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7 November, 2018 11:13:21 AM

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For a holistic approach for health

The health of humans, animals and the environment are inextricably linked
Mohammed Abul Kalam, PhD
For a holistic approach for health

Global One Health Day is  held annually on 3 November. Officially launched in April 2016 by 3 leading international One Health groups -- the One Health Commission, the One Health Initiative Autonomous pro bono Team, and the One Health Platform Foundation -- One Health Day answers the urgent need for a One Health trans-disciplinary approach towards solving today's critical global health challenges.

It is a timely initiative that gives scientists and advocates a powerful voice for moving beyond current provincial approaches to emerging zoonotic infectious diseases, antimicrobial resistance, climate change, environmental pollution, food safety, comparative/translational medicine, and many other problems, to a holistic default way of doing business. Today, this initiative has grown into an annual, sustainable platform for One Health supporters around the world.

The One Health approach is rooted in knowledge that the health of humans, animals and the environment are inextricably linked.  Activities conducted under the banner of One Health seek to promote and protect the health and well-being of all species.

The concept of One Health is not new, but new life was breathed into this approach early in the 21st century by the fear of emerging zoonotic diseases with the potential for extensive mortality to humans and animals, including food animals.  At the same time, biotechnology breakthroughs, such as whole genome sequencing and genetic engineering, provided unprecedented ability to address One Health challenges.The One Health concept is also a worldwide strategy for expanding interdisciplinary collaborations and communications in all aspects of health care for humans, animals, and the environment. The synergism achieved will advance health care for the 21st century and beyond by accelerating biomedical research discoveries, enhancing public health efficacy, expeditiously expanding the scientific knowledge base, and improving medical education and clinical care. When properly implemented, it will help protect and save untold millions of lives in our present and future generations.

The One Health concept recognizes that the health of people is closely linked to the health of animals and the environment. The One Health approach encourages the collaborative efforts of the human health, veterinary health, and environmental health communities working locally, nationally, and globally, to achieve optimal health for people, animals, and our environment. The One Health concept has become more important in recent years because many factors such as population growth, globalization of commerce, finance, production, and services, environmental changes such as climate change and deforestation, ever-increasing movement of people, animals, plants, food, and feed have altered the interactions among humans, animals, and the environment. These changes have caused the emergence and re-emergence of many diseases. The World Health Organization (WHO), the Food Agriculture Organization of the United Nations (FAO), the World Organization for Animal Health (OIE), the Centers for Disease Control (CDC), and the European Union all support the adoption of the One Health approach to respond to emerging infectious diseases and outbreaks. Without a One Health approach to understanding all the inter-related factors affecting transmission and spread of emerging infectious diseases, prevention, management and elimination will remain beyond our reach. Since its inception in 1994, ISID's Program on Monitoring Emerging Infectious Diseases (ProMED) has advocated the One Health concept by covering emerging and re-emerging infectious diseases and toxic exposures of interest to the plant, animal and human health sectors.

The last decade of the twentieth century and the first decade of the twenty-first century saw the emergence of a plethora of public health challenges at the convergence of human, animal, and environmental health, including bovine spongiform encephalopathy (BSE) and variant Creutzfeldt–Jakob Disease, H5N1 influenza, Nipah virus, West Nile Virus, 9/11 and the threat of bioterrorism, SARS, and the impact of climate change on global food systems. While the concept of zoonotic disease (i.e., diseases that are transmitted from animals to humans), and social and environmental determinants of health are well recognized in the public health community, education of medical professionals, by and large, remains segregated between human health (human medicine, nursing, public health), animal health (veterinary medicine, agricultural workers), and environmental health (ecologists).

One Health is a collaborative, multi-sectoral, and trans-disciplinary approach, working locally, regionally, nationally, and globally, to achieve optimal health and well-being of all animals, people, plants and their shared environment, recognizing their inextricable interconnections. The key idea is called 'one health': the concept that the well-being of humans, animals and the environment are linked. Applications of the one-health perspective abound.

The One Health approach states that the health of humans, animals, and the environment are interdependent and that promoting optimal health in any of these sectors requires cross-sectoral collaboration, communication, and respect. One Health is “the collaborative effort of multiple disciplines – working locally, nationally, and globally – to attain optimal health for people, animals, and our environment. Implementation of a One Health approach requires a team effort that brings together professionals who come from a variety of disciplines, including human medicine, veterinary medicine, ecosystem health, and agriculture. The Word Health Organization, World Organisation for Animal Health, and the Food and Agriculture Organization of the United Nations have recognized their shared responsibility to use One Health approaches for addressing a number of complex global challenges, such as rabies and antimicrobial resistance.

Although the One Health approach has resurfaced in recent years as a strategy to address complex problems at the interface of human, animal, and environmental health, little effort has been directed at identifying the seminal knowledge, skills, and attitudes necessary for individuals to successfully contribute to One Health efforts. The multidisciplinary nature of the One Health approach requires that One Health professionals are proficient in knowledge, skills, behaviors, and attitudes that go beyond the discipline-specific knowledge gained through traditional training programs. Identifying a set of One Health core competencies is critical to prepare professionals to tackle the health threats of the twenty-first century by working collaboratively with peers in other areas of expertise using a One Health approach. Education and training programs, which incorporate these core competencies, will create a workforce better able to address One Health challenges.

Rationale of One Health concept: (1) Planetary Environmental health may affect human and animal health through contamination, pollution and changing climate conditions that may lead to emergence of new infectious agents; (2) Worldwide, nearly 75 percent of all emerging human infectious diseases in the past three decades originated in animals; (3) The world population is projected to grow from 7 billion in 2011 to 9 billion by 2050; (4) To provide adequate healthcare, food and water for the growing global population, the health professions, and their related disciplines and institutions, must work together; and (5) Human-animal interactions / bonds can beneficially impact the health of both people and animals. Scope of One Health:Some people misunderstand and think that One Health is about everything therefore if must be about nothing.  But the truth is that One Health thinking (see definition above) and using the One Health approach is needed in so many arenas that it just seems to be about 'everything'. Here are a few arenas that urgently need the One Health approach, at all levels of academia, government, industry, policy and research, because of the inextricable interconnectedness of animal, environmental, human and plant health. Convergence of human, animal, and plant health and the health of the environment: (1) Human-animal bond (2) Professional education and training of the Next Generation of One Health professionals (3) Research, both basic and translational (4) Ensuring a safe food and water supply that is high quality, available and affordable (5) Agricultural production and land use / soil health (6) Natural resources and conservation (7) Disease surveillance, prevention and response, both infectious and chronic diseases (8) Comparative Medicine: commonality of diseases among people and  animals, such as cancer, obesity, and diabetes (9) Clinical medicine needs for interrelationship between the health professions (10) Environmental agent detection and response (11) Disaster preparedness and response (12) Public policy and regulation (13) Global trade, commerce and security; and (14) Communications and outreach

Potential Outcomes from the One Health Approach:(a)more interdisciplinary programs in education, training, research, and established policy; (b) more information sharing related to disease detection, diagnosis, education and research; (c) more prevention of diseases, both infectious and chronic; and (d) development of new therapies and approaches to treatments

Animals are sentinels for environmental contamination, but the signs they highlight are typically overlooked. For example, in the 1950s, health professionals in Minamata, Japan, ignored the local 'dancing' cats with neuropathological symptoms such as difficulty walking, convulsions and excess salivation. When humans also began to show signs of neurological damage, extensive investigations revealed that mercury was to blame, and that the source of the poisoning was local fish. Eventually, researchers discovered that a chlor-alkali production facility was releasing mercury into the bay, contaminating the fish and exposing the town's cats and humans.

Pets share people's homes and are vulnerable to similar environmental contaminations. Lead poisoning from sources such as paint, for instance, continues to be a major public health concern, especially in children. Using a one-health approach, monitoring the levels of hazardous substances such as lead in pets would guard against the poisoning of children.

The availability of safe, nutritious food is essential for global health and well-being. But agriculture, especially livestock production, has led to widespread deforestation that has contributed to the emergence of zoonotic diseases and exacerbated the climate impact of greenhouse gases. Severe acute respiratory syndrome (SARS), Ebola and Nipah virus infection are among the diseases that have emerged from our demand for meat. SARS and Ebola spread directly to people who ate wild animals, or 'bushmeat.' Nipah virus spread to humans through pigs kept on farms built on deforested land — deforestation in Malaysia destroyed the habitats of the virus's host fruit bats, which began to feed on fruit trees near the farms and contaminate the fruit with their droppings.

Animal proteins are not essential for human health, but they do provide important nutrients. For everyone to become a vegetarian is not a realistic solution; evidence suggests that we are human because our ancestors hunted, cooked and ate meat. Ultimately, we must work out how to sustainably meet our need for animal proteins without unleashing more zoonotic diseases in a warming climate. A one-health approach is needed to ensure food security in the twenty-first century.

The writer is Former Head, Department of Medical Sociology,

Institute of Epidemiology, Disease Control & Research (IEDCR)

Dhaka, Bangladesh

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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