany, Greece, Kuwait, New Zealand, Samoa, and the United Kingdom. Children across the world are also becoming overweight and obese, with the highest rates in the Middle East, Chile, Greece, and Italy. Analysis & Recommendations World Health Organization 6

7 Obesity is predominantly a social and environmental disease. Modernization has increased sharply for the past 50 years. The growth of industry and technology leads to an over-abundance of high caloric foods and a decrease in overall physical activity. Urbanization, population growth in large cities, is another factor in rising obesity rates, as it is associated with changes in diet and a more sedentary lifestyle. Both preventive and therapeutic strategies need to be developed to limit the impact of obesity. Effective weight management for individuals and groups at risk of developing obesity involves a range of long-term strategies. These include prevention, weight maintenance, management of co-morbidities, and weight loss. They should be part of an integrated approach, which includes environmental support for healthy diets and regular physical activity. In this approach, a supportive environment should be created through public policies that promote a variety of low-fat, high-fiber foods, provide opportunities for physical activity, and promote overall healthy behaviors to encourage weight loss. Both governmental and community support to patients is critical to achieving success. Strategies for supporting patients depend on individual health care systems. Dietary programs that emphasize weight management, rather than short-term extreme weight reduction should be the focus of longterm therapies. Patients at higher risk for obesity may benefit from additional drug therapy. Gastrointestinal surgeries should be limited to those who have developed life-threatening conditions. Preventing obesity in children should be a major focus area, as children respond best to clear dietary advice compared to all other age groups. Patterns of healthful eating behavior that begin in childhood are shown to preserve throughout adulthood. Guardians and the surrounding community are thus World Health Organization 7

8 essential to the prevention and treatment of obesity in children. They have the opportunity to serve as healthy lifestyle role models. WHO has been following the obesity epidemic since the 1990s. Although numerous public awareness campaigns were initiated to sensitize policy makers, private sector partners, medical professionals, and the public at large, they have failed to slow down the increase in obesity rates. A shift towards more actionbased programs is needed in combating this disease. Committee Mission It is the job of the World Health Organization to determine the courses of action that should be taken by the United Nations and the world to end the global obesity epidemic. Not only should immediate intervention programs be established, but long-term prevention programs should also be endorsed. How can the United Nations encourage all nation states to participate in this campaign, despite the fact that the disease does not affect all regions equally? Delegates will discuss, debate, and make compromises, keeping in mind that the final resolution may not satisfy the petitions of every nation. It is our goal to come to an agreement upon a solution to a heath crisis that negatively affects hundreds of millions of adults and children, and to determine the implications of our compromise throughout our sessions together. Questions to Consider How does the obesity crisis influence your country, and to what extent? Which areas of the Global Strategy on Diet, Physical Activity, and Health should be considered as part of the new resolution, and which areas should not? What specific economic or political measures can be taken to reduce global obesity rates? What specific preventative and educational programs will benefit children s choices in food consumption and physical activity? World Health Organization 8

9 Resources How can the WHO work to integrate with pre-existing nutritional programs in countries where obesity is prevalent? If obesity rates fall below an acceptable level, what steps can your country take to ensure they will not rise again in the future? World Health Organization: WHO obesity page: World Health Reports: Centers for Disease Control and Prevention: World Health Organization 9

10 TOPIC B Malaria Introduction Malaria is a serious disease that if left untreated, can become a deadly illness. It is transmitted to humans by the bite of the female Anopheles mosquito, which requires blood to nourish her eggs. Approximately 40% of the world s population mostly those living in the world s poorest countries are currently at risk for malaria, as 90% of all deaths due to malaria occur in sub- Saharan Africa. The World Health Organization has implemented the Roll Back Malaria (RBM) initiative with the objective of halving the world s malaria problem by the year Two main components of RBM are monitoring and evaluation of the programs put into action to combat malaria. Although the WHO has begun implementation of a directly combative series of measures, malaria continues to plague afflicted areas. It is imperative that the WHO analyze its current institutions and programs, assess their success, and think forward in designing new procedures to ensure concrete preventative measures in addition to care and treatment for individuals throughout Africa and the developing world. Historical Description Because it was once thought to come from rotten marshes, malaria comes from the word mal aria, or bad air. It was not until 1880 that scientists discovered that the real cause of malaria is plasmodium, a one-cell parasite. It was later still that the mechanism of transmission was discovered to be the bite of a female Anopheles mosquito. In 1955 at the World Health Assembly, the WHO proposed to eradicate malaria worldwide, using methods such as house spraying with insecticides, treatments with anti-malarial drugs and observation of incidences. This eradication effort was successful in nations with temperate climates and seasonal malaria transmission. In countries such as India and Sri Lanka, incidences of malaria World Health Organization 10

11 were vastly reduced. These decreased levels, however, skyrocketed soon after eradication efforts ended. Countries such as Indonesia, Afghanistan, Haiti and Nicaragua made very little progress during this campaign, and some nations (including those comprising most of sub-saharan Africa), were completely excluded from it. Factors such as the emergence of drug resistance, widespread resistance to available insecticides, wars, massive population movements, difficulty in obtaining steady funding from donor countries and lack of community participation ultimately made the goal of complete eradication unattainable. It was then that the WHO s focus shifted from total eradication to control of the disease. Malaria remains a life-threatening disease in undeveloped nations where prevention and treatment is scarce. Today, it primarily plagues the tropical and sub-tropical regions of the world, causing more than 500 million illnesses and at least one million deaths each year. Current Situation Ninety percent of all deaths due to malaria occur in sub-saharan Africa, accounting for 10% of the continent s overall disease burden. This startling figure is due to a combination of factors, including a very efficient mosquito vector (Anopheles gambiae) that assures high transmission, a predominant parasite species (Plasmodium falciparum) that causes the most severe form of malaria, local weather conditions that allow transmission to occur year-round and scarce resources that restrain efficient Malaria control efforts. Plasmodium falciparum is the parasite that causes its victims to develop the most severe complications of malaria such as brain disease, severe anemia and kidney failure. Because malaria parasites destroy red blood cells, people subjected to frequent malarial infections (especially young children and pregnant women in sub-saharan Africa) are prone to anemia. Severe cases of anemia may then require blood transfusions (which are highly unregulated in developing countries), leaving World Health Organization 11

12 these individuals susceptible to acquiring HIV and other blood borne diseases. Pregnant women who have malaria during their pregnancy run the risk of giving birth to a low weight or premature baby, which drastically increases his or her chance of surviving after birth. Unfortunately, the harmful effects of malaria in developing countries combine with other diseases and conditions such as HIV/AIDS, malnutrition and anemia. Together, these illnesses can severely weaken the patient, forcing him or her to deteriorate rapidly and die quickly. Bloc Positions The malaria crisis is most prominent in sub-saharan Africa. Moreover, children constitute most of this region s malaria patients; the disease kills an African child every 30 seconds, accounting for one of every five child deaths in Africa as a whole. Of the more than 500,000 African children who develop malaria each year, 10-20% die and 7% are left with permanent neurological damage. Children who survive a particularly severe case of malaria (from the Plasmodium falciparum parasite) may also suffer from learning impairments or brain damage. In particularly afflicted areas of sub-saharan Africa, the disease currently accounts for roughly 40% of public health expenditure, 30-50% of inpatient admissions to various clinics, hospitals and health care centers and up to 50% of outpatient visits in areas with high malaria transmission. From 1950 to the 1990s, Asia has seen near eradication followed by resurgence in Sri Lanka, control and resurgence in India, and the adverse affects of drug resistance in Cambodia. In China, community organization and increased emphasis on case detection have eliminated malaria from large areas of the nation. Thailand, Malaysia and to an extent Vietnam have all reached essential elimination in their rice fields, but are still affected by the disease at the outskirts. Malaria cases in India and Pakistan account for nearly 3 million of the total 5 million confirmed cases reported each year from countries outside of World Health Organization 12

13 Africa. Roughly 45% of the cases reported in India were Plasmodium falciparum cases. The risk of contracting malaria in India is very unevenly distributed in the country, as only 20% of the population reports 80% of the cases. In particular, the Northeast states have a high incidence of malaria overall and also a problem with drug resistance. Although the burden is much less in nations of the Western Pacific Region (WPR) than sub-saharan Africa or India, malaria is a major problem in roughly ten nations of the WPR. In this region, resistance to anti-malarial drugs is the major issue in controlling the epidemic. The problem is most serious in countries of the Mekong region where the production and use of low-quality and counterfeit drugs have expedited individuals levels of resistance. Malarial transmission has been eliminated in the United States and most Western European countries. Cases do occur in these countries, however, but are found mostly in travelers and immigrants who are quickly treated to prevent its effects and transmission to others. Analysis & Recommendations: Malaria is a catastrophic epidemic because it inflicts enormous costs to individual patients and governments alike. Although treatments for the disease are relatively inexpensive, those who acquire it often live in poverty and cannot afford them. Governments need to maintain health facilities, purchase drugs and take preventative measures against malaria. One example in this could be distributing insecticide-treated bed nets and spraying various locations with insecticides. The problem with the use of insecticides is that mosquitoes eventually become resistant to them. These resistant mosquitoes reproduce and are consequently unharmed by a particular insecticide. Changing insecticides often becomes expensive and problematic, as it becomes difficult for governments to provide any single, long-term strategy to combat and prevent malaria. World Health Organization 13

14 Another crucial component of this crisis is that malaria is currently viewed as a disease of poverty. In a retrospective analysis, it was estimated that economic growth per year of countries with severe malaria was 1.3% lower than that of countries without it. Although 1.3% may not see like much, this rate creates significant long-term differences in the economic situations of various countries. Furthermore, it prevents economic growth in not only afflicted countries, but also surrounding countries in the region. Drug resistance is one of the greatest challenges facing nations in the prevention of malaria. The cheapest and most widely used anti-malarial drug is chloroquine, but resistance to this drug is very common throughout Africa. Sulfadoxine-pyrimethamine (SP) is viewed as the first and least expensive alternative to chloroquine, but resistance to this drug is also on the rise. Consequently, many countries are facing pressure to change their treatment policies and use more expensive drugs, including drug combinations, which are thought to slow the development of malarial resistance. These drugs, however, cost money that is scarce and incredibly difficult to obtain for the afflicted Third World countries. The WHO implemented the Roll Back Malaria (RBM) initiative in 1998 with the objective of halving the world s malaria problem by The four technical elements of the RBM initiative are: prompt access to effective treatment, promotion of insecticide-treated nets, prevention and management of malaria in pregnancy, and improving the prevention of and response to malaria epidemics in complex emergencies. Two years later, many African heads of state met in Abuja, Nigeria to further the plan to take initiative into action. Signed in April of 2000, the Abuja Declaration provided a concrete plan to combat the epidemic. Since Abuja, significant progress has been made almost 20 African nations have reduced or eliminated taxes on insecticide-treated nets to make them more World Health Organization 14

15 affordable. Additionally, many African countries have developed Country Strategic Plans (CSPs) to assist them in achieving their RBM goals. These countries are currently coordinating their efforts on the local, state and global levels to fully implement their CSPs and have been successful for the most part in garnering support. Unfortunately, only 20% of the necessary funds that are needed to complete the project by 2010 are currently available. The global community must unite to find ways to mobilize resources in carrying on the initiative. These countries have already begun inquiring about funding from national treasury and donor community sources in addition to debt relief organizations and the United Nations Global Fund to Fight AIDS, TB and Malaria. Although insecticide-treated nets are relatively inexpensive yet tremendously effective in the prevention of malaria, local governments are often not able to assist in extensive funding for these preventative measures because of the relative poverty of these afflicted areas. The RBM and Abuja Declaration are concrete, practical plans, but unless the financial resources needed to move forward with these initiatives are collected, these useful tactics of tremendous promise can never be fully implemented. Committee Mission It is imperative that the WHO address the crucial issues associated with the global malaria epidemic. The Roll Back Malaria initiative created in 1998 was initially valuable, but only five more years remain until the original goal of the year arrives. How can the WHO coordinate efforts on local, regional, state and global levels to acquire funding? Furthermore, how can the WHO convince wealthy nations unaffected by the epidemic that without their financial support, the epidemic may only get worse? Delegates will discuss, debate, and make compromises, keeping in mind that the final resolution may not satisfy the petitions of every nation, keeping in mind that the common goal of the WHO World Health Organization 15

16 committee as a whole is the achievement of the highest possible level of total health for all people in the global community. Questions to Consider: Sources: How should the problem of mosquitoes increased resistance to insecticides be addressed given that without changing insecticides, no long term solution will ever be successful in the prevention of malaria? What can be done to decrease people s resistance to anti-malarial drugs in the most economically efficient way? How can the WHO use its influence to garner support of wealthy, Western nations that are un-afflicted by Malaria given the attitude that since their own nation will not benefit they are not obligated to get involved? How can insecticide-treated nets be more widely distributed to especially rural, isolated and poverty-stricken areas? If funding can be acquired to fully implement the RBM initiative and countries CSPs currently, what can be done to maintain these goals beyond 2010? sia IAEXT/INDIAEXTN/0,,contentMDK: ~pagePK: ~piPK:217854~t hesitepk:295584,00.html World Health Organization 16