Build the world we want: A healthy future for all

Shobha Shukla *

So goes the theme of this year's (2022) Universal Health Coverage Day. Air to breathe, water to drink and food to eat are the three basic necessities to sustain life. But the poor quality of any of these can lead to unhealthy outcomes, which we are seeing in today's world in the form of a plethora of air, water and food borne illnesses.

Destruction of biodiversity by humans is also creating conditions that abet the spread of new diseases. Logging, mining, deforestation, road construction, all bring people into closer contact with animal species. Data show that an estimated 75% of the emerging infectious diseases in humans have an animal origin, triggered by viruses or bacteria.

Then again, processed or unprocessed plant based foods like fruits, vegetables, etc are also carriers of food borne illnesses caused by pathogens, pesticides, or harmful toxins. And let us not forget that air pollution, that is closely linked to the earth's environment, is killing 6.7 million humans prematurely every year (due to ischaemic heart disease, stroke, chronic obstructive pulmonary disease and lung cancer).

All this points to the fact that the health of human beings is impacted by the health of animals and agricultural produce, while all three are impacted by the health of our environment. Many of us live in close proximity to animals - be they pets or farm animals- and we consume a variety of plant/animal based foods, including seafood. No wonder, our health is bound to be affected by the microbes present in them and/or the toxins and chemicals that contaminate them.

Gyanendra Gongal, Senior Public Health Officer at The World Health Organization (WHO)'s regional office for Southeast Asia, rightly says that "There are increasing health risks from zoonotic diseases and pandemics, food safety hazards, antimicrobial resistance, and ecosystem degradation that jeopardise human, animal and environmental health and well being, with lasting implications on health and food security."

He was speaking at the online National media workshop on 'Applying One Health Approach in Reporting on Health and Development Issues' held recently in Bali, Indonesia, just prior to the 7th Asia Pacific Summit of Mayors (APCAT 2022 - hosted by the Asia Pacific Cities Alliance for Health and Development - APCAT along with partners).

The One Health strategy connects human, animal, plant and environment health. It is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants, and the environment are closely linked and inter-dependent. It thus enables multi-sectoral and multidisciplinary collaborations between human health, animal husbandry, and agriculture and climate change mitigation sectors to provide effective interventions at local, sub-national, country and global level to achieve the best health outcomes for the people, plants, animals, and the environment.

Sharing his country's response to One Health, Professor Dr Dante Saksono Harbuwono, Deputy Minister of Health of Indonesia said, "In Indonesia, the implementation of One Health Approach was strengthened by the issuance of a Presidential Instruction No.4/2019, which governs the national and sub-national institutions, including the cabinet ministers, governors, and mayors/sub-national leaders all over the country. The government has also set up the National Action Plan for Health Security for the period 2020-2024 to strengthen Communication, Coordination and Collaboration and Implementation of One Health Approach. One Health was also on the agenda of the recent G20 Summit that took place in Bali, Indonesia".

He emphasised upon the important role of the mayors and other sub-national leaders/officials in planning for development of community health status and well being.

"By strengthening communications, coordination and collaboration among human, animal and health experts we will be in a better position to put in place the preparedness, prevention, and response mechanism to deal with public health threats and crises and achieve better health resilience" he said.

While acknowledging that the risk of the animal-human interface is increasing due to environmental degradation, rapid urbanization and international travel and trade, Prof Tjandra Yoga Aditama, Senior Advisor at APCAT, was positive that all of us (humans, animals, plants, ecosystems) can coexist through the One Health approach.

Noting that "we already have the 'One Health Joint Plan of Action' developed by the 4 global agencies that have united to address antimicrobial resistance (these 4 agencies include: WHO, Food and Agriculture Organization of the United Nations (FAO), United Nations Environment Programme (UNEP), and World Organisation for Animal Health (WOAH)." The G20 Lombok One Health Policy Brief was recently delivered by the G20 Health Ministers, during a side event of the G20 meet held in Indonesia, he said: "These are grand concepts that must be translated into workable and implementable local policies. Local policies have significant and direct impacts on people. Media, civil society, academia, as well as the governments must work together to solve problems within the One Health Approach Framework."

Impact of climate change

Gongal rightly points out that climate change is a driver for emerging risks in food safety. "Its impact is more evident in food borne pathogens with low infective doses. The production of mycotoxins and bio toxins may be affected by temperature and moisture conditions. Extreme weather conditions also create stress in plants and pests. Thus changes in plant pests are expected, leading to increasing use of pesticides. Indiscriminate use of veterinary medicines in farm animals is leading to antimicrobial resistance creating resistant pathogens."

"Globalisation of food trade, changing food habits and intensification of food production is leading to the spread of human health conditions. Unhealthy agricultural practices, as well as vehicular emissions during transportation, contaminate the crops, livestock, and seafood. We need a holistic approach when we talk of from farm to fork. We cannot compromise on food safety in the name of food security", says Gongal.

One Health approach to curb antimicrobial resistance

Adopting a One Health approach is critical to not only prevent outbreaks of zoonotic and emerging infectious diseases, but to also address other urgent environmental issues including antimicrobial resistance.

Antimicrobial resistance is a global health concern with 1.27 million deaths in 2019 directly attributed to antimicrobial resistance and it may become the leading cause of deaths globally by 2050. Antimicrobial resistance occurs when microbes like bacteria, viruses, fungi and parasites develop the ability to defeat the drugs used to kill them, thus rendering many diseases untreatable or difficult to treat.

Although antimicrobial resistance occurs naturally, it is facilitated by the irresponsible and excessive use of antimicrobials in human health, food-animal production and agriculture, as well as poor waste management. As antimicrobial resistance depends greatly on the interaction between humans, animals and the environment, it is logical to adopt a One Health approach for developing appropriate inter-sectoral collaborative responses to combat antimicrobial resistance to achieve better public health outcomes.

"a healthy city is a resilient city"

"Healthy city is a resilient city," said Dr Tara Singh Bam, Regional Director for Asia Pacific, International Union Against Tuberculosis and Lung Disease (The Union). "Along with stronger policies and effective implementation of tobacco control and disease-specific programmes for NCDs and TB, we need to transition towards One Health approach."

The only way to prevent future epidemics and pandemics is to view human, animal, plant and environmental health as one unit, as is envisaged in the One Health concept. Then again, Global health security and universal health coverage are key to a healthier and safer world. Strengthening the health systems, empowering people and communities, providing universal access to quality health services, and implementing the "One Health" strategy through a multi-sectoral approach will help countries to realize both universal health coverage and global health security, to 'Build the world we want: A healthy future for all'.