ONE HEALTH LEADERSHIP EXPERIENCE Dr. Mark Raizenne Centre for Food-Borne, Environmental and Zoonotic Infectious Diseases Public Health Agency of Canada

Breaking Down Barriers, Creating Connections ONE HEALTH LEADERSHIP EXPERIENCE Breaking Down Barriers, Creating Connections Public health has had a long history of recognizing that animal health and human health are linked – veterinary public health Some initiatives such as EcoHealth programs have explored the importance of human and ecosystem health Traditional silos exist between public health professionals, doctors, vets, ecologists, social scientists

Drivers of Public Health Threats Today ONE HEALTH LEADERSHIP EXPERIENCE Drivers of Public Health Threats Today Food and water consumption Catastrophic natural events Habitat disruption or modification (agricultural practices) Ecosystems Casual exposures Human population growth Animals Humans Estimates suggest that approximately 70% of emerging and re-emerging diseases are zoonotic in origin and global trends such as human population growth, increase in livestock production, climate change, the movement of animals, people and goods, rapid urbanization, changing farming systems and forest encroachment, are creating favourable conditions for the emergence and re-emergence of infectious diseases. Occupational exposures Economics Climate change Movement of people, animals, goods

Public Health Agency of Canada | Agence de la santé publique du Canada What is One Health? Transcending Borders: One Health recognizes the linkages among human, animal and ecosystem health domains. A Whole-of-Society Approach: It proposes an international, interdisciplinary, cross-sectoral approach to surveillance, monitoring, prevention, control and mitigation of emerging diseases, as well as to environmental conservation. PHAC is exploring the One Health approach as a means to prevent and respond to complex public health threats at the animal-human-ecosystem interface The collaborative efforts of multiple disciplines working locally, nationally, and globally, to attain optimal health for people, animals, and our environment (AVMA 2008) Source: “Contributing to One World, One Health” Strategic Framework, Oct. 14, 2008

The Environment/Ecosystem Connection ONE HEALTH LEADERSHIP EXPERIENCE The Environment/Ecosystem Connection Environmental health is often forgotten Challenge to engage environmental health researchers and scientists Climate change creates favourable conditions for the emergence and establishment of disease vectors Examples of environmental issues Antimicrobial resistance Prions Shale gas and oil sands Arboviruses Other pathogens which may emerge in Canada because of climate change: Arboviruses - Eastern Equine Encephalitis Virus (EEEV) and California serogroup viruses (Jamestown Canyon and Snowshoe Hare) Changing weather patterns can create favourable conditions for the spread of vector-borne diseases. In Canada, we have observed the spread of Lyme disease and the West Nile virus – in both cases warmer temperature may well have facilitated the spread of these vectors into parts of our country where they did not exist previously. Lyme disease is emerging in Canada because the tick vector is expanding its range. Studies show that the ticks are establishing in the warmest regions of Canada. Risk maps will help to meet the public health challenge of Lyme disease by allowing targeting of surveillance and intervention activities

One Health Helps us Focus on the Margins ONE HEALTH LEADERSHIP EXPERIENCE One Health Helps us Focus on the Margins Big problems cross disciplines…and solutions are not specific to any one of us We need to focus on the margins – the spaces between human, animal and ecosystem health Risk of missing “causes of the causes” – what expertise don’t we need? http://lasirenagrill.wordpress.com/2012/03/03/the-green-iceberg/

One Health Advantages Multiple perspectives are better than one ONE HEALTH LEADERSHIP EXPERIENCE One Health Advantages Multiple perspectives are better than one Looking at human disease without including the context in which human illness occurs will not inform our decision-making ability One Health is a useful paradigm to frame complex public health issues A way to foster information sharing and integrative surveillance Improved professional competencies and education One Health is an integrated approach to risk management and decision making

How Can One Health Improve What We Do? ONE HEALTH LEADERSHIP EXPERIENCE How Can One Health Improve What We Do? Current Situation With One Health Focus on outbreak response Focus is generally on health and scientific aspects of disease Approach tends to be siloed and fragmented Focus is primarily national Education tends to be discipline-specific Communities engaged and mobilized only after outbreak event Focus on preventing outbreaks Focus includes social and cultural determinants of health Approach is holistic, integrative and interdisciplinary Focus includes international cooperation and prevention Education is cross-sectoral, including other disciplines and perspectives Early education and information sharing with communities to prevent zoonotic outbreaks 8

One Health Activities PHAC’s One Health activities ONE HEALTH LEADERSHIP EXPERIENCE One Health Activities PHAC’s One Health activities PHAC is highly engaged in promoting One Health; collaborating with other departments (CFIA) PHAC is applying a One Health approach to AMR policy development, CIPARS, C-EnterNet, West Nile and Lyme disease surveillance, Science-Policy Integration One Health Operational Model Provinces and Territories Manitoba, Ontario, Alberta, Saskatchewan, Quebec Manitoba: One Health Committee with a food safety and surveillance focus – pilot on Salmonella Medical Officer of Health working with National Collaborating Centre for Infectious Diseases Quebec: “One Health, Health for All”: animal health and welfare strategy with a strong focus on animal-human interaction Alberta: applying One Health to Salmonella surveillance and AMR Ontario: Public Health Ontario and Ontario Ministry of Agriculture, Food and Rural Affairs looking into One Health

Infectious Disease Prevention and Control Branch (IDPC) ONE HEALTH AND THE PUBLIC HEALTH AGENCY OF CANADA Infectious Disease Prevention and Control Branch (IDPC) One Health Operational Model One Health provides a means to look at the complete picture, so that all emerging health issues are tackled in a balanced and effective way Stage 1 of the framework involves identifying the One Health issue to be investigated or supported. Stage 2 involves a more detailed description of how the 3 relevant sectors (human health, animal health and environmental health) are associated with the issue/project/program being investigated. Stage 3 of the framework examines the data needs of the project, activity or program. Stage 4 involves a description of the human resource needs and contacts that need to be made for successful completion of the project activity or program. Stage 5 of the framework includes the identification of options or solutions for the original One Health issue presented. Stage 6 of the framework involves describing the final outcome(s) of the project or program, what is needed for this outcome to take place (funding, materials, and human resources) and what will be necessary for further research, the communication plan, the education plan and the surveillance plan, if they apply.

International One Health Activities ONE HEALTH LEADERSHIP EXPERIENCE International One Health Activities United States: CDC – One Health Office USDA-APHIS – OH Coord’n Office Multiple Universities European Union: Animal Health Strategy (2007 – 2013) Australia World Health Organization (WHO), World Organization for Animal Health (OIE), Food and Agriculture Organization (FAO), the World Bank

Upcoming International Events POWERPOINT TITLE GOES HERE USING: VIEW > HEADERS AND FOOTERS Upcoming International Events 2nd GRF One Health Summit 2013 One Health - One Planet – One Future: Risks and Opportunities Davos, Switzerland November 17 – 20, 2013 3rd International One Health Congress Amsterdam, Netherlands March 15-18, 2015 Would be an excellent meeting to showcase the One Health activities at the University of Saskatchewan GRF = Global Risk Forum

ONE HEALTH LEADERSHIP EXPERIENCE One Health Education One Health curriculum needs to address the effects of climate on ecosystem health, wildlife, and the movement of plant, animal, and human diseases There is an opportunity for veterinary medicine to leverage its expertise in One Health and lead advances in food-animal husbandry and welfare, water safety and security, and the health of wildlife and ecosystems Need to integrate the key disciplines of human medicine, veterinary medicine, conservation biology, public health, basic sciences, agriculture, economics, social sciences and environmental sciences AVMA 2008 The convergence of people, animals, and our environment has created a new dynamic in which the health of each group is inextricably interconnected The veterinary medical profession must implement solutions to the critical workforce challenges in collaboration with multiple professions, including public health, human medicine, bio-engineering, animal science, environmental science, and wildlife

Education Recommendations ONE HEALTH LEADERSHIP EXPERIENCE Education Recommendations One Health is an “… opportunity to connect and educate health professionals at an early stage, when they are naturally learning together. As undergraduates, these students are excited about integrating new ideas, and their academic schedule may be more accommodating to a variety of classes. Presenting One Health concepts to students at this stage of their education could have a positive impact on their awareness of and attitudes toward public health.” Farone TS. Incorporating the one-health concept into undergraduate education.J Am Vet Med Assoc. 2011 Dec 1;239(11):1406-7. “Introducing this concept to students early in their academic careers is important to ensure that they are still open to broad-based, interdisciplinary ways of thinking. Kahn LH. Educating undergraduates on one health. J Am Vet Med Assoc. 2012 Jan 15;240(2):144. “Schools of medicine and veterinary medicine should provide their students the opportunities to learn about how animal and human health can impact on each other.” Kahn LH, Kaplan B, Monath, TP, Steele JH. Teaching “One Medicine, One Health”. The American Journal of Medicine, Vol 121, No 3, March 2008

Challenges for One Health Leaders ONE HEALTH LEADERSHIP EXPERIENCE Challenges for One Health Leaders Labelled as a non-expert Issues with common language when mixing disciplines Lack of funding – public, private and industry, competing priorities Small number of One Health mentors and senior faculty No unifying vision for One Health in Canada and abroad - poor coordination among Canadian health actors, “siloes” Career paths in One Health are often unclear and few well-paying job opportunities are advertised for graduates Limited opportunities to mobilize interest in One Health outside of academia in Canada Will require changing behaviours and mindsets One Health generally accepted by veterinary medicine, not so in other sectors Need to substantially expand the traditional roles of health and medicine and redefine competencies The veterinary profession needs to expand recognition of its immense responsibilities in addressing global food security and resilience Too few positions that pay appropriately – incongruences in pay for DVMs, MDs, environmental sciences There is often limited application of our understanding of the impacts of animal and environmental health on human health, policies and actions There are limited avenues or opportunities to mobilize interest in One Health. Need opportunities in curriculum to expose students to public (govt), corporate and academia employment opportunities

ONE HEALTH LEADERSHIP EXPERIENCE An Uphill Battle “…a shortage of collaborative student programs, insufficient environmental training for health professionals, and a lack of institutional support impede progress” Meredith A Barrett, Timothy A Bouley, Aaron H Stoertz, and Rosemary W Stoertz. 2010. Integrating a One Health approach in education to address global health and sustainability challenges. Frontiers in Ecology and the Environment (e-View)

ONE HEALTH LEADERSHIP EXPERIENCE “If you always do what you've always done, you'll always get what you've always got.”

The Benefits of One Health (AVMA 2008) ONE HEALTH LEADERSHIP EXPERIENCE The Benefits of One Health (AVMA 2008) Improving animal and human health globally through collaboration among all the health sciences, especially between the veterinary and human medical professions to address critical needs Meeting new global challenges head-on through collaboration among multiple professions—veterinary medicine, human medicine, environmental, wildlife and public health Developing centers of excellence for education and training in specific areas through enhanced collaboration among colleges and schools of veterinary medicine, human medicine, and public health Increasing professional opportunities for veterinarians Adding to our scientific knowledge to create innovative programs to improve health

Advantages for One Health Leaders ONE HEALTH LEADERSHIP EXPERIENCE Advantages for One Health Leaders Marketable Nimble, adaptable Responsive to disease outbreaks, challenges Broader perspective, see the commonalities Chance to show leadership nationally and globally Canada has recognized leaders in One Health – available for mentoring and support Help to bridge the educational and research gap between the human, veterinary and environmental science fields Potential employers – government, educational institutions, NGOs

Physical Environments ONE HEALTH LEADERSHIP EXPERIENCE The Next Generation of One Health Practitioners Governance Psychological Public and Population Health Sociological Physical Environments Veterinary Medical Historical Public Population Health Anthropological Humans Animals Animal Science Economic Evolutionary and Comparative Political Social Environments Environmental and Ecological Public Policy Medical Communication Studies Biomedical Source: Rock et al., 2009

“Gentlemen, we can rebuild him, we have the technology” ONE HEALTH LEADERSHIP EXPERIENCE “Gentlemen, we can rebuild him, we have the technology”