IAMWHO Study Guide 2019 by IPSF Asia Pacific Regional Office

IAMWHO Study Guide 2019

Many people contributed to the development of this resource, generously taking time to research, share tips, compile and design. The IPSF APRO would like to thank the following people for their role in developing the IAMWHO Study Guide 2019. Written by:  Stephanie Hunto  Aulia Hanifah Faldol  Polo Diep  Sangmin Lee  Silviana Florencia  Wanwarat Aree  Winona Susanti Designed by:  Murtadha Mazwil Proofread by:  Ashley Soyeon Lee  Amira Amelia

Table of Contents

Welcoming Remarks

About World Health Organization

About World Health Assembly

Providing Solutions to Reducing Tobacco-Related Mortality and Morbidity in the Asia Pacific Region 6 Introduction

Current Situation

Major Stakeholders

Past Actions

Sources

1. Welcoming Remarks Dear Delegates, It is our great pleasure and honor to welcome you to the first IPSF APRO Model WHO. The idea of implementing model WHO stemmed from the question, â&#x20AC;&#x153;What would happen if there are as many pharmacists in public health decision-making positions as doctors or nurses?â&#x20AC;? With this engraved in our hearts, we have worked with the aim of cultivating pharmacy leaders who are passionate about global health. The topic of IAMWHO 2019 is Providing Solutions to Reducing Tobacco-Related Mortality and Morbidity in the Asia Pacific Region. Fourteen years have passed since the WHO Framework Convention on Tobacco Control (WHO FCTC) entered into force. During this time, tobacco has rarely been discussed at the WHA because most tobacco-related discussions have happened at the FCTC Conference of the Parties (COP). While COP could be an opportunity to discuss exclusively on tobacco control, it holds a risk that tobacco issues might be neglected by the health ministry officials who come to WHA. We expect you to raise your placards high, come up with great ideas to solve the tobacco-related health issues, have heated discussions on various perspectives, and enjoy the IAMWHO journey. Best of luck to everyone and we will be waiting for you in Bandung! Ashley Soyeon Lee Regional Projects Officer of IPSF APRO 2018-19

Stephanie Hunto Public Health Coordinator of IPSF APRO 2018-19

2. About World Health Organization The World Health Organization (WHO) is an agency of the United Nations which specializes in international public health. It was established on 7 April 1948 and is headquartered in Geneva, Switzerland. WHO works worldwide to promote health, keep the world safe and serve the vulnerable. Its goal is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion with better health and wellbeing.i It is now working with 194 Member States, across six regions, and from more than 150 offices to achieve better health for everyone, everywhere. WHO member states are divided into six regions where each region has a regional office. The six regional offices of WHO are SouthEast Asia Regional Office (SEARO), Western Pacific Regional Office (WPRO), Africa Regional Office (AFRO), Americas Regional Office (AMRO), Eastern Mediterranean Regional Office (EMRO), and Europe Regional Office (EURO).1 WHO fulfils its objectives through its core functions: 1. providing leadership on matters critical to health and engaging in partnerships where joint action is needed; 2. shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; 3. setting norms and standards and promoting and monitoring their implementation; 4. articulating ethical and evidence-based policy options; 5. providing technical support, catalysing change, and building sustainable institutional capacity; and 6. monitoring the health situation and assessing health trends. Today, WHO works alongside a large number of health and development partners to achieve the health-related targets laid out in the Sustainable Development Goals (SDGs), especially SDG 3: Good Health and Well-being. With an eye set firmly on 2030, WHO will build on the lessons learnt over its first 70 years.

Some IPSF APRO members including Bangladesh, India, Indonesia, and Thailand are part of SEARO and other members including Australia, Japan, Malaysia, New Zealand, Papua New Guinea, the Philippines, Republic of Korea, Singapore, Taiwan, and Vietnam are part of WPRO. 4

3. About World Health Assembly The World Health Assembly is the place where the decision-making of WHO takes place. It is held annually in Geneva, Switzerland and attended by delegates from all WHO Member States. Each year, WHA focuses on specific health agenda items and determine the Organizationâ&#x20AC;&#x2122;s policies, approve resolutions and decisions, appoint the Director-General, supervise financial policies, approving and reviewing the proposed programme budget.ii IPSF sends delegates to the WHA to represent the pharmacy students worldwide. The delegates deliver statements to advocate for pharmacists and attend plenary, committee meeting, and side events.

4. Providing Solutions to Reducing Tobacco-Related Mortality and Morbidity in the Asia Pacific Region a. Introduction Tobacco use has reached epidemic proportions worldwide, and despite efforts to reverse smoking trends, the problem only seems to be getting bigger each year. Death is a definite outcome for a long-term smoker. It is known as a silent killer as current smoking mortality is the result of past lifetimes of tobacco consumption. Today, tobacco kills around half of all smokers. It kills more than 7 million people each year and more than 6 million of those deaths are the result of direct tobacco use while around 890,000 are the result of secondhand smoke. Tobacco can be found in cigarettes, cigars, bidis2, and kreteks3. Smoking tobacco causes exposure to a lethal mixture of more than 7,000 toxic chemicals, including at least 70 known carcinogens that can damage nearly every organ system in the human body. iii Tobacco is one of the four major risk factors for noncommunicable diseases and known for probable cause of 25 diseases, including lung cancer, bronchitis, and emphysema. Tobacco may also harm infants whose mother smokes during pregnancy. It increases the risk of congenital disorders, cancer, lung diseases, and sudden death in infants. Tobacco is a concern for all, smokers and non-smokers alike. Tobacco is everybody's problem. It is a major public health issue that demands urgent action now.

2 3

Bidi is a thin Indian cigarette filled with tobacco flake and wrapped in Tendu Leaf with a string or adhesive. Kreteks is a cigarette made from a blend of tobacco,cloves and other flavors. 6

b. Current Situation Tobacco smoking has been a great issue in the world due to its hazardous effect on human health. It is estimated that 1 out of 10 deaths is caused by tobacco smoking. In 2016, the WHO Western Pacific Regional Office (WPRO) and South-East Asia Regional Office (SEARO) had the highest number of deaths caused by the use of tobacco, compared to the other WHO regions. The total number of deaths in WPRO exceeds 2.4 million, while in SEARO, the total number of deaths almost hit the number of 1.2 million.

In western countries, the total number of mortality and morbidity related to tobacco use has been decreased steadily over the past decade, however, in Asia countries, the numbers surge rapidly. This might be due to the dynamic socioeconomic changes such as the rapid economic growth, war, and westernization. These events may induce different patterns of tobacco use across the birth cohorts. 4 Indonesia, India, and China are the three big populous countries in the world as well as the biggest number of smokers. Japan and Bangladesh also rank among the top 10 countries with the largest smoking population. A study was conducted to analyze tobacco smoking mortality and morbidity in Asia.v The study showed that Asian male smokers had a higher risk for all-cause and lung cancer mortality than never-smokers. The data uncovered that Asian men in recent birth cohorts tended to start smoking in younger age which may increase the risks for all-cause and lung cancer mortality. On the other hand, men who quit smoking before the age of 40 showed no elevated risk of all-cause mortality compared with never-smokers. In the figure below,

Birth cohorts means the groups of people born in a given calendar year. 7

it is shown that tobacco smoking is accounted for a significant portion of the deaths of Asian men.

<Population-Attributable Risk of Tobacco Smoking in Asian Male Populations>

Compared to the Asian men, few Asian women smoked cigarettes. However, the increasing number of younger and female smokers in recent years is also concerning. The improvement of womenâ&#x20AC;&#x2122;s social status is one of the factors that contribute to the increasing number of womanâ&#x20AC;&#x2122;s smokers. Tobacco smoking epidemic in Asia highlighted the need to implement policies to reduce tobacco smoking and its burden on the health of populations in Asia. Tobacco smoking leads to a large public health problem. The problem spreads all over the body, from head to toe. Starting from your head, smoking increases the risk of getting a stroke, Alzheimerâ&#x20AC;&#x2122;s disease, headaches, and multiple sclerosis. Smokers can also develop cataracts which may lead to blindness. The effect of smoking on the mouth goes beyond bad breath. Oral cancer is six times more common in smokers than those who are not. vi Recent studies suggest that smoking has its own effect on mental health. Not to mention that smoking is addictive, it may cause depression in teens and increase the risk of divorce in adults. Smokers can develop cancer cell on the neck and throat, as well as thyroid diseases. It will certainly cause lung cancer or esophageal cancer. It also affects the heart and causes coronary artery disease, atherosclerosis, high blood pressure, and elevated cholesterol. Furthermore, it causes pancreatic cancer and abdominal aortic aneurysms, as well as heartburn and ulcers in the abdomen. Male smokers may establish erectile dysfunction and infertility, along with kidney cancer and a high chance of prostate cancer. On the other hand, female smokers have a high chance of developing breast cancer, early menopause, and infertility. Smoking during pregnancy is downright hazardous, leading to preterm labor, stillbirths, placental damage, or colic. 8

There are still many more unmentioned diseases resulting from tobacco consumption. Therefore, countries are trying to prevent it. Prevention may start from policy-level measures by increasing taxation of tobacco products, strengthening laws in regulating who can purchase tobacco products, as well as how and where they can be purchased. It also includes restrictions on advertising and mandatory health warnings on packages of tobacco products.vii Prevention can also take place at the school or community level by educating potential smokers about the health risks, and using evidence-based interventions to reduce or delay the initiation of smoking. Smoking restrictions in public places such as restaurants, schools, and some workplaces may reduce tobacco consumption in smokers in addition to sparing the non-smokers from exposure to the health risks and nuisance of second-hand tobacco smoke.viii

c. Major Stakeholders Major stakeholders are the one who can affect or be affected by the organization’s actions, objectives. In this case, the major stakeholders include the World Health Organization (WHO), Non-State Actors (NSAs), Pharmaceutical Companies, and Intergovernmental Organizations (IGOs). The delegation from the major stakeholders attends the World Health Assembly and affects the policies of the WHO.

I. World Health Organization (WHO) Headquarters The main office or headquarters of WHO has programs to monitor the use of tobacco. They also made publications on tobacco cessation training and made policies regarding tobacco control.  Tobacco Free Initiative (TFI): The TFI supports strengthening tobacco control and monitoring tobacco use in the Member States. TFI aims to achieve the lowest possible level of tobacco use prevalence and the highest level of protection from secondhand smoke. The TFI works towards a world free of tobacco: tobacco-free people, communities and environments.x  Framework Convention on Tobacco Control (FCTC) WHO FCTC is the first global treaty negotiated under the support of WHO. It was adopted by the World Health Assembly on 21 May 2003 and entered into force on 27 February 2005. It reaffirms the right of all people to the highest standard of health. It aims to tackle various causes of the tobacco epidemic that occur between the countries, such as trade liberalization and direct foreign investment, international marketing, advertising, promotion, sponsorship and global contraband of cigarettes. The Conference of the Parties (COP) is the governing body of the WHO FCTC and is comprised of all 180 Parties to the Convention. Regular sessions of the Conference of the Parties (COP) are held every two years.xi South East Asia Regional Office (SEARO) Home to a quarter of the world population, WHO SEARO provides support to the 11 Member States and monitors health trends. SEARO helps the Member States to combat the tobacco use by monitoring and controlling tobacco use with many programs such as providing data and workshops, implementing campaigns, publishing manual on how to quit smoking by the help of medical experts.  Regional Workshop on mHealth5 Interventions to Prevent and Control NCDs It is one of the workshops that SEARO held to promote and surge the implementation of mHealth initiatives for prevention and control of NCDs and risk factors in South East Asia Region Member States. The event also 5

mHealth is an abbreviation for mobile health, a term used for the practice of medicine and public health supported by mobile devices. 10



discussed the global and regional best practices on mHealth interventions for prevention and control of NCDs, including mCessation, mDiabetes, mCervicalCancer and the possibility of SEAR countries adapting the practices. Tobacco monitoring groupxii The SEARO has established the surveys to monitor tobacco use and get data about the key tobacco control indicators. As part of the Global Tobacco Surveillance System (GTSS), two surveys were made with two different groups, the adult (the Global Adult Tobacco Survey; GATS) and the youth (the Global Youth Tobacco Survey; GYTS). It assists countries in fulfilling their obligations under the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) to generate comparable data within and across countries.

Western Pacific Regional Office (WPRO) The WHO WPRO is home to 1.9 billion people in 37 countries and areas. The region works with governments in each Member States countries and partners across the regions to promote health. WPRO is also working hard to tackle the issue of tobacco use by implying the WHO FCTC and TFI. They also provide workshops on the implementation of TFI and data from the tobacco monitoring group using the GYTS.xiii  Regional action plan for the tobacco free initiative in the Western Pacific (2015-2019) To guide Member States in accelerating the implementation of the WHO FCTC with support from WHO, the Regional Committee for the Western Pacific endorsed the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019) at its sixty-fifth session in October 2014. Building on its experiences, the new regional action plan is structured around three pillars: strengthening sustainable institutional capacity; developing comprehensive legislation and regulation; and facilitating consistent enforcement through a whole-of-society approach.xiv

II. Member States A Member State (MS) Representative is a diplomat of one of the countries listed as Member States of the WHO. The Representatives can draft resolutions and have full voting rights during the IAMWHO with the goal to achieve their nation’s health standard in the assembly. They will work with other Member State Representatives to share information, discuss, create alliances, and draft resolutions. They are also expected to engage with the Non-State Actors (NSAs), Pharmaceutical Companies, and Intergovernmental Organizations (IGOs) to get support on the draft resolution, such as seals of approval and financial aid. For more information about each Member State, please refer to the Delegate Position Guide.

III. Non-State Actors Non-State actors (NSAs) are nongovernmental organizations, international business associations and philanthropic foundations that have had and continue to have a sustained and systematic engagement in the interest of the WHO. As non-voting delegates, each non-State actor will affect the decision-making process by giving out three seals of approval to various resolution clauses to support the clauses that align with the NSA’s aim. They may also offer specific resources that can be provided by the NSA, such as workforce, technology, financial aid, etc. 1. 2. 3. 4. 5. 6. 7.

Bill & Melinda Gates Foundation (BMGF) Framework Convention Alliance on Tobacco Control (FCA) International Pharmaceutical Federation (FIP) International Pharmaceutical Students’ Federation (IPSF) International Union Against Tuberculosis and Lung Disease (The Union) International Network of Women Against Tobacco (INWAT) World Medical Association (WMA)

For more information about each non-State actor, please refer to the Delegate Position Guide.

IV. Pharmaceutical Companies Pharmaceutical Companies are licensed to research, develop, market and/or distribute drugs, most commonly with the aim to maximize profit. At the same time, they serve as a major source of funding for innovation. Although the Pharmaceutical Representatives do not have voting rights, each one has 10 million dollars to distribute to various resolution clauses as a way of showing their company’s support on the very clauses. In this way, the pharmaceutical companies will influence the development of health policy. 1. 2. 3. 4.

GlaxoSmithKline (GSK) Novartis Pfizer Sanofi

For more information about each pharmaceutical company, please refer to the Delegate Position Guide.

V. Intergovernmental Organizations Intergovernmental Organizations (IGOs) are composed of UN agencies and the World Bank. They are specialized agencies that have a relationship with United Nation through negotiated agreements. They are experts in their particular programmes and can add weight to the decision-making procedure with their 12

experience, even though they do not have voting rights. Similar to that of non-State actors, each IGO representative will offer three seals of approval to various resolution clauses to support the clauses that align with the NSAâ&#x20AC;&#x2122;s aim and affect the decisionmaking process. 1. 2. 3. 4. 5.

Food and Agriculture Organization (FAO) International Labour Organization (ILO) United Nations Development Programme (UNDP) United Nations International Childrenâ&#x20AC;&#x2122;s Emergency Fund (UNICEF) World Bank

For more information about each Intergovernmental Organization, please refer to the Delegate Position Guide.

Past Actionsxv I. New Zealand New Zealand has been one of the leading countries for tobacco control. In 2016, New Zealand developed programs to achieve two purposes -- stopping people, especially children, and adolescents, from starting to smoke and encouraging smokers to quit. Since 1983 until 2014, the percentage of adult smoker population decreased to only 16.6 percent in total. Between 2010 until 2014, the number of adult per capita consumption of tobacco has dropped 23 percent. Being the part of WHO FCTC allowed New Zealand to develop comprehensive and evidence-based programs that are also implemented by other countries such as Australia, Canada, UK, and Ireland. The Ministry of Health implemented policy, service development and operational aspects of tobacco control. New Zealand has visionary goals to reduce the number of smokers to reach lower than 5% of the total population. The developed programs to reach the goal are cost-effectiveness of tobacco control interventions, funding of smoking cessation medicine, funding of Quitline (a national smoking cessation service), funding of community-based smoking cessation services, District Health Board (DHB) tobacco control funding, health promotion activities through public health unit, mass media campaigns, and funding to Smokefree New Zealand Innovation Fund.xvi II. Philippines The Philippines has made significant advances using the WHO FCTC as a basis and legal instrument to adopt comprehensive tobacco control measures at both national and local levels. The Philippines is a tobacco-growing country and the industry is represented at the Inter-Agency Committee on Tobacco (IACT). Civil society in the Philippines has rallied together to accelerate tobacco control progress and ensure adherence to the Convention. NGOs have developed strong relationships with the Department of Health (DOH), are habitually providing technical advice and spearheading tobacco control initiatives. The Philippines has made significant strides in implementing measures for protection from tobacco smoke exposure by using WHO FCTC Article 8 as a key reference in developing local ordinances, administrative orders, and memorandums. For example, a 100% smoke-free policy has been established in all government facilities. III. Republic of Korea The Republic of Korea has changed its view to tobacco taxes thanks to WHO FCTC: taxes are now perceived not only as a revenue-generating tool, but also as an instrument for protecting and promoting public health. In Korea, several different taxes apply to tobacco products, including the Health Promotion Fund, excise tax, local education tax, waste management charge, individual consumption tax, and value-added tax. The tobacco tax increase in 2015 resulted in an 80% price rise, from US$ 2.20 (2500 Republic of Korea Won, KRW) to US$ 4 (4500 KRW), and a decline in smoking prevalence. The increase of cigarette prices in 2015 has also 14

resulted in a direct budgetary increase for health programs and the frequency of antismoking ads. The Republic of Korea has a strong national tobacco cessation infrastructure, which it continues to strengthen to achieve universal coverage. IV. Kenya Kenya has made significant advances in initiating and strengthening smoke-free legislation. Its example was quickly followed by other municipalities, including Nairobi, Mombasa, and Kangundo. The WHO FCTC facilitated links between tobacco control, noncommunicable disease (NCD) strategies, community health strategies and Sustainable Development Goals (SDGs) in Kenya. In 2010 and 2015, the government launched the National Tobacco Control Action Plan (NTCAP 20102015) and Strategy for the Prevention and Control of Noncommunicable Diseases (2015- 2020) respectively, drawing on global initiatives including the WHO FCTC. Collaboration on tobacco control has flourished between the government and the civil society. This is best exemplified by the establishment of the Tobacco Control Board in 2007 (a multisectoral advisory board to the Minister of Public Health) which is comprised of members from government agencies, civil society and NGOs. Kenya is now recognized as a leader in tobacco control in the East African region.

5. Sources www.who.int www.undp.org www.fao.org worldbank.org www.unicef.org www.ilo.org www.gatesfoundation.org www.fctc.org www.ipsf.org www.fip.org www.theunion.org https://inwat.org www.wma.net www.novartis.com www.gsk.com www.pfizer.com www.sanofi.com

https://www.who.int/about/what-we-do/en/ https://www.who.int/mediacentre/events/governance/wha/en/ iii https://www.who.int/mediacentre/factsheets/fs221/en/ iv https://tobaccoatlas.org/topic/deaths/ v Yang JJ, Yu D, Wen W, et al. Tobacco Smoking and Mortality in Asia: A Pooled Meta-analysis. JAMA Netw Open. 2019;2(3):e191474. doi:10.1001/jamanetworkopen.2019.1474 vi Saha SP, Bhalla DK, Whayne TF Jr, Gairola C. Cigarette smoke and adverse health effects: An overview of research trends and future needs. Int J Angiol. 2007;16(3):77â&#x20AC;&#x201C;83. vii https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/how-can-weprevent-tobacco-use viii https://www.who.int/tobacco/research/economics/restrictions/en/ ix https://www.who.int/tobacco/mpower/graphs/en/ x https://www.who.int/topics/tobacco/en/ xi https://www.who.int/fctc/WHO_FCTC_summary.pdf xii http://www.searo.who.int/tobacco/data/adult_tobacco_brochure_2015.pdf xiii http://origin.wpro.who.int/tobacco/en/ xiv https://iris.wpro.who.int/bitstream/handle/10665.1/10894/9789290617044_eng.pdf xv http://origin.who.int/fctc/cop/sessions/cop8/Factsheets-impact-assessment-all-countries.pdf ii

xvi

https://www.health.govt.nz/system/files/documents/pages/cabinet-paper-8-april-2016.pdf