From "one medicine" to "one health" and systemic approaches to health and well-being

Abstract

Faced with complex patterns of global change, the inextricable interconnection of humans, pet animals, livestock and wildlife and their social and ecological environment is evident and requires integrated approaches to human and animal health and their respective social and environmental contexts. The history of integrative thinking of human and animal health is briefly reviewed from early historical times, to the foundation of universities in Europe, up to the beginning of comparative medicine at the end of the 19th century. In the 20th century, Calvin Schwabe coined the concept of "one medicine". It recognises that there is no difference of paradigm between human and veterinary medicine and both disciplines can contribute to the development of each other. Considering a broader approach to health and well-being of societies, the original concept of "one medicine" was extended to "one health" through practical implementations and careful validations in different settings. Given the global health thinking in recent decades, ecosystem approaches to health have emerged. Based on complex ecological thinking that goes beyond humans and animals, these approaches consider inextricable linkages between ecosystems and health, known as "ecosystem health". Despite these integrative conceptual and methodological developments, large portions of human and animal health thinking and actions still remain in separate disciplinary silos. Evidence for added value of a coherent application of "one health" compared to separated sectorial thinking is, however, now growing. Integrative thinking is increasingly being considered in academic curricula, clinical practice, ministries of health and livestock/agriculture and international organizations. Challenges remain, focusing around key questions such as how does "one health" evolve and what are the elements of a modern theory of health? The close interdependence of humans and animals in their social and ecological context relates to the concept of "human-environmental systems", also called "social-ecological systems". The theory and practice of understanding and managing human activities in the context of social-ecological systems has been well-developed by members of The Resilience Alliance and was used extensively in the Millennium Ecosystem Assessment, including its work on human well-being outcomes. This in turn entails systems theory applied to human and animal health. Examples of successful systems approaches to public health show unexpected results. Analogous to "systems biology" which focuses mostly on the interplay of proteins and molecules at a sub-cellular level, a systemic approach to health in social-ecological systems (HSES) is an inter- and trans-disciplinary study of complex interactions in all health-related fields. HSES moves beyond "one health" and "eco-health", expecting to identify emerging properties and determinants of health that may arise from a systemic view ranging across scales from molecules to the ecological and socio-cultural context, as well from the comparison with different disease endemicities and health systems structures.

Fig. 1

Calvin Schwabe's “one medicine” as general medicine of humans, domestic and free-living animals (reproduced with permission from Schwabe, 1984).

Fig. 2

Scales of Mycobacterium tuberculosis infection and their system interactions. Reprinted by permission from Macmillan Publishers Ltd: Nature Microbiology Reviews, Young et al. (2008), copyright (2008).

Fig. 3

Livestock to human transmission of brucellosis (reproduced with permission from Roth et al., 2003).

Fig. 4

A multitier framework for analyzing Socio-Ecological Systems SES (Ostrom, 2007, Copyright (2007) National Academy of Sciences, U.S.A.).

Fig. 5

Flow chart of antimicrobial resistance of the Canadian Integrated Programme for Antimicrobial Resistance Surveillance (CIPARS) www.phac-aspc.gc.ca/cipars-picra/index-eng.php. Irwin (2005) adapted from Linton (1977) (personal communication by Rebecca Irwin 07.21.2010).

Fig. 6

(a) Generalized systems dynamic framework of health of humans and animals in social-ecological systems extending the schematic used by Schwabe (1984). (b) Generalized systems dynamic framework of health of humans and animals extended from Ostrom (2007), Young et al. (2008) and Rock et al. (2009).

Fig. 7

From efficacy to effectiveness, or how interventions lose traction (adapted from Zinsstag et al., 2011).