David Waltner-ToewsCommunities of Practice for Ecosystem Approaches to HealthVeterinarians without Borders/ Vétérinaires sans Frontières

Framing zoonoses: from single diseases to systemic challenges

We need to ensure that interventions made

in the name of biodiversity, health, or others

sectors do not compound …the public health

and conservation challenges…TOO LATE !

A STATE: “... of complete physical, mental and

social well-being and not merely the absence of

disease or infirmity” WHO Constitution, 1948

“modus vivendi enabling imperfect [people] to achieve a rewarding and not too painful existence while they cope with an imperfect world” Rene Dubos

Health is Three F’s:

Friends, Food, and

Freedom from

Disease

HEALTH IS: FOOD

If God keeps me, I will make sure that no peasant in my realm will lack the means to

have a chicken in the pot on Sunday! -Henry IV circa 1600

Eggs - 67 million

tonnes

Meat - 280 million

tonnes

Milk - 696 million

tonnes

Food: Success!

Unexpected Outcomes

So much dung! So

little time!

World Excrement Production

• 1961 – about 8.5 billion tonnes

• 2013 about 14 billion tonnes

Kg Per Capita Meat Consumption

Inequality of wealth & power

Emerging Diseases

Typhoid versus non Typhoid in the United States

From Epidemics of Cases to Epidemics of Epidemics

1850s -1980s cases = epidemics =

Population Problems. Seriously complicated. Can model.

1980s - ???? epidemics = Systemic

Problem. Wickedly complex. Require narratives.

The Third F = “Friends”. Can they help us?

• Social Determinants of Health (Virchow’s Upper Silesia Moment, 1848; WHO, 2005) – distribution of money, power, knowledge, and

resources

• Ecological Determinants of Health –– Potable water, breathable air, a disease-free

environment, adequate food…

• WAIT A MINUTE. DIDN’T WE ALREADY TAKE CARE OF FOOD AND DISEASE?

Childhood Vaccinations

POPULATION GROWTH

Economic Development

“Resource”Use

Water Infrastructure

AgriculturalIntensification

Democracy

Localized Pollution

LandRestructuring

Water scarcity

Species extinctions

EcologicalFragility

Economic Trade &Connectivity

Economicdisparity

Emerging Diseases

Fast Food

More Food War

EconomicInstability

PoliticalInstability

Art

MUSIC

BIODIVERSITY

GMOs

Excrement/Waste

Climate Change

Wicked Problems

From One Medicine to One Health

Beyond emergency medicine. One Health requires systems approaches, but not just any systems. This is not a mechanical system.

Acting as if it were masks conflicts based on political and economic power, cultural biases, values.

Disease emergence occurs through complex eco-social relationships across temporal and spatial scales.

Dangerous illusions: How can WE feed 9 billion people? How can WE prevent EIDs?

Who are WE?

Inside the Lab, cafeteria, food kitchen Inside academia

One World, One Health

Problem: there is no generic chicken, (or insect, or person) just as there is no generic health

The Challenge for Everyone

Before the science: Articulating our values

“Above all, science is bereft of deontology: it cannot tell why one should be interested in science or anything else." Lederberg, 1995

Science of intrinsic quality needs narratives with explicit values – not just facts –particularly as it faces multi-level complexity… Allen et al. 2001

The Challenge for Scientists Livestock, insects, soybeans, GMOs, economies of scale,

industrialization…[pick your solution] are:

the sources of world’s worst environmental problems

the major drivers of emerging infectious diseases

the best solution to protein insufficiency

a way out of poverty for women

a way to reinforce gender inequity

a way to reinforce the power of multinational chemico-agro-industries

a way to solve social problems (economic inequity - access to adequate food) with “neutral” agricultural technologies

There are data to support and/or refute each of these propositions: what does evidence-based mean?

The Challenge for Practitioners

• How to deal with a wide diversity of legitimate perspectives and values while maintaining quality.

• How to deal with uncertainty and complexity without being paralyzed.

• How to talk about this: “Biology is already so fact-laden that it is in danger of being bogged down awaiting advances in logic and linguistics to ease the integration of the particulars.” Lederberg, 1995.

The Challenge for Policy

• Diseases are emerging under circumstances where "facts are uncertain, values in dispute, stakes high and decisions urgent."

• Conflicts are unavoidable.

• How can we create spaces, and regulate them to ensure “high quality conflicts”, where the actors with conflicting goals, working at different temporal and spatial scales, are mutually respectful, and where outcomes and processes will need to be continually renegotiated?

To impact the food supply of “the world,” it is necessary to attend to many different worlds.” Emily Yates-Doerr