Social insights on the implementation of One Health in zoonosis prevention and control: a scoping review | Infectious Diseases of Poverty

Cindy F. Cape

Overview of studies included

A total of 32 studies met the eligibility criteria and were included in the scoping review, in which three studies were included after searching reference list of included studies (Fig. 1). Most articles (24/32) were published between 2014 and 2021. The most common methods were qualitative or semi-qualitative, including case studies (11/32), semi-structured or in-depth interviews and questionnaires (10/32), general literature reviews (4/32), and ethnographic studies (2/32). Some studies used mixed methods to research social determinants, such as combining Delphi technique with qualitative interviews (2/32). Quantitative methods were also used to research zoonotic diseases (2/32) and assess the economic benefit of OH outcomes (2/32). Twenty studies analyzed OH implementation in the context of zoonosis prevention and control with cases provided. Other studies focused on a particular zoonotic disease, such as rabies and brucellosis. Nineteen studies were conducted in low- and middle-income countries (LMICs), including 12 in Africa and eight in Asia (one study conducted in both continents). Six studies were conducted in high-income countries [Australia (n = 4), Singapore (n = 2), and Switzerland (n = 1)]. Some studies did not mention study settings but evaluated cases in Africa or LMICs. It can be seen from included studies that various impacts of OH implementation were demonstrated from the perspective of ‘integration’, ‘economic impacts’, and ‘social determinants of health’ (Tables 1 and 2).

Fig. 1

Literature search and review process

Table 1 Impacts of OH implementation focus
Table 2 Literature’s main findings regarding social-related impacts of OH approach on zoonosis prevention and control

Integration reflected from OH implementation on zoonosis prevention and control

Political integration

Various literatures mentioned the interaction of several factors that were brought together for OH implementation. “Political will” were seen to hold strong influence over different actors and their conversations in public health and policy [23,24,25]. The political will to develop health programs and strategies is extremely important. As demonstrated in the Medicaid project in the United States [25], the mobilization of projects and resources transcends the health sector as the decisions come from leaders and politicians. Political involvement is absolutely necessary to overcome operational barriers, which is essential to involve relevant politicians and ministers as they make crucial decision about the scalability of health promotion projects [23]. Farag et al. [24] showed how in the Middle East political will played a key role in influencing OH implementation. It specifically outlined that poor leadership and the absence of committees involved in infection prevention and control helped spread Middle East respiratory syndrome coronavirus (MERS-CoV), limiting the implementation of OH.

Another key factor was the engagement of stakeholders in OH projects. Various actors cooperate to support the health sector and develop health programs. Hermesh et al. [26] pointed out that these actors, such as decision- and policy-makers who can drive the political will, must take their responsibility with more active engagement instead of a passive presence. For instance, in the brucellosis intervention campaign, these actors jointly elaborated effective long-term strategies by considering different barriers and allowed the implementation of sustainable and ethical practices in disease prevention.

Interdisciplinary integration

It is imperative that stakeholders and donors must understand their roles and responsibilities in OH implementation. It is the engagement of global donors that can give impetus to the research on global health issues and pushed it into higher levels [27]. It increased the interest in disease prevention and control, thus supported small scale local OH projects and studies to address health crises with the engagement and participation of multiple disciplines [27]. It was noticed that economists and social scientists contributed significantly to designing programs to decrease the risk of HPAI A(H5N1) infection in Nigeria, Tanzania, and Uganda [27]. For example, economists can help understand the disease burden on the national and the individual level, as well as help elicit how poverty and unemployment act as catalysts to the spread of diseases, and social scientists can help analyze how human activities, including their economic conditions, cultural practices and social trends, contributed to the spread of diseases [26]. Moreover, in a case of rabies control in Colombo City, Sri Lanka, OH framework integrating methods and data from multiple disciplines provided decision-makers with relevant information[28]. Thus, it was important to onboard people from various academic fields to build up a health program.

Cross-sectoral integration

Communication is a key problem which was addressed by the integration of individuals from varying fields [29]. A study conducted by Bardosh et al. [14] mentioned how medical researchers failed to see the social contexts of the study when making suggestions. The suggestions made by the researchers was impractical as they failed to account for regional social organization of people, power dynamics, socio-cultural norms, and etc. Degeling et al. [25] also identified the broader reach of the social sciences which go beyond just suggestions of technologies and hygiene practices and were more policy focused. It was pointed out that with the integration of the social sciences the OH approach allows for better communication among different sectors and a broader understanding of causality. Thus, the social determinants of health are integral to health promotion and OH implementation. In addition, communication between researchers and sectors seems relatively essential in managing health issues, and OH is greatly helpful in strengthening the communication by collaborating sectors, academics and individuals.

Economic impacts of OH implementation on zoonosis prevention and control

Financial resource allocation

An essential part of OH implementation is its funding. Farag et al. [24] found that the financial resource allocation played a pivotal role in the MERS-CoV programs, as the cost of OH programs had been underestimated, leading to poor management. Underfunding was attributed to miscalculations and the disproportionate allocation of funds among different sectors, decreasing the effectiveness of control programs. This proves that not only it is essential to understand the cost of technology and pharma involved but also to understand the costs of management, organization and operation. This was further expanded in a study [30] that the stakeholders must be willing to invest resources in the OH program and its activities. These activities may not be entirely predictable but if succinct they will have a potential to provide large benefits to the prevention of zoonotic disease. Zoonotic disease also impacts markets through price mechanisms. It was noticed that social planners of OH programs should consider the social cost of a disease to prevent market failure which may further leads to the unavailability of resources [30]. For instance, in the livestock industry, a radical decrease in the availability of meat products would lead to market failures, recession, and poverty, thus increasing disease risk [30, 31].

Long-term economic impacts

The included studies provided some long-term economic impacts of the OH implementation and its complexity, including cost–benefit ratio and other monetary and non-monetary outcomes. There are snowball effects to the economics and society that disease and poverty as multidimensional social phenomenon are enclosed in a positive feedback loop that the worse of one may results in the exacerbation of the other [29]. For example, on the one hand, livestock industries provided value to society in the form of food, agriculture, employment and producing revenue, on the other hand, the loss of livestock due to zoonotic diseases can pose adverse impact to human societies in these areas [32]. Though current available evidence may not be enough to demonstrate the impact of OH in alleviating poverty, the correlation between OH implementation and poverty alleviation is becoming more obvious, because OH may be potential to reduce the economic burden of disease and generate more efficient systems.

OH programs have direct and indirect costs in human societies [27, 30]. The costs of death, sickness and injury and the costs of treating the disease were valued as direct costs of a health intervention, while indirect costs are more difficult to estimate, including the loss of wages to workers who are sick and the reduced productivity of workers who may have sub-clinical effects of disease [32]. Similarly, the indirect impacts of OH implementation were described as societal benefits including improved governance, increased social acceptance of interventions and social equity [29], and direct impacts were economic benefits and a reduction in disease burden, such as fluctuations in costs and disability-adjusted life years (DALYs) [32, 33]. According to several case studies on neglected zoonotic diseases, the costs of a OH program can be outweighed after taking these monetary and non-monetary benefits into account [34].

In determining the potential effectiveness of OH programs, the indirect costs and impacts may be more important than the direct ones. It is indicated that economic benefits in the form of a reduced disease burden can be evidently seen when there is a long-term inter-sectoral approach to be implemented [33]. Nonetheless, tangible benefits of OH might be vague at the initial stage as OH implementation tend to cost more financial resources at first and show positive effects after a long time [35]. In the assessment on Campylobacter surveillance in Switzerland [33], although the direct effect and measurable benefit were reported being intangible in the initial 5 years of the program, its positive effects were estimated to increase with time [33]. Similar results were found in rabies control in Colombo City, where for the four-year time period the OH interventions cost nearly 1 million US dollars more than their previous program. But apart from reducing dog rabies cases, OH also achieved in reducing people’s distress due to dog bites and animal suffering, and led to positive changes in society [28]. Overall, the value of OH’s potential achievements can exceed the monetary cost of the program and present its overall worth, thus it is better for decision-makers to implement OH programs that can positively affect markets and societies [29].

Social determinants of health considered by OH approach

Improving health through social perspectives

It is fundamental to adopt a multidisciplinary approach to explore the social dimensions and human behaviors associated with disease transmission and understand the conditions and circumstances in which zoonotic diseases emerge and spread [36]. Thus, OH programs can be better understood from a social perspective [37]. This perspective can help promote OH programs to the public and improve them at the level of governance, which can further influence power and politics. OH implementation is also expected to achieve better local or regional understandings and capacities from social insights [14, 38].

From the lens of social determinants of health, OH proved that anthropogenic factors contribute to the spread of zoonotic pathogens to humans, such as high-risk lifestyles, intensive livestock production, exhaustive agricultural practices, urbanization, globalization, and pollution [36]. These factors were also found to be interrelated with social classes and socioeconomic status in human society [39]. Thus making zoonotic disease transmission not only related to its pathophysiology but also to certain social determinants, such as social norms, economic imperatives and human values, which shows the pattern that humans interact with animals [40]. For example, the risk of infection with Rift Valley fever in Kenya was found to be strongly linked to the socioeconomic status of affected and at-risk communities, as people of lower socioeconomic status were more likely to be exposed to environments full of mosquitoes [41]. To minimize the health gap between communities with different socioeconomic status, it is important to consider the difference in their social needs when conducting health interventions. It is also acknowledged that zoonotic diseases transmission is affected by ecological and social dynamics, thus analyzing epidemiology patterns with ecological and social factors is needed [26, 42]. For instance, climate change in tropical areas is associated with the emergence and spread of zoonotic pathogens. Additionally, the ecotourism can increase the risk of zoonotic disease transmission and spread over long distances [42].

Implementing OH under local contexts

Understanding local contexts and behavioral patterns that affect disease transmission can help improve the response efforts and design culturally-acceptable interventions. For instance, in Lao Peoples’ Democratic Republic (Lao PDR), social determinants such as poor latrines coverage, limited access to clean water, and consumption of raw pork meat can increase the risk of Taenia solium infection [39]. In addition, the trust between health workers and local leaders were found to be essential in better performing the intervention [39]. For example, because of anthropologists’ insights and research on local societal hierarchy and social practices, a better cooperation between local communities and international health workers were achieved, which increased the effectiveness of controlling Ebola outbreaks in Africa[43]. These cases demonstrated the effectiveness of OH programs depends on understanding local systems [37]. The social and cultural factors complicate disease transmission and the implementation of health interventions [44], thus it is necessary to include social and ethnographic study into OH implementation.

Moreover, LMICs were found to be more susceptible to infectious disease, economic vulnerability and food security, which may be due to limited financial resources and governance capacity [29]. The health system in many LMICs is either out of pocket or subsidized thus marginalizing the communities of lower socioeconomic status. Therefore, in LMICs, OH is adopted to provide an in-depth understanding of the economic feasibility of projects and increase the availability of local resources [14]. The OH approach takes into account how complex the issue and program planning can be. It also holds responsibility for cost saving and using the limited resources effectively.

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