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One Health is an emerging concept that stresses the linkages between human, animal, and environmental health, as well as the need for interdisciplinary communication and collaboration to address health issues including emerging zoonotic diseases, climate change impacts, and the human-animal bond. It promotes complex problem solving using a systems framework that considers interactions between humans, animals, and their shared environment. While many medical educators may not yet be familiar with the concept, the One Health approach has been endorsed by a number of major medical and public health organizations and is beginning to be implemented in a number of medical schools. In the research setting, One Health opens up new avenues to understand, detect, and prevent emerging infectious diseases, and also to conduct translational studies across species. In the clinical setting, One Health provides practical ways to incorporate environmental and animal contact considerations into patient care. This paper reviews clinical and research aspects of the One Health approach through an illustrative case updating the biopsychosocial model and proposes a basic set of One Health competencies for training and education of human health care providers.
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Saúde Ambiental/educação , Saúde Global/educação , Pessoal de Saúde/educação , Aprendizagem Baseada em Problemas/organização & administração , Animais , Mudança Climática , Doenças Transmissíveis Emergentes , Comportamento Cooperativo , Educação Médica , Saúde Ambiental/organização & administração , Humanos , Comunicação Interdisciplinar , Saúde Pública , ZoonosesRESUMO
This short communication is an effort to describe and elucidate the trajectory of the modern historical concept of "One Health." It is dedicated to the many integrated approaches of health closely related to One Health, while also recognizing the contribution and origination of One Health perspectives/notions from those that have led the way and spearheaded this movement while considering Indigenous cultures across the world. The effects of synergies of those involved in building these integrative approaches are potentially bigger and better lasting than the sum of the individual players. It is only through collaboration, cooperation and diplomacy that we can achieve impactful transformation to benefit health. In this commentary, we aim to appropriately and accurately describe how the current use of "One Health" came to be and who were the main players.
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The One Health concept that human, animal, plant, environmental, and ecosystem health are linked provides a framework for examining and addressing complex health challenges. This framework can be represented as a multi-dimensional matrix that can be used as a tool to identify upstream drivers of disease potential in a concise, systematic, and comprehensive way. The matrix can involve up to four dimensions depending on users' needs. This paper describes and illustrates how the matrix tool might be used to facilitate systems thinking, enabling the development of effective and equitable public policies. The multidimensional One Health matrix tool will be used to examine, as an example, global human and animal fecal wastes. The fecal wastes are analyzed at the microbial and population levels over a timeframe of years. Political, social, and economic factors are part of the matrix and will be examined as well. The One Health matrix tool illustrates how foodborne illnesses, food insecurity, antimicrobial resistance, and climate change are inter-related. Understanding these inter-relationships is essential to develop the public policies needed to achieve many of the United Nations' Sustainable Development Goals.
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Professionals throughout the world have been working to assess the interdisciplinary interaction and interdependence between health and wellbeing in a constantly changing environment. The One Health concept was developed to encourage sustainable collaborative partnerships and to promote optimal health for people, animals, plants, the environment, and the whole planet. The dissemination of scientific discoveries and policies, by working directly with diverse communities, has been one of the main goals for Global One Health. The One Health concept has also been referred or related to as "One Medicine, One Medicine-One Health, One World-One Health, EcoHealth," and Planetary Health," depending on each fundamental view and approach. In Latin America, despite the concept still being discussed among health professionals and educators, several One Health initiatives have been used daily for more than decades. One Health action has been applied especially in rural and underserved urban areas where low socioeconomic status, lack of health professionals, and scarcity of medical resources may require professionals to work together. Local communities from diverse social and economic statuses, including indigenous populations have been working with institutions and social organizations for many years, accomplishing results through grassroots movements. These "bottom-up" socio-community approaches have also been tools for the prevention and control of diseases, such practice has preceded the One Health concepts in Latin American countries. It is strongly believed that collaborative, multidisciplinary, political, and economic initiatives with prosocial focus may become investments toward obtaining significant results in the face of global, economic and health challenges; working for a healthier world with inclusivity, equity, and equality. In this study, it is briefly presented how the One Health approach has been initiated and developed in Latin America, highlighting the events and actions taken in Brazil, Chile, and Colombia.
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Saúde Única , Brasil/epidemiologia , Chile , Colômbia , Humanos , América Latina/epidemiologiaRESUMO
Ecosystem Health, Conservation Medicine, EcoHealth, One Health, Planetary Health and GeoHealth are inter-related disciplines that underpin a shared understanding of the functional prerequisites of health, sustainable vitality and wellbeing. All of these are based on recognition that health interconnects species across the planet, and they offer ways to more effectively tackle complex real-world challenges. Herein we present a bibliometric analysis to document usage of a subset of such terms by journals over time. We also provide examples of parasitic and vector-borne diseases, including malaria, toxoplasmosis, baylisascariasis, and Lyme disease. These and many other diseases have persisted, emerged or re-emerged, and caused great harm to human and animal populations in developed and low income, biodiverse nations around the world, largely because of societal drivers that undermined natural processes of disease prevention and control, which had developed through co-evolution over millennia. Shortcomings in addressing drivers has arisen from a lack or coordinated efforts among researchers, health stewards, societies at large, and governments. Fortunately, specialists collaborating under transdisciplinary and socio-ecological health umbrellas are increasingly integrating established and new techniques for disease modeling, prediction, diagnosis, treatment, control, and prevention. Such approaches often emphasize conservation of biodiversity for health protection, and they provide novel opportunities to increase the efficiency and probability of success.
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To reduce the use of antibiotics in animal agriculture, a number of effective or commercially viable alternatives have been implemented by food animal producers or are under development. Perhaps the most well-established strategies are flock and herd management practices to mitigate disease introduction and spread, and, subsequently, reduce the need for antibiotic use. While vaccines in food animal production have been used to prevent both bacterial and viral diseases, but historically, most vaccines have targeted viral diseases. Though vaccines against viral diseases can help reduce the need for antibiotic use by controlling the spread of secondary bacterial infections, more recent vaccines under development specifically target bacteria. New developments in selecting and potentially tailoring bacteriophages provide a promising avenue for controlling pathogenic bacteria without the need for traditional small-molecule antibiotics. In this article we discuss these established and emerging strategies, which are anticipated to reduce the reliance on antibiotics in food animal production and should reduce the prevalence and transmission to humans of antimicrobial resistant bacteria from these systems.
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Agricultura , Animais Domésticos , Terapia por Fagos/métodos , Animais , Antibacterianos/administração & dosagem , Bacteriófagos , Controle de Doenças Transmissíveis/métodos , Resistência Microbiana a Medicamentos , Vacinas/administração & dosagemRESUMO
Antimicrobial resistance (AMR) is a significant threat to both human and animal health. The spread of AMR bacteria and genes across systems can occur through a myriad of pathways, both related and unrelated to agriculture, including via wastewater, soils, manure applications, direct exchange between humans and animals, and food exposure. Tracing origins and drivers of AMR bacteria and genes is challenging due to the array of contexts and the complexity of interactions overlapping health practice, microbiology, genetics, applied science and engineering, as well as social and human factors. Critically assessing the diverse and sometimes contradictory AMR literature is a valuable step in identifying tractable mitigation options to stem AMR spread. In this article we review research on the nonfoodborne spread of AMR, with a focus on domesticated animals and the environment and possible exposures to humans. Attention is especially placed on delineating possible sources and causes of AMR bacterial phenotypes, including underpinning the genetics important to human and animal health.
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Animais Domésticos , Resistência Microbiana a Medicamentos , Meio Ambiente , Agricultura , Animais , Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Bactérias/genética , Bactérias/isolamento & purificação , Portador Sadio , Resistência Microbiana a Medicamentos/genética , Fezes/microbiologia , Humanos , Higiene , Microbiologia do Solo , Microbiologia da ÁguaRESUMO
Globally, increasing acquired antimicrobial resistance among pathogenic bacteria presents an urgent challenge to human and animal health. As a result, significant efforts, such as the One Health Initiative, are underway to curtail and optimize the use of critically important antimicrobials for human medicine in all applications, including food animal production. This review discusses the rationale behind multiple and competing "critically important antimicrobial" lists and their contexts as created by international, regional, and national organizations; identifies discrepancies among these lists; and describes issues surrounding risk management recommendations that have been made by regulatory organizations on the use of antibiotics in food animal production. A more harmonized approach to defining criticality in its various contexts (e.g., for human versus animal health, enteric diseases versus other systemic infections, and direct versus indirect selection of resistance) is needed in order to identify shared contextual features, aid in their translation into risk management, and identify the best ways to maintain the health of food animals, all while keeping in mind the wider risks of antimicrobial resistance, environmental impacts, and animal welfare considerations.
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Criação de Animais Domésticos , Animais Domésticos , Antibacterianos/administração & dosagem , Carne , Bem-Estar do Animal , Animais , Antibacterianos/classificação , Inocuidade dos Alimentos , Internacionalidade , Gestão de Riscos , Estados Unidos , United States Food and Drug AdministrationRESUMO
Introduction: Worsening antimicrobial resistance (AMR) threatens the practice of modern human and veterinary medicine. For decades, medicine and agriculture have blamed each other for the rise of resistant microbes. Widespread use and misuse of antibiotics in both medicine and agriculture have increased the prevalence and expression of resistance genes. VRE: The rise of vancomycin-resistant Enterococcus faecium (VRE) in the European Union (EU) led to the ban of avoparcin, an antibiotic that is chemically related to vancomycin. In the years post-ban, VRE surveillance data of EU hospitals showed no obvious reduction in VRE rates. The USA never approved avoparcin, yet VRE has been an enormous problem in its hospitals. AMR surveillance data showed zero rates of VRE in US livestock. Whole-genome sequencing data suggest that VRE might have evolved from ampicillin-resistant E. faecium from dogs. Companion animals have been completely ignored in the AMR debate. Sanitation: In addition, 1 billion people openly defecate around the world. Of these, 60% live in India, a country with highly resistant microbes. Conclusion: A One Health approach integrating human, animal and environmental whole-genome sequencing surveillance data is essential to getting to the root of AMR and developing effective prevention and control strategies.
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Doenças dos Animais/microbiologia , Antibacterianos , Controle de Doenças Transmissíveis , Farmacorresistência Bacteriana , Enterococcus faecium , Saúde Única , Enterococos Resistentes à Vancomicina , Resistência a Ampicilina , Animais , Antibacterianos/uso terapêutico , Proteínas de Bactérias/genética , Cães/microbiologia , Farmacorresistência Bacteriana/genética , Enterococcus faecium/genética , Europa (Continente) , Fezes/microbiologia , Glicopeptídeos/uso terapêutico , Humanos , Índia , Gado/microbiologia , Animais de Estimação/microbiologia , Saneamento , Estados Unidos , Resistência a Vancomicina , Enterococos Resistentes à Vancomicina/genética , Sequenciamento Completo do GenomaAssuntos
Infecções por Coronavirus , Coronavirus , Saúde Única , Pandemias , Pneumonia Viral , Síndrome Respiratória Aguda Grave , Betacoronavirus , COVID-19 , Saúde Global , Humanos , SARS-CoV-2RESUMO
A key element missing in the federal bioterrorism preparedness plan is qualified physician leadership at the local level. Physicians now lead fewer than one-fourth of local health departments. When appointed leaders are not physicians, leadership falls on elected officials or non-medical administrators who become managers of outbreaks. As illustrated in recent case examples, these leaders may find themselves in medical emergencies that they are not qualified to handle. In serious disease outbreaks, unprepared leadership could contribute to unnecessary illness and death. Here I propose strategies to increase qualified physician leadership in state and local public health infrastructures.
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Bioterrorismo/prevenção & controle , Defesa Civil/organização & administração , Surtos de Doenças/prevenção & controle , Liderança , Diretores Médicos , Papel do Médico , Administração em Saúde Pública , Defesa Civil/legislação & jurisprudência , Humanos , Governo Local , Estudos de Casos Organizacionais , Diretores Médicos/educação , Diretores Médicos/normas , Administração em Saúde Pública/legislação & jurisprudência , Governo Estadual , Estados UnidosRESUMO
Over the next 10 years, the United States will spend 6 billion US dollars to develop countermeasures against biological and chemical weapons. Much of this research on highly virulent pathogens will be done in academic settings around the country. This article explores the challenges in ensuring secrecy to protect national security while accommodating the right of local communities to have access to safety information regarding select agents and laboratory-acquired infections. Secrecy has been defended as being vital for protecting national security. Problems with secrecy can include the misinterpretation of intentions, particularly in laboratories located in nuclear weapons design facilities, and the restricted access to information relevant to public health and safety. While federal select agent legislation requires laboratories to have emergency plans in place with first responders, these plans do not necessarily include public health professionals, who will be responsible for any future public health action, such as quarantine, surveillance, or mass vaccinations, in the unlikely event that a laboratory-acquired infection spreads into a community. Laboratory-acquired infections do occur, even with the best safety mechanisms in place; however, the epidemiology of the incidence and severity of these infections are not known since there is no national surveillance reporting system. Evidence suggests that many of these infections occur in the absence of an actual laboratory accident. The best emergency plans and surveillance systems are only as good as the participation and vigilance of the laboratory workers themselves. Thus, laboratory workers have a responsibility to themselves and others to report all laboratory accidents and spills, regardless how minor. In addition, they should have a lower threshold than normal in seeking medical attention when feeling ill, and their physicians should be aware of what pathogens they work with to reduce the risk of a delay in diagnosis.
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Bioterrorismo/prevenção & controle , Confidencialidade/tendências , Pesquisa/tendências , Medidas de Segurança/tendências , Confidencialidade/normas , Planejamento em Desastres/organização & administração , Guias como Assunto , Humanos , Laboratórios/normas , Prática de Saúde Pública/normas , Medidas de Segurança/normas , Estados UnidosRESUMO
In the event of a severe nuclear power plant emergency resulting in the release of radioactive iodine, potassium iodide, a relatively safe and effective salt, may be used as prophylaxis. This article presents a history of thyroid cancer due to radiation exposure and the risks and benefits of potassium iodide prophylaxis.