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Progress report – One Health
  1. Adele Waters

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THIS journal has a proud history of driving the important concept of One Health – the understanding that the health of our species is inextricably interwoven with that of animals and the environment.

In November 2005, Veterinary Record and The BMJ published a joint issue with numerous articles on the theme of animal and human health (November 26, 2005, vol 157, pp 669-716).

Three years ago, we followed up with a series of articles exploring the meaning of One Health and how a collaborative and interdisciplinary approach could help solve emerging global problems.

And we have chronicled the history of this movement. While One Health is about more than infectious disease, its early roots date back to the mid-19th century when vets and doctors began working together, mainly around the zoonotic diseases – rabies, anthrax, glanders and TB, for example. It is this century, however, that has seen the most significant progress, following the emergence of diseases such as severe acute respiratory syndrome (SARS) and highly pathogenic avian influenza (HPAI H5N1).

In his review of progress for Veterinary Record (January 25, 2014, vol 174, pp 85-91), Paul Gibbs, professor emeritus at the College of Veterinary Medicine, University of Florida, explored whether the One Health movement would prove to be a short-lived response to that spate of animal-linked diseases or a paradigm shift that would lead to a deeper commitment to interdisciplinary action addressing the needs of society.

There is continued effort to make it the latter. It is recognised by key international agencies – FAO, WHO and OIE, for example – and there is a steady stream of global academic conferences badged under the One Health theme.

There are also significant programmes of work linked to One Health, for example the Zoonoses and Emerging Livestock Systems programme – an £18.5 million initiative that supports research into zoonotic diseases in developing countries, partly funded by the Department for International Development.

And while veterinary schools have incorporated One Health into their curricula, there are now signs that it is beginning to penetrate medical education.

It would seem that One Health has certainly established itself as a globally recognised concept in academic and professional circles. However there is some way to go before it is adopted as a universal ambition for all vets, doctors and environmentalists across the world or before it enters the public lexicon.

This summer, the BVA will host the first meeting of the UK One Health coordination group with representatives from BMA, the NHS, Veterinary Public Health Association, Royal College of Nursing and the Wildlife Trust as well as the BVA and BVNA.

At its core, One Health encourages interprofessional collaboration, education and problem-solving so, says BVA senior vice-president Sean Wensley, who will be drawing the group together, the group will explore how to make One Health just as much a reality for practitioners and educators as it is for policymakers and researchers.

One barrier to address is the One Health brand. Ironically, perhaps, there seems to be a plethora of terms for One Health. Eco Health, Eco-System Health, Planetary Health, Global Health, One Medicine, One Biology, One Welfare, as well as One Health. One view is that the label shouldn't matter so long as collaboration takes place. But One Health has become embedded as a term internationally and it makes intuitive sense – easily embracing physical, mental, social and environmental health.

Another barrier is size. Its remit has grown from a focus on infectious and emerging disease to a holistic one embracing climate change, other environmental issues plus social sciences. It has become rather a big beast, amorphous with unclear boundaries.

While this elasticity has encouraged adoption and spread, its more dilute meaning has perhaps made it more difficult to run with in terms of deliverables. What does One Health mean to a hardworking small animal vet in Cambridge, for example? How do you get traction with busy healthcare professionals? It is surely here, at the coalface, that One Health meets its biggest challenge.

That is not to say that practitioners are not engaged. Across the UK, vets are focused on tackling antibiotic resistance and minimising antibiotic use. Rightly so. Of all the One Health issues, antibiotic resistance has become the new driving force for cross-professional collaboration. Where as avian influenza was the key prompt for the WHO and FAO to work together in 2004, it is now antibiotic resistance that is bringing people together, including environmental leaders.

But there are other examples, too, of how vets are practising One Health. A group of vet practices in Scotland has teamed up with NHS Fife, for example, to educate clients about the dangers of passive smoking to their pets and encourage them to provide smoke-free homes. Others are have set up schemes to reduce obesity in clients and their pets.

So what does the progress report conclude for One Health? Professor Gibbs is satisfied that the concept has taken root – One Health has certainly become entrenched in the psyche of the veterinary profession. But what are the next steps?

There is a need for more practical support to help practitioners embrace One Health – perhaps a toolkit to help vets put One Health into practice?

It would be helpful, too, to identify One Health champions across the key disciplines. We need to identify the next Lord Soulsby, a vet whose contribution to interdisciplinary collaboration was marked by his presidency of the Royal Society of Medicine as well as the RCVS. The NHS has used tsars to champion good practice in complex areas of activity, perhaps that could work to good effect here?

And perhaps collaboration could be encouraged though vet-medic regional meetings to foster common thinking and common approaches?

Looking ahead, there will be a need to push for indicators and data to measure One Health progress in order to drive activity in priority areas. And there will be a clear need to influence government policy in order to further drive the One Health agenda.

But, probably a key requirement is to create a positive vision of One Health.

What would it feel like to be part of a One Health world? How would patients experience it? What would other spheres of life and work look like? Could it bring a better approach to dealing with work-life balance, the use of green space? Could it bring a ban on non-stun slaughter? Could it provide a means of alleviating poverty in the world's poorest societies?

Setting out that vision more tangibly, perhaps in the form of a short animation, would help coalesce understanding, not only among professionals but with the public.

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