Seeing the forest for the trees: how "one health" connects humans, animals, and ecosystems

Positioning zoonotic disease research in forced migration: A systematic literature review of theoretical frameworks and approaches

BACKGROUND

The emergence and transmission of zoonotic diseases are driven by complex interactions between health, environmental, and socio-political systems. Human movement is considered a significant and increasing factor in these processes, yet forced migration remains an understudied area of zoonotic research-due in part to the complexity of conducting interdisciplinary research in these settings.

OBJECTIVES

We conducted a systematic review to identify and analyze theoretical frameworks and approaches used to study linkages between forced migration and zoonotic diseases.

METHODS

We searched within eight electronic databases: ProQuest, SCOPUS, Web of Science, PubMed, PLoSOne, Science Direct, JSTOR, and Google Scholar, to identify a) research articles focusing on zoonoses considering forced migrants in their study populations, and b) forced migration literature which engaged with zoonotic disease. Both authors conducted a full-text review, evaluating the quality of literature reviews and primary data using the Critical Appraisal Skills Programme (CASP) model, while theoretical papers were evaluated for quality using a theory synthesis adapted from Bonell et al. (2013). Qualitative data were synthesized thematically according to the method suggested by Noblit and Hare (1988).

RESULTS

Analyses of the 23 included articles showed the increasing use of interdisciplinary frameworks and approaches over time, the majority of which stemmed from political ecology. Approaches such as EcoHealth and One Health were increasingly popular, but were more often linked to program implementation and development than broader contextual research. The majority of research failed to acknowledge the heterogeneity of migrant populations, lacked contextual depth, and insufficient acknowledgments of migrant agency in responding to zoonotic threats.

CONCLUSIONS

Addressing the emergence and spread of zoonoses in forced migration contexts requires more careful consideration and use of interdisciplinary research to integrate the contributions of social and natural science approaches. Robust interdisciplinary theoretical frameworks are an important step for better understanding the complex health, environment, and socio-political drivers of zoonotic diseases in forced migration. Lessons can be learned from the application of these approaches in other hard-to-reach or seldom-heard populations.

The role of environmental health in One Health: A Uganda perspective

Background

One Health is the integrative effort of multiple disciplines working locally, nationally and globally to attain optimal health for people, animals and the environment. As the human population continues to increase across the world, the interface of people, animals and the environment becomes more significant and impactful. For the past few years, the One Health concept has brought together experts in the areas of animal and human health. It has provided a new synthesis for public health and veterinary communities across the world. One Health initiatives have majorly focused on veterinarians, medical doctors and public health professionals. However, the Environmental Health profession has a major role to play in One Health activities based on Uganda's experiences.

Contribution of environmental health to One Health

In Uganda, Environmental Health Practitioners (EHPs) carry out several duties that contribute towards One Health. These include: inspection of animals before slaughter (antemortem) and meat in abattoirs (postmortem); inspection of meat in butcheries; destruction of condemned meat; disease surveillance; outbreak investigation and control of zoonoses; control of vectors and vermin such as rats, fleas, mosquitoes and monkeys; health education on pertinent issues such as vaccination of dogs; and food safety including meat and milk. EHPs also play an important role in prevention, detection and abatement of microbial and chemical pollution of land, air and water sources that have created new threats to the health of both animals and humans. EHPs carry out house to house inspections on water, sanitation and hygiene hence involved in abating nuisances at households that could pose a threat to public health. Such threats could be emerging from the environment including animals. Enforcement of public health legislation is also a key contribution of EHPs to One Health in Uganda.

Conclusion

EHPs play an important role in disease surveillance, prevention and control. Therefore, Environmental Health professionals should be involved as stakeholders in local, national and global One Health initiatives.

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One Health approach advocates the integration of multiple disciplines at all levels.

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It stresses that humans, animals, and environment health are all interconnected.

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One health challenges are on the increase especially in developing countries.

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Environmental health practitioners play many roles which contribute to One Health.

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Environmental health practitioners should therefore be involved as stakeholders in all One Health initiatives.

One health-Transdisciplinary opportunities for SETAC leadership in integrating and improving the health of people, animals, and the environment

One Health is a collaborative, transdisciplinary effort working locally, nationally, and globally to improve health for people, animals, plants, and the environment. The term is relatively new (from ∼2003), and it is increasingly common to see One Health included by name in interinstitutional research partnerships, conferences, communications, and organizational frameworks, particularly those championed by the human health and veterinary medical communities. Environmental quality is arguably the least developed component within the One Health framework, but can be guided by expertise within the Society of Environmental Toxicology and Chemistry (SETAC). Despite SETAC's long history of tripartite (academic, government, business) interdisciplinary environmental science activities, the term "One Health" is seldom used in SETAC communications (i.e., many of SETAC's activities are guided by One Health, but it is called by other names in SETAC's journals, newsletters, and presentations). Accordingly, the objective of this Focus article is to introduce the One Health concept to the SETAC membership. The article discusses the origins, evolution, and utility of the One Health approach as an organizational framework and provides key examples of ways in which SETAC expertise can benefit the One Health community. The authors assert that One Health needs SETAC and, to be most effective, SETAC needs One Health. Given that One Health to date has focused too little on the environment, on ecosystems, and on contaminants, SETAC's constructive involvement in One Health presents an opportunity to accelerate actions that will ultimately better protect human and ecosystem health. Environ Toxicol Chem 2016;35:2383-2391. © 2016 SETAC.

Global health education in Swedish medical schools

AIMS

Global health education is increasingly acknowledged as an opportunity for medical schools to prepare future practitioners for the broad health challenges of our time. The purpose of this study was to describe the evolution of global health education in Swedish medical schools and to assess students' perceived needs for such education.

METHODS

Data on global health education were collected from all medical faculties in Sweden for the years 2000-2013. In addition, 76% (439/577) of all Swedish medical students in their final semester answered a structured questionnaire.

RESULTS

Global health education is offered at four of Sweden's seven medical schools, and most medical students have had no global health education. Medical students in their final semester consider themselves to lack knowledge and skills in areas such as the global burden of disease (51%), social determinants of health (52%), culture and health (60%), climate and health (62%), health promotion and disease prevention (66%), strategies for equal access to health care (69%) and global health care systems (72%). A significant association was found between self-assessed competence and the amount of global health education received (p<0.001). A majority of Swedish medical students (83%) wished to have more global health education added to the curriculum.

CONCLUSIONS

Most Swedish medical students have had no global health education as part of their medical school curriculum. Expanded education in global health is sought after by medical students and could strengthen the professional development of future medical doctors in a wide range of topics important for practitioners in the global world of the twenty-first century.

Need for Enhanced Environmental Representation in the Implementation of One Health

Issues of global environmental change, global health, emerging disease, and sustainability present some of the most complex challenges of the twenty-first century. Individual disciplines cannot address these issues in isolation. Proactive, innovative, and trans-disciplinary solutions are required. Recognizing the inherent connectedness of humans, animals, plants, and their shared environment, One Health encourages the collaboration of many disciplines-including human and veterinary medicine, public health, social science, public policy, environmental science, and others-to address global and local health challenges. Despite great progress in this shift toward transdisciplinarity, the environmental component of the One Health paradigm remains underrepresented in One Health discourse. Human and animal health issues are commonly discussed under the umbrella of the One Health paradigm, while upstream environmental drivers and solutions are less prominent. We assessed the current integration of environmental issues in One Health publications and leadership. There is room for enhanced integration of environmental knowledge in the implementation of One Health approaches. We discuss the potential benefits from the collaboration between One Health and ecohealth, and explore strategies for increased environmental involvement.