One health: A conceppt KAHN_OHC_2016.ppt

21st century

1. One Health: A Concept
for the 21
st
Century
Laura H Kahn, MD, MPH, MPP, FACP
Program on Science and Global Security
Woodrow Wilson School of Public and
International Affairs
Princeton University

2. 
What is One Health?

The concept: human health is
inextricably linked with animal and
environmental health.

One Health seeks to increase
communication and collaboration
between human, animal, environmental
health professionals.
www.onehealthinitiative.com

3. Why One Health?

Zoonotic disease risks from
wildlife, livestock, and pets.

Over 75% of emerging infectious
diseases are zoonotic

60% of human pathogens are zoonotic.

Most agents of bioterrorism are
zoonotic.

Beyond zoonoses: Disease processes
across species are shared.

4. The Price of
Agriculture and
Domestication of
Animals

Agriculture about 10,000
years ago.

Agriculture (aka food
security) is foundation of
civilization.
http://www.nature.com/nature/journal/v447/n7142/full/nature05775.html

5. Why is food security
so important?

Agriculture and food security (a.k.a. preventing
hunger) form the foundation of civilization.

Food security is inextricably linked with global
health, global sustainability, and international
security.

There is no global health without global food
security.

Many diseases (i.e. Ebola, Zika, Chikungunya, SARS,
Nipah, etc.) are emerging and spreading because of
widespread deforestation, environmental
degradation, and bushmeat consumption—linked to
food security.

Global climate change affects food security.

6. https://commons.wikimedia.org/wiki/File:All_palaeotemps.png
http://gergs.net/2015/06/updating-the-geological-temperature-plot/all_palaeotemps/
Time of Complex Life on Earth
Cambrian Explosion: Thriving life in seas but barren land
Earth is 4.5 Billion Years Old
Early hominids
Paleozoic Era
Permian-Triassic Extinction
Cenozoic Era

7. http://newsarchive.medill.northwestern.edu/chicago/news-229454.html
Diminishing Water
Supplies in U.S.
https://stateimpact.npr.org/texas/2014/05/06/more-drought-heat-and-water-wars-what-climate-change-already-means-for-texas/

8. Price of Agriculture

Measles (Rinderpest) Cattle

BrucellosisGoats/Sheep

Q feverGoats/Sheep

Tularemia Rabbit/Squirrels

BSECattle
http://www.nhbs.com/beasts_of_the_earth_tefno_141345.html

9. Went both ways…

Mycobacterium tuberculosis appeared
about 40,000 years ago, coincided
with human migration out of Africa.

Two main lineages 20-30,000 years
ago: 2
nd
lineage associated with
animals.

Humans probably infected livestock.
http://www.plospathogens.org/article/info%3Adoi
%2F10.1371%2Fjournal.ppat.1000160

10. Hippocrates (ca. 460 BCE--ca.
370 BCE)
Recognized the
link between
human health and
the environment.
Malaria=“mal” +
“aria.”

11. Middle Ages (14
th

Century): Black Death
Bacteria: Yersinia pestis
Spread by fleas
carried by rats

12. Some of the greatest discoveries in
the history
of medicine and public health were
made at the
intersection between human and animal
health.
Beginning in the 18
th

century…

13. 18
th
Century:
Vaccination against
smallpox
Dr. Edward Jenner vaccinating 8 yr old boy
“Vacca”
is
Latin
word
for cow.

14. Opposition to
Vaccination

15. 19
th
Century:
Germ Theory of Disease

Louis Pasteur,
French chemist
studied chicken
cholera

Robert Koch,
German
physician
studied anthrax

16. Additional 19
th
Century
Developments

Rudolf Virchow
(1821-1902), a
German physician and
pathologist said,
“between animal and
human medicine there
are no dividing
lines--nor should
there be.”

Coined term
“zoonosis”

17. Early Meat Inspection
Programs Improved Food
Safety
Virchow’s father
was a butcher.
Animal experiments
on life cycle of
Trichinella
spiralis in
porcine muscular
tissue.
Studied
cysticercosis and
tuberculosis in
cattle.

18. 19
th
Century
Developments
Sir William Osler
received his medical
degree from McGill
University, Canada
Went to Berlin to
work with Virchow
Returned to Canada
in 1874
Est. veterinary
pathology as an
academic discipline
in North America

19. 19
th
Century Discovery:
Diseases can be transmitted
by arthropods
Theobald Smith, MD
(pictured) and F.L.
Kilbourne, DVM
discovered cause of
cattle fever
Babesia bigemina
transmitted by the
cattle tick.

Set the stage for
Walter Reed and
colleagues’ discovery
that mosquitoes
transmit yellow fever.

20. 20th Century
Developments

Scientific knowledge exploded

Medicine became increasingly
specialized

Medicine and veterinary
medicine diverged

21. Emergence of new
infectious diseases in
20
th
century

22. Why are these diseases
emerging?

Increasing global population
pressures

Deforestation and
environmental destruction

Intensive agriculture

Global trade and travel

Climate change

23. 1999 West Nile Virus
Outbreak in NYC

24. Two Simultaneous
Outbreaks

25. Solving the Mystery
Dr. Tracey McNamara, Chief
Veterinary
Pathologist, Bronx Zoo
Birds native to North
America

26. Challenges of the 21
st

century

Requires a new paradigm, One
Health:

Zoonotic diseases

Cancer

Cardiovascular Diseases

Metabolic Diseases

Neurological Diseases

Degenerative Diseases and Injuries

And others…

27. Humans and Animals Get the Same
Diseases: New Therapeutic
Discoveries Can Benefit All
Species

28. Human and Animal Health:
A Symbiotic Relationship

Pets, Livestock, Wildlife

Benefits our physical health

Benefits our mental health

Benefits our social health

Benefits our environmental
health

29. Pets

30. Livestock

31. Wildlife

32. Physical Health

Owning a pet improves human
health.

But risks must be
acknowledged and addressed.

33. Pets

American Pet Products Association
2013-2014 Owners Survey:

68% of U.S. households own a pet

Approx. 82.5 million homes

56.7 million households own a dog

45.3 million households own a cat

In 2013, est. $55.53 billion spent
on pets in U.S.
http://www.americanpetproducts.org/press_industrytrends.asp

34. Physical Health
Benefits

Lower high blood pressure

Reduces risk of allergies in
children

Increases exercise motivation
http://www.cdc.gov/healthypets/health_benefits.htm

35. University of Missouri Human-Animal
Center Established a Walk a Hound,
Lose a Pound Program
http://cvm.missouri.edu/News/walkahound.htm
Eric and Peety video: https://www.youtube.com/watch?v=Rm0qYRWQpZI

36. Dog Walking

37. Risks of Pet Ownership:
Microbes are shared
New York Times, September 21, 2009
“Tie to pets has germ jumping to and fro ”
Methicillin Resistant Staph aureus (MRSA)
is infecting both humans and animals.
Dr. Elizabeth A. Scott
et al.
swabbed household
surfaces
at 35 randomly
selected addresses.
Nearly half of homes
had MRSA on surfaces.
Cat owners were 8
times more likely than
others to have MRSA at
home.
American Journal Infection Control Aug. 2009: 37:
447-453

38. Zoonotic diseases and
pets

Some people are at greater
risk:

Chronically immunosuppresed

HIV/AIDS

Organ transplant recipients

People with autoimmune diseases

Pregnant women

Infants and very young children
http://www.cdc.gov/healthypets/extra_risk.htm

39. Grant and Olsen Study,
1999

Grant and Olsen, EID, “Preventing zoonotic
diseases in immunocompromised persons. ”

Surveyed MDs and DVMs in Wisconsin

MDs generally not comfortable discussing role
of animals in zoonotic disease transmission.

DVMs typically didn’t know pet owner’s health
status.

Found nearly a complete lack of communication
between MDs and DVMs.

Result: Zoonotic disease risk communication to
patients falls through the cracks.
http://wwwnc.cdc.gov/eid/article/5/1/99-0121_article.htm

40. Grant and Olsen Study,
1999

MDs and DVMs asked to rank animals
posing greatest risk to
immunocompromised patients.

DVMS: ranked reptiles (Salmonella)
and puppies (Campylobacter)

MDs: ranked cats and kittens

Both groups ranked Salmonella and
Toxoplasma gondii as microbes of
greatest risk.

41. Risks of Pet Ownership
for Immunosuppressed

Reptiles carry Salmonella in their
guts.

In U.S., exposure to these animals
leads to 100,000 cases of reptile-
associated salmonellosis each year.

Reptiles are popular pets: In 2001,
estimated households with reptiles—
1.7 million
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5249a
3.htm

42. Risks of Exotic Pet
Ownership

43. Monkeypox Outbreak
2003

Orthopoxvirus group: Includes smallpox,
cowpox, and other pox viruses.

Viral disease found mostly in rainforest
countries of Central and West Africa.

Called “monkeypox” because first
identified in lab monkeys in 1958.

Natural host may be African squirrel

Shipment of rodents from Africa to U.S.
set off Midwest outbreak requiring
smallpox vaccinations to stop it.

44. Root Cause of Outbreak:
People buying wild exotic
animals as pets
Giant Gambian Rat
Dormice
Striped Mice
Tree Squirrel
Brushtail Porcupines
April 9, 2003:
Shipment of 800 small mammals
from Ghana
(including 762 African rodents)
arrived in Texas.

45. Monkeypox
Chain of Transmission
Giant Gambian Rat Prairie Dog Human
35 laboratory confirmed cases.
28 adults and 2 children in 6 states
received the smallpox vaccine to
prevent further monkeypox transmission.

46. Trade in Exotic
Animals

2000 to 2006: 1.5 billion live
wild animals legally imported
into U.S.

Approx. 120,000,000 per year.

90% destined for pet industry.

Minimal surveillance; health
risks unknown.
http://www.plosone.org/article/info%3Adoi
%2F10.1371%2Fjournal.pone.0029505#pone.0029505-
Smith1

47. Some animals simply
shouldn’t be pets
BuyTigers.com
15,000 big cats
and
15,000 primates
in private hands
in U.S.
according to
Humane Society
of US.
400 tigers left
in Sumatra.
Only 18 states
have
outright bans on
exotic animals
as pets. NYTimes
Jan. 10, 2012.
More tigers
are now kept
as pets
in the U.S.
than living
in the wild.

48. Mental Health Benefits

Human-animal bond:

Lower feelings of
loneliness

Reduces depression

32% of dog owners
take their pets
with them when gone
for 2 or more
nights.

Animal-assisted
therapy
Hurricane Katrina
2005

49. Social Health Benefits

For elderly or
people living
alone, pet might
be only family
member.

Increases social
interactions.

Increases sense
of well-being.

50. Social Health Benefits

Animals teach
responsibility
and caring

Animals give
people a sense of
purpose and self
esteem

Animals provide
unconditional
lovePuppies for Prisoners

51. Environmental Health
Benefits
Plants and animals help people
heal
Which scene would you rather look at?

52. Environmental Health
Benefits
Healthy Environment = Healthy People and Animals

53. How can One Health be
promoted?

DVMs are well positioned to promote
One Health.

Establish inter-disciplinary, inter-
species conferences.

Develop collegial relationships with
human and environmental health
professionals.

Educate policy makers and the public
about the importance of One Health.

54. Take Home Messages

Human, animal, and environmental health are linked.

One Health concept provides an important strategy to
improve the lives of all species

Animals suffer from many of the same diseases as
people: new therapies would benefit all species.

Animals (and plants) improve people ’s physical,
mental, social, and environmental health.

A healthy environment benefits everybody.

Animal health professionals should work with human
health professionals to prevent zoonotic disease
transmission, especially in high risk groups, that
rely on pets for mental and social well-being.

55. The One Health
Umbrella

56. One Health
Endorsements

American Medical Association

American Veterinary Medical Association

American Nurses Association

American Association of Medical Colleges

American Association of Veterinary Medical
Colleges

American Society for Microbiology

American Society of Tropical Medicine and Hygiene

Council of State and Territorial Epidemiologists

Association of Schools of Public Health

57. 
Acknowledgements

Collaborators:

Bruce Kaplan DVM, Dipl. AVES (Hon)

Tom Monath MD

Jack Yuill, PhD

Lisa Conti, DVM, MPH
http://www.onehealthinitiative.com

58. Thank you!