David Nabarro discussed health risks at the human-animal-ecosystem interface. He argued that the present is a time of opportunity. The emergence of disaster risk reduction, coupled with the renewed perception of risk connected with highly pathogenic avian influenza, led in 2005-6 to a huge coming together of collective energy. A final understanding was reached that an animal health issue could evolve into a human health problem with major consequences for humanity. The 2009 influenza pandemic was fortunately not quite so infectious or lethal. Nevertheless, the Global Risk survey carried out on behalf of the World Economic Forum (Davos 2012) raised anxiety about human health risks, and in response multiple stakeholders have become actively involved. The narrative is thus evolving at great speed. Planetary, food and human security are featuring in dialogue everywhere. There is a general recognition that progress is brought by work across boundaries between people, species, systems, professions and cultures. The dangers lurk at the boundaries and interfaces. However, work on these problems is very challenging to sustain. Dr Nabarro commented as follows:
"There is a movement underway that values interface and boundary working, and that is the movement onto which we need tenaciously to hold."
Most of the major diseases, and associated problems, have emerged at the interfaces (for example, between specialisms). It is sobering to reflect that cost-cutting preferentially affects interface work.
We need to operate beyond the constraints and rigidities of disciplinary work. We must start with experience acquired locally. We must bring consideration of livestock and animals into all politics and policies. We should focus on creating resilience at the interfaces where health risks are great. We must avoid individual disciplinary thinking and be more holistic in our outlook. The future lies in professional networks, but at the same time we must ensure that there is a strong institutional anchor for One Health work. Partnering can be used to stimulate innovation and creative energy. Furthermore, we must establish and maintain an operational framework as a basis for investment, and must ensure that this is backed by a strong regulatory framework. In this context, we should seek financing mechanisms and support effective investments. The entire initiative must occur under the aegis of a multiple stakeholder guidance process. It is important to remember that the process is carried out by individuals, rather than institutions. Hence, the promise lies in networks of individuals.
Discussants from the floor countered that institutions are nonetheless vital. The real power lies in consensus-building among communities. National policy is influenced by evidence, which is collected regionally and locally. The discussion covered the vital role of animals in the survival of poor households, which however also represents a potential for disease transmission.
Now is the time to balance strategic and opportunistic approaches. The One Health narrative needs to be introduced into different subject areas.
Watch the video recording of David Nabarro's keynote below: