With the human healthcare infrastructure deeply challenged and unable to meet demand, especially in the context of the added burden of the COVID-19 pandemic, should the broader topic of 'One Health' be a priority?
This is an important question, especially in the light of an increasing number of global and Indian leaders and institutions encouraging the need to adopt One Health as a key focus area.
The US CDC describes One Health as "a collaborative, multisectoral, and transdisciplinary approach, working at the local, regional, national, and global levels, with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment."
A One Health approach recognises that the health and well-being of animals, humans and the environment are deeply and increasingly interlinked, spurred by the growing population, increased travel and connections across the planet, and the proximity of contact of humans with animals and the environment.
These interconnections have resulted in an increase in zoonotic as well as multifactorial chronic diseases. Compounded by antimicrobial resistance and environmental pollution, addressing these diseases holistically requires a collaborative approach involving multiple stakeholders and experts across healthcare providers and systems, public health, forestry, veterinary, environmental, and other related disciplines.
Historically, challenging times have fostered increased global collaboration. Over the past months, we have seen such partnerships and collaborative networks across the world and in India to benefit millions of people impacted medically, economically and socially by COVID-19. This has helped accelerate the momentum of One Health.
One Health in India, while nascent, is increasingly taking root. The government has launched initiatives to tackle problems such as antimicrobial resistance, zoonotic diseases, and food safety using a One Health approach, which is multidisciplinary in nature, entailing cross-ministerial work, and navigating institutional networks and hierarchies.
This represents a great opportunity to further enhance and strengthen this approach and to seamlessly integrate several aspects of the ecosystem and make our healthcare systems future-ready.
Delivering on One Health will need to solve for several priorities, of which three focus areas are key: (1) a holistic approach to healthcare, (2) a strong network of skilled professionals, and (3) partnerships and infrastructure.
Holistic health is becoming increasingly important as the connections between different zoonotic, infectious and chronic diseases become clearer, with one disease impacting the risk of vulnerability to or complications from others.
In response, therapeutic interventions are focused on targeting multiple indications and/or complications. Prevention is increasingly seen as a key priority and key pillar of holistic health and well-being.
Additionally, we are learning that the relationship of humans with animals and nature as it pertains to health and well-being is more nuanced than traditionally understood.
The benefits of Animal-Assisted Therapy (AAT) for humans have been well-documented not only with pets but also through farm animals.
The utilisation of agricultural farms as a basis for promoting human mental and physical health in cooperation with health authorities is growing in several countries in Europe and in the US.
In some countries, this is called Green care, a concept that is not restricted to the use of animals but also includes plants, gardens, forests, and the landscape. In India, advocacy and support for green care driven by clinicians, reinforced at an institutional level, together with well-coordinated commissioning, can be part of a 'green recovery' and increased sustainability of healthcare.
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Given the magnitude of demand posed by the large population, capability and capacity building is critical. This requires bringing together a network of skilled professionals specialising in a wide range of disciplines, such as medicine, veterinary medicine, life sciences, mathematics, physics, chemistry, social sciences, environmental sciences, etc.
One Health workers need to have both a strong disciplinary background as well as training to work in multi-disciplinary settings. Few countries can point to their cross-disciplinary leadership and management training programs and graduates with the same facility as they track graduates from specific disciplinary programs such as medicine.
This is important to change. One Health education has been successfully integrated into high schools in some countries, while many nations offer university level and postgraduate programs. Schools and universities in India should look at integrating One Health as a program not only in medical courses but also as part of other programs.
Partnerships and infrastructure
Coordination mechanisms are necessary to support One Health approaches, for example working groups and inter-personal relationships that span government agencies and jurisdictions, public-private partnerships, networks and community working groups.
These can be based on informal relationships driven by a shared vision, or formal mechanisms governed by laws. The need for coordination also applies to surveillance efforts. For example, we have surveillance programs for both human and animal diseases.
It is worth considering if these systems could be integrated to help establish a roadmap towards creating a unified One Health surveillance system in the country. A key role for One Health governance is to sustain and nurture relationships over the long term. Productive, trusting and mutually rewarding partnerships take time to build and require support.
One Health has the potential to drive an ecosystems approach in healthcare, with the diverse components of the system working respectively in their areas of expertise but learning from and collaborating with each other to make available cohesive solutions of health and care to humans and animals alike.
(The author is Managing Director, Boehringer Ingelheim India.)
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