The One Health approach: is it truly one health?

2023

The relationship between human, animal, and environmental health has been widely acknowledged for years. Yet it wasn’t until 2000 that the concept of One Health—"the collaborative effort of multiple disciplines working locally, nationally, and globally to attain optimal health for people, animals, and our environment”—was introduced, and only recently that this approach has truly been incorporated into international community strategic discussions, despite the many terms (like planetary health and global health) that intersect and even overlap, making it challenging to adopt a unified position. The One Health approach poses that various issues, such as inequity in social determinants of health, migratory movements, unhealthy diets, agricultural and livestock farming models, biodiversity loss, increased transmission of infectious diseases and their vectors, climate change and deforestation, are interrelated and therefore require a shared, unified approach.

One Health

There are currently three major challenges that make the One Health strategy a priority:

  1. The first challenge is the unchecked and exponential growth of the global population, which translates into more demand for limited natural resources, resources that we are pushing to their limits primarily because of our acceptance of a socio-economic model that pursues infinite growth without considering the limits of the planet. The global population is projected to reach 9.7 billion by 2050, 38 times the population at the beginning of the 1st century. Population growth may lead to intensive land use to meet the growing demand for food and other resources. Deforestation is one consequence of this intensive land use, increasing the likelihood of human contact with new pathogens. With humans and animals sharing about 300 diseases, it is logical that some zoonotic diseases are gaining global significance. The COVID-19 pandemic is a prime example: one of the widely accepted theories attributes its origin to animal transmission, making One Health a strategy to be considered in the future.
  2. It’s more than just a problem of numbers. The current socio-economic model strives for endless profit and growth, ignoring the fact that our planet's resources are limited and that we are on the verge of reaching that limit. One of the most harmful effects is the intensity of the climate crisis, now one of humanity's biggest challenges.
  3. Despite its many positive aspects, globalisation also has many negative consequences for the health of the planet, animals and people. Increased global transport of both animals and people facilitates the spread of several infectious diseases, as evidenced by the COVID-19 pandemic.

According to the World Health Organization (WHO), the One Health initiative can be applied to several areas, including:

  1. Antimicrobial resistance (AMR), a major problem affecting global health and development. AMR kills 700,000 people worldwide every year, and it is projected that more people will die from this cause than from cancer by 2050.
  2. Zoonotic diseases, which are diseases caused by germs that spread between animals and humans. Examples include Ebola, avian influenza, rabies, coronaviruses, and COVID-19.
  3. Vector-borne diseases, which affect people who are bitten by a vector: mosquitoes, ticks, lice, and fleas. Examples include dengue, West Nile virus, Lyme disease, Chagas disease, and malaria.
  4. Foodborne diseases caused by food contamination at any point along the production, delivery, and consumption chain. Examples include norovirus, salmonella, listeria, and others.
  5. Environmental health, which includes issues like water pollution, air pollution, and climate change.

Antimicrobial resistance: a global problem that One Health aims to tackle

Along with the rising relevance of emerging and re-emerging diseases, antimicrobial resistance has been a major driver behind the One Health initiative, in light of how antimicrobials are used in animal health. The discovery of penicillin in 1928 kicked off an age in which antimicrobials have played a central role in fighting infectious diseases. Since 1928, antimicrobial medicines have been a key element in the fight against infectious diseases. However, the chronic misuse and overuse of antibiotics in both animals and humans has led to antibiotic resistance, an issue that the WHO has rated as one of the top ten global threats to public health. The issue is not simply the overuse of antibiotics in animals, but the chronic neglect of research into new antibiotics. In 2019, the WHO identified 32 antibiotics in clinical development that address the list of priority pathogens, but only six of these were classified as innovations.

Criticisms of One Health

Criticism of the One Health approach are also being voiced from different sectors and include:

1. Issues with implementation:

The World Bank estimates that $10.3 to $11.5 billion per year is needed to implement One Health globally. However, funding for One Health is nowhere near enough. But it's not all about money. According to the WHO, critical gaps in the implementation of One Health that need to be filled include:

  • Databases and resources to support information sharing and adopting measures in line with the One Health approach.
  • The identification and dissemination of best practices in One Health implementation.
  • Mapping existing initiatives and capacities for One Health research and the creation of a dedicated One Health workforce.
  • Having a blueprint for a comprehensive One Health surveillance system.
  • Establishing routine and emergency coordination mechanisms with relevant stakeholders.
  • A more holistic understanding by society as a whole, including policy makers, of the drivers of the spread of zoonotic (animal-to-human) diseases. This includes animal trade, agriculture, animal husbandry, urbanisation and habitat fragmentation.
  • A standardised approach to assessing the risks of the spread of pathogens between different animal and human populations and the outbreak of zoonotic diseases, including those originating in food systems.
  • Methods to identify and reduce the risks of contagion and spread of zoonotic diseases that minimise their effects and maximise spillover benefits with other health and sustainable development objectives.

There also appears to be a lack of guidelines for evaluating and visualising the results of the implementation of the One Health initiative, which may limit its wide-scale adoption.

2. Criticisms of the definition and underlying model:

In theory, the three areas that One Health covers should have been developed equally, but the environmental dimension has lagged behind human and animal health. Additionally, even though human, animal and environmental health should be treated on an equal basis, this is not currently the case. For some authors, animal and environmental health is only seen as worthy of protection to the extent that it contributes to human health. For these authors, One Health would effectively be nothing more than a new label to protect public health. As in public health policy, where the focus is on the distributional aspects of health in human populations, the One Health paradigm forces us to think about a fair distribution of health between humans, animals and the environment.

The underlying models of this initiative are crucial, since they replicate existing power dynamics. On one hand, they have favoured biased colonial agendas above those of impoverished countries and marginalized communities. Tensions have also arisen between scientific and non-scientific discourses, as well as between anthropocentric narratives and those that address more-than-human perspectives.

Solutions to the problems with One Health

Obviously, there are fundamental considerations that need to be addressed before the One Health initiative can become a reality. A potential first step would be to reaffirm the concept of One Health as the indivisible work in three areas of health: human health, animal health, and environmental health. Likewise, it is important to clearly communicate that the ultimate goal of implementing this strategy is comprehensive health, ensuring the medium and long-term sustainability of the planet, animals, and people. Understanding health as “resilience” could be a good starting point, where prevention is prioritised over cure. At the operational level, an expert panel identified seven recommendations for the G20 so that countries can scale up this holistic approach:

  1. Increase awareness and advocacy of One Health priorities.
  2. Identify gaps and opportunities.
  3. Improve One Health governance.
  4. Support funding/investment in One Health.
  5. Use a One Health joint action plan as a blueprint for action.
  6. Incorporate the One Health approach into all relevant policies.
  7. Facilitate One Health research, knowledge and capacity.

Justice and equity need to be at the core of One Health policies to ensure that policy and legal frameworks are not underpinned by processes that perpetuate racism and environmental injustice. It is also important to recognise that the current socio-economic model is incompatible with a One Health approach and to act accordingly.

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