Public health ethics and more-than-human solidarity

Human-animal interaction and One Health: establishment and validation of the Brazilian version of the Animal Empathy Scale

OBJECTIVE

To design and validate a Brazilian version of the Animal Empathy Scale, based on the existing Portuguese version.

METHODS

Content validity assessment was performed by expert judges, and the adapted scale was administered to a sample of 386 participants. Exploratory and confirmatory factor analyses were performed.

RESULTS

The bifactorial profile of the scale remained consistent, comprising Empathic Concern for Animals (Cronbach's alpha and McDonald's omega coefficients: 0.75) and Emotional Attachment with Animals (Cronbach's alpha and McDonald's omega coefficients: 0.79). Considering the One Health framework, collaborative, multidisciplinary, and intersectoral approaches are essential for achieving optimal health conditions for people, animals, and the environment given their intricate interconnections. Empathy plays a crucial role in promoting proximity between humans and animals, fostering positive connections that encourage biodiversity conservation.

CONCLUSION

The 13 statements were retained, confirming the validity of the animal empathy scale for use in Brazil, and a Brazilian version of the Animal Empathy Scale was established.

"Lives versus livelihoods": Conflict and coherence between policy objectives in the COVID-19 pandemic

Many policies were put in place during the COVID-19 pandemic in the United States to manage the negative impact of the coronavirus. Limiting severe illness and death was one important objective of these policies, but it is widely acknowledged by public health ethicists that pandemic policies needed to consider other factors. Drawing on semi-structured interviews with 38 people across 17 states who participated in the state-level COVID-19 pandemic policy process, we examine how those actors recounted their engagement with four different objectives over the course of the pandemic: protecting public health with respect to COVID-19 (which we refer to as pathogen-focused disease prevention), protecting the economy, promoting the public's broader health and wellbeing, and preserving and restoring individual freedoms. We describe the different ways that pathogen-focused disease prevention was thought to have conflicted with, or to have been coherent with, the other three policy objectives over the course of the pandemic. In tracing the shifting relationships between objectives, we highlight four reasons put forward by the participants for why policy changes occurred throughout the pandemic: a change on the part of decisionmaker(s) regarding the perceived acceptability of the negative effects of a policy on one or more policy objectives; a change in the epistemic context; a change in the 'tools in the toolbox'; and a change in the public's attitudes that affected the feasibility of a policy. We conclude by considering the ethical implications of the shifting relationships that were described between objectives over the course of the pandemic.

Uncovering associations between interest in One Health and pre-existing conditions and behaviours: Evidence from a UK survey

This paper endeavours to unveil individual characteristics associated with an interest in One Health. Through the distribution of an online survey randomly distributed among the United Kingdom population, we discovered significant correlations between pre-existing attitudes towards and relationships with nature and animals and interest in One Health, which is quantified by the number of additional pages of One Health information participants agreed to view at the survey's conclusion. Additionally, individuals with poorer mental health demonstrated a higher level of interest in One Health. The findings suggest that interest in One Health and people's connections with nature and animals are driven by the same personal preferences. These insights point towards the potential for more targeted communication strategies to specific groups, facilitating more effective promotion of the One Health concept.

Understanding Pandemic Solidarity: Mutual Support During the First COVID-19 Lockdown in the United Kingdom

Throughout the COVID-19 pandemic, the concept of solidarity has been invoked frequently. Much interest has centred around how citizens and communities support one another during times of uncertainty. Yet, empirical research which accounts and understands citizen's views on pandemic solidarity, or their actual practices has remained limited. Drawing upon the analysis of data from 35 qualitative interviews, this article investigates how residents in England and Scotland enacted, understood, or criticised (the lack of) solidarity during the first national lockdown in the United Kingdom in April 2020-at a time when media celebrated solidarity as being at an all-time high. It finds that although solidarity was practiced by some people, the perceived lack of solidarity was just as pronounced. We conclude that despite frequent mobilisations of solidarity by policy makers and other public actors, actual practices of solidarity are poorly understood-despite the importance of solidarity for public health and policy.

Solidarity for the Anthropocene

Social solidarity is essential to large-scale collective action, but the need for solidarity has received little attention from scholars of Earth Systems, sustainability and public health. Now, the need for solidarity requires recognition. We have entered a new planetary epoch - the Anthropocene - in which human-induced global changes are occurring at an unprecedented scale. There are multiple health crises facing humanity - widening inequity, climate change, biodiversity loss, diminishing resources, persistent poverty, armed conflict, large-scale migration, and others. These global challenges are so far-reaching, and call for such extensive, large-scale action, that solidarity is a sine qua non for tackling these challenges. However, the heightened need for solidarity has received little attention in the context of the Anthropocene and, in particular, how it can be created and nurtured has been overlooked. In this commentary, we explore the concept of solidarity from inter-species, intra-generational and inter-generational perspectives. We also propose strategies to enhance solidarity in the Anthropocene.

"Whoever takes the dog gets the house": How older adults negotiate, budget, and deploy resources for multispecies family health and well-being

In this study, we interrogate the ways that older adult pet owners exercise their agency within the limits of their social statuses to allocate their resources for the management of the health needs of their multispecies families. Guided by fundamental cause theory, we consider how the participants' memberships in socially constructed categories can impact their experiences with household health management. We conducted focus groups with 30 community-dwelling older adults who owned pets. Using a thematic analytic approach, we found that the participants' bonds with their pets led them to negotiate priorities and make concessions for the benefit of the household.

What does One Health want? Feminist, posthuman, and anti-colonial possibilities

What does One Health want? Despite its touted interdisciplinarity, to date there has been limited engagement with the social sciences and humanities - in particular with streams of critical social theory that enable a response to this question. In this paper we draw on the critical social sciences to consider how One Health is defined, conceptualized, and positioned, and discuss what we see as vital challenges within One Health that both limit its potential for meaningful change and contribute to a potential for ongoing harm - namely, medicalization, anthropocentrism, and colonial-capitalism. We then advance three areas in the critical social sciences that hold potential for addressing these challenges - feminist, posthuman, and anti-colonial approaches. By doing so we seek to encourage a deeper transdisciplinarity within One Health - one that is open to a genuine engagement with insights from critical social theory and a re-orientation towards more creative and radical re-imaginings in the service of wellbeing for diverse peoples, animals, other beings, and the land.

In critique of anthropocentrism: a more-than-human ethical framework for antimicrobial resistance

Antimicrobial resistance (AMR) is often framed as a One Health issue, premised on the interdependence between human, animal and environmental health. Despite this framing, the focus across policymaking, implementation and the ethics of AMR remains anthropocentric in practice, with human health taking priority over the health of non-human animals and the environment, both of which mostly appear as secondary elements to be adjusted to minimise impact on human populations. This perpetuates cross-sectoral asymmetries whereby human health institutions have access to bigger budgets and technical support, limiting the ability of agricultural, animal health or environmental institutions to effectively implement policy initiatives. In this article, we review these asymmetries from an ethical perspective. Through a review and analysis of contemporary literature on the ethics of AMR, we demonstrate how the ethical challenges and tensions raised still emerge from an anthropocentric framing, and argue that such literature fails to address the problematic health hierarchies that underlie policies and ethics of AMR. As a consequence, they fail to provide the necessary tools to ethically evaluate the more-than-human challenges that the long list of actors involved in managing AMR face in their everyday practices. In response to such shortcomings, and to make sense of these challenges and tensions, this article develops an ethical framework based on relationality, care ethics and ambivalence that attends to the more-than-human character of AMR. We formulate this approach without overlooking everyday challenges of implementation by putting the framework in conversation with concrete situations from precarious settings in West Africa. This article concludes by arguing that a useful AMR ethics framework needs to consider and take seriously non-human others as an integral part of both health and disease in any given ecology.

One Health: An Effective and Ethical Approach to Leptospirosis Control in Australia

The increasing concerns over emerging infectious diseases and potential pandemics led to the formation of One Health, a collaborative, multidisciplinary approach to address the risks from human-animal-ecosystem interactions. This multi-sectoral approach is specifically important in Australia, a biodiverse country with unique flora, fauna, and many infectious diseases, including leptospirosis. Leptospirosis is a relatively rare but potentially fatal zoonosis, with an attributed mortality of around 60,000 deaths per year worldwide. In recent years, sporadic cases and alarming outbreaks of leptospirosis have been notified in many states and territories of Australia, noteworthily in 2018 and 2019. The sudden outbreaks in these two years have raised a question about the possibility of a more severe menace or a potential threat to both humans and animals. Amid the fight against leptospirosis, One Health has been shown to be an excellent and ideal framework, especially in Australia, the country that has taken the lead in zoonosis control using this approach. In this review, the focus will be put on the effectiveness and ethics of One Health in leptospirosis control under the Australian setting to further advocate the implementation of this framework for many other infectious diseases.

Processes underpinning survival in gay men living with HIV and a history of suicidality

Gay men living with HIV represent a particularly high risk group for suicide; however, little is known about suicidality, specifically, resiliencies in the context of suicidality among this particular group of men. The current study draws on photovoice and grounded theory methods to examine the processes that underpin survival for gay men living with HIV who have experienced suicidality. Twenty-two Canadian-based gay men participated, taking photographs to depict and discuss their perspectives on resiliencies. Analyses revealed three processes that supported men's survival: (1) connecting to key supports, (2) finding sanctity in the outdoors, and (3) giving help as purposeful value-adding. Connecting to key supports highlighted the utility of connection and therapeutic communication, listening and support provided by friends, family and professionals. Finding sanctity in the outdoors emphasised the healing capacity of outdoor green spaces, and giving help as purposeful value-adding illustrated the meaning and purpose men derived from supporting others. These findings can inform public health and primary care interventions to foster gay men's resilience and coping, and ultimately suicide prevention efforts.

Institutional one health and animal-human health connections in Nthongoni, Eastern Kenya

In recent years, there has been increased global advocacy for the use of a collaborative, multisectoral, and transdisciplinary approach: a One Health approach, with the goal to achieve optimal health outcomes for people, animals and their shared environment. This study explored One Health implementation and practice in Kenya. Further, I used a case study of Nthongoni, a remote rural area in Eastern Kenya, to help us to understand and think about implementation of One Health in an area where mainstream biomedical system runs parallel to or is in conflict with, a deeply entrenched indigenous health system. I used a qualitative research approach including participant observation, and key informant and general respondents' in-depth interviews. Data was transcribed verbatim, translated, checked for consistency and coded for content and thematic analysis. The findings indicate that although Kenya's One Health approach was hailed as a key strategy and a model for other countries in the region, the approach faced significant challenges including insufficient funding, competing priorities and concerns over its sustainability. But while the formal One Health is embroiled in structural and politico-economic influences that curtail its operationalization and success, this study illuminates a lay one health that is part of lived realities in Nthongoni, inviting us to reflect on the place for and status of traditional healers, and meaning of health for people and animals. The study further provokes our thoughts over whether One Health should integrate or do away with traditional health systems, or be abandoned altogether. I argue that incorporating traditional health knowledge and practitioners in One Health might help to make health care more robust and culturally responsive. The work contributes to debates on anthropology of health in general and to anthropological understanding of both the lay one health and the institutional One Health agenda.

Leashes, Litterboxes, and Lifelines: Exploring Volunteer-Based Pet Care Assistance Programs for Older Adults

At the convergence of population aging and pet-ownership, community stakeholders are well-positioned to support older adults' relationships with companion animals through age-related transitions in health and living arrangements. In this study's setting, a volunteer-based pet care assistance program launched in 2017 to provide practical assistance with pet care for socially disadvantaged, community-dwelling older adults. This case study explored the impacts and feasibility of this and similar programs via (i) an Internet-based environmental scan to compare similar programs and (ii) qualitative interviews with a sampling of diverse community stakeholders (n = 9). A small number of comparable international programs (n = 16) were found. Among these, programs were delivered using a range of funding models; fewer than half involved collaborations across human social services and animal welfare sectors; and none addressed all dimensions of support offered by our local program. Analysis of qualitative interviews highlighted five major themes confirming the value of the volunteer-based approach and the importance of cross-sectoral collaborations in addressing older adults' under-recognized pet care-related needs. Taken together, the findings confirmed the effectiveness of our local program model. Collaborative, cross-sectoral programs that target both human and companion animal well-being hold promise to reduce barriers to pet ownership that many disadvantaged older adults face. This unique approach leverages the health-promoting potential of human-animal relationships in ways that enhance quality of life for individuals, animal welfare, and age-friendliness of communities.

Bio-Ethics and One Health: A Case Study Approach to Building Reflexive Governance

Surveillance programs supporting the management of One Health issues such as antibiotic resistance are complex systems in themselves. Designing ethical surveillance systems is thus a complex task (retroactive and iterative), yet one that is also complicated to implement and evaluate (e.g., sharing, collaboration, and governance). The governance of health surveillance requires attention to ethical concerns about data and knowledge (e.g., performance, trust, accountability, and transparency) and empowerment ethics, also referred to as a form of responsible self-governance. Ethics in reflexive governance operates as a systematic critical-thinking procedure that aims to define its value: What are the “right” criteria to justify how to govern “good” actions for a “better” future? The objective is to lay the foundations for a methodological framework in empirical bioethics, the rudiments of which have been applied to a case study to building reflexive governance in One Health. This ongoing critical thinking process involves “mapping, framing, and shaping” the dynamics of interests and perspectives that could jeopardize a “better” future. This paper proposes to hybridize methods to combine insights from collective deliberation and expert evaluation through a reflexive governance functioning as a community-based action-ethics methodology. The intention is to empower individuals and associations in a dialogue with society, which operation is carried out using a case study approach on data sharing systems. We based our reasoning on a feasibility study conducted in Québec, Canada (2018–2021), envisioning an antibiotic use surveillance program in animal health for 2023. Using the adaptive cycle and governance techniques and perspectives, we synthesize an alternative governance model rooted in the value of empowerment. The framework, depicted as a new “research and design (R&D)” practice, is linking operation and innovation by bridging the gap between Reflexive, Evaluative, and Deliberative reasonings and by intellectualizing the management of democratizing critical thinking locally (collective ethics) by recognizing its context (social ethics). Drawing on the literature in One Health and sustainable development studies, this article describes how a communitarian and pragmatic approach can broaden the vision of feasibility studies to ease collaboration through public-private-academic partnerships. The result is a process that “reassembles” the One Health paradigm under the perspective of global bioethics to create bridges between the person and the ecosystem through pragmatic ethics.

Getting out of crises: Environmental, social-ecological and evolutionary research is needed to avoid future risks of pandemics

The implementation of One Health/EcoHealth/Planetary Health approaches has been identified as key (i) to address the strong interconnections between risk for pandemics, climate change and biodiversity loss and (ii) to develop and implement solutions to these interlinked crises. As a response to the multiple calls from scientists on that subject, we have here proposed seven long-term research questions regarding COVID-19 and emerging infectious diseases (EIDs) that are based on effective integration of environmental, ecological, evolutionary, and social sciences to better anticipate and mitigate EIDs. Research needs cover the social ecology of infectious disease agents, their evolution, the determinants of susceptibility of humans and animals to infections, and the human and ecological factors accelerating infectious disease emergence. For comprehensive investigation, they include the development of nature-based solutions to interlinked global planetary crises, addressing ethical and philosophical questions regarding the relationship of humans to nature and regarding transformative changes to safeguard the environment and human health. In support of this research, we propose the implementation of innovative multidisciplinary facilities embedded in social ecosystems locally: ecological health observatories and living laboratories. This work was carried out in the frame of the European Community project HERA (www.HERAresearchEU.eu), which aims to set priorities for an environment, climate and health research agenda in the European Union by adopting a systemic approach in the face of global environmental change.

Human-Animal Relationships in Supported Housing: Animal Atmospheres for Mental Health Recovery

Being in a relationship with an animal can promote the well-being of people. For many individuals, this usually takes place at home. This study reports about homes for people with mental health problems (with or without co-occurring substance use), who live in supported housing operated by public landlords, entailing tenancies that are usually stricter regarding their pet policies than ordinary homes. We thus addressed the following research questions through ethnographic fieldwork at seven distinct places: which types of human–animal relationships occur in supported housing, and how do they affect the tenants? We analyzed the collected data informed by the Grounded Theory approach and found three types of human–animal relationships within supported housing affecting the tenants differently, namely, “no animals,” “visiting animals,” and “shared/sole ownership of animals.” Animals in the buildings can stage atmospheres that promote solidarity and connectedness among people. In contrast, situations in which animals are forbidden can create emotional tensions between tenants and staff or landlords. When discussing fostering animal atmospheres and limits to keeping pets, we concluded that animals can contribute to the mental health recovery of tenants by creating acknowledgment and rootedness. Therefore, public housing services need to guarantee equal rights to the tenants as they do with every citizen, including the right to keep a pet.

What Do Veterinary Students Value about Service Learning? Insights from Subsidized Clinics in an Urban Environment

To promote accessible veterinary care in the community and to help students refine their communication skills, the University of Calgary, Faculty of Veterinary Medicine (UCVM) partnered with the Calgary Urban Project Society (CUPS), a human services organization, to develop the UCVM-CUPS Pet Health Clinics. These clinics are a service-learning experience where third-year students provide services to those facing barriers to veterinary care in Calgary, Alberta. The clinics are offered at CUPS for 6 weeks at 1 day per week. Each student participates in one 4-hour lab; running two 90-minute appointments. In this mixed-methods article, the question was asked: How does a communication-based veterinary service learning program impact students' perception and knowledge of their skills and their perceived role in community outreach to underserved populations and their animals? All third-year veterinary students (N = 30) participated in the 2018 UCVM-CUPS Pet Health Clinics. Students completed a demographics survey, and a pre- and post-clinic questionnaire. Statistical analysis was used to compare pre- and post-clinic responses, and to determine relationships between questionnaire responses and the demographics survey data. Students were significantly more in agreement with statements that demonstrated confidence in their medical knowledge, technical abilities, and communication skills after participating in the program. There was significantly more disagreement to continue volunteering after graduation, but many planned on providing community outreach. Overall, students felt a strong sense of social responsibility and were motivated to help underserved populations. The findings suggest that communication-based, service-learning experiences are related to greater social awareness and enhance students' clinical skills including communication.

Responsibility-sharing for pets in disasters: lessons for One Health promotion arising from disaster management challenges

During disasters, the behaviour of pet owners and of pets themselves may compromise the ability of emergency responders to perform their duties safely. Furthermore, pet loss can have deleterious effects on personal and community recovery. To explore these issues and their implications for health promotion and disaster management practice, we conducted semi-structured interviews with 27 emergency responders in Australia, where disaster policy embraces shared responsibility yet does not acknowledge pets. We found that responders commit to being responsible for protecting human lives, especially members of their teams. Frontline emergency responders did not regard pets as their responsibility, yet decisions made with tragic consequences for pets exacted an emotional toll. Emergency managers consider community education as a pivotal strategy to support building people's capacity to reduce their own risk in disasters. While important, we question whether this is sufficient given that human life is lived in more-than-human contexts. Reformulating the parameters of the Ottawa Charter for Health Promotion as 'One Health Promotion' may help to account for the intermeshed lives of people and pets, while acknowledging human priority in public policy and programming. To acknowledge the influence of people's pets in disaster responses and recovery, we recommend five overlapping spheres of action: (i) integrate pets into disaster management practice and policy; (ii) create pet-friendly environments and related policies; (iii) engage community action in disaster management planning; (iv) develop personal skills by engaging owners in capacity building and (v) reorient health and emergency services toward a more-than-human approach.

Relational health: Theorizing plants as health-supporting actors

'Plant blindness' stops people from recognizing the important role that plants play in society, and is acute when it comes to seeing how plants support health. The social sciences are beginning to explore how plants are imbricated in sociopolitical processes, including ones that produce health. This paper theorizes people-plant relations and the agency of plants in the production of health, drawing on data from a multispecies ethnography conducted in Toronto's largest social housing community during the 2018 growing season. The paper applies a posthumanist lens to find that food-producing plants in the area exert their agency and are health-supporting actors when collaborating with residents to advocate for community gardens and influence neighbourhood design. By arguing that plants are actual agents of change in sociopolitical processes, the article deepens an understanding of the health-supporting role of plants and provides empirical evidence for a view of health as a process, as opposed to a status, that is produced through relationships. The paper suggests that the term 'relational health' be used to describe a conception of health that recognizes that health is produced through interconnections and interdependencies, including between people and plants. The article contributes to discourses exploring the human health relationship to nature, including One Health.

The Berlin principles on one health - Bridging global health and conservation

For over 15-years, proponents of the One Health approach have worked to consistently interweave components that should never have been separated and now more than ever need to be re-connected: the health of humans, non-human animals, and ecosystems. We have failed to heed the warning signs. A One Health approach is paramount in directing our future health in this acutely and irrevocably changed world. COVID-19 has shown us the exorbitant cost of inaction. The time to act is now.

Korean mothers' morality in the wake of COVID-19 contact-tracing surveillance

The Korean government collects and releases sociodemographic information about people infected with COVID-19, their travel histories, and whether or not the patients wore masks. Korean mothers then upload this information on the boards of online groups called "mom cafes." Based upon a digital ethnography of 15 "mom cafes," we examine how Korean mothers understand the travel histories of virus patients and explore the relationships between morality and materiality in the context of infectious disease surveillance. The main findings reveal that mom cafe mothers form moral personhood based on information gathered about artifacts, places, and the mobility of patients. They tie patients' travel histories inextricably to moral identities. Non-maleficence is central to Korean mothers' morality. This morality appears through the material discourses of artifacts, places, and mobility. A face mask becomes one such hallmark of morality. It is a requisite for moral persons. Those who visit crowded places, such as churches, clubs, and room salons, become immoral because they can be easily infected and spread the virus to their families and communities. To mom cafe mothers, mobile patients, such as clubbers, appear less moral than those who self-quarantine due to the high infection rate of COVID-19. We conclude that morality in this context involves the materiality of artifacts, a sense of place, and the spatial mobility of people.

"Health in" and "Health of" Social-Ecological Systems: A Practical Framework for the Management of Healthy and Resilient Agricultural and Natural Ecosystems

The past two decades have seen an accumulation of theoretical and empirical evidence for the interlinkages between human health and well-being, biodiversity and ecosystem services, and agriculture. The COVID-19 pandemic has highlighted the devastating impacts that an emerging pathogen, of animal origin, can have on human societies and economies. A number of scholars have called for the wider adoption of “One Health integrated approaches” to better prevent, and respond to, the threats of emerging zoonotic diseases. However, there are theoretical and practical challenges that have precluded the full development and practical implementation of this approach. Whilst integrated approaches to health are increasingly adopting a social-ecological system framework (SES), the lack of clarity in framing the key concept of resilience in health contexts remains a major barrier to its implementation by scientists and practitioners. We propose an operational framework, based on a transdisciplinary definition of Socio-Ecological System Health (SESH) that explicitly links health and ecosystem management with the resilience of SES, and the adaptive capacity of the actors and agents within SES, to prevent and cope with emerging health and environmental risks. We focus on agricultural transitions that play a critical role in disease emergence and biodiversity conservation, to illustrate the proposed participatory framework to frame and co-design SESH interventions. Finally, we highlight critical changes that are needed from researchers, policy makers and donors, in order to engage communities and other stakeholders involved in the management of their own health and that of the underpinning ecosystems.

One health ethics: a response to pragmatism

Johnson and Degeling have recently enquired whether one health (OH) requires a comprehensive normative framework, concluding that such a framework, while not necessary, may be helpful. In this commentary, we provide a context for this debate, and describe how pragmatism has been predominant in the OH literature. We nevertheless argue that articulating a comprehensive normative theory to ground OH practice might clear existing vagueness and provide stronger guidance in relevant health dilemmas. A comprehensive theory will also be needed eventually to ground notions such as universal good. We, thus, call for the systematic articulation of a comprehensive, metaethical theory, concomitantly with already ongoing normative work.

One Health promotion and the politics of dog management in remote, northern Australian communities

Community perspectives are rarely sought or integrated into dog management policy and practice. Dog management in remote communities in Australia has focused on reducing the number of dogs, which is often implemented by visiting veterinarians, despite widely-held opinions that fly-in-fly-out services provide only temporary solutions. We conducted participatory research in a group of remote communities in northern Australia to explore how dog-related problems arise and are managed, and explain their impacts from a One Health perspective. Over the course of a year, 53 residents from a range of backgrounds contributed through in-depth interviews with key community service providers, and informal semi-structured discussions with community residents. Free-roaming dogs have broader impacts on canine and human health than previously documented. Dog-keeping norms that enable free-roaming can enhance human and dog wellbeing and intra-family connectivity. This can also cause disengagement and conflict with other residents, leading to resentment and occasionally violence towards dogs. Dog-related problems are underpinned by constraints associated with remote-living, governance and differing sociocultural norms. Focusing on dog population reduction detracts from the welfare benefits and sociocultural value of free-roaming dogs and undermines community-determined management that can overcome constraints to support local values and co-promote canine and human wellbeing.

Rethinking One Health: Emergent human, animal and environmental assemblages

One Health perspectives are growing in influence in global health. One Health is presented as being inherently interdisciplinary and integrative, drawing together human, animal and environmental health into a single gaze. Closer inspection, however, reveals that this presentation of entanglement is dependent upon an apolitical understanding of three pre-existing separate conceptual spaces that are brought to a point of connection. Drawing on research with livestock keepers in northern Tanzania, in the context of the history of livestock policy in colonial and postcolonial East Africa, this demonstrates what an extended model of One Health - one that moves from bounded human, animal and environmental sectors to co-constitutive assemblages - can do to create a flexible space that is inclusive of the multiplicity of health.

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We show that One Health is based on conceptual separation

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Colonial and postcolonial health policy in East Africa enacted this separation

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Critical social science forces One Health to recognise interspecies entanglements.

From more-than-human solidarity to multi-species biographical value: insights from a veterinary school about ethical dilemmas in One Health promotion

This article features a partnership between a veterinary school and a charity that aims to enhance the wellbeing of low-income people. Through this partnership, the charity periodically hosts veterinary clinics for clients and their pets. Even as the veterinarians and veterinary students duly examine people's pets, these pop-up clinics aim to help people and their pets. Hence our analysis revolves around the ethics of 'more-than-human solidarity'. By 'more-than-human solidarity', we mean efforts to help others that either center on or that implicate non-human beings. To delve into the ethical and sociological implications of subsidised veterinary services, and to assist with program planning, we conducted several in-depth interviews with veterinarians. Most substantively, we found that the veterinary school's outreach clinics give rise to multi-species biographical value, which is prized as a pedagogical resource for veterinary students. The veterinarians whom we interviewed felt troubled by the extent to which the pop-up clinics ultimately benefited the veterinary school, but also by the shortage of subsidised veterinary services in the vicinity. Based on these interviews and our own reflections, we invite more scholarship on cultural, economic and political influences that shape the lives of human beings and non-human animals alike.

One Health and Zoonotic Uncertainty in Singapore and Australia: Examining Different Regimes of Precaution in Outbreak Decision-Making

A One Health approach holds great promise for attenuating the risk and burdens of emerging infectious diseases (EIDs) in both human and animal populations. Because the course and costs of EID outbreaks are difficult to predict, One Health policies must deal with scientific uncertainty, whilst addressing the political, economic and ethical dimensions of communication and intervention strategies. Drawing on the outcomes of parallel Delphi surveys conducted with policymakers in Singapore and Australia, we explore the normative dimensions of two different precautionary approaches to EID decision-making—which we call regimes of risk management and organizing uncertainty, respectively. The imperative to act cautiously can be seen as either an epistemic rule or as a decision rule, which has implications for how EID uncertainty is managed. The normative features of each regime, and their implications for One Health approaches to infectious disease risks and outbreaks, are described. As One Health attempts to move upstream to prevent rather than react to emergence of EIDs in humans, we show how the approaches to uncertainty, taken by experts and decision-makers, and their choices about the content and quality of evidence, have implications for who pays the price of precaution, and, thereby, social and global justice.

Integrative concepts and practices of health in transdisciplinary social ecology

Increasing recognition of interdependencies of the health of humans, other organisms and ecosystems, and of their importance to socio-ecological systems, necessitates application of integrative concepts such as One Health and EcoHealth. These concepts open new perspectives for research and practice but also generate confusion and divergent opinion, prompting new theories, and call for empirical clarification and evaluation. Through a semi-systematic evaluation of knowledge generation in scientific publications (comprised of literature reviews, conceptual models and analyses of communities of practice), we show how integrative concepts and approaches to health evolve and are adopted. Our findings indicate that while their contexts, goals and rationales vary, integrative concepts of health essentially arise from shared interests in living systems. Despite recent increased attention to ecological and societal aspects of health including broader sustainability issues, the focus remains anthropocentric and oriented towards biomedicine. Practices reflect and in turn transform these concepts, which together with practices also influence ways of integration. Overarching narratives vary between optimism and pessimism towards integrated health and knowledge. We conclude that there is an urgent need for better, coherent and more deeply integrative health concepts, approaches and practices to foster the well-being of humans, other animals and ecosystems. Consideration of these concepts and practices has methodological and political importance, as it will transform thinking and action on both society and nature and specifically can enrich science and practice, expanding their scope and linking them better. Transdisciplinary efforts are crucial to developing such concepts and practices to properly address the multiple facets of health and to achieve their appropriate integration for the socio-ecological systems at stake. We propose the term “transdisciplinary health” to denote the new approaches needed.

Attending to scalar ethical issues in emerging approaches to environmental health research and practice

Accelerated changes to the planet have created novel spaces to re-imagine the boundaries and foci of environmental health research. Climate change, mass species extinction, ocean acidification, biogeochemical disturbance, and other emergent environmental issues have precipitated new population health perspectives, including, but not limited to, one health, ecohealth, and planetary health. These perspectives, while nuanced, all attempt to reconcile broad global challenges with localized health impacts by attending to the reciprocal relationships between the health of ecosystems, animals, and humans. While such innovation is to be encouraged, we argue that a more comprehensive engagement with the ethics of these emerging fields of inquiry will add value in terms of the significance and impact of associated interventions. In this contribution, we highlight how the concept of spatial and temporal scale can be usefully deployed to shed light on a variety of ethical issues common to emerging environmental health perspectives, and that the potential of scalar analysis implicit to van Potter's conceptualization of bioethics has yet to be fully appreciated. Specifically, we identify how scale interacts with key ethical issues that require consideration and clarification by one health, ecohealth, and planetary health researchers and practitioners to enhance the effectiveness of research and practice, including justice and governance.

Vaccination uptake and income inequalities within a mass vaccination campaign

BACKGROUND

In July 2013, Israel was swept with fear of a polio outbreak. In response to the importation of wild polio virus, the Ministry decided to take preventive action by administering oral poliovirus vaccine (OPV) to all children born after 1 January 2004 who had received at least one dose of inactivated poliovirus vaccine (IPV) in the past. This study analyzes the vaccination uptake rates resulting from the mass polio vaccination campaign on the basis of health inequality parameters of socioeconomic status (SES), principles of solidarity, and the Gini inequality index. The research explores understanding the value of the Gini inequality index within the context of SES and solidarity.

METHODS

The study is based on data gathered from the Israeli Ministry of Health's administrative records from mother-and-child clinics across Israel. The research population is comprised of resident infants and children whom the Ministry of Health defined as eligible for the OPV between August and December 2013 (the "campaign period"). The analysis was carried out at the municipality level as well as the statistical area level.

RESULTS

The higher the SES level of the municipality where the mother-and-child clinic is located, the lower the OPV vaccination uptake is. The greater the income inequality is in the municipality where the mother-and-child clinic is situated, the lower the vaccination uptake.

CONCLUSIONS

Public health professionals promoting vaccine programs need to make specially-designed efforts both in localities with high average income and in localities with a high level of income diversity/inequality. Such practice will better utilize funds, resources, and manpower dedicated to increasing vaccination uptake across varying populations and communities.

Insights about the Epidemiology of Dog Bites in a Canadian City Using a Dog Aggression Scale and Administrative Data

Simple Summary

Any dog is capable of biting, and dog bites can cause serious injuries to humans or other animals. To prevent dogs from biting, we need to understand the circumstances in which dog bites are most likely to occur. Once we have that information, we can act by improving public awareness and tailoring interventions to those most at risk of being injured. In this study, we assess the circumstances surrounding dog-bite injuries, by considering dog-bite severity in conjunction with information about where the incident occurred, about human victims, and about the dogs themselves. This approach was possible because The City of Calgary systematically tracks dog-bite severity. We found that from 2012–2017, the number of severe bites occurring in Calgary has fallen. That said, severe bites tended to occur in the homes where the dogs lived, and to be directed towards children and older adults. The results from our study underscore that educational communication for parents, grandparents, and other caregivers should emphasize the importance of constant supervision around dogs, including family dogs, whenever children are present. In addition, more attention should be paid to the risks that dogs pose to older adults. Failure to protect people from dog-bite injuries has implications for the dogs’ own welfare, as well as for human health. Dogs are most likely to bite when they feel insecure in the first place. Furthermore, common responses to severe dog-bite injuries in people include rehoming and euthanizing dogs.

Abstract

Dog bites are a public health concern that also implicates animal welfare, with negative outcomes such as rehoming or euthanasia for the animals responsible. Previous research has shown that the severity of dog-bite injuries reflects multiple factors, including the degree of inhibition exhibited by dogs and how people behave towards dogs. This study utilizes an objective dog bite injury assessment tool: The Dunbar aggression scale. Trained officers employed by The City of Calgary systematically use the Dunbar scale whenever investigating dog-bite complaints. We analyzed The City of Calgary’s administrative data on confirmed dog-bite injuries in people, 2012–2017, with a multivariable generalized ordered logistic regression model. Severe dog-bite injuries occurred more frequently in the family home than in any other setting. Young children, youths and older adults were at higher risk of more serious bites than adults. There has been a decreasing trend in the probability of a high or medium severity bite, and an increasing trend in the probability of a low severity bite since 2012. These results indicate that greater public awareness regarding dog-bite injuries is needed. Consideration should be given to campaigns targeted towards different demographics, including older adults, to provide an understanding of dog behaviour and to emphasize the need to supervise children closely in the presence of all dogs at all times, including family dogs in the home environment. Given that dog-bite injuries are not just a public health issue, but also an animal welfare issue, we endorse One Health responses in educational campaigns, policy development, and professional practice.

Does One Health require a novel ethical framework?

Emerging infectious diseases (EIDs) remain a significant and dynamic threat to the health of individuals and the well-being of communities across the globe. Over the last decade, in response to these threats, increasing scientific consensus has mobilised in support of a One Health (OH) approach so that OH is now widely regarded as the most effective way of addressing EID outbreaks and risks. Given the scientific focus on OH, there is growing interest in the philosophical and ethical dimensions of this approach, and a nascent OH literature is developing in the humanities. One of the key issues raised in this literature concerns ethical frameworks and whether OH merits the development of its very own ethical framework. In this paper, we argue that although the OH approach does not demand a new ethical framework (and that advocates of OH can coherently adhere to this approach while deploying existing ethical frameworks), an OH approach does furnish the theoretical resources to support a novel ethical framework, and there are benefits to developing one that may be lost in its absence. We begin by briefly explaining what an OH approach to the threats posed by EIDs entails before outlining two different ways of construing ethical frameworks. We then show that although on one account of ethical frameworks there is no need for OH to generate its own, there may be advantages for its advocates in doing so.

The good, the bad and the ugly: framing debates on nature in a One Health community

Originating in medical and veterinary spheres, the One Health concept stands as an open call for collaboration also between these disciplines or professions and those of environmental and social science. However, the communities of practice in question show uneasy or under-developed collaborations, due to a variety of factors. We argue that an important factor is the way issues are raised and questions are formulated, i.e., their framing. Based on complementary perspectives on health and knowledge, this overview provides an inter- and trans-disciplinary analysis of the role of the framing of « nature » in One Health discourses as a barrier or a facilitator to collaboration, as revealed by the scientific literature. We find that the lack of reflection by scientists about the framing under which they operate appears as a major factor of misunderstanding between disciplines, and a barrier for inter- and trans-disciplinary solutions to improve management of health risks and benefits. Hence, to build such solutions, framing will have to be a conscious and repeated step in the process, acknowledging and explaining the diversity of viewpoints and values. The interdisciplinary dialogues inherent in this process promote translation between scientific domains, policy-makers and citizens, with a critical but pluralistic recourse to various framings of health risks and benefits associated with nature, and a deep awareness of their practical and ethical consequences.

One Health as a moral dilemma: Towards a socially responsible zoonotic disease control

During the last decade, the concept of One Health has become the international standard for zoonotic disease control. This call for transdisciplinary collaboration between professionals in human, animal and environmental health has produced several successes in zoonotic disease control, surveillance and research. Despite the lack of a clear definition, a shared agenda or institutional governance, One Health has proven to be a fruitful idea. Due to its ambiguity, the One Health concept functions as a boundary object: by leaving room for interpretation to fit different purposes, it facilitates cooperation. In many cases, this results in the promotion of health of humans, animals and the environment. However, there are also situations in which this mutual benefit of a One Health approach is not that evident, for instance, when healthy animals are culled to protect public health. Although such a strategy could well be part of a One Health approach, it is hard to understand how this contributes to the health of concerning animals. Consequently, these practices often lead to public debate. This raises questions on how we should understand the One Health concept in zoonotic disease control. Is it really about equally improving the health of humans, animals and the environment and is this even possible? Or is it ultimately just public health that counts? In cases of conflict between different values, the lack of a universal definition of the One Health concept contributes to this complexity. Although boundary objects have many positive aspects, in the context of One Health and zoonotic disease control, this conception seems to conceal underlying normative differences. To address moral dilemmas related to a One Health approach in zoonotic disease control, it is important to reflect on moral status and the meaning of health for humans, animals and the environment.

A Radical Approach to Ebola: Saving Humans and Other Animals

As the usual regulatory framework did not fit well during the last Ebola outbreak, innovative thinking still needed. In the absence of an outbreak, randomised controlled trials of clinical efficacy in humans cannot be done, while during an outbreak such trials will continue to face significant practical, philosophical, and ethical challenges. This article argues that researchers should also test the safety and effectiveness of novel vaccines in wild apes by employing a pluralistic approach to evidence. There are three reasons to test vaccines in wild populations of apes: i) protect apes; ii) reduce Ebola transmission from wild animals to humans; and iii) accelerate vaccine development and licensing for humans. Data obtained from studies of vaccines among wild apes and chimpanzees may even be considered sufficient for licensing new vaccines for humans. This strategy will serve to benefit both wild apes and humans.

Training Dogs to Feel Good: Embodying Well-being in Multispecies Relations

Social science concepts of well-being are largely premised on notions of a common humanity with shared physical needs and broadly legible experiences of the world. While medical anthropologists have interrogated ideas of universal bodily subjectivities, articulations of well-being across species boundaries remain underexplored. This article offers a conceptualization of well-being that attends to species difference. Drawing on ethnographic research with an animal rescue organization, I argue that in the context of partially connected bodily experiences, rescue workers navigate distinctions between dogs' internal feelings and external actions, and they train their bodies alongside dogs' bodies to cultivate canine well-being. A multispecies perspective complicates ideals of autonomy and self-actualization long associated with well-being and opens up avenues for considering well-being as an intercorporeal relationship conditioned in unequal bodies and embodied interactions.

Disruptive Solidarity or Solidarity Disrupted? A Dialogical Narrative Analysis of Economically Vulnerable Older Adults' Efforts to Age in Place with Pets

Over one-third of older adults in many countries have a companion animal, and pets may harbor health-promoting potential. Few studies have considered pet-ownership in relation to economic vulnerability, and pet-ownership has not been often considered within policy efforts to promote ageing-in-place. We conducted a mixed methods case study to understand perspectives of both community agencies that support ageing-in-place and older adults themselves. A shortage of affordable, appropriate pet-friendly housing emerged as a challenge, even when framed as a legitimate choice and preference for many older adults. In this manuscript, we share the trajectories of three economically vulnerable older adults whose affordable housing needs became entangled with commitments to pets. Guided by dialogical narrative methodology, we offer each narrative as a short vignette to (i) illustrate the extent to which older adults will practice 'more-than-human solidarity' for a pet, even when their own well-being is compromised as a result; and (ii) highlight incongruence between the underlying moral values that shape solidaristic practices of individuals versus solidaristic arrangements that shape affordable housing opportunities. We suggest that housing rules and legislation that disrupt, rather than confirm, more-than-human solidarity may render older adults susceptible to, rather than protected from, deteriorating physical, mental and social well-being. We propose that collective solidaristic practices must reflect and subsume the moral complexity of solidarity practiced by individuals, to enable fair and equitable ageing-in-place.

Spatial Overlap Between People and Non-human Primates in a Fragmented Landscape

In western Uganda, the landscape surrounding Kibale National Park (KNP) contains households, trading centers, roads, fields, and forest fragments. The mosaic arrangement of these landscape features is thought to enhance human-primate interaction, leading to primate population declines and increased bi-directional disease transmission. Using a social-ecological systems research framework that captures the complexity of interaction among people, wildlife, and environment, we studied five forest fragments near KNP and conducted intensive on-the-ground mapping to identify locations of human-primate spatial overlap. Primate locations and human activities were distributed within, on the edges, and far beyond fragment borders. Analysis of shared spaces indicated that 5.5% of human space overlapped with primate spaces, while 69.5% of primate spaces overlapped with human spaces. Nearest neighbor analysis indicated that human activities were significantly spatially clustered within and around individual fragments, as were primate locations. Getis-Ord statistics revealed statistically significant "hotspots" of human activity and primate activity, but only one location where spatial overlap between humans and primates was statistically significant. Human activities associated with collecting fuelwood and other forest products were the primary drivers of human-primate overlap; however, primates also spent time outside of forest fragments in agricultural spaces. These results demonstrate that fragmented landscapes are not uniform with respect to human-primate overlap, and that the implications of human-primate interaction, such as primate population declines and possible cross-species disease transmission, are spatially aggregated.

Thinking ethical and regulatory frameworks in medicine from the perspective of solidarity on both sides of the Atlantic

This article provides a concise overview of the history of scholarship on solidarity in Europe and North America. While recent decades have seen an increase in conceptual and scholarly interest in solidarity in North America and other parts of the Anglo-Saxon world, the concept is much more strongly anchored in Europe. Continental European politics in particular have given rise to two of the most influential traditions of solidarity, namely, socialism and Christian ethics. Solidarity has also guided important public instruments and institutions in Europe (e.g., welfare, healthcare, etc.). Despite the much stronger affinity of continental European societies to solidaristic thinking, we argue that solidarity has much to offer for addressing societal challenges on both sides of the Atlantic and beyond. After proposing a working definition of solidarity that highlights its utility for guiding policy and practice, we give an example of how a solidarity-based perspective can shape instruments for the governance of data use.

Culling and the Common Good: Re-evaluating Harms and Benefits under the One Health Paradigm

One Health (OH) is a novel paradigm that recognizes that human and non-human animal health is interlinked through our shared environment. Increasingly prominent in public health responses to zoonoses, OH differs from traditional approaches to animal-borne infectious risks, because it also aims to promote the health of animals and ecological systems. Despite the widespread adoption of OH, culling remains a key component of institutional responses to the risks of zoonoses. Using the threats posed by highly pathogenic avian influenza viruses to human and animal health, economic activity and food security as a case exemplar, we explore whether culling and other standard control measures for animal-borne infectious disease might be justified as part of OH approaches. Our central premise is that OH requires us to reformulate 'health' as universal good that is best shared across species boundaries such that human health and well-being are contingent upon identifying and meeting the relevant sets of human and non-human interests and shared dependencies. Our purpose is to further nascent discussions about the ethical dimensions of OH and begin to describe the principles around which a public health agenda that truly seeks to co-promote human and non-human health could potentially begin to be implemented.

Towards better-informed consent: Research with livestock-keepers and informal traders in East Africa

With the rise of the One Health paradigm, ethicists have called for new research approaches, considering the interdependent relationships of humans, animals, and their environment. These relationships can be particularly complex within resource-poor, smallholder livestock systems, necessitating a rigorous informed-consent process. Little has been published on informed consent beyond human-subject research. This paper outlines two studies on informed consent, for research identifying diseases of animal and human importance, within smallholder livestock value chains. Firstly, a randomized independent-group study compared three communication tools (written, cartoons, and photographs) for informing 22 Tanzanian livestock-keepers before seeking their consent. A significant difference in comprehension and engagement in the informed-consent process was found between tools, and cartoons had the highest (i.e. best combined comprehension and engagement) scores. Most (21 out of 22) farmers answered half or more the questions correctly, but none were able to answer all questions. Comprehension testing allowed identification of common misunderstandings, such as immediate benefits the farmers would receive and the process to be used for relaying research results. Dialogue stimulated by cartoons and photographs allowed researchers to determine and respond to participants' varied relationships with their livestock. The second study assessed preferred methods for indicating consent among informal-sector milk vendors in Nairobi, Kenya. Of consenting participants, 61% (140/230) indicated consent verbally, 39% (90/230) signed consent and none chose thumbprint. There was a significant enumerator-effect on both overall consent and the methods chosen. Several of these findings echo those published in human-medical research. Additionally, highlighted here is the importance of facilitating dialogue during the informed-consent process in One Health research, for a more nuanced understanding of relationships between humans, animals, and their environment. Also discussed is how a requirement to sign consent forms might limit consent among workers in informal markets, which are commonly studied in One Health research. We suggest expansion of these, and development of further, studies towards improving consent processes in One Health research.