On November 3, 2023 (i.e., One Health Day), we aired a live webinar, titled “Why is the One Health Approach Important?”. Specifically, a multidisciplinary panel discussed how the One Health approach addresses a wide range of public health concerns, including antimicrobial resistance and zoonotic diseases, as well as gender equity, food security, and livelihood resilience. Watch the webinar replay. In this article, we present a summary of the Q & A gathered after the live event, because of the value in the continuation of such an important conversation.
Meet the speakers:
Julie Truelove
Head of Policy and Advocacy · WaterAid Canada
Julie Truelove is a water, sanitation, and hygiene (WASH) specialist focused on policy, advocacy, and program development with WaterAid. She has collaborated extensively with civil society to position WASH as a pathway to gender equality and empowerment of women and girls across Canada’s feminist policy, and water security for climate resilience. Julie holds a Master of Science in Water and Environmental Management from Loughborough University, and an Honours Bachelor of Science in Physical Geography from Carleton University.
Dr. William de Glanville
Animal Health and Zoonotic Disease Technical Advisor · VWB/VSF
William is a veterinarian and public health scientist who has worked on a range of human and animal health issues in Africa and Asia since 2008. In addition to earning Honours degrees in Conservation Medicine and Veterinary Medicine, he completed a residency in Veterinary Public Health and has a Master’s and PhD degree in Epidemiology.
Dr. Regan McLeod
Associate Veterinarian · High View Animal Clinic
Regan is a veterinarian at a mixed animal veterinary practice in High River, Alberta. Regan received her Doctor of Veterinary Medicine and an Honours Bachelor of Science from the University of Calgary. She recently completed a volunteer placement with VWB in Vietnam working alongside the Institute of Environmental Health and Sustainable Development.
Questions for Julie Truelove:
Q: The environmental health component of One Health has historically been slower to develop (notably, the UN Environment Program officially became part of the "quadripartite" with FAO, WHO, and WOAH in March 2022). What additional steps or changes can be taken at this point to enhance the practical implementation of the environmental health pillar?
Julie: Climate change is forcing us to do things differently and to adapt which is much about behavior change individually, organizationally, institutionally. Halting biodiversity loss is similarly compelling us to pay more attention to environmental health including soil health, erosion, land use, habitats, agricultural practices and so forth. There was a special half day session on One Health at COP15 for biodiversity last year in Montreal (in addition to the invite only dialogues on One Health in the negotiated text) where the representative of the UN Environment Program urged actors to:
- Rally and operationalize the environment sector to engage for health of people and planet.
- Build the evidence base to inform decisions including evidence informed by Indigenous, traditional, and cultural knowledge of places where people live, not only academic evidence.
- Ensure the ‘noise’ on One Health which grew during the pandemic translates to action on the ground not only theories or sentiment.
- Complexity of working with systems thinking.
Q: How can the One Health approach, which emphasizes inclusion, collaboration, and coordination, help alleviate inequalities for individuals?
Julie: Climate change, COVID and other shocks exacerbate inequalities, and WASH inequalities are stark in these instances (i.e., lockdowns with no toilet or running water during the pandemic, further distances to seek daily water supplies with the burden largely falling on women and girls). These lived experiences are not in siloes – they occur within and among environmental conditions, health of people, livestock sharing water sources, and compounds where people live.
Whose knowledge counts? The One Health approach is more closely connected to Indigenous and traditional knowledge. As such, we need a process of co-creating solutions in each context and considering vulnerabilities unique to people living there. Who does or doesn’t have a voice in decision making? Similarly, raising the voices of people with different perspectives, expertise, experience to come together can find ways of working together and shared interests that are not immediately obvious.
See, for example, the WHO Global Center for Traditional Medicine – one of the first sessions listed from the summit in August is Biodiversity, One Health, and Traditional Medicine.
Q: How do you see the role of agriculture extension workers re OH?
Julie: There is much to consider for agricultural expertise in relation to irrigation, water demands of crop production, water security of a targeted area, basin or watershed, and local knowledge held by agricultural workers for early warning systems in climate change monitoring. Additionally:
- Soil health has come forward as a key issue in nature-based solutions and halting biodiversity loss. It has also been noted as a potential mechanism in helping to manage floods/droughts with absorptive capacity of healthy soils and soil management.
- Agricultural extension workers can bring their expertise to these key aspects of soil, land use, integrated water resource management and becoming trainers, leaders, by exemplifying good management practices around the interface of human, animal, and environmental health in practice on-farm and some off-farm too, such as practices at abattoirs.
For interest, see a short video from Burkina Faso (4 min) where volunteer local water monitors measure precipitation and report data to the community, including local farmers who can improve management of seeding times given rainfall patterns are changing.
Questions for William de Glanville:
Q: Do you have some good examples of community veterinary workers doing an acceptable job?
William: In many remote and rural communities in LMICs, an absence of regulations on drug control or poor enforcement of these regulations means livestock keepers can purchase and use a wide range of veterinary pharmaceuticals, including antibiotics, without prescription. In these circumstances, when there is no trained person to provide support, livestock keepers very commonly administer the wrong drug, at the wrong dose, for the wrong duration. This has implications for animal welfare, food safety, risks for AMR, and is also a waste of livestock keepers often limited financial resources.
Although these livestock keepers should have access to fully trained animal health professionals, and there is an enormous need for vets to work in these communities, we have found that even simple training of community members, such as in how to estimate the weight of animals to correctly determine drug dose or how to use a thermometer to support decisions on the need to use drugs and which drugs to use, can have important impacts on improving and reducing antimicrobial use.
One of the challenges we face globally is that there are no commonly accepted standards, curricula, or competency requirements for training CAHWs. CAHWs also often do not have official recognition in the countries in which they work, which means national veterinary authorities do not regulate or supervise their work. This can mean the quality of CAHWs, and their ability to do an acceptable job, can be quite variable. Veterinaires sans Frontieres International is working with the World Organisation for Animal Health to develop curricula and competency guidelines, which will be a big step forward in ensuring consistently high standards in CAHW training (see https://vsf-international.org/woah-vsf-project-cahws/).
Q: What is your advice on how do find the "A" type farmers at the village level? These would be the famers with a natural understanding of good animal husbandry.
William: In many livestock keeping communities, there are already community members considered to be livestock experts. These may be people who have been rearing animals for a long time, have many animals, or are skilled in the use of traditional medicines. These are often already the people who others in their community consult when they have a livestock problem. By providing additional training in the use of modern medicines and new ways to think about livestock management, we seek to support (while being careful to not undermine) the existing knowledge that these livestock keepers have. We are also careful to make sure we empower women and girls as part of this process – in many communities, livestock expertise is often considered a male domain. Clearly this is not the case, and bringing previously trained CAHWs from other communities, particularly female CAHWs, to speak to a target community can help get the message across about how both women and men can support animal health in their communities.
Q: You talked about the important role CAHWs can play in supporting livestock keepers in many countries. One of the big challenges we face is integrating CAHWs into wider veterinary services and particularly making sure they are well supported by vets, who are often absent from remote and rural areas. Are you able to talk anymore on how the linkages between CAHWs and vets can be strengthened?
William: It is a big challenge and I think it is one that needs more innovative approaches around funding. The ideal CAHW model would probably involve a veterinarian based in a small town who supervises multiple CAHWs working in the remote and rural communities surrounding the town. This would be a sort of hub and spoke model, with the veterinarian acting as the hub and the CAHWs as the spokes. The veterinarian could recruit and train the CAHWs, provide them with the drugs and vaccines they need and supervise their use (even if from a distance), as well as acting as a source of referral for more complex cases.
There are some examples of this sort of private vet and CAHW model working well but, in general, it is often very hard for vets to make money with such a model, or at least they are likely to make considerably less money than they could running a companion animal practice in a city.
For me, this represents a clear market failure and there is therefore a need for public investment to enable and support these kinds of models. Although funding such investments will of course be a challenge, there are good examples of how this might work from around the world. For example, in the UK we have the Scottish Government’s Highlands and Islands Veterinary Service scheme. This is a government subsidy for private veterinary practices operating in the remote, sparsely populated areas of Scotland. The scheme recognises that livestock-focused veterinary practice, and therefore service delivery to the livestock keepers who live in such areas, is not economically viable without government support.
Q: You highlighted the importance of bringing multiple disciplines together to strengthen animal health systems within a One Health approach. How do you think we can get those other disciplines to be more interested in animal health issues?
William: Without effective and equitable animal health services, it is very hard to see how the benefits the SDGS are intended to bring can reach the poorest, a very large proportion of whom rely on livestock to fund health care and education and for household nutrition. We should therefore continue using the awareness and momentum that has grown around One Health to advocate strongly for the central role of improved animal health in poverty reduction, food security, and human health and wellbeing, as well as in tackling global issues such as biodiversity loss and climate change, AMR, and pandemic prevention.
One of the key messages from One Health is that disciplinary and sectoral boundaries create barriers that get in the way of improving health for all. Strengthening animal health services requires the focus of vets, medical doctors, social scientists, economists, policy makers, and WASH specialists, as represented in Julie’s excellent presentation on the work of WaterAid, to name just a few.
Julie: Following the webinar, our team who attended were reflecting on the similarities with CAHWs and the use of Community Health Workers or Volunteers (CHWs or CHVs) in many countries where WaterAid works. The CHWs and CHVs are primarily responsible for community human health promotion (example from Nepal) and are often being trained as trainers for hygiene behaviour change. It seems if CAHWs and CHWs could join in a One Health team, this could make for stronger ways of working at community and district levels with more purposeful interactions across sectors if it’s not happening already.
Questions for Regan McLeod:
Q: How have your experiences working with VWB in Vietnam affected your work as a veterinarian in Canada?
Regan: One thing I noticed upon returning to Canada is that I am more aware of how I practice veterinary medicine and I am thinking more regularly about the broader impact of my actions and the treatments I recommend. For example, I have reviewed my practices around prescribing and dispensing of antimicrobials. The recommendations on prescribing and dispensing are changing often and it can be easy to fall into a routine. Sharing these updates with the other veterinarians I work with has generated discussions on how we as a team can improve our antimicrobial use and has led to changes within our practices that should help prevent antimicrobial resistance.
Q: How do people as individuals practice good One Health?
Regan: One Health can seem like a daunting topic, and it is hard to see how to make a difference. One of the first steps is recognizing that the actions you take as an individual do have an impact. Simple things such as taking medications as they are prescribed and using medications responsibly or wearing PPE to prevent disease spread are all good One Health practices. Getting involved and educating yourself on One Health topics such as antimicrobial resistance, biosecurity, food security are also great steps to take.
Q: Name the three most important tasks of the veterinary profession in light of One Health.
Regan: In my perspective as a veterinary professional, the three most important tasks are:
- Educating farmers – The intersection of human and animal is a difficult topic to understand, and many famers do not realize the impacts human, animal and environmental health have on each other. By educating farmers on One health, we can help farmers develop better protocols that can have significant impact on animal health and production.
- Facilitating change – We can spend a lot of time educating farmers but if they are unable to adjust based on our recommendations then we may create a sense of helplessness. A one-strategy-fits-all approach does not work, and farmers get frustrated if they are unable to make changes or afford the recommendations suggested – they may give up trying altogether. Working directly with farmers to help them create protocols that suit their farms or providing a range of protocols that farmers can then tailor to their farm is extremely important in achieving good compliancy. Recognize that this process can be very slow, but over time, efforts can make significant change.
- Addressing concerns – Support farmers in the changes they have made and work with them when they are facing challenges. If there is not an immediate improvement in overall animal health or production, farmers might see your recommendations as a failure and stop using them. Working with farmers through the challenges they face and supporting them throughout the process can help them continue with the strategies you have recommended and encourage them to turn to their veterinarian for support when they have problems.
Questions for the panel:
Q: What are the main challenges you encounter: 1) in collaboration with human medical doctors; and 2) at the community level?
William: A potential challenge can be lower awareness about the inter-relationships between human and animal health and the value of One Health interventions among medical doctors and the wider human health sector than among vets and allied professions. This can lead to missed opportunities for collaboration and can have wider implications around disease management and health financing. A good example of this comes from rabies control in countries with dog rabies. Despite clear evidence of the value mass dog vaccination in preventing human rabies cases, dog vaccination tends to be under-prioritized and under-utilized in many low- and middle-income countries.
Julie: From the WASH perspective, the sharing of water sources with livestock and people remains a significant challenge given limited access to quality water services/protected sources for human use and needs for animals. Mapping of water demand, supply (video 5 min), types of use and water quality is an important target for behavior change yet remains a challenge with increasingly scarce water resources in some areas like the Sahel and at household and community level.
Q: Have you noted gender differences in acceptance of One Health approach at the community level?
Julie: Further to the mapping of water demands noted above, women and girls remain the predominant stewards of household water supplies – a considerable burden of unpaid work. When resources are scarce, conflict can emerge between women and girls tasked with collecting household supplies of good quality water and those who may be seeking water supplies for livestock or other agriculture purposes for income generation. This speaks to powers in decision making across multiple use needs of the environment and access to natural resources where marginalized groups, including women, may not have equal voice and participation. This is more a water example however such power dynamics are likely at play across sectors in context of a One Health approach too.
Regan: Speaking from my experiences in Vietnam, training programs have traditionally been targeted towards male members of the household even though in many households’ females are responsible for the care of livestock. Many women tend to be resistant to one health policies as their current practices are rooted in tradition so including women in education and training programs is crucial as they are the ones handling animals on a day-to-day basis.
Q: I have seen a documentary in Kenya where antibiotics has been given for chicken to prevent disease and this will have impact on resistance. Do you have such experience in Vietnam?
William: Many countries allow the use antimicrobials at low, sub-therapeutic doses to promote growth in animals reared in commercial agriculture. Many other countries prohibit this. This prohibition is mainly to reduce risks for drug resistance, as you say, as sometimes the antimicrobials used are important for treating clinical human and animal disease. Vietnam banned the use of antibiotics in animal feed for growth promotion in 2018.
Regan: The Vietnam government passed a law in 2018 that all antimicrobials require a veterinary prescription. However, the systems in place for policing this in Vietnam are poor and so many drug stores continue to sell antibiotics to farmers without a prescription and without proper guidance on how the antibiotic should be given. For many farmers it is easier to go to a drug store then it is to seek veterinary guidance when animals are sick, especially in remote regions where access to veterinary care is limited. This is where the CAHW can act in an intermediary role to provide guidance on when and how to use antibiotics.
Q: I am a veterinarian, and I do not know the statistic on human zoonotic diseases in my area.
Regan: As a veterinarian you do not need to have statistics on human zoonotic disease – in fact, that information can be difficult to come by. However, it is important to know about zoonotic diseases that you may encounter in your area and educate owners on the risks of transmission from animals to humans and vice versa. It is also important when gathering history to include the animal care takers in your assessment if you suspect a zoonotic disease. You should also ask if anyone who cares for the animal is experiencing symptoms, and if so, direct them to appropriate care facilities.
Q: Not a question but a couple of comments: (1) We need to break the link with farm animals in the domicile; (2) We need to consider the transmission of diseases to farm animals; and (3) It would be interesting to see a year or two after training how much people are really applying good One Health practices when partner organization is not around.
Julie: These points are all well received and come under the umbrella of behavior science and targeted behavior change. Across the One Health pillars, and further with climate adaptation, there is still much to learn about behavior science and how to apply context-specific behavior change in practice for the long-term. The point on observing a year or two after training is important and one where we collectively need systems and funding mechanisms that allow for a longer-term view given the time needed to establish changed behaviors and practices.
