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Article

One Health

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'One Health' is an approach for designing and implementing programmes, policies, legislation and research where multiple sectors communicate and work together to achieve better public health outcomes.

One Health2.png

'One Health' is an approach for designing and implementing programmes, policies, legislation and research where multiple sectors communicate and work together to achieve better public health outcomes.

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What is One Health?

'One Health' is an approach for designing and implementing programmes, policies, legislation and research where multiple sectors communicate and work together to achieve better public health outcomes.[i] WHO also states that a One Health approach is particularly relevant for working areas like:

  • food safety,
  • the control of zoonoses, diseases that transmit between animals and humans, such as influenza, rabies and Rift Valley Fever
  • in combating antibiotic resistance, when bacteria mutate after exposure to antibiotics and become more difficult to treat.[ii]

Combating emerging health threats, foodborne diseases, zoonoses and antibiotic resistance are central for One Health working areas. Moreover, One Health closely relates to climate change and environmental studies. Therefore, public health organisations need to be active both in the health systems in the strict sense of the term as well as in non-health sectors.

In the health sector strategies, we need enhanced and targeted epidemiological and entomological surveillance by developing epidemic early warning systems using climate scenarios. Measures in non-health sectors, such as meteorology, civil defence and environmental sanitation, contribute to better preparedness and decrease the risk of infection under climate change.[iii]

In Norway, the Norwegian Institute of Public Health (NIPH) collaborates closely with other organisations like Norwegian Veterinary Institute and Norwegian Food Safety Agency, in order to achieve better outcomes in prevention and investigation of infectious diseases outbreaks. In cooperation with the Norwegian Directorate of Health, the NIPH provides advice to Ministries (Ministry of Health and Care Services, Ministry of Climate and Environment and Ministry of Agriculture and Food) on development of better policies and legislation within public health. 

Our One Health Approach does not stop there, the NIPH also works towards regions and local health services (municipal medical officers) as well as internationally building sustainable partnerships in Europe, European Agencies (ECDC, EMA and EFSA) and beyond with other important global stakeholders (WHO, FAO, OIE).[iv][v] 

One Health2.png
Illustration of One Health.

[vi]

Historical Perspective

The One Health concept is already apparent in the work "On Airs, Waters, and Places" from Hippocrates (460 - 370 BCE) promoting public health dependence on a clean environment.[vii]

Later, increased travel between continents not only contributed to international trade development but also to outbreaks of animal pests leading to several pandemics of plague. The most well-known is the Black Death that hit Europe in the  14th century, and resulting in the death of a third of the European population (more than 25 million people).[viii] [ix] [x] [xi]  Plague transmission is generally from infected fleas carried by rodents or rarely, in clothing or grain, but may also occur through eating contaminated animals, physical contact with infected victims, or direct inhalation of infectious respiratory droplets.[xii] [xiii] [xiv] [xv] 

Since then, humans went through several pandemics caused by transmission of disease by animals like Spanish flu[xvi]  [xvii]or from polluted environments, namely water in cholera times[xviii].

Today, humanity is facing another pandemic that has taken the lives of over 1.46 million people (30th November 2020 statistics)[xix].  Similarly, with many other pandemics, COVID-19 is transmitted by infected animals and humans where good hygiene plays an important role.[xx]

A health threat anywhere is a health threat everywhere

globat luftfartsnettverk.png
Illustration of Global aviation network: Air traffic to most places in Africa, regions of South America, and parts of central Asia is low. If travel increases in these regions, additional introductions of vector-borne pathogens are probable. [xxi].

[xxi]

We live in an interconnected world where diseases know no borders and are spreading farther and faster than ever before. A health threat anywhere is a health threat everywhere. Nearly 70% of the world’s governments are underprepared to manage and control health emergencies, leaving gaps that make us all vulnerable to epidemics. Outbreaks have an enormous social and economic impact locally and globally. SARS and Ebola each had a devastating economic impact, causing a loss in growth and revenues in the order of billions of U.S. dollars.[xxii] The COVID-19 pandemic has so far claimed over one million of lives globally [xxiii]and the socioeconomic impact is still unknown. 

Nevertheless, we should also consider possible source of disease like animals not only as a threat but also as an opportunity in prevention and treatment.  Some animals carry disease without having any symptoms.[xxiv] More research on why animals are better adjusted to pathogens[xxv] could have breakthrough results in future medicine and a positive outcome on biodiversity[xxvi] [xxvii].

How does the NIPH contribute to One Health?

The NIPH is involved in number of projects where One Health plays a central role. More information such initiatives can be found on the following links:

References

[i] World Health Organisation. (21st September 2017) What is 'One Health'? Retrieved from https://www.who.int/news-room/q-a-detail/one-health,

[ii] Confalonieri, U. E., Menezes, J. A., & Souza, C. M. D. (2015). Climate change and adaptation of the health sector: the case of infectious diseases. Virulence, 6(6), 554-557.

[iii] Kapperud G. (30th November 2020) Utbruddsveilederen. Retrieved from https://www.fhi.no/nettpub/utbruddsveilederen/

[iv] BfR & SSI. (20th April 2020) Links between COVID-19 related needs of stakeholders and One Health EJP activities. Retrieved from https://onehealthejp.eu/wp-content/uploads/2018/12/Links-between-COVID-19-needs-and-OHEJP.pdf

[v] Centers for Disease Control and Prevention. (19th November 2020) One Health. Retrieved from https://www.cdc.gov/onehealth/images/homepage-resources.jpg,

[vi] Fresco, L. O., Bouwstra, R. J., de Jong, M. C. M., van der Poel, W., Scholten, M. C. T., & Takken, W. (2016). A European Perspective: Global one health - a new integrated approach. In J. Frenk (Ed.), Global Health Challenges (pp. 67-121). (Task Force Report; No. TFR 67). The Trilateral Commission.

[vii] Glatter, K. A., & Finkelman, P. (2020). History of the Plague: An Ancient Pandemic for the Age of COVID-19. The American journal of medicine, S0002-9343(20)30792-0. Advance online publication. https://doi.org/10.1016/j.amjmed.2020.08.019

[viii] Riedel, S. (2005, April). Plague: from natural disease to bioterrorism. In Baylor University Medical Center Proceedings (Vol. 18, No. 2, pp. 116-124). Taylor & Francis.

[ix] Bramanti, B., Stenseth, N. C., Walløe, L., & Lei, X. (2016). Plague: A disease which changed the path of human civilization. In Yersinia pestis: retrospective and perspective (pp. 1-26). Springer, Dordrecht. 

[x] Prentice, M. B., & Rahalison, L. (2007). Plague. The Lancet, 369(9568), 1196-1207.

[xi] Park, Y. H., Remmers, E. F., Lee, W., Ombrello, A. K., Chung, L. K., Shilei, Z., ... & Hoffmann, P. (2020). Ancient familial Mediterranean fever mutations in human pyrin and resistance to Yersinia pestis. Nature Immunology, 21(8), 857-867.

[xii] Yang, R. (2018). Plague: recognition, treatment, and prevention. Journal of clinical microbiology, 56(1).

[xiii] Butler, T. (2013). Plague gives surprises in the first decade of the 21st century in the United States and worldwide. The American journal of tropical medicine and hygiene, 89(4), 788-793.

[xiv] Mead PS. (2019) Plague (Yersinia pestis). In: Bennett JE, Dolin R, Blaser MJ, editors. Principles and Practice of Infectious Diseases. Elsevier Publishing; London, UK: 2019. pp. 2779–2787.

[xv] Reid, A. H., Fanning, T. G., Hultin, J. V., & Taubenberger, J. K. (1999). Origin and evolution of the 1918 "Spanish" influenza virus hemagglutinin gene. Proceedings of the National Academy of Sciences of the United States of America, 96(4), 1651–1656. https://doi.org/10.1073/pnas.96.4.1651 

[xvi] Nelson, M. I., & Worobey, M. (2018). Origins of the 1918 pandemic: revisiting the swine “mixing vessel” hypothesis. American journal of epidemiology, 187(12), 2498-2502. doi: 10.1093/aje/kwy150

[xvii]   Lekshmi, N., Joseph, I., Ramamurthy, T., & Thomas, S. (2018). Changing facades of Vibrio cholerae: An enigma in the epidemiology of cholera. The Indian journal of medical research, 147(2), 133–141. https://doi.org/10.4103/ijmr.IJMR_280_17

[xviii] Johns Hopkins University (JHU). (19th November 2020) COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE). Retrieved from https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

[xix] Glatter, K. A., & Finkelman, P. (2020). History of the Plague: An Ancient Pandemic for the Age of COVID-19. The American journal of medicine, S0002-9343(20)30792-0. Advance online publication. https://doi.org/10.1016/j.amjmed.2020.08.019

[xx] Kilpatrick, A. M., & Randolph, S. E. (2012). Drivers, dynamics, and control of emerging vector-borne zoonotic diseases. The Lancet, 380(9857), 1946-1955.

[xxi] Centre for Disease Control and Prevention (CDCP). (30th November 2020) Global Health Security. Retrieved from https://www.cdc.gov/globalhealth/newsroom/topics/ghs/index.html

[xxii] Johns Hopkins University (JHU). (19th November 2020) COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE). Retrieved from https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

[xxiii] Jørgensen, H. J., & das Neves, C. (2020). Covid-19: Én verden, én helse. Tidsskrift for Den norske legeforening.

[xxiv] Aisling I. (17th November 2020) Five things you need to know about bats, disease and coronavirus. Retrieved from https://horizon-magazine.eu/article/five-things-you-need-know-about-bats-disease-and-coronavirus.html?utm_source=icf&utm_medium=email&utm_campaign=horizon_news_alerts&utm_content=This+week+in+Horizon%3A+the+promise+of+electronic+skin+and+what+humans+could+learn+from+bats

[xxv] Fresco, L. O., Bouwstra, R. J., de Jong, M. C. M., van der Poel, W., Scholten, M. C. T., & Takken, W. (2016). A European Perspective: Global one health - a new integrated approach. In J. Frenk (Ed.), Global Health Challenges (pp. 67-121). (Task Force Report; No. TFR 67). The Trilateral Commission.

[xxvi] Ostfeld, R. S., & Keesing, F. (2000). Biodiversity and disease risk: the case of Lyme disease. Conservation biology, 14(3), 722-728.