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World Health Organization

BACKGROUND GUIDE

Vancouver Model United Nations The Twentieth Annual Session | January 29–31, 2021

Dear Delegates, My name is Alishba Irfan and I am immensely delighted to be serving as your Director for the World Health Organization (WHO). On the behalf of the dais team, composed of your exceptional Chair, Kevin Roe, and magnificent Assistant Directors, Brandon Chan and Lauren Thomas, I would like to extend to you a warm welcome to VMUN 2021. As an eager high school student, I participated in several opportunities and activities. Initially, I had always been quite skeptical of MUN; political entanglement and international relations never fascinated me. Three years later and I will be the first to admit that there is nothing quite as enthralling as Model United Nations. But why is this significant? I would say that we share a similar passion for delving into global affairs, building diplomacy, and meeting like-minded individuals. Ultimately, what you accomplish today by deliberating pressing topics will enable you with a plethora of skills and a reservoir of knowledge to pave the path to your future. This weekend, the committee will discuss two issues of utmost concern: Inaccessibility of Medicine and Childhood Obesity. Though challenging and multifaceted, I have no doubt that the deliberations of these topics will be thorough and will breed comprehensive resolutions. I invite you all, whether you are a beginner or an experienced delegate, to exit your comfort zone and partake in discussing these pressing issues. Take a risk—raise your placard for the first time or offer a venturesome perspective. Should you have any inquiries, do not hesitate to contact the dais team at [email protected]. I look forward to greeting you all at VMUN this coming January! Sincerely, Alishba Irfan WHO Director

William Tsai Secretary-General

Vivian Gu Director-General

Derek Wu

Chief of Staff

Tyler Rosenzweig Director of Logistics

Joyce Chen USG General Assemblies

Ethan Jasny

USG Specialized Agencies

Vivian Liang USG Conference

Jonah Ezekiel USG Finance

Laura Choi

USG Communications

Armaan Jaffer USG Delegate Affairs

Mia Tsao

USG Delegate Affairs

Position Paper Policy

What is a Position Paper?

A position paper is a brief overview of a country’s stance on the topics being discussed by a particular committee. Though there is no specific format the position paper must follow, it should include a description of your positions your country holds on the issues on the agenda, relevant actions that your country has taken, and potential solutions that your country would support.

At Vancouver Model United Nations, delegates should write a position paper for each of the committee’s topics. Each position paper should not exceed one page, and should all be combined into a single document per delegate.

For the World Health Organization, position papers are not mandatory but highly recommended, especially for a delegate to be considered for an award.

Formatting

Position papers should:

— Include the name of the delegate, his/her country, and the committee

— Be in a standard font (e.g. Times New Roman) with a 12-point font size and 1-inch document margins

— Not include illustrations, diagrams, decorations, national symbols, watermarks, or page borders

— Include citations and a bibliography, in any format, giving due credit to the sources used in research (not included in the 1-page limit)

Due Dates and Submission Procedure

Position papers for this committee must be submitted by midnight on January 22nd, 2021. Once your position paper is complete, please save the file as your last name, your first name and send it as an attachment in an email, to your committee’s email address, with the subject heading as your last name, your first name — Position Paper. Please do not add any other attachments to the email or write anything else in the body.

Both your position papers should be combined into a single PDF or Word document file; position papers submitted in another format will not be accepted.

Each position paper will be manually reviewed and considered for the Best Position Paper award.

The email address for this committee is [email protected].

Vancouver Model United Nations 2021 1

Inaccessibility of Medicine .......................................................................................................... 3

Overview .................................................................................................................................................. 3

Timeline ................................................................................................................................................... 4

Historical Analysis ................................................................................................................................. 5

Case Study: Syria ................................................................................................................................................7

Case Study: Brazil ..............................................................................................................................................8

Case Study: Uganda ...........................................................................................................................................8

Past UN/International Involvement .................................................................................................... 8

World Health Assembly (WHA) Resolution 54.11 .......................................................................................8

WHO Global Surveillance and Monitoring System for Substandard and Falsified Medicines ..............9

WHO Prequalification Programme ................................................................................................................9

Global Antibiotic Research and Development Partnership .........................................................................9

Current Situation ................................................................................................................................. 10

Lack of Public Sector Investment ................................................................................................................. 10

Poor Procurement Practices .......................................................................................................................... 10

Substandard Management ............................................................................................................................. 11

Medicine Suitability ........................................................................................................................................ 11

Unregulated Supply Chains ........................................................................................................................... 12

National and International Drug Policies ................................................................................................... 12

Financial Drain ............................................................................................................................................... 12

Counterfeit Drugs ........................................................................................................................................... 13

Possible Solutions and Controversies ................................................................................................ 13

Increasing Public-Private Partnerships ....................................................................................................... 13

Training and Education ................................................................................................................................. 14

Public Sector Investment ............................................................................................................................... 14

Data Collection ............................................................................................................................................... 15

Bloc Positions........................................................................................................................................ 15

Developed Nations ......................................................................................................................................... 15


Nations with Rising Healthcare Systems ..................................................................................................... 17

Developing Nations ........................................................................................................................................ 17

Discussion Questions ........................................................................................................................... 17

Additional Resources ........................................................................................................................... 18

Bibliography .......................................................................................................................................... 19

Childhood Obesity ..................................................................................................................... 24

Overview ................................................................................................................................................ 24

Timeline ................................................................................................................................................. 25

Historical Analysis ............................................................................................................................... 26

Past UN/International Involvement .................................................................................................. 29

Global School Health Initiative ..................................................................................................................... 29

World Health Assembly Resolution 57.17 .................................................................................................. 29

Commission on Ending Childhood Obesity ............................................................................................... 29

World Health Assembly Resolution 65.6 .................................................................................................... 30

Current Situation ................................................................................................................................. 30

Causes of Childhood Obesity ........................................................................................................................ 30

Impacts of Childhood Obesity ...................................................................................................................... 32

Possible Solutions and Controversies ................................................................................................ 33

Integrations into School Systems .................................................................................................................. 33

National Actions ............................................................................................................................................. 34

Restricting Access to Unhealthy Foods ....................................................................................................... 35

Bloc Positions........................................................................................................................................ 35

Developed Nations ......................................................................................................................................... 35

Developing Nations ........................................................................................................................................ 36

Discussion Questions ........................................................................................................................... 38

Additional Resources ........................................................................................................................... 38

Bibliography .......................................................................................................................................... 39


Inaccessibility of Medicine

Overview

The World Health Organization deems access to secure and attainable medicine crucial to ensuring the highest possible health standard.1 However, approximately 2 billion people in the status quo are deprived of essential medicines—ranging from standard cough syrups to integral painkillers. 2 Due to Western control over the pharmaceutical industry and a lack of generic drug producers, the cost of modern medicine poses extreme financial challenges on an individual and national scale. Developing nations are excluded from advancements in modern science, while impoverished and middle-class citizens in the developed world are rapidly losing eligibility for medical insurance programs.3 As a result, deaths by curable illnesses and treatable conditions have increased exponentially. In conjunction with deteriorating public health circumstances, citizens are also often required to pay extraordinary prices for life-sustaining pharmaceuticals. Without access to basic medicines, diseases will continue to endanger the lives of civilians globally.4

The inaccessibility of medicine is perpetuated by the lack of availability and affordability of medications, supply chain regulations, and national drug policies. Poor procurement practices, entailing the obtaining of medicine, among federal governments catalyze frequent stock-outs in local and rural pharmacies. Furthermore, a lack of local manufacturers and an overwhelming majority of medicine being imported with high costs and exchange rates engender medicine that is neither affordable to the average civilian nor suited to the needs of impoverished regions.5 Consequently, hospital staff in states across the globe are left with no alternative but to prescribe painkillers as a universal medicine; such painkillers are ineffective when combating specific illnesses, including rashes and cold symptoms. The inaccessibility of medicine further stimulates the creation of counterfeit drugs that hold no probative medical value and may contain dangerous toxins.6

Many civilians around the globe are thus left with two choices: leaving an illness or infection untreated or paying a hefty price for treatment. By choosing to treat themselves, families, especially in developing nations, are required to sell a family asset, such as cattle or a home, the absence of which perpetuates an intergenerational poverty cycle.7 Those who are wholly unable to afford treatment are left in misery, with no escape from the

1 “Human Rights and Healthcare,” World Health Organization. December 29, 2017, https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health 2 Ibid. 3 “Access to Medicines: Making Market Forces Serve the Poor,” World Health Organization, May 22, 2017, https://www.who.int/publications/10-year-review/medicines/en/. 4 Tefo Pheage, “Dying from Lack of Medicines | Africa Renewal,” Africa Renewal, United Nations, March 2017, https://www.un.org/africarenewal/magazine/december-2016-march-2017/dying-lack-medicines. 5 “A Complex and Vexing Problem," Access to medicines: making market forces serve the poor, World Health Organization, May 22, 2017, https://www.who.int/publications/10-year-review/medicines/en/index1.html. 6 “Keeping Substandard and Falsified Products out of the Supply Chain,” Access to medicines: making market forces serve the poor, World Health Organization, May 22, 2017, https://www.who.int/publications/10-year-review/medicines/en/index2.html. 7 Ibid.

https://www.who.int/news-room/fact-sheets/detail/human-rights-and-healthhttps://www.who.int/news-room/fact-sheets/detail/human-rights-and-healthhttps://www.who.int/publications/10-year-review/medicines/en/


symptoms of a common cold or the excruciating pain of childbirth—all conditions that can be easily ameliorated, should the benefits of modern science be readily available to all.8

Timeline

1977 — WHO publishes its first list of Essential Medicines. This list, containing 208 medicines, is created as a model for all nations to integrate into national healthcare systems and serves as a massive breakthrough in universal medicine.9

1978 — The Declaration of Alma Ata, healthcare is declared a human right and an international effort is made to reinforce primary health support in all regions.10

2002 — India generates USD 9 billion from medicine revenue. 60 percent of these medicines, which were produced in bulk, are exported to Russia and the United States.11

2003 — Médecins Sans Frontières (MSF), WHO, and five other pharmaceutical organizations co-form the Drugs for Neglected Diseases Initiative (DNDI). This non-profit initiative would research, develop, and distribute medications for fatal illnesses in developing nations, including hepatitis C and visceral leishmaniasis.12

2007 — The "Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes" framework is published by WHO and establishes a six-pronged approach to international involvement in global healthcare. One of these pillars is the “equitable access to essential medicine products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their medical scientifically sound and cost-effective use.”13

2011 — 200 people in Pakistan die from consuming falsified and contaminated medication for heart disease.14

2013 — A vaccination made for Japanese encephalitis in China is prequalified by WHO. This vaccine is simple to administer, efficacious after a single dose, safe for infants, and inexpensive in comparison to traditional vaccine market prices.15

8 Ibid. 9 Dipika Bansal and Vilok K Purohit, "Accessibility and use of essential medicines in health care: Current progress and challenges in India," US National Library of Medicine, January 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3643337/. 10 Laura Garabedian, Dennis Ross-Degnan, Maryam Bigdeli, Richard Laing, and Anita K Wagner, “Medicines in Health Systems: Advancing Access, Affordability and Appropriate Use,” World Health Organization, 2014, https://www.who.int/alliance-hpsr/resources/FR_Ch2_Annex.pdf?ua=1. 11 “Pharmaceutical Industry in India,” Wikipedia, Wikimedia Foundation, August 4, 2020, https://en.wikipedia.org/wiki/Pharmaceutical_industry_in_India. 12 “Who We Are: DNDi,” Drugs for Neglected Diseases initiative (DNDi), 2020, https://dndi.org/about/who-we-are/. 13 Ibid. 14 Rae Ellen Bichell, “Fake Drugs Are A Major Global Problem, WHO Reports,” NPR, November 29, 2017, https://www.npr.org/sections/goatsandsoda/2017/11/29/567229552/bad-drugs-are-a-major-global-problem-who-reports. 15 “Building on Previous Innovations,” Access to medicines: making market forces serve the poor, World Health Organization, May 22, 2017, https://www.who.int/publications/10-year-review/medicines/en/index3.html.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3643337/


2015 — An estimated 1.6 million people in Africa have died from illnesses including malaria, tuberculosis, and HIV/AIDS. These diseases are preventable by timely access to appropriate and attainable medicines.16

2017 — The Patient Protection and Affordable Care Act (ACA), colloquially referred to as Obamacare, is repealed in the United States. The ACA provides health coverage for approximately 9.9 million low-income citizens.17

2018 — A malaria vaccination referred to as RTS,S is introduced in three African countries—Ghana, Kenya, and Malawi—to boost immunization.18

2019 — In a sample of 25 nations surveyed between 2008 and 2019, it is deduced that 28 percent of nations are unable to provide accessible medicines in health facilities. In this context, a health facility is deemed a sufficient healthcare source if that facility “[provides] an available and affordable (accessible) core set of relevant essential medicines for treatment.”19

2020 — Zipline, a company based in California, United States, begins delivering essential medications and tests for COVID-19, as well as personal protective equipment to Rwanda, Ghana, and Chile.20

Historical Analysis

The adoption of an essential medicines list (EML) by the World Health Organization in 1977 proved to be effective in providing nations with a model upon which they could base their domestic healthcare policy. Countries were strongly recommended to ensure that a supply of all 205 medicines on the list was acquired and distributed to hospitals and health facilities.21 Not only did the EML outline medicines that were integral to any functioning healthcare system, but it also provided a model for nations to advance medicine accessibility to essential pharmaceuticals. Today, over 140 countries have integrated the essential medicines list into national health systems. In October 2007, the EML also instigated the formulation of the essential medicines list for children (EMLc), which is now referenced in pediatric facilities all across the world. Although the EMLc urged 14 African nations to reconsider their approach regarding medical care for children, it is critical to note that access to child-friendly medicines is still sparse in these regions.22

A large factor in medicine accessibility is the availability of proper and appropriate medicines, which has been prevented by the U.S. Food, Drug, and Cosmetic Act of 1938. This act, preventing the exportation of medicines

16 Ibid. 17 “Obamacare: Has Trump Managed to Kill off Affordable Care Act?” BBC News, BBC, March 29, 2019, https://www.bbc.com/news/world-us-canada-24370967. 18 “Malaria vaccine implementation programme,” World Health Organization, n.d., https://www.who.int/initiatives/malaria-vaccine-implementation-programme. 19 “World Health Statistics 2020,” World Health Organization, 2020, https://apps.who.int/iris/bitstream/handle/10665/332070/9789240005105-eng.pdf. 20 Harry Kretchmer, “Medical Delivery Drones Are Helping Fight COVID-19 in Africa, and Soon the US,” World Economic Forum, May 8, 2020, https://www.weforum.org/agenda/2020/05/medical-delivery-drones-coronavirus-africa-us/. 21 Bansal and Purohit, "Accessibility and use of essential medicines in health care: Current progress and challenges in India." 22 Kalle Hoppu and Shalini Sri Ranganathan, “Essential Medicines for Children,” Archives of Disease in Childhood. BMJ Publishing Group Ltd, February 1, 2015, https://adc.bmj.com/content/100/Suppl_1/S38.


outlawed in the United States, has been easily circumvented.23 Through the use of foreign subsidiaries, U.S.-based pharmaceutical firms utilize markets of developing nations to retail prohibited medicines, as these nations lack regulations, drug policies, and policing of imports. During the 1970s, when the list of outlawed medicines increased, investments by pharmaceutical companies in foreign countries rose at this time as well. Noticeably, international medicine trafficking expanded dramatically during these years. Today, the drugs funnelled into the markets of developing countries by Western pharmaceutical firms—such as strong birth control pills or high doses of antibiotics—are then purchased by consumers oblivious to the legitimacy of these substances.

After medicines have been imported to recipient nations and entered the market, it is imperative that nations document and regulate them. However, as found in a Ford Foundation study conducted in 1976, registering a drug before marketing it was not a requirement in 36 countries, while 64 other nations, including Brazil, only required that the drug be licensed in the exported nation—meaning that pharmaceuticals banned in various countries can simply be channelled into these nations that lack drug regulation. The lack of drug regulation simplifies the flooding of markets with unsubstantiated medicines, which, in turn, results in civilians purchasing counterfeit drugs.24

Counterfeit drugs often flood the markets of developing nations with ineffective medicines. Civilian groups and deceptive firms profit from medicine scarcity by creating false drugs with minimal-to-no medicinal value. Noticeably, counterfeit medicines have plagued the road to medicine accessibility for all civilians. In 2011, 200 Pakistani citizens lost their lives due to falsified heart medicines, while in both 2014 and 2015, more than a thousand people in the Democratic Republic of the Congo were hospitalized after consuming a counterfeit drug for schizophrenia. In Nigeria, for example, 64 percent of antimalarial medicine was falsified.25 The World Health Organization estimated that 1 in 10 medicines in Africa are falsified and considered counterfeit drugs.26 In 2011 alone, the counterfeit drugs industry grew by 13 percent and generated USD 75 billion in revenue.27

Around the early 2010s, the need for medicine was incredibly dire. A multitude of military conflicts, including the Central African Republic Civil War and worsening economic or political conditions in Venezuela and Greece, left civilians without medicine. In nations subjected to warfare, such as Nigeria and Sudan, a lack of clinics prevented access to pharmaceuticals for civilians. Attacks on hospitals in Syria or pharmacies in South Africa resulted in low supplies of medicine and a lack of infrastructure for healthcare.28

By the end of the 20th century, the world had taken more action to combat medicine inaccessibility in developing nations. Programs including Medicines for Malaria (MMV), Gavi, the Drugs for Neglected Diseases Initiative (DNDI), and the Clinton Health Access Initiative (CHAI) were operationalized with a specific focus on

23 Ibid. 24 Ibid. 25 “Counterfeit Medications,” Wikipedia, Wikimedia Foundation, July 29, 2020, https://en.wikipedia.org/wiki/Counterfeit_medications. 26 In 10 Medical Products in Developing Countries Is Substandard or Falsified,” World Health Organization, November 28, 2017, https://www.who.int/news-room/detail/28-11-2017-1-in-10-medical-products-in-developing-countries-is-substandard-or-falsified. 27 “The War Against Counterfeit Drugs,” Pharmaceutical Technology, March 30, 2011, https://www.pharmaceutical-technology.com/features/feature114721/. 28 Ibid.


ameliorating healthcare systems and researching or developing vaccinations. These initiatives, composed of private-public foundation partnerships, have proven to be efficient. 29 For example, the Meningitis Vaccine Project, a collaboration between WHO and PATH, a global health non-profit organization with considerable funding from the Bill and Melinda Gates Foundation, created a vaccine for meningitis in 2010. With the help of researchers and scientists from Africa, the vaccine was tailored to suit regional needs and pricing, costing one-tenth of the average global price of a novel vaccine. Since the project’s inception, an estimated 230 million civilians in 12 countries within Africa’s meningitis belt—stretching from Ethiopia to Senegal—have been vaccinated.30

Another example of a public-private partnership includes the Global Antibiotic and Development Partnership inaugurated in 2016. This project was a collaboration between the WHO, DNDI, and the governments of South Africa, the Netherlands, the U.K., and Germany, who have pledged USD 5.3 million for the initiative’s funding. The project has begun to research and develop antibiotics in disease-stricken regions. Conclusively, public health efforts, funded by private foundations, to increase medicine accessibility have historically proven to be efficient.31

Case Study: Syria

Prior to the Syrian Civil War, over 90 percent of medicines in Syria were produced locally. Given that a significant portion of the nation has been a war zone since March 2011, Syria has faced countless infrastructural and economic barriers to producing medicine, resulting in a 90 percent drop in general medicines available throughout the nation.32 Today, Syria lacks the personnel, infrastructure, and facilities to distribute medicine, especially in fatal circumstances. One-quarter of a million civilians, including 948 healthcare workers, have died during the military conflict within the past nine years. Furthermore, 566 attacks have been documented on 348 healthcare facilities.33 Only five years into the conflict did the Syrian government approve a medicine shipment to a hospital in Aleppo, meaning that civilians who have been injured as collateral damage in the war effort or who are sick are largely unable to access necessary medicines.34 The lack of facilities pose various difficulties in administering medicines to citizens. Although initiatives have been launched by NGOs in Syria, including the humanitarian efforts of MSF to establish medicine distribution and healthcare camps, several non-government organizations are forced to exit the region due to safety precautions and the ongoing conflict.35

29 Hilde Stevens and Isabelle Huys, “Innovative Approaches to Increase Access to Medicines in Developing Countries,” Frontiers in medicine, US National Library of Medicine, December 7, 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725781/. 30 Ibid 31 “Partnerships: Another Route to New Products,” Access to medicines: making market forces serve the poor, World Health Organization, May 22, 2017, https://www.who.int/publications/10-year-review/medicines/en/index4.html. 32 “Shortages in Life-Saving Medicines in Syria of Major Concern to WHO,” World Health Organization, March 8, 2013, http://www.emro.who.int/media/news/shortages-in-life-saving-medicines-syria.html. 33 Evan Hill and Christiaan Triebert, “12 Hours. 4 Syrian Hospitals Bombed. One Culprit: Russia,” The New York Times, October 13, 2019, https://www.nytimes.com/2019/10/13/world/middleeast/russia-bombing-syrian-hospitals.html. 34 Ibid 35 “How We're Helping Syria,” Doctors Without Borders - USA, n.d., https://www.doctorswithoutborders.org/what-we-do/countries/syria.


Case Study: Brazil

Health issues—such as malaria, yellow fever, and the Zika virus—pose prominent threats to civilians in Brazil.36 Despite the prevalence of several acute diseases, Brazil is one of the leading South American countries in healthcare and medicine access. Healthcare and timely access to medicine was declared a constitutional right in 1988. Since then, the Brazilian healthcare system has covered a significant portion of the cost of medicine through insurance programs and extended services to the poor. For example, treatments for HIV and medicines for critical illnesses do not bear a cost. Continuing the partnership with UNAIDS, the Brazilian health ministry is aiming to fully fund HIV treatments for all civilians by 2030. Currently, more than 70 percent of people are able to access medicine in a timely manner.37

Case Study: Uganda

In several developing nations, a massive disparity exists between the quality of medicines in public and private healthcare systems. Uganda is no different. Uganda has three tiers of healthcare facilities: private-for-profit, general hospitals, and lower-level facilities which are closest to civilians. Private-for-profit facilities contained four times as many medicines for non-communal diseases than lower-level facilities. Furthermore, in the public sector, a study conducted by WHO discovered that 40 percent of communal pharmacies did not stock medicines for chronic pains.38 As such, medicine in lower-level facilities in Uganda are vastly unavailable. Another aspect to note is that Ugandan citizens who choose to purchase medicine are often required to pay up to 30 times more for medicine than its actual manufacturing cost. While generic medicines comprise around 85 percent of the medicine market in developed nations, private manufacturers comprise most of the medicine industry in Uganda and drive-up drug prices.39 An average Ugandan citizen would need to invest 36 days of wages to purchase one month of ulcer medicines and treatment from a private pharmacy but only three days to purchase the lowest priced generic medicines, which are typically unavailable in the public sector.40

Past UN/International Involvement

World Health Assembly (WHA) Resolution 54.11

Adopted in 2001, WHA Resolution 54.11 calls for the development of "systems for voluntary monitoring [of] drug prices and reporting global drug prices.” In order to meet this goal, a standardized surveying technique to measure medicine availability, affordability prices, and price components was created. Since its inception, the

36 “Brazil - Chapter 10 - 2020 Yellow Book,” Centers for Disease Control and Prevention, June 24, 2019, https://wwwnc.cdc.gov/travel/yellowbook/2020/popular-itineraries/brazil. 37 Ibid. 38 Jeremy Schwartz and Mari Armstrong-Hough, “40% Of Uganda's Health Centres Don't Stock Drugs to Treat Chronic Diseases,” The Conversation, April 2, 2020, https://theconversation.com/40-of-ugandas-health-centres-dont-stock-drugs-to-treat-chronic-diseases-91631. 39 “Low-Income African Countries 'Pay 30 Times More' for Drugs,” BBC, June 18, 2019, https://www.bbc.com/news/world-africa-48674909. 40 “MEDICINE PRICES IN UGANDA,” World Health Organization, HAI, n.d., https://www.who.int/medicines/areas/technical_cooperation/MedicinePricesUganda.pdf?ua=1.


survey has been considered a verifiable mechanism of collecting reliable and transparent data on medicine accessibility and has been used in over 50 countries. The data has been utilized to aid sovereign governments in implementing efficient medicine policies and managing pharmaceutical prices.41

WHO Global Surveillance and Monitoring System for Substandard and Falsified Medicines

The WHO Global Surveillance and Monitoring System was introduced in West Africa in July 2013. The goal of this system was to track counterfeit and substandard medication that could potentially halt medicine access. The system has been rather successful, training over 400 personnel from 126 nations to use the program to report falsified products in the pharmaceutical market. Within 24 hours, WHO responds to the report, providing resources and support to counter the issue. When warranted, a global Medical Product Alert alerts sovereign governments about the dangerous medical product in question; in the past, these have included falsified yellow fever, hepatitis, and meningitis vaccines. This program has deterred health ministries from purchasing falsified medicines, helped identify illegitimate supplies, and reduced the presence of counterfeit drugs. As a result, access to legitimate medicines via the use of research within procurement methods has increased.42

WHO Prequalification Programme

Introduced in 2001, the WHO Prequalification Programme was designed to assess and aid medical production by ensuring that all parties complied with adequate manufacturing practices. For example, before February 2017, inexpensive treatments for malaria, tuberculosis, and HIV were being produced in large quantities in India by generic manufacturers. However, these producers lacked market authorization. By deploying a team of scientists and experts, the products were tested for quality by and obtained approval from WHO, which increased the production of inexpensive vaccines and antibiotics in India. Today, the program has helped 18 million people with HIV across the world access antiviral medications. Furthermore, the program fosters capacity-building by conducting in-country training programs and strengthening regulatory authorities in developing nations.43

Global Antibiotic Research and Development Partnership

This Global Antibiotic Research and Development Partnership was initiated in 2016 to research, produce, and deliver antibiotic treatments with fixed sustainable prices. The partnership responds to the WHO Global Action Plan on Antimicrobacterial Resistance to develop accessible and cost-efficient antibiotics. With pledges of USD 5.33 million from the non-government organization MSF and the governments of South Africa, Switzerland, the United Kingdom, the Netherlands, and Germany, the initiative is another example that highlights the success of public and private foundation partnerships. The partnership is launching several priority projects to develop accessible antibiotics for neonatal sepsis and gonorrhoea using data—such as clinical trials and test results—from pharmaceutical companies that have abandoned production of such medicines. Using this data, the

41 “WHO/Health Action International Project on Medicine Prices and Availability,” World Health Organization, September 30, 2016, https://www.who.int/medicines/areas/access/Medicine_Prices_and_Availability/en/. 42 “Keeping Substandard and Falsified Products out of the Supply Chain,” Access to medicines: making market forces serve the poor, World Health Organization, May 22, 2017, https://www.who.int/publications/10-year-review/medicines/en/index2.html. 43 World Health Organization, “Building on Previous Innovations.”


coalition also aims to recover urgently needed replacement products for other expensive antibiotics, including Lassa fever, Nipah virus disease, and Middle East respiratory syndrome (MERS).44

Current Situation

Inaccessibility of medicine is fueled by two factors: unavailability and unaffordability. With regards to unaffordability, governments are unable to efficiently and appropriately procure cost-effective medicine for the public sector. On an individual level, civilians are unable to afford medicines due to high costs from inefficient government procurement or a lack of medical insurance programs. Unavailability of medicine on a national scale means that the medicine imported is unsuited to meet regional needs or prices. For example, as medicines imported to tropical regions require a higher degree of management and temperature control, pharmaceuticals that do not require refrigeration are necessary, yet unavailable. As a result, civilians may resort to traditional healing methods, cheaper counterfeit drugs, or simply leaving the disease untreated.

Lack of Public Sector Investment

As a result of medicine scarcity and healthcare disparity in the public sector, the healthcare industry has shifted toward becoming privately operated. For instance, the healthcare industry in India is 87 percent privately operated.45 Pharmacies and hospitals in the private sector are able to export expensive medicines, which are then purchased by the region’s more financially stable consumers. As a result of procurement failures, a lack of health infrastructure, and convoluted supply chains, national governments are disincentivized to continue investing into public health and typically lack the resources to do so.46 Due to a lack of government funding for the public sector, medicines in state pharmacies and hospitals are typically unavailable. As a result, the nation’s poorer and middle-class individuals are unable to access appropriate medicines for diseases. In Africa, for example, nurses resort to administering ibuprofen as a universal drug for all symptoms.47 In nations that have fully functioning and universal healthcare systems—such as the United Kingdom or Canada—a lack of public sector investment into medicine is still prevalent. Subsequently, low-income civilians are continuously losing eligibility to medical insurance programs and medicine bursaries that cover a large portion of medicine costs.48

Poor Procurement Practices

A lack of a procurement system has fuelled medicine scarcity in developing nations. Procurement in this context refers to the act of obtaining proper medicines from the correct suppliers in sufficient quantities. 49 Poor procurement stems from inefficient data collection—a process that includes taking inventory of drugs, assessing

44 World Health Organization, “Partnerships: Another Route to New Products." 45 Ibid. 46 Cameron, A, M Ewen, D Ross-Degnan, D Ball, and R Laing. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. U.S. National Library of Medicine, January 19, 2009. https://pubmed.ncbi.nlm.nih.gov/19042012/. 47 Ibid. 48 Ibid. 49 Blood-Rojas, Chris. “The 7 Steps of a Strategic Procurement Process.” Trade Ready, May 13, 2020. http://www.tradeready.ca/2017/fittskills-refresher/7-steps-of-a-strategic-procurement-process/.


needs and costs, and understanding external factors that may prohibit efficient collection and distribution. Without assessing the need for medicine, incorrect doses and amounts are more likely to be purchased.50

Currently, national governments procure far too little medicine while paying high prices. Additionally, several third parties—including private donors and beneficiaries—are involved in the process. An assessment in Burundi exposed the participation of 25 financiers with 25 different agents funding medicine procurement.51 As a result, third parties tend to overcomplicate the procurement system by having unique demands following investment and disregarding regulation, such as failing to inventory medicines or screen drugs for their validity.

Substandard Management

Another salient issue that must be addressed is substandard management of medicine. Due to a lack of inventorying mechanisms at the national and local level and functioning systems to manage supply, medicine is unlikely to reach civilians at full capacity. Statistically, between 15 to 20 percent of medicine imported by some nations go unused yearly. To further contextualize this situation, about USD 19 is wasted from every USD 100 used to purchase medicine.52

A study in Cameroon conducted in 1982 revealed that 30 percent of essential medicines went “missing” from central medical stores due to poor management practices, including improper stocking and cataloguing of supply.53 In Uganda, one-third of drugs were lost to theft and corruption.54 Addressing the management of pharmaceuticals is critical to ensuring that medicines are readily available to civilians who need them.

Medicine Suitability

Medicine suitability primarily refers to medicine being fit for different nations with varying climates, budgets, and management patterns. For example, nations undergoing military conflict require medicines that can be administered efficiently through camps rather than clinics. Temperature is also a critical factor, as a 45-year supply of an antibiotic produced by Hoechst with a shelf life of two years in conventional circumstances would perish in less than six months in tropical regions.55 Costs incurred when transporting or refrigerating these drugs pose additional financial barriers to accessible medicine.

Another aspect of medicine suitability is price. Medicine bears extreme monetary repercussions to states and consumers, particularly because most medicine produced in the developing world is suited for Western prices

50 “Operational Principles for Good Pharmaceutical Procurement.” World Health Organization, 1999. https://www.paho.org/bra/index.php?option=com_docman&view=download&alias=813-operational-principles-for-good-pharmaceutical-procurement-3&category_slug=vigilancia-sanitaria-959&Itemid=965. 51 “Medicines Supply.” World Health Organization. World Health Organization, February 24, 2017. https://www.who.int/medicines/areas/access/supply/en/index3.html. 52 W.B, “The Importance of Pharmaceuticals and Essential Drug Programs,” Better Health in Africa, New Zealand Digital Library, 1994, http://www.nzdl.org/gsdlmod?e=d-00000-00---off-0fnl2.2--00-0----0-10-0---0---0direct-10---4-------0-0l--11-cs-50---20-about---00-0-1-00-0--4----0-0-11-10-1big5-10&cl=CL1.1&d=HASH0167173ea35f563351bf7a8b.9&gt=1. 53 Ibid. 54 Ibid. 55 Ibid.


and needs. 56 This means that medicines are manufactured for cooler temperatures and are relatively more expensive. On a national level, governments are also unable to purchase medicines in Western currency, as such purchases take up considerable portions of healthcare budgets. On an individual level, poverty-stricken civilians across the world are unable to access medicines due to unaffordable prices. In Colombia, for instance, mark-ups for medicines have reported to be as high as 6000 percent, blocking citizens from purchasing essential medicines. 57 A lack of generic medicine producers and medical insurance programs for civilians further exacerbates this issue.

Unregulated Supply Chains

The public sector—especially in developing nations—faces countless obstacles when obtaining essential medicines. The most secure and reliable medicines, which must be imported from developed nations, bear acute financial burdens. Therefore, to avoid monetary repercussions, a majority of medicine is purchased from third party sources, including counterfeiting groups, neighbouring nations, and the medical black market.

National and International Drug Policies

While drug policies pressure governments to evaluate the legitimacy of medicines circulating through borders and across the nation, they also often shift government budgets to enforcement of drug policies rather than medicine distribution, public sector investment, or efficient procurement.58

On the other hand, most international medicine policies are created to accommodate developed nations; thus, developing nations often struggle to meet their standards. As such, governments spend a significant portion of the budget to implement unsuitable drug policies rather than investing funds into proper procurement and regulation of medical expenses. For example, an efficient solution to increase access to medicine that is suited to the needs of developing nations is to invest in domestic production in these countries. When nations manufacture their own medicines, national governments have better control over pricing and availability. However, to manufacture medicines, nations must conform to the Current Good Manufacturing Practices (CGMPs), which includes sterilization and testing bylaws. Unfortunately, developing nations generally lack the capital and domestic resources to undergo such high-level medicine production.59

Financial Drain

Though it may seem counterintuitive, the purchasing of medicine from supposedly cheaper alternative sources actually results in harsher financial drain. A report conducted in Africa in the 1980s indicated that when purchasing medicines, nations pay 10 percent more due to the absence of companies’ cost-effective mechanisms, such as tiered pricing.60

56 Ibid. 57 Ibid. 58 Ibid. 59 Pheage, “Dying from Lack of Medicines | Africa Renewal.” 60 Ibid.


Additionally, due to poor procurement practices and an unregulated supply chain, medicine prices are exceptionally inconsistent. For instance, in Nigeria, it was found that medicine expenditures in the late 1980s were 30 percent higher than they needed to be due to the prescribing of increased and more potent doses of antibiotics.61 Additionally, a study in Ghana uncovered that 96 percent of patients with the same condition were given four different prescriptions, while a survey in Mali discovered that an average of 10 different prescriptions for medicines were issued and included duplications of drugs under different names.62 Unnecessary purchases for several inefficient drugs continue to drain the pockets of patients and civilians.63

Counterfeit Drugs

A significant barrier to the accessibility of medicine is the prevalence of counterfeit drugs. Counterfeit drugs refer to falsified and often dangerous medicines and are sold at a lower price in areas lacking medicines with the intent of generating profit.64 In Nigeria alone, 64 percent of antimalarial drugs are counterfeit.65 The circulation of counterfeit drugs can be attributed to poor procuring methods from illegitimate suppliers and such purchasing results in a financial drain of individual and national resources to purchase legitimate medicine. When nations purchase counterfeit medicines, resources are drained, and the purchasing power of nations decrease. Worse, falsified drugs flood the public sector and are then purchased by civilians who are harmed by the toxins in counterfeit medicine.

Possible Solutions and Controversies

To counter the inaccessibility of medicine, delegates must first understand the nature of the medicinal supply chain. Secure medicines travel from suppliers, to governments, to pharmacies, and finally, to civilians, with the absence of third parties. At each level, potential problems arise with regards to medicine availability and affordability. By examining each party’s role and the challenges faced, more comprehensive resolutions can be created.

Increasing Public-Private Partnerships

Historically, public and private foundation partnerships have proven to be effective in increasing medicine accessibility in developing nations. In such partnerships, efforts to research, develop, and distribute medicines are operationalized by public institutions, including the World Health Organization, and funded by private foundations or sovereign governments. The goal of public-private partnerships is to produce medicine that is well-suited to the region of distribution in terms of climate, price, and general administration. By supplying medicine in developing regions, the overall access to appropriate medicines can be increased as there is a general increase in supply, and medicines are legitimate and not falsified. Public-private partnerships can also be altered to promote long-term medicine accessibility instead of sporadic medicine distribution. By forming research and

61 Ibid. 62 Ibid. 63 Ibid. 64 “Counterfeit Medications,” Wikipedia, Wikimedia Foundation, July 29, 2020, https://en.wikipedia.org/wiki/Counterfeit_medications. 65 "Bad medicine," The Economist, October 13, 2012, https://www.economist.com/international/2012/10/13/bad-medicine.


testing bases in target nations, necessary infrastructure, materials, and data are established. This is crucial to long-term development of the medical sector.

The involvement of regional scientists and governments in efforts launched by public-private partnerships yields further benefits. Firstly, their involvement thoroughly trains regulatory agencies, contributors, and scientists in managing medicine development in their respective regions. Secondly, medicines created are better suited to the region because regional parties bring their lived insights to medicine development in their regions.

Training and Education

Training and education among governments, healthcare workers, and civilians is vital in ensuring that medicine is properly procured, managed, and administered. Firstly, it is necessary that government officials are trained in medicine procurement and supply chain regulation, especially in nations where health bodies lack training. By working with pre-existing programs such as the WHO prequalification programme, health ministries can learn to identify flawed supply chains, conduct data collection, and formulate more practical procurement systems. It is also critical to train health officials in proper medicine acquisition practices, including identifying legitimate suppliers and purchasing medicine in large quantities, so that medicine can be made more accessible.

Public Sector Investment

Although private sector healthcare systems are flourishing in most nations, healthcare in the public sector in both developing and developed nations require improvement. Recognizing that the public healthcare sector is typically accessed by middle- and lower-class individuals who cannot afford private healthcare—yet often require medicine the most—is crucial. There are several methods through which public sector health can be advanced:

Insurance Programs

In nations with fully functioning healthcare systems, medicine insurance may be granted for citizens. In the case of Brazil, for example, medicine insurance programs ensured that medicine was either completely or mostly free of cost. As medicine prices increase, implementing insurance programs to sponsor the cost of medicine either partially or fully is crucial to boosting medicine accessibility.

Generic Manufacturers

Perhaps the best way to increase the access to medicine in the public sector is to procure more medicines from generic manufacturers. In most developing nations, medicines are branded and purchased from private producers, while in developed nations, generic medicines comprise nearly 85 percent of medicine supply.66 Generic medicines bear a lower financial cost for governments and consumers alike; based on large scale procurement methods, buying medicine in bulk costs less per unit than does purchasing a few individual units.

66 Eva Taylor Grant, "New Study Finds Some Poor Countries Paying 20 to 30 Times More for Basic Medicines Than Others," Center for Global Development, June 17, 2019, https://www.cgdev.org/article/new-study-finds-some-poor-countries-paying-20-30-times-more-basic-medicines-others.


Data Collection

To understand the need for medicine access, which medicines are required, the most suitable prices, and several other factors related to medicine accessibility, data collection is imperative. Data collection can serve a multitude of purposes and can take several forms:

Pharmacovigilance

Pharmacovigilance refers to the surveillance and prevention of adverse medicines. These actions can be used to identify the presence of counterfeit medicines by tracking drugs, purchasers, and symptoms and is crucial to improving access to secure medicines.67 An example of such a mechanism is the WHO Global Surveillance and Monitoring System for Substandard and Falsified medicines. In this program, reports of illegitimate medicines are uploaded to a database viewable by health officials. Issues are addressed by WHO within 24 hours.

Surveying

In both developing and developing nations, the need for medicine and the prices that civilians can afford to pay—especially in rural areas or marginalized communities—is crucial to recognize. Surveying enables many courses of action. Firstly, governments are enabled to procure the correct medicines in the correct quantities. Secondly, surveying allows health sectors to understand the price civilians can afford to pay. Thirdly, local barriers to access, such as cost or lack of available pharmacies, can be identified and countered by surveying. Lastly, based on data gathered, governments can use information to create social programs that further improve medicine access.

Bloc Positions

Developed Nations

Generally, developed nations have advanced healthcare systems that either provide medical assistance from taxation or private insurance.68 Additionally, the supply of medicine in these countries is largely composed of those produced by generic manufacturers. For instance, generic medicines composed nearly 85 percent of the drug supply in both the United Kingdom and United States.69

United States

The United States—a nation with a privatized healthcare system—has the most expensive medicine market in the world, with prices of medicine around 306 percent higher than the global median cost.70 As a result, one in

67 Kevin Hansberry, “What Is Pharmacovigilance and Why Is It Important?: Proclinical Recruitment Blogs.” Proclinical, August 23, 2017, https://www.proclinical.com/blogs/2017-8/what-is-pharmacovigilance-and-why-is-it-important. 68 Kate Harveston, “4 Types of Healthcare Systems,” IVN.us, May 21, 2018, https://ivn.us/2018/05/21/types-of-healthcare-systems. 69 Ibid. 70 Morgan Haefner, “10 Countries with the Most Expensive Medicines,” Becker's Hospital Review, November 21, 2019, https://www.beckershospitalreview.com/rankings-and-ratings/10-countries-with-the-most-expensive-medicines.html.


five Americans are unable to afford standard prescription medicines. 71 Furthermore, those with chronic conditions struggle to access urgent medicines. For example, diabetic citizens are required to pay USD 300 for a vial of insulin.72 Factoring in inflation, the cost of insulin in the United States is a 1000 percent increase from its retail price.73 However, existing programs to provide medical care to civilians with disabilities can be augmented to provide low income and chronically ill civilians with insurance programs that partially reimburse medicine costs.74

Canada

Under the Canadian Health Act, prescription drugs are free of charge to qualifying citizens or to patients admitted in hospitals.75 Outside of hospital settings, publicly funded drug programs insure medicine costs for citizens based on income, age, presence of illness, and a variety of additional factors. Furthermore, as a part of some employment benefits, workers can receive substantial reimbursements or discounts on medicine from the employee and their families.76

Despite such benefits, Canada is the only nation with a universal healthcare system that does not provide free-of-cost essential medicine to all civilians. In fact, 700,000 civilians remain unable to afford medicines, while benefits provided by medicine insurance programs fall short for another 3.6 million people. This issue stems from the 1960s, when the Canadian healthcare system was designed—without accessibility as its focus.77

European Countries

Although many European nations have attained a high standard of medicine accessibility, there are several barriers to full medicine access. In the past few years, pharmacies in the United Kingdom have undergone medicine shortages, and in some situations, the dire circumstances resulted in drug rationing. Such medicine shortages can be contributed to European nations often administering three times the required amount of antibiotics, in contrast to other nations with similar disease profiles. Given that the average expenditure for antimicrobacterial treatment is EUR 9 billion in Europe, stock-outs are a frequent topic of concern.78

However, a benefit to receiving healthcare in European countries is that over-the-counter medicine and prescription drugs are not overly priced—largely due to procurement from generic manufacturers. However, in financially struggling European Union states, such as Greece, or nations with private healthcare systems, such as

71 Steven Reinberg, “Almost 1 in 5 Americans Going Without Health Care,” ABC News Network, March 23, 2008, https://abcnews.go.com/Health/Healthday/story?id=4509618. 72 Ibid. 73 Ibid. 74 Ritu Prasad, “The Human Cost of Insulin in America,” BBC, March 14, 2019, https://www.bbc.com/news/world-us-canada-47491964. 75 “Prescription Drug Insurance Coverage,” Government of Canada, August 13, 2018, https://www.canada.ca/en/health-canada/services/health-care-system/pharmaceuticals/access-insurance-coverage-prescription-medicines.html. 76 Ibid. 77 Ashifa Kassam, “The Serious Flaw in Canada's Healthcare System: Prescription Drugs Aren't Free,” The Guardian, October 20, 2017, https://www.theguardian.com/world/2017/oct/20/canada-national-pharmacare-prescription-drugs 78 Kathleen Holloway and Lisen van Dijk. “THE WORLD MEDICINES SITUATION 2011,” World Health Organization, February 2, 2011, https://www.who.int/medicines/areas/policy/world_medicines_situation/WMS_ch14_wRational.pdf.


Romania and Cyprus, millions of citizens are unable to afford medicine.79 The shifting economic climates of such regions have resulted in colossal inflation rates, closure of government facilities, and cancellations of insurance policies—all of which prevent medicine access.

Nations with Rising Healthcare Systems

This bloc includes nations such as Morocco, South Africa, and Brazil. These nations, which have suffered through a lack of medicine supply in the past, have transformed their healthcare systems to better provide pharmaceuticals. Through the use of data collection and local production, medicine in these nations is now better suited to regional prices, needs, and uses. However, these nations still face several challenges.

For example, in Morocco, medicines in the public sector are free-of-cost but are typically unavailable. The same circumstances exist in Brazil, where medicines are generally unavailable in lesser-developed areas. Moreover, the lowest priced generic drugs cost about 2.7 times higher than the international reference price, while the average cost of general medicines, such as painkillers or standard cough syrups, equates to two days of wages for the average citizen. 80 Although generic drugs are more available in these nations, these medicines compose approximately 50 percent of the drug supply.81 Expanding the supply of generic medicines in these regions is crucial, as generic drugs cost relatively less for civilians than branded drugs. On aggregate, nations with rising healthcare systems have established effective health policies and programs, but procurement policies and medicine insurance programs can still be improved to increase medicine accessibility.

Developing Nations

Healthcare systems in developing nations generally consist of a two-tier system, composed of a private and public sector. The private sector provides healthcare for the population’s elite and more financially stable consumers, and is supplied with medicines. Conversely, the public sector— which is utilized by the nation’s low-income and poor individuals—lacks affordable medicine as a result of weak procurement policies, supply chain regulations, and investment into the public sector. Medicine in these nations is also susceptible to trafficking, corruption, and theft. Furthermore, the presence of ineffective and dangerous counterfeit drugs in supply chains and pharmacies further augments medicine scarcity. When discussing developing nations, deliberating both long-term and short-term solutions is integral. While foreign assistance may provide impermanent benefits, solutions to better medicine management and procurement practices may ultimately prove more effective.

Discussion Questions

1. How can medicine be made accessible in regions experiencing military conflict or warfare?

79 Henriette Jacobsen, “Citizens in Poor EU States Can't Afford Medicines, Health Promoters Say,” EURACTIV.com, May 17, 2013, https://www.euractiv.com/section/health-consumers/news/citizens-in-poor-eu-states-can-t-afford-medicines-health-promoters-say/. 80 Ibid. 81 “Morocco: Medicine Prices, Availability, Affordability, and Price Components,” World Health Organization, 2008, https://applications.emro.who.int/dsaf/dsa944.pdf?ua=1.


2. What actions must sovereign governments take in terms of procuring and surveilling medicine to ensure that medicine is secure?

3. How do national and international drug laws and policies impact medicine accessibility?

4. How can access to medicine be strengthened in the short-term and the long-term?

5. Why should medicine be suited to fit regional needs and prices? How can this be implemented?

6. What barriers must be combated to ensure that civilians in your country are able to access medicine? What solutions can you implement to counter those barriers?

7. How is medicine procured, managed, and administered in your country? Are all civilians able to equally access medicine at the end of this cycle? Why or why not? Which of these aspects can be improved? How?

Additional Resources

Access to Medicines: Making Market Forces Serve the Poor: https://www.who.int/publications/10-year-review/medicines/en/. Medicines in Health Systems: Advancing Access, Affordability and Appropriate Use: https://www.who.int/alliance-hpsr/resources/FR_Ch2_Annex.pdf?ua=1. WHO/Health Action International Project on Medicine Prices and Availability: https://www.who.int/medicines/areas/access/Medicine_Prices_and_Availability/en/. Timeline: Five Decades of Building a Better World Through Health: https://50years.ifpma.org/50-year-timeline/. Essential Medicines and Pharmaceutical Prices by Country: http://www.emro.who.int/essential-medicines/publications/.


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“World Health Statistics 2020.” World Health Organization, 2020. https://apps.who.int/iris/bitstream/handle/10665/332070/9789240005105-eng.pdf.


Childhood Obesity

Overview

The World Health Organization defines obesity as “abnormal and excess fat accumulation that presents a risk to overall health.”82 In 2019, an estimated 150 million children suffered from obesity—a number that is likely to increase by another 206 million by 2025.83 The childhood obesity epidemic is widespread across the globe, with 75 percent of obese children residing in developing nations.84 Due to the advancement of international trade agreements and the lower costs attached to the global importation of unhealthy foods, the diets of civilians have shifted dramatically in previous decades. Furthermore, educational measures exposing the causes and impacts of child obesity among adolescents and physical education policies have been scarce among national governments. As a result of insufficient health policies, nutritional awareness campaigns, and exercise programs, rates of childhood obesity are rapidly increasing—an issue that poses numerous physical and psychological health risks to people worldwide.

In particular, advertising of unhealthy foods has adversely affected youth. The marketing of fast food as inexpensive, accessible, and delectable has transformed the fast food industry and its consumers. The strategic marketing of nutrient-deficient and processed foods to children have enabled diets and eating habits to prioritize unhealthy foods and marginalize healthier alternatives, including produce, whole grains, lean meats, beans and legumes, and low-fat dairy.85 The vast availability of processed goods and fast foods have urged adolescents to consume calorically dense foods containing high amounts of sugar, fats, and carbohydrates. Combined with a rising number of children not participating in physical activity due to the surge of technology and a lack of education about healthy eating and exercise, obesity rates among children continue to quickly multiply.

Obesity exposes children to a multitude of health and psychological consequences, both in the short and long term. Young children with obesity suffer psychological distress, including higher susceptibility to anxiety, depression, eating disorders, low self-esteem, and a lack of social acceptance.86 Up to 80 percent of children are likely to remain obese through their adult years, which poses grave long-term consequences. 87 Noncommunicable diseases (NCDs) including type 2 diabetes, cardiovascular illnesses, and cholesterol concerns also stem from child obesity. In fact, nearly 75 percent of deaths in 2012 that occurred in the countries of the

82 “Obesity,” World Health Organization, World Health Organization, September 5, 2014, www.who.int/topics/obesity/en/. 83 “Statistics,” Childhood Obesity Foundation, October 2019, https://childhoodobesityfoundation.ca/what-is-childhood-obesity/statistics/. 84 Kate Bennion, “Child Obesity a Global Health Issue, According to WHO,” Deseret News, June 7, 2013, https://www.deseret.com/2013/6/6/20520776/child-obesity-a-global-health-issue-according-to-who. 85 Ibid. 86 Ibid. 87 Amanda Gardner, “Overweight Kids Often Become Obese, Unhealthy Adults,” ABC News Network, March 23, 2008, https://abcnews.go.com/Health/Healthday/story?id=4509648.


Pacific Islands resulted from the presence of NCDs. 88 Finally, child obesity increases the vulnerability of adolescents to dangerous health issues, mental distress, and early mortality.89

By 2040, the global childhood obesity rate is anticipated to reach an average of 50 percent.90 Through examining the causes of childhood obesity as a result of individual preference, national policies, and corporate practices, the delegates of WHO will be equipped to operationalize thorough resolutions to combat childhood obesity.

Timeline

1820 — The first form of physical education is introduced in schools in the United States. The curriculum focuses on gymnastics, bodily development, and maintenance of personal hygiene.91

1954 — The Japan School Lunch Act, which issues the responsibility of providing nutritious meals for children to government and school officials, is passed in Japan. To implement healthier school lunches, nutritionists are recruited to create adequate food guides and meal plans.92

November 19, 1993 — Fiji becomes a member of the General on Tariffs and Trade (GATT), allowing for the removal of import licenses and the redesigning of tariff systems. As a result, larger quantities of unhealthy foods are imported to the region.93

2006 — The top 44 fast food companies spend almost USD 2 billion in marketing targeting children.94

October 7, 2008 — A study presented at the American Heart Association correlates childhood obesity and heart disease.95

88 Phil Baker, “Free Trade, Food Systems and Dietary Change in the Pacific,” Deakin Nutrition, October 9, 2017, https://blogs.deakin.edu.au/deakinnutrition/2017/10/09/free-trade-food-systems-and-dietary-change-and-in-the-pacific/. 89 Ibid. 90 The Huffington Post Canada, “What's To Blame For The Massive Number Of Obese Children?” HuffPost Canada, March 5, 2013, https://www.huffingtonpost.ca/2013/03/05/obesity-in-ontario_n_2812060.html. 91 “Brief History of Physical Education, Physical Education History,” Excite Education, accessed August 25, 2020, https://www.excite.com/education/subject/brief-history-of-physical-education. 92 “Japan's School Lunch Program Serves Nutritious Meals,” NYC Food Policy Center, November 15, 2019, https://www.nycfoodpolicy.org/food-policy-snapshot-japans-school-lunch-program/. 93 Amerita Ravuvu, Sharon Friel, Anne Marie Thow, and Wendy Snowdon. “Monitoring the Impact of Trade Agreements on National Food Environments: Trade Imports and Population Nutrition Risks in Fiji,” Research Gate, June 2017, https://www.researchgate.net/publication/317590171_Monitoring_the_impact_of_trade_agreements_on_national_food_environments_Trade_imports_and_population_nutrition_risks_in_Fiji. 94 “Marketing Food to Children and Adolescents,” FEDERAL TRADE COMMISSION, July 2008. https://www.ftc.gov/sites/default/files/documents/reports/marketing-food-children-and-adolescents-review-industry-expenditures-activities-and-self-regulation/p064504foodmktingreport.pdf. 95 Stephen R. Daniels, Marc S. Jacobson, Brain W. McCrindle, Robert H. Eckel, and Brigid M. Sanner, “American Heart Association Childhood Obesity Research Summit Report,” American Heart Association, March 30, 2009, https://www.ahajournals.org/doi/full/10.1161/circulationaha.109.192216.


2008 — Approximately 80 percent of children between 13 to 15 years old fail to satisfy WHO recommendations to receive a minimum one hour of physical activity daily.96

June 2009 — A woman in South Carolina, United States, is arrested and charged with custodial interference and child neglect—a combined 15-year sentence—due to her son’s acute obesity.97

2010 — An estimated 35 million children in developing nations are obese.98

2011 — To reduce the purchasing of unhealthy foods, Denmark introduces a tax on all foods that contain a saturated fat level exceeding 2.3 percent.99

November 2017 — Fast-food outlets within a 400-meter radius of schools are banned in London, United Kingdom. Restaurants aiming to operate near school areas are required to provide healthier foods and methods, including reducing fried foods and salt intake.100

October 22, 2019 — The World Economic Forum estimates that tackling issues related to obesity accounts for 8.4 percent of total healthcare expenditures in nations within the Organisation for Economic Co-operation and Development (OECD).101

August 5, 2020 — Oaxaca becomes the first Mexican state to outlaw selling junk food—foods high in calories from fat and sugars—to children, placing junk food in the same prohibited category as cigarettes and alcohol. Consequences for parents who supply children with junk food include fines and jail time.102

Historical Analysis

Following World War II, famines occurred across the globe. Famine-related deaths exceeded 10 million people in the Soviet Union and two million in Henan Province, China.103 Such famines drastically reduced caloric intake and increased food rationing globally. Although not all nations were impacted by food shortages, fears of famine sparked significant health and feeding policies across the world. As a result, several nations implemented school

96 “New WHO-Led Study Says Majority of Adolescents Worldwide Are Not Sufficiently Physically Active,” World Health Organization, November 22, 2019, https://www.who.int/news-room/detail/22-11-2019-new-who-led-study-says-majority-of-adolescents-worldwide-are-not-sufficiently-physically-active-putting-their-current-and-future-health-at-risk. 97 Lauren Cox, “Courts Charge Mother of 555-Pound Boy,” ABC News Network, June 26, 2009, https://abcnews.go.com/Health/WellnessNews/story?id=7941609. 98 Nagisa Mori, Armada Francisco, and Craig D Willcox, “Walking to School in Japan and Childhood Obesity Prevention: New Lessons from an Old Policy,” American journal of public health, American Public Health Association, November 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3477970/. 99 “Population-Based Approaches to Childhood Obesity Prevention,” World Health Organization, 2012, https://www.who.int/dietphysicalactivity/childhood/WHO_new_childhoodobesity_PREVENTION_27nov_HR_PRINT_OK.pdf. 100 Pippa Crerrer, “Total Ban on Fast-Food Outlets within 400m of London Schools,” Evening Standard, November 27, 2017, https://www.standard.co.uk/ne

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