Relational One Health: A more-than-biomedical framework for more-than-human health, and lessons learned from Brazil, Ethiopia, and Israel.

The One Health conceptual framework envisions human, animal, and environmental health as interconnected. This framework has achieved remarkable progress in the control of zoonotic diseases, but it commonly neglects the environmental domain, implicitly prioritizes human life over the life of other beings, and fails to consider the political, cultural, social, historical, and economic contexts that shape the health of multispecies collectives. We have developed a novel theoretical framework, Relational One Health, which expands the boundaries of One Health, clearly defines the environmental domain, and provides an avenue for engagement with critical theory. We present a systematic literature review of One Health frameworks to demonstrate the novelty of Relational One Health, and to orient it with respect to other critically-engaged frameworks for One Health. Our results indicate that while Relational One Health complements several earlier frameworks, these other frameworks are either not intended for research, or for narrow sets of research questions. We then demonstrate the utility of Relational One Health for One Health research through case studies in Brazil, Israel, and Ethiopia. Empirical research which is grounded in theory can speak collectively, increasing the impact of individual studies and the field as a whole. One Health is uniquely poised to address several wicked challenges facing the 21st century-climate change, pandemics, neglected zoonoses, and biodiversity collapse-and a unifying theoretical tradition is key to generating the evidence needed to meet these challenges.

The cycle of distrust in health policy and behavior: Lessons learned from the Negev Bedouin.

BACKGROUND: Over the last decades, health systems worldwide have faced a decline in public trust. For marginalized minority populations, who generally suffer from poverty and political exclusion, the roots of this trend go much deeper, establishing a state of bi-directional distrust between them and health institutions. Although studied to a lesser extent compared to trust, distrust does impede health initiatives, such as infectious diseases prevention programs, mostly of so-called Neglected Zoonotic Diseases (NZDs). Where distrust prevails, even trust building actions such as defining rights and obligations, prioritizing "the greater good" and increasing transparency, are prone to failure. In this study, we deepen the understanding of the concept of distrust through a unique case study of Brucellosis, a prevalent bacterial zoonotic disease endemic to disadvantaged Bedouin communities in southern Israel. METHODS: In the years 2015-2019, we qualitatively studied socio-political aspects in a governmental Brucellosis control campaign in southern Israel. We used in-depth interviews with 38 governmental and private health workers, agriculture and nature preservation workers, livestock owners and community leaders. Further, we conducted participant observation in 10 livestock pens and in policymaking meetings, and collected policy and media documents in order to triangulate the results. RESULTS: We conceptualize three different types of distrust between authorities and marginalized communities-"intention-based distrust", "values-based distrust" and "circular distrust"-to better explain how distrust originates and reinforces itself, reproducing the endemicity of NZDs. Based on that, we portray a practical framework to reduce distrust in health policies, by reframing local discourses, reshaping disease monitoring schemes from enforcement-based to participation-based, and promoting political inclusion of disadvantaged communities. CONCLUSIONS: The suggested analysis and framework redirect health policy objectives to not only acknowledge, contain and reduce the consequences of distrust, but also to strive for societal justice as a tool for health promotion.

Rethinking "One Health" through Brucellosis: ethics, boundaries and politics.

One Health, as an international movement and as a research methodology, aspires to cross boundaries between disciplines. However, One Health has also been viewed as "reductionist" due to its overemphasize on physicians-veterinarians cooperation and surveillance capacity enhancement, while limiting the involvement with socio-political preconditioning factors that shape the impact of diseases, and the ethical questions that eventually structure interventions. The current article draws on a qualitative study of Brucellosis control in Israel, to address the benefits of broadening the One Health perspective to include ethical considerations and the socio-political aspects of health. Using in-depth-interviews, observations and document review, the article analyzes stakeholders' knowledge (policy makers, practitioners and livestock owners) to understand Brucellosis control interventions in the Negev region of Israel. The analysis highlights four different types of boundaries: geographical, professional, disciplinary and participatory. The variety of boundaries going beyond disciplinary ones, are often neglected by traditional One Health discourses, however they provide clearer understanding regarding the role of the Israel and Palestine relations; enforcement activities and trust creation; and mechanisms of decision-making and public participation, in Brucellosis interventions. A broad One Health analysis that addresses ethical concerns and socio-political environments, as well as human and veterinary medicine, encourages re-framing of causes and solutions when dealing particularly with Brucellosis in the Negev, but more generally with zoonotic diseases, low-trust settings and inequitable distribution of power. The inclusion of historical, political and bioethical considerations of Public Health in One Health creates opportunities to increase the relevance of One Health and expand its scope as a novel scientific paradigm.