From We to One: Trans-disciplinary approaches to transform Global Health

  GLOBAL HEALTH WRITES

Citizen Journalist & Editor: Bianca van Bavel

Globally, most emerging diseases and persisting infections are zoonoses transmitted from animals to humans. Their origins are associated with societal and cultural adaptations over tens of thousands of years, such as the introduction of agriculture, transforming the way humans, environments, pathogens, and animals interact.  A trans-disciplinary approach, combining both biomedical and social science, may be the only way to control resilient zoonoses that affect humans.

With current global pressures of migration, trade, urbanization, and environmental collapse, centuries of pathogenic exposures are culminating in unforeseen ways.  In recent news, the Ebola outbreak in Western Africa illustrates how (re)-emerging zoonotic pathogens with epidemic potential can impact on human, animal, and environmental health.  The epidemiological complexity and variability of zoonoses means that mitigating risk, reducing burden, and improving health outcomes require a One-Health collaborative trans-disciplinary approach.  The UN tripartite partnership between the World Health Organization, the World Organisation for Animal Health, and the Food and Agriculture Organization (WHO, OIE, FAO) exemplifies one of the strategies to address diseases at the human-animal-ecosystem interface.

Recently, I attended the 2^nd meeting of the European Leptospirosis Society (ELS) in Amsterdam.  The conference presented a broad range of research, focusing on developments at the vanguard of leptospirosis and other rodent borne haemorrhagic fevers.  Leptospirosis is a complex bacterial disease transmitted through the urine of infected animals, either directly to other animal and human hosts or into the environment via the contamination water and soil.

Given its world-wide distribution and ‘hotspots’ of epidemic potential, leptospirosis is now recognized as a disease of global importance.  However, there is still much to be discovered about the disease and its mediating factors through the integrated knowledge of social, environmental, and biological determinants.  Yet, even with the elaborate range of presentations covering everything from pathophysiology, clinical, molecular and diagnostic, to veterinary, epidemiological and ecological aspects of the disease, there was a stark absence of social science perspectives.

Since its establishment in 2010, the Global Leptospirosis Environmental Action Network (GLEAN) is charged with directing and coordinating research on leptospirosis into interventions and policies to protect affected communities.  The Network’s priorities for action include: urban leptospirosis outbreaks linked with natural catastrophes, limitations and inconsistencies in reporting, and the inclusion of missing expertise and additional disciplinary collaborations – such as social sciences.

To address these identified gaps in knowledge and research, four Working Groups—Prediction; Prevention; Detection; Intervention—were established as part of a work plan ending in 2016.  Within each working group the importance of combining diverse knowledge and inter-sectoral support is crucial. An understanding of the social and cultural factors that influence individual and community-level decision-making is essential for attitude and behavioural change. There also needs to be better awareness of transmission risk.  In these instances, the combined expertise offered by social scientists—anthropologists, psychologists, economists, geographers, political scientists, lawyers, and sociologists—is key to translating some of the complex clinical rhetoric of healthcare practitioners and the molecular lab-based research of life scientists.

Is it too much to think that a better understanding of the social, political and economic determinants of population health could complement biomedical interpretations of the infection? Research from the Natural Resources Institute at the University of Greenwich demonstrates the need to integrate knowledge from social anthropology and rodent biology for the design of ecologically-based, sustainable pest management solutions.

Other trans-sectoral approaches include systemic assessments of the interactions between water and disease, such as: testing wildlife, livestock, and water sources for the presence of pathogens; environmental monitoring of water quality, water use, and land use.  The effects of existing waste disposal infrastructure, drainage systems, seasonal trends, as well as variance in temporal, spatial and demographic patterns, can increase exposure to bacterial agents.  Targeted advocacy can be leveraged to inform social policies and public health agendas to improve sanitation networks, domestic environments, as well as general access to diagnostics and treatment.

In a break following the ELS member meeting, there was a discussion around the absence of political will and advocacy in the field of leptospirosis.  While some scientists are beginning to recognise the need to bring these issues outside the lab and translate their research into action through policy development, we still need a sustainable, long-term political commitment that will help to coordinate concerns and manage impacts of diseases at the human-animal-environment interface.

Despite prioritising the inclusion of ‘missing expertise’ and ‘additional disciplines’, the question of how to traverse these ‘gaps’ and realise integration—say of anthropologists in a field heavily dominated by bacteriologists and bio-medics—remains a challenge.  In the interest of collaboration, it is not unrealistic to think that the solution lies outside of the comfort of our own silos.

It is the apparent failure to first recognise, and then adapt to, the need for trans-disciplinary One Health approach that ultimately requires bridging the conceptual, theoretical and methodological differences between disciplines.  A lack of coordination and dialogue between disciplines limits the progress of disease prediction, prevention, detection, and intervention.  Surely, the potential public health benefits that will result from integrating human, animal and environmental foci into one are greater than if we continued to work in isolation.  While there are certainly raw benefits of independent expertise, true trans-disciplinary collaboration provides a means to optimize the significance of our work, together.  Only by doing this are we able to control resilient diseases like leptospirosis.

Bianca van Bavel holds an MSc in Global Health and has carried out research in Indonesia on the social and environmental determinants of Leptospirosis.  While advocating for a holistic One Health and systems approach to global health research and practice, she is an Intern with the IFGH and editor of their Global Health Writes initiative. 

Email: bianca@globalhealth.ie

Photo Credits: North Carolina State University College of Veterinary Medicine & Jiajing Li, University of California Berkley School of Public Health

This article was brought to you by the IFGH Global Health Miles Programme.  It is also just one of the many great pieces in our growing library of Global Health Writes articles from our ever-expanding team of IFGH Citizen Journalists.