Examining One Health as a Political Priority
The introduction of the U.S. Senate Bill 2615, Advancing Emergency Preparedness through One Health Act of 2018 in March 2018 has prompted questions about the salience of One Health as a policy issue. The bill has drawn renewed attention to One Health policy, even though the underlying concept of One Health is centuries old (Okello, Gibbs, Vandersmissen, & Welburn 2011).
The timing of the bill is noteworthy since there are increasingly few examples of commitment to One Health by nations “in the absence of a specific disease threat” (Okello, Bardosh, Smith & Welburn 2014, pp. 1). For example, the resurgence of One Health that took place in the 1990s and early 2000s was provoked by a series of health crises, which included avian influenza, severe acute respiratory syndrome (SARS), and West Nile virus (Okello et al. 2011; Gibbs 2014). Crises, however, often provide only short-term opportunities for policy change to take place (Kingdon 1995). Other factors can contribute to an issue resonating with the public and decision-makers, which ultimately affect more enduring policy changes.
Angela Cassidy (2016) has examined the One Health agenda and suggests that the concept is gaining traction. She describes that the One Health agenda has the characteristics of a “scientific bandwagon”, a concept first developed by Joan Fujimura to explain the emergence of the molecular biological approach to the study of cancer in the 1980s. She argues that features of One Health fit with Fujimura’s bandwagon concept, but there are important differences and other factors need to be considered. She suggests that a new type of agenda building mechanism — an “interdisciplinary bandwagon” (p. 216) — may also be at work (Cassidy 2016). Similarly, Susan Craddock and Steve Hinchliffe (2015) have asked “Why now?” with regard to One Health and suggest that One Health has become prominent as the result of political insecurity and trends toward more interdisciplinary approaches to problem solving and cooperation.
Another agenda-setting model used to examine initiatives, like One Health, was developed by Jeremy Shiffman and Stephanie Smith (2007). The Shiffman and Smith (2007) framework has been applied to global health initiatives, such as maternal and newborn survival (Shiffman & Smith 2007; Smith & Shiffman 2016), international health regulations (Ottersen, Hoffman, & Groux 2016), and mental health (Tomlinson & Lund 2012), in an effort to explain why some initiatives become global health priorities and others do not. The framework includes eleven factors in four broad categories that assess whether an issue will become a political priority (Shiffman & Smith 2007). The four categories-- actor power, ideas, political contexts, and issue characteristics (Shiffman & Smith 2007)-- may be applied to One Health.
Table 1. The Shiffman and Smith Framework (2007). This framework describes four categories (actor power, ideas, political contexts, and issue characteristics) with relevant factors. Adapted from Shiffman, J. & Smith, S. (2007). Generation of political priority for global health initiatives: a framework and case study of maternal mortality. Lancet, 370(9595), 1370-1379.
Actor Power Influence of organizations and individuals involved
Ideas How an issue is understood and expressed
1. Cohesiveness of policy community
2. Existence of respected leaders
3. Guiding coordinating institutions
4. Grassroots organizations
5. Internally: Agreement within the policy community on the definition, causes, and solutions
6. Externally: The way the issue is portrayed to the public and those in power
Political Contexts The environment
Issue Characteristics Characteristics of the problem
7. Policy windows
8. Existence of global norms with institutions that can enforce the norms
9. Degree to which the issue can be measured
10. Relative harm
11. Existence of effective interventions
One Health’s Actor Power. One Health’s international policy community involves a constellation of organizations that influence policy and practice (Lapinksi, Funk, & Moccia 2015). A myriad of agencies participate in One Health policymaking in the United States alone (Cardona et al. 2015).
One Health is also supported by reputable health professional organizations. Both the American Veterinary Medical Association (AVMA) and American Medical Association (AMA) have endorsed fuller collaboration between human and animal health (Gibbs 2014). In spite of endorsements from human and animal health professionals, mainstream support for One Health has come primarily from the veterinary medicine and animal health communities (Gibbs 2014).
With regard to mobilizing civil society, there is reference in the literature to non-governmental stakeholder involvement in global health security issues (U.S. Department of Health and Human Services et al. 2018). Nonetheless, it is difficult to identify specific nongovernmental actors, outside of the professional associations, participating in One Health within the U.S.
The number of powerful actors in the One Health policy community would seem to have a positive influence on the initiative, but there are disadvantages. The breadth of the institutions involved at national and international levels complicates the creation of consistent goals and priorities.
One Health’s Ideas. Cassidy (2016) has traced the history of One Health back to the One Medicine concept and One World-One Health initiative. The contemporary concept of One Health is even broader than its predecessors. It is a “big tent” term, which includes numerous disciplines and health concerns. The breadth of the concept is evident by the use of the popular umbrella metaphor to portray One Health (Cassidy 2016). As Cassidy (2016) notes, the flexibility in the term has been welcomed by many advocates. Using an all-inclusive construct that lacks clear boundaries, however, can present challenges when trying to develop consensus within the policy community.
Another hurdle for One Health is the way that it may be portrayed to the public and policymakers. The porous boundaries of the definition present challenges when communicating the complex issue to the public clearly. As suggested by Trygve Ottersen, Steven J. Hoffman, and Gaelle Groux (2016), global health issues may not resonate with the public since their risk is “unknown, remote, and distant” (p. 383). This may be particularly true of zoonotic diseases that may be framed as national security (U.S. Department of Health and Human Services et al. 2018) or humanitarian concerns rather than immediately relevant domestic concerns for developed countries.
One Health’s Political Contexts. The political context for One Health shares features in common with other global health initiatives. As explained by Ottersen, Hoffman, and Groux (2016), the “policy windows,” or chances for advocates to make change, are short-lived for epidemics. Once an epidemic or health crisis occurs, advocates have only a short period of time to press for enduring reforms.
Additionally, Otterson, Hoffman and Groux (2016) have identified sovereignty as a challenge for international health regulations. The political context for One Health is similarly complicated by the challenge of being a global concern that crosses international borders while being constrained by the legal boundaries of state sovereignty (Ottersen, Hoffman & Groux, 2016). Craig Stephen and Barry Stemshorn (2016) have identified improved governance structures as a key feature in strengthening One Health. They emphasize an approach that supports new governance structures at the country level as well as relationships among the partnering countries (Stephen & Stemshorn 2016).
One Health’s Issue Characteristics. The benefits of taking a coordinated and integrated One Health approach to zoonotic disease have been studied by the World Bank. The report concludes that investment in One Health will yield economic benefits as well as gains in efficiency and effectiveness (Word Bank 2012). The importance of being able to measure the impact of One Health is illustrated by the description of 2018 U.S. Senate Bill, which highlights the global costs of zoonotic outbreaks in financial terms ($80 billion) and human lives (2.7 million deaths). The value of One Health may be measured and assessed in ways that resonate with the public and policymakers.
Figure 1. US Capitol Building. (Photo by Louis Velazquez on https://unsplash.com/).
In summary, it appears that One Health is gaining traction in the U.S. An issue’s rise in importance on the U.S. government’s agenda may lead to additional resources and policy change. One Health’s current rise may be attributed to:
- The strength of the actors in the U.S., primarily the veterinary medicine community,
- The association of One Health with political insecurity and interdisciplinarity (Craddock & Hinchliffe 2015; Cassidy 2016), and
- The ability to measure the issue and assess the harm (Shiffman & Smith 2007) in persuasive terms.
A fuller application of the Shiffman and Smith (2007) framework may help guide possible directions for the future of One Health if advocates wish to continue building momentum. The recommendations suggested by an initial application of the framework to the existing literature include:
- Identifying an entity charged with leadership at both international and national levels to bring unity to establishing goals and priorities.
- Engaging human health professionals and non-governmental stakeholders in the U.S. more fully in One Health.
- Developing consensus on what One Health means in order to establish priorities more consistently internally, and to explain One Health more clearly and consistently to the public.
- Readying advocates to act if a new policy window opens since the timeframe for action is limited.
- Continuing to develop accurate indicators of the effectiveness and impact of a One Health approach to persuade political actors of the importance of the initiative and gain their attention in advance of the next crisis.
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Cassidy, A. (2016). One Medicine? Advocating (inter)disciplinarity at the interfaces of animal health, human health, and the environment. In S. Frickel, M. Albert, & B. Prainsack (Eds). Investigating interdisciplinary collaboration: Theory and practice across disciplines (pp. 213-235). New Brunswick, NJ: Rutgers University Press. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK395883/
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Tomlinson, M. & Lund C. (2012). Why does mental health not get the attention it deserves? An application of the Shiffman and Smith Framework. PLoS Med, 9(2), e1001178.
U.S. Congress. (2018). Advancing emergency preparedness through One Health Act of 2018. https://www.congress.gov/bill/115th-congress/senate-bill/2615/text
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, U.S. Department of State, USAID, U.S. Department of Defense, U.S. Department of Agriculture, U.S. Department of Justice, U.S. Department of Homeland Security. (2018, February). Implementing the global health security agenda: Progress and impact from U.S. government investments. Retrieved from: PDF LINK
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Rebekkah Stuteville, MA, PhD
Assistant Dean of Academic Support Services, Teaching Associate Professor
Kansas State University - Olathe