Spreading the one-health concept
Human, animal, and ecosystem health intertwine to make "one health."
For five years, a movement stemming largely from the veterinary community has promoted the one-health concept and an accompanying one-health approach involving collaboration among the health professions and relevant associated disciplines to improve health locally and globally.
In that time, the one-health concept has resonated increasingly in academia and government, especially in fields related to public health. The idea remains less familiar to many veterinarians and physicians in private practice, although they often encounter zoonoses and other examples of the one-health concept in their work.
One Health Commission
As AVMA president from July 2006 to July 2007, Dr. Roger K. Mahr envisioned a broad movement and, particularly, creation of a One Health Commission to focus attention on the one-health concept. Today, he is the chief executive officer of the commission.
"It's been very heartening to reflect on the various activities, the leadership, and the support that are coming forth toward the one-health approach," Dr. Mahr said.
In response to a recommendation from Dr. Mahr, the AVMA Executive Board formed a one-health task force in 2007. The task force paved the way for a joint steering committee in 2008, and the committee transitioned to the One Health Commission. The commission incorporated as a nonprofit in June 2009 with initial membership consisting of veterinary, human health, and other relevant organizations.
Also in recent years, Dr. Mahr said, new one-health centers and groups have been developing in academia and government. Iowa State University's One Health Consortium attracted the One Health Commission to establish permanent headquarters at ISU in January 2011. Now the commission and university are working together to create and implement a joint strategic business plan.
The one-health concept is not new, Dr. Mahr noted. He said the interdisciplinary one-health approach has long been key in fields such as comparative medical research, disease surveillance, food safety, and the human-animal bond.
Dr. Mahr said the One Health Commission aims to inform all audiences about the one-health approach by establishing a center for communications and resources. The commission also seeks to promote more collaboration among health professions and relevant disciplines by facilitating demonstration projects that illustrate the value of the one-health approach.
The book "Zoonoses: Protecting People and Their Pets" will be the first demonstration project. The ISU Center for Food Security and Public Health is producing the new reference on zoonoses of companion animals as an expansion of a 2008 handbook on the subject.
The plan is to create a grant program to offer the new books and support materials free of charge to students of veterinary medicine, human medicine, and public health. The books and support materials also will become available to health care practitioners.
Sharing knowledge
Dr. Cheryl M. Stroud, AVMA representative to the One Health Commission, has spent time in basic research and in small animal practice. She currently is a relief veterinarian and chair of the North Carolina One Health Collaborative in the Research Triangle.
"One-health issues are everywhere," Dr. Stroud said. "The need for a one-health approach is literally everywhere you look. That's why I'm so passionate about making this way of thinking a reality."
Dr. Stroud embraced the interdisciplinary approach early on because of her own life experiences with zoonoses. Years ago, for example, a pediatrician was unable to determine the cause of her 19-month-old son's terrible diarrhea. Her veterinarian husband took a diaper to a parasitologist at the North Carolina State University College of Veterinary Medicine who immediately identified cryptosporidia.
Seeing a need for animal and human health professionals to share knowledge, Dr. Stroud recently helped spearhead formation of the North Carolina One Health Collaborative.
The collaborative assumed leadership of a one-health discussion series and started offering a one-health course within the series. The sessions attract students, practitioners, and others in the health professions and relevant disciplines. Topics have ranged from zoonoses to comparative research to ecologic issues.
Dr. Stroud became the AVMA representative to the One Health Commission in April. She said the broad one-health movement has come a long way, but she's impatient for the commission to make more progress. She thinks the one-health concept needs to gain momentum beyond the academic and governmental sectors.
"Private practitioners, in both the human and the veterinary world, need to become more aware of a one-health approach," Dr. Stroud said. "I think it's a huge educational process to help the human medical care community realize the significance of this interdisciplinary way of thinking."
Spreading the word
The One Health Initiative website, www.onehealthinitiative.com, is an independent effort to promulgate the one-health concept. The site features one-health news, events, and publications along with other information relevant to the one-health movement.
Dr. Bruce Kaplan and two physicians—Laura H. Kahn, MD, and Thomas P. Monath, MD—created the website in October 2008. Research scientist Jack Woodall, PhD, later joined the team. The site has attracted an international audience, Dr. Kaplan said, and traffic has expanded exponentially in three years.
Dr. Kaplan is a longtime supporter of the interdisciplinary one-health approach as a means to expand scientific knowledge, accelerate medical research discoveries, and enhance efficiency in public health.
"All of these features, once fully implemented, will obviously significantly help improve medical education as well as clinical care measures," Dr. Kaplan said. "Consequently, practitioners of veterinary medicine and human medicine will reap rewards in a multiplicity of ways."
Dr. Kaplan said the one-health concept has become fairly widespread in academia and government in the United States and around the globe. Adoption of the one-health approach in these sectors is partly a response to the fact that most emerging and re-emerging diseases are zoonotic, he said.
Two journals are consulting with the One Health Initiative website team to promote the one-health concept to more veterinarians, physicians, and other health scientists. Clinician's Brief, which is the journal of the North American Veterinary Conference, and Infection Ecology & Epidemiology, a journal out of Sweden, have begun featuring articles relevant to the one-health concept.
Among other efforts, the website team recently consulted with the mayor of Moscow, Idaho, on the adoption of a one-health resolution by the National League of Cities.
CDC Office of One Health
The Centers for Disease Control and Prevention is among the governmental agencies that have been implementing the one-health approach. In 2009, the CDC established a One Health Office, now within the National Center for Emerging and Zoonotic Infectious Diseases.
Dr. Carol S. Rubin, director of the office, said the current one-health movement and other factors influenced formation of the office. She said many organizations are seeking to incorporate the one-health concept into regular operations.
"I think there was a bit of a concern during the last few years that there had been a lot of talk and perhaps not enough action," Dr. Rubin said. "We're now seeing real progress toward integrating 'one health' into surveillance and outbreak response—and getting closer to making it the normal way of doing business."
The CDC One Health Office has placed veterinary medical officers around the world at international agencies and in countries that are potential sites for emergence of diseases. The officers work in surveillance, epidemiology training, outbreak investigations, and communications.
"We consider them a network and a resource—certainly a resource to CDC but also a resource to external partners," Dr. Rubin said. "It's an unusual kind of job description, because it's someone who can have one foot in both the animal side and the human sector."
The One Health Office also works to increase collaboration among animal and human health professionals within the United States. The office recently coordinated with veterinary and wildlife professionals, for example, during an investigation into a case of a human naturally acquiring inhalational anthrax in Minnesota.
Reaching physicians
The Infectious Diseases Society of America just became the newest member of the One Health Commission. The IDSA represents nearly 10,000 physicians, scientists, and other professionals who focus on infectious diseases.
James M. Hughes, MD, IDSA representative to the One Health Commission, is a professor of medicine and public health at Emory University in Atlanta and past director of the former CDC National Center for Infectious Diseases. He has long valued interactions with veterinarians.
"There are a lot of common concerns that members of IDSA share with their veterinary colleagues," said Dr. Hughes, adding that a small number of veterinarians belong to the society. These common concerns include food-borne disease, antimicrobial resistance, health care–associated infections, spread of disease through the wildlife trade, and emergence of new pathogens.
The veterinary community deserves credit for advancing the one-health concept in recent years, Dr. Hughes said.
"The level of awareness and interest has clearly increased across a number of medical and biomedical organizations," Dr. Hughes said. "The question now is: What's the way forward in this era of severe fiscal constraints?"
Despite various challenges, the public health community has begun to embrace the one-health concept, according to Dr. Hughes. He said the idea remains less familiar even to practicing physicians who focus on infectious diseases, prompting the IDSA to join the One Health Commission in December 2011.
Looking ahead
To enhance communication about the one-health approach, the One Health Commission recently redesigned its website to be a more extensive and interactive resource.
The commission's website, www.onehealthcommission.org, now provides more information about the one-health concept and a "who's who" of the commission and the broader one-health movement. The site also provides news, events, and reference material relevant to the interdisciplinary one-health approach.
"There have been significant successes through this interdisciplinary approach over the years," Dr. Mahr said. "As we now embrace the term 'one health' and bring more focus to the importance and value of this interdisciplinary approach, we trust that there will be more and even greater achievements toward improving the health of people, domestic animals, wildlife, plants, and our environment."
Commission members:
- AVMA
- Association of American Veterinary Medical Colleges
- American Medical Association
- Association of American Medical Colleges
- Association of Academic Health Centers
- American Public Health Association
- Infectious Diseases Society of America
National League of Cities adopts one-health resolution
By Katie Burns
The National League of Cities adopted a resolution in November 2011 supporting the one-health concept, especially the part emphasizing that ecosystem health affects human and animal health.
The resolution states that the league supports integrated decision making in the context of the one-health movement and "calls on the federal government to adopt legislation and practices that address human health, animal health, and ecological health in an integrated fashion and support local efforts to advance sustainability goals."
The originator of the resolution was Nancy J. Chaney. Chaney is mayor of Moscow, Idaho, home of the University of Idaho. She worked as a nurse for many years before earning a master's degree in environmental science and starting a political career. Her husband is a veterinary ophthalmologist, Dr. Gary M. Bryan.
Chaney became aware of the one-health movement by reading the JAVMA. She and her husband wrote a March 1, 2011, letter to the editor on the subject. According to the letter: "The aspect that seems lacking is the overt and routine integration of ecological health in the human-animal-environment triad ... ."
The city of Moscow is implementing the ecologic and other aspects of the one-health concept in a variety of ways, Chaney said. One project to advance a sustainable regional food system involves building a facility for handling area agricultural products, including meat and dairy, that would help supply food banks, allow home gardeners to process produce in a commercial kitchen, and support sale of local food products by entrepreneurs.
Chaney said the one-health resolution met with a favorable response from members of the National League of Cities.
"It fits so well with so many of the other initiatives we have taken," Chaney said. She said the league is discussing and acting on issues such as renewable energy, water and air quality, disposal of electronic waste, and other "public health aspects of livable, sustainable communities."
In drafting the one-health resolution, Chaney consulted with the team that operates the One Health Initiative website. Dr. Bruce Kaplan, a member of the website team, lauded the efforts by Chaney and the National League of Cities.
Dr. Kaplan believes the resolution is a very important step in the political arena, providing a mechanism to help spread the one-health concept throughout the country.
The resolution is available at www.nlc.org/influence-federal-policy/resources by clicking on "2012 NLC National Municipal Policy" and scrolling to page 68.