Daszak, Peter

Heymann, David

Jeggo, Martyn

Mackenzie, John

Patz, Jonathan

Zinsstag, Jakob

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Mainstreaming One HealthJakob Zinsstag,1,2 John S. Mackenzie,3,4 Martyn Jeggo,5 David L. Heymann,6,7 Jonathan A. Patz,8and Peter Daszak91Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 4002 Basel, Switzerland2University of Basel, Petersplatz 1, 4003 Basel, Switzerland3Faculty of Health Sciences, Curtin University, P.O. Box U1987, Perth, WA 6845, Australia4The Burnet Institute, Melbourne, VIC 3004, Australia5Australian Animal Health Laboratory, P.O. Box 100, Geelong, VIC, Australia6Centre on Global Health Security, Chatham House, London, UK7Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK8Global Health Institute, University of Wisconsin, 1710 University Avenue, Madison, WI 537269EcoHealth Alliance, 460 West 34th Street, 17th Floor, New York, NY 10001The term ‘One Medicine’ was coined by Schwabe (1984)and focuses attention on the commonality of human andanimal health. The underlying concept is traceable to thelate nineteenth century, in contributions of the Germanpathologist and architect of social medicine Rudolf Vir-chow (Saunders 2000; Zinsstag and Weiss 2001). Schwabestates that there is no difference in paradigm between hu-man and veterinary medicine and that both medicines havethe same scientific foundations. Yet, human and animalhealth developed during the nineteenth and twentiethcenturies into fairly segregated disciplines or ‘silos’, sepa-rated at the academic, governance and application levels. Inrecent decades, the concept of ‘One Medicine’ evolving to‘One Health’ has gained momentum worldwide after theSARS outbreak in 2003, and then driven by fears of apossible pandemic of H5N1 avian influenza (Zinsstag et al.2005; Worldbank 2010). One Health now encompasses abroad agenda from zoonotic infections (Roth et al. 2003),food safety, to health services delivery (Schelling et al.2005), and beyond.Consideration of ‘One health’ calls for a reflection onthe human–animal relationship from its natural history tocultural influences. Molecular genetics suggests that thehuman genome is 99 % similar to great apes and 95 % topigs. Genetically, humans can be seen as only slightlyremodelled chimpanzee-like apes (Wildman et al. 2003).From a biological perspective, humans should considersuch domesticated animals and wildlife as close relatives,with similar capacity to transmit infectious organisms to usas members of our human family. We should thereforetreat our relationship with other animal species as part of acontinuum across which pathogens can emerge and spread,exploiting new niches as we change our interactions, andmoving into and out of erstwhile distinct species, regions orcommunities (Daszak et al. 2000).Nevertheless, the contemporary human–animal rela-tionship is complex and profound, ranging from exploita-tion of livestock for food and anthropomorphisation ofanimals as pets, to live ‘wet markets’ and internationaltrade in animal species; these processes, which are highlyculturally determined, create interfaces between animalsand humans, which lead in some instances, to diseaseemergence. Additional driving mechanisms of potentialdisease emergence or resurgence stem from: indiscriminatePublished online: July 10, 2012Correspondence to: Jakob Zinsstag, e-mail: Jakob.Zinsstag@unibas.chEcoHealth 9, 107–110, 2012DOI: 10.1007/s10393-012-0772-8Editorial 2012 The Author(s). This article is published with open access at Springerlink.comdestruction of native habitats for economic or agriculturaldevelopment; biodiversity loss and niche invasions; in-duced genetic changes (e.g. antibiotic-resistant bacteria orpesticide-resistant mosquitoes); and environmental con-tamination (Patz et al. 2005).Of these activities, probably the primary factor drivinghuman and animal interaction is globalised livestock pro-duction, which tends to focus on maximising profit,sometimes with ethical implication. This leads to compet-ing agendas as, ironically, moderate intensification oflivestock production is the way out of poverty for millionsof smallholder farmers. Similarly, naturalist movementssometimes claim that human rights extend to primates,whales or other species, yet these are not widely held beliefs.It is these dilemmas of aspiration for economic gain in aglobalised economy, desire for social development andconcern over animal welfare that largely determines thehuman–animal relationship. Intercultural work on thehuman–animal relationship requires a clarification of one’sown perspective in a self-reflective way. ‘What is my per-sonal cultural/and ethical background that determines myrelationship with animals and my concept of one health?’Answers critically determine the emotional or financialvalue assigned to animals. Could this lead to a new sub-jectivism in Science? ‘One health’, for example, can beinfluenced by philosophical ramifications, that determinethe method of economic analyses of the cost of infectionsthat are transmissible between humans and animals (Nar-rod et al. 2012).How can we benefit most from ‘One health’? Firstly,through the broad implications of closer cooperationbetween human and animal health sectors and recognisingthe linkages among humans, animals and the environ-ment. This broad vision means that One Health solutionswill benefit health, conservation and development. Sec-ondly, mainstreaming a ‘One Health’ approach shouldlead to better health for humans and animals and finan-cial savings to society from such a closer cooperationbetween the sectors which could not be obtained if theyworked in separation. Recently, ‘One health’ conceptualthinking has evolved towards systemic approaches thatconsider health as an outcome of social–ecological sys-tems. This includes concerns about social equity and the‘integrity’ of the environment (Zinsstag et al. 2011). ‘OneHealth’ is clearly part of the broader consideration ofecology and health.There is, however, a large unfinished agenda in the‘mainstreaming’ of one health that requires enhancedcooperation and communication between human and ani-mal health. There are obstacles, many of which are eco-nomic, to broad transdisciplinary acceptance of the benefitsgained from a One Health approach. These range fromunderstanding and mitigating the determinants of zoonosesand emerging infections to the prevention, detection andresponse when they occur in animal and/or human out-breaks. To overcome these obstacles, we urgently needstronger international leadership from the major interna-tional organizations—the World Health Organization(WHO), the Food and Agriculture Organization (FAO) andthe World Animal Health Organization. The Office of theUnited Nations Secretary General’s Special Representativefor Food Security and Nutrition may also play a crucial role.A tripartite agreement has been signed by WHO, FAO andOIE for sharing responsibilities and coordinating globalactivities to address health risks at the animal–human–ecosystems interface (Anonymous 2010). Stronger imple-mentation of this agreement and associated advocacy isessential to give credibility and support to the One Healthconcept, and to ensure national One Health planning thatcan better respond to zoonoses and food safety.Working together under this agreement, these threeinternational organisations could provide the evidenceand rational answers to questions such as: What are thedirect benefits of joint human and animal communicabledisease surveillance, along with environmental monitor-ing, for time to detection and response, the number oflives saved, and associated financial savings? How is powermost effectively shared in leadership and chain of com-mand that leads to effective and nimble implementationof integrated disease surveillance and control? What arepotential benefits of joint antibiotic resistance surveillance,as in the Canadian Integrated Programme for Antimi-crobial Resistance Surveillance (CIPARS)? What are ben-efits of joint laboratory facilities for human and animalcommunicable diseases, modelled after Canada’s NationalMicrobiology Laboratory? What might be the benefits ifcancer registries for humans and animals were joined(O’Brien et al. 2000)? How could the Performance ofVeterinary Services (PVS) and the International HealthRegulations (IHR), be linked in order to enhance theirperformance?Answers to these and other such questions may notnecessarily lead to new structures, new governance or evena ‘One Health’ society. Rather, the existing internationalorganizations, by providing the scientific evidence andguidance based on this evidence, could provide what is108 Editorialneeded to change current siloed practices that are ournormal way of doing business. Let us continue to work inour disciplines and institutions to bring them closer byimproved communication, greater collaboration and betterinformation sharing. Fostering mutual respect amongstdoctors and veterinarians and recognising and acknowl-edging the interdependence of health in humans and ani-mals is a necessity. At the same time, new evidence isexpanding on the dependence of both human and animalhealth on ecosystem functioning, generally termed as‘ecosystem services.’ According to a 2011 US report of thePresident’s Council of Advisors on Science and Technology(PCAST), ‘Ecosystems and the biodiversity they embodyconstitute ‘‘environmental capital’’ on which human well-being heavily depends,’ (PCAST 2011).However, two impediments will need to be overcomeif One Health is to achieve its potential as a solution toglobal health issues that brings an economy of disciplinaryscale. Firstly, the health of humans, livestock and wildlifeare connected to, and often grounded in, the environmentthey inhabit. The importance of underlying environmentalchange to the spread of infectious agents across thesepopulations is now widely appreciated. Indeed, under-standing the ecology of diseases is often the way thatsolutions to outbreaks or disease emergence are formed.Therefore, One Health needs a far greater engagement ofthe ecological and environmental sciences to achieve itspotential. Secondly, breaking down the siloed approach tohealth will not be possible unless funding from govern-ment agencies, ministries, and intergovernmental fundingmechanisms supports new collaborations and new com-munication channels. This will be difficult because min-istries often compete for funding. However, specific lineitem funding for inter-departmental, interagency and in-ter-institutional collaboration may provide a solution.They would almost certainly be incredible value formoney, given the importance of zoonotic agents to globalpublic health, livestock production and wildlife conser-vation. In summary, what can be achieved in one healthwill depend on the ability of society to understand andaccept scientific evidence and guidance for one health.Operationalizing this guidance can be enhanced byunderstanding being gained from a growing body of socialscientists working on these linkages. Mainstreaming ‘Onehealth’ will lead to closer cooperation between human andanimal health and with other health related sectors (i.e.social and environmental sciences and economics), andwill provide a road map for developing a sustainableapproach to diseases at the human–animal–ecosytemsinterface.OPEN ACCESSThis article is distributed under the terms of the CreativeCommons Attribution License which permits any use,distribution, and reproduction in any medium, providedthe original author(s) and the source are credited.REFERENCESAnonymous (2010) The FAO–OIE–WHO collaboration: sharingresponsibilities and coordinating global activities to addresshealth risks at the animal-human-ecosystems interfaces. A Tri-partite Concept Note. http://www.who.int/influenza/resources/documents/tripartite_concept_note_hanoi/en/index.html. Acc-essed 25 April 2012Daszak P, Cunningham AA, Hyatt AD (2000) Emerging infectiousdiseases of wildlife—threats to biodiversity and human health.Science 287:443–449Narrod C, Zinsstag J, Tiongco M (2012) A one health frameworkfor estimating the economic costs of zoonotic diseases onsociety. EcoHealth [Epub ahead of print]O’Brien DJ, Kaneene JB, Getis A, Lloyd JW, Swanson GM, LeaderRW (2000) Spatial and temporal comparison of selected cancersin dogs and humans, Michigan, USA, 1964–1994. PreventiveVeterinary Medicine 47:187–204Patz JA, Confalonieri UEC, Amerasinghe F, Chua KB, Daszak P,Hyatt AD, Molyneux D, Thomson M, Yameogo L, Malecela-Lazaro M, Vasconcelos P, Rubio-Palis Y (2005) Health: Eco-system Regulation of Infectious Diseases. In: Millennium Eco-system Assessment (eds) Ecosystems and Human Well-Being:Curent State and Trends. Findings of the Condition and TrendsWorking Group Millennium Ecosystem Assessment Series. IslandPressPresident’s Council of Advisors on Science and Technology(PCAST) (2011) Biodiversity Preservation and Ecosystem Sus-tainability Working Group. Report to the President: SustainingEnvironmental Capital: Protecting Society and the Economy.Washington, DCRoth F, Zinsstag J, Orkhon D, Chimed-Ochir G, Hutton G, CosiviO, Carrin G, Otte J (2003) Human health benefits from live-stock vaccination for brucellosis: case study. Bulletin of theWorld Health Organization 81:867–876Saunders LZ (2000) Virchow’s contributions to veterinary medi-cine: celebrated then, forgotten now. Veterinary Pathology37:199–207Schelling E, Wyss K, Bechir M, Moto DD, Zinsstag J (2005)Synergy between public health and veterinary services to deliverhuman and animal health interventions in rural low incomesettings 18. British Medical Journal 331:1264–1267Schwabe CW (1984) Veterinary Medicine and Human Health,Baltimore: Williams & WilkinsWildman DE, Uddin M, Liu G, Grossman LI, Goodman M (2003)Implications of natural selection in shaping 99.4 % nonsyn-onymous DNA identity between humans and chimpanzees:Editorial 109enlarging genus Homo. Proceedings of the National Academic ofSciences of the United States of America 100:7181–7188Worldbank (2010) People, pathogens and our planet: Volume 1:Towards a one health approach for controlling zoonotic dis-eases. Report No. 50833-GLB, p 56Zinsstag J, Schelling E, Waltner-Toews D, Tanner M (2011) From‘‘one medicine’’ to ‘‘one health’’ and systemic approaches tohealth and well-being. Preventive Veterinary Medicine 101:148–156Zinsstag J, Schelling E, Wyss K, Bechir M (2005) Potential ofcooperation between human and animal health to strengthenhealth systems. Lancet 466(9503):2142–2145Zinsstag J, Weiss M (2001) Livestock diseases and human health.Science 294:477110 Editorial

Mainstreaming One Health

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