Stewardship of health security: The challenges of applying the One Health approach

Date01 February 2019
Published date01 February 2019
AuthorAngkana Sommanustweechai,Krishna Hort,Laurence Gleeson,Wiku Adisasmito
Stewardship of health security: The challenges of applying the
One Health approach
Krishna Hort
|Angkana Sommanustweechai
|Wiku Adisasmito
|Laurence Gleeson
University of Melbourne, Australia
Ministry of Health, Thailand
University of Indonesia, Indonesia
LJG Consulting, Australia
K. Hort, Nossal Institute for Global Health,
Level 5, 333 Exhibition St, University of
Melbourne, Melbourne, VIC 3000, Australia.
Experience with the control of epidemics, notably the 2004 outbreaks of avian influ-
enza, has demonstrated that a One Health approach,that recognizes that human,
animal, and environmental health are interdependent, is the most effective way of
dealing with threats from emerging infectious diseases (EID). However, introducing
and applying a One Health approach is challenging for many countries. One of the
key challenges relates to stewardship.
The evolution of the strategies and policies used to introduce and adopt the One
Health approach in the detection and response to EID over the period 2005 to
2017 is described at global level and in country case studies of Thailand and Indone-
sia. Both countries experienced significant outbreaks of H5N1 avian influenza from
2004 and have sought to adopt the One Health approach in their response strategies.
The challenges for stewardship of health systems in introducing a One Health
approach are described, and key lessons identified in regard to national level agency
coordination, engagement of the broader civil society outside government, and devel-
oping a reliable, credible, and impartial decisionmaking process. The concept of stew-
ardship provides valuable insights for policymakers on how to incorporate a One
Health approach into their EID response systems.
emerging infectious diseases, Indonesia, One Health, stewardship, Thailand
Emerging infectious diseases (EID) and the capacity of health systems
to detect and respond to outbreaks of infectious disease have been
recognized as a key challenge for health systems (Frieden et al.,
2014). This has led to increasing interest in health security and the
responsibility of governments to protect the health and safety of its
people,through the elements of prevention, early detection, and
timely and effective response (Frieden et al., 2014).
Experience of the Ebola outbreak in West Africa in 20142016
demonstrated the risks from the emergence of new infectious dis-
eases that frequently arise from the interaction of humans, animals,
and the environment. Jacobsen et al. (2016) in their review of the les-
sons from the Ebola outbreak identified the need to increase zoonotic
surveillance activities, implement more effective ecological health
interventions, and to support medical and public health systems to
improve local and international responses to epidemics(p. 200).
A One Health approach is increasingly considered to be the most
effective way of managing and addressing EID threats (Degeling et al.,
2015; Vandersmissen & Welburn, 2014). One Health is grounded in
the recognition that human, animal, and environmental health are
interdependent, that animal species provide a shared reservoir for
pathogen exchange and spread, and that many EIDs are driven by var-
ied and dynamic humananimal interactions (Degeling et al., 2015;
Smith, de Hann, Larson, Robles, & Sperling, 2010).
However, implementing a One Health approach requires coordi-
nation and integration of programmes and activities across three sec-
torshuman health, animal health, and the environmentwhich are
traditionally managed separately by different government agencies.
It also requires a decisionmaking approach that extends beyond the
Received: 7 December 2017 Revised: 8 April 2018 Accepted: 10 April 2018
DOI: 10.1002/pad.1826
Public Admin Dev. 2019;39:2333. Copyright © 2018 John Wiley & Sons, 23

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