1
Q
What is a sector?
A
A sector is an area of activity aimed at benefits to society, characterised by common processes and institutions
2
Q
What is a discipline?
A
A discipline is an area of work or study characterised by common goals, approaches and tools
3
Q
Examples of sectors:
A
- Health
- Environment
- Agriculture
4
Q
Examples of disciplines:
A
- Sociology
- Education
- Biology
- Veterinary science
- Economics
5
Q
Which parts of the sectors agriculture, health and environment relate to the discipline Biology?
A
Agriculture:
- Increasing animal production
Health:
- Reducing disease burden
Environment:
- Conserving biodiversity
6
Q
Which parts of the sectors agriculture, health and environment relate to the discipline Economics?
A
Agriculture:
- Markets, prices, supply and demand
Health:
- Cost-effectiveness of interventions
Environment:
- Valuing ecosystem services
7
Q
Which parts of the sectors agriculture, health and environment relate to the discipline Sociology?
A
Agriculture:
- Acceptance of new foods, technologies
Health:
- Acceptance of new drugs, treatments
Environment:
- Attitudes towards the environment
8
Q
What is One Health and its aims?
A
- The collaborative effort of multiple disciplines - working locally, nationally and globally - to attain optimal health for people, animals and the environment
- An inter-sectoral and an inter-disciplinary collaboration
- A paradigm that addresses complex challenges to promote the health and well-being of all species and the environment through the integration of relevant sciences at systems level
- Aiming to improve health and well-being through the prevention of risks and the mitigation of effects of crises that originate at the interface between humans, animals and their various environments.
9
Q
What is the latest One Health definition?
A
One Health is an integrated, unifying approach that aims to sustainably balance and optimise the health of people, animals and ecosystems.
It recognises that the health of humans, domestic and wild animals, plants and the wider environment (including ecosystems) are closely linked and inter-dependent.
The approach mobilises multiple sectors, disciplines and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems, while addressing the collective need for clean water, energy and air, safe and nutritious food, taking action on climate change, and contributing to sustainable development.
10
Q
What are the examples that show how One Health is evolving?
A
The Manhattan Principles (2009)
The Berlin Principles (2020)
11
Q
What do the Manhattan Principles (2009) encompass?
A
Recognise the essential link between human, domestic animal and wildlife health and the threat of disease
Recognise that decisions regarding land and water use have real implications for health[…]
Include wildlife health science as an essential component of global disease prevention, surveillance, monitoring, control and mitigation
Recognise that human health programs can greatly contribute to conservation efforts
Devise adaptive, holistic and forward-looking approaches to the prevention, surveillance, monitoring, control and mitigation of emerging and resurgent diseases that take the complex interconnections among species into full account
Seek opportunities to fully integrate biodiversity conservation perspectives and human needs[…]
Reduce the demand for and better regulate the international live wildlife and bushmeat trade[…]
Increase investment in the global human and animal health infrastructure commensurate with the serious nature of emerging and resurgent disease threats[…]
Form collaborative relationships among governments, local people, and the private and public (i.e. non profit) sectors to meet the challenges[…]
Invest in educating and raising awareness among the world’s people and in influencing the policy process to increase recognition that we must better understand the relationships between health and ecosystem integrity to succeed in improving prospects for a healthier planet.
12
Q
What do the Berlin Principles (2020) encompass?
A
Recognise and take action to retain the essential health links between humans, wildlife, domestic animals and plants, and all nature[…]
Take action to develop strong institutions that integrate understanding of human and anima health with the health of the environment[…]
Take action to combat the current climate crisis[…]
Recognise that decisions regarding the use of land, air sea and freshwater directly impact health and well-being of humans, animals, and ecosystems[…]
Devise adaptive, holistic, and forward-looking approaches to the detection, prevention, monitoring, control and mitigation of emerging/resurgent diseases and exacerbating communicable and non-communicable diseases[…]
Increase cross-sectoral investment in the global human, livestock, wildlife, plant, and ecosystem health infrastructure[…]
Enhance capacity for cross-sectoral and trans-disciplinary health surveillance and clear, timely information sharing[…]
Form participatory, collaborative relationships among governments, NGOs, indigenous peoples, and local communities while strengthening the public sector to meet the challenges of global health and biodiversity conservation.
Invest in educating and raising awareness for global citizenship and holistic planetary health approaches among children and adults in schools, communities, and universities while also influencing policy processes to increase recognition that human health ultimately depends on ecosystem integrity and a healthy planet.
13
Q
What is the dilemma with One Health, what it is lacking and what’s needed?
A
Dilemma:
- One Health is intuitively appealing
- Multiple benefits and added value perceived and described
What’s lacking:
- Not mainstream (yet)
- No systematic resource allocation
What’s needed:
- Standardised methods, approaches and data to evaluate One Health activities
- Robust evidence base for informed decision-making and resource allocation
14
Q
What does One Health do?
A
One health is a concept that addresses complex challenges to promote the health and well-being of all species through the integration of relevant sciences at systems level
- Combination of multiple sciences
- Differing paradigms
- Differing approaches
- Differing outcomes of interest
Requires communication, coordination, capacity building and collaboration (the 4Cs)
15
Q
What are the 4 Cs of One Health?
A
Communication
Coordination
Capacity Building
Collaboration
16
Q
What are the 5 One Health High Level Expert Panel (OHHLEP) Principles?
A
- Equity between sectors and disciplines
- Sociopolitical and multicultural parity (the doctrine that all people are equal and deserve equal rights and opportunities) and inclusion and engagement of communities and marginalised voices;
- Socioecological equilibrium that seeks a harmonious balance between human-animal-environment interaction and acknowledging the importance of biodiversity, access to sufficient natural space and resources, and the intrinsic value of all living things within the ecosystem;
- Stewardship and the responsibility of humans to change behaviour and adopt sustainable solutions that recognise the importance of animal welfare and the integrity of the whole ecosystem, thus securing the well-being of current and future generations; and
- Transdisciplinarity and multisectoral collaboration, which includes all relevant disciplines, both modern and traditional forms of knowledge and a broad representative array of perspectives.
17
Q
What are the dimensions of One Health?
A
- Systemic thinking
- Holistic planning
- Transdisciplinary working
- Sharing
- Learning
- Systemic organisation
18
Q
What is systemic thinking?
A
- Recognise interconnections
- Synthesise them into a unified view of the whole
19
Q
What is holistic planning?
A
Common aims, problems, financing
20
Q
What is transdisciplinary working?
A
Working across sectors, disciplines, groups in society
21
Q
What is sharing (in One Health)?
A
Sharing people, knowledge, data, information across sectors and disciplines
22
Q
What is learning (in One Health)?
A
Learning as an individual, in groups or across whole institutions
23
Q
Is One Health One Medicine?
A
No
One Medicine (or comparative medicine) is not a new paradigm and many vets and medics confuse the current One Health initiatives with older paradigms which were focussed only on the health disciplines and medicine (see histories that mention e.g. Virchow, Osler, Steele, Schwabe).
One Health is much BROADER and recognises the health is a transdisciplinary domain.
Narrow perspective and control over health matters has led to a predominance of curative over preventative approaches to disease.
24
Q
What is comparative medicine, examples of it and its value?
A
It is a type of experimental medicine that uses animal models of human and animal disease in translational and biomedical research, also the study of similarities and differences between human and veterinary medicine.
Examples:
Jenner cowpox experiments; experimentation on rhesus monkey for polio vaccine; cancer research on animal models.
Value:
Translational value, biomedical breakthroughs.
25
What is One Medicine, examples of it and its value?
Originally referring to the collaboration between professionals in human and veterinary public health to address zoonotic disease concerns (bidirectional). Now seen as collaboration for equal medical progress; has a clinical connotation.
Examples:
Human medical principles for orthopaedic surgery; linking animal clinical trials and human clinical trials.
Value:
Faster medical progress and impact, more ethical and human lives saved.
26
What is One Health (where we are currently)?
Where we are currently at:
Medical or negative framing / focus on health promotion across populations.
Emphasising health promotion leaving the clinical field of disease; expands to consider health across populations with a focus on reducing risks of health hazards at the animal-human-ecosystem interfaces.
Examples:
Zoonotic disease control, food safety, antimicrobial use and resistance, biosecurity and biocontainment, surveillance.
Value:
Added value in terms of the health of humans and animals, financial savings or environmental services through cooperation when compared to working separately.
Approaches: Economic evaluation, environmental economics, neoclassical economics.
27
What is One Health (where we may need to go for our future)?
One Health - positive framing or structural One Health - the future?
Focus on how we can achieve healthy systems that sustain animals, people and ecosystems in the long term; requires shifting of the underlying structure to allow health to thrive moving away from conceptualisations that focus on disease.
Examples:
Ecological economics focusing on degrowth and doughnut economics, changing dietary practices.
Value:
Sustainability - all pillars, i.e. a better future for all because of social, economic, environmental sustainability. It's not an added value of One Health, but a systems value.
Approaches: Ecological economics, doughnut economics, systems economics.
28
What do we know about doughnut economics and One Health?
In this framework, the "doughnut" represents a safe and just space for humanity to thrive, bounded by social foundations on the inner ring and environmental limits on the outer ring.
In the context of One Health, which focuses on the interconnections between human health, animal health, and the environment, applying doughnut economics means ensuring that human well-being is maintained within the social foundation while respecting the ecological boundaries that support life on Earth. This includes considerations such as:
- Health equity
- Ecosystem health
- Resilience
- Collaboration
29
What are the sustainable development goals?
1. No Poverty
2. Zero Hunger
3. Good Health and Well-being
4. Quality Education
5. Gender Equality
6. Clean Water and Sanitation
7. Affordable and Clean Energy
8. Decent work and Economic growth
9. Industry, Innovation and Infrastructure
10. Reduced Inequalities
11. Sustainable cities and communities
12. Responsible consumption and production
13. Climate action
14. Life below water
15. Life on land
16. Peace, Justice and Strong Institutions
17. Partnerships for the goals
30
What does the Doughnut in doughnut economics show?
Shortfall:
- Health
- Water
- Food
- Energy
- Networks
- Housing
- Gender equality
- Political voice
- Peace and justice
- Income and work
- Education
Social foundation
Ecological ceiling
Overshoot:
- Climate change
- Ocean acidification
- Chemical pollution
- Nitrogen and phosphorus loading
- Freshwater withdrawals
- Land conversion
- Biodiversity loss
- Air pollution
- Ozone layer depletion
31
What does the One Europe for Global Health Coalition (OEGH) Berlin 2023 encompass?
"The mission of the One Europe for Global Health Coalition (OEGH) is to improve and integrate Global Health and One Health coalition is to improve and integrate Global Health and One Health priorities into European policies, strategies and actions by engaging European civil society and convening actors from all sectors
The covid-19 pandemic has made it clear that, with ever-increasing global interconnectedness, we can no longer view our health in isolation
Healthy living is only possible on a health planet. This includes all life on Earth: from plants to animals to humans - everywhere. We must work together to develop and implement a One Health and Global Health strategy that recognises the interdependency of all living things and acknowledges a healthy environment as a global common"
32
What is a food system?
A food system encompasses all the processes, activities, and actors involved in producing, processing, distributing and consuming food.
It includes everything from the cultivation of crops and livestock to the transportation, marketing, and sale of food products, as well as the waste management and recycling of food byproducts.
Food systems are complex and interconnected, involving various stakeholders, such as farmers, producers, processors, distributors, retailers, consumers, and policymakers.
Food systems play a crucial role in shaping human health, environmental sustainability, economic development, and social equity. They influence what foods are available, how they are produced, and who has access to them. A sustainable food system is one that ensures food security and nutrition for all people while minimizing environmental impacts, promoting economic viability for producers, and fostering social equity and cultural diversity.
33
What are 'activities' in food systems?
- Producing
- Processing/packaging
- Disposing/reusing
- Consuming
- Wholesaling/retailing
- Storing
- Governing
All of which are controlled by a range of 'actors'
34
Activities are all controlled by a range of 'actors'. What are actors?
- Input industry
- Farmers, fisherman
- Traders, processors (subsistence farmers)
- Food industry
(subsistence farmers)
- Retailers, food service
(subsistence farmers)
- Consumers
- Waste process, sewage
All come under governance, policy and regulation. All of them also have a range of motives.
35
Actors all have a range of motives, called drivers, what are these drivers?
Social organisations:
- Education
- Media
- Household structure
- Social movements
- Health care system
Science and technology:
- Farm inputs
- Food processing
- Food preparation
- Transportation and storage
- Medical technologies
Biophysical environment:
- Soil
- Water
- Climate
- Plants and animals
- Nutrients
Policies:
- Farm
- Food and nutrition
- Labor and trade
- Environment
- Health and safety
Markets:
- Food preferences
- Market structure
- Competition
- Global trade
- Wages and working conditions
36
Ideally, what would our food systems deliver?
- Food, food security, healthy diets
- Income, employment, profit, livelihoods
- Rural development
- Healthy environment, biodiversity
- Intact landscapes, ecosystem services
- Equity
- Pleasure, company, satisfaction
37
What are some concerns related to (animal source) food systems?
Biodiversity loss, disease emergence, antimicrobial resistance, plastic pollution and other hazards
Ethical concerns:
- Child labour
- Animal welfare
- Workers' rights
- Inter-generational legacy
- Food waste
- Producer welfare and safety
38
What are the positive effects of (animal source) food systems?
- Economic development
- Employment, income and livelihoods
- Use of land not suitable for crop production
- Positive effect on biodiversity
- Positive effect on gender equality
- Livestock manure as organic fertilisers and fuel
- Reduction of waste through the use of by-products from other industries
- Storage of wealth, social security, prestige
39
How many people suffer from malnutrition?
Globally, 1 in 3 people suffer from some form of malnutrition.
40
What are some food system problems we are facing?
- Triple burden of malnutrition
- Greenhouse gas emissions
- Land use changes
- Pollution
- Biodiversity loss
- Food waste
41
What is livestock livestock-associated dynamics?
Livestock-associated dynamics encompass the complex interactions and effects of livestock farming on ecosystems, human health and socio-economic factors. They include environmental impacts, human health risks, livelihoods, food security, climate change contributions and biodiversity conservation concerns.
42
What do we know about farming systems numbers and density?
- In 2007, over 21 billion animals were produced for over 6 billion people
- By 2020, the demand for animal protein was up by 50% mainly in high income countries requiring over 30 billion animals
43
How has the planetary boundaries framework evolved (where do animals sit)?
2009 - 7 boundaries assessed, 3 crossed: Biosphere intensity, climate change, biochemical flows
2015 - 7 boundaries assessed, 4 crossed: Biosphere intensity, climate change, biochemical flows, land-system change
2023 - 9 boundaries assessed, 6 crossed: Biosphere intensity, climate change, biochemical flows, land-system changed, novel entities, freshwater change
9 boundaries: Biosphere intensity, climate change, biochemical flows, land-system changed, novel entities, freshwater change, ocean acidification, atmospheric aerosol loading, stratospheric ozone depletion
44
What is the growing evidence on the importance of animal source foods on nutrition?
Meat, milk and eggs are nutrient-rich products that could efficiently boost nutrient-poor diets either as part of the normal diets or if access is increased through interventions.
- Good source of protein, energy, omega-3 fatty acids, iron, iodine, zinc, folic acid, vitamin A, D3 and B12
- High bioavailability
Some scientific evidence exists on the role of livestock products in improving nutrition, especially during the first 1,000 days of life in low- and middle- income countries
45
Where may food system risks occur?
- Waste disposal
- Recycling
- Consumption
- Retail
- Storage
- Harvesting
- Transport
- Primary production
46
What is the ecological process of communicable disease emergence?
Pathogen evolution is being driven by anthropogenic environmental changes and expanding, intensified livestock production, increasing rate of emergence and transmission within or between populations
Occurs within a background of enormous potential pathogen and host diversity
47
What is the ecological process of non-communicable disease emergence?
Emergence largely anthropogenic - nutrition and diet, pollution, behaviour effects, epigenetics, environmental change and stressors
48
What are some One Health contributions?
Working at human-animal-plant-environment (HAPE) interfaces for better health including infectious diseases and AMR
- Promote health and welfare
- Safeguard steady food supply
- Promote food security
- De-risk investments
- Reduce of emissions/output
- Improve resource use
- Enhance livelihoods
Addressing food safety risks in food value
Integrating environment into OH / healthy environments:
- Systems thinking
- Awareness of risks of resource depletion
Participation, engagement, equity and rights-based approaches
49
What are some examples of further opportunities for One Health?
Integrative decision making considering simultaneous outcomes for human-animal-plant-environment (HAPE)
- Systematically connecting stakeholders
- Trade-offs
- Co-positive solutions
- Knowledge and evidence
Standards to balance the rights of HAPE:
- Context-specific
- Feasible
Role of animals in questions on planet's carrying capacity and a net zero agenda
Evaluation frameworks for One Health in food systems as an integrative concept.
50
What is the one health negative framing (around disease/threats/hazards) - "food system generates disease problems / food system the source of problems" for:
1. Systemic thinking
2. Holistic planning
3. Transdisciplinary working
4. Sharing
5. Learning
6. Systemic organisation?
1. Recognise the interconnections in a food system and where disease (communicable and non-communicable), threats, hazards may occur and how they may be mitigated for the health of animals, people and the environment
2. Aims are formulated with the focus of disease prevention and mitigation while considering the influence of the wider environment and with efforts to minimise negative effects
3. Engagement of all groups in society that are affected directly or indirectly by the disease, threats, hazards in the food system and can contribute to solutions
4. Knowledge, data, information, resources on disease, threats, hazards in food systems including where they occur, their dynamics and potential solutions
5. Generate new knowledge and use an understanding of food systems to develop prevention and mitigation methods for the food system and beyond
6. Governance that focuses on how the food system can avoid generating disease problems
51
What is the one health positive framing (around healthy systems) - "food system generates health / a healthy food system a buffer against crises" for:
1. Systemic thinking
2. Holistic planning
3. Transdisciplinary working
4. Sharing
5. Learning
6. Systemic organisation?
1. Connective across the system, transformative in that it aims to generate better values for all with equal agency of ecosystems, animals and people
2. Aims are formulated with the aim of sustainability which places functioning and healthy systems at the forefront
3. Engagement of all groups in society who will benefit from a healthy food system and can contribute to formulating pathways for change
4. Knowledge, data, information, resources on positive change stories and how they work
5. Generate new knowledge on what a healthy system constitutes, find consensus and solutions for change
6. Governance that focusses on how the food system can be sustainable with health values for all
52
How could we move towards a positive framing of One Health in food systems?
The positive framing of 'health' calls for long-term actions on structural promoters of health
- E.g. social drivers, environmental drivers
Get the framing right, face som uncomfortable truths and pre-conceptions and generate a willingness for a different dialogue
- Leave the comfort zone of disease and medically related problems?
Need to put healthy systems at the centre and strive for structural change:
- Metrics
- Theories of change
- Solutions
53
How is the positive framing of OH in food systems different from Ecohealth, planetary health etc?
- Agency of animals, people and the environment
- Need to articulate joined-up environmental ethics, public health and non-human ethics in the health sector
- Do we subsume the medical dimension?
54
What is the overview of malnutrition?
1. Malnutrition = catch-all term
2. Undernutrition and over nutrition = more specific
3. Protein-energy malnutrition: stunting, wasting, underweight; micronutrient malnutrition; over-weight, obesity, non-communicable diseases = Related to what we can measure
4. Anthropometry; Vitamins and minerals in the body, clinical signs; Anthropometry/clinical = What we measure
55
What is stunting?
- Chronic undernutrition
- Low height-for-age index
- Stunting in children is associated with poor cognitive, educational, productivity and income attainment through life
56
What is wasting?
- Acute undernutrition
- Low weight-for-height index
- Wasting is associated with high risk of death and requires treatment (in-patient or in the community)
57
What is the double burden of malnutrition?
Countries in nutrition transition:
- Rapid economic growth + urbanisation
- Changes in dietary patterns (fats, animal and processed foods)
- Lifestyle choices: smoking, physical inactivity, alcohol
- Improvements of health but double burden of disease
At community and family level
Inadequate foetal and young child nutrition followed by exposure to unhealthy energy dense nutrient poor foods and lack of physical activity
58
What is the nutrition transition?
The nutrition transition is a model used to describe the shifts in diets, physical activity and causes of disease that accompany changes in economic development, lifestyle, urbanisation and demography.
It is most commonly used to refer to the change from traditional diets towards "western" diets rich in fats, sugars, meat and highly processed foods and low in fibre, and accompanied by a rise in sedentary lifestyles"
59
What does the nutrition transition mean?
Traditional to modern meals
Traditional to modern snacking
Traditional to modern marketing of food
60
What are the stages of the nutrition transition?
1. Hunter-gatherer: Collecting food
2. Early agriculture: Famine
3. Scientific agriculture, early industrialisation: Receding famine
4. Industrialised lifestyle: Nutrition-related non-communicable diseases
5. Post-modern industrial lifestyles: Behaviour change
61
What do we mean by 'system'?
Parts + relationships + function(s) = system
"A whole containing elements which are interconnected... distinguished for some purpose and capable of effecting a transformation"
62
What does taking a systems approach do?
It (ideally) brings different disciplines, approaches, and stakeholders together
Enables creative solutions
Uses systems thinking
- The consideration of something in its totality, its interaction with the wider environment, while also considering its constituent parts and their interactions
- Incorporating diverse perspectives
Focuses on reflexive attempts at holism or comprehensiveness
63
What may we do if we do not take the system into account?
- Lose sight of the bigger picture
- Cause new problems. Particular solutions, when implemented, can cause problems elsewhere in the system - unintended outcomes/consequences
- Not tackle sufficiently ambiguity, uncertainty and ignorance
- Not bring together all the different material, intellectual, and financial components that are required to solve a problem
- Neglect key leverage points
- Exclusion of groups from decision-making processes
64
What do we know about obesity in captive elephants?
Can cause problems with heart disease, arthritis, foot issues, and ovarian cycle abnormalities
Approx. 74% of zoo elephants are overweight
Female elephants experience weight problems much more often than males
Asian elephants have a higher risk of being overweight or obese than African elephants
65
What is a system?
A system is a set of related components that work together in a particular environment to perform whatever functions are required to achieve the objective of the system.
66
What is systems thinking?
- Interdisciplinary / transdisciplinary
- Holistic thinking
- Interconnections
- Reflexive
- Multiple perspectives
- Boundary judgements
- Iterative
67
One Health problems are complex, what do they consist of?
Within other systems/levels:
- Ecosystem
- Biome
- Biosphere
Other drivers and influences:
- Policy
- Economics
- Technology
- Perspectives/worldviews
- Societal norms
Complex adaptive systems (CAS)
68
What is the "worldview"?
The rationale/ belief/perspective that underpins how you see and interact with the world
Collection of attitudes, values, stories and expectations about the world around us, which inform our every thought and action. Worldview is expressed in ethics, religion, philosophy, scientific beliefs and so on (Sire, 2004)
69
What are some examples of different "worldviews"
- Scientific/technological solutions
- Socially just food production
- Profit maximisation
- Maximising consumer choice
- Environmentalism
- Animal rights
- Human-centric
70
What is "framings and boundaries"?
The way we see the world is only ever partial and selective
Systems approach = be aware of the power and our limited knowledge, communicate effectively with people who can fill in the gaps
Framings and boundaries are useful metaphors and tools for seeing how we all create and use knowledge
Can help us to ask better questions and choose more appropriate methods for the situation
71
What are some critiques of rich pictures/mindmaps?
- Easy method with limited resources
- Will not help formalise knowledge, instead creates discursive and rich descriptions
- Can't depict all the nuances of the complexity, but a good start
- Study showed importance of involving stakeholders and other perspectives being included, provided the 'richness'
- Didn't ask informants if more people should be asked? Assumed they knew all the "right" people to ask.
72
What is a fuzzy cognitive map?
Attempts to capture the functioning of a complex system based on people's understanding and their belief systems
Networks of factors and their causal connections
- Set of nodes representing variables connected through links denoted by arrows
- Variables/factors can be physical, measurable entities and qualitative, aggregate or abstract ideas including ethical, political or aesthetic issues
Factors and connections are usually given values; impacts of changes in a factor value on the rest of the map are computed in different ways
- Relationships between these variables are labelled with positive or negative polarities. These polarities describe the arrangement of the system with the positive sign indicating a direct relationship and the negative sign an inverse one.
73
CASE STUDY. Singh and Nair 2014. Livelihood vulnerability assessment to climate variability and change using fuzzy cognitive mapping approach. What does it describe?
Marginal agro-pastoral communities (Bhilwara, Western India), the most affected by climate variability and change were selected for the study.
5 questions asked, based on the answers cognitive maps of climate induced perturbations and coping mechanisms were drawn up and causal relationships established between variables:
- Weights assigned by group participants based on their understanding of the influence of one variable over another
- 10 representing the highest influence and 0 no influence
Variables categorised under various assets of the SL framework by researchers and refined by experts.
74
What are some pros and cons of fuzzy cognitive maps?
Pros:
- Quantitative storytelling = ideal for workshops
- Shows what factors are highly driven and by what and impacts of interventions
Cons:
- But as a 'quick and dirty' method with no data or empirical evidence as such backing it up, misunderstandings and misapplications could be possible
75
What are causal loop diagrams?
Causal links between elements are indicated by arrows labelled as:
+ to indicate changes in the same direction
- to indicate changes in the opposite direction
Feedback loops are either reinforcing or balancing based on net effect
R loops can be virtuous = healthy growth or vicious = runaway destruction D-E-F
B loops seek to stabilise H-I-J
76
Why was the causal loop diagram created?
To visualise the complex array of feedback loops in the multisectoral health system
77
What are some critiques of causal loop diagrams?
- Good visually, can tweak complexity to audience
- Focus on feedbacks can mean a lot of power is in the researchers' hands, and if no loops present can be lost from the map
78
Who is a stakeholder?
A stakeholder = someone who can affect, or is affected by, decisions about an issue that concerns them
Concerned with the same issues but from different perspectives or different interests
E.g. Farmer, consumers, animals, governments, industry, veterinarians
79
What are the levels of influence and change?
- Developmental change
- Transitional change
- Transformational
- Systemic change
80
What is radical change?
Radical change calls governments to move past a current practice and create a new one entirely to better suit the obstacles presented
Depending on the urgency of a problem, radical change can be a good tactic to promote instantaneous change
81
What is incremental change?
Incremental change attempts to solve problems with small, systematic steps that provoke change over time
By using this approach, a government can reduce the risk and focus on trying to improve the system they already have in place, rather than starting from scratch and creating a new one.
82
What is the theory of change?
Focusses on mapping out a change and helping us identify what needs to happen to elicit this change
Shows what INPUTS are needed to implement ACTIONS (activities) to generate RESULTS (impact) through CHANGE PATHWAYS
Logical process, explicit connections - forces you to think if and how they are linked
Helps with understanding of the problem; the context and roots of it and therefore what type of stakeholders you need to get involved to solve this
Creates shared understanding and responsibility - connects stakeholders.
83
What does BATWOVE do?
Helps to structure our thinking around a potential intervention, determine the boundaries of possible action within the problem context.
Uses logic to define what a 'good outcome' looks like and then helps us to move towards it
Doing BATWOVE helps to analyse the potential of an intervention and also highlights areas of conflict that may occur.
84
What does BATWOVE stand for?
Beneficiaries = who benefits
Actors = people doing the transformation
Transformation * = the planned intervention
Worldview * = Worldview that underpins the transformation
Owners = People who 'own' the process, who could stop or change it
Victims = People adversely affected
Environmental constraints = limitations applied to the transformation (e.g. budget, time, laws etc)
* start with these first
85
What is the root definition and its formula?
A statement of purpose that captures the essence of the particular situation of the relevant system.
Do P, by Q to achieve R
P = what?
Q = how?
R = why?
86
Is the One Health One Pathogen framework reliable?
Often, in infectious diseases, we consider how a single parasite affects a single host species, but a given parasite rarely infects just one host species.
87
What is a One Health Perspective of host-parasite relationships?
Understanding a host-parasite relationship within the broader ecological context - that of other infectious agents, and other hosts in the ecosystem, can improve our ability to maximise health at the individual host, population and community level.
88
What are infectious agents?
Infectious agents are not normally present within an organism, able to invade and develop within this organism and can be transmitted to others, with or without causing disease.
Interaction between an infectious agent and a host can result in disease
Infectious agents that cause disease are called pathogens
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What is parasitism?
Parasitism is a non-mutual relationship where one organism, the parasite, benefits at the expense of the other, the host
Traditionally, parasite referred primarily to organisms visible to the naked eye, or macro parasites
Pathogenic organisms are parasites, including both micro-parasites (e.g. viruses and bacteria) and macro-parasites (e.g. worms)
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What is co-infection?
The infection of a single host individual by more than one parasite species/strain
Synonyms: mixed infection, multiple infection;
- Superinfection, polyparasitism, polymicrobial infection
Co-infection is the norm in nature!
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Why do we care about co-infection at the individual level vs population level?
Individual:
- Does co-infection alter parasite infectivity, growth, life-history?
- Why does a 'parasite' cause no symptoms in one host and severe disease in another?
Population:
- Transmission dynamics
- Spatial heterogeneity in infection prevalence/incidence
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What is the organisation of hosts as an ecosystem?
Predators = immune system
Consumers = parasites
Primary producers = Host resources
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What are direct interactions?
Interactions while sharing a host can drive evolution of ways to directly affect one another.
E.g. chemical weapons
Direct interactions in parasitology refer to the close physical contact between a parasite and its host organism. These interactions are essential for the parasite's survival, reproduction, and transmission. Direct interactions can take various forms depending on the type of parasite and its life cycle.
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What are immune-mediated interactions?
Immune facilitation
- E.g. helminth induced immunosuppression facilitates microparasite growth (Graham 2008 PNAS)
Immune-mediated competition
- E.g. cross-reactive immune responses against viruses (Saline et al 1998, J Exp Med)
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What are resource-mediated interactions?
- Competition for shared resources
- Resource-mediated facilitation
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What are some consequences of within-host interactions in helminths and microparasites?
Consequences on morbidity:
- Helminth infection may lead to more severe disease or more rapid disease progression (e.g. HIV, Tuberculosis)
- BUT may also prevent hyperimmune activation which may lessen disease severity (e.g. SARs-CoV-2, Malaria)
Consequences on transmission:
- May lead to increased host susceptibility, increased transmissibility and decreased recovery rate which all enhance transmission
- BUT may also increase infection-related mortality rate which would decrease transmission.
Within-host interactions can have varying and unpredictable consequences!!!
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What do you know about the example: Deworming and Bovine TB?
Deworming has no effect on susceptibility to TB
No effect on recovery rate: Lifelong infections
BUT decreased infection-related mortality and therefore increased transmission at the population level
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What are some disease management implications of co-infection?
Simple measures:
- Avoid contact between individuals infected with parasites that interact and increase disease severity (e.g. HIV and TB)
Control program integration:
- Deworm before vaccination programmes (as helminths reduce vaccine efficacy)
- Treat 'simple' diseases to tackle more difficult ones, e.g. treat worms to tackle HIV, TB, malaria.
- Understand the nature of interactions!!!
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What is a multi-host parasite?
A parasite that infects multiple host species for the entire life-cycle (if monotonous), or a single life-cycle stage (if heteroxenous)
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What percentage of parasites are multi-host?
Most parasites are multi-host!
62% of Human parasites
77% of Livestock parasites
68% of Wild primate parasites
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Many major pandemics have a zoonotic origin, can you name any?
- Black Death, killed 30-60% European population (~100 million deaths)
- HIV ~75 million deaths to date
- West African Ebola Outbreak >10,000 deaths
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Most livestock and wild animal emerging infectious diseases are multi-host, can you name any?
- Rinderpest outbreaks throughout history
- 1993-present: Amphibian declines Chytridiomycosis, ranavirus, trematodes
- 1993-4: Canine distemper outbreak in Serengeti Lions
- 2006-present: White-nose syndrome in bats
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What are neglected zoonotic diseases and examples?
Neglected zoonotic diseases (NZDs) are an important diverse subset of neglected tropical diseases (NTDs), many of which are caused by multi-host pathogens.
E.g:
- Salmonellosis and campybacteriosis
- Human African trypanosomiasis
- Echinococcosis
- Schistosomiasis
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What complicates elimination and eradication of multi-host diseases?
Presence of multi-host parasites in wildlife complicates elimination and eradication efforts of several diseases in domestic livestock.
Eg. Brucellosis, classical swine fever, bovine tuberculosis
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All hosts are not equal. What are some key traits in which they can differ?
- Susceptibility to getting infected
- Ability to control infection
- Degree to which feed vectors
- Disease-induced mortality
- Abundance
- Contact with other host species
- Ability to pass on infection
All affect the pathogen's overall basic reproduction number, R0, the key measure of its fitness/transmission
R0 = the number of new infections (for a micro parasite) or new adult parasites (for a macro parasite) arising from primary infection in a wholly susceptible host population
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How do we understand reservoirs?
Define a target population (e.g. humans, livestock or species of conservation concern) and aim to characterise the reservoir
Key questions for effective control:
- What is the contribution of each host species to overall parasite persistence?
- Which hosts are crucial for parasite persistence?
- What are the source populations that directly transmit to the target population?
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Define target population
Host population of concern
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Define source population
Population that is a direct source of infection for the target
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Define reservoir
One or more epidemiologically connected populations or environments in which a pathogen can be permanently maintained and from which infection is transmitted to the target population
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Define maintenance population
A host population capable of maintaining a pathogen over the long term
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Define non-maintenance population
A host population not capable of maintaining the pathogen over the long term
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Define maintenance community
Any set of connected host (sub)populations that together can maintain a pathogen over the long term
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Define minimal maintenance community
A minimal maintenance community is a maintenance community of which all subsets are non-maintenance
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What do we know about components of R0?
Components of the R0 are useful to characterise the level of transmission to a target population from a source, and within the target population
R01,1 = Infections in host 1 from host 1
R01,2 = Infections in host 1 from host 2
R02,1 = Infections in host 2 from host 1
R02,2 = Infections in host 2 from host 2
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Define infection dynamics
How high and consistent is the incidence in different species? Are there breaks between outbreaks suggesting limited transmission among target hosts?
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Define pathogen genetics
Are cases genetically independent? Can all cases be genetically traced back to a single/small number of spillovers? Does pathogen genotype cluster by host species?
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CASE STUDY: Describe Rabies in the Serengeti
Several target populations - humans, endangered species, livestock
Domestic dogs reported source of human infection in 90% of cases (WHO)
But rabies recorded in 12 Serengeti carnivore species
Is there surveillance bias? Are wild carnivores part of the reservoir/maintenance community?
Multi-pronged approach:
1. Long-term surveillance data (~1992-2006 monitoring species-specific cases)
2. Contact tracing in districts adjacent to park (2002-7) to find source animal and potential cases of onward transmission
3. Genetic characterisation of virus from carcass brain samples
Persistent cases in dogs vs sporadic cases in wildlife.
Temporal association between cases in dogs and those from dogs and wildlife intermingled suggesting frequent cross-species transmission
Mostly dog-dog transmission events inferred from contact tracing, but some wildlife-wildlife
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What is biodiversity and the dilution effect hypothesis?
Can biodiversity benefit health?
Non-competent hosts may dilute disease transmission through interfering with transmission, or competing with susceptible hosts
If as biodiversity declines one disproportionately loses less competent hosts, transmission and disease levels may increase
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CASE STUDY: Describe Lyme disease in the USA
Caused by Borrelia burgdoferi, a vector-borne multi-host parasite with complex life cycle
Reservoir hosts vary in competence (i.e. their ability to pass infection on to a feeding vector)
A relative increase in less competent hosts may lead to a lower prevalence of infection among ticks, through transmission interference ('wasted bites')
Increasing biodiversity favours less competent hosts over competent hosts
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Summarise parasites and their traits:
- Infectious agents that benefit at the expense of the host; parasites that cause disease are called pathogens
- Co-infection with multiple parasites is common; interactions among co-infecting parasites has consequences at the host and population levels
- Many parasites can infect multiple hosts; the ecology of transmission can be complex but essential to understand for effective disease control
- Changes to biodiversity may change disease risk and transmission dynamics
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What is an infectious disease model?
- Describes mathematically the transmission of a pathogen among human /animal/environmental hosts
- Determines the population-level effect of fundamental infection and transmission processes occurring at the individual level
- Simplifies complex biological processes to describe essential behaviour of an infection/disease dynamics
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What are the principles of infectious disease modelling in One Health?
- An uninfected individual's risk of becoming infected depends on the prevalence of infectious individuals/hosts, their rate of contact, their infectiousness etc.
In a One Health context we are likely to consider:
- Multiple host species, intra- and inter-species contact rates; contact rates mediated by the environment; differential intra- and inter-species infectiousness; effects of co-infection on susceptibility etc.
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What are the principles of infectious disease modelling in One Health regarding transmission?
Transmission is a dynamic process, an individual's risk of infection changes with time
In a One Health context we are likely to consider:
- Risk of infection among different host-species and presence of co-infecting parasites; environmental heterogeneities or secular (temporal) changes may modify risk (e.g. climate change)
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What are the principles of infectious disease modelling in One Health (how do we do it)?
It requires dynamic models for analysis and prediction (think rates of change, ie. calculus)
In a One Health context we use the same mathematical tools, albeit with more complex structures.
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What is a modelling example of rabies transmission?
Births --> Susceptible dogs --transmissions--> Exposed dogs --Progressions--> Infectious dogs --> Deaths
OR
Births --> Susceptible dogs --transmissions--> Exposed dogs --> Vaccinated dogs <-- Infectious dogs --> Deaths
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What are some applications of disease modelling in One Health?
Infectious disease models are useful in One Health for:
- Predicting population-level consequences of interactions among co-infecting parasites
- Estimating the contribution of different hosts to transmission in multi-host parasite systems
- Comparing effectiveness of One Health intervention strategies to control/eliminate infectious diseases
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What are the consequences of HIV-malaria interactions?
- Geographic distribution of malaria and HIV strongly overlaps in Sub-Saharan Africa
- Susceptibility to Malaria is enhanced by infection with HIV
- HIV loads increase during Malaria episodes
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What are the consequences of lymphatic filariasis-malaria interaction?
- Both diseases transmitted by mosquitoes, infected mosquitoes have a higher mortality rate than uninfected mosquitoes
- Th1 immune responses induced by malaria infection increases mortality rate of lymphatic filariae macro parasites
- Th2 immune response induced by lymphatic filariasis increases the recovery time from malaria
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What is Human African Trypanosomiasis?
- Parasitic disease transmitted by Tsetse flies that left untreated is always fatal
- Trypanosoma bruceii gambiense found in West and Central Africa and traditionally thought of as transmitted predominantly among humans
- T.b. rhodesiense found in East Africa and predominantly zoonotic from cattle
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So, what is Disease Modelling in One Health used for?
- Predicting consequences of interactions in parasite co-infections
- Estimating host contributions to transmission in multi-host systems
- Comparing the effectiveness of One Health intervention strategies
Basic modelling principles and mathematical building blocks are the same as in single-host, single-parasite contexts but with added complexity.
One Health
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