The continuum of care as a unifying framework for intergenerational and interspecies health equity

Introduction

Unlocking the full potential of different people and organizations to address existential health threats requires shared goals and frameworks that allow people to see themselves contributing to a common and shared continuum of care. A new narrative to help people implement collective action for collective problems is needed.

Methods

This paper is draw from the co-authors experience working from the local to international level on planetary health problems.

Results

The proposed conceptual framework expands the socioecological model of health to help formulate multilevel approaches that foster healthier circumstances for all by revealing the mutual benefits that emerge from pooling expertise, funding, and political will to solve multiple problems with coordinated investment of resources and effort. It is intended to support program planning and communication. This framework is a response to the absence of systematic attempts to concurrently counteract the social and environmental conditions leading to disease, dysfunction and deficits which is increasingly seen as being problematic, especially as the root causes of health problems and solutions converge across species, sectors, and generations. The framework is embedded in the idea of interspecies and intergenerational health equity.

Discussion

Ensuring interspecies and intergenerational health equity requires each actor to fulfill their roles along the continuum while supporting the needs of others. A socio-ecological continuum of care provides bundled options that combine knowledge from different sectors, disciplines and perspectives to guide interventions over time across a comprehensive array of services and support spanning all levels of needs, species and generations.

Understanding Community Perceptions of the St. Kitts’ “Monkey Problem” by Adapting Harm Reduction Concepts and Methods

Wicked problems in One Health are associated with dynamicity and uncertainty that require experts, authorities and community members to reach for innovative means of collective inquiry, and collaborative interventions to address the deep social issues at the root of interspecies problems. In this study we explore the value of harm reduction concepts to understand a hundreds of year old issue, the St. Kitts’ “monkey problem,” which involves the invasive African green monkey (Chlorocebus sabaeus) as the cause of deleterious effects on agriculture, but concurrent positive effects on tourism and biomedical research. The harm reduction approach, a systems and settings-based approach with decades of success in public health, can serve as a framework to produce action on persistent societal problems. Harm reduction concepts and methods and participatory epidemiology were used to uncover local perceptions about human-monkey interactions and “meet people where they are” by asking the research question: Are there commonalities in perceptions and values linked to the St. Kitts’ “monkey problem” that are shared across diverse representatives of society that can act as a common starting place to launch collaborative responses to this invasive species? Through a series of focus group activities and interviews we found that the Kittitian “monkey problem” is a contentious and dichotomous problem pervasive in most of society that has no single stakeholders nor one solution. Harm reduction helped to map the island’s human-monkey system and elucidated an entry point toward tackling this problem through the identification of shared values, and also provided a model for incremental gains that may be achieved. Likening the St. Kitts “monkey problem” to a wicked problem enabled stakeholders to seek more options to manage the problem rather than to conclusively solve it. Frequently mentioned shared values including the protection of farmer crops and backyard harvests likely represent strong entry points to this problem and a jumping-off point to begin collective action toward future improvements.

Reconsidering the “War on Rats”: What We Know From Over a Century of Research Into Municipal Rat Management

To sustainably control urban rat infestations, management efforts need to encompass large areas of urban centers. Therefore, the objective of this review and narrative synthesis was to collate what is known about municipal-scale rat management. We explored the management frameworks that have been used at a large scale in cities and we describe the expectations of experts who have designed and implemented these frameworks. We found that there has been a persistent “war on rats” paradigm driving this literature since the early 1900s. Not only was there little quantitative evidence to support this paradigm and associated methodologies, but together, they failed to meet the expectations of those who designed and implemented them due to real-world constraints (i.e., limited resources). To improve the field of municipal management, we identify two distinct options. First, stakeholders may continue to wage the “war on rats” while improving existing strategies within this paradigm. Key pathways forward include developing evaluation metrics aligned with program objectives, establishing the cost-effectiveness of methodologies, and improving control efficacy. Second, we suggest a new paradigm, one that considers that rat management is a complex system that must be approached by first mapping its complexity to highlight and prioritize the many complex upstream determinants of infestations. This perspective highlights how rat management may be a wicked problem for which there is no overarching solution and instead can only be managed by making incremental gains in individual components of the problem over time. Importantly, we propose an alternative management objective that places a priority on improving the overall health of the community, instead of on eliminating rats, and we stress that management goals must address stakeholders’ goals as their investment is essential for a sustained program.

The implications of climate change for Veterinary Services

Climate change due to increasing greenhouse gas (GHG) emissions is one of the most pressing issues facing society on a global scale. The growth of GHG emissions between 2000 and 2010 was higher than in each of the previous three decades, and each of the past four decades has been successively warmer than any preceding decades since 1850. Continued GHG emissions will cause further warming and changes in the climate system. Climate change affects livestock production in multiple ways, both directly and indirectly. Many of the impacts on the livestock sector result from increasing frequency and magnitude of weather and climate extremes such as droughts, flash floods, untimely rains, frost, hail and severe storms. This article describes some of the most vulnerable disaster communities in Asia, Africa, Australia, Europe and South America. It then describes the importance of meteorological information provided by national Meteorological and Hydrological Services to help Veterinary Services support sustainable management of livestock in vulnerable pastoral communities.

Health promotion and harm reduction attributes in One Health literature: A scoping review

One Health faces enormous pressure and challenges as it attempts to mitigate dynamic, surprising and complex global events that threaten the health and sustainability of human and animal populations and the biosphere. One Health practitioners and researchers need every advantage to developing working solutions to the world's imminent complex issues. Heath promotion and harm reduction, interrelated approaches that have seen much success over decades of use in global public health, may be important models to consider. Both use an upstream socioecological determinant of health approach to reach beyond the health sector in all health efforts, and encourage active community participation and empowerment to attain and sustain human and ecological health. This scoping review of 411 documents, believed to be the first to relate health promotion and harm reduction to One Health, searched self-declared One Health research literature for evidence of health promotion and harm reduction policies, principles and methodologies. It sought to answer the questions: "What is the scope of practice of One Health in self-declared One Health publications?" and "Are attributes of health promotion and harm reduction found in self-declared One Health-reviewed research literature?" Over half of the papers revealed no health promotion or harm reduction attributes while 7% were well-endowed with these attributes. These 7% of papers focused on deep-seated, complex health issues with systemic knowledge gaps and decision-making issues revolving around specific population vulnerabilities, social inequities and competing stakeholders. Implementing 'on the ground change' was a common theme in the strongest health promotion/harm reduction papers we identified. Alternatively, papers lacking health promotion or harm reduction attributes focused on managing proximate risks, primarily for infectious diseases. The addition of health promotion and harm reduction to One Health practices may help the field rise to the growing expectations for its involvement in complex global issues like pandemics and climate change.

Stakeholder perspectives on the development and implementation of approaches to municipal rat management

Rats evoke public health and economic concern in cities globally. Rapid urbanization exacerbates pre-existing rat problems, requiring the development and adoption of more effective methods of prevention, monitoring and mitigation. While previous studies have indicated that city-wide municipal management approaches often fail, such outcomes are often left without specific explanation. To determine how municipalities could more effectively develop and implement large-scale approaches, we interviewed stakeholders in municipal rat management programs to document their opinions, recommendations and the challenges they face. Using a thematic framework method, this study collates and analyzes in-depth interviews with 39 stakeholders from seven cities across the United States. Overall, stakeholders’ recommendations for municipal rat management aligned with many conceptual attributes of effective management reported in the literature. Specifically, stakeholders highlighted the need to prioritize the reduction of resources available to sustain rat infestations (e.g. food, water and harborage), to focus on proactive (vs. reactive) measures, and to implement large-scale data collection to increase the efficiency of cross-city rat control. Stakeholders also suggested novel approaches to management, such as mitigating rat-associated risks for vulnerable populations specifically and developing tailored initiatives based on the specific needs and desires of residents. We synthesize these recommendations in light of reported barriers, such as resource limitations, and consider several opportunities that may help municipalities reconceptualize their approaches to city-wide rat management.

Implications of Zoonoses From Hunting and Use of Wildlife in North American Arctic and Boreal Biomes: Pandemic Potential, Monitoring, and Mitigation

The COVID-19 pandemic has re-focused attention on mechanisms that lead to zoonotic disease spillover and spread. Commercial wildlife trade, and associated markets, are recognized mechanisms for zoonotic disease emergence, resulting in a growing global conversation around reducing human disease risks from spillover associated with hunting, trade, and consumption of wild animals. These discussions are especially relevant to people who rely on harvesting wildlife to meet nutritional, and cultural needs, including those in Arctic and boreal regions. Global policies around wildlife use and trade can impact food sovereignty and security, especially of Indigenous Peoples. We reviewed known zoonotic pathogens and current risks of transmission from wildlife (including fish) to humans in North American Arctic and boreal biomes, and evaluated the epidemic and pandemic potential of these zoonoses. We discuss future concerns, and consider monitoring and mitigation measures in these changing socio-ecological systems. While multiple zoonotic pathogens circulate in these systems, risks to humans are mostly limited to individual illness or local community outbreaks. These regions are relatively remote, subject to very cold temperatures, have relatively low wildlife, domestic animal, and pathogen diversity, and in many cases low density, including of humans. Hence, favorable conditions for emergence of novel diseases or major amplification of a spillover event are currently not present. The greatest risk to northern communities from pathogens of pandemic potential is via introduction with humans visiting from other areas. However, Arctic and boreal ecosystems are undergoing rapid changes through climate warming, habitat encroachment, and development; all of which can change host and pathogen relationships, thereby affecting the probability of the emergence of new (and re-emergence of old) zoonoses. Indigenous leadership and engagement in disease monitoring, prevention and response, is vital from the outset, and would increase the success of such efforts, as well as ensure the protection of Indigenous rights as outlined in the United Nations Declaration on the Rights of Indigenous Peoples. Partnering with northern communities and including Indigenous Knowledge Systems would improve the timeliness, and likelihood, of detecting emerging zoonotic risks, and contextualize risk assessments to the unique human-wildlife relationships present in northern biomes.

Mapping Rocky Mountain ridged mussel beds with preliminary identification of overlapping Eurasian watermilfoil within the Canadian range

The Rocky Mountain ridged mussel (Gonidea angulata) is a bivalve species whose Canadian range is limited to the Okanagan Valley, British Columbia. In 2019, conflicts between habitat protection for the mussel and potential habitat alteration to control the invasive Eurasian watermilfoil (Myriophyllum spicatum) (milfoil), led to a decision to maintain the status of the mussels as Special Concern under Canada’s Species at Risk Act (SARA) rather than classify it as Endangered. Milfoil control can cause direct mortality and/or burial of the mussels, but there had been no systematic study of the impacts of milfoil control on mussel beds. The purpose of this study was to address knowledge gaps by delineating known mussel beds and potential overlap with milfoil to provide information for management decisions that balance the needs of native species protection and invasive species control. Rocky Mountain ridged mussels in three reference locations were enumerated using snorkel surveys. The presence and distribution of milfoil was documented in relation to five sites within these three locations. Milfoil was encroaching on one site, causing some changes to the substrate. At other sites, the differences in the depth and distribution of the mussel and the milfoil could allow milfoil control without damaging the mussel beds. It is recommended that, before milfoil removal near known mussel beds be undertaken, a detailed site evaluation be conducted to determine potential impacts. This study suggests presumed impediments to co-managing the mussels and controlling an invasive species should not preclude classifying the mussels as Endangered and affording protections under SARA.

Missing in action: Sustainable climate change adaptation evidence for animal health

Health impacts of climate change are now inevitable. The objective of this study was to see if animal health climate change adaptation was a subject of scholarly inquiry, advice, or discussion and if there was an evidence base from which to make adaptation recommendations. A scoping review of English-language literature over the past 10 years was undertaken and the top findings related to animal health adaptation and climate change were inventoried on Google. Documents found in the search focussed predominantly on hypothesizing what hazards might occur with climate change, describing their spread or proposing possible impacts. Scant evidence was found of scholarship related to sustainable animal health climate change adaptation planning or action. Investment and attention to adaptation planning and research are needed to increase confidence in climate change recommendations in the face of continuing uncertainty about the breadth of effects on animal health and the best actions to take in preparing and responding to them.

Rethinking pandemic preparedness in the Anthropocene

The social and ecological changes accompanying the Anthropocene require changes in how pandemics are anticipated, conceived, and managed. Pandemics need to be reframed from infections we can predict to inevitable infectious and non-communicable surprises with which we need to cope. A hazard-by-hazard approach to planning and response is insufficient when the next pandemic cannot be predicted. Decision-making will benefit from scoping the problem broadly to generate deeper insights into potential threats. The origins of pandemics come from our relationships with the world around us. Health leaders, therefore, need to be aware of primordial determinants of risk arising from these changing relationships. Cross-sectoral co-learning to anticipate surprise will require bridging agents embedded within a health agency to facilitate transdisciplinary intelligence gathering. A unified set of guidelines is needed to promote pandemic resilience by collaboratively tending to the determinants of health for each other, our communities, and the natural environment.

Integration of wildlife and environmental health into a One Health approach

Climate change, habitat fragmentation and pollution, and subsequent loss of biodiversity and degradation of natural environments, threaten the range of ecosystem services that support all life on this planet. These changes, among others, are also driving the emergence of infectious diseases, with negative health outcomes for humans, animals, and our shared environment. Historically, interventions aimed at human and agricultural health issues did not always integrate wildlife or environmental health as part of the solution, which has resulted in unintended consequences. One Health recognises the interdependence of humans, animals and their shared environment, and provides a conceptual framework for developing interventions that optimise outcomes for human, animal and environmental health. However, there is a need to clearly articulate the core values, goals, and objectives of One Health for all relevant sectors in order to maximise synergies for communication, coordination, collaboration and, ultimately, for joint actions on disease control and prevention. The application of systems and harm reduction approaches, focusing on the socio-economic and environmental determinants of health, and ensuring good governance and effective leadership will also maximise the opportunities to develop 'win-win-win' solutions to global health and environmental challenges. These solutions would help propel One Health forward to reach its full potential and truly optimise health outcomes for all.

Is there a due diligence standard for wildlife disease surveillance? A Canadian case study

Due diligence is a concept used to justify investment in wildlife health surveillance to satisfy trading partners and other animal health stakeholders. Canadian literature and legislation were reviewed and key informant interviews were used to determine if a wildlife surveillance due diligence standard existed. Wildlife surveillance is constrained by challenges that necessitate convenience and opportunistic sampling, making it difficult to apply surveillance performance standards from public or domestic animal health. Key informants cited due diligence to justify wildlife health surveillance activities but could not identify a due diligence threshold nor could regulations, international obligations, or the literature. The lack of a due diligence standard puts wildlife health surveillance managers at a disadvantage when trying to show public return on investment or when assessing the adequacy of surveillance efforts. Steps being taken by the Canadian Wildlife Health Cooperative to meet the performance needs of the Pan-Canadian Approach to Wildlife Health are introduced.

Is Fisheries and Oceans Canada policy receptive to a new Pacific salmon health perspective?

The concept of health permeates priorities and policies for managing wild Pacific salmon ( Oncorynchus spp.). Regulatory agencies rely largely on salmon abundance and (or) the absence of pathogens to declare if a population is healthy. Our goal was to determine if there was a receptive policy environment within Fisheries and Oceans Canada (DFO) to adopt a cumulative effects perspective of health. We used a previously developed health model along with a multiple streams framework and a narrative review of DFO policy to see how fish health was situated in DFO’s salmon management problems, policy, and politics. We discovered that a cumulative effects perspective was consistent with policy goals and priorities. DFO’s guiding principles and responsibilities for aquatic animal health were spread across multiple policies and regulations. There were no processes or people responsible for integrating information and activities. The use of the word health in policies and planning without a consistent definition meant that DFO could not explicitly assess if it has reached its management target of healthy salmon. An option for transitioning to cumulative effects perspective is to adopt a healthy public policy perspective and processes to integrate the diverse information linked to social and environmental determinants of health.

Serological and molecular detection of Toxoplasma gondii in terrestrial and marine wildlife harvested for food in Nunavik, Canada

BACKGROUND

Toxoplasma gondii, a zoonotic protozoan parasite, infects mammals and birds worldwide. Infection in humans is often asymptomatic, though illnesses can occur in immunocompromised hosts and the fetuses of susceptible women infected during pregnancy. In Nunavik, Canada, 60% of the Inuit population has measurable antibodies against T. gondii. Handling and consumption of wildlife have been identified as risk factors for exposure. Serological evidence of exposure has been reported for wildlife in Nunavik; however, T. gondii has not been detected in wildlife tissues commonly consumed by Inuit.

METHODS

We used a magnetic capture DNA extraction and real-time PCR protocol to extract and amplify T. gondii DNA from large quantities of tissues (up to 100 g) of 441 individual animals in Nunavik: 166 ptarmigan (Lagopus lagopus), 156 geese (Branta canadensis and Chen caerulescens), 61 ringed seals (Pusa hispida), 31 caribou (Rangifer tarandus) and 27 walruses (Odobenus rosmarus).

RESULTS

DNA from T. gondii was detected in 9% (95% CI: 3-15%) of geese from four communities in western and southern Nunavik, but DNA was not detected in other wildlife species including 20% (95% CI: 12-31%) of ringed seals and 26% (95% CI: 14-43%) of caribou positive on a commercial modified agglutination test (MAT) using thawed heart muscle juice. In geese, tissue parasite burden was highest in heart, followed by brain, breast muscle, liver and gizzard. Serological results did not correlate well with tissue infection status for any wildlife species.

CONCLUSIONS

To our knowledge, this is the first report on the detection, quantification, and characterization of DNA of T. gondii (clonal lineage II in one goose) from wildlife harvested for food in Nunavik, which supports the hypothesis that migratory geese can carry T. gondii into Nunavik where feline definitive hosts are rare. This study suggests that direct detection methods may be useful for detection of T. gondii in wildlife harvested for human consumption and provides data needed for a quantitative exposure assessment that will determine the risk of T. gondii exposure for Inuit who harvest and consume geese in Nunavik.

Effects of Culling on Leptospira interrogans Carriage by Rats

We found that lethal, urban rat control is associated with a significant increase in the odds that surviving rats carry Leptospira interrogans. Our results suggest that human interventions have the potential to affect and even increase the prevalence of zoonotic pathogens within rat populations.

Foxes (Vulpes vulpes) as sentinels for parasitic zoonoses, Toxoplasma gondii and Trichinella nativa, in the northeastern Canadian Arctic

Outbreaks of Toxoplasma gondii and Trichinella spp. have been recurring for decades among Inuit of Nunavik, northeastern Canada. Contact with wildlife has been identified as a risk factor for Inuit exposure to T. gondii, but reservoirs have yet to be confirmed based on direct detection of DNA or organism. Similarly, little is known about the occurrence of Trichinella spp. in wildlife species of Nunavik other than walrus (Odobenus rosmarus) and bears (Ursus americanus, Ursus maritimus). Foxes (Vulpes vulpes) were targeted as possible sentinels for T. gondii and Trichinella spp. because of their high trophic position within the Arctic food chain as carnivorous scavengers. A total of 39 red foxes were sampled from four communities in southern and western Nunavik between November 2015 and September 2016. For the first time in wildlife, a novel magnetic capture DNA extraction and real-time PCR technique was used to isolate and detect T. gondii DNA from the heart and brain of foxes. A double separatory funnel digestion method followed by multiplex PCR was used to recover and genotype larvae of Trichinella spp. from tongues of foxes. Seroprevalence based on detection of antibodies to T. gondii was 41% (95% CI: 27-57%) using a commercially available modified agglutination test (MAT). Detection of DNA of T. gondii and larvae of Trichinella nativa (T2) occurred in 44% (95% CI: 28-60%) and 36% (95% CI: 21-51%) of foxes, respectively. Coinfection with both T. nativa and T. gondii occurred among 23% (95%CI: 13-38%) of foxes which can be attributed to co-transmission from prey and scavenged species in their diet. There was only moderate agreement between T. gondii serology and direct detection of T. gondii DNA using the MC-PCR technique (Kappa test statistic: 0.321), suggesting that using both methods in tandem can increase the sensitivity of detection for this parasite. These findings show that foxes are good sentinels for circulation of parasitic zoonoses in terrestrial northern ecosystems since they are highly exposed, show measurable indicators of infection and do not serve as exposure sources for humans.

Wildlife Population Welfare as Coherence Between Adapted Capacities and Environmental Realities: A Case Study of Threatened Lamprey on Vancouver Island

Wildlife conservation lacks a well-accepted ethical foundation for population welfare. In this paper we propose a definition of wildlife population welfare and use a case study to suggest its value for species recovery planning. We define wildlife population welfare as coherence between the species' adapted capacities and the realities of its current environment. We present a case study of the Cowichan Lake lamprey (Entosphenus macrostomus), a parasitic fish species endemic to three connected lakes in British Columbia, Canada. Individual-level welfare concerns were insufficient to inspire actions to protect this threatened species. The key threats to Cowichan Lake lamprey can be linked to anthropogenic changes and global threats such as climate change. Due to prevailing uncertainties and the inability to eliminate critical threats, the species recovery plan was focussed on securing critical environmental and social assets to meet evolved adaptations of lamprey while considering the needs of other species, including people. This assets focussed approach was well suited to developing consensus for action to enable a harm reduction perspective that recognizes that many of the threats cannot be eliminated but actions could be taken to enable the population to succeed by protecting critical environmental resources. This was consistent with our population welfare perspective which focusses on assets rather than deficits to help identify shared priorities for species recovery, conservation obligations, and social expectations.

Leadership, governance and partnerships are essential One Health competencies

One Health is held as an approach to solve health problems in this era of complexity and globalization, but inadequate attention has been paid to the competencies required to build successful teams and programs. Most of the discussion on developing One Health teams focuses on creating cross-disciplinary awareness and technical skills. There is, however, evidence that collaborative, multi-disciplinary teams need skills, processes and institutions that enable policy and operations to be co-managed and co-delivered across jurisdictions. We propose that competencies in leadership and human resources; governance and infrastructure; and partnership and stakeholder engagement are essential, but often overlooked One Health attributes. Competencies in these staple attributes of leadership and management need to be more prominent in training and One Health capacity development. Although One Health has been in existence for over a decade, there has been no systematic evaluation of the essential attributes of successful and sustainable One Health programs. As such, much of this paper borrows from experience in other sectors dealing with complex, cross and inter-sectoral problems. Our objective is to advocate for increased investment in One Health leadership, governance and partnership skills to balance the focus on creating cross-disciplinary awareness and technical proficiency in order to maintain One Health as a viable approach to health issues at the human-animal-environment interface.

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Cross-disciplinary technical proficiency is necessary but insufficient for One Health.

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One Health needs skills, processes and institutions that enable co-management and co-delivery.

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Leadership, governance and partnership are essential but overlooked competencies.

Finding a Place for Systems-Based, Collaborative Research in Emerging Disease Research in Asia

The need to adequately predict, prevent and respond to infectious diseases emerging unexpectedly from human-animal-environmental systems has driven interest in multisectoral, socio-economic, systems-based, collaborative (MSC) research approaches such as EcoHealth and One Health. Our goals were to document how MSC research has been used to address EIDs in Asia, and to explore how MSC approaches align with current priorities for EID research in Asia. We gathered priorities for EID research from the peer-reviewed and grey literature, documented organizational descriptions of MCS research approaches, and analysed a series of EID MSC projects. We found that priority areas for EID research in Asia included (1) understanding host-pathogen-environment interactions; (2) improving tools and technologies; (3) changing people's behaviour; and (4) evaluating the effectiveness of interventions. We found that the unifying characteristics of MSC research were that it was action-oriented and sought to inspire change under real-world conditions at the complex interface of human and natural systems. We suggest that MSC research can be considered a type of 'pragmatic research' and might be most useful in describing change in complex human-animal-environmental systems, accelerating research-to-action, and evaluating effectiveness of interventions in 'real world' settings.

Using expert informed GIS to locate important marine social-ecological hotspots

The marine environment provides significant benefits to many local communities. Pressure to develop coastal waterways worldwide creates an urgent need for tools to locate marine spaces that have important social or ecological values, and to quantify their relative importance. The primary objective of this study was to develop, apply and critically assess a tool to identify important social-ecological hotspots in the marine environment. The study was conducted in a typical coastal community in northern British Columbia, Canada. This expert-informed GIS, or xGIS, tool used a survey instrument to draw on the knowledge of local experts from a range of backgrounds with respect to a series of 12 social-ecological value attributes, such as biodiversity, cultural and economic values. We identified approximately 1500 polygons on marine maps and assigned relative values to them using a token distribution exercise. A series of spatial statistical analyses were performed to locate and quantify the relative social-ecological importance of marine spaces and the results were ultimately summarized in a single hotspot map of the entire study area. This study demonstrates the utility of xGIS as a useful tool for stakeholders and environmental managers engaged in the planning and management of marine resources at the local and regional levels.

Japanese Encephalitis: Estimating Future Trends in Asia

Limited surveillance programs and lack of diagnostic laboratory testing capacity in many low and middle income Asian countries have made it difficult to validate epidemiological patterns and anticipate future changes in disease risk. In this study, we consider the case of Japanese Encephalitis in Asia and examine how populations of human hosts and animal reservoirs are expected to change over the next three decades. Growth was modelled at the sub-national level for rural and urban areas to estimate where high-density, susceptible populations will potentially overlap with populations of the virus' amplifying host. High-risk areas based on these projections were compared to the current distribution of Japanese Encephalitis, and known immunization activities in order to identify areas of highest priority for concern. Results indicated that mapping JE risk factors at the sub-national level is an effective way to contextualize and supplement JE surveillance data. New patterns of risk factor change occurring in Southeast Asia were identified, including around major urban areas experiencing both urbanization and growth in pig populations. A hotspot analysis of pig-to-population ratio found a significant spatial cluster extending northward through Southeast Asia and interior China. Mapping forecasted changes in risk factors for JE highlights regions vulnerable to emerging zoonoses and may be an important tool for developing effecting transnational health policies.

Is One Health delivering results? Introduction

The One Health concept is responsible for a shift towards practices, policies and partnerships that better link the health of people, animals and our shared environments. The papers in this issue of the World Organisation for Animal Health Scientific and Technical Review illustrate a myriad of ways in which a One Health approach could advance or has already advanced human and animal well-being. Independently, the authors conducted their own thematic analysis of One Health activities and found strong support for the notion that One Health has inspired a renaissance in veterinary public health, increased our basic knowledge of the mechanisms and natural history of many animal diseases, promoted systems approaches to health issues and encouraged stronger cross-sectoral collaboration. Unfortunately, many collaborations often end when funding ends and many remain distinct partnerships. One Health still suffers from a lack of strong environmental stakeholders and has mostly worked on infectious disease rather than addressing many of the pressing determinants of health that will confront us in the next century. There is no shared conception of health across veterinary, medical and environment sectors, and this is an issue that must be confronted if there are to be programmes that are truly integrated across people, animals and the environment.

Wildlife parasites in a One Health world

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One Health emphasizes the interdependence of human, animal, and environmental health.

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Wildlife parasites are ubiquitous; how do we decide which are One Health issues?

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We propose questions to help to prioritize wildlife parasites in a One Health context.

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We suggest principles for taking action on wildlife parasites with One Health significance.

One Health has gained a remarkable profile in the animal and public health communities, in part owing to the pressing issues of emerging infectious diseases of wildlife origin. Wildlife parasitology can offer insights into One Health, and likewise One Health can provide justification to study and act on wildlife parasites. But how do we decide which wildlife parasites are One Health issues? We explore toxoplasmosis in wildlife in the Canadian Arctic as an example of a parasite that poses a risk to human health, and that also has potential to adversely affect wildlife populations of conservation concern and importance for food security and cultural well-being. This One Health framework can help communities, researchers, and policymakers prioritize issues for action in a resource-limited world.

A scoping analysis of peer-reviewed literature about linkages between aquaculture and determinants of human health

For many of the world's poor, aquatic products are critical for food security and health. Because the global population is increasing as wild aquatic stocks are declining, aquaculture is an increasingly important source of aquatic products. We undertook a scoping review of the English-language peer-reviewed literature to evaluate how the research community has examined the impacts of aquaculture on four key determinants of human health: poverty, food security, food production sustainability, and gender equality. The review returned 156 primary research articles. Most research (75%) was focused in Asia, with limited research from Africa (10%) and South America (2%). Most research (80%) focused on freshwater finfish and shrimp production. We used qualitative content analysis of records which revealed 11 themes: famer income; the common environment; shared resources; integrated farming/ polyculture; employment; extensive vs. intensive production; local vs. distant ownership; food security; income equity; gender equality; and input costs. We used quantitative content analysis of records and full-text publications about freshwater finfish and shrimp aquaculture to record the frequency with which themes were represented and the positive or negative impacts of aquaculture associated with each theme. Scatter plots showed that no theme was identified in more than half of all articles and publications for both production types. Farmer income was a theme that was identified commonly and was positively impacted by both shrimp and fresh water finfish aquaculture. Polyculture, employment, and local ownership were identified less often as themes, but were also associated with positive impacts. The common environment and shared resources were more common themes in shrimp aquaculture than freshwater finfish aquaculture research, while polyculture and local ownership were more common themes in freshwater finfish aquaculture than shrimp aquaculture. Gender equality, employment, and food security were themes found in a lower percentage of records than full-text publications for both production types.

Regional variation in pig farmer awareness and actions regarding Japanese encephalitis in Nepal: implications for public health education

Japanese encephalitis (JE) is a mosquito-borne zoonotic disease that has pigs as the major amplifying hosts. It is the most important cause of viral encephalitis in people in Nepal and is spreading in its geographic distribution in that country. Pig farming is increasing in Nepal due to reducing cultural biases against pigs and government programs to support pig farming for poverty alleviation. Major strategies for JE prevention and control include education, vector control, and immunization of people and pigs. This study used a survey of 400 pig farmers in 4 areas of Nepal with different JE and pig farming histories to explore regional variations in farmer awareness and actions towards JE, the association of awareness and actions with farm and farmer variables, and the implications of these associations for public health education. Exposure to JE risk factors was common across pig farms and pig farming districts but there were significant district level differences in knowledge and practices related to on-farm JE risk reduction. Social factors such as literacy, gender, and cultural practices were associated with farmer attitudes, knowledge and practices for JE control. JE vaccine uptake was almost non-existent and mosquito control steps were inconsistently applied across all 4 districts. Income was not a determining factor of the differences, but all farmers were very poor. The low uptake of vaccine and lack of infrastructure or financial capacity to house pigs indoors or away from people suggest that farmer personal protection should be a priority target for education in Nepal. This study re-enforces the need to attack root causes of people's personal disease prevention behaviours and take into account local variation in needs and capacities when designing health or agriculture education programs.

Using network analysis to explore if professional opinions on Japanese encephalitis risk factors in Nepal reflect a socio-ecological system perspective

Japanese encephalitis (JE) is the leading cause of viral encephalitis in Asia and a significant public health problem in Nepal. Its epidemiology is influenced by factors affecting its amplifying hosts (pigs), vectors (mosquitoes), and dead-end hosts (including people). While most control efforts target reduced susceptibility to infection either by vaccination of people or pigs or by reduced exposure to mosquitoes; the economic reality of Nepal makes it challenging to implement standard JE control measures. An ecohealth approach has been nominated as a way to assist in finding and prioritizing locally relevant strategies for JE control that may be viable, feasible, and acceptable. We sought to understand if Nepalese experts responsible for JE management conceived of its epidemiology in terms of a socio-ecological system to determine if they would consider ecohealth approaches. Network analysis suggested that they did not conceive JE risk as a product of a socio-ecological system. Traditional proximal risk factors of pigs, mosquitoes, and vaccination predominated experts' conception of JE risk. People seeking to encourage an ecohealth approach or social change models to JE management in Nepal may benefit from adopting social marketing concepts to encourage and empower local experts to examine JE from a socio-ecological perspective.

Comparative spatial dynamics of Japanese encephalitis and acute encephalitis syndrome in Nepal

Japanese Encephalitis (JE) is a vector-borne disease of major importance in Asia. Recent increases in cases have spawned the development of more stringent JE surveillance. Due to the difficulty of making a clinical diagnosis, increased tracking of common symptoms associated with JE-generally classified as the umbrella term, acute encephalitis syndrome (AES) has been developed in many countries. In Nepal, there is some debate as to what AES cases are, and how JE risk factors relate to AES risk. Three parts of this analysis included investigating the temporal pattern of cases, examining the age and vaccination status patterns among AES surveillance data, and then focusing on spatial patterns of risk factors. AES and JE cases from 2007-2011 reported at a district level (n = 75) were examined in relation to landscape risk factors. Landscape pattern indices were used to quantify landscape patterns associated with JE risk. The relative spatial distribution of landscape risk factors were compared using geographically weighted regression. Pattern indices describing the amount of irrigated land edge density and the degree of landscape mixing for irrigated areas were positively associated with JE and AES, while fragmented forest measured by the number of forest patches were negatively associated with AES and JE. For both JE and AES, the local GWR models outperformed global models, indicating spatial heterogeneity in risks. Temporally, the patterns of JE and AES risk were almost identical; suggesting the relative higher caseload of AES compared to JE could provide a valuable early-warning signal for JE surveillance and reduce diagnostic testing costs. Overall, the landscape variables associated with a high degree of landscape mixing and small scale irrigated agriculture were positively linked to JE and AES risk, highlighting the importance of integrating land management policies, disease prevention strategies and promoting healthy sustainable livelihoods in both rural and urban-fringe developing areas.

A focused ethnographic study of Sri Lankan government field veterinarians' decision making about diagnostic laboratory submissions and perceptions of surveillance

The global public health community is facing the challenge of emerging infectious diseases. Historically, the majority of these diseases have arisen from animal populations at lower latitudes where many nations experience marked resource constraints. In order to minimize the impact of future events, surveillance of animal populations will need to enable prompt event detection and response. Many surveillance systems targeting animals rely on veterinarians to submit cases to a diagnostic laboratory or input clinical case data. Therefore understanding veterinarians’ decision-making process that guides laboratory case submission and their perceptions of infectious disease surveillance is foundational to interpreting disease patterns reported by laboratories and engaging veterinarians in surveillance initiatives. A focused ethnographic study was conducted with twelve field veterinary surgeons that participated in a mobile phone-based surveillance pilot project in Sri Lanka. Each participant agreed to an individual in-depth interview that was recorded and later transcribed to enable thematic analysis of the interview content. Results found that field veterinarians in Sri Lanka infrequently submit cases to laboratories – so infrequently that common case selection principles could not be described. Field veterinarians in Sri Lanka have a diagnostic process that operates independently of laboratories. Participants indicated a willingness to take part in surveillance initiatives, though they highlighted a need for incentives that satisfy a range of motivations that vary among field veterinarians. This study has implications for the future of animal health surveillance, including interpretation of disease patterns reported, system design and implementation, and engagement of data providers.

Raising chickens in city backyards: the public health role

There is increasing interest in raising chickens in urban settings across North America. Current regulations on backyard chickens vary by jurisdiction due to concerns about perceived health threats. Proposed negative impacts on public health and community well-being include infectious diseases acquired through rearing practices or consumption of eggs, inappropriate waste management, interaction with pests and predators and nuisance factors such as noise and odour. Proposed benefits are derived largely from the human-animal bond and from feelings of autonomy over food selection. The importance or validity of claims of positive and negative effects cannot be supported by literature specific to the urban agriculture context. Public health practitioners might approach this issue in a manner analogous to concerns over keeping domestic pets.

Knowledge and practices of pig farmers regarding Japanese encephalitis in Kathmandu, Nepal

Japanese encephalitis (JE) is the single largest cause of viral encephalitis in the world and has been endemic in Nepal since the early 1980s. Since then, it has spread from its origins in lowland plains to the Kathmandu Valley as well as in hill and mountain districts. Pigs are amplifying hosts for the virus. The Nepal government has been encouraging the development of pig farming as a means of poverty alleviation. Whereas other countries have reduced JE through vaccination programmes and improvements in pig husbandry, these options are not economically possible in Nepal. The objective of this study was to examine the occupational risk of pig farmers in Nepal and to determine their level of knowledge and practice of JE prevention techniques. We surveyed 100 randomly selected pig farmers in the Kathmandu District and found that pig farmers were exposed to many JE risk factors including poverty and close proximity to pigs, rice paddy fields and water birds, which are the definitive hosts for the virus. Forty-two percent of the farmers had heard of JE, 20% associated it with mosquito bites and 7% named pigs as risk factors. Few protective measures were taken. None of the farmers were vaccinated against JE nor were any pigs, despite an ongoing human vaccination campaign. This farming community had little ownership of land and limited education. JE education programmes must consider gender differences in access to public health information as there were an equal number of male and female farmers. We provide findings that can inform future JE education programmes for this vulnerable population.