By Violet Barasa
The One Health concept is gaining increasing attention in health research today because of its emphasis on collaboration between animal, human and ecological health stakeholders as a means to achieve efficiency and save costs. Last month some 1,000 academics, policymakers and practitioners from the worlds of public health, veterinary science, epidemiology, anthropology and other disciplines gathered in Melbourne, Australia, at One Health EcoHealth 2016 to discuss the health linkages between humans and animals and their shared environments, and to reinforce the importance of greater collaboration between and across these sectors.
The One Health approach makes a business case for integration across sectors, arguing that money is saved and expertise applied more effectively and efficiently when these stakeholders work together rather than apart. The theory has it that coordination and cooperation make disease surveillance and earlier detection of any outbreaks more likely. Response to outbreaks would be enhanced as warning signs are shared and passed on to relevant actors.
However, there is a lack of empirical evidence proving to what extent, if any, this collaboration works in practice, particularly within dynamic pastoralist settings of Africa.
At the Melbourne Congress I presented my poster, ‘Is One Health a one-size fits all? Critical reflections on One Health in dynamic pastoral settings in Africa’ (pdf), in which I critique the assumptions inherent in these approaches using examples from northern Tanzania where I am conducting fieldwork for my PhD.
Participation and equity
In Tanzania, the human and animal health departments are independent state ministries with independent policies and funds. As such, policy responses to disease outbreaks, including zoonotic disease events, are likely to reflect these sectoral divisions. To achieve coordination, therefore, diverse sectors beyond official health departments, such as lay health systems need to be included. That is, integration needs to happen across knowledge perspectives and among different knowledge providers and users, such as indigenous communities, academics, field workers, policy actors etc. This way, One Health approaches will not only promote disciplinary collaboration, but they will also enhance greater participation and equity.
A major focus of the Melbourne conference was the role that social sciences play in helping to better understand the dynamic drivers of zoonotic diseases in resource-poor settings. Participants also highlighted the role of lay knowledge in diagnosing and treating zoonotic diseases as a critical component in bridging the gap between social and biological drivers of disease. Technical interventions need to be backed by local solutions to health problems for these to be sustainable.
It emerged from the conference that drivers of zoonoses occur at three broad levels: community, system and policy levels.
Community-level drivers of zoonoses
Low level of knowledge about causes, symptoms and spread of diseases in the herd and their zoonotic potential is a major factor in the persistence of zoonotic diseases in many parts of Africa and Asia. Case studies from West Africa on bovine tuberculosis, for instance, showed evidence of rampant self-treatment that often resulted in casualties.
Indeed, in northern Tanzania where my research is focused, “at home” treatment based on lay diagnoses of disease is also very common among the local Maasai communities. In many cases, misdiagnosis of illnesses, involving fever such as malaria and brucellosis, have been found to be common.
Additionally, behavioural and economic factors, such as the consumption of raw milk and blood, selling infected livestock and limited or non-existent screening of livestock before purchase, also put communities at risk of exposure to zoonotic pathogens
System-level drivers of zoonoses
At the level of systems, limited extension services and a lack of diagnostic support play a critical role in spreading and sustaining many zoonoses. For example, there are generally no mechanisms to dispose of the dead animals, particularly if an animal dies in the field during grazing. When carcasses are left to rot in the open (right), it puts other livestock and people at risk of infectious zoonotic diseases.
Policy-level drivers of zoonoses
In many developing countries, there may be a lack of official initiatives and programmes related to zoonoses as they are overshadowed by higher priority, higher profile health challenges such as HIV and AIDS. The absence of policy in itself is a driver of the spread of zoonotic diseases. During the conference, many of the exhibitors and presentations showed that an absence of treatment protocols and disease surveillance poses a challenge to early detection and prevention of many zoonoses in resource-poor settings.
To combat misconceptions about the risk of zoonoses and enhance their visibility, it was suggested that more evidence is needed about the burden of zoonotic disease. This would help create a sense of urgency and make zoonoses a policy priority for health actors. In addition, it is important to educate farmers about the drivers of zoonoses and the potential routes of exposure to these diseases in people and animals, as behavioural factors such as eating habits can sustain exposure to zoonotic pathogens.
More importantly, ethnographic methods should be asking questions of How, What, and Why, examining everyday animal-human interaction in order to appreciate and debunk local, historical and cultural theories about food safety, hygiene and risk of exposure to zoonotic disease.