One Health and Environment

Published on 26 October 2023

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During the early developments of COVID-19, this disease was often related to certain animals …

Written by: Prof. Tjandra Yoga Aditama,
Senior Advisor Communicable Disease for the Australia Indonesia Health Security Partnership (AIHSP).

The article was published in the KOMPAS Daily on 28 June 2022.

“One Health”

In the early stages of COVID-19, the disease was linked to specific animals‒bats and pangolins‒however, transmissions were also reported in ferrets, cats, and others. As a result, people commonly associate COVID-19 with Zoonotic diseases related to animals. A few years ago, the world was alarmed by the spread of bird flu transmitted by birds. In some places in our country, there have been reports of rabies cases in humans due to dog bites, as well as cases of anthrax and various other Zoonotic diseases.

Global data shows that 60 per cent of pathogenic agents causing diseases in humans are related to domestic or wild animals. Furthermore, 75 per cent of newly emerging pathogens and 80 per cent of pathogens in bioterrorism are also related to animals. Disruptions in animal supplies can affect our food patterns and safety. It is estimated that more than 70 per cent of additional animal protein will be required for human consumption by 2050.

Due to the importance of the relationship between human health, animal health, and a healthy environment, the concept of “One Health” has been recognised. While there is no official Indonesian term for it, it might be aptly translated as "Health, Together." One Health is implemented as a collaborative approach in human, animal, and environmental healthcare carried out in an integrated manner across sectors and, of course, with the involvement of the community. The One Health approach‒initially connected with the control of Zoonotic diseases‒has since evolved to address new infectious diseases (emerging diseases) and those re-emerging. It is now associated with the control of current and future pandemics, encompassing prevention, preparedness, and the response to be taken when pandemics occur. One Health also covers food security, neglected tropical diseases, and antimicrobial resistance (AMR). Because of its broad impact and scope, it is accurate to say there is no health without One Health.

In recognition of the importance of implementing the One Health concept, on 17 March 2022, the leaders of four international organisations (the Food and Agriculture Organization, the World Organisation for Animal Health, the United Nations Environment Programme, and the World Health Organization (WHO) signed a Memorandum of Understanding (MoU) called the ‘New Era of One Health Collaboration’. This Quadripartite MoU provides a formal foundation for addressing public health, animal, plant, and ecosystem issues in a coordinated and integrated manner. In follow-up, a Joint Plan of Action has also been developed at the global level.

Indonesia should also establish a formal, multi-sectoral One Health forum at the national level, involving various relevant ministries, professional organisations, academics, and other stakeholders. National and regional work plans need to be developed‒with the most crucial aspect being actual implementation in the field. Practical work in the field is increasingly needed because the Indonesian G20 presidency has included One Health as one of its agenda items, along with tuberculosis and AMR. The results have already been presented by Prof. Tjandra at the G20 Health Ministers' Meeting and in front of the WHO Director-General.

Environment

We know that the importance of preserving a healthy environment is not only related to the concept of One Health. Since 1972, the United Nations has designated World Environment Day‒celebrated annually on 5 June. Various changes in the global environment will affect human health‒such as climate change, ozone layer depletion, land degradation, decreased water resources, changes in ecosystem functions, and the loss of biodiversity.

Climate change will cause regional weather changes‒including extreme weather, temperature increases, changes in rainfall patterns, and rising sea levels. In climate change terminology, these components are known as climate change hazards. Climate change can cause diseases or deaths due to extreme weather, landslides, floods, storms, and other natural disasters. Furthermore, malnutrition can occur due to disrupted food sources and harvests.

The health impacts arising from climate change can affect human health in two ways: directly and indirectly. The direct health impact on humans consists of direct exposure to changes in weather patterns, such as temperature fluctuations, rainfall, rising sea levels, and an increase in the frequency of extreme weather. The indirect impact can occur through specific mechanisms. For example, climate change affects environmental factors such as changes in the quality of the environment‒including water, air, and food quality‒and vector-borne disease transmission patterns. A 2-3°C temperature increase is predicted to increase the number of vector-borne disease cases by 3-5 per cent. A temperature increase will also expand the distribution of disease vectors and enhance the development and growth of parasites to become more infectious. Furthermore, changes in rainfall, along with changes in temperature and humidity, can increase or decrease the density of disease vector populations and human contact with disease vectors. Changes in ecosystems such as wetlands and mangroves can also alter the distribution patterns of disease vectors.

Ozone layer depletion in the stratosphere can increase the risk of skin cancer, while temperature increases due to climate change can increase surface ozone concentrations‒which are one of the main air pollutants that can cause respiratory diseases. The WHO reports that 9 out of 10 people in the world live in environments where air pollution levels exceed WHO thresholds. It also mentions that 4.2 million deaths occur worldwide each year due to outdoor air pollution, as well as millions of deaths caused by indoor air pollution. The loss of biodiversity can lead to a shortage of medicinal plant resources, while a decrease in water resources limits access to clean water and healthy sanitation with various consequences.

In regard to air pollution in particular, the World Health Organization (WHO) said that 9 out of 10 people in the world live in an environment where air pollution levels exceed WHO thresholds. According to WHO there are 4.2 million global deaths every year due to outdoor air pollution and millions more people die due to indoor air pollution.

To mitigate the adverse effects of environmental changes on health, a vulnerability assessment and risk assessment of the health sector due to climate change need to be conducted. This includes studies, analyses, and research on hazards, vulnerabilities, risks, and the health impact of climate change, as well as the development of adaptation models for selected districts and cities. Studies on the relationship between climate change and the development of vector-borne diseases through water or air, the occurrence of disasters and accidents, and non-communicable diseases can also be conducted. Data that needs to be collected includes environmental data that affects exposure, sensitivity, and the adaptive capacity of public health systems and various factors that influence the occurrence of climate change-related hazards. Early warning and emergency response systems in the community should be established or strengthened for both natural disasters and infectious disease threats. Furthermore, efforts to prevent the worsening of climate change should also be a shared priority in our daily lives.

In a broader sense, we are also familiar with the term "social determinants of health" which are non-medical factors that influence health status. This includes factors starting from birth, growing up, education, work, and interacting with other people, the surrounding environment, and existing systems. It is also related to economic policies, regional and national development‒even global norms, social norms, and political developments. In short, health cannot stand alone; many factors that affect it need to be understood and mastered to improve the nation's health status.

Selamat merayakan Hari One Health 2023!

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Happy One Health Day 2023!

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