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