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Where to Now for One Health and Ecohealth?

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Where to Now for One Health and Ecohealth? EcoHealth 13, 12–17, 2016 DOI: 10.1007/s10393-016-1112-1 Ó 2016 International Association for Ecology and Health Forum Where to Now for One Health and Ecohealth? Emma Mi,1 Ella Mi,1 and Martyn Jeggo2 1Polygeia, Cambridge, UK 2Geelong Centre for Emerging Infectious Diseases (GCEID), Deakin University Medical School, Deakin University, Geelong, 25 South Shore Avenue, Melbourne, VIC 3030, Australia Keywords: One Health, Ecohealth, public health, human health, environmental health, animal health INTRODUCTION emphasis on optimising ecosystem health to benefit human health. It is traditionally applied in a development context: Whilst subdivided and with complex interactive origins, socioeconomic development activities give rise to social two broad groups, One Health and Ecohealth, currently factors (e.g. poverty reduction) which improve health but characterise global efforts to tackle the health of people, also ecological factors (e.g. natural resource depletion) animals and our environment. One Health and Ecohealth which threaten health. These factors are exacerbated by have much in common conceptually in the issues they social inequity factors (Charron 2012b). Ecosystem ap- address (although they differ in their emphasis) and insti- proaches use an action-research framework informed by six tutionally in their emphasis on interdisciplinary collabo- principles: systems thinking, transdisciplinarity (incorpo- ration, but both suffer from limited resources and support. rating nonacademic knowledge of communities and deci- We explore the possibilities for further convergence or sion makers), multi-stakeholder participation, unity. sustainability, social and gender equity and knowledge-to- action (Charron 2012b). Ecological approaches to public health, represented EVOLUTION OF ECOHEALTH mainly by the field of environmental health, seek to understand and mitigate physical and social environmental Ecohealth seeks to understand how social, economic and factors affecting health. The effect of the environment on ecological factors and their interactions affect ecosystem health has long been recognised: in the 18th century, Vicq ‘health’—the condition and sustainability of ecosystems d’Azyr linked climate and geographical circumstances to (natural or man-made, e.g. agroecosystems, urban ecosys- epidemics (Bresalier et al. 2015). However, the germ theory tems) (Costanza et al. 1998a, b)—including the ability to of disease brought about the era of infectious epidemiology provide ecosystem services, and the impact of this on hu- (Susser and Susser 1996a), with its reductionist focus on man health. Ecohealth is anthropocentric, but has an the specific pathogens causing disease diverting attention away from environmental determinants (Bresalier et al. 2015). In the twentieth century, infectious epidemiology gave way to chronic disease epidemiology, which high- Published online: March 11, 2016 lighted behavioural risk factors for disease (Pearce 1996; Correspondence to: Martyn Jeggo, e-mail: [email protected] Susser and Susser 1996a). The ecological approach to Where to Now for One Health and Ecohealth? 13 public health was revived in the 1970s due to increasing EVOLUTION OF ONE HEALTH appreciation of social environmental factors, e.g. poverty, poor education, unequal power resulting in health One Health seeks to understand how interactions between inequality (Dakubo 2010). The Lalonde report laid the humans, animals and environmental factors affect human foundations for the revival: it set out biological, physical and animal health, and in return, the impact of health on and social environments, behavioural and healthcare as the environmental factors. One Health interventions strive to four fundamental determinants of health (Lalonde 1974), optimise human and animal health (placing equal impor- and the 1986 Ottawa Charter for Health Promotion tance on the two) and environmental factors, but does not advocated health promotion using an ecological approach emphasise improving ecosystem health. One Health can be (WHO 1986). More recently, the field of eco-epidemiology defined as the ‘‘added value in terms of health of humans, has emerged (Susser and Susser 1996b), which focusses on animals, financial savings or environmental services the interactions between physical and social environmental achievable by the cooperation of human and veterinary factors. Emerging in the late nineteenth century, the field of medicine when compared to the two medicines working ecology studies the interactions of populations, commu- separately’’ (Zinsstag et al. 2015, p. 18). It uses strategies nities, and biotic and abiotic components of the ecosystem including integrated surveillance and prevention, e.g. hu- (Odum 1971). The ecology-and-health approach can ad- man and animal vaccination (Atlas 2013). dress more complex problems than the traditional envi- The One Health idea has been revisited many times. ronmental health approach, specifically interactions Integrated human and animal medicine was the norm in between health determinants and indirect effects on health. the 19th century. Louis Pasteur’s development of vaccines This was furthered by the emergence of human ecology and Robert Koch’s studies on anthrax and TB, developing (Parkes et al. 2003). the germ theory of disease, highlighted the common causes The ecosystem health concept originated in environ- of diseases in different species (Atlas 2013). Rudolph Vir- mental management, addressing the need to balance chow and William Osler championed comparative medi- socioeconomic development with ecosystem sustainability cine (Saunders 2000). Virchow founded the field of cellular (Great Lakes Research Advisory Board 1978). The pathology, whilst Osler played a key role in both medical Brundtland report defined sustainable development and veterinary education (Kahn et al. 2007). The first vet- (Brundtland 1987) and Agenda 21 of the 1992 Earth erinary school was established in 1761 in Lyon but physi- Summit in Rio de Janeiro addressed its importance for cians continued to study animal health in collaboration human health (UNCED 1992). with veterinarians (Bresalier et al. 2015). However, The ecosystem approach to human health arose from increasing academic specialisation and divergence in gov- the union of ecological approaches to public health and ernance led to isolated professional silos (Zinsstag et al. ecosystem health from environmental management (Forget 2012). and Lebel 2001). In recent years, the Canadian Interna- In the twentieth century, veterinarians revived the One tional Development Research Centre (IDRC) has been the Health movement. Calvin Schwabe, the pioneer of veteri- leading advocate. In 1996, it introduced the Ecohealth re- nary epidemiology, coined the term ‘One Medicine’ to search programme. The first International Ecohealth For- assert that the paradigms of human and animal medicine um was held in Montreal in 2003, and in 2004, the IDRC are no different (Schwabe 1984), and advocated integrated founded the Ecohealth journal, merging previous journals disease surveillance (Atlas 2013). The field of veterinary Ecosystem Health and Global Change and Human Health. public health, in which James Steele was a leading fig- The IDRC established the International Association for ure (Zinsstag et al. 2015), uses veterinary medicine to tackle Ecology and Health (IAEH) in 2006, to organise the Eco- disease threats from animals to humans (WHO/FAO 1951). health movement globally and curate the journal (Charron The increasing emergence of zoonotic infectious dis- 2012a). Other important international initiatives include eases, notably HIV/AIDS, BSE and SARS renewed the the International Panel on Climate Change which ad- interest in One Health (Zinsstag et al. 2012). In September dressed the health risks of climate change and the Millen- 2004, the Wildlife Conservation Society held a ‘One World nium Ecosystem Assessment which identified the links One Health’ symposium. Here, the Manhattan Principles between ecosystem services and human health (Parkes were devised with 12 recommendations for a holistic 2011; Charron 2012b). 14 E. Mi et al. approach to preventing disease. These identified the Combination or closer cooperation can have signifi- importance of ecosystem health and biodiversity for human cant value. Ecohealth approaches can contribute to One and animal health (Cook et al. 2004), representing a Health. A good example is the evolution of our under- broadening of One Health. Since then, One Medicine and standing of Nipah. This disease emerged in Malaysia and One World have come together under the single One was first realised to affect pigs and humans through the Health movement (Bresalier et al. 2015). work of medical and veterinary virologists. Fruit bats were The One Health Commission was formed in 2009 in the then identified as a major wildlife reservoir of Nipah virus. USA with the aim of building interdisciplinary collabora- Pig farming in fruit tree plantations where bats used to tions and educational opportunities to improve human, forage led to pigs consuming fruit contaminated by bat animal and plant health and environmental resilience (One saliva containing the virus, developing respiratory symp- Health Commission 2015). The One Health Foundation toms and subsequently transmitting the virus to farmers. was established in 2010 in Zurich to more specifically focus This led to control strategies based around keeping pigs on improving human health and livestock productivity away from plantations. However,
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