One Health: Health Population Block 5 Exam

Health from human perspective

state of complete physical, mental, and social wellbeing and not merely absence of disease or infirmity

Five Freedoms

• freedom from hunger, malnutrition, and thirst

• freedom from fear and distress

• freedom from heat stress or physical discomfort

• freedom from pain, injury, and disease

• freedom to express normal patterns of behavior

One health definition

integrated approach that aims to sustainably balance and optimize the healthy of people, animals and ecosystems; it recognizes health of humans, domestic and wild animals, plants, and wider environment are closely linked and inter-dependent

One Health Approach

4 C’s

• communication

• collaboration

• coordination

• capacity building

Historical perspective of one health

• human and veterinary medical origins

• drivers of development

• holistic health perspective

• need for integrated solutions

sentinel

• animals used as early warning sign for disease and conditions to come

• ex: cat and flame retardants, canary in coal mine

How was one health used in 1854 cholera outbreak

• local priest found index case

• physician rallied community to investigate and communicate findings

• engineer created famous cholera spot map

National interprofessional collaboration

• congress mandated CDC, DOI, USDA develop National One Health Framework as well as formalize One Health Coordination Unit at federal level

• aims to:

  • establish standing, formal coordination mechanism

  • achieve better understanding of drivers of zoonotic disease

  • improve disease prevention and detection

  • enhance disease preparedness, response, and recovery at federal level

Interprofessional Collaboration State

• Ohio Department of Health

  • statewide network focused on supporting collaboration across human, animal, and environmental health

  • quarterly calls to share resources, facilitate dialogue, strengthen state-level health partnerships

Benefits and Challenges of One Health

• helps to better understand health threats and design more effective solutions, but comes at cost in terms of time, skills, commitment, capacity, and resources

• use economic evaluation to help collate evidence on One Health value

• outcomes can vary widely and may include health, ecosystem, social, and economic benefits that may be difficult to quantify and even indirect/unintended

• implementing can have higher value but greater costs

One Health Strategies Local to Global

• US

  • one health clinic model

• International

  • global health security agenda

• intergovernmental

  • FAO-OIE-WHO-UNEP, sustainable development goals

• NGO/Non-profit

  • ISID ProMED

  • academic institutions

Global Health Security Agenda

• launched in 2014

• >70 countries

• form interconnected network to advance world safe and secure from infectious disease threats

• provide support through collaboration, information sharing, technical assistance

• aim to increase multi-sectoral collaboration across public health, medicine, agriculture, veterinary medicine, environment, education, and defense agencies

Global Health Security Agenda Roles

• prevent

  • antimicrobial resistance

  • zoonoses

• detect

  • surveillance

  • reporting

• respond

  • emergency preparedness

  • risk communication

• IHR related hazards

  • points of entry

  • chemical events

Quadripartite partnership for one health

• WHO-WOAH-UNEP-FAO

• started as tripartite in 2010

• added UNEP in 2022

• recognize joint responsibility for addressing zoonotic and other high impact disease

• collaborate to form early warning systems, mechanisms for enhanced coordination between member countries

  • global early warning and response system for major animal diseases

• provide neutral platform for countries to engage in dialogue and negotiations

Core competencies

• skills

• values and attitudes

• knowledge and awareness

technical skills

• epidemiology

• ecosystem health

• risk analysis

• infectious/zoonotic disease management

• food protection

soft skills

• management

• conflict resolution

• communication

• leadership

• collaboration and partnership

• policy and advocacy

clinicians and disease surveillance

• many human diseases legally required to be reported to public health are zoonotic

• only human cases are required to be reported

Population Medicine

• global

• regional

• national

• state

• community

• herd

• individual

Urbanization

more than half of people living in cities; projected to be 68% by 2050

evolution of population-level health approaches

• public health

  • science and art of preventing disease, prolonging life, and promoting health

  • population health management

• international health

  • rooted in tropical medicine and hygiene

  • focused on developing countries

• global health

  • promotion of health for all

  • improve health equity

  • transcends national boundaries

  • not restricted to low-resource regions

  • can be conducted locally

what is global health

global health is field of academic study, research, policy, and applied practice that advances equitable protection and improvement of population and planetary health

Current Global Health Risks

• emergence and spread of new infectious diseases

• expanding travel and trade

• drug resistance

• accidental release, theft, illicit use of dangerous pathogens

Global Health Risks

• zoonotic

  • HIV/AIDS

  • plague

  • ebola

  • NvCJD

  • Nipah

  • SARS

  • HPAI H5N1

  • H1N1 Pand.

  • MERS CoV

  • Ebola VD

• non infectious

  • Chernobyl

  • Chemical events

• Humans only

  • meningitis

  • cholera

How many hours does it take for disease to spread from any remote village to any major city in world?

36 hours

International Health Regulations 2005

• legally binding agreement by 196 countries

• require all countries have ability to detect, assess, report, and respond to public health events

  • surveillance systems and laboratories

  • collaborate for decision making during an emergency

  • notify appropriate authorities

  • respond efficiently

• require all countries detect and report events that may constitute a potential public health emergency of international concern (PHEIC)

7-1-7 rule

• 7 days

  • time to detection

• 1 day

  • time to notification

• 7 days

  • time to early response

When is a PHEIC declared?

• if situation meets 2/4 criteria

  • is public health impact of this event serious

  • is event unusual or unexpected

  • is there significant risk of international spread

  • is there significant risk of international travel or trade restrictions

What disease always require reporting

• smallpox

• poliomyelitis due to wild type poliovirus

• human influenza caused by new subtype

• severe acute respiratory syndrome (SARS)

Monitoring and Evaluation Framework (IHR-MEF)

• states parties self assessment annual reporting (SPAR)

  • mandatory

• joint external evaluation (JEE)

• after action reviews (AAR)

• simulation exercises (SimEx)

  • tabletops

  • functional

  • field/full-scale

Joint External Evaluation

• incorporates self-assessment and external evaluation

• brings health experts together to assess country’s strengths and gaps within their health systems

• 19 technical areas

  • zoonotic disease

  • antimicrobial resistance

  • food safety

  • biosafety and biosecurity

• 125 countries have completed JEE to date

  • voluntary

  • every 4-5 years

Major Gaps

• understanding of roles/responsibilities in PHE response

• coordination

• communication

• surveillance

• supplies/equipment

WOAH

• intergovernmental organization responsible for improving animal health worldwide

• established in 1924 in response to rinderpest

• 183 member countries

• headquarter in Paris

• primary objective to protect health of animals and ensure safe and fair trade in animals and animal products worldwide, ensuring better future for all

• world animal health information system is online reporting system

• members obligated to report disease events of animal health significance

Performance of Veterinary Services

• flagship capacity building program of WOAH

• specific to veterinary services

• voluntary

• assessment based

• 149 countries

• external, expert led but country driven process

• triangulates inputs from documentation, stakeholder interviews, first-hand observation

IHR-PVS National Bridging Workshop

• improve collaboration between human and animal sectors

• 3-day event facilitated by WHO and WOAH

• focus on zoonoses

• voluntary

• performed after JEE and PVS

• strengths/weaknesses across 16 technical areas are mapped on IHR-PVS matrix

  • field investigation

  • risk assessment

  • response operations

  • education/training

  • communication

  • financing

• prioritization vote used to finalize roadmap

Veterinarian role in Global Health Security

• mitigation and prevention

• preparedness

• detection

• response

• recovery

Mechanisms for animal disease monitoring

• reports of diseases to local/state health officials

• sales/prescriptions of veterinary drugs

• health certificates

• farm-visits

• reports of animal deaths

mitigation primary vs secondary

• primary

  • reducing vulnerability to hazard

• secondary

  • reducing effects of hazard

Emerging pandemic threats program

• USAID

• 2009

• proactive

• 20+ countries in hot spot regions