Evolution and Expansion of the One Health Approach to Promote Sustainable and Resilient Health and Well-being: A Call to Action

"By increasing community and social engagement and by recognizing and entwining different worldviews, the plurality of disciplines, and traditional and scientific ways of knowing to address community concerns in the contexts in which they exist, we can ensure that One Health remains effective and true to its paradigm in our rapidly changing and complex world."

One Health is a multisectoral, interdisciplinary approach to address complex concerns related to human, animal, plant, and ecosystem health by strengthening trust, collaboration, communication, and coordination. A key tenet of the One Health approach has been inclusion of all relevant stakeholders, from conceptualising and planning through implementation and assessment. Importantly, Indigenous voices are also calling for more authentic inclusion in One Health. This call to action introduces and proposes an evolution and expansion of the current One Health approach across scope, approach, and worldview, to encourage broader engagement with and support for voices and knowledge from diverse contexts.

As outlined here, "limited worldviews and persisting systems of colonialism, discrimination, and oppression perpetuate and widen disparities, sustain community and environmental degradation, drive ecosystem collapse, and harm communities." These limitations also threaten the ability to respond collectively to complex crises with sustained action. The Sustainable Development Goals (SDGs) are offered here as an example of how insufficient recognition of system complexity, as articulated in the frequent focus on achieving a limited number of indicators within one or a few SDGs, is likely to lead to a failure to meet these goals by the 2030 deadline. Broadly, various changes are forcing continual and rapid reconsideration of current practices and opportunities across a range of social and health development activities, including One Health activities.

The authors argue that, to ensure the One Health approach can function effectively within the new global context of converging and escalating health, social, economic, and ecological crises, it must evolve and expand in three overlapping dimensions:

1. Scope: the partners, knowledge, and knowledge systems included - "Currently, all descriptions of the One Health approach include the presumption of inclusivity and refer to including multiple stakeholders and the perspectives and knowledge they bring. However, in practice, this inclusivity tends to refer only to partners within the dominant or mainstream scientific contexts directly related to health. The One Health scope must broaden substantially to include a 'system of systems' and all the associated partners including Indigenous peoples and local communities and other disciplines (e.g., biologic, social, political, economic)....Once identified, existing power imbalances among all the actors must be acknowledged and managed. This will require a continued and intentional focus on justice and equity..."
2. Approach: the techniques, methodologies, and scholarship considered - "One Health approaches must ...move past mainstream scientific linearity and the current focus on a system's individual components. They must instead focus on a system's dynamic processes and interconnections and its functions and purposes....Inclusion of a wider scope of actors and stakeholders' groups would allow target outcomes to include the optimal health and well-being of humans, animals, plants, and ecosystems. In all instances, rather than describing what should be done and by whom for each relevant objective, the systems-focused plan would describe the processes for evaluating the system, deciding what would be done and who to involve, determining if the objectives were being achieved, and making decisions to reevaluate and redirect as needed....Ensuring terminology is clearly defined in context will be critical to effectively conduct and share research and test the application of these concepts within an expanded One Health approach."
3. Worldview inclusivity: the interweaving of other worldviews together with the mainstream scientific worldview - "One Health activities must expand to bridge multiple worldviews. The first step to authentically engaging Indigenous worldviews, for example, would be to eliminate barriers for effective Indigenous leadership and governance and to partner in true collaboration with communities using co-design and co-conception from an activity's inception....A partnership that includes multiple worldviews will need to acknowledge the inherent power dynamics between mainstream, academically generated science and community-driven knowledge systems. Holistically including additional worldviews will require a framework such as 'Two-Eyed Seeing,' championed by Mi'kmaw Elder Dr. Albert Marshal and his wife, which approaches Indigenous knowledge and mainstream science as equals..."

As part of the next iteration of One Health proposed here, the authors urge that "scholarship and methodologies being applied in other fields and contexts to solve complex challenges and manage uncertainty, such as collaborative governance, social-ecologic systems theory, and complexity science, must be recognized and incorporated." In terms of specific ways forward, the author team calls on these methodologists, and on Indigenous experts and traditional knowledge keepers, to move the conversation forward - toward tailored solutions to be explored and co-created with the appropriate scope of partners. "Proactive efforts to understand the complex systems we work in and applying a lens of inclusivity will provide opportunities for improved communication and allow us to access knowledge, experience, and practice currently compartmentalized within sectoral or disciplinary silos that we may not yet have identified."

The authors conclude by encouraging and inviting contributions to the proposed evolution and expansion of One Health. They "hope to build a coalition of individuals, communities, and institutions with diverging perspectives and worldviews who believe that we can and must rapidly and fundamentally change our approach to health, development, and ecology."