Veterinaria Italiana, 44 (4), 577‐582 Human and veterinary medicine: the priority for public health synergies Adriano Mantovani Summary activities, protecting the population The concepts of ‘one medicine’ and ‘one (consumers and producers), the animals and health’ are supported and visualised as a tree their products and the environment from the (medicine), placed on the fertile soil (basic possible adversities linked to health. sciences), which divides into the two major Keywords branches of human and veterinary medicine, Animal, Health, Public health, Medicine, connected by the large branch of public health; Zoonosis. minor branches (specialisations) depart from the three larger ones. The synergy between human and veterinary medicine is not only a Medicina umana e medicina must for public health, but also implies ethical veterinaria: sinergia prioritaria considerations. The basic reasons requiring per la salute pubblica synergy are found in the common sharing of the environment, in the use of animal products Riassunto by humans, in the common culture and in the I concetti di “medicina unica” e “salute unica” many problems to be faced together. The long vengono supportati e visualizzati come un albero list of adversities requiring synergy is topped (la medicina), piantato su un suolo fertile (scienze by zoonoses (intended both in the classic and di base), diviso nei due principali rami della in the extended sense) and food safety that medicina umana e medicina veterinaria, collegati extends to many other items connected with dall’ampio ramo della sanità pubblica; i rami minori nutrition, environment, human/animal (le specializzazioni) si diramano dall’albero più coexistence and the management of public grande. La sinergia tra medicina umana e health; the entire quality of human life is veterinaria non è solo una necessità per la sanità affected. Human and veterinary medicine have pubblica, ma implica anche considerazioni etiche. a strong cultural background (many subject La condivisione dell’ambiente, l’uso dei prodotti matters) in common, but unfortunately the animali, la comune cultura e i principali problemi undergraduate and postgraduate education da affrontare insieme sono le ragioni basilari della programme (with few important exceptions) necessità di sinergia. Il lungo elenco delle avversità do not offer training in cooperation. The che hanno bisogno di sinergia ha al vertice le synergy between human and veterinary zoonosi (intese tanto in senso classico quanto medicines is an indicator of ‘good public esteso) e la sicurezza alimentare che si estende ad health practice’ and any obstacles to this altri elementi connessi alla nutrizione, all’ambiente, collaboration should be identified and alla coesistenza uomo/animale e alla gestione della eliminated. The logo for a public health salute pubblica; viene coinvolta la qualità della vita founded on synergy is drawn as an umbrella umana nel suo insieme. La medicina umana e formed by the medical and veterinary veterinaria hanno una forte base culturale World Health Organization/Food and Agriculture Organization Collaborating Centre for Veterinary Public Health – Department Food Safety and Veterinary Public Health, Istituto Superiore Sanità, Viale Regina Elena 299, 00161 Rome, Italy [email protected] © IZS A&M 2008 www.izs.it/vet_italiana Vol. 44 (4), Vet Ital 577 Human and veterinary medicine: the priority for public health synergies Adriano Mantovani (molteplici aspetti) in comune ma purtroppo i collaboration between the two medicines. A programmi di istruzione universitaria e post laurea strong input to synergy was obtained in 1978 (salvo poche importanti eccezioni) non offrono when the General Assembly of the WHO in formazione congiunta. La sinergia tra le medicine Alma Ata introduced primary health care, umana e veterinaria è un indicatore di “buona which required interprofessional contributions. pratica di sanità pubblica” e perciò è necessario Presently, similar input may be obtained by identificare ed eliminare ogni ostacolo alla sua applying the techniques of ‘evidence based realizzazione. Il logo della sanità pubblica basata prevention’. Pioneers of the concept were sulla sinergia è rappresentato graficamente da un Bernardino Ramazzini, Giovanni Maria ombrello formato dalle attività mediche e veterinarie, Lancisi, Rudolf Virchow, Louis Pasteur, Calvin che proteggono dalle potenziali avversità connesse Schwabe and others. alla salute la popolazione (consumatori e produttori), gli animali e i loro prodotti, e l’ambiente. Parole chiave Animale, Medicina, Sanità, Sanità pubblica, Zoonosi. Introduction Medicine is born as ‘one’. In Figure 1, the concept of ‘one medicine’ is illustrated as a large tree (medicine), the trunk of which is placed on fertile soil (basic sciences); it divides into two principal branches (human medicine and veterinary medicine) that are connected to each other by a large branch (public health). Satellite branches (specialisations) derive from each of the three main branches. Babylonian, Egyptian, Greek, Roman and Arabic healers and physicians cured both human and animal diseases. During the Middle Ages, the two medicines were separated for religious and practical reasons. Figure 1 The Renaissance witnessed a revival of The ‘One Medicine’ tree comparative medicine. Cattle plague which occurred between the xvi and the xix centuries In this paper, the factors that explain and highlighted the value of the contributions of encourage the link between the two medicines many outstanding physicians and other are analysed; this is a concept that is strongly scientists. The need for specialised operators supported by the Mediterranean Zoonoses justified the establishment of veterinary Control Programme (MZCP). schools in many countries. This emphasised and formalised the division between the two An ethical consideration medicines and constituted an important handicap for the practice of a holistic public Humans (one species) and animals (many health. In 1948, the importance of re‐bridging species) share the same planet and live on its the division between the two encouraged the resources. A partnership was established for World Health Organization (WHO) to set up a which animals provide to humans a series of veterinary public health programme, the goods and facilities; humans provide a selected principal function of which is to promote number of animals (the domesticated and 578 Vol. 44 (4), Vet Ital www.izs.it/vet_italiana © IZS A&M 2008 Adriano Mantovani Human and veterinary medicine: the priority for public health synergies semi‐domesticated species) what is required The production of these items requires the for their sustenance and production, while sharing of a number of resources, as follows: taking the authority and responsibility for the foodstuffs general management of the planet. Many water aspects concerning the fulfilment of the ethical space (aquatic, rural, urban, wild) obligations connected with this duty are environment debated in the academic, political, social and pharmaceutical products religious arenas. This discussion will be knowledge and technologies limited to the professional responsibilities, economic resources. even if some of the items that are presently Without the exploitation of these resources, considered ‘critical’ (e.g. food supply, human life would be very difficult or would environmental contamination and genetically differ greatly from what it is today. Human modified organisms or ‘GMO’) will have medicine, alone, does not have the necessary severe consequences on the future and deserve competence to manage human‐animal attention that is not limited to the medical coexistence for human survival and profit. professions. This may be achieved only by the contributions of veterinary medicine that The reasons of synergy oversee animal production. Table I lists the products of animal origin that are enjoyed, used or consumed by humans. The operational ground These are distinguished between those that are The activities that require synergy between obtained directly from living animals and human and veterinary medicine are as follows: those which require the death of the animal. zoonoses (classical) control The products are food and feed, protection and zoonoses (extended) control production materials, work, leisure, education, emergencies (action in) etc. environmental safety epidemiological investigation Table I food safety (including hazard analysis Products of animal origin used by humans critical control point or HACCP) Animal Product human nutrition From live animals Milk human/animal coexistence Blood professional education Eggs public health legislation Honey, wax, etc. public health management Manure research urban hygiene Work use of animals for human welfare. Wool Feathers The list commences with zoonoses, intended Company both in the classical sense (only communicable Sport agents, as defined by the WHO) and in the Prestige extended sense (any detriment to the health Education/rehabilitation and/or quality of human life derived from From dead animals Meat and viscera relationships with vertebrate or edible or toxic Skin, hairs, feathers invertebrate animals, as illustrated in Table II. Silk All activities connected with food safety are Bones, horns, etc. probably those that most need attention and Fats and oils collaboration. Important factors are connected to the environment, with the management of © IZS A&M 2008 www.izs.it/vet_italiana Vol. 44 (4), Vet Ital 579 Human and veterinary medicine: