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ОглавлениеJAKOB ZINSSTAG,1,2* DAVID WALTNER-TOEWS3 AND MARCEL TANNER1,2
1 Swiss Tropical and Public Health Institute, Basel, Switzerland; 2 University of Basel, Basel, Switzerland; 3 Ontario Veterinary College, University of Guelph, Guelph, Canada
One Health: Benefits from Closer Cooperation
The convergence of interests in human and animal health, based on careful observation and scientific study, has a long history which has gained attention from medical historians in the last few years (Woods et al., 2018). Much of this convergence is based on inferences and analogies from empirical observations of specific diseases and comparative anatomy rather than on broader definitions of health (Bresalier et al., Chapter 1, this volume). Among the many proponents of a closer interaction of human and animal health (Zinsstag et al., 2015), two are particularly noteworthy: (i) Rudolf Virchow, the founder of cellular pathology in the late 19th century; and (ii) Calvin Schwabe (Box 2.1), an internationally renowned veterinary epidemiologist and pioneer of veterinary public health in the 20th century. Virchow and Schwabe were among the first to articulate key points that motivated elaboration of the premise of One Health. Discussing bovine tuberculosis (Tschopp and Yahyaoui, Chapter 22, this volume) at a hearing in the Prussian senate, Virchow stated: ‘There is no scientific barrier between veterinary and human medicine, nor should there be. The experiences of one must be used for the development of the other’1 (Bollinger, 1902; Saunders, 2000). Influenced by his experience of working with Dinka pastoralists in Sudan, Schwabe coined the term ‘one medicine’, to make the point that ‘There is no difference of paradigm between human and veterinary medicine. Both sciences share a common body of knowledge in anatomy, physiology, pathology, on the origins of diseases in all species’ (Schwabe, 1984).
Indeed the methods of comparative medicine used in both human and veterinary medicines are closely related and have produced – and continue to produce – enormous mutual benefits. Most therapeutic interventions in human medicine were developed and tested in animals. Under the increasing influence of specialization, however, human and veterinary medicine diverged, and too often fail to communicate, even when they share interests in the same disease. For example, during a recent outbreak of Q-fever in the Netherlands, public health authorities were not informed by veterinary authorities about a wave of abortions in goats (Enserink, 2010). Similarly, outbreaks of Rift Valley fever in humans in Mauritania were identified as yellow fever by mistake. The correct diagnosis was made only after public health services contacted livestock services and learned about the occurrence of abortions in cattle (Digoutte, 1999; Schelling et al., 2007a).
Box 2.1. Calvin Schwabe 15 March 1927–27 July 2006 (Zinsstag and Sackmann, 2007).
Calvin Schwabe graduated with a zoology degree in 1948 and obtained his doctorate in veterinary medicine in 1954. At Harvard, he obtained a master’s degree in public health and a PhD in parasitology and tropical medicine (1956). For 10 years, Schwabe worked at the American University in Beirut. His main interests were parasitic diseases, mainly echinococcosis. He initiated control programmes and led the WHO expert committee on veterinary public health in Geneva. In 1966, he became a full professor in veterinary epidemiology at UC Davis (California). Schwabe’s interests reached far beyond health issues towards more integrated approaches to science. His overarching views on health of all species influenced modern concepts of veterinary public health, One Health and ecosystem health. His vast bibliography is accessible at: https://oculus.nlm.nih.gov/cgi/f/findaid/findaid-idx?c=nlmfindaid;idno=schwabe (accessed 27 March 2020).
Collaborations between veterinarians and physicians should produce benefits that are broader than merely additive. The beyond-additive value-added benefits are related to direct positive outcomes not just in reduced risks and improved health and well-being of animals and humans, but also in financial savings, reduced time to detection of disease outbreaks and subsequent public health actions, as well as improved environmental services (Zinsstag et al., Chapter 31, this volume). For example, a mixed team of doctors and veterinarians examining human and animal health in mobile pastoralist communities in Chad found that more cattle were vaccinated than children. None of the children were fully vaccinated against childhood diseases. Recognition of this fact enabled subsequent joint human and animal vaccination campaigns providing preventive vaccination to children who would otherwise not have had access to health services. Clearly, a closer cooperation of veterinarians and doctors generated a better health status than what could have been achieved by working in isolation (Schelling et al., 2007a; Häsler et al., Chapter 10, this volume; Danielsen and Schelling, Chapter 14, this volume). Such joint services are scalable to national and regional level by adopting a systems strengthening perspective leading to an extension from Calvin Schwabe’s concept of ‘one medicine’ to One Health (Zinsstag et al., 2005). This has been clearly validated as a public health concept in different areas of the world, ranging from Africa to Asia (Zinsstag et al., 2011).
Today, One Health has become a broad international movement supported by the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (OIE). The World Bank produced a first account of economic aspects of One Health (World-Bank, 2010, 2012), which can include health consequences of structural aspects such as political change (Roth et al., 2003) or globalized agriculture (Wallace et al., 2015). In the USA, a One Health commission coordinates and assembles many of the activities (‘www.onehealthcommission.org’ (accessed 27 March 2020)).The European Cooperation in Science and Technology (COST) funded the creation of a Network for Evaluation of One Health (NEOH), which developed an evaluation framework (Rüegg et al., 2017) and coined the term ‘One Health-ness’. One Health-ness is expressed as a mixed method index of quantitative and qualitative operational and infrastructural aspects of One Health. NEOH includes environmental, ecosystem and structural elements of health, and connects to the Sustainable Development Goals (SDGs) of the United Nations (Rüegg et al., 2017, 2018; Hitziger et al., 2018).
One Health has thus gained broad recognition as an integrated approach to health when compared with mainstream reductionist approaches in the health sciences. Yet, by expanding the integration of health towards broad social-ecological issues like antimicrobial resistance or deforestation, complex interactions can become ‘wicked’ and hardly tractable.
Rüegg and co-workers state: ‘There is a need to provide evidence on the added value of these integrated and transdisciplinary approaches to governments, researchers, funding bodies and stakeholders’ (Rüegg et al., 2018). We thus recall the foundational principles of One Health:
1. One Health is about cooperation between different academic disciplines underlying human and veterinary medicine in the first place, but without any barrier to natural and social sciences and the humanities. One Health also engages with non-academic actors in the co-production of knowledge (Berger-González et al., Chapter 6, this volume).
2. Cooperating partners will seek a benefit of working together sooner or later. To fully understand the range of potential benefits of a closer cooperation implies a deeper and comprehensive recognition and understanding of how humans and animals and their environment are interrelated at all scales. This is a necessary requirement of One Health but still not sufficient.
A sufficient requirement for One Health is demonstrating the benefits and added values resulting from the crosstalk and closer cooperation between human and animal health and all related disciplines and stakeholders.
We thus define One Health as any added value in terms of health of humans and animals, financial savings, social resilience and environmental sustainability achievable by the cooperation of human and veterinary medicine and other disciplines when compared to the two medicines and other disciplines working separately.
The equal focus on the health of people and animals is one of the characteristics that has differentiated the organization, strategy and practice of One Health from several other related fields, such as veterinary public health, resilience, ecohealth, and most recently, planetary health (Horton et al., 2014; Pongsiri et al., 2019). The latter two consider ecological resilience and sustainability more prominently (see more discussion on this below; also Bunch and Waltner-Toews, Chapter 4, this volume; Lerner and Zinsstag, Chapter 5, this volume).
Based on these characteristics, the challenge is to show how, through highly iterative processes and actions, both directly and indirectly, physicians serve animal health and veterinarians serve public health. We need methods that are capable of quantitatively and qualitatively measuring interactions at the interface of human and animal health. Such methods have been developed for survey design (Schelling and Hattendorf, Chapter 8, this volume), integrated surveillance and response (Aenishaenslin et al., Chapter 9, this volume), economics (Häsler et al., Chapter 10, this volume), animal-to-human transmission of infectious diseases (Chitnis et al., Chapter 12, this volume) and integrated health services (Danielsen and Schelling, Chapter 14, this volume). The postulate of an added value of such a closer cooperation is summarized in Zinsstag et al. (Chapter 31, this volume).
Cultural Differences in Human–Animal Relations and their Implications
Dealing with human and animal health as One Health inevitably sheds light on the human–animal relationship and bond. Domestication of wild animals was one of the fundamental cultural achievements of humans, and the use of animals for hunting and as livestock was critical for human development and culture. One Health, even in a more restricted definition as offered here, faces challenging questions regarding cultural differences in view of animals and how they are valued. Thus One Health should reflect on the normative aspects (values) of the human–animal relationship with emphasis on improving animal protection and welfare (see also Wettlaufer et al., Chapter 11, this volume; Hediger and Beetz, Chapter 26, this volume; and Fries and Tschanz Cooke, Chapter 27, this volume). Secondly, even if ecological resilience or health is not the primary outcome of concern, One Health implies an interface of humans and animals with the environment, which can be highly complex, requiring systemic approaches to the physical and social environment. They relate human and environmental systems and are also called social-ecological systems (SES). SES relate to theory of complexity (Ostrom, 2007). Thirdly, One Health empirical experience involves not only human and animal health professionals but also reaches out to many other academic domains, as well as to non-academic actors like public and private institutions, authorities, civil societies, communities and households. It engages with the public in a transdisciplinary way, considering all forms of academic and non-academic knowledge for practical problem solving at the animal–human interface. The strongest leverage of One Health is observed when it is applied to practical societal problem solving (Berger-González et al., Chapter 6, this volume).
Normative aspects of the human–animal relationship
Similarly to the human–human relationship, the human–animal relationship is governed by norms and values determined by culture and religion. Animals are regarded as intimate companions with a high emotional value or simply as prey with a financial value for their meat. Humans are also valued as prey by animals under certain circumstances. This is certainly one of the reasons for deep-seated fears against wildlife, which have led to the extinction or threat of extinction of predators in large parts of the world (White et al., Chapter 3, this volume; Bunch and Waltner-Toews, Chapter 4, this volume). There is no biological reason why humans should not consider their surrounding domesticated animals and wildlife as close relatives and treat them with utmost care. Currently, on the one hand, globalized livestock production maximizes profits with little regard for humane standards towards animals. At the same time, moderate intensification of livestock production is a way out of the poverty trap for millions of smallholder farmers. On the other hand, we observe very close relationships with companion animals, to the point of humanizing them and considering them as family members. Although not adhering to any of the more dogmatic and naturalist-populist moves, with promotion of person rights to primates and whales, we must recognize that animals cannot be considered as commodities without certain rights. We refer the reader to the growing literature on the moral status of animals and animal welfare (Wettlaufer et al., Chapter 11, this volume). More recently and controversially, these considerations have been extended to arthropods (Waltner-Toews and Houle, 2017).
Ancient Egyptians saw humans and animals as ‘one flock of God’, and contemporary Fulani express similar views in their creation myths in West Africa (Sow, 1966). Medical knowledge in India is influenced by beliefs about metempsychosis and reincarnation between animals and humans. According to various schools of Hindu spirituality, there is no distinction between human beings and other life forms. All life forms, including plants and animals, possess souls, and humans can be reborn as animals and vice versa. Such thinking greatly influences how animals are perceived and handled. Comparable to Hinduism2 and Jainism, in Buddhism, as little harm as possible is done to animals. Buddhists treat the lives of human and non-human animals with equal respect (Ryder, 1964; Cowell, 1973; Sangave, 1991). Judeo-Christian traditions focused less on spiritual kinship than on the moral and empirical responsibilities of humans towards other animals. Biblical texts report that humans and terrestrial animals were created on the same day, and the Sabbath regulations also imply the resting of livestock, indicating a strong co-creational attitude in the Judeo-Christian Bible. In the Qur’an, animals are considered close to humans. Modern animal welfare has roots in southern German pietism, and here we cite Albert Schweitzer, inspired for his philosophical idea of ‘reverence for life’, or in the original German language: ‘Ehrfurcht vor dem Leben’. In summary, the contemporary human–animal relationship is polarized between merciless exploitation of livestock and humanizing of pets. Within the dilemma of aspirations of a globalized economy, social development and animal welfare, culture and religion as well as economic considerations largely influence the human–animal relationship and subsequently the potential of a closer cooperation of human and animal health.
Working in different cultures to achieve One Health outcomes implies adopting the view that there are multiple legitimate perspectives and that practices must be adapted to local contexts. We need to clarify both our own perspective and point of view. Adopting a self-reflexive attitude, we may ask, ‘What is the personal cultural/religious background driving my animal–human relationship?’ Our own attitude towards animals influences how we value animal life economically or emotionally. For example, the dogs in Fig. 2.1A have a market value for consumption of approximately US$12 in a local market in West Africa, whereas the pet cat in Fig. 2.1B is part of a household in Europe, with a willingness to spend a considerable amount of money on veterinary care. Consequently, when we report about our research from One Health studies we also need to explain the perspective (i.e. the social, cultural and religious background, from which the animal–human relationship is seen) as it strongly determines the valuing in economic frameworks and societal contexts (Zinsstag and Weiss, 2001; Narrod et al., 2012). The overarching approach in practising One Health, however, clearly ought not to be driven by any specific perspective but rather by the pragmatic approach, which effectively brings together resources from different disciplines and resources to address the priorities of the concerned human and animal populations.
Fig. 2.1. A dog trader on his way to the market in Eastern Mali, West Africa (A) and pet cat in a household in Switzerland (B). Photos courtesy of J. Zinsstag.
One Health and animal ethical and welfare issues
A One Health perspective also encompasses reflections on human and animal well-being per se. Humans have rights and seek to maximize their well-being. Similarly, one might ask, if animals have rights, how do we consider their well-being (Wettlaufer et al., Chapter 11 this volume)? Despite an overall protective attitude in most cultures and religions, the reality is often appalling. Worldwide, and across different cultures and religions, millions of animals are reared, transported and slaughtered under terribly inhumane conditions, urgently calling for much stronger engagement on animal protection and welfare.
Animal biodiversity contributes to stable ecosystem services, and extensive livestock rearing maintains carbon sequestration in semi-arid areas. Animal disease threatens human health and food security, for example through transmission of zoonotic diseases or loss of animals for ploughing. Large parts of the world could not be inhabited without the use of livestock in a moderate way. Consequently, we can no longer close our eyes to the close linkage, interrelations and interdependencies of human and animal health without considering simultaneously maintenance of stable ecosystem services, some of which are seriously threatened by livestock rearing methods and/or excessive human exploitive activities.
Peter Rabinowitz, an occupational physician at Yale University proposed that humans should change their point of view towards animals from an ‘us versus them’ to a ‘shared risk’ attitude between humans and animals (Rabinowitz et al., 2008; Rabinowitz and Conti, 2010). As an example, we can consider the high cancer rate of beluga whales in the Saguenay Fjord in Canada. Belugas are continually exposed to industrial and other human-derived wastes. The beluga cancer incidence has become an indicator of environmental quality. Humans therefore have an interest in preserving the quality of the environment in a state that does not adversely affect both whale and human health.
From an integrative One Health, conservation biology and/or an ecosystem perspective, animals should be much better valued and treated as part of an overall effort to maintain and sustain ecosystem integrity and, thus, comprehensive well-being. This involves, among other things, animal husbandry and rearing, animal transport, slaughter practices, animal traction and wildlife conservation (see White et al., Chapter 3, this volume; Bunch and Waltner-Toews, Chapter 4, this volume; Wettlaufer et al., Chapter 11, this volume).
Globally, most livestock holders treat their animals well. In Fig. 2.2 we observe a nearly unrestrained type of animal husbandry. The horse being milked by the Kyrgyz lady stands still without being tied. Similarly, the camels and donkeys in Ethiopia are calm and obviously well treated. However, animal welfare is clearly insufficient in semi-intensive and intensive production systems. Livestock holders should be continuously trained on best animal welfare practices in their rearing systems. From an animal welfare perspective, the current practice of transporting livestock on foot, say from Ireland to France for slaughter, is not acceptable. Similarly, in developing countries, small ruminants and poultry are transported hundreds of kilometres under congested conditions, often without water, and sometimes severely beaten. Slaughtering practices should aim to reduce stress during animal handling. As part of economic growth, meat consumption has grown massively in the last decades. Livestock plays an important role especially in the livelihoods of hundreds of millions of small-scale farmers. However, ruminant livestock production contributes to the emission of greenhouse gases, and reduction of ruminant meat consumption is part of the overall strategy to avert climate change (Gordon et al., Chapter 25, this volume).
Fig. 2.2. Camels and donkeys in Ethiopia (A) and a woman milking a horse in Kyrgyzstan (B). Photos courtesy of J. Zinsstag.
Animals are also, one might say mostly, used in agriculture in developing countries for ploughing, transport and traction of carriages. While cattle and camels used for ploughing or transport are usually well treated, there is undeniably huge suffering in horses and donkeys used for transport. Donkeys are among the worst-treated animals worldwide and urgently need better treatment and husbandry. There is increasing research on livestock, companion animals and wildlife in developing countries. However, there is almost a complete lack of legislation on animal testing. Care should be taken that animal testing is not exported from industrialized countries to evade stringent regulations. We should not forget the welfare standards for pets, which may similarly undergo huge suffering. For example, dogs and cats are often abandoned at the beginning of the summer holidays, so that owners do not have to care for them.
From a One Health perspective, the notion of burden of disease should be extended to animals to reflect the toll of life and suffering of humans and animals, for example in road traffic, which causes hundreds of thousands of wildlife deaths. Road safety should then be expressed as causing this number of human and this number of animal casualties. Modern highway planning effectively protects animal life by utilizing fencing, bridges and tunnels for safe animal movement. While animal lives can be counted, estimating animal suffering and disability, similarly to human burden measures like the disability adjusted life year (DALY), is hardly possible because of the variation of norms and values across cultures and production systems. For example, how would expected years of life for male calves or fattening pigs be adequately assessed? There is an ongoing and controversial debate, but still not enough research undertaken, in development of a combined metric of human and animal disease burden. The recent introduction of the zDALY, an adjusted indicator to estimate the burden of zoonotic diseases, is controversial because it puts a monetary value on human life depending on local purchasing power (Torgerson et al., 2018; Häsler et al., Chapter 10, this volume). Improving animal welfare remains a permanent challenge to any effort and ethical aspiration of One Health (Wettlaufer et al., Chapter 11, this volume).
One Health as embedded in landscapes
One Health as presented here is not an isolated idea. There are earlier more limited and also broader concepts. We should mention Evgeny Pavlovsky’s (1884–1965) concept of disease nidality. He considered pathogens from an ecological perspective having their own ecological niche. This might be a specific space in an ecosystem or an animal or organ to which they are most adapted. For example, marmots in Mongolia carry Yersinia pestis, the agent of plague, without symptoms. Occasionally, marmot hunters become ill with plague after handling marmot carcasses.
Calvin Schwabe met Evgeny Pavlovsky in Leningrad in 1965 and wrote in his memoirs:
The only noteworthy work-related event in Leningrad was my meeting with Eugene Pavlovsky, the dean of the Soviet descriptive epidemiologists, formal developer of medical ecological notions like ‘landscape epidemiology’ and ‘natural foci of infections’. … He had read Veterinary Medicine and Human Health [(Schwabe, 1984) reference added] already and said he was pleased to see an American author write on the ‘Ecological Study of Disease’, which was my title of the 1st edition chapter introducing epidemiology.
(C. Schwabe, unpublished)3
More recent examples of landscape–disease interactions include the ways in which emerging diseases, such as those associated with West Nile virus and Borrelia burgdorferi, are related to urban landscape design (Waltner-Toews and Waltner-Toews, 2017).
One of the most prominent interactions of human and animal health is veterinary public health (VPH), which is defined as the contribution of veterinary medicine to public health. VPH is well established in international organizations, governmental administrations and academia. VPH was originally conceived by the Centers for Disease Control in Atlanta by James H. Steele. Schwabe refers to it as ‘the innovative Veterinary Public Health Unit founded by Jim Steele, … helping to demonstrate the value of an organised and systematic capability for disease intelligence’ (C. Schwabe, unpublished)4.
Compared to One Health, VPH mainly serves public health. Conceptually, it does not consider a mutual benefit from public health for animal health.
A much broader concept is an ‘ecosystem approach to health’ or ‘ecohealth’. Ecohealth considers inextricable linkages between ecosystems, society and health (Rapport et al., 1999). It seeks in-depth understanding of ecological processes and their relation to human and animal health. For example, using an ecohealth approach it was demonstrated that mercury poisoning of fish and impending health risks for humans in the Amazon were not due to upstream gold mining but due to soil erosion following deforestation (Forget and Lebel, 2001). Ecohealth has become an internationally scholarly movement organized by Ecohealth International.5 Ecohealth is a systemic approach, tackling complex problems as embedded in non-linear systems dynamics quantitatively and qualitatively. It involves transdisciplinary approaches, connecting academic and non-academic knowledge in a mutual learning process. It includes all stakeholders from communities to authorities as actors in the research process, pays particular attention to gender and social equity and thrives to put knowledge into action through policy change, interventions and improvement of practices (Charron, 2012). Hence, One Health is embedded in and an integral part of the ecohealth concept (Zinsstag, 2012).
Knowledge and information in veterinary and medical sciences are growing continuously, with the consequence that we know more and more about progressively narrower subjects. The ongoing and accelerated fragmentation of veterinary and medical science is not conducive to complex problem solving, and we face an increasing risk for misinterpretation, for example, in comparative diagnosis and pathology (Cardiff et al., 2008; Zinsstag et al., 2009). Mainstream reductionist research seeks to explain phenomena at an increasingly smaller scale. On the other hand, major current challenges, like development of antimicrobial resistance in a complex environment, call for rethinking modern theory of health of animals and humans. One Health provides the respective conceptual grounding and operational outlook.
There are signs of convergence in various fields in systems biology, the social sciences and networks of ecological scholars such as the Resilience Alliance6 (Zinsstag et al., 2011). The interactions of humans, animals and the environment are not straightforward. They are part of human-environment systems or SES. SES are, in the words of economist Elinor Ostrom, complex, multivariable, non-linear, cross-scale and changing (Ostrom, 2007). Humans and animals are inextricably linked to ecological systems, both natural and manmade, called cultural and social systems. Biomedical health sciences need to interact with all scholarly pursuits related to social systems, like sociology, economy, political sciences, anthropology and religion. Similarly, they need to interact with ecology, geography and all environment-related sciences. All these processes span across scales, like from molecules to populations. Health can be considered as an outcome of SES and so we speak about health in social-ecological systems (HSES) (Fig. 2.3). HSES clearly transcends One Health conceptual thinking as defined above. Considering health as an outcome of SES relates to theory of complexity and systems theory (Bertalanffy, 1951). Attempts to understand health in complex systems can be regarded as processes generating unexpected and new phenomena (described by the term ‘emergence’).7 Currently, we are exposed to a number of unintended and poorly understood damages to natural resources and life support systems, like climate change or nuclear catastrophes, which cannot be tackled by normal reductionist scientific approaches. Normal expert knowledge is no longer sufficient in situations of high uncertainty as we have experienced in the recent past and well postulated in writing about ‘post-normal science’ (Bunch and Waltner-Toews, Chapter 4, this volume). Planetary health aspires to demonstrate linkages of global change and health (Horton et al., 2014; Pongsiri et al., 2019).
Fig. 2.3. Health in social-ecological systems (HSES).
One Health and transdisciplinarity
As developed in the previous section, One Health is a scientifically established and validated concept that also created a movement with its origins in management of disease threats to humans and animals (Zinsstag, 2012). During development of health services and zoonoses control in developing countries, scientists engaged with communities, authorities and other stakeholders (Danielsen and Schelling, Chapter 14, this volume; Léchenne et al., Chapter 19, this volume). Periodic communication of research findings by scientists to all stakeholders, such as local communities, peripheral health workers and public health and VPH practitioners, led to more integrated research processes, assuring validity, social relevance and translation for impact. As a consequence, mutual trust increased gradually. Progress in One Health research can clearly benefit from combining academic and non-academic knowledge in the search for improving health and access to health care for humans and animals in pastoralist communities (Schelling et al., 2007b). Engagement of science with non-academic stakeholders and knowledge is a form of ‘transdisciplinary’ research, as a further development of ‘interdisciplinary’ approaches, which usually combine different academic disciplines such as medicine and social science, but do not encompass non-academic stakeholders. Mittelstrass defines ‘transdisciplinarity’ as a form of research that transcends disciplinary boundaries to address and solve problems related to the life-world (Hirsch Hadorn et al., 2008). Transdisciplinarity clearly matches the concept of ‘post-normal’ science, as discussed above (Hirsch Hadorn et al., 2008; Bunch and Waltner-Toews, Chapter 4, this volume; Berger-González et al., Chapter 6, this volume).
In conclusion, One Health represents a harmonic development of traditional VPH within the context of transdisciplinarity and post-normal science, challenged by the situation of our planet that is threatened by the overwhelming demands of populations of people, companion animals, livestock and wildlife (Box 2.2). As such, it raises questions that encompass conventional understandings of comparative medicine but go far beyond this into the intense, unstable and complex interactions among culture, economic aspirations and ecological sustainability. The interactions over time from which health emerges are embedded in narratives that reflect the concerns of the scholars and political leaders who espouse them. These narratives clarify points of disagreement and conflict but also suggest possibilities, if not for resolution of conflicts, then at least as avenues for accommodating multiple perspectives (Waltner-Toews, 2017).
Box 2.2. Summary of theoretical issues of One Health.
One Health can be defined as any added value in terms of health of humans and animals, financial savings or environmental services achievable by the cooperation of human and veterinary medicine when compared with the concepts of approaches of the two medicines working separately.
• One Health inevitably sheds light on the human–animal relationship and bond. It should reflect on the normative aspects (values) of the human–animal relationship with emphasis on improving animal protection and welfare in an inter-cultural context.
• One Health engages with the public in a transdisciplinary way, considering all forms of academic and non-academic knowledge for practical problem solving at the animal–human interface. The strongest leverage of One Health is observed when it is applied to practical societal problem solving.
• One Health approaches are embedded into ‘ecohealth’ conceptual thinking, which are further expanded to ‘health in social-ecological systems’ (HSES) addressing complex issues of human-environment systems.
Notes
1 Original citation in German ‘Es gibt keine wissenschaftliche Barriere zwischen Veterinär- und Humanmedizin, noch sollte es eine geben; die Erfahrung der einen muss gebraucht werden für die Entwicklung der anderen’ (Saunders, 2000).
2 Protocol for handling animal welfare cases in cooperation with the Hindu community. Available at: http://archive.defra.gov.uk/foodfarm/farmanimal/welfare/documents/hindu-protocol-0812.pdf (accessed 27 March 2020).
3 Calvin Schwabe, Hoofprints of Cheiron, Book two, page 262 unpublished memoirs.
4 Calvin Schwabe, Hoofprints of Cheiron, Book two, page 223 unpublished memoirs.
5 https://www.ecohealthinternational.org/ (accessed 27 March 2020).
6 https://www.resalliance.org/ (accessed 27 March 2020).
7 Such thoughts can be traced to process philosophy (Alfred North Whitehead). Causal inference is limited and processes appear as random events. At best, we can understand partial processes.
Acknowledgement
Thank you to Mitchell Weiss for critical comments about the manuscript and providing references to Asian literature.
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