'One Health', or OH, was limited to select specialists across veterinary, biomedical, life sciences and environmental disciplines. The Covid-19 pandemic and the climate crisis has helped One Health make its way to the media and popular discourse.
The Declaration of the G20 Ministers of Health on September 6, 2021, in Rome emphasised "greater and more predictable funding" to support the WHO in strengthening the One Health functions. It stressed ensuring that there are no gaps in the surveillance-to-action loop.
The WHO defines One Health as an integrative effort of multiple disciplines working locally, nationally, and globally to achieve optimal health for people, animals and the environment. The overarching purpose is to encourage collaborations in research and sharing of knowledge at multiple levels across various disciplines like human health, animal health, plants, soil, environmental and ecosystem health in ways that improve, protect and defend the health of all species.
India has taken several key policy initiatives in the backdrop of the Covid-19 pandemic, seeking to mainstream OH. These include the setting up of a National Expert Group on One Health as a multi-sectoral transdisciplinary collaborative group and a National Institute of One Health and Integrated Public Health Laboratories. The Department of Biotechnology announced a "mega consortium on One Health" on October 14, 2021. The central and state governments are increasingly adopting OH approaches to respond to antimicrobial resistance, zoonotic diseases and food safety.
Some enabling crosscutting policies and regulatory measures exist and are being leveraged to develop the OH approach further. For example, the National Standing Committee on Zoonoses collaborates with the Food Safety and Standard Authority of India and the National Centre for Disease Control are collaborating on government policies and regulatory mechanisms.
The One Health approach essentially mandates effective teamwork and an enabling environment among various actors within the complexities of a diversity of related systems. A wide range of OH initiatives are underway globally, and the Indian approaches have so far mainly been solution-based – specifically during emergencies and outbreaks. A deep understanding of the local needs is essential, and chances for collaboration need to be ascertained.
The success of OH initiatives is contingent upon a knowledge and practice ecosystem that promotes multi-sectoral, transdisciplinary collaboration and cooperation. Rather than technical or disciplinary, the global experience is that barriers are more commonly institutional - structures and interests of governments, corporates and other hugely influential organisations - or behavioural.
A key challenge to meaningful collaboration is the absence of a common OH language. One Health challenges by their very nature are complex health problems that require collaboration across disciplines and sectors, cultures and animal species, and across organisational turfs and even state or national borders. One Health initiatives engaged with human health, environmental health or veterinary public health constantly struggle with the fuzziness of what characterises a meaningful and successful One Health approach, and how to set its goals, establish frameworks, facilitate collaborative exercises and measure outcomes.
The absence of formalised training opportunities and shared competencies impedes rapidly scaling up the OH workforce. Both organisational structures and organisational cultures matter. Organisational structures that need recalibration include technical guidelines and standard operating procedures and appropriate management, response, and communication strategies. These structures need to be adaptive, flexible, reflexive and constantly improve through iterative feedback cycles.
Organisational cultures that are relevant include accountability, ownership, cultural engagement and diversity, and trust, credibility, and transparency. While established network relationships can effectively support outbreak response to a health event, developing formal relationships and networks (over and above existing informal ones) that respond before a health event is vital to enable individuals, organisations and networks to effectively respond to epidemics.
Strategies and activities thus need to be based on shared needs, common objectives and health priorities and have shared benefits; importantly, these should be nested within existing state/district infrastructure. One Health leadership is about managing a set of complex issues and integrating, negotiating, and evaluating collaborative partnerships. 'Strong man' leadership is rarely fit for the purpose. One health is both "inter-professional and inter-organisational", and OH leadership has been characterised as "horizontal leadership". The imperative is to excel in leading networks across traditional command boundaries and information flow in all directions. Horizontal leaders are required to be proficient in strategic analysis and have relational and troubleshooting capacities.
Core values required are constant flexibility and absolute transparency and an "an innate sense for organising work in complex models". Effective governance is best shaped by legal and policy frameworks aligned with current structures and avoid creating novel ones. At the same time, the relevance of strong sectoral systems remains as operational aspects are shaped by these.
The ongoing pandemic enables the possible framing of OH as a human health imperative, albeit an urgent one. One Health initiatives, by their essentially multidisciplinary nature, entail working across ministries and navigating tacit institutional hierarchies and allocating leadership roles. These may also not fully succeed if they remain purely a governmental endeavour; the cooperation and active engagement of individuals, communities, the private sector and society as a whole are paramount.
(The writer is Chairperson at the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi and Co-Investigator of UKRI-GCRF One Health Poultry Hub)
Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.
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