Advancing Inclusive Health Approach

In the era of globalisation, human health and the health of our planet are closely linked. Our civilisation largely relies on human health, flourishing natural systems, and the wide stewardship of natural resources. In the human history, while we continue to observe the gradual degradation of natural systems, both our health and health of the planet are at high risk and consequently, it has adverse differential effects on the lives of many people in and across societies. 

In recent years, the concept of inclusive One Health approach has received renewed attention because of the increased frequency and severity of threats linking the health of humans, animals, plants and environment. Among many others, the environmental degradation caused by human activities poses significant health threats that are invariably complex, and rooted in how humans interact with and use the environment. Therefore, it is largely an integrated and unifying approach that primarily seeks to balance and promote the health of people, animals and ecosystems in a more holistic and sustainable approach. 

Unsafe water

Similarly, evidence suggests that unsafe water, poor sanitation, and hygiene are responsible for human and animal mortality and morbidity due to various diseases, particularly vulnerable populations in low-and- middle income countries. Moreover, the differential effects of climate change on human and animal health are also alarmingly on rise. More importantly, the growing threat of Antimicrobial Resistance (AMR) is a matter of serious concern as it is a leading cause of death around the world with the highest burdens on low-income countries. The AMR also threatens the health of animals and plants grown for foods, with profound effects on food security, food safety and the environment. 

Unfortunately, the AMR is still ever-increasing and widespread threat as there are numerous social, cultural, economic and environmental factors that are profoundly accelerating the emergence and spread of resistant genes and pathogens among and between humans, animals and environment. Largely, these include lack of public awareness and education on appropriate use of antimicrobials, inadequate access to essential health care services, lack of access to safe water and sanitation, waste management and hygiene, and limited regulatory as well as policy frameworks. 

Like many other countries, Nepal is undertaking several measures to address the complex challenges of the AMR. While the national health policy 2019 clearly articulates the containment of AMR as a priority health agenda, a National Action Plan (2021-2026) is recently endorsed to reduce the AMR and effectively control and regulate the use of antibiotic through multi-sectoral approach. Combating AMR through inclusive One Health approach is the central focus of the strategic action plan which not only aims to reduce associated mortality and morbidity, but also address socio-cultural, economic and political impacts on the everyday life of people living in different socio-cultural contexts.      

The priority interventions broadly include raising public awareness through effective communication, education and training, strengthening the knowledge and evidence, ensuring effective infection prevention and control, optimising the use of antimicrobial agents in human, animal and food, and more importantly, promoting investments for AMR activities, research and innovations. In addition, it is high time to ensure the rational use of antimicrobials and contain the AMR in a more efficient and sustainable approach.   

The technical assistance from Fleming Fund country grant through FHI360, WHO and other partners have been instrumental in addressing the critical gaps in AMR surveillance by enhancing the capacity of human resources and laboratory facilities, and generating quality data and  evidences to inform policy and practice for the sustained response. Multi-sector coordination is needed to enhance the national capacity of public health and veterinary laboratories in AMR surveillance, increase resource mobilisation and ensure sustainability of the surveillance system in the federal context.  

Additionally, the AMR is undoubtedly a social, economic and political problem. As a dominant global health concern, Nepal needs to ensure the effective implementation of the action plan for combating this threat. The political economy analysis can further help provide a better understanding of socio-political and economic dynamics of the AMR by exploring underlying interests of the stakeholders, incentives, social trends and historical legacies, and connecting how these factors facilitate or constrain the desired progress.  

Considering such a diversity, there is a critical need to strengthen multi-sectoral engagement and collaboration across sectors to protect human health, and address multi-dimensional health challenges such as emerging infectious diseases, AMR and food safety at large. Consequently, it is high time to promote the health and integrity of our ecosystems and contribute to global health security. In this scenario, the One Health approach significantly helps in disease control – from prevention to detection, preparedness, response and management. 

Political will

There is an emerging need of sustained political will to ensure One Health principles are integrated to national health policies and strategic action plans. Taking advantage of science and available evidence, more concerted efforts are needed to further enhance the capacity of governments for evidence informed strategic actions to better prevent, predict, detect, and respond to the health threats and ensure sustained mobilisation of resources for effective implementation of the One Health approach at all levels. 

More collaborative actions are needed to drive the change and transformation needed to mitigate the impact of present and future health challenges at the human-animal-plant-environment interface at all levels. In the context of pandemics and other disasters, the inclusive One Health approach and the initiatives largely aim at strengthening capacity to address complex multi-dimensional health risks with more resilient health systems at all levels.  

(Bhandari is a health policy analyst.)