One Health- from a narrow to a wider view.


By Peter Rabinowitz, MD MPH, COHR Director

Recently I spent time working in a tropical, rural region of Africa where livestock ownership is common and where many individuals live in close contact with their animals. Wildlife is also abundant although there are few wild areas nearby. It would seem to be a place where One Health would be a powerful and effective way to address health issues.
Yet when I asked local medical clinicians and public health officials about their opinion on issues of human animal contact and possible connections between human, animal health , and environment, I got shrugs- the connections did not seem obvious. And when I brought up the question of zoonotic diseases, they acknowledged that these occur, but seemed to assign lesser importance to them. Instead, these professionals were overwhelmed with the local impact of HIV, TB, and malaria, three diseases for which the local prevalence rates were some of the highest  in the world. These three diseases represented the greatest killers for the local population in many age categories.  
I could see their point- there is a need to focus on what is killing the most people, and usually that is not a zoonotic disease or anything directly to do with animals. As a result, conceptualizing One Health as primarily focused on zoonoses greatly limits the application of the approach.
Yet when one looks deeper, and takes a wider and more systems-based approach to One Health, the value becomes greater, and questions such as the following become the foundation to a more holistic approach to community health and disease challenges.
-What is the impact of the animal agriculture on the health of the community in terms of food, economic security, and other uses of animal products?
- what health complaints are tracking together in people and animals, and how can this information be used to improve medical care as well as vet care?
-what questions regarding animal contact should be incorporated into medical history taking?
-what is the impact of animal agriculture on the environment? And conversely;
-what environmental factors (including climate change, water scarcity, vector habitat, and sanitation) are affecting both humans and animals?
-what is the current use of antibiotics and the degree of antibiotic resistance in humans and animals, and are they related?
-what other changes in animal husbandry practices could improve both human and animal health?
-what are models for medical care that capitalize on human-animal relationships, such as joint vaccination drives for humans and animals?
There is a need to test the utility of such systems approaches, and the time to start is now.