Dear Delegates and Moderators,

Transcription

1 Dear Delegates and Moderators, Welcome to NAIMUN LV and more specifically welcome to The World Health Organization! The staff of NAIMUN LV has been working day and night to make this the most rewarding and educational experience yet, and we are excited to welcome you all to DC in February! This document is the topic abstract for The World Health Organization. It contains three key elements to allow you all to prepare well in advance for the committee: topics, structure, and research avenues. The goal of this abstract is to give you a better understanding of the content in the committee. As well, it is meant to be a jumping off point for further research about the content of this committee. By reading and understanding the topic abstract, you will more fully get a sense of how this committee will be run at NAIMUN and what specific issues the NAIMUN staff want you to focus on. We hope to be of assistance to you in your preparation for NAIMUN LV. If you have any questions, comments, or concerns, please feel free to contact the Secretary- General or Director-General. We look forward to welcoming you to the NAIMUN family! Best, Christian and Brendan Christian Mesa Secretary-General c.mesa@modelun.org Brendan Stelmach Director-General b.stelmach@modelun.org

2 Topic Abstract: The World Health Organization Introduction The World Health Organization (WHO) was established in 1948 as a specialized agency of the United Nations (UN) that promotes public health around the world. Over the course of history, it has played a leading role in the eradication of smallpox, the expansion of access to essential medicines, and much more. Today, it s priorities include communicable and noncommunicable diseases, nutrition, environmental health, humanitarian response, and health equity. Within the context of the global health system, the WHO provides leadership, shapes the research agenda, and monitors health in order to mitigate the biomedical and socioeconomic burden of disease. During times of crisis, it also plays a particularly critical role directing the resources of the global health community. This committee will be an emergency session of the WHO Regional Committee for the Americas (AMRO/PAHO), one of the WHO s six regional divisions. Rather than dealing with all issues on a global level in the World Health Assembly, regional offices often set guidelines for implementing policies and respond directly to regional crises. As such, delegates will need to quickly develop a health agenda in the midst of a dire situation. Health outcomes and broader socioeconomic factors will be affected by the implications of their decisions on the various determinants of health. In particular, this committee will focus on the complications to health that arise during crises and delegates will be encouraged to think holistically when developing solutions. Topic A: Antimicrobial Resistance In 1928, Alexander Fleming, a Professor of Bacteriology at St. Mary s Hospital in London, returned from vacation and examined his petri dishes that contained a strain of Staphylococcus bacteria. In one dish, he noticed that it was filled with colonies except in one zone where mold, a strain now known as Penicillium

3 chrysogenum, was growing. 1 Fleming discovered that the secretions from this strain of mold were capable of killing a wide range of harmful bacteria, including streptococcus, meningococcus, and diphtheria bacillus. When he initially published his findings in June 1929, the only practical application was in isolating penicillininsensitive bacteria from penicillin-sensitive bacteria in a mixed culture, but this research would ultimately lead to the creation of the first therapeutic antibiotic in Today, antibiotics are classified into bactericidal drugs, which induce cell death, and bacteriostatic drugs, which inhibit cell growth. They generally accomplish these goals by interfering with DNA, RNA, or protein synthesis. 3 Historically, the first epidemiological transition was characterized by the widespread emergence of infectious diseases, potentially caused by the development of agriculture and close proximity to domestic animals. The development and distribution of antibiotic drugs were then a critical component of the second epidemiological transition: for the past 200 years, improvements in medical practices, nutrition, and public health have resulted in a decline in early mortality resulting from infectious disease and an increase in deaths caused by chronic conditions such as heart failure, cancer, and diabetes. 4 However, bactericidal antibiotics are not always capable of killing all targeted microbes. The ones that remain are resistant to the drug and replicate, resulting in drug-resistant strains, exacerbated by the rapid evolutionary timeline of bacteria. As such, the third epidemiological transition is understood to be the re-emergence of infectious diseases previously thought to be under control and the evolution of entirely new diseases. The extensive use of antibiotic treatments and creation of a globalized transportation network has thus facilitated the transmission of dangerous, potentially resistant, 1 "Discovery and Development of Penicillin." American Chemical Society International Historic Chemical Landmarks. Accessed July 15, Ibid. 3 Kohanski, Michael A., Daniel J. Dwyer, and James J. Collins. "How Antibiotics Kill Bacteria: From Targets to Networks." Nature Reviews Microbiology. May 4, Accessed July 15, Harper, Kristin, and George Armelagos. "The Changing Disease-Scape in the Third Epidemiological Transition." International Journal of Environmental Research and Public Health. February 24, Accessed July 15,

4 pathogens at a pace never seen before. Patients exposed to these pathogens are at risk of worse health outcomes and require much more intensive care than patients with non-resistant strains of the same bacteria. Examples of emerging resistant bacteria include Klebsiella pneumoniae, E. coli, tuberculosis, and Methicillin-resistant Staphylococcus aureus (MRSA), among many more. As such, in the context of a drugresistant disease outbreak, the public health community will need to consider interventions that are not based on this critical component of disease management. A coordinated approach will need to consider both scientific solutions such as research innovation as well as policy-based approaches such as quarantine. Topic B: Health Inequity in Crisis Health outcomes are affected by a wide range of factors beyond biomedical ones. The various determinants of health include income, geography, access to clean water, nutrition, access to health services, and much more. To evaluate the effectiveness of a healthcare system in the context of these determinants, experts look at geographic accessibility, availability, financial accessibility, and acceptability. 5 Geographic accessibility refers to the physical distance and travel time for an individual to reach a healthcare facility, which also accounts for the physical infrastructure of a country, such as roads and bridges. Availability considers the ability of individuals to obtain proper care at a healthcare facility, considering things such as trained personnel, waiting times, and access to medications. Financial accessibility refers to the cost of services and medications, particularly when there is a lack of public financing or regulation on private providers. Finally, the acceptability factor considers the relationship between health services and the social and cultural practices of a community. The constitution of the World Health Organization states: The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human 5 Institute of Medicine (US) Forum on Microbial Threats. Global Infectious Disease Surveillance and Detection: Assessing the Challenges Finding Solutions, Workshop Summary. Washington (DC): National Academies Press (US); Summary and Assessment. Available from:

5 being without distinction of race, religion, political belief, economic or social condition. 6 As such, accounting for the various determinants of health is a core component of the WHO s mission. One example of how it has acted in this space is the development of the essential medicines list in Mindful of how important the price of drugs is in facilitating their distribution, this list represents medicines that should be available within the context of functioning health systems at all times in adequate amounts at a price the individual and the community can afford. 7 The WHO Model List of Essential Medicines is updated every two years and demonstrates a direct action towards stabilizing healthcare systems across the world. However, in times of crisis, the determinants of health are put under stress and existing inequality is exacerbated. Although disasters are indiscriminate in whom they affect, poor and already medically underserved populations tend to bear a disproportionate amount of the burden, especially as disasters tend to cause new disparities. For example, the health systems of medically underserved regions are likely to be operating near capacity, meaning that in the event of disaster, they are incapable of managing the surge of demand for services. 8 Furthermore, in catastrophic disasters, the question of who receives care first is often a critical question with clear implications for health equity. Resources for Further Research TOPIC 1 Resources: "Antimicrobial Resistance." World Health Organization. Accessed July 15, "Constitution of the World Health Organization." World Health Organization. Accessed July 15, "Essential Medicines." The World Health Organization. Accessed December 27, Davis, Jennifer R., Sacoby Wilson, Amy Brock-Martin, Saundra Glover, and Erik R. Svendsen. "The Impact of Disasters on Populations With Health and Health Care Disparities." Disaster Medicine and Public Health Preparedness. March Accessed July 15,

6 A fact sheet provided by the World Health Organization that summarizes antimicrobial resistance and some major examples. "Discovery and Development of Penicillin." American Chemical Society International Historic Chemical Landmarks. Accessed July 15, gpenicillin.html. An overview of the development of penicillin, which provides historical context and a basic understanding of the importance of antibiotics. Harper, Kristin, and George Armelagos. "The Changing Disease-Scape in the Third Epidemiological Transition." International Journal of Environmental Research and Public Health. February 24, Accessed July 15, An overview of the theory of epidemiological transition, which provides an understanding of the significance of antimicrobial resistance in the history of human disease. Omran, Abdel R. "The Epidemiologic Transition: A Theory of the Epidemiology of Population Change." The Milbank Quarterly. December Accessed July 15, The original theory of the epidemiologic transition proposed by Abdel Omran. The theory has since been modified by the research community, but it essentially provides an in-depth look at what is now considered the second epidemiological transition. TOPIC 2 Resources: Davis, Jennifer R., Sacoby Wilson, Amy Brock-Martin, Saundra Glover, and Erik R. Svendsen. "The Impact of Disasters on Populations With Health and Health Care Disparities." Disaster Medicine and Public Health Preparedness. March Accessed July 15,

7 An overview of how disasters impact populations with existing health disparities. Disasters are divided into two categories: natural and technological, where natural disasters affecting health are not limited to epidemics. "Determinants of Health." Determinants of Health Healthy People Accessed July 15, An overview of the various determinants of health, providing a holistic perspective to health outcomes and the factors that contribute to them. "Essential Medicines." World Health Organization. Accessed July 15, The hub for information about the World Health Organization s essential medicines program, an example of how the WHO is working in the health equity space. Farmer, Paul. "SARS and Inequality." The Nation. May 3, Accessed July 15, Paul Farmer, a leading global health expert, writes about how the SARS epidemic demonstrates the inequality of the global health system. Because it affected areas with high economic significance, its response commanded a disproportionate amount of resources. Smith, Joan. "Inequality Remains the Real Killer in Africa - as the Ebola Outbreak Has Shown." The Independent. March 15, Accessed July 15, Human rights activist Joan Smith writes about the different level of treatment that infected foreign medical personnel received during the Ebola crisis, a theme that is common to many epidemiological responses in developing nations.