Health solutions : theoretical foundations of the shift from sectoral to integrated systems

Abstract

The current fragmented framework of health governance for humans, animals and environment, together with the conventional linear approach to solving current health problems, is failing to meet today’s complex health challenges and is proving unsustainable. Advances in healthcare depend increasingly on intensive interventions, technological developments and expensive pharmaceuticals. The disconnect grows between human health, animal health and environmental and ecosystems health. Human development gains have come with often unrecognised negative externalities affecting ecosystems, notably loss of resilience, mostly through biodiversity loss and land degradation. Reduced capacity of the ecosystem to serve humanity threatens to reverse the health gains of the last century. A paradigm shift is urgently required to de-sectoralise human, animal, plant and ecosystem health and to take a more integrated approach to health, One Health (OH). The sustainable development goals (SDGs) offer a framework and unique opportunity for this and we argue the need of an OH approach towards achieving them. Feasibility assessments and outcome evaluations are often constrained by sectoral politics within a national framework, historic possession of expertise, as well as tried and tested metrics. OH calls for a better understanding, acceptance and use of a broader and transdisciplinary set of evaluation approaches and associated metrics, which is a key objective of NEOH. We need to shift our current sectoralised, linear focus to a more visible balanced health investment with more global benefits to all species. This is encapsulated in the movements for OH, EcoHealth, Planetary Health and Ecological Public Health, which are essentially converging towards a paradigm shift for a more integrated approach to health.