One Health: Human, Animal, and Environmental

Health
By: Cary Griffin, Joanna Harrison, My Na Mao, Tracy Ngo, Ji Seo, & Elizabeth Zech
ENV H 311: Introduction to Environmental Health
FALL QUARTER - December 10, 2013

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As human population growth continues to expand and move into new geographic areas,
more people live in close contact to wild and domesticated animals, leading to opportunities for
zoonotic diseases to pass between animals and humans. Historically, humans used animals for
sustenance in a hunter-gatherer society. Today, as the agricultural revolution changes the
dichotomy between humans and wildlife, anthropogenic impacts on bordering ecosystems and
habitats threaten wildlife, which in turn increases the rate of potential exposure to zoonotic
disease. Clearly, this is a real problem and there needs to be a community which can bridge the
gap between civilized growth and the protection of wildlife. This is what the collaborative
community known as One Health is designed to promote. One Health is a collection of
different professionals like veterinarians, physicians, nurse practitioners, and environmentalists
coming from a wide array of industries aimed to address the issues we as humans face with
zoonotic diseases (One Health). Such a collaborative process is needed to tackle this complex
matter because there are many organizations, scientists, and professionals that collectively work
with humans, animals, and the environment.
In the industrialized world, human population has already drastically changed the
physical surrounding environment. This changing environment forces animals to adapt to new
changes, which can lead to degradation of the quality of life to animals, causing potential issues
of exposure to humans. There is a positive correlation between the numbers of diseases that
human populations share with domesticated animals dependent on the proximity to the animals,
shown in the following diagram provided in an environmental health lecture at the University of
Washington in the fall of 2013.


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Domesticated Animals # of Diseases
Shared with Humans
Poultry 26
Rodents 32
Horse 35
Pig 42
Sheep/Goats 46
Cattle 50
Dog 65
(McNeil WH. Plagues and People, 1977)
The closer humans are to the domesticated animal, the more diseases we share with the
given subject. The diseases we share and are vulnerable to include: Anthrax from Sheep,
Ringworm from Dogs, Salmonellosis from Poultry, among many other diseases that threaten the
health and resiliency of a human population (Dykstra).
The cause of this relationship between diseases from animals to humans can be attributed
to modern globalization. Urbanization, deforestation, and the reduction of natural resources have
moved wildlife into urban environments, increasing the amount of certain dangerous hosts and
vectors. In such a large arena for vulnerability, all subjects are at risk such as people, animals and
the environment that One Health aims to connect. An example of an issue One Health has
interest in could be the following; deforestation of timber resources used for the construction of
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suburbs leads to a degraded habitat for the many species living in that area. After the habitat has
been removed, the health and wellbeing of the organism has been dissipated. The organism must
now adapt to a new environment or live in the current depleted environment causing a surge in
zoonotic and vector borne disease. Anthropogenic practices have an immense impact on the
health and resiliency of wild and domesticated animals, which in turn creates a risk to the human
population. One Health addresses this risk and acts as the collaborative strategic planning
organization that hopes to minimize the exposure to the groups who are negatively affected,
while protecting the health of animals, humans and the environment.
Even though zoonotic diseases are more than 60% of the newly identified infectious
agents that have affected people over the past few decades (Zoonoses and Food Safety),
comprising a significant threat to public health, they are not considered to be a great threat,
especially in developed countries. Because zoonotic diseases are not highly prioritized by the
government in developed countries, it does not reduce the threat it has overall. It is commonly
accepted that zoonotic diseases caused when living in close proximity to animals is the highest
risk area for human exposure. We are born into an intertwined cycle with animals and nature,
and therefore inseparable from it, what hurts us, can hurt the other. Take for example, a zoonotic
disease, West Nile virus. Illustrated in the article, Perspective: One Health: A Compelling
Convergence, West Nile virus is a mosquito-borne virus that is known to have originated from
temperate and tropical regions of the world. This zoonotic disease strongly caught the attention
of the public health of United States in 1999, when a mysterious disease took the lives of large
numbers of birds. The birds were only the beginning. Death of the birds was soon followed by
the sudden spread of an at-the-time unexplained sickness in elderly people. The connection
between bird deaths and humans was soon linked through the communication of a zoo
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veterinarian and a hospital physician (Shomaker et al). This outbreak shows how pathogens can
have negative effects on animal and human populations simultaneously. According to CDC data
for the year 2012, [a] total of 5,674 cases of West Nile virus disease in people, including 286
deaths, were reported to CDC from 48 states (excluding Alaska and Hawaii). This data provides
evidence that zoonotic diseases are still considered deadly to people even in the developed 21
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century United States. The current best offensive for us is prevention. Humans all around the
world must be aware of the fact that we are always linked with the possibility of contracting
zoonotic and other infectious diseases from the world around us.
The majority of zoonotic disease incidents are in developing countries. In the article,
Emerging and Re-emerging Bacterial Diseases in India, it is estimated that 25% of the annual
deaths occurring globally are caused by microbes. A major proportion of these deaths occur in
the developing world (Chugh). Zoonoses result from interconnections between human and the
natural environment, in which humans may acquire pathogens from animals (and vice versa).
Most developing countries still depend on domestic livestock to make a living, As a result,
people naturally come in contact with a wide range of animal hosts (animals who carry diseases
that do not affect them). According to the authors from the article Climate Change, Zoonosis
and India, they stated that livestock excrete many micro-organisms which have zoonotic
potential (Singh et. al). In addition, close relationship between humans and their livestock also
results in risks of disease transmission. Their close-living lifestyle puts them in jeopardy,
exposing them to the possibility of attaining zoonotic diseases through animal contact. Also,
developing countries tend to have a natural condition that is a perfect fit for growth and spread of
vector borne diseases. Close living conditions of humans, hot weather and unsanitary life are
perfect homes for mosquitos and ticks. To make the case worse, the zoonoses found in the
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developing countries are usually endemic, which unlike emerging zoonoses, are not a hot topic
and do not catch a lot of the medias attention (Tackling Neglected Zoonoses). Once neglected,
these endemic zoonoses often results in growth of significant health problems. Commonly
neglected zoonoses includes, anthrax, rabies, brucellosis, bovine TB, and many more. These tend
to have a major effect on developing countries, occasionally resulting in an epidemic illness. Not
only can this be a health problem, but it can also become a threat to their livelihoods. Neglected
zoonoses also affect livestock, sickening animals and in some cases causing them to die. Those
who raise animals for food are often related with international trading and such livestock loss
would also lead to loss of trading partnership, which can severely impact the rate of employment
and economic prosperity in the area.
The situation becomes worse when it comes to the poorest communities in developing
countries. The poor are at higher risk of contracting zoonotic disease due to their close
interactions with domestic and wild animals, unhygienic living conditions, lack of education, and
lack of affordability of medical treatment. These unhealthy living conditions are factors that
increase the vulnerability to zoonotic diseases, which is why those with low-income, tend to have
higher rates of zoonotic disease infection. One Health does however, involve many different
people and organizations as it pertains to both human and animal health. Each entity is
considered a stakeholder in that they have a personal interest in the One Health Initiative. Each
stakeholder has influence on the progress of the movement and will be impacted by the initiative
(Schmeer).
When we think about preventing vector-borne and zoonotic infections, we immediately
think of those who are directly involved with the healthcare of humans and animals. This group
of people includes veterinarians, physicians, nurse practitioners and physician assistants.
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Physicians and their staff care about One Health, as it would improve the health of their patients.
The majority of infectious diseases are caused by zoonotic pathogens, which can lead to
disability or death. Vector borne and zoonotic diseases are preventable because physicians and
their staff can track outbreaks and possibly determine the source (One Health - CDC). They have
an influence on One Health in that they have the authority to communicate with and educate their
patients about preventing the spread and exposure of infections.
Veterinarians have similar interests as physicians caring for the animals health.
Veterinarians can further prevent outbreaks by educating pet owners about safe pet handling and
care. Zoonotic infection can also be spread when an animal bites a human, so training pets at a
young age can be a cost-effective step in infection prevention. Pet owners are also important
stakeholders, as more than 50% of households in the United States have at least one pet (2020
Healthy Pets). Owners can work to keep their pets free of fleas, ticks and other parasites that are
vectors for harmful diseases. In addition, they can also clean up the feces from the animals to
prevent contamination in the community. Little steps go a long way in the prevention of disease.
For those people who are in direct contact with animals, and people already burdened
with a vector-borne or a zoonotic disease, there are multiple governmental organizations to
contact. On a relatively small scale, there are local, county, and state Public Health departments.
Public Health refers to protecting the health of entire populations through preventative measures,
which is what the departments strive to achieve. These departments monitor animal health trends
and track the spread of zoonotic diseases in human populations. They analyze the data and use it
to implement public health interventions and improve services to populations at risk
(Zoonotic/Vector-Borne/Infestations).
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On a broader scale, there is the national public health institute - Center for Disease
Control and Prevention (CDC) - and the United States Department of Agriculture (One Health -
USDA). CDC scientists study how bacteria and viruses are spread and determine how one can
decrease their risk of infection. The CDC can then implement educational programs that inform
people, especially those at risk, on how to prevent the spread of infection between animals and
humans. One example includes teaching the public on how to prevent themselves from getting
bitten by disease-carrying vectors, such as mosquitoes and ticks. They also teach proper hand
washing techniques and food safety. Food handling can mean washing fruits and vegetables that
might be contaminated or cooking meats to the proper temperature to kill pathogens (One Health
- CDC). The USDA is essential to the safety of our foods and they have a department dedicated
to One Health the Animal, Plant and Human Inspection Service (APHIS). One of the
stakeholders especially interested in the One Health Initiative are farmers. Farmers do not want
infections spreading throughout their animal herds and poultry flocks, nor do they want their
fruit and vegetables to be contaminated. Infection and contamination directly affect the farmers,
if an outbreak occurs from their product, the result can be a decrease in their income. Farmers
and the USDA can have a great impact on One Health as they can prevent disease at the source.
Microbial or chemically polluted land and water sources on farms can harbor pathogens which
means keeping our land and water clean stops pathogens from being transmitted to our food, and
therefore will further prevent food-related infections (One Health - USDA).
Internationally, there are even more organizations involved with One Health World
Health Organization, World Organization for Animal Health, and the Food and Agriculture
Organization of the United Nations (Greger). These institutions are in place to allow
collaboration to ensure that national and local organizations are working together and sharing
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information on how to prevent zoonotic and vector borne diseases. One Health is a global issue,
which means everyone is a stakeholder. We all have a role in preventing the transmission of
infection and improving global public health.
In addition to improving public health, One Health also aims at solving some of the
health issues dealing with animals and humans and how they interact together in their
environment. These public health issues include emerging infectious diseases linked between
humans and wildlife, foodborne illnesses pertaining to foods that come in contact with animals,
and the change in the environments where humans and animals live that is influenced by
urbanization, climate shifts, and ecoterrorism. What makes it difficult for One Health to tackle
these issues is that humans, animals, and the environment all interact with each other, making it
harder to control for every factor between them.
Among the human population, infants, the elderly and the immunocompromised
individuals are more susceptible to zoonotic infections because of their weak immune systems
(DEOHS at UW). Many households with and without susceptible individuals nowadays keep a
range of animals as pets inside the home. This range includes pigs, rats, birds, and an assortment
of animals previously considered as only outside pets. These inside-outside animals may have
interacted with other animals outdoors that carry zoonotic disease, or eaten and stepped on feces
of other animals. They then bring the feces inside the home, where humans come in contact with
the pathogens. Petting zoos are also a likely place to contract zoonotic diseases, as they
encourage lots of contact between animals and humans. A case located at a state fair in North
Carolina looked at 108 individuals who developed E. coli infections when exposed to feces-
contaminated materials in the petting venue (Microbe Magazine). These wastes were walked on
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by many people, their feet spreading the E. coli elsewhere. Zoonotic infections are everywhere,
and continue to threaten the health of humans in their environments.
In addition to zoonotic diseases, food safety has been an issue that continues to sicken
and kill consumers. Farmers raise animals as food and have concentrated mass amounts of
animals in small areas, for better profit. The close living proximity of most these animals means
that if one is infected, many others get infected as well. One of the most common diseases
associated with food contamination is Salmonella. Many diseases can transfer to humans through
saliva, blood, open-cuts, urine, and feces that - like Salmonella - can be ingested through
contaminated, unwashed foods. The ways that animals are raised on farms and slaughtered, and
how they are handled while they are being transported to stores and eventually onto the dinner
table can lead to sickness in humans who consume these foods if not dealt with properly
(Microbe Magazine). Improper food handling in the kitchen can mean undercooked meats will
still contain traces of harmful bacteria. Cross-contamination of meats with other foods is a
common way that humans can get sick even when they think they have thoroughly cooked or
washed their food. In 2003, ground beef was recalled from stores, claiming to have been
contaminated with E. coli (Microbe Magazine). For those who had eaten the beef, many visited
the hospital and luckily very few of them died. Food is very universal, and thus should be
handled, kept, and cooked safely to ensure that the meat of animals and vegetables used, are rid
of harmful bacteria.
As well as food handling, changes to the environment also create threats to the health of
humans and animals. An example of this is from urbanization. Deforestation for agriculture can
decrease the amount of animal habitat, bringing the animals - and their diseases - closer to
humans. Climate changes in temperature and precipitation prompts vector populations to move
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to different areas where they can multiply. For example, mosquito vectors that carry malaria can
move to areas that were initially too cold to live in, increasing their population (NIH). With
increase in both hazard and exposure rates, risk of getting malaria increases. Animals and
humans that live in these once-colder areas have the possibility of being bitten and becoming ill
with malaria. It is not easy controlling the activities that going on in the environment that impact
the health of animals and humans, but One Health is making the effort to try.
When working human, animal and environment health fields together under One Health,
it promotes a good overall worldly health. By working with veterinarians, physicians who have
better understanding of zoonotic diseases can improve the diagnoses of their patients. In the
same way, physicians can work with veterinarians to ensure that human impact is not a threat to
animal health - especially for animals that are living with humans. For this reason, One Health is
an important initiative; it benefits all.
In June of 2007, the American Medical Association passed, in collaboration with the
American Veterinary Medical Association, the One Health initiative (Resolution: 530). The goal
of this initiative was to combine the fields of environmental health, human, and animal medicine
in such a way that information and treatment practices could be shared to improve the health of
both the greater public and the environment. In general, people can agree that this is a fairly
noncontroversial topic. The obstacles to the success of the One Health Initiative are rooted more
in the economy and inadequate infrastructure then opposition by society or political groups.
Perhaps one of the biggest social implications of the One Health Initiative is its ability to
recognize and analyze Sentinel Health Events (SHE). A sentinel event is described as a
preventable disease, disability, or untimely death whose occurrence serves as a warning signal
that the quality of preventive and/or therapeutic care may need to be improved (Rutzstein,
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1054). Sentinel events are already tracked within human and animal populations but One Health
aims to strengthen the connection of the shared risks of overlapping human and animal
populations. The classic example is the canary in the coalmine. Canaries were brought down into
mines with works to monitor the quality of air. Presence of toxic gases would affect sensitive
canaries before the workers alerting them to either evacuate or put on masks. This type of early
alert system could be invaluable to both the human and animal populations.
While we typically think of animals acting as sentinels for humans the relationship can
also work the other way. Though animals may be exposed first due to greater environmental
contact, humans may receive medical attention first either due to better communication of
symptoms or better accessibility to appropriate health professionals. Human diagnosis may direct
attention to screening for animal exposure (Rabinowitz).
The potential positive social impact of implementation of the One Health approach is
shown in the following example. Lead exposure and poisoning continue to be a leading cause of
unintentional death among infants and small children even though lead based materials have
been taken off the market (Accidents lecture). The ineffectiveness of first hand prevention has
lead healthcare professionals to look down alternative avenues. Presence of animals in homes
could help diagnose potential exposure for children not presenting symptoms and vice versa
(Rabinowitz). The CDC recommended level for lead is < 10 micrograms per deciliter
(Screening). In one case a family cat was taken to the veterinarian after displaying symptoms
such as vomiting and ataxia. The cat was diagnosed with lead poisoning, which lead to referral of
the familys asymptomatic two year old for testing. The child had blood levels well above the
recommended amount of 10 ug/dL at 24 ug/dL and underwent chelating therapy for lead removal.
In another case, a house painter was admitted to the hospital with blood levels of 112 ug/dL after
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sanding the exterior of a Victorian era house. His admitting physician contacted the local health
department which got in contact with the homeowners. They had no children but after testing
both of their dogs had blood levels of lead indicative of poisoning (Dowsett).
These are both examples of how, when used properly, the One Health system can save
lives of both humans and animals. However, the biggest challenge to this success is the lack of
infrastructure. Currently, there are no systems in place for tracking sentinel events which both
human and animal professionals both have access to. Part of this problem is separation of
information, animal disease notification goes to the corresponding Department of Agriculture
and human health disease information goes to the Department of Public Health. In order to have
sufficient sharing of information a new department would need to be created or a mandate passed
that health professionals on one side must share disease events with professionals on the other.
The push for creation of a national tracking system is supported by the success of
ArboNET. ArboNET is a database that was created in the early 2000s that tracks outbreak of
WNV, whether cases break out in animals or humans the data is inputted into the system. This
information can be used to analyze affected populations and predict and possible prevent the
spread of disease. However, ArboNET is only used for mosquito born disease. There is currently
no nationwide health-tracking network that coordinates the monitoring of diseases and connects
them to possible related factors (ANIMAL). Dissemination of information and communication
between fields is critical and yet there still lacks an organized system for this data. Part of this
problem is no one agency has clear leadership to oversee the nations response to animal-borne
diseases (ANIMAL). Politically, for One Health to reach its full potential there will have to be
the creation of some overseeing agency to coordinate federal, state, and local public health
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efforts to control zoonotic diseases. The knowledge and manpower is available but separation is
crippling the potential response of prevention of public health professionals.
To further this information predicament, Peter Rabinowitz explains, the fields of animal
and human health remain far apart, and the prevailing human health attitude toward disease
events in animals is an us vs. them paradigm. Humans tend to see animals as only a threat to
human health. One Health hopes to reverse this idea and cultivate the concepts of animals as
models for environmentally induced disease, as well as potential sentinels providing early
warning of both noninfectious and infectious hazards in the environment (L.Odowitz).
The other arena in which One Health could have large impacts is our economy. The
World Bank states that [t]he direct cost of zoonotic diseases over the last decade has been
estimated to be more than $20 billion with over $200 billion indirect losses to affected
economies as a whole (World Bank 2010). As a developed nation we take many precautions to
minimize the cost on zoonotic disease including test and slaughter, feed bans, mass
vaccination of domestic animals and wildlife, health education and milk pasteurization (Narrod).
However, these precautions are very expensive; most developing countries do not have the
means to implement these measures. However, education and knowledge of the potential benefits
may increase support for these expensive measures. When looked at from a purely public health
perspective, vaccinating livestock may seem to be less cost beneficial than just treating people
affected by zoonotic disease. However, if you spread out the cost over not only the public sector
but also the agriculture and food-processing industry suddenly the vaccinations become cost
effective (Narrod). Zoonotic disease prevention eliminates the spread of disease and
consequently increases human activity/ability to work and therefore their economic production.
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Using the One Health approach to decrease the amount of disease and as an early warning
system has potentially to increase economic activity.
In conclusion, the concept of One Health ties together the fields of environmental science,
human, and animal health. By integrating the fields and making sure communication and
education are consistently shared throughout health processes, overall world health can improve.
This benefit comes from the fact that humans are constantly impacted by the change in their
environment and by the animals around them (and vice versa). One Health promotes the idea that
not only human lives will be improved, but that of all species. When the species and environment
around us are healthier, in turn, we are. Not only does this communication between fields have a
positive change on health, but also on the economy. Billions of dollars are spent every year to
pay for medical costs of those infected with zoonotic diseases and to combat their spread. If the
One Health initiative were to be better embedded within society, the medical and economic cost
of zoonotic diseases would drop, leaving more money for the government to spend on other
important problems. As is the main goal for Public Health, One Health strives to reduce the
amount of people needing medical treatment through preventative measures and research. This is
achieved again through education and communication between the three fields mentioned above.
The West Nile case in New York in 1999 is a great example of what could have been achieved
through better communication. As the earth has been warming due to climate change
(environmental factor), the Aedes aegypti mosquito typically found in Africa, was able to survive
in North America. When the West Nile outbreak occurred, a veterinarian at a zoo first saw the
signs in her birds (animal factor). As the virus moved on to killing humans (human factor), the
veterinarian tried to contact the CDC and other health officials, to no avail. Only when the
veterinarian contacted a doctor at a hospital to discuss both their findings did the pieces fall into
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place. Had the health officials listened to the veterinarian earlier, many human deaths could have
been prevented (ANIMAL). On an economic front, the government could have saved money
because it costs more to be treated than to prevent.
It is becoming impossible to live in a world where humans are humans, animals are
animals, plants are plants, and their spheres of influence are not integrated. We are not alone in
this world, all living and nonliving things affect each other. The balance of life is easily tipped,
and one change - such as global warming - can not only affect one field but also many others -
such as birds and humans. It is in the best interest of all people living in this world to consider
the One Health concept; the importance of communication and education through multiple fields.
For now, One Health focuses on the environment, animals, and humans. But in the future it could
be found that other fields, such as electronics or food services become part of the integrated
culture that is slowly entering into the minds of health professionals. All things are connected.
One Health has found that through the integration of three previously separate areas, the lives of
species can be improved and health will reign supreme.




















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