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One world, one medicine

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ENGLAND and America have been described as two nations separated by a common language. Whether one believes that or not, there is no doubt that they approach things differently in the usa. This was demonstrated at the American Veterinary Medical Association's (avma's) annual convention in Washington dc last week, during a series of sessions discussing the veterinary contribution to public health.

Veterinary public health is taken very seriously in the usa, not least because it is seen as being tied up with the issues of national security and safeguarding the nation's food supplies. This is reflected in the number of veterinarians working in this area and the fact that many of them are employed by the military. The subject already has a higher profile in the usa than in the uk but, with a theme of ‘One world, one health, one medicine’, the avma convention sought to raise that profile further. The initiative was given added momentum by the fact that, just a couple of weeks before the convention, the American Medical Association (ama) had adopted a ‘one health’ resolution aimed at promoting greater collaboration between human and veterinary medicine. This could include: joint educational efforts between human medical and veterinary medical schools; cross-species disease surveillance and control efforts in public health; and joint efforts for the development and evaluation of new diagnostic methods, medicines and vaccines. Following the ama's resolution, a multidisciplinary task force has been established to identify ways of taking the concept forward.

Giving the keynote address at the avma convention, Dr Julie Gerberding, director of the Centers for Disease Control and Prevention based in Atlanta, Georgia, eloquently expressed the need for veterinarians to be involved in disease prevention and public health, not least because the challenges facing the health professions were increasing. The nature of disease and other threats, coupled with higher public expectations, demanded a faster and better response, in a funding environment in which resources were limited. The solution, she suggested, was to improve ‘connectivity’ between the traditional health system, the public health system and the veterinary profession, and work towards a more integrated whole. Areas in which the veterinary contribution was needed related to global challenges from zoonotic and emerging infectious diseases, disaster management, and food production and food safety. It was also needed in the companion animal field, whether in relation to the human-companion animal bond or zoonotic hazards from pets. The veterinary contribution in these areas was vital but, she told delegates, ‘We don't have enough of you.’

The need for greater veterinary involvement in these fields was emphasised by a number of other speakers at the convention. The point was also made that, as well as strengthening links between the health professions, there was a need to improve connectivity between the public and private veterinary sectors.

Bridging the gap between the human and veterinary medical fields will require input from both sides, as well as better understanding by the professions of what each has to offer. Acknowledging this point in a press conference after her address, Dr Gerberding outlined a vision in which, rather than attending separate veterinary and medical schools, future students might initially study at ‘schools of health’. That way, rather than having two professions and building bridges afterwards, the health professionals of the future would start from a common base.

The ‘one medicine’ concept is by no means new, but there is no doubt that, with increased globalisation and advances in the understanding of disease, it is becoming increasingly relevant. Diseases such as bse, sars, monkeypox and avian influenza have highlighted the need for interprofessional collaboration, not just locally and nationally, but on a global scale. Some of these issues were explored in a joint issue of The Veterinary Record and the British Medical Journal published in 2005 (VR, November 26, 2005, vol 157, pp 669-716; BMJ, November 26, 2005, vol 331, pp 1213-1280). As articles in the two journals made clear, there are many areas of overlap and various initiatives are under way. However, as both they and the recent avma convention highlighted, there is considerable scope for closer collaboration and developing a more integrated approach.

Approaches might differ on different sides of the Atlantic, but there is a need, globally, to work towards a common goal. At a time when its traditional role in agriculture is changing, the veterinary profession in the uk should consider how big a role it wants to play in this area and what it can do to help drive the ‘one medicine’ concept forward. In the uk, as in the usa, there are undoubtedly opportunities, and greater veterinary involvement will be to the benefit of society as a whole.

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