Economic Benefits of a "One Health" Approach

Economic Benefits of a One HealthApproachJonathan Rushtonjrushton@rvc.ac.uk 1

Acknowledgements• Liz Redmond, Barbara Häsler & Ruth Rushton – UK• Katharina Stärk, Dirk Pfeiffer, Javier Guitian – RVC, UK• Nicoline de Haan – FAO, Rome• Wantanee Kalpravidh, David Castellan – FAO, Bangkok• Mark Rweyemamu and the SACIDS team• Jeff Waage and colleagues at the Leverhulme Centre for Integrative Research on Agriculture and Health, UK 2

Overview• Economic logic of health interventions• Three areas where One Health can add value in infectious disease management• Is this added value sufficient for a One Health business case?• Being more ambitious in order to improve resource allocation and improve economic and social returns 3

Economic logic for investment in One Health 4

Impact of a health problem Without the health problem Losses due Output to the health($,€, ¥, £, problem DALYs) With control Losses with control With the health problem Time 5

Necessary versus sufficient information• The losses due to a health problem are necessary• However, they are not sufficient to make a judgment on whether to intervene• Going a step further it does not tell us either how, when or where to intervene Prevention is better than cure? Stop or control at the source? 6

Economic logic for investment• Economic logic: Where Avoidable Losses are greater than Costs of a Change in Disease Status the investment is worthwhile 7

Where would this economic logic translate into successfor One Health?• Specific diseases• Where resources are scarce• Where resources are underutilised 8

Specific diseasesStrong argument for specific, specialised approaches Animal Zoonotic & Food- HumanDiseases Borne Diseases Diseases Arguments for systems approaches and more generalisation 9

Where resources are scarce• Many people live in geographical isolation• A large proportion of these people are reliant on livestock• Making resources available for either human or animal health is difficult due to the limited availability of trained resources and/or the lack of demand for such services• One Health approaches would make sense in terms of matching overall demand for animal and human health services and the potential to supply adequate services• Strong arguments for generalised services 10

Where resources are underutilised• Many facilities are built that have low throughput• Human resources are trained in data collection, storage and analysis but: • in too fewer numbers and/or • with a low demand for skills in their specific health field 11

Where resources are underutilised• Low throughput and low demand often leads to poor calibration of standards and variable output of results• Small numbers of trained people limit interchange and advancement in knowledge• There are strong arguments that certain aspects of human and veterinary diagnostics, data collection and analysis need to be combined to create synergies which will improve resource use 12

Are the costs of the One Health interventions greaterthan the benefits (avoidable losses)?• The One Health concept is not new, but only recently has this approach begun to gain momentum• Yet it is not accepted by all parts of the health professions, it is not mainstream• It may be that the benefits from One Health infectious disease management are too small to justify the costs of large scale changes in resource allocation and accompanying institutional change• What could be the tipping point? 13

Habitat WildlifeDestruction Disease Human Human Healthcare Deaths Disease Costs Environmental impacts Infectious disease through food-borne transmission Food Systems Malnutrition through poor distribution and availability of macro and micro nutrients Infectious disease Undernourished Over nourished in animalsProduction Animal Human Human Healthcare Losses Healthcare Costs Deaths Disease Costs

Environmental impacts FoodLivestock Disease System Nutritional Impacts Problems Food Borne Disease

One Health and Food Systems• Food systems are central to food security, GDP and employment• They are also central to • food safety • food quality – in all dimensions • environmental sustainability• Understanding the food system (the milieu or context), its positive and negative impacts, would allow resource allocation proportionate to the scale of the problems generated 16

One Health and Food Systems• Given the centrality of food systems to so many positive and negative aspects of human welfare, one would expect a combined public and private institutional response• Yet few countries have food ministries, and no countries are in a position to estimate the relative impacts on their economies of: environmental effects; animal disease; food borne disease; and nutritional problems created by food systems• We are NOT yet in a position to be proportionate in our responses to food system problems or even know what these problems are 17

Adding value through One Health• A One Health approach that is interdisciplinary and food system (milieu or context) focussed will be able to: • Improve understanding of infectious and nutritional health problem emergence and re-emergence that allow proportionate and timely responses • Identify where we need generalised systems of health delivery • Create synergies through combined use of infrastructure and skillsets 18

Think SystemicallyResearch Thoroughly Act Personally 19

One Health oriented Food Systems Helping PEOPLE, Protecting PEOPLE Working with PEOPLE

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Economic Benefits of a "One Health" Approach

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