Public health with a one-health focus

The one-health, one-medicine movement has gained steam in the past few years, but the St. George's University Department of Public Health and Preventative Medicine in Grenada, West Indies, has been collaborating with human and veterinary medicine for more than a decade now.

Established in 1999, the department administers the Graduate Public Health Program at SGU, which offers a stand-alone master's of public health or dual degrees of MD/MPH and DVM/MPH in collaboration with the university's medical and veterinary schools. Students can pursue a 42-credit degree focusing on epidemiology, health policy and administration, environmental and occupational health, or veterinary public health in as little as a year or as many as five.

Part of the program's requirements is that students complete a field-based, 240-hour practicum at one of 100 sites in more than 50 countries around the world. Students have done practicums ranging from infectious diseases in Tanzania to dengue fever in Puerto Rico to global health with the World Health Organization in Switzerland.

The program collaborates with the university's research arm, the Windward Islands Research & Education Foundation, a 501(c)(3) nonprofit. WINDREF coordinates international collaborative research in such areas as medical and veterinary public health, ecology, and marine and terrestrial biology.

Omur Cinar Elci, MD, chair of the public health department, said the program is in the process of building relationships with other international organizations, which could lead to substantial developments in public health in the region.

"There are significant public health problems in the region, but resources are limited. We need to work from an academic perspective to build more problem-oriented research activities in the region. We need to build more collaborations. We need to attract more international organizations to work with," Dr. Elci said.

The department is focusing on working with the government of Grenada on various projects such as chronic diseases, alcohol consumption and abuse, maternal-child health, and domestic and child abuse. Infectious diseases and HIV infection and AIDS are also big focuses, as are health education and occupational health.

On the veterinary side, the department has identified leptospirosis as a major public health threat on the island. Grenada has seen an increase in human cases in some communities, precipitated by improper waste management and rodents. The department hopes to educate those communities about safe waste disposal and exposure prevention.

Other potential zoonotic problems in the region, such as highly pathogenic H5N1 avian influenza, have also caught the department's attention. Dr. Satesh Bidaisee, deputy chair of the department, is working with the World Organisation for Animal Health (OIE) to track avian influenza cases in Southeast Asia and determine whether infected migratory birds interact with local naïve birds.

"The Caribbean is in the migratory pathway ... and poultry is a major source of protein here, so there's potential for a food security breach," Dr. Bidaisee said.

Dr. Bidaisee came from the University of West Indies School of Veterinary Medicine and has a joint faculty appointment with the SGU veterinary school. Dr. Elci, a physician, said working together promotes good synergy. The relationship also ensures a one-health focus that has become a trademark of the program.

For example, students are expected to prepare a paper on the topic of one health, examining the published literature since the concept began. The department also has students involved in topics that require collaboration in how they look at zoonotic diseases and public health. Collaboration happens at the faculty level, too. The veterinary school, for example, will support research on farmers' exposure to toxicants resulting from contact with ruminants.

Muge Akpinar-Elci, MD, associate professor and research coordinator in the department, said from a research perspective, they are at an advantage.

"The world is changing. When you go to funding agencies and say, 'I'm looking at just animal perspective,' they're not accepting. If it's just, let's say, occupational health for farmers, you can't do that. You need to make a combined effort for medicine and veterinary medicine together. All research will be getting to this," she said. "As a department, we are really supportive of these ideas."

The one-health emphasis doesn't stop at the public health department but applies universitywide.

SGU has a One Health Committee for faculty in which all schools are represented. This past fall, they hosted a symposium on one medicine. More than 70 percent of presentations came from the Department of Public Health and Preventative Medicine.

In addition, every year, SGU hosts the One Health, One Medicine Fair during which medical and veterinary students go into the community and work together. Community members come to campus for free health screenings for themselves and their animals.

"There are combined issues that pertain to someone screened and their dog, too, such as diabetes or ringworm," Dr. Bidaisee said.

Dr. Elci says the department still has much work to do in terms of marketing strategies.

"We would like to target those who want to do medicine or veterinary medicine and public health together, but I can't say we're there yet," he said.