System Thinking and Citizen Participation Is Still Missing in One Health Initiatives - Lessons From Fifteen Evaluations

Who coined the term "One Health"? Cooperation amid the siloization

This short communication is an effort to describe and elucidate the trajectory of the modern historical concept of "One Health." It is dedicated to the many integrated approaches of health closely related to One Health, while also recognizing the contribution and origination of One Health perspectives/notions from those that have led the way and spearheaded this movement while considering Indigenous cultures across the world. The effects of synergies of those involved in building these integrative approaches are potentially bigger and better lasting than the sum of the individual players. It is only through collaboration, cooperation and diplomacy that we can achieve impactful transformation to benefit health. In this commentary, we aim to appropriately and accurately describe how the current use of "One Health" came to be and who were the main players.

The importance of incorporating systems thinking and One Health in global health classrooms: findings from a One Health simulation activity

There are several challenges and opportunities in health education in global health. Given the field's rapid expansion, demand for including systems thinking and One Health (a unifying approach that considers human, animal, and environmental health) in global health courses has recently increased. Simulation activities provide an avenue to attain and assess learning objectives that foster critical and systems thinking. This study carried out a One Health simulation activity in an undergraduate global health course, conducted a focus group discussion, and obtained responses from written questionnaires from students who participated in the activity. Data were analyzed using thematic analysis. Results show that the One Health simulation was instrumental for students to understand the complex interactions between different actors and stakeholders in global health systems. The One Health simulation also improved class dynamics, peer-to-peer interactions, and collaborations in the remaining part of the course. The activity helped assess two of the critical thinking learning objectives of the course, and there was some evidence that student agency and confidence may have been improved. Evidence shows that the activity helped students understand the principles of systems thinking and apply them in complex scenarios. Findings support including interactive simulation activities in global health courses to include elements of system science and One Health into classroom activities innovatively and engagingly.

Developing One Health surveillance systems

The health of humans, domestic and wild animals, plants, and the environment are inter-dependent. Global anthropogenic change is a key driver of disease emergence and spread and leads to biodiversity loss and ecosystem function degradation, which are themselves drivers of disease emergence. Pathogen spill-over events and subsequent disease outbreaks, including pandemics, in humans, animals and plants may arise when factors driving disease emergence and spread converge. One Health is an integrated approach that aims to sustainably balance and optimize human, animal and ecosystem health. Conventional disease surveillance has been siloed by sectors, with separate systems addressing the health of humans, domestic animals, cultivated plants, wildlife and the environment. One Health surveillance should include integrated surveillance for known and unknown pathogens, but combined with this more traditional disease-based surveillance, it also must include surveillance of drivers of disease emergence to improve prevention and mitigation of spill-over events. Here, we outline such an approach, including the characteristics and components required to overcome barriers and to optimize an integrated One Health surveillance system.

Implementation of 'One Health' approach in Kerala state, India - A systematic review

With humans, animals and the environment being as interconnected as they are, the science describing their interactions needs to cut across disciplinary boundaries. Systems research at the interface between the three goes by several names, such as 'Eco-Health' and 'Planetary Health', each with a varied focus, but the concept of 'One Health' (OH) has stood out as the most popular one. COVID-19 has reiterated the importance of OH in response to health challenges. This review aimed to assess the OH approach integration and implementation level in Kerala state, India, in the context of emerging zoonotic diseases. A systematic literature review was conducted by searching for relevant articles with specific keywords across six electronic databases. This involved screening the initial hits for titles and abstracts, then systematic sorting to identify the ones that met the criteria, followed by more thorough scrutiny to finally shortlist the six studies to be included in the review. We found that OH in Kerala has made good progress, as evident from a few recent examples, but has a long way to go with significant challenges. In line with the study's aim, identifying and analysing what is already done, what is missing and what needs to be done can have wider implications for future OH implementation. Relevant threats and opportunities were identified, with lessons for Kerala and India and broader applications.

The Past, Present, and Future of One Health in India: A Narrative Review

Humans have experienced a long-lasting pandemic of COVID-19 going on since the year 2020. Such events have recently increased the demand for a competent disease outbreak response system, more precisely, a One Health platform. The interaction between humans, animals, and ecosystems is inevitable. It is a known fact that the interface between these three entities is important for survival. In rural areas, especially in developing countries, it is a common practice to keep the animal shed in close proximity to their homes. Further, this intricate relationship itself plays a role in the spread and transmission of the disease. The involvement of the human-animal interface in emerging and re-emerging diseases has caused havoc in recent times and might prove challenging to overcome. Over the years, many efforts have been made on international and national platforms to adopt and implement a transdisciplinary, collaborative, intersectoral approach in India. This review highlights the major initiatives taken for the implementation of one health and the challenges faced over the years in our country.

Pillars for successful operationalization of one health as an ecosystem approach: experience from a human-animal interface in the Maasai steppe in Tanzania

BACKGROUND

Solving complex public health challenges requires integrated approaches to health, such as One Health. A key element of the One Health approach is the interrelationship between human, animal and environmental health and the associated multistakeholder collaboration across many cultural, disciplinary, institutional and sectoral boundaries. Here we describe a pragmatic approach for One Health operationalisation basing on our long-term engagement with communities faced with health challenges in a human-livestock-wildlife interface in the Maasai steppe in northern Tanzania.

METHODS

Using a qualitative study design we performed an outcome mapping to document insights on results integration from our previous project. Data were collected through participatory community meetings, in-depth interviews and field observations. Field notes were coded and analysed using inductive thematic analysis.

RESULTS

We found that effective implementation of One Health interventions in complex ecosystems works best by understanding local conditions and their context and by working closely with the local people and relevant disciplinary players as one complex adaptive system. Community engagement, systems analysis, transdisciplinarity as well as political commitment played critical roles in successful operationalization of One Health. We have further emphasized that project ownership is as important to the local community as it is to the researchers. When used in combination, these elements (community engagement, systems analysis, transdisciplinarity) provide essential pillars for co-creation and maintaining collective action to set a common vision across disciplines, serving as inputs for a metrics-based toolbox for One Health operationalisation.

CONCLUSION

Considering the novelty and complexity of One Health operationalisation, there is need also to develop scorecard-based guidance for assessment of One Health programs at local and national level. This paper proposes a framework for the optimization of an ecosystems-based One Health approach for prevention and control of Vector-Borne Diseases implemented at the local, sub-national or national level.

Translating One Health knowledge across different institutional and political contexts in Europe

BACKGROUND

Implementing a One Health approach is complex. It demands engaging different sectors and actors in the promotion and protection of human, animal and environmental health. A key challenge for successfully implementing the One Health approach are knowledge translation processes among scientists and policy-makers.

METHODS

An online survey reached 104 experts from 23 European countries, working at national agencies or institutes, universities, ministries, non-governmental organisations (World Health Organization, World Organisation for Animal Health), and European Union (EU) agencies. Qualitative and quantitative analyses were conducted to describe experts' perceptions.

RESULTS

This study indicated a lack of networks among scientists and between scientists and policy-makers. Relations of scientists and policy-makers were perceived as challenging due to different interests and priorities, leading to difficulties in reaching political attention for One Health topics. It also highlighted a favoured attention to some One Health topics (e.g. antimicrobial resistance) as opposed to others (e.g. environmental issues). Important international actors to push One Health policies forward were the Quadripartite organisations and EU agencies. National actors (government agencies, national research institutes, universities) were on average perceived to be more important than international actors due to their roles and influences. Factors influencing the knowledge translation process were the different languages spoken by scientists as well as politicians, and an equivocal understanding of the One Health approach.

CONCLUSION

The study shows the importance of leadership to establish interdisciplinary networks and to problematise One Health issues with clear scope and targets. This will help to link knowledge to needs and capabilities of policy-makers. Establishing strong relationships among national and international actors can encourage networks and raise awareness of the One Health approach to policy-makers. Lastly, promoting research communication skills of scientists can provide a valuable tool to reach policy-makers to enhance attention to One Health topics.

Research on Citizen Participation in Government Ecological Environment Governance Based on the Research Perspective of "Dual Carbon Target"

As the people's demand for a better life is getting higher and higher, citizens' requirements for the rural ecological environment are also constantly improving. At present, the deterioration of many rural environments and the cross-flow of sewage have brought great challenges to the governance of the rural ecological environment. Therefore, the improvement in the ability and level of rural ecological environment governance is the key to winning the battle of rural ecological environment governance, and the participation of citizens in rural ecological environment governance is even more crucial to the improvement in the ability and level of rural ecological environment governance. At present, academic achievements on rural ecological environment governance are increasingly enriched, but there are few academic achievements on rural ecological environment governance from the perspective of citizen participation. Since public participation in ecological environment governance is still in the initial stage of development, there are many factors that affect the effective implementation and development of public participation in the ecological environment. For example, various factors such as the imperfect legal system related to citizens' participation in rural ecological environment governance, weak awareness of citizen participation, and difficulty in determining the methods of citizen participation seriously hinder citizens' participation. Improve the theme awareness and ability of citizens to participate in ecological environment governance and to improve the citizen participation mechanism in my country's rural ecological environment governance. By analyzing and discussing the problems and countermeasures of public participation in environmental governance in my country, it is of positive significance to promote citizens' participation in ecological environmental governance.

Co-production of knowledge as part of a OneHealth approach to better control zoonotic diseases

There is increased global and national attention on the need for effective strategies to control zoonotic diseases. Quick, effective action is, however, hampered by poor evidence-bases and limited coordination between stakeholders from relevant sectors such as public and animal health, wildlife and forestry sectors at different scales, who may not usually work together. The OneHealth approach recognises the value of cross-sectoral evaluation of human, animal and environmental health questions in an integrated, holistic and transdisciplinary manner to reduce disease impacts and/or mitigate risks. Co-production of knowledge is also widely advocated to improve the quality and acceptability of decision-making across sectors and may be particularly important when it comes to zoonoses. This paper brings together OneHealth and knowledge co-production and reflects on lessons learned for future OneHealth co-production processes by describing a process implemented to understand spill-over and identify disease control and mitigation strategies for a zoonotic disease in Southern India (Kyasanur Forest Disease). The co-production process aimed to develop a joint decision-support tool with stakeholders, and we complemented our approach with a simple retrospective theory of change on researcher expectations of the system-level outcomes of the co-production process. Our results highlight that while co-production in OneHealth is a difficult and resource intensive process, requiring regular iterative adjustments and flexibility, the beneficial outcomes justify its adoption. A key future aim should be to improve and evaluate the degree of inter-sectoral collaboration required to achieve the aims of OneHealth. We conclude by providing guidelines based on our experience to help funders and decision-makers support future co-production processes.

Health promotion and harm reduction attributes in One Health literature: A scoping review

One Health faces enormous pressure and challenges as it attempts to mitigate dynamic, surprising and complex global events that threaten the health and sustainability of human and animal populations and the biosphere. One Health practitioners and researchers need every advantage to developing working solutions to the world's imminent complex issues. Heath promotion and harm reduction, interrelated approaches that have seen much success over decades of use in global public health, may be important models to consider. Both use an upstream socioecological determinant of health approach to reach beyond the health sector in all health efforts, and encourage active community participation and empowerment to attain and sustain human and ecological health. This scoping review of 411 documents, believed to be the first to relate health promotion and harm reduction to One Health, searched self-declared One Health research literature for evidence of health promotion and harm reduction policies, principles and methodologies. It sought to answer the questions: "What is the scope of practice of One Health in self-declared One Health publications?" and "Are attributes of health promotion and harm reduction found in self-declared One Health-reviewed research literature?" Over half of the papers revealed no health promotion or harm reduction attributes while 7% were well-endowed with these attributes. These 7% of papers focused on deep-seated, complex health issues with systemic knowledge gaps and decision-making issues revolving around specific population vulnerabilities, social inequities and competing stakeholders. Implementing 'on the ground change' was a common theme in the strongest health promotion/harm reduction papers we identified. Alternatively, papers lacking health promotion or harm reduction attributes focused on managing proximate risks, primarily for infectious diseases. The addition of health promotion and harm reduction to One Health practices may help the field rise to the growing expectations for its involvement in complex global issues like pandemics and climate change.