Wednesday, 16 February 2011

WHAT DOES "ONE HEALTH" MEAN?

STEPS Centre researcher Paul Forster is blogging from the International One Health Congress in Melbourne. This is his second and final post from the Congress.

Three full days on from its start on Monday (adding up to 38 hours of hard conferencing plus a further 38 hours of parallel sessions), the 1st International One Health Congress in Melbourne concluded this Wednesday evening, resolving to... meet again in a year or two. Encompassing an astounding number and range of subjects and disciplines - a glance at just two hours from today’s parallel sessions throws up land use, laboratory services, virology, epidemiology, food security, wildlife management, institutional structures, curriculum development, trade, and public health, for example - serious mutterings emerged in the concluding session regarding possible needs for a ‘One Health’ society and a ‘One Health’ journal.

The main issue that remained to be resolved was critical: what is ‘One Health’? How is this putative, cross-cutting, neo-discipline that aspires to link human health, animal health and what is perhaps best described as environmental health, to be defined? At the evangelical end of the spectrum, the enthusiasts talk of a 'movement', urging the laggards to 'get out of their comfort zones'; and are keen to broaden the enterprise to include nutrition, livelihoods and trade, for example, and set metaphorical explosive charges against the thick concrete walls of the silos that exist within many existing institutions and much existing thinking. The less enthusiastic - there are not many, but one or two are vocal, perhaps mischievously so - press for a clear definition, looking to both tear down existing silos and create new ones.

Aside from a definition, which I’d suggest is unnecessary (clich├ęd phrases like 'let many flowers bloom', or 'horses for courses' come to mind), the other significant matter outstanding at the congress’s conclusion was the need to quantitatively prove that benefits would accrue from the One Health approach. Qualitatively, there’s little or no dispute that a One Health approach makes sense; but as one World Bank representative put it: we need to define some economic drivers for One Health. This is difficult, if not impossible, especially if the enterprise remains loosely defined, with any number of useful fuzzy edges. Estimates suggest that the major zoonotic diseases (excluding HIV/AIDS) have had impacts of at least $80 billion over the last 12 years, but those doing the sums stress that this is more of a guess than an estimate, and excludes the likes of ‘ripple’ and ‘overspill’ effects. There remains a monumental task for someone with both imagination and an extensive spreadsheet.

Having got my two reasonably well rehearsed presentations ('Responding to highly pathogenic avian influenza – surveillance in Indonesia' and 'Responding to highly pathogenic avian influenza – contract farming, market chains, and debt relations') out of the way, my main task today was to fly the STEPS flag as a discussion speaker in a plenary session. I was speaking alongside, among others, David Butler-Jones (Canada’s Chief Public Health Officer) and Jane Halton (currently Secretary of Australia’s Department of Health and Ageing, and a past President of the World Health Assembly). Following in Andy Stirling’s clear footsteps, and his paper 'Keep it complex' in Nature in December last year (Nature 468:1029-1031), the job involved introducing upwards of 300 delegates to what was for most of them a relatively novel approach to a fundamental concept: risk. In a nutshell, Stirling suggests that a narrow focus on risk is an inadequate response to incomplete knowledge. As my synopsis continued, I had a feeling that the panel was ever-so-discreetly shuffling their chairs away from mine, and the audience itself was distant, all but invisible beyond the stage lighting.

As it turned out, at coffee afterwards, it felt better: congratulations and even a "bravely said" from one particularly respected colleague. There were also a dozen requests for Andy’s paper to be sent on. A success perhaps then, both qualitatively and quantitatively defined.

Other posts

One Health, One World?

Links

STEPS research on Health
Future Health Systems

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