ecology & epidemiology æ The Journal

DEBATE PIECES One Health and EcoHealth: the same wine in different bottles?

Franc¸ ois Roger, DVM, PhD1*, Alexandre Caron, DVM, PhD1, Serge Morand, PhD1, Miguel Pedrono, PhD1, Michel de Garine- Wichatitsky, DVM, PhD1, Veronique Chevalier, DVM, PhD1, Annelise Tran, PhD1, Nicolas Gaidet, PhD1, Muriel Figuie´ , PhD2, Marie-Noe¨ l de Visscher, PhD1 and Aure´ lie Binot, PhD1

1AGIRs Research Unit, CIRAD, Montpellier, France; 2MOISA Research unit, CIRAD, Montpellier, France Responsible Editor: Tanja Strand, Uppsala University, Sweden. *Correspondence to: Franc¸ois Roger, CIRAD, Campus International de Baillarguet, 34398 Montpellier Cedex 5, France, Email: [email protected]

Received: 13 January 2016; Accepted: 20 January 2016; Published: 17 February 2016 lobal approaches to health such as One Health or standards institutions (OIE, FAO, WHO) and is sup- EcoHealth paradigms posit that the epidemiolo- ported and recognized by the donor community. The Ggical dynamics and stakeholders’ actions that EcoHealth paradigm, however, takes a broader view of determine the health of animal and human populations health and links to natural resource manage- need to be studied in their interconnected ecological, ment within an approach to human health. socioeconomic, and political contexts. So far they have EcoHealth is seen by several scientists as a One Health received scant mutual theoretical discussions, despite approach which optimizes interdisciplinarity including enjoying widespread attention and empirical support. strong participatory and citizenship components. Both One Health and EcoHealth are conceptual move- Despite their different origins, One Health and Eco- ments, scientific areas, and political endeavours. However, Health are convergent in their vision and goals to their development has been driven by different scientific reposition animal and public health within their broader concerns, institutional frameworks, and cultures. context. Both are motivated by the conviction that health One Health deals with biomedical questions, with an concerns must be addressed at the humanÁanimal inter- emphasis on zoonoses, and is historically more health face within their broader natural and social environments science-driven. In contrast, the EcoHealth concept is (i.e. socio-ecosystem approach). Both try to integrate sci- defined as an ecosystem approach to health, tending to entific disciplines combining multi- and cross-disciplinary focus on environmental and socioeconomic issues and approaches. Both aim to mitigate the risks threatening initially designed by disease ecologists working in the field and public health, including veterinary public of biodiversity conservation. This concept results from the health. Both deal with the complexity of diseases and hybridization of different approaches and thematic fields: health (4). Finally, both struggle to properly define the conservation medicine, disease ecology, and the frame- boundaries of their paradigms despite their apparent work developed by the Millennium Ecosystem Assess- similarities regarding principles and objectives. There are ment (1). This vision led to the notion of ecosystemic concerns about the risk of instrumentalisation of the services linked to health and welfare, integrating social socio-ecological aspects (conservation, ecosystemic ap- and citizen dimensions. From a socio-political perspec- proaches) by the medical sector. Thus, the health sector tive, EcoHealth and One Health refer to two different could use the ‘politically correct’ discourse of One Health regimes of health governance. Public health policy studies but without in effect changing its practices of leadership converge in considering two regimes in health governance: and funding opportunities regarding environment and ‘international health’ and ‘global health’ (2, 3). EcoHealth ecosystem approaches to health. is related to the international health regime, as One Health professionals and researchers perceive the Health is linked to global health. The field of One Health paradigms differently. For academics, both paradigms is evolving on a large scale and at official levels, whereas can be applied to inter- and trans-disciplinary frameworks EcoHealth operates at a more grass-root, pragmatic for research activities on zoonotic diseases or health level. The One Health approach is driven by international matters and/or are viewed as research topics (e.g. efficacy

Infection Ecology and Epidemiology 2016. # 2016 Franc¸ ois Roger et al. This is an Open Access article distributed under the terms of the Creative Commons 1 Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Infection Ecology and Epidemiology 2016, 6: 30978 - http://dx.doi.org/10.3402/iee.v6.30978 (page number not for citation purpose) Franc¸ ois Roger et al.

and efficiency of One Health). Zinsstag (5), who distinctly functioning among other ecological indicators. applies One Health and EcoHealth according to a given For example, in the case of bushpigs, the relation- health issue or disease, suggests they should converge in ship between bushmeat culture and practices that the areas of zoonoses, disease emergence, and pandemic provide safety nets for local communities (e.g. the threats. Barrett and Bouley (6) examined the potential huge impact of African swine fever on domestic benefits from collaboration between One Health and pig populations) demonstrate how health situa- EcoHealth. For Ngyuen-Viet et al. (7), EcoHealth is tions can be the catalyst for actor concerns and at progressively converging with the One Health paradigm the same time the whistle blower of non-linear and suggests combining the two paradigms. For health dysfunctioning within the socio-ecosystem. professionals, policy- and decision-makers, both para- . In Southeast Asia, GREASE (www.grease-net digms, but especially One Health, have underpinned work.org) is a regional network to support research official cooperation among sectors for food safety and activities for better health risk management at public health improvement, mostly in developing coun- the animal, human, and environment interface. It tries in and Southeast Asia. But a better connection responds to the challenge of animal and zoonotic between the two spheres is needed. Leung et al. (8) diseases and public health through a theoretical emphasise the decisive function of governance and and operational framework. GREASE provides partnerships for the development of holistic tactics: scientific and institutional support to facilitate ‘Further research on governance and partnership models, interactions between various stakeholders, includ- as well as systems-based organizational working practices, ing scientists from Southeast Asia and worldwide, is needed to close the gap between One Health and policy- and decision-makers (national veterinary EcoHealth theory and public health practice’. However, services and institutes, international agencies, i.e. until now, despite these calls from the scientific commu- OIE, FAO, WHO), and local actors (farmers, value nity, both concepts have failed to converge from an chain operators, local authorities, NGOs, commu- institutional viewpoint. The ideology behind both con- nity representatives). Research and development cepts being globally similar, hidden interests or sectorial projects allow for work on holistic approaches: deadlocks must be preventing closer integration. Cross- One Health surveillance (REVASIA programme sectorial and interdisciplinary scientific collaboration on and zoonotic influenza in Cambodia); EcoHealth analysis, modelling, and risk management will allow joint and One Health case studies in the framework of development of decision support tools to help implement the EuropeAid ComAcross project (www.one integrated health strategies and policies. healthsea.org/comacross) on the health impact of Several authors have emphasised the lack of certain water and waste management, zoonotic encepha- key components for the One Health paradigm: social litis involving wildlife (i.e. Nipah virus) and sciences have remained marginalized (9), the wildlife livestock (Japanese encephalitis) and neglected component and its associated thematic fields in ecology zoonoses impacting family farmers; rodent-borne are frequently a neglected element (10), and the environ- diseases (www.biodivhealthsea.org/); and participa- mental component remains underrepresented (6). tory One Health modelling at the field level CIRAD and partners from low-income countries (Regional EU-ASEAN Dialogue, www.bit.ly/ implement both One Health and EcoHealthÁapplied 1MK7U5W). research programmes through research platforms in . In southern Africa, the research platform ‘Produc- partnership based in the developing countries (Box 1). tion and Conservation in Partnership’ (RP-PCP: www.rp-pcp.org) promotes the sustainable coex- Box 1. From field research activities in low-income istence between agricultural production and the countries to revised concepts conservation of natural resources in the complex . In Madagascar, the research platform ‘Forests socio-ecosystems presented by the Transfrontier and Biodiversity’ (www.forets-biodiv.org) aims at Conservation Areas. The RP-PCP aims to con- combining biodiversity conservation and the en- tribute to sustainable development, nature con- hancement of natural resources to ensure the servation, and improved rural livelihoods through resilience of socio-ecosystems. Some activities aim strengthening national research capacities, multi- at exploring the links between the restoration of disciplinary approaches, and institutional partner- forest ecosystem functions (e.g. through the re- ships. ‘Health and Environment’ is one of the four introduction of key-stone species) including a pillars of the platform that allows ecosystem hypothetised improved ecosystem resilience with approaches to (animal and human) health and that health indicators for both animal and human contributes to the global objective of improving populations. Such health indicators can contri- conservation and development in these socio- bute in return to the monitoring of ecosystem ecosystems. Research activities focus on livestock

2 Citation: Infection Ecology and Epidemiology 2016, 6: 30978 - http://dx.doi.org/10.3402/iee.v6.30978 (page number not for citation purpose) One Health and EcoHealth

diseases linked to production and markets at investigations on proposals that need to be addressed at various scales (e.g. tick-borne diseases or foot diverse scales using a blend of biological and social and mouth disease); on neglected zoonoses such disciplines at the junction between the environmental, as bovine tuberculosis, brucellosis, or rift valley social, medical, and animal science sectors. Among fever; or on diseases potentially detrimental to others, we propose to tackle the following topics (Box 2). wildlife populations (e.g. bovine tuberculosis, Box 2. Relevant topics for considering the convergences anthrax). The humanÁlivestockÁwildlife interface among One Health and EcoHealth is central to all the research activities on health and other thematics which implies One Heath and . Antimicrobial resistance (AMR) at different scales EcoHealth approaches. and in several contexts. AMR is a universal emerg- ing issue for public and , These initiatives provide inclusive opportunities for both in developed and developing countries, studying diseases and health in tropical areas in order to affecting animals and humans, with AMR genes design risk-reduction strategies and policies, with parti- prevailing in anthropised and natural environ- cular emphasis on the environmental aspects. In these ments (13). three regions of the world, biodiversity Á and its . Bushmeat, its impact on human nutrition and ambivalent role in the emergence and maintenance of livelihoods in the developing world, the threats it disease in local livelihoods Á and related issues, such as poses to biodiversity conservation and its poten- wildlife conservation and bushmeat consumption, are tial to jeopardise public health. ‘‘The bushmeat taken into account. These components are critical drivers problem raises an intricate complex of environ- of health operating at different scales, and their integra- mental, economic, social, cultural and ethical tion into all-inclusive studies could facilitate the unifica- challenges’’ (14). tion of the two paradigms. Human and social sciences and . Associated diseases in rodents and bats (micro- modelling approaches are increasingly associated with the mammals): ‘‘bat-associated [...] diseases suffer field studies carried out in these three sites in order to from basic ignorance and perpetuated misunder- improve health of vulnerable populations exposed to standing of fundamental reservoir and vector eco- diseases and to manage animal and public health. logy tenets, translated into failed control policies Furthermore, social sciences and modelling could act as that only exacerbate the underlying environmen- catalysts to merge the two paradigms and empower local tal conditions of concern’’ (12). Recent emer- and national authorities within a cross-sectorial scheme. gences (e.g. Ebola, MERS-CoV) remind us that it But beyond the theories, we need to shape tangible field is essential to tackle spillovers and interspecies experiences before proposing a possible joint model. To transmission. Reliance on such scientific facts to move forward, we could assess and compare the impacts design cross-sectorial health policies and frame- of the two paradigms. Initiatives regarding the evaluation works constitutes a real challenge. of One Health Á for example, NEOH project, www.neoh. . The development and assessment of ‘One Health onehealthglobal.net/; Hall and Le (11) Á could help surveillance’ Á systematic collection at grass-roots reconcile the two paradigms. Indeed, if the grey literature level, validation, analysis, interpretation of multi- on the topic has been blooming in recent years, in practice, ple data (e.g. not only health data but also pro- empirical experiences that would allow a combination or duction, ecological, and environmental data) and definitive separation of the concepts are still lacking. dissemination of information collected on hu- It would be constructive to confront and compare One mans, domestic and wild animals, and the envi- Health vs. EcoHealth approaches applied on the same ronment to inform decisions for more effective, case studies, in order to test limits of divergence/conver- evidence- and system-based health interventions gence of both concepts. Beyond integrated studies on (15) Á could be a stimulating goal for the real zoonoses (such as rabies or vector-borne diseases) (12), implementation of One Health and EcoHealth other health issues call for integrated approaches. Such paradigms. In this perspective, multi-stakeholder diseases do not fit ‘traditional One Health topics’ linked participation, one of the pillars of EcoHealth, is to previous experience of emerging zoonotic diseases under development in the field of surveillance. within global health governance schemes (which One Moreover, ‘One Health surveillance’ should be Health paradigm is actually rooted in). Such topics call developed and applied to AMR, bushmeat, and for global governance schemes such as One Health and for micromammal issues. holistic and integrated approach to health. It allows emphasising local context importance (both from an Systematic reviews and meta-analysis of published environmental and socio-economic perspective), partici- studies in these four domains regarding integrated ap- pation, and multi-level governance. We suggest conducting proaches could help outline study design (i.e. comparing

Citation: Infection Ecology and Epidemiology 2016, 6: 30978 - http://dx.doi.org/10.3402/iee.v6.30978 3 (page number not for citation purpose) Franc¸ ois Roger et al.

One Health vs. EcoHealth and using ‘here and elsewhere’ the Research Network ‘‘Management of Emerging Risks in and ‘before and after’ analyses) and fieldwork to be Southeast Asia’’, GREASE; and the Platform in partnership for research and training ‘‘Forests and Biodiversity in Madagascar’’, carried out in low-income countries. F&B. If their points of origin differ, the relative synchrony of the success of both paradigms is timely and did not come about purely by chance: they respond to a growing com- Conflict of interest and funding mon perception of the complexity of the linkages between The authors have not received any funding or benefits animal and human health and their proximate and dis- from industry or elsewhere to conduct this study. tant socio-ecological environment, and to some extent, to a shifting allocation of funding resources. Despite References the fact that One Health and EcoHealth have been 1. Millennium Ecosystem Assessment (2005). 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4 Citation: Infection Ecology and Epidemiology 2016, 6: 30978 - http://dx.doi.org/10.3402/iee.v6.30978 (page number not for citation purpose)