1 Julia Davis Whittier College MUNFW 67th Session World Health Organization

Addressing Pandemics and Other Global and Regional Health Crises

Introduction

The World Health Organization (WHO), formed in 1948 under the United

Nations (UN), has defined its primary role as directing and coordinating international

health within the UN system. Its vision is an “integrated global alert and response system

for epidemics and other public health emergencies based on strong national public health

systems and capacity and an effective international system for coordinated response.”1 To

carry out the organization’s goals efficiently and effectively, WHO created five strategic

categories for addressing international health issues: communicable diseases, non-

communicable diseases, health through the life course, health systems, and preparedness,

surveillance and response. Each area has a corresponding team of specialized experts

tasked with finding innovative means of addressing global and regional health problems,

such as sanitation and access to clean, drinkable water, HIV/AIDS, climate change and its

affect on health, and specific viruses like Ebola and Zika.

Although there are international guidelines, health measures, regulations and

systems that have been established and put into effect by the UN and the World Health

Organization, pandemics and disease outbreaks often affect regions very differently due

1 "Information and Communication Technologies for Public Health Emergency Management," 2016.

2 to differences in climate, health care systems in place, and technology available in that

specific region. The Ebola outbreak was a strong indicator of the weakness of

international systems in the face of resurgent viruses. Today, the UN and WHO are

working to strengthen response and alert systems for health emergencies, both at local

and international levels.

Frameworks, Guidelines and International Programs

The UN and the World Health Organization recognize the direct link between

health and wellness, and economic, political and social stability. In September 2014, the

Security Council adopted Resolution 2177, which stands as the “first recognition by the

Council of the threat posed by an epidemic to international peace and security.”2

Referencing Ebola, the resolution underlined that, unless contained, the outbreak could

lead to “further instances of civil unrest, social tensions and a deterioration of the

political and security climate.”3 Acknowledging the direct impact of health issues on

security was a huge step forward. The WHO aims for the prevention of international

health events, the term “event” being defined as “a manifestation of disease or an

occurrence that creates a potential for disease.”4 When an event occurs, the goal of the

WHO is a fast and effective response, so as to avoid the deterioration of security and

social and economic stability.

2 "In Hindsight: The Security Council and Health Crises,” 2014. 3 “Resolution 2177”, United Nations Security Council, 2014. 4 Ibid,.

3

Since its inception, WHO has created guidelines and international programs to

target world health issues with this goal of prevention and fast response in mind. In

addition to networks and technological resources that have been set up by WHO since

1948, the organization originally formed individual departments that correspond with

each of the aforementioned five strategic categories. Each of these departments oversees

specific regional and global health issues. The Department of Pandemic and Epidemic

Diseases (PED) was specifically created and appointed to tackle the fifth category,

“preparedness, surveillance and response.” PED is a team consisting of disease-specific

and public health experts that addresses and responds to outbreaks and emergencies. The

WHO asserts that emerging and re-emerging epidemic diseases pose an on-going threat

to global health security, requiring an adaptable approach that can be proactive in

preparing for, monitoring, and responding to new health issues across the world.5 PED

was created with the stance that the combination of technical expertise and scientific

knowledge is the critical foundation of effective strategies for epidemic control. With the

creation of specific departments such as PED, WHO established a more comprehensive

and efficient system for coordinated response.

Beneath this general, five-category framework, there are many focused and

specifically technology-oriented programs that the WHO and individual departments

within the WHO direct. For example, in April 2000, members of WHO and other UN

health-related agencies met in Geneva to discuss the need for a global network that deals

with emerging diseases, pandemics and global outbreaks. Consequently, the Global

5 Pandemic and Epidemic Disease Brochure

4 Outbreak Alert and Response Network (GOARN) was created, with the goal of

“[combating] the international spread of outbreaks, [ensuring] that technical assistance

reaches affected states rapidly, and [contributing] to long-term preparedness and capacity

building.”6

A similar program was created more recently following an initial meeting of

partners in Geneva in April 2009, a meeting which brought together interested parties

from academia, non-governmental organizations (NGOs) and the private sector.

Following this conference, an idea for a website for “information and communication

technologies for public health emergency management (ICT4PHEM),” a derivative of

GOARN, came to fruition and was launched in June 2016. This technical collaboration

will pool human and technological resources in order to provide enhanced information

and communication technology (ICT) solutions to predict, prevent and support public

health emergencies. It will enable individuals and communities that have access to the

internet to find solutions to and ask questions about health emergencies. It also will create

a means through which experts can communicate with communities that might not be

easily accessible physically, in order to address, and ideally prevent, pandemics and

outbreaks. Though the website itself has not been set up yet, ICT4PHEM is the latest UN

project focusing on global health, with a specific emphasis on prevention of and fast

response to pandemics and outbreaks, and its potential is huge.7

At the broadest level, WHO has established International Health Regulations

(IHR), an international agreement that is legally binding on 194 countries, including all

6 “Global Alert and Response Network (GOARN),” 2015. 7 "Information and Communication Technologies for Public Health Emergency Management," 2016.

5 WHO Member States, and which is intended to help the World Health Organization

“prevent, protect against, control and provide public health response to the international

spread of disease.”8 The regulations are consistent with international humanitarian law

and human rights law and should be implemented with “full respect for the dignity,

human rights and fundamental freedoms of persons,”9 a stipulation that ensures that

nations and peoples are protected. The scope of the IHR is purposely broad in order to

maximize the probability that the regulations are able to address and apply to all global

health events. Essentially, the IHR aims to protect the global community from public

health risks and emergencies that cross international borders through the collaborative

actions of Member States, while avoiding unnecessary interference with international

politics and trade.

Sanitation and Access to Clean Water

Today, it is estimated that 1.8 billion people worldwide use a source of drinking

water that is contaminated with some fecal matter. This is not surprising considering that

1 billion people openly defecate—nine out of ten in rural areas—and that hundreds of

millions of people have no access to soap and water to wash their hands.10 Contaminated

water carries diseases such as cholera, diarrhea, dysentery, hepatitis A, typhoid, and

polio. Simply having access to soap would empower those most prone to disease and

infection spread via water to block the spread of disease. Over 800,000 adult and 300,000

8 “About IHR,” 2005. 9 Ibid,. 10 “Water Supply, Sanitation and Hygiene Development,” 2015.

6 child deaths could have been prevented if sanitation systems were improved, such as the

basic provision of soap.11 Promoting these basic rights, safe and sufficient drinking water

and adequate sanitation and hygiene, had implications across all Millennium

Development Goals (MDGs), “from eradicating poverty and hunger, reducing child

mortality, improving maternal health, combating infectious diseases, to ensuring

environmental sustainability.”12 While much remains to be done to increase access to

these rights and to reduce inequalities across populations, there has been progress over

the past decade. For example, 2.3 billion people gained access to improved drinking

water between 1990 and 2012. Additionally, the number of children dying from diarrheal

diseases, which are strongly associated with poor water, inadequate sanitation and

hygiene, have steadily fallen over the past two decades. Today, fewer than 1,000 children

under five die each day from diarrhea caused by inadequate water and sanitation

compared to over 2,000 fifteen years ago.13

In Zambia, for example, efforts have been made to improve water, sanitation and

hygiene (WASH) services in health care facilities, and recent home visits have shown

that these improvements are working. In 2010, the Ministry of Health, with support from

the Tropical Disease Research Center and other organizations, installed small water

stations for safe drinking and handwashing in 150 health care facilities, which were

chosen because they reported high levels of diarrhea and low access to clean water. Two

locally produced water stations were placed at key points within each health facility, one

11 “Lack of Sanitation for 2.4 Billion People Is Undermining Health Improvements,” 2015. 12 “Water Supply, Sanitation and Hygiene Development,” 2015. 13 “Lack of Sanitation for 2.4 Billion People Is Undermining Health Improvements,” 2015.

7 with chlorinated water for drinking and one for handwashing with soap. There are

dedicated personnel to manage the stations in order to ensure proper operation. Besides

making it possible for health workers to wash their hands, the water stations are

increasing patients’ satisfaction and promoting hygiene practices. The home visits have

seen patients now regularly washing their hands with soap and safely storing and treating

their water.14

While gains have been made, progress has been stymied by a number of factors,

including inadequate investments in behavior change campaigns, lack of affordable

products (like soap and toilet seats) for the poor, and social norms which accept or even

encourage open defecation. The practice of open defecation, which affects dietary

behavior when it causes illness, is also linked to a higher risk of chronic malnutrition,

affecting 161 million children worldwide.15 Diarrhea is often caused by lack of clean

water for proper washing, and a lack of toilets only further exacerbates the problem.

Feces on the ground contributes to contaminated drinking water and water resources in

general, and leads to diarrhea and chronic malnutrition.16 One of the targets under Goal 6

of the 2015 Sustainable Development Goals (SDGs), which addresses clean water and

sanitation, is to completely end open defecation by 2030.17 This would require a doubling

of current rates of reduction, especially in South Asia and sub-Saharan Africa, according

to WHO and UNICEF.

14 “Simple solution improves water and sanitation in Zambian health-care facilities,” 2015 15 Ibid,. 16 “Water, Sanitation, Hygiene, and Malnutrition in India,” 2015 17 2015 Sustainable Development Goals

8

In addition to setting goals and working to improve sanitation systems, the UN

focuses on health education. For example, improving water sanitation at the facility-

delivery points does not necessarily ensure that water is clean when it reaches individual

homes and mouths. While WHO has developed a series of water quality guidelines in

order to ensure that water treatment products and facilities are actually producing clean

water, the water can still be contaminated during transport or be home to vectors (insects

that breed in clean water). Education regarding how to cover containers can “reduce

vector breeding and may also have a co-benefit of reducing fecal contamination of water

at the household level.”18

Climate Change and its Effect on the Spread of Diseases

Climate change continues to put pressure on water supply systems. It is estimated

that if current trends continue, in ten years, “half of the world’s population will be living

in water-stressed areas.19 The Intergovernmental Panel on Climate Change (IPCC)

findings indicate that the contrast in precipitations between wet and dry regions and wet

and dry seasons is likely to increase, thus also increasing flood and drought risks.

Research predicts, based on current global trends, that many mid-latitude arid and semi-

arid regions (also commonly the poorest areas), are likely to receive less precipitation,

with the likelihood of having droughts larger and longer than those observed since

18 “Drinking Water,” 2015. 19 Ibid,.

9 1900.20 With less water available, there are even higher risks of contamination and the

spread of disease through water. Thus, a focus on dissemination of information about safe

water use and treatment, and defecation practices is even more crucial. In years to come,

water will be instrumental in the prevention of the spread of disease, outbreaks of

pandemics, and other regional and global health crises.

HIV/AIDS

The Human Immunodeficiency Virus (HIV), which causes Acquired Immune

Deficiency Syndrome (AIDS), is an ongoing pandemic that affects over 35 million

people worldwide. Of the 36.9 million people living with HIV worldwide, an estimated

25.8 million are in sub-Saharan Africa, accounting for 70% of the global total.21 While

the number of those infected by HIV each year continues to go down as information

about the virus and ways to prevent transmission spreads, the main problem posed by this

ongoing pandemic has become how to treat it. One of the targets under Goal 3 of the

2015 Sustainable Development Goals (to ensure healthy lives and promote well-being at

all ages), is to end the AIDS epidemic by 2030.22 The primary barrier standing in the way

of this target is not an inability to create effective medications and treatments, but rather

the high demand for them. Even though infection rates have decreased, demand for

antiretroviral therapy, which is accepted by physicians today as the best treatment for

20 “A Post-2015 Global Goal for Water: Synthesis of key findings and recommendations from UN-Water,”

2014. 21 "Global HIV and AIDS Statistics,” 2015. 22 2015 Sustainable Development Goals

10 HIV/AIDS, continues to well surpass supply. Additionally, these treatments are

extremely expensive, so the regions most in need are often the ones that receive the least.

Although the number of people receiving antiretroviral therapy continues to rise

in Africa, this trend masks significant gaps. In at least 14 countries in Africa, 80% or

more of people who were estimated to be eligible for free treatment under the 2013 WHO

guidelines were not receiving therapy as of December 2012. People living with HIV in

Eastern and Southern Africa are more likely to obtain services than those in Western and

Central Africa, who are still more likely to receive treatment than those in North Africa.

The theme of the 21st International AIDS conference, which took place in Durban, South

Africa this past July, was “access equity right now,” a call to action for access to

antiretroviral treatments to be equal.23 The goal for the outcome of this conference, at

which WHO played a major role and which focused on finding financing solutions, is

better, broader, and more equal distribution of antiretroviral therapies.

New Outbreaks: Ebola and Zika

Though the Ebola and Zika viruses are both considered new outbreaks, this is in

large part where their similarities end. They affected different demographics and

geographic regions, and had entirely different physical effects. That being said, a

comparison of the responses to each outbreak by the international community does show

the progress that has been made in efficiency and effectiveness of response. Though the

Ebola breakout was unprecedented and its scale impossible to predict, it served as a

23 WHO at AIDS, 2016.

11 representation of a weak framework. Hospitals and Ebola treatment facilities were

overflowing and were forced to turn people away at the height of the outbreak. After

billions of dollars were pledged, the most ever to the outbreak of a single virus, new

treatment units were built and ultimately, stood empty due to lack of patients. By the time

the international community reacted, it was in large part too late. In 2014 alone, almost

5,000 died of the nearly 10,000 who had been infected. The WHO identified what would

have been a good outbreak control system for Ebola as the application of a package of

interventions, “namely case management, surveillance and contact tracing, a good

laboratory service, safe burials.”24 The primary failure of the international community

following the 2014 outbreak was delayed intervention and containment of the virus. All

over West Africa, health systems did not meet standards and failed to prevent or delay the

rapid spread of Ebola. Without proper systems of containment, the virus was also able to

spread via plane and boat.

Less than a year after WHO acknowledged its failures with addressing Ebola, it

was faced again with the outbreak of a new virus: Zika. The Zika virus disease is caused

by a virus transmitted primarily by Aedes Mosquitoes, and there is scientific consensus

that the Zika virus is a cause of Microcephaly and Guillain-Barré syndrome. Correlations

with other neurological complications are also being investigated.25 A group of experts

cited WHO’s biggest mistake as sounding the alarm too late, noting that it took until

August 2014 for the Ebola outbreak to be declared a public health emergency despite the

24 “Ebola virus disease,” 2016. 25 “Zika virus,” 2016.

12 outbreak getting out of control by spring of the same year.26 While WHO did refrain from

declaring Zika a global health emergency in February 2016 for three full months after

Brazil declared a public health emergency in November 2015, there has undoubtedly

been a faster, and more comprehensive response to the outbreak of Zika than there was to

Ebola. WHO/Pan American Health Organization (PAHO) and other global health

partners have drafted and begun to implement a strategic response to Zika, which focuses

on preventing and managing medical complications caused by the Zika virus. The WHO

has called for $122.1 million to implement the plan between July 2016 and December

2017. The strategy also focuses on “communicating risks with women of child-bearing

age, pregnant women, their partners, households and communities, so that people have

the information they need to protect themselves.27

Conclusion

Today, with pandemics and epidemics posing a threat to global security, the

World Health Organization places huge importance on the prevention and containment of

such global health crises. Though there are established frameworks and guidelines in

place that dictate how to respond to such events, as well as new programs and

technologies constantly being developed, we still have a long way to go. As droughts

loom and water contamination and improper, or altogether absent, sanitation systems

remain a consistent issue, particularly in rural and poor areas, the World Health

Organization must collaborate with State Parties, non-governmental organizations and

26 “An Indictment of Ebola Response,” 2015. 27 Zika Strategic Response Plan, 2016.

13 other United Nations bodies to address these problems, but this will require political will

and financial and technical support from member states. States must decide how they can

best support these goals and what means of cooperation might be most effective and

efficient.

14

Questions

1. How could access to healthcare, sanitation and clean drinking water be improved,

particularly in rural areas?

2. How can technology be used to improve sanitation systems?

3. How can technology be used to prevent and more quickly address world health

events?

4. How should allocation of resources by determined? Should more resources and

efforts be directed towards ongoing pandemics such as HIV/AIDS, malaria and

tuberculosis, or towards preventing and addressing new outbreaks like Ebola and

Zika?

5. Are the 2015 Sustainable Development Goals regarding health what they need to

be?

6. Should individual state governments be held more accountable for preparing for

pandemics?

7. How can the spread of diseases across international borders be stopped?

8. Should there be international guidelines for training healthcare officials?

15

Bibliography

A Post-2015 Global Goal for Water: Synthesis of Key Findings and Recommendations from UN-

Water. UN Water, 18 Feb. 2014. Retrieved August 5, 2016 from

<http://www.unwater.org/fileadmin/user_upload/unwater_new/docs/UN-

Water_paper_on_a_Post-2015_Global_Goal_for_Water.pdf>. Access to Antiretroviral Therapy in Africa: Status Report on Progress towards the 2015 Targets.

Rep. N.p.: UNAIDS, 2013. Colen, B. D. "An Indictment of Ebola Response." Harvard Gazette. N.p., 22 Nov. 2015. Web. 5

Aug. 2016. <http://news.harvard.edu/gazette/story/2015/11/an-indictment-of-ebola-

response/>. "Global HIV and AIDS Statistics." Avert, 2 Oct. 2015. Web. 5 Aug. 2016.

<https://www.avert.org/global-hiv-and-aids-statistics>. "In Hindsight: The Security Council and Health Crises : October 2014 Monthly Forecast :

Security Council Report." Security Council Reports. United Nations, 30 Sept. 2014.

Retrieved July, 20, 2016, from <http://www.securitycouncilreport.org/monthly-

forecast/2014-10/in_hindsight_the_security_council_and_health_crises.php> Keenan, K. (2016). Humanitarian Response to Pandemics and Other Health Crises. General

Assembly, MUNFW 66th Session Issues Book. Retrieved July 10, 2016 from

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<http://www.securitycouncilreport.org/atf/cf/%7B65BFCF9B-6D27-4E9C-8CD3-

CF6E4FF96FF9%7D/S_RES_2177.pdf> United Nations. “Goal 6: access to water and sanitation for all.” Sustainable Development Goals.

Last modified 2015. Retrieved August 5, from

<http://www.un.org/sustainabledevelopment/water-and-sanitation/> United Nations. “Goal 3: ensure healthy lives and promote well-being for all at all ages

Sustainable Development Goals. Last modified 2015. Retrieved August 5, from

<http://www.un.org/sustainabledevelopment/health/> WHO/UNICEF. Media Centre. Lack of Sanitation for 2.4 Billion People Is Undermining Health

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16

World Health Organization. "About IHR: Ten Things You Need to Do to Implement the IHR.”

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WHO/ZIKV.

1

Julia Giffin Whittier College

MUNFW 67th Session World Health Organization

Strengthening Implementation of the Health-related Sustainable Development Goals

Introduction

On April 7, 1948 the World Health Organization’s constitution was ratified. While this

was not the first international health organization, it included more Member States than those of

the past. The World Health Organization (WHO) has worked adamantly to adapt to the ever

changing international health community and concerns. Currently the WHO is working to meet

the Sustainable Development Goals (SDGs).

Briefly summarized, the Seventeen SDGs are the following:

1. No Poverty

2. No Hunger 3. Good Health

4. Quality Education 5. Gender Equality

6. Clean Water and Sanitation 7. Renewable Energy

8. Good Jobs and Economic Growth 9. Innovation Infrastructure

10. Reduced Inequalities 11. Sustainable Cities and Communities 12. Responsible Consumption and Production

13. Climate Action 14. Life Below Water

15. Life on Land 16. Peace, Justice, and Strong Institutions

17. Partnerships for the Goals1

1 "Sustainable Development Goals (SDGs)." GlobalGiving. N.p., 2016. Web. 12 Aug. 2016.

<https://www.globalgiving.org/sdg/?rf=ggad_15&gclid=CjwKEAjw26C9BRCOrKeYgJH17kcSJACb-

HNAbKPNnhpicJx-OPK_XXX-FS4y34WGHRwKsuGqz3Ue5RoC7vrw_wcB>.

2

These seventeen goals were agreed upon by the United Nations Member States in 2015

and are intended “to help us all end extreme poverty, fight inequality & injustice, and fix climate

change.”2 Although Goal Three is the only one that addresses health by name, all of the SDGs

relate to health in some way and are important in the effort to achieve a healthy international

community.

World Health Organization Reform and Modernization

In recent years, WHO has been working to reform and modernize in an effort to better

use funding as well as to “[pursue] a higher degree of excellence, [contribute] to greater

coherence in global health and, most important of all, [achieve] better health outcomes.” WHO

has six priorities which all aim to “accelerate progress towards the new Sustainable Development

Goal for health: Ensure healthy lives and promote well-being for all at all ages.” These priorities

are “[a]dvancing universal health coverage: enabling countries to sustain or expand access to all

needed health services and financial protection, and promoting universal health coverage,”

“[a]chieving health-related development goals: addressing unfinished and future challenges

relating to maternal and child health; combating HIV, malaria, TB, and completing the

eradication of polio and a number of neglected tropical diseases,” “[a]ddressing the challenge of

noncommunicable diseases and mental health, violence and injuries and disabilities,” “[e]nsuring

that all countries can detect and respond to acute public health threats under the International

Health Regulations,” “[i]ncreasing access to quality, safe, efficacious and affordable medical

products (medicines, vaccines, diagnostics and other health technologies),” and “[a]ddressing the

social, economic and environmental determinants of health as a means to promote health

2 Ibid,.

3

outcomes and reduce health inequalities within and between countries.”3 WHO feels that in

achieving these they will improve global health as well as achieve many of the SDGs the

international community is looking to reach.

Public healthcare is constantly changing, and WHO must adapt to combat this issue. It

has been doing so through expert meetings, surveillance, activities to test preparedness, field

visits emergencies, data sharing, research, and many other methods. These methods are intended

to not only allow WHO organization to function more effectively, but also to better inform and

prepare Member States in order to improve global health.4 The constant changing of the public

health field has shown the need for more flexible structures, both physical and policy-oriented,

that can allow for better adaptation.

The World Health Organization is currently working on renovating its headquarters in

Geneva in an effort to decrease its operational budget increase its efficiency and investing in an

energy-efficient modern building The renovation will be done in two phases and is scheduled to

be completed in 2024. The renovation was estimated at 250 million Swiss francs (over 250

million US dollars).5 “The new building will be entirely financed from a [fifty]-year, interest-free

loan provided by Switzerland, the Host State for WHO’s headquarters. After completion of

construction, the loan will be repaid through WHO’s Real Estate Fund. The fund is anticipated to

retain a positive balance throughout the project. Member States will, therefore, not be called

3 "The Global Guardian of Public Health." World Health Organization. N.p., 2016. Web. 12 July 2016.

<http://www.who.int/about/structure/global-guardian-of-public-health.pdf?ua=1>. 4 "Modernizing the WHO Headquarters in Geneva." World Health Organization. N.p., 2016. Web. 12 July 2016.

<http://www.who.int/about/structure/modernizing-who-headquarters.pdf?ua=1>. 5 Ibid,.

4

upon to provide financial contributions.”6 While the renovation is primarily physical in nature, it

will help improve the organization as a whole by strengthening internal communication and

work patterns. This in turn will strengthen coordination within WHO, with country teams, and

enhance its ability to work with governments, ultimately allowing it to be more effective in

addressing the SDGs.

World Health Organization Policy-Oriented Reforms

WHO has been working on reforming its operations to better meet the needs of the

changing public health field. Public health is not a stagnant field; there are constantly new health

problems as well as advancements in medicine. “Reform has three aims: programmatic reform to

improve people’s health; governance reform to increase coherence in global health; and

managerial reform in pursuit of organizational excellence.”7 After two years of negotiations, the

WHO Framework of Engagement with Non-State Actors (FENSA) was adopted in May 2016,

providing “comprehensive policies and procedures on engaging with non-governmental

organizations, private sector entities, philanthropic foundations and academic institutions. It was

intended to strengthen “engagement with stakeholders” and encourage transparency.8

At the 69th World Health Assembly, in May 2016, steps were agreed upon to lay the

groundwork for pursuing the health-related Sustainable Development Goals (SDGs), with the

6 "Modernizing the WHO Headquarters in Geneva." World Health Organization. N.p., 2016. Web. 12 July 2016.

<http://www.who.int/about/structure/modernizing-who-headquarters.pdf?ua=1>. 7 "Sixty-ninth World Health Assembly Closes." World Health Organization. N.p., 28 May 2016. Web. 13 July 2016.

<http://www.who.int/mediacentre/news/releases/2016/wha69-28-may-2016/en/>. 8 Ibid,.

5

priority being universal healthcare with a greater focus on equity of coverage.9 WHO was

encouraged to look outside the health sector at other areas that could help develop methods to

better address issues. It was also encouraged to ensure all aspects of its programs can be funded

and to take the SDGs into consideration when developing budgets to make sure they are all

addressed effectively. WHO is also working to strengthen the ability for countries to monitor

their progress. In addition, at the conference the WHO Framework on Integrated, People-

Centered Health Services was adopted, which “calls for a fundamental shift in the way health

services are funded, managed and delivered.”10 At the conference Member States agreed that

people-centered approaches to health made more financial sense and allowed for better

healthcare, resulting in a strategy of focusing on the community that is being helped rather than

individual health issues.11

The WHO Emergency Medical Team (EMT) Initiative gives countries their own teams to

allow for quicker response time during an emergency. WHO will use EMT Coordination Cell

Training to help organize the country teams, which will allow them to gain universal training as

well as country specific training. These teams are intended to be self-sufficient and quickly

deployable, allowing for more immediate responses to emergencies than in the past. WHO is also

working on a Global Vaccine Action Plan and a Global Observatory on Health Research and

Development (R&D).12

WHO and the Health-Related SDGs

9 Ibid,. 10 Ibid,. 11 Ibid,. 12 Ibid,.

6

In September 2015 the United Nations General Assembly adopted a set of Sustainable

Development Goals (SDGs). In an effort to ensure these goals are relevant to all Member States,

the seventeen SDGs are broader than the Millennium Development Goals (MDGs) that came

before them. While some of these goals may relate more to public health than others, they all

have some sort of connection to health.13 Although progress has been made to achieve the health-

related SDGs, WHO and Member States are just getting started. Member States must work

together along with WHO to achieve these goals and help ensure equitable health for all.14

The key goal related to health is SDG Goal Three: “Ensure healthy lives and promote well-

being for all at all ages.”15 This goal has thirteen targets that aim to build on the progress

achieved by the MDGs. The main aspect of this goal that is important to WHO are non-

communicable diseases and universal healthcare. WHO has made equitable universal health care

a major focus, because it is vital for ensuring the health of the international community. While

universal healthcare is most clearly addressed in Goal Three it plays an important role in

promoting other health-related SDGs.16

One target of Goal Three (Target 3.a) that has already seen a great deal of focus from the

international community is to “strengthen the implementation of the World Health Organization

Framework Convention on Tobacco Control in all countries” (WHO FCTC).17 Although

13 "From MDGs to SDGs, WHO Launches New Report." World Health Organization. N.p., 8 December 2016. Web.

13 July 2016. <http://www.who.int/mediacentre/news/releases/2015/mdg-sdg-report/en/>. 14 "MONITORING THE HEALTH GOAL – INDICATORS OF OVERALL PROGRESS." World Health

Statistics. World Health Organization, 2016. Web. 12 July 2016. <http://www.who.int/gho/publications/world_health_statistics/2016/EN_WHS2016_Chapter3.pdf?ua=1>. 15 "From MDGs to SDGs, WHO Launches New Report." World Health Organization. N.p., 8 December 2016. Web.

13 July 2016. <http://www.who.int/mediacentre/news/releases/2015/mdg-sdg-report/en/>. 16 Ibid,. 17 "WHO IRIS: Sustainable Development Goals (SDGs) : Goal 3. Target 3.a : Strengthen the Implementation of the

World Health Organization Framework Convention on Tobacco Control in All Countries, as Appropriate

7

Member States have increasingly addressed the articles set forth in the WHO FCTC, they have

yet to be implemented by all Member States. Many of the Member States have increased

education of their citizens as to the harm of tobacco, with some even setting forth bans. In Iran

bans have been set on the advertisement and promotion of tobacco.18 But there is still much

more to be done in order to reduce tobacco use. To further address the issue of tobacco, the

Convention of the Parties (COP) has met to discuss tobacco control efforts; the seventh session

of the COP is being held 7-12 November 2016 in New Delhi, India, where states will look again

at the WHO FCTC. 19

Another target set forth by the SDGs is to lower road traffic related injuries and deaths by

fifty percent (50%) by 2020. In an effort to reach this target, the Brasilia Declaration on Road

Safety was adopted on 28 May 2016 “requesting Member States to accelerate implementation of

the outcome document of the Second Global High-Level Conference on Road Safety 2011-2020

held in November 2015.”20 Road traffic is an important issue for global health because “crashes

kill more than 1.2 million people annually and injure up to 50 million.”21 Although auto crashes

can be a threat to the health of all, some groups are more vulnerable to these crashes, such as

[poster]." WHO IRIS. World Health Organization, 2016. Web. 13 July 2016.

<http://apps.who.int/iris/handle/10665/208288>. 18 Secretariat of the National Tobacco Control Committee Islamic Republic of Iran. "A Report on Smoking

Advertising and Promotion Bans in The Islamic Republic of Iran." World Health Organization. Ministry of Health

and Medical Education Deputy of Health, n.d. Web. 07 Oct. 2016.

<http://www.who.int/tobacco/training/success_stories/en/best_practices_iran_report_ban.pdf>

19 Global Progress Report on Implementation of the WHO Framework Convention on Tobacco Control.

Auckland, N.Z.: Auckland Transport, 2012. World Health Organization. 2012. Web. 12 July 2016.

<http://apps.who.int/iris/bitstream/10665/79170/1/9789241504652_eng.pdf>. 20 "Sixty-ninth World Health Assembly Closes." World Health Organization. N.p., 28 May 2016. Web. 13 July

2016. <http://www.who.int/mediacentre/news/releases/2016/wha69-28-may-2016/en/>. 21 Ibid,.

8

“children, youth, older people and people with disabilities.”22 Member States and WHO aim to

raise awareness for this issue during the Fourth United Nations Global Road Safety Week in

May 2017. At the most recent COP there was a call for an increase in public transportation,

walking, and biking, because these methods encourage less road traffic, resulting in fewer

crashes.23

This solution would help with other health-related SDGs as well. For example, an increase in

these sorts of transportation helps decrease air pollution, which is another target of the SDGs. Air

pollution contributes to many health problems globally, with 4.3 million annual deaths from

indoor air pollution and 3.7 million annual deaths from outdoor air pollution. The issue of air

pollution cannot be fixed through prevention alone, so the delegates at the World Health

Assembly in May 2016 created a roadmap to tackle this issue, which was divided into four main

areas: knowledge, monitoring, coordination, and training.24

This increase in coordination is addressed in Goal Seventeen of the SDGs as well, which

calls for strengthening of implementation and a global partnership to help achieve sustainable

development. This cooperation is important for global health, because many health issues

originate regionally or even globally. For this reason, constant cooperation is important to share

health-related findings to help cure and stop the spread of deadly diseases.25 Health issues are not

typically common to just one place, making it beneficial to know how other countries have dealt

with issues, to allow them to work together on solutions.

22 Ibid,. 23 Ibid,. 24 "Sixty-ninth World Health Assembly Update." World Health Organization. N.p., 27 May 2016. Web. 13 July

2016. <http://www.who.int/mediacentre/news/releases/2016/wha69-27-may-2016/en/>. 25 "WHO IRIS: Sustainable Development Goals (SDGs) : Goal 17 : Strengthen the Means of Implementation and

Revitalize the Global Partnership for Sustainable Development [poster]." WHO IRIS. World Health Organization,

2016. Web. 13 July 2016. <http://apps.who.int/iris/handle/10665/208305>.

9

Another major target is maternal health. Approximately 830 women die every day from

preventable maternal health-related complications.26 Goal Three, Target 1 of the SDGs (3.1) is to

reduce maternal mortality rates to below 70 per 100,000.27 Some Member States, such as

Thailand, Belarus, Armenia, and Republic of Moldova have made progress for maternal and

infant health. Sharing their best practices and lessons learned could benefit many other Member

States.28 Currently medical interventions are available to reduce maternal mortality rates;

however, lack of access to healthcare for pregnant mothers keeps this goal from being obtained.

Mothers have a lack of access both before and during their pregnancy, leading to increased

complications. During the period of the MDGs, the approach was contraceptive services, but this

was found to be ineffective as the main approach to reducing maternal mortality. WHO is

working to help reduce maternal mortality through educating midwives and promoting

emergency obstetric care, as it believes this will be a better approach to achieve this target.29 This

target also relates to Goals One and Ten (reducing poverty and inequalities). Maternal mortality

happens more often in poorer rural areas, with ninety-nine percent of occurring in developing

countries.30 Adolescent women are at a higher risk of maternal complications and mortality.

While progress has been made to lower childhood pregnancy, this still accounts for eleven

26 "Maternal Mortality." World Health Organization. WHO, Nov. 2015. Web. 08 Aug. 2016.

<http://www.who.int/mediacentre/factsheets/fs348/en/>. 27 "Health - United Nations Sustainable Development." UN News Center. UN, 2016. Web. 13 July 2016.

<http://www.un.org/sustainabledevelopment/health/>. 28 "World Health Statistics 2016: Monitoring Health for the SDGs." World Health Organization. N.p., 2016. Web. 13 July 2016. <http://www.who.int/gho/publications/world_health_statistics/2016/en/>. 29 "10 Facts on Maternal Health." World Health Organization. WHO, Nov. 2015. Web. 08 Aug. 2016.

<http://www.who.int/features/factfiles/maternal_health/en/>. 30 "Maternal Mortality." World Health Organization. WHO, Nov. 2015. Web. 08 Aug. 2016.

<http://www.who.int/mediacentre/factsheets/fs348/en/>.

10

percent of births, with higher rates in poor rural areas, and it remains one of the major causes for

premature deaths among adolescent women.31

Breastfeeding a child is vital for their health. Globally an average of one in three babies less

than six months old is exclusively breastfed; this number has not changed in decades. “If all

children 0-23 months were breastfed, more than 800,000 children under five could be saved

every year.”32 SDG Goal Three Target 2 (3.2) aims to reduce mortality rates for children under

five to 25 in 1,000 births.33 WHO is working to increase breastfeeding to help ensure these

children gain the nutrients and antibodies they need. For example, WHO ran a campaign in Viet

Nam promoting the nutritional benefits of breastfeeding and is working to reduce the stigmas of

breastfeeding. The campaign helped increase the number of mothers in Vietnam who breastfed

their children. WHO is working to spread this improvement globally.34

Current Obstacles to Achieving the SDGs

A major issue facing WHO is the increasing pressure on global health systems due to

“longer lifespans and the growing burden of long-term chronic conditions requiring complex

interventions over many years.”35 Currently health systems have many issues, and “[u]nless they

are transformed, health systems will become increasingly fragmented, inefficient and

31 "10 Facts on Maternal Health." World Health Organization. WHO, Nov. 2015. Web. 08 Aug. 2016.

<http://www.who.int/features/factfiles/maternal_health/en/>. 32 "Viet Nam Breastfeeding Campaign Normalizes Practice, Improves Rates."World Health Organization. WHO,

Aug. 2016. Web. 08 Aug. 2016. <http://www.who.int/features/2016/Viet-Nam-breastfeeding-campaign/en/>. 33 "Health - United Nations Sustainable Development." UN News Center. UN, 2016. Web. 13 July 2016.

<http://www.un.org/sustainabledevelopment/health/>. 34 "Viet Nam Breastfeeding Campaign Normalizes Practice, Improves Rates."World Health Organization. WHO,

Aug. 2016. Web. 08 Aug. 2016. <http://www.who.int/features/2016/Viet-Nam-breastfeeding-campaign/en/>. 35 "Sixty-ninth World Health Assembly Closes." World Health Organization. N.p., 28 May 2016. Web. 13 July

2016. <http://www.who.int/mediacentre/news/releases/2016/wha69-28-may-2016/en/>.

11

unsustainable.”36 This means that changes in the public health field must be made in order to

ensure that structures can support the new challenges to come. Another issue is a “global

shortage of medicines and vaccines, especially for children.”37 Children are among the most

vulnerable groups, and due to these shortages they are unable to get healthcare that could

possibly save their lives. Such healthcare needs to be made more available. Also, some diseases

“disproportionately affect developing countries and attract little investment.”38 Diseases that are

not as present in other areas receive less funding. Countries that do not experience a certain issue

may find it unnecessary to help with funding, as they do not find it threatening to the health of

their citizens.39

There are currently gaps in Research and Development, which hinder WHO’s ability to

provide effective support for the international community. At the 69th World Health Assembly

delegates decided to accelerate the development of the WHO Global Observatory on Health

Research and Development to help fill these gaps. The completion of this observatory is

expected to greatly improve WHO support to the international community.40

Conclusion

Many steps can be taken in order to help strengthen the implementation of health-related

SDGs. Increased cooperation is important to ensure that all offices are working together to help

keep the entire international community informed about changes in healthcare. It is important to

ensure that the methods being used are sustainable in order to keep from hindering healthcare in

36 Ibid,. 37 Ibid,. 38 Ibid,. 39 Ibid,. 40 Ibid,.

12

the future. While one solution would be to work to increase funding, this tends to be

unattainable, so another solution would be to ensure that budgets are developed to fund all areas

necessary while keeping the SDGs in mind to make sure they are all being reached. Another very

important step is the completion of the WHO Global Observatory on Health Research and

Development, as this observatory will help greatly in achieving the health-related SDGs.41

Significant progress has been made towards improving global health; however, there is

still much to be done. Seven thousand fewer children die daily “than in 1990, but more than six

million children still die before their fifth birthday each year.”42 Another issue that is still very

present is the inequality in areas hit by these health issues; four out of five child deaths before

age five take place in sub-Saharan Africa and Southern Asia. While maternal deaths have

dropped by fifty percent (50%) since 1990, this has also been disproportionate, with developing

countries seeing a higher rate of maternal mortality. Although there has been a decrease in teen

pregnancy since 1990, this trend has greatly slowed. These issues and many more remain. WHO

and Member States must work together to target the many health problems seen globally in order

to achieve the health-related SDGs.43

41 Ibid,. 42 "Health - United Nations Sustainable Development." UN News Center. UN, 2016. Web. 13 July 2016.

<http://www.un.org/sustainabledevelopment/health/>. 43 Ibid,.

13

Questions

1. What methods does your country use to implement the Sustainable Development Goals?

2. Which health-related Sustainable Development Goals are most important to your

country?

3. What changes would your country like to see with the implementation of the health-

related Sustainable Development Goals?

4. Which health-related SDGs has your country made significant improvement towards

meeting and which still need improvement?

5. Does your country have equitable universal healthcare? If not, is it taking steps towards

this goal? If so, how can it help with equitable universal healthcare for the international

community as a whole?

6. Does your country have Emergency Medical Teams (EMTs)? If so, what suggestions can

it give other countries in order to develop their own? If not, what actions can it take in

order to create EMTs?

14

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15

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16

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1 Scarlett Del Giudice Boyer Whittier College MUNFW 67th Session World Health Organization

The World Health Organization and the 21st century struggle for Universal Health

Coverage and Promotion of maternal, child and newborn health

Introduction

On April 7, 1948, the World Health Organization was created as a specialized agency

with a primary focus on international health and with the goal of building “a better, healthier

future for people all over the world.”1 Since its establishment, the WHO has focused on six

primary areas: health systems; non-communicable diseases; promoting health through life-

courses; communicable diseases; preparedness; surveillance and response; and corporate

services.2 In order to effectively address these areas of focus, the WHO has worked within the

United Nations’ system by providing leadership, establishing a well-structured research agenda,

instituting norms and standards and providing support.3 The WHO supports member states by

establishing a physical presence via offices and professional staff to coordinate any efforts on the

agency’s behalf. In addition, the WHO has worked intensively with bilateral and multilateral

organizations, civil society organizations, non-governmental organizations and the private sector

in order to create a path to better health outcomes all across the globe. Overall, the core function

of the WHO is “to direct and coordinate international health work by promoting collaboration,

1 "Who We Are, What We Do." World Health Organization. Accessed August 10, 2016. http://www.who.int/about/en/. 2 "Who We Are, What We Do." World Health Organization. Accessed August 10, 2016.

http://www.who.int/about/en/. 3 "Who We Are, What We Do." World Health Organization. Accessed August 10, 2016.

http://www.who.int/about/en/.

2 mobilizing partnerships and galvanizing efforts of different health actors to respond to national

and global health challenges.”4 It is the WHO’s firm belief that health is fundamental to

achieving peace, as health is a state of physical, mental and social well-being as much as it is a

basic human right.5

Throughout the agency’s existence, and especially during the 21st century, the World

Health Organization has faced numerous international health challenges, including ongoing

global occurrences such as the HIV/AIDS Crisis, malaria and tuberculosis, and health

emergencies such as swine flu, and most recently, Ebola and the Zika virus. In addition to

fighting disease, the WHO has taken the initiative to encourage advances in universal health

coverage as well as the promotion of maternal, newborn and child health, both prominent issues

that continue to have massive impacts on the international system and citizens of the world.

While there is consensus about the need to improve maternal, newborn and child health, the

international community does not have full agreement on the issue of universal health care.

Universal Health Coverage

The words of WHO Director-General, Dr. Margaret Chan, are candid and direct: “I

regard universal health coverage as the single most powerful concept that public health has to

offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way,

based on primary health.”6 Universal health coverage (UHC) was established as a key priority on

4 “Collaborations and Partnerships." World Health Organization. Accessed August 10, 2016. http://www.who.int/about/collaborations/en/. 5 "Constitution of WHO: Principles." World Health Organization. Accessed August 10, 2016.

http://www.who.int/about/mission/en/. 6 "Global Coalition Calls for Acceleration of Access to Universal Health Coverage." WHO. Accessed August 10,

2016. http://www.who.int/universal_health_coverage/en/.

3 the WHO agenda for the years 2014-2019. Universal health coverage is also assigned Target 3.8

under the Sustainable Development Goal 3, with the intention of providing protection from

financial risk, access to quality and essential medications as well as healthcare services overall.7

In a WHO report titled “Arguing for Universal Health Coverage,” UHC is defined as existing

when all people receive necessary and quality health care services without financial strain in any

aspect. The report states that everyone should have facilitated access to a wide and complete

range of health services, which include “promotion, prevention, treatment, rehabilitation and

palliative care.”8 Those who face financial hardships and obstacles tend to be prevented from

using the health care services they need, and thus face serious health consequences. Simply

stated, the importance of universal health coverage relates to the issues of life, death, equality

and equity. Director General Chan regards universal coverage to be one of the most powerful

social equalizers among all policy options, as it is the ultimate expression of fairness worldwide.9

In achieving universal health coverage, those facing death, or their families, can easily regain a

new path to life without becoming financially burdened.

The health benefits that would result from UHC are evident: those who have access to

health care services without severe financial repercussions clearly have the ability to lead longer

and healthier lives. Those who are now in low income countries and living in poverty would be

able to gain access to health care services once considered inaccessible due to financial

restrictions. It is this access that allows those without the financial means to improve themselves,

7"UNIVERSAL HEALTH COVERAGE – AT THE CENTRE OF THE HEALTH GOAL." 2015. Accessed August 10, 2016. http://www.who.int/gho/publications/world_health_statistics/2016/EN_WHS2016_Chapter4.pdf. 8 "Arguing for Universal Health Coverage." 2013. Accessed August 10, 2016.

http://www.who.int/health_financing/UHC_ENvs_BD.PDF. 9 Chan, Margaret. "Universal Health Coverage: The Post-2015 Challenge." Speech, Ministerial Meeting, Singapore,

2015. Accessed August 10, 2016. http://www.who.int/dg/speeches/2015/singapore-uhc/en/.

4 improving the overall health of the population. The economic benefits that would result from

UHC are significant. If health care services are presented as affordable, financially comfortable

options, then financial risk is diminished. Those facing health care situations could save money

for future health events. Fewer would face bankruptcy or fall under the poverty line as a result of

“out of pocket payments” (also known as OOP).10 Out of pocket payments can be defined as

payments that result from unexpected health care situations and payments that have negative

impact upon the household being affected. In addition, the implementation of reform leading to

UHC could potentially bring political benefits. David Heymann notes that UHC serves to

strengthen democratic platforms and values within any country, especially those in transition.11

For example, countries like Tunisia, a country which has recently undergone a democratic

transition, has started re-orienting its health sector to focus on primary health care objectives

while specifically focusing on vulnerable population sub groups such as women, newborns and

children, all in collaboration with other countries and WHO.12

In 2015, WHO, alongside the World Bank, published the inaugural progress report

focusing on universal health coverage facts and statistics, revealing intriguing global realities.

The report noted that in the 21st century, “400 million people lack access to one or more of seven

lifesaving health services, including childhood immunization, malaria control, HIV/AIDS

treatment and family planning.”13 A majority of these 400 million are located in poorer and

developing countries. This first-ever report noted that countries are embracing UHC, recognizing

10 Heymann, David. "Embracing the Politics of Universal Health Coverage." Chatham House. June 25, 2014.

Accessed August 10, 2016. https://www.chathamhouse.org/expert/comment/14972. 11 Heymann, David. "Embracing the Politics of Universal Health Coverage." Chatham House. June 25, 2014. Accessed August 10, 2016. https://www.chathamhouse.org/expert/comment/14972. 12 "UHC Partnership Tunisia Country Profile." UHC Partnership. Accessed August 10, 2016.

http://uhcpartnership.net/country-profile/tunisia-2/. 13 Tracking Universal Health Coverage: First Global Monitoring Report." June 2015. Accessed August 10, 2016.

http://www.who.int/healthinfo/universal_health_coverage/report/2015/en/.

5 its immense benefits for their populations, economies, private sectors and societies, with over

one-hundred low and middle income countries following paths to universal health coverage.14

Despite positive steps being taken, significant gaps in coverage still exist. The 400

million without facilitated access to the multiple health services that exist are also those who

experience catastrophic health expenditures, that are those out of pocket payments for health

services which exceed a significant fraction of total household expenditure, and thus lead to

significant financial strain and burden.15

One of the greatest challenges to implementation of universal health coverage is

financing. Without government financing, the possibility of a well-run health system and access

to medicine, technologies and other resources fade away. For the average citizen, the most

common form of financing is the out of pocket payments, which reduce family savings or money

available for normal, everyday expenditures. As expected, those in low and lower middle income

countries pay more out-of-pocket payments (OOP) than those in higher income countries,

creating a significant gap that has yet to be filled.16 It is estimated that every year, 100 million

fall into poverty as a result of these payments that account for 32% of health expenditures.17 As

the WHO “Arguing for UHC” report states, even highly developed countries like the United

14 "Education International - New Report Backs the Importance of Universal Health Coverage." Education

International. June 18, 2015. Accessed August 10, 2016. https://www.ei-ie.org/en/news/news_details/3579. 15 "Tracking Universal Health Coverage: First Global Monitoring Report." June 2015. Accessed August 10, 2016. http://www.who.int/healthinfo/universal_health_coverage/report/2015/en/. 16"Tracking Universal Health Coverage: First Global Monitoring Report." June 2015. Accessed August 10, 2016.

http://www.who.int/healthinfo/universal_health_coverage/report/2015/en/. 17 "Universal Health Coverage (UHC) - Key Facts." World Health Organization. December 2015. Accessed August

10, 2016. http://www.who.int/mediacentre/factsheets/fs395/en/.

6 States are not excluded from the effects of having to pay directly out of pocket for healthcare,

which can result in bankruptcies and many people being pushed below the poverty line.18

The First Global Monitoring Report on tracking UHC includes a simple conclusion: UHC

is a viable and very genuine reality. The issue is how to make UHC become a reality for those

countries currently without it. The first step begins with the tracking of data and monitoring of

each member state’s steps towards UHC, which the WHO has done through an established

monitoring framework. The WHO has also entered a collaborative agreement with the European

Union for the purpose of “building country capacities for the development, negotiation,

implementation, monitoring and evaluation of robust and comprehensive national health policies,

strategies and plans, to promote UHC…”19 With constant and consistent monitoring of UHC

objectives and indicators, the WHO and other organizations and agencies involved are able to

pinpoint which issues or aspects of UHC an individual country needs assistance with, such as the

effects of OOP health payments.

The second step to implementing UHC is closing the gap in health care services

provided. This is made possible by establishing a framework for prepayment and pooling of

resources for health, instead of relying on out of pocket payments overall. There are three forms

or systems of prepayment and pooling of resources for health, which remove the financial barrier

and facilitate access to healthcare services. There is the single payer system where the

government provides insurance and pays all health care expenses for all, the two tier system

where the government provides at least minimum insurance coverage for all residents with the

18 "Out-of-pocket Health Payments and Catastrophic Expenditures." World Health Organization. Accessed August

10, 2016. http://www.who.int/health_financing/catastrophic/en/. 19 "Universal Health Coverage Partnership." Universal Health Coverage Partnership. Accessed August 10, 2016.

http://uhcpartnership.net.

7 option to purchase additional coverage, and, finally, an insurance mandate where the government

strongly encourages the purchase of private or public insurance.20

In order to enhance a nation’s ability to finance these health care systems, the WHO

provides structural support for major health financing reform. This reform includes allocation of

domestic funds for higher income countries and external aid for lower income countries.

Governments, which have succeeded in financial reform have generally devoted 5% or more of

their GDP to health expenditures.21 Compulsory mechanisms such as taxes and specific

government charges (which would be directly targeted for health costs) are also suggested to

collect funds for health expenditures. In lower income countries, where OOP disparity exists,

external aid may be necessary, not only in the form of funds, but through planning and

implementation of strategies which will allow for UHC to become a reality.22 The WHO has

concluded that UHC can exist in every country around the world if the right steps are taken. The

WHO believes no one should have to face the decision between paying for health care or paying

for food or shelter. Health care is a basic human right and access to this right should not be

denied.

Promotion of maternal, child and newborn health

Women, children and newborns are considered a very vulnerable demographic. Their

lack of access to appropriate health care has led to high mortality rates or other health problems,

20 "List of Countries with Universal Healthcare." True Cost Analyzing Our Economy Government Policy and

Society through the Lens of Costbenefit. August 09, 2009. Accessed August 10, 2016. https://truecostblog.com/2009/08/09/countries-with-universal-healthcare-by-date/. 21 "Arguing for Universal Health Coverage." 2013. Accessed August 10, 2016.

http://www.who.int/health_financing/UHC_ENvs_BD.PDF. 22 "Arguing for Universal Health Coverage." 2013. Accessed August 10, 2016.

http://www.who.int/health_financing/UHC_ENvs_BD.PDF.

8 primarily infection and preventable diseases like tuberculosis or malaria.23 A report published by

the U.S. Department of State on the needs of vulnerable women and children, noted that there is

a humanitarian and strategic imperative to promote all aspects of maternal, child and newborn

health.24 The WHO agrees with this report. Thus a major priority of the WHO in the 21st century

is to improve the provision of health care services to mothers, children and newborns.

The current health issues faced by mothers, children and newborns are substantial. Any

woman who becomes pregnant is immediately subject to increased health concerns. One in every

138 live births leads to the death of a mother from a variety of preventable causes such as

hemorrhage, sepsis, infection, or other reasons related to limited or overall lack of general

obstetric care.25 In 2015, 830 women died daily from pregnancy and childbirth complications.26

These deaths primarily occur where there is a lack of resources or a lack of access to health care

services or personnel; this is especially seen in low income countries, where there a large gap

between rich and poor. Post-natal care is extremely important to avoid infection and hemorrhage;

post-natal complications that arise out of lack of health care services and resources can

potentially lead to death. Newborns are also subject to increased health risks, especially those

born in developing countries. The WHO reports that many unborn children face high possibilities

of being born prematurely or with infections. The use of medical resources, like ultrasounds,

preventative labor medicines, or trained midwives can avoid premature births and other

complications; the lack of access to these technologies and resources has led to many newborn

23 "WHO Recommendations on Health Promotion Interventions for Maternal and Newborn Health." 2015. Accessed

August 10, 2016. http://apps.who.int//iris/bitstream/10665/172427/1/9789241508742_report_eng.pdf. 24 "Addressing the Needs of Vulnerable Women and Children." U.S. Department of State. May 06, 2011. Accessed August 10, 2016. http://www.state.gov/j/prm/releases/onepagers/181034.htm. 25 "Maternal Health." World Health Organization. Accessed August 10, 2016.

http://www.who.int/maternal_child_adolescent/topics/maternal/en/. 26 "Maternal and Reproductive Health." World Health Organization. Accessed August 10, 2016.

http://www.who.int/gho/maternal_health/en/.

9 deaths during their first weeks of life.27 Children ages 5 and under are especially prone to health

problems, in particular respiratory illnesses, diarrhea and malnutrition. In 2015, approximately 6

million children aged 5 and under died as a result of preventable and treatable health

occurrences.28

One of the primary forms of intervention recommended by WHO begins with prenatal

care involving consistent monitoring of pregnancy to assure the well-being of mother and child,

detection of problems before birth, medical intervention if necessary and birth planning.29

Maternal care post-birth is also important, including monitoring of labor, detection of problems

during labor, safe delivery and immediate care of a newborn child as well as the mother to

prevent infection, hemorrhaging or other life threatening emergencies. The WHO recommends

assessing the health of the mother for at least six weeks to prevent or detect any complications

and to provide information in regard to child rearing and overall planning and preparedness. In

regard to newborn care, the WHO recommends immediate and consistent immunizations,

monitoring of growth, infection protection and more.30 For the promotion of maternal and

newborn health to be considered successful and integrative, the WHO recommends

establishment of health centers, maternity wards, and outpatient clinics as well as provision of

workers with midwifery skills and the ability to administer medication.31 The WHO recommends

access to essential immunizations and a specific focus on preventing and managing diarrhea,

27 "Newborns: Reducing Mortality." World Health Organization. January 2016. Accessed August 10, 2016.

http://www.who.int/mediacentre/factsheets/fs333/en/. 28"Child Health." Accessed August 10, 2016. http://www.who.int/gho/child_health/en/. 29 "WHO Recommended Interventions for Improving Maternal and Newborn Health." 2009. Accessed August 10, 2016. http://apps.who.int/iris/bitstream/10665/69509/1/WHO_MPS_07.05_eng.pdf?ua=1&ua=1. 30 "WHO Recommended Interventions for Improving Maternal and Newborn Health." 2009. Accessed August 10,

2016. http://apps.who.int/iris/bitstream/10665/69509/1/WHO_MPS_07.05_eng.pdf?ua=1&ua=1. 31"WHO Recommended Interventions for Improving Maternal and Newborn Health." 2009. Accessed August 10,

2016. http://apps.who.int/iris/bitstream/10665/69509/1/WHO_MPS_07.05_eng.pdf?ua=1&ua=1.

10 malaria and pneumonia as well as the provision of general nutritional education to prevent

malnutrition.32

The process of enabling people to increase control over their health begins with increased

training of health professionals, external funding and aid to provide vaccinations and

medications, creation of medical facilities and infrastructure and even the implementation of

universal health care coverage options within nations that have high mortality rates of mothers,

infants and children. Promotion of health care for these specific populations can also occur

through intense social interventions in the form of distribution of printed materials, public

meetings, and the use of mass media and other communication methods to increase awareness of

ongoing health issues faced by mothers, children and newborns.33 For example, the WHO noted

the effectiveness of participatory learning and community mobilization of women in countries

like Nepal and Malawi. As a result, women in Nepal and Malawi had decreased mortality rates

overall, and the women felt empowered to share concerns and gain a greater understanding of

health issues, health resources and more.34 One example of a successful international effort was

the Ottawa Charter for Health Promotion, an agreement adopted in 1986 that made a full

commitment to health promotion worldwide via a framework that placed public health policy on

the agenda of policy-makers. It also calls for creating supportive environments that are safe and

enjoyable, strengthening community empowerment, promoting learning opportunities and

resources and reorienting health services to ensure that all who need them can access them

32 "Child Health - Africa." Accessed August 10, 2016.

http://www.afro.who.int/index.php?option=com_content&view=article&id=1543&Itemid=2300. 33 "WHO Recommendations on Health Promotion Interventions for Maternal and Newborn Health." 2015. Accessed

August 10, 2016. http://apps.who.int//iris/bitstream/10665/172427/1/9789241508742_report_eng.pdf. 34 "WHO Recommendation on Community Mobilization through Facilitated Participatory Learning and Action

Cycles with Women’s Groups for Maternal and Newborn Health." February/March, 2014. Accessed August 10,

2016. http://apps.who.int/iris/bitstream/10665/127939/1/9789241507271_eng.pdf?ua=1.

11 easily.35 The promotion of maternal, child and newborn health has affected the demographics of

some of the world’s most vulnerable populations. Since 1990, maternal deaths have decreased by

43%, and children’s deaths have decreased by almost 50%. However, despite significant

progress, there are still major improvements that can occur with regard to interventions and

implementations of WHO proposals. This will require cooperation among member states and

collaboration with civil society and the World Health Organization.

Conclusion

The 21st century has seen its fair share of conflict and crises. Access to health care services

remains a crisis of its own in many countries. One of the major steps countries have taken to

make universal health care a reality, especially in lesser developed countries, has been through

the collaborative agreement of the European Union and the WHO to promote policy dialogue,

strategies and plans in twenty countries, primarily those in Africa.36 Many countries, especially

highly developed ones, have established specific agendas and have gained momentum in

achieving health reform. By joining and participating in coalitions and partnerships, countries are

not only aiding the promotion of health care but are creating a powerful unity, which will allow

for significant health care reform to occur. In 2014, a coalition of 500 leading health and

development organizations worldwide joined forces to urge governments to push forward health

35 " Working with Individuals, Families and Communities to Improve Maternal and Newborn Health." 2010. Accessed August 10, 2016. "WHO Recommendations on Health Promotion Interventions for Maternal and Newborn

Health." 2015. Accessed August 10, 2016.

http://apps.who.int//iris/bitstream/10665/172427/1/9789241508742_report_eng.pdf. 36 "Universal Health Coverage Partnership." Universal Health Coverage Partnership. Accessed August 10, 2016.

http://uhcpartnership.net.

12 care reform and increase access to services.37 Health statistics show that through partnership and

collaboration, there has already been a significant increase in promotion and steps towards

reform. The WHO notes that there has been new prominence given to health systems on the

agendas of donors, and that many member states have responded to increased demands from

their populations, thus leading to gradual, yet intense, political reform in many states, especially

those in developing regions.38

The World Health Organization recognizes that now is the time to make extensive

advances in universal health coverage and the promotion of maternal, child and newborn health.

It is the intensified focus on these two intersectional and interconnected matters that will

eventually lead to equity and equality for citizens of the world. Through well-researched

recommendations, intense monitoring and innovative societal frameworks and interventions

along with the collaboration and cooperation of member states, international organizations and

agencies, universal health coverage can exist within every country and the promotion of

maternal, child and newborn health can lead to positively changed lives.

37 "500 Organizations Launch Global Coalition to Accelerate Access to Universal Health Coverage." December 12,

2014. Accessed August 10, 2016. http://www.who.int/universal_health_coverage/universal-health-coverage-access-

pr-20141212.pdf?ua=1. 38 "Health System Strengthening - Current Trends and Challenges." April 7, 2011. Accessed August 10, 2016.

http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_13-en.pdf?ua=1.

13

Questions

1. What has your country been doing to advance universal health coverage and the

promotion of women’s, children’s, and newborn health within their borders?

2. If your country currently has UHC, what allowed for successful implementation? If your

country doesn’t, what obstacles have been faced in the process?

3. What has your country done specifically in regards to the promotion of maternal,

newborn and child health? Does your country prioritize the health of women and

children?

4. If your country is a donor country, who has benefitted from its donorship and in what

form? If your country receives aid in regard to UHC and other health related concerns,

what progress has been made?

5. In what ways has your country directly been affected by a presence or lack of (access to)

health care services and other resources? What are the positive/negative political,

economic and social impacts?

6. What does your country believe is necessary to achieving successful UHC

implementation as well as successful promotion of maternal, child and newborn health?

7. Is your country a member of any coalition or partnership connected to promotion of

health, universal coverage and general health reform? Have they played any specific role

within any international organization in regard to health care overall?

8. What more can/should the United Nations system, and, in particular, the World Health

Organization do to address these issues?

14

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