The role of the veterinarian in the One Health movement

One Health, the global initiative to achieve optimal health for people, animals and the environment, is more important than ever. Experts estimate that more than two-thirds of emerging and re-emerging infectious diseases are vector-borne or zoonotic, and that most of these zoonoses come from wild animals.1.2

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There is no doubt that this collaborative, all-species approach to healthcare has grown exponentially over the past 2 decades, but there is still a long way to go for full acceptance and application. Audrey Ruple, DVM, MS, PhD, DACVPM, MRCVS, assistant professor of One Health Epidemiology at Purdue University College of Veterinary Medicine in West Lafayette, Indiana, spoke with American vet® about this important healthcare initiative and how it is incumbent on veterinarians – who by the nature of their work play an important role in human and animal health – to advance the cause.

Do vets think about One Health as much as they should?

Audrey Ruple, DVM, MS, PhD, DACVPM, MRCVS: The One Health mindset is inherent in the profession of veterinarian. I believe all vets are One Health practitioners, trained to see the whole world through a One Health lens, but some vets may not be aware that this is their perspective. Veterinarians are an integral part of the One Health movement, and we are seeing a shift in how other healthcare professionals recognize our value as a member of the wider medical community, which I like to think of as a puzzle with many interlocking pieces. Veterinarians have a lot of this One Health puzzle that doctors don’t, because doctors aren’t routinely trained in zoonotic diseases the same way veterinarians are.

How can vets get the word out to doctors?

When I do One Health talks for vets and ask if people have heard of One Health, almost everyone raises their hand. When I ask the same question in a room full of doctors, hardly anyone has ever heard of One Health. It’s a message that our profession has done a very good job of communicating to each other, but we haven’t been as good at getting the word out outside of our profession. I think many vets see themselves as working in a silo rather than seeing how their work fits together with the rest of the puzzle.

To get the message across, we should talk to our counterparts in human medicine as equal partners in health care. We should say, “Here’s the whole healthcare landscape – here’s this piece you have, and here’s this piece we have, let’s work together to see how they fit together.” We have great examples over the past decades where we have built high performing teams of One Health practitioners: physicians and DVMs with different specialties like oncology, toxicology and virology. When we get a whole team together, we can solve the puzzle faster than any of us could do it alone.

Lyme disease and other vector-borne illnesses are prime examples of this, as the geographic ranges of the vectors change. Let’s say you see the incidence of Lyme disease increasing in your area of ​​practice. Do you keep this information in your silo or do you share it with other healthcare professionals in your area, either by contacting doctors directly or by going to the local health department? Missing this opportunity to work with other medical professionals can have real consequences, as doctors may not have Lyme disease on their differential list if they are not yet aware of its spread in the area. In a sense, animals can serve as sentinels of the spread of disease to humans, and it’s part of our job to make sure the right alarm bells are ringing on the human side of healthcare to ensure that diagnoses specific are posed in the human population in the region.

Are some medical specialties more in tune with One Health than others?

Obviously, any veterinarian working with zoonotic diseases is very sensitive to the overlap between human health and animal health, but oncology is one specialty that has truly embraced the One Health approach. In this field, the canine spontaneous tumor model is gaining ground as a model for human health because many cancers are molecularly identical between the 2 species. This allows us to leverage data from one species to help the other and vice versa. By using data from both dogs and humans, we can get a full picture of what is happening in terms of the prevention and treatment of many cancers.

The One Health approach has been adopted by the National Institutes of Health, which has created a comparative oncology program that studies cancers in dogs as models for human health.3 Another example of this is Stephen Withrow, DVM, DACVS, DACVIM (oncology), surgical oncologist and retired founding director of Colorado State University Flint Animal Cancer Center, who pioneered a treatment for canine patients with a bone cancer in which the diseased area of ​​bone is replaced by healthy bone. This was developed alongside human limb-sparing techniques, and the procedure is now used nationwide to prevent amputation in dogs and children diagnosed with osteosarcoma.4

How do zoos work with public health professionals to address conservation and public health issues?

Zoos have become increasingly active in conservation measures as well as research and education, almost all of which involve the One Health perspective. The St. Louis Zoo, for example, demonstrated how zoos can partner with schools of public health to create a learning environment in which students integrate their knowledge of public health into the environmental and animal health model provided. by zoological societies. The zoo’s partnership with the University of Missouri-Columbia School of Public Health has led to collaborations in which human health outcomes associated with visiting the zoo are examined. Through this collaboration, they noted health outcomes such as lower blood pressure and reduced stress in humans after a visit to the zoo.5 The zoo has also carried out projects in Africa and on the Galapagos Islands.5 This approach provides a One Health educational experience for students of public health, veterinary medicine, human medicine and environmental health.

If not, how can vets get involved, or become more involved, in One Health?

Veterinarians must recognize that they own part of the One Health landscape. There is a large piece of this puzzle that is entirely ours, and no other healthcare professional can do what we do. We also need to do a better job of communicating what we are already doing in One Health. We need to keep being active, showing up and speaking the One Health language, because the importance of the communication part cannot be underestimated. We need to make our voice heard as a profession because we are not doing a very good job in this area. If people don’t know what we do and how important our piece of the puzzle is, how can we complain when they don’t take us seriously as healthcare professionals?

I think there are still opportunities in veterinary medicine that we haven’t created yet. It’s going to take one person – and it often literally comes down to one individual – who says, “I see a gap here and I’m passionate about this and I’m going to find a way to bridge this gap for the betterment of humans and animals.” I believe a lot of progress in terms of One Health is going to happen at the local level. It’s going to happen at the local level where individuals are willing to dig in and do the work to create a healthier society. At the local level nationally, we need to do a better job of representing what we do not only at veterinary conferences but also at medical conferences, we need to come to the table as their equals, their peers.

Research has shown that 50% of physicians acknowledge that they know nothing about zoonotic diseases or are uncomfortable with their knowledge of zoonotic diseases.6 These same doctors also recognize that veterinarians are the best sources of information about zoonotic diseases. So while some doctors will be hesitant to consider us their peers, there are others who will walk us to the table and work together to solve major health problems for all species. We’ll never know how much support we’ll get on this One Health journey until we start showing up regularly and talking about our own piece of the puzzle.

References:

  • Frank D. One world, one health, one medicine. Can Vet J. 2008;49(11):1063-1065.
  • One Health Initiative will bring together human and veterinary medicine [home page]. One Health Initiative website. onehealthinitiative.com. Accessed February 28, 2018.
  • Comparative oncology program. National Cancer Institute Cancer Research Center website. ccr.cancer.gov/Comparative-Oncology-Program. Accessed February 27, 2018
  • Dr. Stephen Withrow receives lifetime achievement award. Colorado State University College of Veterinary Medicine and Biomedical Sciences website. csu-cvmbs.colostate.edu/Pages/withrow-stephen-lifetime-award.aspx. Published February 2011. Accessed February 28, 2018.
  • Robinette C, Saffran L, Ruple A, Deem SL. Zoos and public health: a partnership at the border One Health. One health.2016;3:1-4. doi:10.1016/j.onehlt.2016.11.003.
  • Kersting AL, Medeiros LC, LeJeune JT. Zoonoses and the role of physicians in educating agricultural patients. J Agromedicine.2009;14(3):306-311. doi: 10.1080/10599240903058160.

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