Cover
Title Page
List of Contributors
Foreword
Foreword
Preface
1. Reference
Section 1: The Science of One Health
1. 1 Epidemiology
  1. 1.1 Introduction
  2. 1.2 Enhancing Our Understanding of Health and Disease
  3. 1.3 From Understanding Epidemiology to Public Policy
  4. 1.4 Examples of the Benefits of Using a One Health Approach
  5. References
2. 2 Health Impacts in a Changing Climate
  1. 2.1 Introduction
  2. 2.2 Our Changing Climate
  3. 2.3 The Basis for a Human Cause for Climate Change
  4. 2.4 Twenty‐first Century Projections of Climate Change
  5. 2.5 Climate and Health
  6. 2.6 Summary and a Look Forward
  7. References
3. 3 Food Safety and Security
  1. 3.1 Evolution of Food Production
  2. 3.2 Foodborne Illness
  3. 3.3 A One Health Approach to Foodborne Illness Detection and Response
  4. 3.4 Antibiotic Resistance and Food Safety
  5. 3.5 Zoonotic Disease and Foodborne Pathogens
  6. 3.6 Outbreak Response Communication
  7. References
4. 4 Water Security in a Changing World
  1. 4.1 Introduction
  2. 4.2 Waterborne Pathogens and Contaminants: Technologies for Drinking Water Treatment and Management of Water Safety
  3. 4.3 The Water/Energy/Food Nexus: Mitigating Global Risks
  4. Acknowledgments
  5. References
5. 5 One Toxicology, One Health, One Planet
  1. 5.1 Introduction
  2. 5.2 Key Concepts
  3. 5.3 Ecotoxicology and Human Exposures
  4. 5.4 Toxicological Risk Assessment and One Health
  5. 5.5 Conclusions
  6. References
6. 6 Biodiversity and Health
  1. 6.1 Introduction
  2. 6.2 Connectivity
  3. 6.3 Grand Challenges, Development Goals, Global Health Security, and Ecosystem Health
  4. 6.4 Conclusions and a Way Forward
  5. References
7. 7 Emerging Infectious Diseases
  1. 7.1 Introduction
  2. 7.2 Rabies
  3. 7.3 Avian Influenza
  4. 7.4 Zika Virus
  5. 7.5 Ebola Virus Disease (EVD)
  6. 7.6 Summary
  7. Acknowledgments
  8. References
8. 8 Reigning Cats and Dogs
  1. 8.1 Introduction
  2. 8.2 Benefits and Hazards of Human‐Pet Relationships
  3. 8.3 Interactions Among Humans, Pets, and the Environment
  4. 8.4 Conclusion
  5. Disclaimer
  6. References
9. 9 Zoological Institutions and One Health
  1. 9.1 Introduction
  2. 9.2 Zoos, Aquariums, and Field Conservation
  3. 9.3 Zoos, Aquariums, and the Care of Animals
  4. 9.4 Social Aspects of Zoos and Aquariums
  5. 9.5 Zoonotic Disease Challenges: Protecting Visitors, Staff, and Animals
  6. 9.6 Case Studies in One Health from Zoological Institutions
  7. 9.7 Conclusion
  8. References
Section 2: Four Perspectives on One Health Policy
1. 10 One Health Leadership and Policy
  1. 10.1 Introduction and Definitions
  2. 10.2 Grand Challenges in Health (aka “Wicked Problems”)
  3. 10.3 Implications of Grand Challenges for One Health Leadership
  4. 10.4 Critical Competencies for One Health Leadership
  5. 10.5 Policy‐Making with One Health in Mind
  6. 10.6 Integrating One Health Leadership Approaches in Hierarchical Organizations
  7. 10.7 Demonstrating One Health Leadership and Policy in Action
  8. 10.8 Case Study 1: National One Health Policy Development in Cameroon and Rwanda
  9. 10.9 Case Study 2: The Campaign for Global Elimination of Dog‐Mediated Human Rabies
  10. 10.10 Case Study 3: Antimicrobial Resistance – USA
  11. References
2. 11 Implementing One Health
  1. 11.1 Financing One Health Initiatives
  2. 11.2 Conclusion
  3. References
3. 12 The Social Cost of Carbon
  1. 12.1 Introduction
  2. 12.2 Some Context on Cost‐Benefit Analyses
  3. 12.3 The Social Cost of Carbon (SCC)
  4. 12.4 Current Challenges to Reducing and Mitigating the Effects of Climate Change
  5. References
4. 13 Complex Problems, Progressive Policy Solutions, and One Health
  1. 13.1 One Health as Prevention
  2. 13.2 Translating Science: Risk Communication and Science Literacy
  3. 13.3 The Economics of One Health
  4. 13.4 From Here to There
  5. References
Section 3: Conclusion
1. 14 The Long and Winding Road
  1. 14.1 One Health: Many Facets, All Interrelated
  2. 14.2 One Health Policy Development
  3. References
Index
End User License Agreement

List of Tables

Chapter 01
1. Table 1.1 Incubation periods of selected exposures and diseases.
2. Table 1.2 Important anthroponoses, zoonoses, and sapronoses.
3. Table 1.3 Illustration of savings in US dollars as a result of applying a One Health approach to a brucellosis outbreak investigation and response in Western Uganda 2013.
Chapter 04
1. Table 4.1 Selected waterborne pathogens and their characteristics.
2. Table 4.2 Water usage per electricity generation method.
Chapter 06
1. Table 6.1 Millennium and Sustainable Development Goals compared.
Chapter 08
1. Table 8.1 Epidemiologic characteristics of various infectious organisms with established potential for transmission from dogs, cats, birds, and rabbits to humans.
2. Table 8.2 Centers for Disease Control and Prevention (CDC) rabies post‐exposure prophylaxis (PEP) guidelines for various animal bites.
3. Table 8.3 World Health Organization (WHO) rabies post‐exposure prophylaxis (PEP) guidelines.
4. Table 8.4 Reported cases of infectious diseases in companion animals with molecular or other strong evidence to support humans as the source.
Chapter 09
1. Table 9.1 Summary of serologic and clinical data from animals sampled during the 1999 West Nile virus (WNV) outbreak at the Bronx Zoo, New York.
2. Table 9.2 West Nile virus disease cases reported to ArboNET, USA, 2000.
Chapter 14
1. Table 14.1 Timeline of environmental milestones – USA.
2. Table 14.2 Summary of international environmental legislation.

List of Illustrations

Chapter 01
1. Figure 1.1 The One Health triad.
2. Figure 1.2 The “epidemiologic triad” of infectious disease summarizes the factors that influence an infection, and the measures you might take to combat the infection.
3. Figure 1.3 Infection modeling: the SIR model. Susceptible nodes – have not been infected yet and are therefore available for infection. They do not infect other nodes. Infectious nodes – have been infected and infect other nodes with a certain probability. Removed (recovered) nodes – have gone through an infectious period and cannot take part in further infection (neither actively nor passively).
4. Figure 1.4 Necessary, sufficient, and component causes. The individual factors are called component causes. The complete pie (or causal pathway) is called a sufficient cause. A disease may have more than one sufficient cause. A component that appears in every pie or pathway is called a necessary cause, because without it, disease does not occur.
5. Figure 1.5 Natural history of disease timeline.
6. Figure 1.6 The steps for confirming that a pathogen is the cause of a particular disease using Koch’s postulates.
7. Figure 1.7 Ecosocial framework. An heuristic framework for the social epidemiology of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). The dotted lines separating the levels illustrate the porous nature of the distinctions made between levels of analysis. In reality, there are extensive linkages between factors at all levels that give rise to observed epidemic patterns. STI, sexually transmitted infection.
8. Figure 1.8 Economic impact of disease.
9. Figure 1.9 Leptospirosis reservoirs and transmission to humans.
10. Figure 1.10 A Nenets herder in a malitsa with his reindeer‐drawn sledge on the Yamal Peninsula in the Siberian Arctic in winter. Yamal Peninsula, Yamalo‐Nenets, Russia (2014).
11. Figure 1.11 Role of epidemiology research in prevention and control of infectious disease. The black arrows illustrate a generalized infectious cycle; the shaded arrows indicate points where infectious diseases can be prevented. (1) A host is infected by the reservoir or a vector for the pathogen. This individual may infect (2) other hosts in a population or (3) new vectors. (4) The pathogen also may cycle between the vector and a reservoir.
12. Figure 1.12 Districts in Western Uganda where brucellosis outbreak investigations were conducted 2013.
13. Figure 1.13 County map of the lower peninsula of Michigan depicting locations where Mycobacterium bovis‐infected deer and M. bovis‐affected beef and dairy herds have been identified between 1975 and 2016.
Chapter 02
1. Figure 2.1 Changes in observed globally averaged temperature since 1880. Red bars show temperatures above the long‐term average, and blue bars indicate temperatures below the long‐term average. The black line shows the changes in atmospheric carbon dioxide (CO₂) concentration in parts per million (ppm) over the same time period (Melillo et al., 2014; temperature data from NOAA National Climate Data Center).
2. Figure 2.2 Surface temperature trends for the period 1901–2012 (top) and 1979–2012 (bottom) from NOAA National Climate Data Center’s surface temperature product. Updated from Vose et al. (2012).
3. Figure 2.3 Observed changes, as analyzed by many independent groups in different ways, of a range of climate indicators. All of these are in fact changing as expected in a warming world. This diagram is from http://nca2014.globalchange.gov/report/appendices/climate‐science‐supplement.
4. Figure 2.4 Global precipitation trends for the period 1901–2012 (top) and 1979–2012 (bottom). Based on data from NOAA NCDC.
5. Figure 2.5 The number of severe loss events from natural catastrophes per year since 1980 through 2015 as evaluated by Munich Re. Overall losses totaled $90 billion dollars (2015 was not a high year in terms of total costs; the previous year was $110 billion), of which roughly $27 billion was insured. In 2015, natural catastrophes claimed 23 000 lives (average over the last 30 years was 54 000).
6. Figure 2.6 Percent increases in the amount of precipitation falling in very heavy events (defined as the heaviest 1% of all daily events) from 1958 to 2012 for each region of the continental USA. These trends are larger than natural variations for the Northeast, Midwest, Puerto Rico, Southeast, Great Plains, and Alaska. The trends are not larger than natural variations for the Southwest, Hawaii, and the Northwest. The changes shown in this figure are calculated from the beginning and end points of the trends for 1958 to 2012.
7. Figure 2.7 Observed global average changes (black line), and model simulations using only changes in natural factors (solar and volcanic) in green, and with the addition of human‐induced emissions (blue). Climate changes since 1950 cannot be explained by natural factors or variability, and can only be explained by human factors.
8. Figure 2.8 Multi‐model simulated time series from 1950 to 2100 for the change in global annual mean surface temperature relative to 1986–2005 for a range of future emissions scenarios that account for the uncertainty in future emissions from human activities – as analyzed with the 20+ models from around the world used in the most recent international assessment (IPCC, 2013). The mean and associated uncertainties (1.64 standard deviations (5–95%) across the distribution of individual models (shading)) based on the averaged over 2081−2100 are given for all of the RCP scenarios as colored vertical bars. The numbers of models used to calculate the multi‐model mean is indicated.
9. Figure 2.9 Projected change in average annual temperature over the period 2071–2099 (compared to the period 1971–2000) under a low scenario that assumes rapid reductions in emissions and concentrations of heat‐trapping gases (RCP 2.6), and a higher scenario that assumes continued increases in emissions (RCP 8.5).
10. Figure 2.10 Projected change in average annual precipitation over the period 2071–2099 (compared to the period 1971–2000) under a low scenario that assumes rapid reductions in emissions and concentrations of heat‐trapping gasses (RCP 2.6), and a higher scenario that assumes continued increases in emissions (RCP 8.5). Hatched areas indicate confidence that the projected changes are significant and consistent among models. White areas indicate that the changes are not projected to be larger than could be expected from natural variability. In general, northern parts of the USA (especially the Northeast and Alaska) are projected to receive more precipitation, while southern parts (especially the Southwest) are projected to receive less.
11. Figure 2.11 Estimated, observed, and projected amounts of global sea level rise from 1800 to 2100, relative to the year 2000. Estimates from proxy data (e.g., based on sediment records) are shown in red (1800–1890, pink band shows uncertainty), tide gauge data in blue for 1880–2009 (Church and White, 2011; Church et al., 2011), and satellite observations are shown in green from 1993 to 2012 (Nerem et al., 2010). The future scenarios range from 0.66 feet (0.20 m) to 6.6 feet (2 m) in 2100 (Parris et al., 2012). These scenarios are not based on climate model simulations, but rather reflect the range of possible scenarios based on scientific studies. The orange line at right shows the currently projected range of sea level rise of 1 to 4 feet (0.3–1.22 m) by 2100, which falls within the larger risk‐based scenario range. The large projected range reflects uncertainty about how glaciers and ice sheets will react to the warming ocean, the warming atmosphere, and changing winds and currents. As seen in the observations, there are year‐to‐year variations in the trend.
12. Figure 2.12 The inner circle represents the physical environment. The first ring represents the four primary manifestations of climate change in the physical environment (climate drivers): increasing carbon dioxide concentrations in the atmosphere (yellow), rising temperatures (red), rising sea levels (blue), and more extreme weather (green). The four climate drivers can act through natural and human systems to cause conditions listed in the second ring, such as changes in vector ecology, extreme heat, and changes in water and food supply. Surrounding the second ring are the types of health effects that may result from the conditions listed in the ring.
13. Figure 2.13 Ragweed pollen season length has increased in central North America between 1995 and 2011 by as much as 11 to 27 days in parts of the USA and Canada in response to rising temperatures. Increases in the length of this allergenic pollen season are correlated with increases in the number of days before the first frost. As shown in the figure, the largest increases have been observed in northern cities.
14. Figure 2.14 Heavy downpours, which are increasing in much of the USA, have contributed to increases in heavy flood events. The figure illustrates how humans can become exposed to waterborne diseases, which typically arise in the weeks following inundation. Human exposures to waterborne diseases can occur via drinking water, as well as recreational waters.
Chapter 03
1. Figure 3.1 A brief depiction of the global food production chain.
2. Figure 3.2 Food production chain with potential points for food safety interventions.
3. Figure 3.3 Burden of illness pyramid: A model for understanding foodborne disease reporting.
4. Figure 3.4 Examples of how consumers can practice good food safety techniques.
5. Figure 3.5 Three legs of evidence used in outbreak investigations to determine food vehicles.
6. Figure 3.6 PulseNet timeline.
7. Figure 3.7 Pulsed‐field gel electrophoresis (PFGE) workflow.
8. Figure 3.8 Whole genome sequencing (WGS) workflow.
9. Figure 3.9 Some examples of how antibiotic resistance can spread.
10. Figure 3.10 Antibiotic resistance from farm to fork.
Chapter 04
1. Figure 4.1 Pore size (dashed lines) and range of removal capacity (solid lines) of various filtration methods and general size range of microbial particles (dotted lines).
2. Figure 4.2 Schematic illustration of the water supply system from raw water source to water consumer (in the middle) combined with the hazards and risk factors (arrow boxes downwards) and risk management options (arrow boxes upwards). Hazards and risk factors may have direct or indirect impacts on drinking water safety and increase the risk consequences and severity. Risk management includes actions that intend to reduce and manage the hazards and risk factors. Steps 0–4 of the Water Safety Plan (WSP) represent fundamental parts of the WSP taking into account the whole water supply system from the raw water to the water consumer.
3. Figure 4.3 Incidence of drought within the state of Illinois.
4. Figure 4.4 Recharge and withdrawals from aquifers across the western USA. HPA, High Plains aquifers.
5. Figure 4.5 Annual growth in electricity consumption (GEC) and nominal gross domestic product (GDP) for India.
6. Figure 4.6 Relationship between energy consumption and gross domestic product (GDP) for the USA.
7. Figure 4.7 Renewable infrastructure trends across Europe. (a) Proportion of electricity generated from renewable sources, 2014 (% of gross electricity consumption). (b) Electricity generated from renewable energy sources, EU‐28, 2004–14 YB16.
Chapter 05
1. Figure 5.1 Rachel Carson and the jacket of her most famous and impactful book.
2. Figure 5.2 Theo Colborn and the jacket of Our Stolen Future.
3. Figure 5.3 Toxicology in the context of One Health.
4. Figure 5.4 Different types of dose‐response relationships.
5. Figure 5.5 Developmental periods: pre‐organogenesis, embryonic, and fetal.
6. Figure 5.6 Mercury biogeochemical cycle.
7. Figure 5.7 A radiographic image of a bald eagle showing the presence of two radio‐opaque lead bullet fragments in the gastrointestinal tract of the bird.
8. Figure 5.8 Lesions in the hippocampus of a domoic acid‐poisoned sea lion (left) as compared to a normal sea lion (right).
9. Figure 5.9 Anabaena, a commonly encountered toxigenic genus of cyanobacteria. Upper right, left, and middle: Photos of bloom materials in ponds where swine died after drinking the contaminated water. Lower left and right: Microscopic views of chains of Anabaena cells; the lower right image is of chains of Anabaena with nitrogen‐fixing heterocyst (clear cell with two “dots”) and spore (large cell).
10. Figure 5.10 Top right: A wind‐concentrated bloom of Microcystis along the shoreline of a pond in a heavily farmed area of central Illinois. Lower right: Microscopic view of thousands of cells of Microcystis. The colonies of cells are often surrounded by a clear coating. Upper middle: Histological section of liver showing early changes due to microcystin poisoning (initial separation of hepatocytes from one another). Lower middle: Histological section of liver showing massive separation of hepatocytes and intrahepatic hemorrhage. Upper left: hepatocytes lost from the damaged liver in capillaries of the lung. Lower left: Transmission electron photomicrograph of liver altered by microcystin poisoning, including damage to hepatocytes and endothelial cells, and red blood cells that have escaped from the damaged sinusoids.
11. Figure 5.11 Life cycle of Schistosoma mansoni in humans and potential changes in the environment that may increase the extent of harm experienced.
Chapter 06
1. Figure 6.1 Ecosystem services.
2. Figure 6.2 Synergistic effects of ecosystem stressors.
Chapter 08
1. Figure 8.1 Examples of the relationships among humans, companion animals, and the environment. Humans can share close contact with pets in much the same way they do with their fellows, supporting each other (e,j,k), eating together (c), sleeping together (g), and sharing kisses (a). When appropriate pet care is provided and hygiene is practiced, human and pet health can thrive. However, this close contact provides opportunities for contamination of indoor and outdoor environments and pathogen sharing (b,d,f). In the presence of negligence (i) or animal or interpersonal violence (h), humans and pets can also share suffering.
2. Figure 8.2 Elderly man hugging black dog.: A dog was suspected to have acquired a fatal MRSA infection through licking the hand of her elderly owner, who had been previously hospitalized for MRSA cellulitis.
3. Figure 8.3 Child kissing cat. A cat was suspected of having acquired a fatal H1N1 influenza A infection following close contact with an infected child.
4. Figure 8.4 Younger man with collared dog. Prison dog‐training programs offer inmates unconditional love, skills, and a sense of compassion and purpose. In return, hard‐to‐adopt shelter dogs get a new shot at finding a forever home and enriching the lives of others.
Chapter 09
1. Figure 9.1 Timeline of West Nile virus (WNV) outbreak in New York, 1999.
2. Figure 9.2 West Nile virus neuroinvasive disease incidence reported to ArboNET, by state, USA, 2002.
Chapter 10
1. Figure 10.1 Examples of how antibiotic resistance spreads.

List of Contributors

Jonathan D. Alpern, MD
Infectious Disease Fellow
Department of Medicine, Division of Infectious Diseases & International Medicine
School of Medicine
University of Minnesota
Minneapolis, Minnesota, USA

Casey Barton Behravesh, MS, DVM, DrPH, DACVPM
Captain, US Public Health Service
Director, One Health Office
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, Georgia, USA

Val R. Beasley, DVM, PhD, Diplomate ABVT
Professor of Veterinary, Wildlife, and Ecological Toxicology
Department of Veterinary and Biomedical Sciences
College of Agricultural Sciences
The Pennsylvania State University
University Park, Pennsylvania, USA

Matteo Convertino, PhD, PE
Assistant Professor
Division of Environmental Health Sciences & PH Informatics
School of Public Health
University of Minnesota
Minneapolis, Minnesota, USA

Meggan Craft, PhD
Assistant Professor of Disease Ecology
Department of Veterinary Population Medicine
College of Veterinary Medicine
University of Minnesota
Minneapolis, Minnesota, USA

William J. Craven, JD
Chief Consultant
California State Senate
Sacramento, California, USA

Timur Durrani, MD, MPH, MBA
Co‐Director of the Western States Pediatric Environmental Health Specialty Unit
Assistant Clinical Professor
University of California at San Francisco School of Medicine
San Francisco, California, USA

Robert V. Ellis, MD, FAAFP
Associate Professor
University of Cincinnati College of Medicine
Cincinnati, Ohio, USA

Thomas R. Gillespie, PhD
Associate Professor
Departments of Environmental Sciences & Environmental Health
Emory University & Rollins School of Public Health
Math and Science Center
Georgia, USA

Marja‐Liisa Hänninen, DVM
Professor Emeritus
Department of Food Hygiene and Environmental Health
University of Helsinki
Helsinki, Finland

John A. Herrmann, DVM, MPH, DACT
Clinical Associate Professor
Director, DVM/MPH Joint Degree Program
Center for One Health Illinois
College of Veterinary Medicine
University of Illinois at Urbana‐Champaign
Urbana, Illinois, USA;
Division Affiliate
Epidemiology and Biostatistics
School of Public Health
University of Illinois at Chicago
Chicago, Illinois, USA

Ronald C. Hershow, MD
Director, Division of Epidemiology and Biostatistics
School of Public Health
University of Illinois at Chicago
Chicago, Illinois, USA

Ari Hörman, DVM, PhD, MPH
Department of Food Hygiene and Environmental Health
University of Helsinki
Helsinki, Finland

Daniel Hryhorczuk, MD, MPH, FACMT
Clinical Professor of Medical Toxicology
Director, Environmental Health, Center for Global Health
College of Medicine
University of Illinois at Chicago
Chicago, Illinois, USA;
Professor Emeritus
Environmental and Occupational Health Sciences and Epidemiology
School of Public Health
University of Illinois at Chicago
Chicago, Illinois, USA

William D. Hueston, DVM, PhD, Diplomate ACVPM, Epidemiology Specialty
Professor Emeritus
College of Veterinary Medicine and School of Public Health
Global Leadership Programs
Center for Animal Health and Food Safety
University of Minnesota
Minneapolis, Minnesota, USA

Yvette J. Johnson‐Walker DVM, MS, PhD
Clinical Epidemiologist
Center for One Health Illinois
University of Illinois Urbana‐Champaign
College of Veterinary Medicine
Urbana, Illinois, USA

Laura H. Kahn, MD, MPH, MPP
Research Scholar
Program on Science and Global Security
Woodrow Wilson School of Public and International Affairs Princeton University
Princeton, New Jersey, USA;
Co‐Founder, One Health Initiative

John B. Kaneene DVM, MPH, PhD, FAES, FAVES
University Distinguished Professor of Epidemiology and Public Health
Director, Center for Comparative Epidemiology
Michigan State University
East Lansing, Michigan, USA

Shaun Kennedy, PhD
President and CEO
Food Systems Institute
St Paul, Minnesota;
Adjunct Associate Professor
College of Veterinary Medicine, University of Minnesota
Minneapolis, Minnesota, USA

Sandra L. Lefebvre, BA, BSc (Hons Neuroscience), DVM, PhD
Assistant Editor, JAVMA and AJVR
American Veterinary Medical Association
Schaumburg, Illinois, USA

Jeffrey M. Levengood, PhD
Illinois Natural History Survey, Prairie Research Institute
University of Illinois at Urbana‐Champaign
Urbana, Illinois, USA

Thomas P. Meehan, DVM
Vice‐President of Veterinary Services
Chicago Zoological Society
Adjunct Clinical Assistant Professor
Veterinary Clinical Medicine
College of Veterinary Medicine
Brookfield Zoo
University of Illinois at Urbana‐Champaign
Brookfield, Illinois, USA

Yvonne Nadler, DVM, MPH
Program Manager
Zoo and Aquarium All Hazards Preparedness, Response, and Recovery Fusion Center
Silver Spring, Maryland, USA

Megin Nichols, DVM, MPH, DACVPM
Lead, Enteric Zoonoses Activity
Division of Foodborne, Waterborne, and Environmental Diseases
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Centers for Disease Control and Prevention
Atlanta, Georgia, USA

Kenneth E. Nusbaum, DVM, PhD
Professor Emeritus
College of Veterinary Medicine
Auburn University
Auburn, Alabama, USA

Kevin O’Brien, PhD
Director
Illinois Sustainable Technology Center Prairie Research Institute
University of Illinois at Urbana‐Champaign
Urbana, Illinois, USA

Robert H. Poppenga, DVM, PhD, DABVT
Professor
CAHFS Toxicology Laboratory
School of Veterinary Medicine
University of California
West Health Sciences Drive
Davis, California, USA

Cheryl Robertson, PhD, MPH, RN, FAAN
Associate Professor
Chair, Population Health and Systems Cooperative Unit
School of Nursing
University of Minnesota
Minneapolis, Minnesota, USA

Innocent B. Rwego, BVM, MSc, PhD
Assistant Professor
Department of Veterinary Population Medicine
College of Veterinary Medicine
University of Minnesota
Minneapolis, Minnesota, USA;
Senior Technical Lead for Africa
USAID One Health Workforce Project
University of Minnesota‐Makerere University Uganda Hub
Kampala, Uganda

Christopher A. Shaffer, PhD
Assistant Professor
Department of Anthropology
Grand Valley State University
Allendale, Michigan, USA

William Stauffer, MD, MSPH, FASTMH
Professor
Department of Medicine, Division of Infectious Diseases & International Medicine
Department of Pediatrics, Infectious Diseases
School of Medicine and Public Health
University of Minnesota
Minneapolis, Minnesota, USA

Lauren Stevenson, MHS
Assessment Epidemiologist
Division of Foodborne, Waterborne, and Environmental Diseases
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention,
Atlanta, Georgia, USA

Robert V. Tauxe, MD, MPH
Director
Division of Foodborne, Waterborne, and Environmental Diseases
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, Georgia, USA

Dominic A. Travis, DVM, MS
Associate Professor
Division of Ecosystem Health
Department of Veterinary Population Medicine
College of Veterinary Medicine
University of Minnesota
Minneapolis, Minnesota, USA

Ed G.M. van Klink, DVM, PhD, Dipl. ECVPH, MRCVS
Senior Lecturer in Veterinary Public Health
School of Veterinary Science
University of Bristol
Lower Langford
Bristol, United Kingdom;
Wageningen Bioveterinary Research
Lelystad, The Netherlands

Donald J. Wuebbles, PhD
Harry E. Preble Endowed Professor of Atmospheric Sciences
Department of Atmospheric Sciences
University of Illinois
Urbana, Illinois, USA

Foreword

We encourage you to set aside time to read Beyond One Health: From Recognition to Results. We hope that you will be as inspired by its contents as we are.

One Health is one of the great innovations of our time. It is an idea, a concept, a way of thinking and working, and a means to organize action. One Health starts from a recognition that 75% of the new infections affecting humans come from animals. The risks of animal diseases can be decreased through proper attention to livestock health in livestock production: the One Health approach guides efforts to intensify production. It recognizes the benefits of food systems that are sensitive to nutrition and the threats posed by infections that are resistant to antimicrobial therapies.

The One Health idea came to life in 2004 as scientists considered how best to tackle diseases that move between human, domestic animal, and wildlife populations. It reflected experiences with the Ebola virus disease, avian influenza, and chronic wasting disease. It is set out as the Manhattan principles (https://www.cdc.gov/onehealth/pdfs/manhattan/twelve_manhattan_principles.pdf) for One World, One Health.¹ It is an international, interdisciplinary approach for tackling threats to the health of life on Earth. It has practical application for reducing risks of unsafe foods and diseases that move from animals to humans.

One Health connects science and systems to the needs of society. It has matured into a new way of thinking and working and contributes to the health of both humans and animals. It links several disciplines that focus on health. It helps professionals to see their work differently and to do it with new purpose. It stimulates integration when remaining separate is less effective. One Health frames how we speak and act: it encourages us to focus on the interfaces between human, animal, and environmental systems. It helps us make sense of multiple interacting determinants of illness. It helps us to better reduce risk and prepare for threats.

Many of us with coordination responsibilities have found that One Health makes our joint working more effective and efficient. It makes sense on the farm, in the factory, and at home, encouraging us to prevent costly outbreaks.

More recently, One Health has helped with restructuring institutions and transforming education. It helped drive collaboration between the World Health Organization (WHO), the World Organisation for Animal Health (OIE), and the Food and Agriculture Organization of the United Nations (FAO). It stimulated new academic departments and degree programmes. It provided a basis for local and national governments to combine animal, human, and environmental health programs, and to reap economic benefits.

Beyond One Health: from Recognition to Results offers us an update on One Health topics from the perspectives of different professional and academic disciplines. It includes an analysis of different threats to people and planet (including zoonoses and climate change), the epidemiology that underlies One Health, as well as the evidence base for different One Health policies and their benefits. It shows how One Health is best approached from a systems perspective and explains the importance of good leadership in making One Health a reality.

If we want to learn how One Health can best be applied in practice, we should study its use in different situations. In this book, we can see how One Health approaches help when analyzing risk and devising prevention, preparedness, and response strategies; when monitoring the evolution of threats and establishing early warning systems; or when prioritizing actions and coordinating actors during implementation. We can understand how One Health has been used in responses to avian influenza, yellow fever, Zika, Middle East respiratory syndrome (MERS), and Ebola.

When combining animal and environmental health practice, we must be sensitive to variations in motivations, responsibilities, and accountability of practitioners in these disciplines. In our experience, the One Health approach is especially useful when coalitions of actors are being established and a consensus is being built. It should be applied in ways that are sensitive to context, adapted to capabilities of systems (for public, veterinary, and environmental health), and adjusted to ecosystem, economic, and societal realities of interfaces between humans, animals, and nature.

We are starting to see One Health approaches being used to frame analyses of costs, benefits, acceptability, and scalability of different interventions. Academic groups are often asked to provide the evidence base for One Health policies and interventions. Their inputs are most helpful when interdisciplinary research methods are used. This is especially necessary when exploring links among environmental dynamics, disease vectors, pathogens, and human susceptibility.

Enlightened approaches like One Health – which focus on prevention and response from the perspectives of multiple disciplines – are vital to success in achieving the 2030 Agenda for Sustainable Development and in building a common future for all. This book will help you move along that path.

Chadia Wannous
David Nabarro

Chadia Wannous, PhD, is a Public Health professional and expert in prevention, emergency preparedness, and risk reduction for health threats. She previously served in several senior policy advisory positions with the UN.

David Nabarro, MD, is a medical doctor and Adviser on Sustainable Development. He previously served as Special Adviser to the United Nations Secretary‐General.

Foreword

The naturalist and conservationist, John Muir, once stated, “When one tugs at a single thing in nature, he finds that it is attached to the rest of the world.” The interconnectedness that Muir described in the early twentieth century is much more profound today, and much more consequential, regarding our health. The globalization of trade, travel, information, and investments, integrated and consolidated global food systems, urbanization, and a group of anthropogenic drivers that negatively impact our ecosystems, have created a new dynamic and an unprecedented interdependence among the health and well‐being of people, animals, and our environment. The complex construct that describes these three domains of health is termed “One Health” and, indeed, tugging on any one of these domains demonstrates their significant attachments to one another. As a corollary to this axiom, we can no longer focus on health through a single lens or discipline.

Our new twenty‐first century interdependence, including social, economic, political, and biological factors, has created new threats and risks to our health and has produced ecological changes that have fractured our planet. Several decades ago, the concept of One Health re‐emerged from past medical thinking and gained important traction and acceptance. Recently, there have been many articles and books published focusing on One Health but, fortunately and very timely, this book has added special insights and brought together diverse disciplines and thinking to give us a better understanding of One Health in our contemporary lives, with an important and unique emphasis on operationalizing the concept. The book’s authors have substantially improved our understanding of the key themes of One Health, added to our knowledge base, and stressed that new skills and competencies need to be acquired to successfully address the threats to human, animal, and ecosystem health.

The factors and drivers of our interdependent world, and increasingly risky lives, show no signs of abating; rather, they are accelerating. These drivers are leading to the intensification of the human‐animal‐ecosystem interface and causing further ecological damage. One consequence of this reality has been the dramatic increase in zoonotic diseases worldwide over the last few decades, which is thoroughly detailed in several chapters. This book also discusses the serious consequences of the degradation of our water resources and ecosystems, as well as threats to biodiversity and food security, all underpinned by climate change. The authors present evidence that our complex and interconnected world has generated a group of “wicked problems” that demand our attention and resources to resolve. A key feature of “wicked problems” is the recognition that past solutions and practices are not likely to be relevant or effective when applied to today’s unparalleled challenges. A One Health mindset and an ability to work holistically across disciplines need to become the new norm to address complex problems and to take appropriate actions. In addition, we must champion new partnerships and innovations, and learn to effectively lead and manage change.

However, our medical fields continue to become progressively more specialized and, at the same time, progressively more isolated and siloed. While we appreciate the impressive advances in medicine, our health systems are increasingly disease‐oriented and reactive. One Health, on the other hand, stresses disease prevention, shifting interventions closer to the origins of the problem, often in our animals and environment. Beyond One Health:From Recognition to Results argues that improving animal and environmental health can be a very effective and cost‐beneficial public health strategy. As this text points out so well, maintaining and improving health must go beyond a strictly disease‐oriented approach to consider the impact of the environment, social‐economic status, genetics and human behavior, and other social determinants of health, which is truly a One Health perspective. This timely book makes the case that we need to normalize good health through this larger and more comprehensive context.

In differentiating Beyond One Health: From Recognition to Results from past One Health books, this book emphasizes the need to translate new knowledge into practice. We know that this transformation is a difficult and dynamic process that involves synthesis, dissemination, exchange, and finally application of One Health knowledge to the maintenance and improvement of health in all of its domains and dimensions. The book’s authors acknowledge and present compelling evidence that critical gaps exist today between the promise of good health and actual results. The book reiterates that developing and implementing new strategies and polices represent the tactics necessary to support a One Health framework and plan of action. In addition, the authors argue in favor of the growing evidence that One Health thinking can offer a favorable value proposition, demonstrating that maintaining the status quo for our current healthcare delivery and disease response system is no longer acceptable, cost‐effective, or scientifically valid.

While we remember John Muir as an outstanding ecological thinker, we also recognize that he was a very effective political spokesperson who understood the importance of translating science and knowledge into policies in support of conservation. Likewise, we need to move One Health from an abstract concept to a catalyst for new policies and interventions that can change the existing dynamic and improve health outcomes across all the domains of health. We understand that there are three stages of translating knowledge into practice, and this book discusses all three throughout its chapters. Awareness, acceptance, and adoption comprise the sectors of translation and all are integrated throughout the text. The authors also stress an important lesson: as we develop and adopt new strategies and policies, we also must design and carry out processes for outcome measurement and evaluation and continuous improvement for them to remain relevant and effective.

We are indebted to the editors and authors who have successfully built momentum toward a more universal acceptance of One Health and, perhaps even more importantly, have been especially instructive in helping us appreciate the need to enact new policies and shift One Health from theory to effective field implementation. They have reminded us, throughout this text, that One Health is likely just to be relegated to an academic exercise if it is not accompanied by a new value proposition, new policies, and more efficient interventions in the rapidly changing human, animal, and environmental health dynamic. Finally, we are grateful for both the intellectual and practical contributions of the book’s editors and authors and are well advised to use their ideas and examples to better address the threats to our health, in all its dimensions.

Lonnie King, DVM, MS, MPA, DACVPM
Professor and Dean Emeritus
College of Veterinary Medicine
Ohio State University

From Recognition to Results

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