1.0 Introduction
According to the definition provided by One Health Commission, one health is the interdisciplinary effort of people to work locally, nationally and globally to attain optimal health for wildlife, human beings and domestic animals (Gibbs, 2014). It can be observed that the One Health concept comprises three pillars, namely human health, domestic health and wildlife health as shown in figure one,
Source Credit: Gibbs, 2014
Fig 1: Three pillars of One Health
Due to the rapid globalization process, most countries in the world are getting more and more interconnected. As such, this concept becomes more and more relevant because it is highly possible for people to interact with others from different parts of world. They may also interact with different animal species, wildlife habitats, etc. Human species are thus exposed to the threat of potential wide-spread pandemic. The outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003 is one such example(Peiri et al., 2003). SARS spread rapidly to more than two dozen countries across the world. Even worse, Covid-19, the current global pandemic creates the highest fatality rate in past two decades. The WHO reports that currently Covid-19 leads to over 346k deaths. 5.5 million people world wide are tested positive for the coronavirus(World Health Organization, 2020). The U.S alone has over 1.7M people who are confirmed to have Covid-19 and 99,462 death cases. It all shows that one health is critical for all countries to fight against viruses and other potential public health problems. One Health takes inspiration from Hippocrates, the Greek father of medicine, who first integrates human health, animal health and environmental health into a whole medical system(Jouanna, 2012). He points out that animal health is also relevant because a significant number of viruses or health issues are attributed to animal infection. Human beings may be inadvertently infected through interaction with wild animals. Covid-19, for instance, is first reported in the Wuhan’s seafood wet market(Wu et al, 2020). Rudolf Virchow, the father of modern pathology, insists that there should not be a dividing line between animal and human medicines because all biological species are interconnected(Kahn et al., 2008). James Harlan Steele, a very reputable veterinary public health expert, believes that it is more important to prevent the spread of diseases and viruses to humans(Cowen, Currier&Steele, 2016). He also leads a group of researchers and scientists to focus on developing animal medicines. However, at present, it should be noticed that complex health issues need innovative and integrated approaches. In other words, it should go beyond the development of animal and human medicine to prevent potential outbreak of diseases. In this essay, the One Health approach will be critically analyzed and evaluated. Both advantages and disadvantages will also be presented in details.
2.0 Advantages of One Health System
2.1 Food Safety
First, One Health is high critical for security food safety in developing and underdeveloped countries. Pork, for instance, is a very important component of Vietnamese diet. As a matter of fact, people from China and other Southeast Asian countries have a very long history of having pork in their regular diets(Duong et al, 2015). The annual pork consumption per capita in Vietnam is about 29kg(Duong et al, 2015). It comprises of 56% of total meat intake in the country. 76% of the pork products are processed directly in the slaughterhouse. Local residents prefer to purchase fresh “warm” pork supplied in the retail and traditional market. However, without proper food safety risk assessment, the lives and health of Vietnamese people are under potential threat of various types of viruses carried by pigs such as Salmonella(Phan et al, 2005). Salmonella infection or Salmonellsois is a common bacterial disease that affects the intestine tract of human beings. Typically, most people with salmonellsois do not exhibit significant symptoms. Others may develop diarrhea. According to WHO, people with diarrhea may have fever and abdominal cramps within 10 to 70 hours(Thai et al., 2012). Without proper action, life-threatening complications may be developed if the salmonella spreads beyond the intestines of human bodies. People may be suffering from dehydration. People may even die in extreme cases(Lam et al, 2016). The Ministry of Health of Vietnam states that even though people may be infected by Salmonella by eating raw and undercooked meat, poultry, eggs, etc, pork is still the major source of infection. Possible signs of Salmonellsois may include vomiting, diarrhea, fever, chills, headache, etc. Therefore, the Ministry of Health regularly conduct food safety risk assessment along the pork value chain. PigRisk Project, for example, has been conducted between 2012 and 2017(Unger et al, 2016). Salmonella risk pathways are identified to comprise of five major components, including farm, transportation to slaughterhouse, slaughter house, retailers or retailing market, and consumers. Along the pathway, people may be potentially infected by Salmonella(Unger et al, 2016).. In farm, Salmonella bacteria is spreading when pigs are fed in cages. Without properly assessment and control, it can be observed that bacteria will spread quickly in the environment. In this sense, not domestic animals should be taken care of. The whole environment should also be inspected with respect to Salmonella. In other words, farmers, farm assistants and other staffs may be all under risks. In the process of the transportation to slaughterhouse and within slaughter house, people may be infected in the dissection of pork meat. Salmonella may be spread in this process. For example, when workers in the slaughter house extracts internal organs such as liver and kidney, they may be infected with the bacteria. In the retailing market, customers and retailers both can be infected with Salmonella. Even when they purchase pork in the retail market and bring it home, they may further spread the bacteria to their immediate family members and close friends. In the PigRisk project, the Ministry of Health of Vietnam decides to collect 1,275 samples from all the major components in the pork value chain(Unger et al, 2016). The collected result in 2015 can be shown in table 1 below. The annual salmonellosis incidence rate is astonishingly high. It shows that there is a potential food safety issue that threatens the health status of average Vietnamese. Apart from the health issues, Salmonella may also lead to potential economic loss for all stakeholders. The cost per treatment episode for foodborne diarrhea case is approximately US$107. Most Vietnamese people cannot afford such high cost. Besides, 51.3% indirect cost may also be incurred in the Salmonellosis. For instance, parents have to spend their time to look after their infected children. As such, they may have to ask for sick leaves themselves. In other worsd, there is no daily income on that day. In other to address the health issue and economic problem, like the aforementioned, the ministry of Health decides to use One Health approach. Apart from the PigRisk Project, the Health Ministry also conducts very strict pilot intervention in the small and medium-sized slaughterhouse. These slaughterhouses are required to separate dirty and clean zones. Dirty zones are referring the place before de-hairing(Unger et al, 2018). Clean rinsing water are also required for performance important operations the SH. From the analysis above, it can be observed that the food safety can be effectively improved through One Health approach. In regards to the prevention of Salmonella, One Health effectively controls and stops the spreading of Salmonella along the pork value chain. It considers the environment, domestic animals and human health as a holistic system. Without ignoring any elements in the One Health system, the Salmonella spreading its well controlled in the last two years. One Health thus does not only protect people from imminent danger of health issues such as Salmonellosis, but also reduce the economic losses for local people.
Table 1: The Annual incidence of Salmonellosis in Vietnam, 2015
Age and Gender Groups |
Estimated annual salmonellosis incidence rate |
|
Children Adult female Adult male Elder Overall |
11.18 (0 - 45.00) 16.41 (0.01 - 53.84) 19.29 (0.04 - 59.01) 20.41 (0.09 - 60.77) 17.70 (0.89 - 45.96) |
Source Credit: Unger et al, 2016
2.2 AMR Prevention
Apart from the food safety issues, Open Health approach can also effectively regulate the problem of antimicrobial resistance (AMR). Antimicrobial resistance is one of the most serious public health threats in this century(Tenover, 2006). Human beings are significantly influenced by the intake of food and antibiotics. Resistance to antimicrobial agents has become a major source of morbidity and mortality worldwide(World Health Organization, 2014). According the report published by the Review of Antimicrobial Resistance in 2016, there are over 700,000 deaths worldwide which are attributed to AMR(Singer et al., 2016). Generally speaking, antimicrobial agents can be divided into groups based on the mechanism of antimicrobial activity, including agents that inhibit cell wall synthesis, inhibit protein synthesis, inhibit acrid synthesis, and depolarize the cell membrane(Poole, 2005). At the beginning of this century, antimicrobial agents are widely used in medical treatment and inhibition of pest growth in agricultural industry. However, it should be noticed that most pathogenic microorganisms have the capability of developing resistance to antimicrobial agents(World Health Organization, 2014). It thus makes antibiotics dysfunctional. However, in reality, antimicrobial agents are widely used on human beings and animals. The residues of antimicrobial agents may also disperse into the aquatic and eco-system of human beings, domestic animals and wildlife. AMR poses a significant threat on people, animals and other stakeholder in the One Health system. In Canada, Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) is initiated by the central government to oversee, regulate and curb the deterioration of AMR in the country(Deckert et al, 2010). The CIPARS is strictly following the epidemiological model of AMR proposed and modified by Linton et al., (1977). In fact, this model is a good example of One Health Approach because it considers all the three dimensions in the One Health concept, namely human beings, food and animals, and aquaculture (environment). Through fully identifying the components which may lead to the ARM, the residues and concentration of antimicrobial agents in human beings’ living environment, food, water, and other areas would be oversaw effectively. When the concentration of antimicrobial agents are kept within the requirement, it will reduce the adverse impact of these agents on human beings’ health status. The CIPARS has pragmatic gains for all stakeholders. First, it increases the knowledge regarding AMR in the public health system in Canada. And also, it accelerates the time to detect the trends, such as an abnormal increase of the antimicrobial concentration in the targeted environment. But in the real world, developing and underdeveloped countries do not have the ability to implement One health system or approach. Instead, countries like India are still using single sector antimicrobial resistance surveillance. In fact, it is both costly and ineffective as compared with an One Health approach. In this new era, single sector antimicrobial resistance surveillance cannot compared with the effectiveness and efficiency of an One Health approach because the latter can utilize big data technology to help analyzing essential data collected from the three pillars , namely human, domestic and wildlife. It can identify potential loopholes in any of the three areas such as a sudden increase in antimicrobial agent concentration. With the assistance of centralized laboratory components and IT infrastructure, researchers and scientists can immediately identify the problems and propose corresponding measures to the reduce the level of antimicrobial agents. It also uses much less labor in the process because most data are analyzed throw computing algorithm and simulation. According to the report published by Canadian Science Center, CIPARS helps to save nearly 26% of the operational cost in fighting against AMR. Therefore, it shows that One Health approach is more cost-efficient and effective than any single part or sector in overseeing and reducing antimicrobial resistance worldwide.
Source Credit: Linton et al., 1977
Fig 2: Epidemiological model of antimicrobial resistance
2.3 Fast identification of Diseases
Furthermore, One Health system can help researchers and scientists identify diseases very fast. As a matter of fact, professional researchers are lack of the ability to detect Salmonella, antimicrobial resistance, and other diseases in a timely manner. Without fast response, human beings may be devastatingly affected or even killed by the unknown or unidentified viruses. Covid-19, for instance, leads to the high mortality rate worldwide largely because scientists and researchers cannot identify the nature, source and other characteristics of the viruses(Del Rio & Malani, 2020). Even now people are just suspecting the virus is carried by wild bats in China without sufficient supporting evidences. Even if bats are the virus-carriers, it is still difficult to know how exactly the viruses is transmitted to human bodies. There are many such examples which shows that without an one health system, human beings’ lives and properties are under imminent threats. In Malaysia, local researchers initially fails to identify that fruit tree is the habitat for bat-to-swine transmission of Nipah (Yob et al, 2001). It is attributed to the lack of interaction and communication between ordinary people, veterinary, and wild life researchers. Without multi- or interdisciplinary efforts, it is almost impossible for researchers to know the source and channels of transmission. Thus, it is difficult for people who work in the public health sector to propose corresponding solutions and measures to reduce the spread of viruses. As a result, more than 100 people died on a single day in Malaysia. One million pigs are also culled for the fear of Nipah spreading(Chua, 2003). Covid-19 is certainly another good example. Without the awareness of the source, channels and characteristics of the corona-virus, the U.S and many other western countries fail to respond fast enough to control the spreading. The U.S only issues a travel ban on Chinese tourists but it fails to realize that the viruses can also be transmitted by European travelers(CDC, 2020). As a result, most countries are not responding correctly with respect to the outbreak of Covid-19. In fact, most people working in the public health sector in the world agree that if the viruses or bacteria are identified fast, the total mortality rate can be effectively brought. But it also shows that many countries are still vulnerable to global pandemics. One Health approach requires interdisciplinary efforts. In other words, it can accelerate the process of identifying unknown viruses and diseases. It is important because respective experts and researchers in the public health management can at least instruct the general public about how to respond appropriate and protect themselves from virus or bacteria infection. In the example of Covid-19, if experts can immediately realize that the new virus is a kind of corona-virus, just like SARS, and carried by wild bats, public health experts can immediately educate the public about the importance of wearing masks because the infection through droplets in the air can be effectively prevented. But without one health system, it is rather time-consuming for researchers to identify what viruses are currently harming the healthiness of people. Or it becomes too late when people realize that a certain type of virus is threatening people’s health.
Three advantages are summarized in this section. It should be noticed that One health system is highly effectively in helping human beings address food safety and AMR issues. It also accelerates the process for researchers in public health sector to identify viruses and instruct the general public about how to deal with the diseases very promptly. However, to a certain extent, one health system is far from being impeccable.
3.0 Disadvantage of One Health System
One potential disadvantage and major challenge is that One Health requires countries from all over the world the share information transparently without covering-up(Yuan, Shawn, 2020). But as a matter of fact, most countries are reluctant to share the full information due to political, social and economic concerns(Yuan, Shawn, 2020). Covid-19 again can be used as a good example to show why it is difficult to implement One Health system in the world. China is reporting the new type of corona-viruses as early as in the mid of January this year. But it is still considered very late because the first identified case can be traced back in December last year. In other words, there is nearly one month gap between the first-identified case and the official reporting. It is understandable that why China is reluctant to share the full information with other countries when the first case of Covid-19 is discovered. At the political level, without full knowledge and information about the new virus, politicians in the local government cannot bear the political responsibility to report the virus as a new and fatal disease. If so, in Wuhan alone, travelers, residents, businesspersons, working professionals, companies and other stakeholders will get into panic. Wuhan. may be out-of-control as people may be rushing out of the city(Tian et al., 2020). At the social level, it should be noticed that January is the month for Chinese to celebrate traditional Chinese New Year (CNY). in other words, if people are informed about the risk of the outbreak of Covid-19, the whole China’s transportation system will become chaotic. Spring Transportation Rush is perhaps the largest migration activity ever in human history. Each year, migrant workers from western or interior regions of China will work in large coastal cities because they can earn a higher pay there. But during the spring festival, they will go back to their own hometown and reunite with their family members(Tian et al., 2020). As such, if these migrant workers are receiving messages about the potential threat of a new virus, they will rush back to their own cities as the place of origin of the new virus may be shut down. It will collapse the local transportation as China has the largest population in the world. Last, at the economic level, it is also costly to report the information regarding to the pandemic to other countries. Let say, if China reports to the WHO and other member countries about the exact death tolls, foreign investors will stop or reduce their investment in China as the pandemic will destruct the local economic activities(Tian et al., 2020). Many countries will also close down their borders to protect their own citizens from being affected by the viruses. Many industries including the manufacturing, tourism, exporting sectors, international trade, etc, will be adversely affected. Therefore, it is not very likely for countries to honestly share and upload the true information to the global One Health system such as WHO before making their own political, social and economic assessment.
4.0 Alternative Solutions
As the above-mentioned, even though One Health has a lot of advantages, it still has shortcomings in address local, national and global health issues. As such, it is necessary and essential to introduce alternative solutions in protecting public health. Eco-health, for instance, can be a good alternative and complementary solution to One Health(Waltner-Toews, 2009). Eco-health concept has a different origin as compared with One-Health. It is originated from biological researches instead of medical or pharmaceutical studies. Eco-health is an emerging field of study focusing on how changes in the earth’s eco-system affect human beings’ health. Therefore, its focus is more on examining the changes in the biological, social, economical environments and how the factors above can be linked to human’s health issues. It can be observed that One-health and Eco-health is using a different approach. For instance, it is reported that the Northern China still relies heavily on the electricity generated by the thermal power plants. In other words, coals are still a major source of electricity generation resource in China. As a result, the northern residents are suffering from heavy air pollution such as suspended particles (e.g PM2.5)(Cao et al., 2012). It further leads to potential health problems such as pulmonary diseases and even lung cancer. In this sense, Eco-health is using a different approach to address the health problem. It emphasizes on improving the political, social and economic environment to address public health issues. One-health system relies more on pathological and medical tools to target at human, animals and environment health issues. One-health and Eco-health approaches are certainly not mutually exclusive. They are working very well within the Public health management system.
5.0 Conclusion
To a very large extent, it can be observed that One-health is absolutely necessary and essential in public health researches and management. It can enhance the food safety, prevent antimicrobial resistance and facilitates fast identification of unknown bacteria or viruses. However, meanwhile it also has a potential challenge, that is, countries may be reluctant to share the true information regarding the pandemics or diseases. Therefore, countries should not only rely on One-health in addressing public health issues. Eco-health approach can be a good alternative and complementary solution to one-health. It deals with public health issues through assessing the impact of political, social and environmental changes. In fact, t is an integrative approach to use one-health and eco-health together to address public health issues. But the major challenge of this integrative approach is certainly the difficulty in so-called integrate researches. Integrate researches are referring to the interdisciplinary and trans-disciplinary studies that use systematic thinking to generate new knowledge and sustainable competencies by combining principles, models, theories and empirical studies in many disciplines together.
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