One Health Approach: “Concept to Practice”

One Health Approach: “Concept to Practice”

Abhinav Verma¹, Sanjay Shakya², Vivek Naik¹ and A. K. Chaturvedani³*

¹Ph.D. Scholar, Department of Veterinary Public Health and Epidemiolgy, College of Veterinary Science and Animal Husbandry, DSVCKV, Durg, Chhattisgarh, 491001, India

² Professor & Head, Department of Veterinary Public Health and Epidemiolgy, College of Veterinary Science and Animal Husbandry, DSVCKV, Durg, Chhattisgarh, 491001, India

³Assistant Professor, Department of Veterinary Extension, Faculty of Veterinary and Animal Sciences, RGSC-BHU, Mirzapur (U.P.)

Department of Veterinary Public Health and Epidemiolgy,

 College of Veterinary Science and Animal Husbandry,

Dau Shri Vasudev Chandrakar Kamdhenu Vishwavidyalaya, Durg, Chhattisgarh, 491001, India

*Email:- ajay.chaturvedani001@gmail.com

 

Introduction

With the beginning of 21^st century we have encountered several life threatening diseases has been successful in stirring panic among both human and animal population directly and indirectly. This all diseases weather communicable or non-communicable disease teaches us a lesson that this diseases control requires a multi-disciplinary and multi-sectoral approach and this awoke the importance of one health. One Health is a collaborative, multi-sectoral, and trans-disciplinary approach-working at the local, national, regional and global levels with the goal of achieving optimal health outcomes that recognize the interconnection between people, animals, plants, and their shared environment. In recent years, concepts such as One Health have been used to explore the complex linkages among humans, animals, plants, and the environment in relation to health and wellbeing. At their core, these concepts promote collaboration across disciplines and sectors to more holistically understand and address health threats at the human-animal-environment interface. A One Health approach has increasingly been adopted in national and international plans and strategies for zoonoses, health security, food safety, and antimicrobial resistance (AMR) and in veterinary medical education. Another matter of concern is many of the diseases considered to be emerging and re-emerging are cross border in nature and thus necessitate both national and international approaches for their effective surveillance (Paolo, 2022). Applying a One Health approach to optimize zoonotic disease prevention and control programs can save lives by improving efficient use of resources (finances, infrastructure and personnel) and the quality and timeliness of healthcare delivery (Häsler et al., 2014). A One Health approach can be applied broadly to support overarching systems that improve multisectoral, One Health coordination, or the approach can be applied to specific topics, such as antimicrobial resistance, climate change, zoonotic disease control, or food safety and security. One Health joins these three interdependent sectors- animal health, human health and ecosystems – with the goal of holistically addressing health issues such as zoonotic diseases, antimicrobial resistance, food borne diseases and environmental conditions (Chiara and Montowani, 2018)

India is currently facing several zoonotic dis­ease threats due to the exponential growth in human and livestock population, rapid urbanization, rapidly changing farming systems, closer interaction between livestock and wildlife, forest encroachment, changes in ecosystems, and globalization of trade of animal products. An estimate indicates that around 1.67 million viruses are enzootic, with up to 50% of these having the potential to invade humans (Carroll et al., 2018). The com­plexities of health threats demand cross-disciplinary strategies and to inculcate these habits, several capac­ity-building programs on One Health concept were held in India (department of biotechnology). Many scientific experts express that India must have an One Health policy for a cogent response (Chatterjee et al., 2016).

 

Importance of One Health

The importance of the connection among humans, animal and the environment in this world is not new. However, to respond the current challenges that the world is facing, the integrated vision that we are all linked has never been so important, and collaboration among multiple disciplines so crucial. One Health issues include the major issue that is zoonotic diseases.  The human health costs of zoonoses are typically equal to or greater than the livestock sector losses, a trend which is becoming more pronounced with time (World Bank 2012). The aforementioned study suggested 2.2 million human deaths and 2.4 billion human illnesses a year from zoonoses (Grace et al., 2012). Using standard and conservative costs of human illness, we may assume losses of at least US$50 billion in 2013. Other issues that can be benefited from one health approaches are for example:

• Antibiotic-resistant germs AMR occur when microorganisms adapt after exposure to antimicrobial drugs and become ineffective so microorganisms are able to proliferate (WHO, 2018). For the last 70 years, antibiotics and antimicrobial agents have been an essential aspect of treating patients with infectious diseases. The drugs have been crucial in reducing illness and death (CDC, 2018). Nonetheless, the wide use of these drugs has come at a cost—the infectious organisms the antibiotics are designed to kill have adapted to them, making the drugs less effective (CDC, 2018).
• Vector-borne diseases Vector-borne diseases transmitted by mosquitoes, such as arbovirus, are currently in prominence, especially in the Americas. In 2016, the WHO declared Zika virus and its complications as a PHEIC (WHO, 2017), while chikungunya was first recorded in the Americas at the end of 2013 (PAHO, 2013). Many dengue epidemics regularly occur around the world, and other arbovirus diseases are presenting new challenges (WHO, 2017). During 2016 and 2017, yellow fever—another well-known arbovirus—re-emerged in some countries in Africa and in the Americas (PAHO, 2016; WHO, 2017).
• Diseases in food animalscan threaten supplies, livelihoods, and economies.
• Mental health human-animal bond can help improve mental well-being.
• Contamination of waterused for drinking, recreation, and more can make people and animals sick.
• Pandemics in addition to the ongoing losses from disease outbreaks, which have become the ‘new normal’; there is considerable concern over the possibility of a civilization-altering pandemic or plague. These have occurred regularly but infrequently throughout history and pre-history, with the most recent example being the HIV pandemic. In a landmark study, the World Bank considers the possible impacts and costs of averting high impact but low probability pandemics (Burns et al., 2008). Recently the whole world facing the covid-19 pandemics and pandemic show a long dramatic effect in all sectors.
• Chronic diseases even the fields of chronic disease, mental health, injury, occupational health, and non-communicable diseases can benefit from a One Health approach involving collaboration across disciplines and sectors.
• Human-wildlife conflict one of the major issues arises due to increased deforestation. Every year no of animals as well as people died due to this conflict.

 

How does a One Health approach work?

One Health is gaining recognition in the United States and globally as an effective way to fight health issues at the human-animal-environment interface, including zoonotic diseases. CDC uses a One Health approach by involving experts in human, animal, environmental health, and other relevant disciplines and sectors in monitoring and controlling public health threats and to learn about how diseases spread among people, animals, plants, and the environment. Successful public health interventions require the cooperation of human, animal, and environmental health partners. Professionals in human health (doctors, nurses, public health practitioners, epidemiologists), animal health (veterinarians, paraprofessionals, agricultural workers), environment (ecologists, wildlife experts), and other areas of expertise need to communicate, collaborate on, and coordinate activities. Other relevant players in a One Health approach could include law enforcement, policymakers, agriculture, communities, and even pet owners. No one person, organization, or sector can address issues at the animal-human-environment interface alone.

Demographics: The estimated world population in 2017 was 7.6 billion and is expected to reach 8.6 billion in 2030 and 9.8 billion in 2050 (United Nations, 2017). This trend is expected to continue, with around 83 million people being added each year, even as fertility levels continue to decline. From 2017 to 2050, it is expected that half of the world’s population growth will be concentrated in just nine countries. In order of their expected contribution to total growth, those countries are India, Nigeria, the Democratic Republic of the Congo, Pakistan, Ethiopia, the United Republic of Tanzania, the United States, Uganda, and Indonesia. Although growth in demand for virtually all food commodities is expected to be less than in the previous decade, food insecurity will remain a critical global concern and the coexistence of malnutrition poses challenges in many countries (OECD & FAO, 2017).

Urbanization: Higher population density, especially in poor countries, can increase contact among people and facilitate the transmission of diseases, as was seen during the Ebola outbreak in 2015 (WHO, 2015). Rapid urbanization implies close proximity with companion animals, and specifically with rodents, as well as greater needs for sanitation and waste disposal in crowded urban settings. On the other hand, rural populations in least-developed countries rely on their animals as a protein source or to help in agriculture, and many live in areas close to forests and in close contact with wild animals.

Poverty: Despite the decline in global poverty and undernourishment rates, around 815 million people are still undernourished. Economic growth is key to reducing undernourishment, but it has to be inclusive and provide opportunities for improving the livelihoods of the poor. One key to progress is to enhance the productivity and incomes of smallholder family farmers. The UN General Assembly in 2015 adopted the resolution of “Transforming Our World: The 2030 Agenda for Sustainable Development,” which recognized the eradication of poverty as the greatest global challenge and an indispensable requirement for sustainable development.

Migration and Displacement: According to the UN Refugee Agency (2018), levels of displacement are the highest on record, with 65.6 million people forced from their homes. Among them are nearly 22.5 million refugees, over half of whom are under the age of 18. Thirty percent of displaced people are being hosted in Africa, 26% in the Middle East and North Africa, 17% in Europe, 16% in the Americas, and 11% in Asia and Pacific. Displaced people often are in situations of overcrowding, inadequate sanitation, and poor access to health services, all of which create the potential for the spread of communicable diseases (Schneider et al., 2012). Things that displaced people need include drinking water, safe food, the means to safely prepare meals, pest control for camps, waste disposal and sanitation, and many other requisites for basic dignity in life.

Infectious Hazards and Epidemics: Studies have found that around 70% of infectious hazard threats to public health have an interface with animals (Schneider et al., 2011). It is found that an estimated 61% of human pathogens worldwide have been classified as zoonoses, a subgroup that comprises 75% of all emerging pathogens of the past decade previous to their study. The emergence of new strains is always a possibility, as has occurred with the Ebola virus, human immunodeficiency virus (HIV), severe acute respiratory syndrome (SARS), influenza A (H5N1) with a pandemic potential, West Nile virus, and the novel influenza A (H1N1) virus (Fraser et al., 2009). At the same time, very old and well-known infectious hazards such as rabies, plague, and anthrax still persist and continue to produce outbreaks and potential public health emergencies of international concern (PHEIC) and damage to animal health (Schneider et al., 2014).

Trade, Tourism, and the Global Economy: For some common animal diseases, the appearance of cases in one country can have an important impact on trade related to animal products in others. This effect was observed across several countries in the case of avian influenza A (H5N1) in 2006. Although H5N1 was not detected in the Americas, there was a 40% drop in the share values of large poultry producers due to the indirect impact of the global market (Newcomb, 2008). Economic losses in trade due to diseases in the animal–human interface have been estimated in billions of dollars. For example, the global economic losses from SARS were estimated to be $40–50 billion, and there was even a significant impact on the GDP. Many of the disease outbreaks in the interface created tension in travel and tourism, even though WHO recommends not to restrict entry of people originating from affected countries. During the SARS outbreak, tourism profits fell by 15–40% in Asian countries.

Climate Change: Climate change is affecting every country, disrupting national economies, and affecting lives (United Nations, 2015a). People are experiencing its significant impacts, which include rising sea level, changing weather patterns, and more extreme weather events. It is already costing communities and countries dearly and this will only increase, with the poorest and most vulnerable people being most affected (United Nations, 2015a). Disasters may increase in frequency, along with an increase in the intensity of extreme weather events such as heat waves, droughts, heavy rainfall, storms, and an expansion in areas affected by droughts and floods (Meehl et al., 2007). The overall issues arising due to many factors like demographics, urbanization, environmental disruption and international travel have a major impact on animal and human health (Samuel et al., 2013).

One Health Approach Paradigm

One Health approaches are likely to have a major impact on public health, with a focus on surveillance and upstream interventions that are likely to reap obvious and rapid benefits for the health of human populations. For that reason public health agencies such as the CDC and the World Health Organization are joining with veterinary organizations and agricultural departments in advancing the One Health agenda. The current One Health approach focused more towards the prevention strategy. The chapters in the book One Health: People, Animals, and the Environment provide compelling examples of the imperatives and opportunities for One Health and the impact of this approach on our future.

Developing Plans to Put One Health Concepts into Practice

Two seminal meetings were held in 2009 and 2010 that were directed at developing ways to put the concepts of OH into practice. The first of these was an expert consultation entitled “One World, One Health: From Ideas to Action”, and second was followed a year later in 2010 by the US Centers for Disease Control and Prevention (CDC) and the major international organizations at Stone Mountain, entitled ‘Operationalizing One Health: a Policy Perspective-Taking Stock and Shaping an Implementation Roadmap’ (CDC 2010). The specific aim of the meeting was to identify clear and concrete actions to move the concept of OH from vision to implementation. Seven working groups were identified as being crucial steps in attaining the 3-5 year vision. These were:

• ‘Training’ to develop and build skills, expertise and competencies through a OH curriculum;
• A ‘One Health Global Network’ as a means of gaining international support and as a vehicle to stimulate further global collaboration;
• An ‘Information Clearing House’ to promote advocacy through providing information on success stories and lessons learned;
• ‘Needs Assessment’, by developing country-level self-assessment methods to identify activities which could benefit from a OH approach;
• ‘Capacity Building’, by identifying ways to leverage existing programs and capacity-building efforts to have a major impact at minimal cost;
• ‘Proof of Concept’, through demonstrating a retrospective and prospective evidence base that the use of OH interventions and/or concepts leads to better cross-species health outcomes; and
• A ‘Business Plan’, by articulating the concept of and rationale for OH more clearly and presenting this information to policymakers and donors worldwide (Centers for Disease Control and Prevention 2010).

Challenges for putting one health into practice

While there has been wide-ranging commitment to the One Health approach for addressing complex health problems by a large number of national and international organizations and professional bodies, its operationalization has so far proved to be challenging.

Leadership is a crucial issue in the development of One Health approaches. It is essential for building relationships and trust, both vertically within an organization and from community to international levels but most importantly horizontally between disciplines and within communities.

Building strong relationships is essential component. Multi-disciplinary is defined as many disciplines being involved, inter-disciplinary as disciplines working very closely with one another and plans fully integrated. It is therefore importance of relationship between different disciplines is a key aspect to obtain a good result.

Infrastructure for OH has developed pragmatically around surveillance and laboratory systems and networks of expertise, but infrastructure also implies dedicated services for development of skills and capacity, communication and information channels and organizational and policy frameworks to support OH. There is much to do in this area as we operationalize the concepts. Most attention to date has been in the development of surveillance and laboratory systems, and those of expert networks. Monitoring of environmental health occurs separately to human and animal health activities, and there are very few linkages.

Education and Training It is essential to recognize that One Health requires thinking and acting across disciplines as a basic tenant. Ideally skills are ‘trans-disciplinary’ that is, not just to know how other disciplines work but sharing skills and agreed goals. One of the ways to demonstrate the necessary skills and benefits is to use examples and case studies of success stories.

Communication and Technology networks are numerous, with many websites and informal and formal reporting tools concerned with OH and other arenas relevant to the animal–human-ecosystems interfaces such as disease emergence. The rapid growth and sophistication of new technologies, particularly information technology, has greatly assisted many areas underlying the One Health approach, including communication, data management, pathogen detection, risk analysis, and modeling. One such new technology has been the development of Geographic Information Systems (GIS) is an element in numerous projects enabling activities such as herd mobilization mapping, and research related to mixing of wildlife and livestock.

Operationalising the “One Health” approach in India

Different program has implanted like national health policy, national livestock policy, etc but all of them were underscores the need for multi-sectoral collaboration in India’s R&D system (including health and drug discovery) but does not spell out the specific contours of each sector and roles or how innovation will contribute to improved diagnostics and surveillance critical for prevention and control of zoonoses. Apart from the above recently Indian govt. launched the 1^st one health project of DBT through video conferencing. The program in envisage carrying out surveillance of important bacterial, viral and parasitic infections of zoonotic as well as trans-boundary disease.

Conclusion

The One Health Approach helps in reorganization of interlinked health and well being of people, animals and environment. Today’s health problems are frequently complex, trans-boundary, multi-factorial, and across species, and require joint disciplinary approach to understand and control. The concept, scope, and implementation of one health are still evolving and need a Govt. support to focus on One Health approach.

Reference

Burns, A., van der Mensbrugghe, D., & Timmer, H. (2008). Evaluating the economic consequences of avian influenza (Report No. 47417). World Bank, Washiongton, DC.

Carroll, D., Daszak, P., Wolfe, N.D., Gao, G.F., Morel, C.M., Morzaria, S., Pablos-Méndez, A., Tomori, O. and Mazet, J.A.K. (2018) The global virome project. Science, 359(6378): 872-874.

Chatterjee, P., Kakkar, M. and Chaturvedi, S. (2016) Integrating one health in national health policies of devel­oping countries: India’s lost opportunities. Infect. Dis. Poverty, 5(1): 87.

Chiara, F. and Mantovani A. (2018). The environment-animal-human web: a “One Health” view of toxicological risk analysis. Frontiers in Public Health, 6:353. doi: 10.3389/978-2-88945-791-5

Coumou, D., & Rahmstorf, S. (2012). A decade of weather extremes. Nature climate change, 2(7), 491-496.

Department of Biotechnology, India. (2019) One Health India Conference-2019. Available from: http://www. dbtindia.gov.in/event/one-health-india-conference-2019 .

Fraser, C., Donnelly, C. A., Cauchemez, S., Hanage, W. P., Van Kerkhove, M. D.,    Hollingsworth, T. D., & WHO Rapid Pandemic Assessment Collaboration. (2009). Pandemic potential of a strain of influenza A (H1N1): early findings. science, 324(5934), 1557-1561.

Grace, D., Mutua, F., Ochungo, P., Kruska, R., Jones, K., Brierley, L. et al., 2012, Mapping of poverty and likely zoonoses hotspots, Zoonoses Project 4, Report to the UK Department for International Development, Nairobi, Kenya, ILRI, p. 119.

Häsler, B., Cornelsen, L., Bennani, H., & Rushton, J. (2014). A review of the metrics for One Health benefits. Revue Scientifique Et Technique De L Office International Des Epizooties, 33(2), 453-464.

Meehl, G. A., Stocker, T. F., Collins, W. D., Friedlingstein, P., Gaye, A. T., Gregory, J. M., … & Zhao, Z. C. (2007). Global climate projections. contribution of working group 1 to the fourth assessment report of the intergovernmental panel on climate change. S. Solomon, D. Qin, M. Manning, Z. Chen, M. Marquis, KB Averyt, Tignor M., and HL Miller, editors, Climate Change.

OECD & FAO. (2017). OECD-FAO agricultural outlook 2017–2026.

Paolo, T. D. (2022). Considerations on the sidelines of the second principle of the Rome Declaration: The challenge of the One Health concept on the health of the future. The International Journal of Risk and Safety in Medicine, 33:117‑124.

Sadanandane, C., Elango, A., Marja, N., Sasidharan, P.V., Raju, K.H.K. and Jambulingam, P. (2017) An outbreak of Kyasanur forest disease in the Wayanad and Malappuram districts of Kerala, India. Ticks Tick Borne Dis., 8(1): 25-30.

Samuel, T. S., Green, E. M. and Yandow, S. M. (2013). Perspective: one health: a compelling convergence. Academic Medicine, 88: 49-55.

Schneider, M.C., Aguilera, X.P., Smith, R.M., Moynihan, M.J., da Silva, J.B. and  Aldighieri S. (2011) Importance of animal/human health interface in potential Public Health Emergencies of International Concern in the Americas. Rev Panam Salud Pública, 29: 371-379.

Schwabe C. (1969). – Veterinary medicine and human health, 2nd Ed. Williams & Wilkins, Baltimore, Maryland.

Tucker, M. A., Böhning-Gaese, K., Fagan, W. F., Fryxell, J. M., Van Moorter, B., Alberts, S. C., & Mueller, T. (2018). Moving in the Anthropocene: Global reductions in terrestrial mammalian movements. Science, 359(6374), 466-469.

United Nations. (2015a, October 21). Transforming our world: The 2030 agenda for sustainable

development.

United Nations. (2017) World population prospects: The 2017 revision. Retrieved July 10, 2017,from https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html

Washington, D.C., viewed 09 December 2013, from http://documents. worldbank. org/curated/ en/2012/06/16360943/people-pathogens

World Bank (2012) People, pathogens and our planet, Vol. 2: The economics of One Health. Report no. 69145-GLB. World Bank, Washington, DC.