One Health: The Shared Future of People, Animals, and the Planet

ROBERT JOHNSON:
This is Public Health Review. I'm Robert Johnson.

On this episode, connections between the health of people, animals and the environment, an examination of the One Health concept.

KAREN SMITH:
None of us exist separate from our environment or separate from the other things that live in that environment.

J.J. JONES:
Bacteria and bugs want to survive, so they're going to fight for survival.

MEGIN NICHOLS:
A One Health approach is needed now more than ever.

JOHNSON:
Welcome to Public Health Review, a podcast brought to you by the Association of State and Territorial Health Officials.

With each episode, we explore what health departments are doing to tackle the most pressing public health issues facing our states and territories.

Today, the urgent need to consider how people, animals and the environment are connected, and how each can impact the health of all living things. Of course, we're talking about the One Health approach. It's getting more attention as policymakers and others begin to realize the dangers that come when viruses jump from animals to people, or learn how to resist once reliable antibiotic treatments.

Dr. Karen Smith is an ASTHO alum and the former public health officer in California. J.J. Jones is executive director of the National Institute for Animal Agriculture.

They'll be along later, but first we visit with Dr. Megin Nichols, a veterinarian who today is deputy division director in the Division of Foodborne, Waterborne, and Environmental Diseases at the CDC.

NICHOLS:
One health is a collaborative, multi-sectoral and transdisciplinary approach, working at the local, regional, national and global levels, with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants and their shared environments. So in plain language, One Health is really an approach that recognizes that the health of people is closely connected to the health of animals and our shared environment.

One Health is not new, but it has become even more important in recent years. This is because many factors have changed the interactions between people, animals, plants and our environment. One Health is really gaining increased recognition in the United States and globally, as an effective way to fight health issues at the human-animal environment interface, including zoonotic diseases, which are those that can be transmitted between people and animals.

JOHNSON:
Even though the One Health approach is not new, how many people in public health know about it?

NICHOLS:
Here at CDC, we use a One Health approach by involving experts in human, animal, and environmental health, and other relevant disciplines and sectors in monitoring and controlling public health threats, and to learn about how diseases are spread among people, animals, plants, and the environment. And we also see a lot of robust One Health work that occurs at the state, local, tribal, and territorial levels, where there are groups that gather from a lot of different sectors to collaborate and discuss really complex issues that involve the intersection of people, animals, and the environment.

JOHNSON:
And there have been some fairly high-profile public health outbreaks that highlight this delicate balance between people and animals, yes?

NICHOLS:
I think one really great example of where One Health approach is needed is antimicrobial resistance, or AMR. An antimicrobial resistance occurs when germs like bacteria and fungi develop the ability to defeat the drugs that are used to kill them. That's a One Health issue that not only affects people, but animals, plants, and the environment.

The use of antimicrobials anywhere, such as in a hospital or on a farm can contribute to antimicrobial resistance, making infections in both people and animals harder to treat. Like humans, animals sometimes carry germs, including antimicrobial resistance germs that can make people sick. People can get sick from these germs by eating contaminated food, or by touching animals and their environments.

CDC has worked diligently with partners such as ASTHO and the National Institute for Animal Agriculture, to improve and optimize how antimicrobials are used in hospitals, on farms, and in agriculture, or antimicrobial stewardship, to really increase awareness of the spread of these resistant germs. And to emphasize the importance of working together with those from agriculture sectors, veterinarians, and others when considering how to use antimicrobials to best promote the health of animals, people and the environment.

JOHNSON:
How much effort does it take on the part of a public health agency to pivot to this way of thinking? Is it a lot of work?

NICHOLS:
One of the best things about taking a One Health approach is it's pretty simple. All it involves is working to establish relationships, and that could be a phone call, it may be attending a meeting, or a gathering, where you're bringing together these different perspectives to talk about some of these complex issues and really start a dialogue. And I think one of the great things that we see is with just a little bit of investment of energy into these opportunities, there have been some really robust results and really great collaborative efforts that have resulted. So, I would say a little effort in this case goes a long way.

JOHNSON:
What is your call to action? For those listening right now.

NICHOLS:
I would challenge everyone this week, to pick up the phone or write an email to someone in a sector that you haven't connected with yet. So, maybe that's from the public health perspective, reaching out to someone in the animal agriculture department at your state or local agency. I'd encourage those who are maybe in the healthcare sector to reach out and touch base with some of the animal health care professionals.

I think it's also great to explore where we have partnerships with industry and maybe make some connections that you haven't outside of your sector. I think that broadens your perspective and can lead to some really robust discussions. I think it's great to start thinking about any of those connections before a disease or event happens, before we have an outbreak, because establishing those relationships can go a long way in the event of an emergency when you need them.

JOHNSON:
Dr. Karen Smith is a career public health leader serving as California's public health officer from 2015 until 2019. Today, she consults agencies and for a while is serving as the interim health officer for Sonoma County, also in California. We began our conversation by asking her what the One Health approach looks like at the state level.

SMITH:
It's a really interesting question, because One Health hasn't really been part of the conversation in public health for very long. Governmental public health is historically even a little bit slower to formally adopt frameworks and approaches, which is what One Health is. That said, I think that at the state level, we have been doing what is functionally One Health for a long time. And that is working with colleagues across the state government, not just within the health programs, but also within environmental programs. So environmental health, often that's within public health, but it isn't always. But also then your agriculture departments, the departments that deal with food safety, and security, and your natural resources departments and development entities as well.

All of those things are related to One Health, in that they either deal with the environment, they deal with humans and human needs, water, and food, and that sort of thing. Or they're straight up about health, as in the public health and healthcare arena. It takes all of those perspectives to actually have what you can call a One Health Program or approach.

JOHNSON:
Why do you think One Health is getting more attention right now?

SMITH:
I think it's becoming more and more obvious as things like climate change, for example, has changed. We now are seeing dengue fever, which is typically a tropical disease or certainly not usually acquired within the United States. But as the weather warms up and the environment changes, mosquitoes, which are the vector of dengue, move into the United States, move up further and further north and now we're seeing people acquiring dengue in the United States. Same as malaria. We had some of the first cases of malaria acquired in the United States, in Texas, very recently.

Events like that make people start to, I think, connect the dots. Connect the dots from the environment is changing, which is changing something about not just insects, but also animals that we're likely to encounter, and that that's having an impact on human health.

It also has become a much more relevant topic to a lot of people who work in the area of say, antibiotic resistance. Because the way that animal agriculture has historically been done in the United States, which is very large numbers of animals requiring a lot of management and part of that management has been the use of antibiotics. Those antibiotics, as it turns out, as you use them, we know this happens in humans, you use an antibiotic, usually at a low level or for too long and see target of that bacteria becomes resistant. We know now that that happens in animals as well. And because we are closely related to the animals, and because we share the environment, that antibiotic resistance in those bacteria have migrated into some human bacteria. And that is a very real, if so far, largely existential threat to human health.

So, I think that's the other factor that has become much more apparent, there's more evidence for it. We understand the pathways better than we did when we first started seeing it. It's a large and growing problem, not specifically in animal agriculture because of some changes in legislation, but for human health, increasing drug resistance through the use of those drugs has actually become a very large problem for us.

JOHNSON:
What are some of the considerations for launching the One Health approach inside a public health agency, that maybe doesn't have it right now?

SMITH:
Well, I think within your own public health department, especially if you're a SHO, you can be a catalyst for education around One Health. There are probably a lot of people who work for you who have no idea what you're talking about. There are some very engaging opportunities to have either lecturers come in who really know One Health, or there's some great stuff online as well. So, you do have the ability to start educating both yourself obviously, first, and your staff.

Then, I think the most important thing that a leader can do is to reach out to your counterparts in other departments and really sort of reach out and say, hey, you don't have to use you know, some places like to adopt names for things like One Health and other places sort of resist that. But reaching out to the people with whom you share a potential issue or with whom you clearly are related, given that environment, humans, and animals, we all live together, and we all share our diseases, et cetera. And so it's not hard to figure out who are the departments that you should be reaching out to.

Find out who your counterpart is, have a conversation. Try to have regular conversations, that's the first step to actually being able to do something that's a little more permanent, like create a council or a working group or whatever that is. And then from there, getting that actually, that group as a whole can actually start to really plan together. You don't have to have a lot of money to do that. What you need to have are willing people at the table, and the right people at the table.

JOHNSON:
So, it sounds like it really depends mostly on things like collaboration and cooperation and discussion, versus needing to go out and convince a legislature to give you 50 million dollars.

SMITH:
I think that's largely true. Once you do have a group of people who are really interested in working on this together over time and maximizing those relationships, then you can think about doing things like creating a standing body that also includes, for example, your academic partners, that can then become an entity that is actually part of the response to an activity when it comes up. Because one of the challenges that we have is when something happens, it always happens in a local area. It doesn't happen statewide typically. The information doesn't necessarily get to everyone who could help, either help with knowledge, help with actual response activities, etc.

I will give you a really concrete example. We had a rabid fox in Sonoma County that was acting very aggressively. It took several days for, it was in a state park, so it's occurring on land that's not controlled by the county or by the local government. And so, it took us several days for the information about this fox and these potential exposures to actually get to public health. And it's our job to make sure that every single person who was exposed to that fox, has been evaluated and got on to rabies prophylaxis. That's in a very small area of a single episode. Imagine when it's something much larger than that.

That's the concern that comes up when you're not all working together. Making sure that all the parties who have a role to play actually know who the others are, and know how to get in touch with them, and when they should get in touch with them. That's the magic that happens when you create a formal infrastructure to work together.

JOHNSON:
What are some of the pitfalls or things to be aware of, or to be on guard against, if you're thinking of pursuing this approach?

SMITH:
Well, there's always whenever you're pursuing something new, a new way of doing business, a new way of thinking about something, there's a lot of resistance in government, mostly because everybody's maxed out doing what they currently have to do. So, I think having a good understanding yourself, about why you want to do this and why you want to engage in a conversation with those folks, is really important before you start to do that.

And then not necessarily requiring that everybody be as enthusiastic as you are, but rather starting small with conversation about "hey, so I've been thinking about this thing, has this come up in your arena? You know, what do you think?" So, small conversations can lead to much better, closer relationships to begin with. As opposed to, there are places where, you know, if you have a governor who's really interested in a One Health approach, they can call together all the right people and they can say, "you all will do this." But, when you're starting from, you know, you're kind of leading from the middle, figuring out who should be at the table and then inviting them, even if it's one on one, "can we have coffee? Or can we just have a quick zoom?" Depending on how you all work, can go a long way to being successful when you do finally try to bring everybody together.

JOHNSON:
So that leads to the last question, thinking about a call to action. What are the stakes involved?

SMITH:
Well, I think the stakes, in terms of if we just think about the risks to human health from what's happening in the environment, how that's going to impact what's happening in animal agriculture, and how that relates to human health are profound. Even leaving aside sort of the scary monster of pandemics or other sorts of emergencies, that climate is continuing to change. That is going to have profound impacts, not just on agriculture, not just on animals, but also on humans. If we aren't looking at the whole picture, we may be designing things to sort of prepare for climate change that aren't taking into account those other areas that are being impacted.

None of us exist separate from our environment, or separate from the other things that live in that environment. So really having at least some level of comprehensive overview within the world of public health can help us be a voice for some of those unanticipated consequences for changes that we may be making.

JOHNSON:
J.J. Jones grew up on a ranch in western Kansas. Today, he leads the National Institute for Animal agriculture in Kansas City, Missouri. His members work to ensure the safety and quality of the food system, a job he says is closely aligned with public health.

JONES:
It is. Obviously we view the food system as a very strong part of public health, whether it's the actual nutrients that people are consuming, or obviously looking at other areas like food safety. So, is there a bacterial contamination that either occurs naturally in nature or is there something that we need to do as farmers and ranchers and veterinarians to combat bacterial or viral infections. Or are there zoonotic diseases that, yes, affect animals, but also affect humans.

So, I would say that public health is a primary focus of animal agriculture just as much as animal husbandry because we want to make sure that those who consume meat, milk, eggs, and other animal derived proteins can do it safely and nutritionally.

JOHNSON:
Understanding that connection, does the work that you do engage the One Health approach?

JONES:
It very much does. In fact, in multiple spaces, we look at a One Health approach. Most directly, the council that has really championed a One Health approach is the NIAA Antibiotics Council. Back in 2011, they first started having conversations around antimicrobial stewardship and resistance, primarily in the animal health space. But because of that one health focus, quickly realized it also needed and must include public health officials, environmental health officials, others in the One Health conversation to look at not only antimicrobial stewardship and resistance, but other factors as well that we would deem One Health.

JOHNSON:
How does your organization interact with public health agencies? Do you help them understand or adopt One Health concepts?

JONES:
The National Institute for Animal Agriculture definitely engages with public health agencies or others who are looking at one health topics. You know, for example, it was early on in the antibiotics council's work that they fostered a relationship with leaders at the Centers for Disease Control and Prevention. As one might imagine coming from the National Institute for Animal Health, our initial interactions were primarily with veterinarians or others who had an animal agriculture background. However, we realized that very quickly and still to this day, that we can all learn from each other. So, we need to engage also with other researchers, whether they have a microbiology background, or a human medicine, or a pharmacology background, etc. And so really, that's how we do engage is one, to make sure they have the knowledge and updates on what's happening in the animal health space.

JOHNSON:
Thinking about AMR or antimicrobial resistance, do you find that most departments are making the agriculture connection that they're considering the agriculture angle? Or is that still an emerging process?

JONES:
I would say it's a yes, and in terms of obviously, we appreciate that when it comes to AMR, it's not just a animal agriculture, or crop agriculture, or public health, or wildlife or or conversation, it's all of the above.

However, I would say sometimes, and this is human nature, we want to be able to point to one sector and say, "if this sector does x, or if this sector would do y, problem solved," and I'm, you know, dusting my hands off as if it's finished. However, if we truly sit back and think about it, especially whether we're a trained scientist, or we just harken back to our first biology course, maybe in junior high or high school, we realize that AMR is part of the evolutionary process.

Just as humans want to survive, bacteria and bugs want to survive, so they're going to fight for survival. It's not just going to be if this group would do x, or that group would do y, we're going to be done with it. And so that, to me, is why it is so important for all of us to work together and fully appreciate what we're each doing in this space so that we can learn from one another, we can build upon each other's key learnings, and research, and insights.

JOHNSON:
I assume that you'd like to see more agencies adopt the One Health approach in the name of trying to avoid these outbreaks in the future.

JONES:
I couldn't agree more. And I'm smiling as you were sharing the that question and those thoughts, because it reminds me of an LA Times article back in 2010, where it talked about a much needed conversation around food. Wasn't a conversation yet, it was two deeply divided groups yelling across one another and it pointed out we can have conversations around conventional or organic production practices, we can have conversations around how livestock should be housed, or how they should be fed, or treated when they become sick or ill.

And the same is true on the human health side. We can have conversations around what diet is right for people, or what foods should or should not be consumed at different levels, etc, etc. But again, instead of us yelling past one another or trying to articulate why we are maybe, quote unquote, right or someone else is wrong, it's always much better to sit down and have a conversation and identify those shared values and how we collectively move forward.

All the research and latest modeling I've seen has demonstrated that whether it's the effects of climate change, whether that's naturally occurring or man contributed towards or cause, whether it's zoonotic diseases and the interaction between humans and wildlife, or humans and domestic animals, we are going to see an uptick in zoonotic diseases and disease outbreaks. And so it's more imperative now, maybe than ever before, that we do engage with one another across different sectors or disciplines in a One Health approach.

JOHNSON:
If an agency wants to do more on this topic, can they connect with you? Are you able to help them with that?

JONES:
Sure, we would love to connect with any public health officials that want to learn more about animal agriculture, whether it's around antibiotic use and stewardship or a variety of other factors. The main ways we do that are one, we have our website, animal agriculture dot O-R-G. We have many of our white papers and proceedings from various events. So for example, we're getting ready to host the 13th annual NIAA Antibiotic Symposium. But the previous 12 white papers are up there. Folks can engage with those by downloading and reviewing them.

We also do host not only our annual antibiotic symposium, but we have an annual conference and many other convenings throughout the year that we keep posted up on our website and through our email distribution list. And then, I would invite them to follow up with me. I can provide you my contact information for the show notes, where people can email me and we actually host on the farm, or on veterinary, or in clinic experiences, where we invite animal health and public health officials to come together and learn in an experiential way.

JOHNSON:
Thank you for listening to Public Health Review.

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This podcast is a production of the Association of State and Territorial Health Officials.

For Public Health Review, I'm Robert Johnson. Be well.