World Health Organization

SMUNC 2015

Chairs: Schyler Cole, Aubrey Beam

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Dear WHO Delegates,

Hello, my name is Schyler Cole, and I will be your chair at SMUNC this year. I can’t wait to

meet you and see who you are. (Terrible pun intended.)

I am a sophomore studying Health policy, planning to minor in Modern Languages. I am also

pre-med. I have been involved in Model UN as a delegate since my freshman year of high

school, and I chaired a UNEP committee my senior year. I fell in love with Model UN freshman

year, and I now can’t imagine not being involved in Model UN in some capacity.

This weekend I look forward to delving deeply into our two topics, debating intensely, and

having some fun while we do. Please feel free to contact me with any questions before the

conference!

(If you couldn’t tell, I am a girl. Schyler as a name is little ambiguous.)

Wishing you a great start to the year,

Schyler Cole

schylerc@stanford.edu

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WHO

What is the WHO?

The World Health Organization, or WHO, is a United Nations body dedicated to

protecting world health. Established April 7, 1948, today the WHO has over 7,000 workers in

150 different countries. Their jobs are to organize international health within the UN and they

promote widespread access to health services, provide treatment for noncommunicable and

communicable diseases, and offer corporate services.

The WHO supports many efforts on the part of member states towards attaining health

goals and shaping health practices. The World Health Organization may work to influence

national and global policies, deploy medical relief in response to epidemics, promote disease

research, and more. Arguably the WHO’s biggest success has been their role in the eradication of

smallpox in 1980. Since then, their focus has shifted to universal health coverage, universal

health regulations, increasing access to medical products, and reaching the health-related

MDGs.1 Most recently, the WHO has come under heavy criticism in the wake of the 2014 West

Africa Ebola crisis. Many people said the WHO was neither equipped nor prepared to combat a

widespread emergency epidemic; many have argued that the WHO needs more money and better

infrastructure in order to effectively combat the next major outbreak.

This year, the WHO will be discussing diseases of affluence and medical waste. A brief

overview of the topics and questions to consider are provided below.

1 WHO. Leadership Priorities, 2015. http://www.who.int/about/agenda/en/ (accessed September 1, 2015).

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Diseases of Affluence

Introduction

Chronic or noncommunicable diseases (NCDs) including cardiovascular diseases,

cancers, and diabetes were once only a problem for developed countries. Infectious diseases

were the main threat for developing countries; however, within the past decades great strides

have been made to reduce mortality from communicable diseases. In the wake of decreased

mortality from infectious diseases, chronic diseases have become the new global economic

burden.2

In high-income countries, the changes in mortality patterns have occurred over

generations, allowing health care systems time to adapt. However, for developing countries,

health care systems have not been able to keep up with the rapid changes in the leading causes of

serious illness and death. Additionally, those individuals developing these diseases in middle and

low-income nations are often much younger than those in developed countries.

In the past decade, many developing countries have been able to improve their public

health systems through improved sanitation and vaccine accessibility. While succeeding in

making infectious diseases less prevalent, decreasing infant mortality, and increasing life spans,

these advances have established a foundation for the growth of chronic disease. While some

believe these new problems are signs of success, the difference in health care systems between

developing and developed nations actually exacerbate these problems.

Indeed, heart attack, stroke and many other chronic diseases are no longer just diseases of

affluence, but world-wide pandemics. High, middle, and low-income countries and developing

nations seek to enact measures that consider the complexities of the issue in their efforts to

improve the health of all citizens.

2 Wagner, K., & Brath, H. (2011). A global view on the development of non communicable diseases. Preventive Medicine.

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History

The lifestyle causes of NCDs are well known, and include: tobacco use, an unhealthy diet

high in saturated and trans fats, salt, and sugar, physical inactivity, and the excessive

consumption of alcohol. These risk factors cause more than two-thirds of all new cases of NCDs

and increase the risk of complications in individuals with NCDs.3 Consumption of foods high in

saturated fat and processed foods coupled with physical inactivity account for approximately 4

million deaths worldwide. As of 2007, this lifestyle phenomena has contributed to obesity rates

of more than 25% in Chinese adults. Additionally, in a diverse range of low-income countries—

including Egypt, Mexico, and South Africa—and higher income countries—including Australia,

the United Kingdom, and the United States -- two-thirds of the adult populations are now

considered overweight or obese.4

Regarding tobacco use, approximately 6 million people die each year, by means of direct

consumption and secondhand smoke.5 By 2020, 7.5 million people are projected to die from

tobacco use, which would account for 10% of all deaths. Tobacco use, unhealthy diet, and

physical inactivity lead to metabolic conditions linked to NCDs, including raised blood pressure,

raised cholesterol and glucose, obesity, and cancer-associated infections.

Development of the Issue

In an effort to frame committee discussion and narrow the breadth of diseases considered

NCDs, this committee will focus on debating the effects of cardiovascular diseases, cancer, and

diabetes in countries’ citizens. In 2008, three of the deadliest NCDs were coronary heart disease,

cancer, and diabetes, responsible for 17 million, 7.6 million, and 1.3 million deaths respectively.

3 WHO, 2002. Diet, nutrition, and the prevention of chronic diseases: WHO Technical Report Series 916. World Health Organization, Geneva 4 Popkin, B.M., 2007. Understanding global nutrition dynamics as a step towards controlling cancer incidence. Nat. Rev. Cancer 7, 61–67. 5 WHO, 2010a. The Global Burden of Disease: 2004 Update. World Health Organization, Geneva. WHO, 2010b. Global Status Report on Non Communicable Diseases. World Health Organization, Geneva.

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Over 80% of cardiovascular and diabetes deaths and two-thirds of all cancer deaths occurred in

low- and middle-income countries.6

Cardiovascular disease (CVD)

Within CVD, coronary heart disease (CHD) is the leading cause of CVD death, the single

largest cause of death in developed countries, and one of the leading causes of disease burden in

developing nations. (main article) In low- and middle-income countries, there is a great rise in

death rates from CVDs. Currently, Eastern Europe, a high income nation, has a 58% death rate

from CVDs while sub-Saharan Africa has a much lower rate of 10%. However, while

occurrences of CVDs in low- and middle-income countries continue to increase, current

healthcare systems struggle to provide the necessary care, a fact that is not an issue for high-

income countries. Additionally, there is a lack of access to preventive interventions that spurn the

rates of CVDs.

Cancer

45 years ago, 15% of newly reported cancers occurred in developing countries. As of

2008, this percentage has leapt to 58%. It is projected that by 2030, the percentage will increase

further to 70%.7 Of the 7.6 million yearly deaths from cancer, two-thirds occur in low- and

middle-income countries. Due to low survival rates in developing countries and improved

survival rates in developed countries, a severe disparity has formed. The case fatality of cancer -

- the ratio of incidence to mortality in a given year -- is estimated to be 75%, 72%, 64%, and

46% in low income, low-middle income, high-middle income, and high income countries

respectively.8

6 WHO, 2010a. The Global Burden of Disease: 2004 Update. World Health Organization, Geneva. WHO, 2010b. Global Status Report on Non Communicable Diseases. World Health Or- ganization, Geneva. 7 Boyle, P., Boffetta, P., Autier, P., 2008. Diet, nutrition and cancer: Public, media and scientific confusion. Annals of Oncology 19 (10), 1665–1667. 8 Farmer, P., Frenk, J., Knaul, F.M., et al., 2010. Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet 2010 (376), 1186–1193.

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Diabetes

In the past three decades the estimated number of adults with diabetes has doubled. There

were 153 million deaths in 1980 versus 347 million in 2008. However, 70% of the causes are

attributed to population growth and aging. Still, these numbers show that there is a global shift

toward a more western lifestyle including an unhealthy diet and physical inactivity. (Danaei)

Projections foresee that the developing nations in Asia, Latin America and the Caribbean, and

sub-Saharan Africa will bear the worst of this burden.9 Growth rates of diabetes in these nations

are expected to exceed 104%-162%, compared to 72% in the United States and 32% in Europe.10

In addition to the staggering growth rates, what sets diabetes apart from CVD and cancer

is the cost to affected individuals over a lifetime. It is the costliest consequence of obesity. (main

article) It is one of the leading causes of visual impairment in developed countries. Furthermore,

diabetics require at minimum, two to three times the healthcare resources compared to non-

diabetics. National healthcare budgets commonly allocate up to 15% of funds toward diabetes

treatment.11

Asian countries currently carry the worst burden associated with diabetes. Between 1970

and 2005 the prevalence of diabetes quadrupled in Indonesia, Thailand, India, and China

compared with a 1.5 times increase in the United States.12

Economic Burden

In addition to the burden on the individual, this global phenomena has a significant

economic burden. In 2005, losses in national income from heart disease, stroke, and diabetes

were approximately 18 billion dollars in China, 11 billion dollars in the Russian Federation, 9 9 WHO. Diabetes Factsheet 2011. http://www.who.int/mediacentre/factsheets/fs312/en/ (accessed July 26, 2011). 10 Hossain, P., Kawar, B., El Nahas, M., 2007. Obesity and diabetes in the developing world—a growing challenge. N. Engl. J. Med. 356, 213–215. 11 Zhang, P., Zhang, X., Brown, J., et al., 2010. Global healthcare expenditure on diabetes for 2010 and 2030. Diabetes Res. Clin. Pract. 87, 293–301. 12 Yoon, K.H., Lee, J.H., Kim, J.W., et al., 2006. Epidemic obesity and type 2 diabetes in Asia. Lancet 368, 1681–1688.

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billion dollars in India, and 3 billion dollars in Brazil. This loss will only get worse as more

people continue to die from NCDs each year.13 In 2015, the losses in these countries are

estimated to be between three and six times more than those ten years prior.

Reasons for Global Trends

Globalization is at the heart of this lifestyle, health, and economic trend. While

globalization has allowed for progress in terms of longevity, rapid urbanization and increasingly

sedentary lifestyles have allowed for chronic diseases to become an enormous burden on

improperly equipped nations. To transition from agrarian to industrial to postindustrial states,

countries must deal with and overcome a host of environmental, social, and structural

developments. The free movement of resources, trade of technology innovations, changes in

transportation and work, globalization of modern food processing, marketing, and distribution,

all contribute to the increased burden of NCDs.14 Particularly crucial to this increase in chronic

disease, is the replacement of fresh markets by multinational, regional, and/or local large

supermarkets. In 1990 in Latin America, supermarkets accounted for 15% of all retail food sales.

In 2000, this percentage jumped to 60%.15 The spread of the supermarket has spread through

countries of all sizes and economies. While the accessibility to food has increased, this by no

means guarantees that the quality of the food and the health of consumers has increased as well.

On the contrary, supermarkets offer processed foods that are higher in fat, sugar, and salt than

the previously dominant fare in developing nations.

13 WHO, 2005. Preventing chronic diseases: a vital investment: WHO global report. World Health Organization, Geneva. 14 Popkin, B.M., 2006. Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases. Am. J. Clin. Nutr. 84, 289–298. 15 Reardon, T., Timmer, P., Berdegue, J., 2004. The rapid rise of supermarkets in developing countries: induced organizational, institutional, and technological change in agrifood systems. J. Agric. Dev. Econ. 1, 168–183.

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Committee Directive:

As stated previously, this committee will focus on addressing the issues stemming from

increases rates of CVD, cancer, and diabetes globally, with special emphasis on low- and

middle-income countries. We will look at not only how developing nations can help themselves,

but also how developed nations contribute to the issue. Our discussion will be framed not only

by the health consequences but by the inherent question of how to sustainably develop.

Questions to Consider:

1. How is your country affected by NCDs? Is this a new phenomena or an long-standing

problem?

2. How does each of the selected diseases affect your country?

3. Are there any other countries in a similar position?

4. In particular to developing nations, how can a nation grow and prosper technologically

while still providing for the health of its people?

5. Is it possible to balance globalization with the protection beneficial pre-globalization

lifestyles choices?

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Medical Waste

Introduction

In 2011, Calin Georgescu, an expert on sustainable development, stated that, “20 to 25%

of the total waste generated by health-care establishments is regarded as hazardous and may

create a variety of health and environmental risks if not managed and disposed of in an

appropriate manner.” Health-care waste typically comes from hospitals, mortuary centers,

laboratories, blood banks, nursing homes, and animal laboratories. The waste has the potential to

infect hospital patients, workers, and the general public through harmful microorganisms. This

has become an even greater issue worldwide, especially as developing countries gain access to

even greater health-care services without an equal opportunity to waste management technology.

Types of medical wastes deemed hazardous include infectious waste (waste that is

contaminated with blood and its products), pathological waste (body parts and animal carcasses),

sharps (syringes, needles, scalpels), chemicals (solvents, disinfectants), pharmaceuticals (expired

or unused drugs), genotoxic waste (cytotoxic drugs), radioactive waste (waste contaminated with

radioactive diagnostic material), and heavy metal waste (such as broken mercury thermometers).

Infectious and pathological wastes make up 15% of hazardous waste. Sharps only make up one

percent of total medical waste but are a major source of disease transmission, as needle-stick

injuries expose people to pathogens such as hepatitis B, hepatitis C, and HIV.

History and a Brief Look at the Afghan Case

Globally in the past ten years, there have been many major public health threats due to

improper waste management. In March 2009, 240 people in the Indian state of Gujarat

contracted hepatitis B following medical care delivered with previously used syringes. These

syringes were later discovered to have been acquired through the black market trade of

unregulated health care waste.16 After further investigation, a 2004 study conducted by the Indian

Clinical Epidemiology Network was found suggesting that more than 30% of the 3–6 billion

16 http://onlinelibrary.wiley.com/store/10.1111/j.1365-3156.2009.02386.x/asset/j.1365-3156.2009.02386.x.pdf;jsessionid=1CB6A0C12360E5E30FAE24C8128F42ED.f04t01?v=1&t=id8doj7n&s=19b9344acebbd7d90353716b5fb74cf4934fa21e

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injections administered each year in India were done with used equipment. According to the

2004 study, this practice has reported in almost 10% of health facilities nationwide. In October

2008, the byproducts of a mass vaccination campaign of 1.6 million against polio were discarded

into the local municipal waste in Kabul, Afghanistan, causing infectious injury to individuals

scavenging landfills for reusable items. An investigation later found that Afghanistan lacks

regulations governing safe hazardous waste management and that more than 60 hospitals in

Kabul do not have incineration capacity or access to other essential waste management

equipment.17

Yet, the Afghanistan issues with waste management extend past the country’s borders. A

2010 report in Afghanistan Today, found that many rag pickers* in Pakistan are actually Afghan

refugees. These individuals suffer infections from medical waste and human rights violations.

Some children are kept in servitude by gang masters at the dump while their parents are paid six

to eight euros for two weeks of work. The rag pickers rely on charities and aid agencies to eat

and are sometimes forced into the sex industry.18

Additionally, many of the issues concerning medical waste stem from the fact that many

developing countries don’t have the necessary means to dispose of it. Many developing countries

use medical waste incinerators, a trend that has been decreasing in industrialized countries due to

the specific requirements for safely burning medical waste and the impact that the soot and ash

has on the surrounding environment. Also, developing countries produce hazardous medical

waste at a much higher rate than the reported 0.2 kg per bed per day because they fail to correctly

separate their hazardous waste from their non-hazardous waste. Along with that, there is the fact

that many of these nations’ incinerators don’t meet the minimum requirements, creating

incomplete waste destruction and increased dioxin emissions.

17 http://onlinelibrary.wiley.com/store/10.1111/j.1365-3156.2009.02386.x/asset/j.1365-3156.2009.02386.x.pdf;jsessionid=1CB6A0C12360E5E30FAE24C8128F42ED.f04t01?v=1&t=id8doj7n&s=19b9344acebbd7d90353716b5fb74cf4934fa21e 18 http://noharm.org/lib/downloads/waste/MedWaste_Human_Rights_Report.pdf *a person who picks up waste materials for a livelihood.

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Questions to Consider :

1) How is your country affected by medical waste?

2) Are their immediate health concerns for your nation’s citizens?

3) Does your country cooperate with other countries in their disposal of medical waste?

4) How well-trained are current medical workers and the public on medical waste issues?

5) How does your control handle other waste problems?

6) Are there any major corporations or organizations that contribute to your country’s

position of medical waste disposal? If so, how and to what effect?

7) What other issues stem from improper medical waste management?