L. Reeve-Johnson

Faculty of Science, Health, Education and Engineering, University of Sunshine Coast, Maroochydore Queensland, Australia; President European Association of Veterinary Pharmacology and Toxicology

The ‘One Health’ approach implies multiple stakeholders with different perceptions of utility interacting daily in the highly complex system of healthcare delivery. As we attempt to adopt increasingly holistic views to major healthcare challenges, “complexity economics” principles demonstrate the difficulty of our medium and longer term problems.¹ To name a few, these include: the impact caused by the interaction between merging disease reservoirs (animals, human, environmental); consequential antimicrobial resistance patterns in multiple species; emerging diseases; climate changes impacting the distribution of disease vectors and species migration; political and economic challenges to sustainability of health provision services - especially long term preventive strategies; and, public media generated perceptions that present only a fraction of the entire scope of these interactions.²

One Health approaches consider multiple facets of population and disease management and tend to be iterative. They evolve to ever greater complexity with interactions between human health, veterinary health, plant and environmental health which in turn are continually impacted by wider issues of politico-economic stability, environmental encroachment between habitats of humans, animals and disease vectors as well as media influence and perception.

Each change to a heath delivery system produces consequences that destabilize the status quo with iterative ramifications. The interplay between social, psychological, environmental and physical determinants for human health mean that for health literacy to improve, we use messages that are easily communicated, disease signs that are easily recognizable and viewpoints that are contiguous with belief systems even where these do not relate directly to the current healthcare issue. The result is inevitable simplification and avoidance of controversial topics. An example is avoidance of finding solutions for the most intractable of problems which is our increasing human population. Despite growing awareness and implementing a carbon economy designed to offset human impact on this planet, human population growth remains the ultimate determinate of the rate of habitat encroachment. This facilitates emergence of diseases from other reservoirs of infection and infects other habitats with biological and non- biological pathogens. The human population has doubled from 4 billion to 8 billion in approx. Fifty years with massive consequence to animal population numbers, diversity of species and with environmental destruction. Every individual brings an undeniable cost (simplistically seen as a ‘carbon footprint’) to the environment and an additive role in the spread of disease and utilization of multiple resources.

A reductionist approach is discussed in this session identifying the key stakeholders in healthcare delivery and general perspectives that each may have when interacting or making healthcare-related decisions. Probability interactions and game theory approaches are increasingly used to predict healthcare demand and to influence outcomes and cost with real-time dynamic predictive models. Current health system provision levels are unsustainable and have been severely tested with the recent Covid-19 epidemic. Costs continue to rise as do patient expectations. Health systems need extensive reform globally which implies different levels of care and expectations with changes from the current unsustainable rate of funding increases.

The mass migrations of the 21st century have most often been due to political instability fuelled by poverty, disease or food and water shortages where local environments no longer sustain growing human populations. Moving the burden to another location generally fails to address the causative factors and indeed drains countries of the intellectual and problem-solving abilities for issues that need to be addressed.

Sustainable, holistic and logical global disease prevention strategies are likely to eventually emerge as more affordable means of maintaining human health within this inter-dependent biosystem, compared to reactive interventional healthcare. This will only occur with understanding the role of environmental and animal health; attention to the consequences of human encroachment on biodiverse habitats which inevitably leads to disruptive consequences; an ability to more openly challenge current belief systems limited by a culture of political correctness, and, population control commensurate with the value placed on: species diversity; environment conditions; and, individual liberty that tends to decline as the human population grows, merges and migrates.

References: 1. Reeve – Johnson, L. (2023). One Health – synergies between man, animals and the environment in the context of failing human health systems. Plenary Lecture. Proc. Of Australian Society for Antimicrobials 24–26 February 2023. Brisbane Convention Centre.

2. Reeve-Johnson, L. (2023). One health, the synthesis of human, animal and environmental approaches. State Medical Testing and Registration Laboratories. Lviv. Ukraine 09–12 July 2019.

3. Reeve -Johnson, L. (2019). One Health and AMR: taking stock 4 years after approval WHO Global Action Plan in AMR. International Conference on One Health Antimicrobial Resistance. Utrecht, Netherlands. April 17-19th 2019.

4. Reeve-Johnson. (2016). One Health: The need for medical and veterinary collaboration to control emerging and endemic disease. Center for Disease Control. United States of America Embassy. New Dehli, India. 20 January 2016.

中文翻译：

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I0 | 一种健康：我们的健康，我们的动物。我们的环境——不断变化的世界背景下的健康和稀缺经济学

L.里夫-约翰逊

阳光海岸大学科学、卫生、教育和工程学院，澳大利亚昆士兰马卢奇多；欧洲兽医药理学和毒理学协会主席

“One Health”方法意味着在高度复杂的医疗保健系统中，对公用事业具有不同看法的多个利益相关者每天都在互动。当我们试图对主要的医疗保健挑战采取越来越全面的观点时，“复杂性经济学”原则证明了我们中长期问题的难度。^1个仅举几例，这些包括： 合并疾病宿主（动物、人类、环境）之间的相互作用造成的影响；多个物种中随之而来的抗菌素耐药性模式；新兴疾病；影响病媒分布和物种迁徙的气候变化；卫生服务可持续性面临的政治和经济挑战——尤其是长期预防战略；而且，公共媒体产生的看法仅代表这些互动的整个范围的一小部分。^2个

One Health 方法考虑了人口和疾病管理的多个方面，并且往往是迭代的。随着人类健康、兽医健康、植物和环境健康之间的相互作用，它们变得越来越复杂，而这些相互作用又不断受到政治经济稳定性、人类、动物和疾病媒介栖息地之间的环境侵蚀以及媒体影响等更广泛问题的影响和感知。

对健康输送系统的每一次改变都会产生破坏现状稳定的后果具有迭代的后果。人类健康的社会、心理、环境和身体决定因素之间的相互作用意味着，为了提高健康素养，我们使用易于传达的信息、易于识别的疾病迹象以及与信仰体系相近的观点，即使这些观点并不相关直接针对当前的医疗保健问题。结果是不可避免地简化和避免有争议的话题。一个例子是避免为我们不断增长的人口这一最棘手的问题寻找解决方案。尽管越来越多的人意识到并实施了旨在抵消人类对地球影响的碳经济，但人口增长仍然是栖息地侵占率的最终决定因素。这促进了疾病从其他感染宿主中出现，并用生物和非生物病原体感染其他栖息地。人口从 40 亿增加到 80 亿，翻了一番。五十年对动物种群数量、物种多样性和环境破坏造成了巨大影响。每个人都给环境带来了不可否认的成本（简单地称为“碳足迹”），并在疾病传播和多种资源利用方面发挥了附加作用。

本次会议讨论了一种简化方法，确定了医疗保健服务中的主要利益相关者以及每个人在互动或做出医疗保健相关决策时可能拥有的一般观点。概率交互和博弈论方法越来越多地用于预测医疗保健需求，并通过实时动态预测模型影响结果和成本。目前的卫生系统供应水平是不可持续的，最近的 Covid-19 流行病已经对其进行了严格的测试。成本和患者的期望一样继续上升。卫生系统需要在全球范围内进行广泛的改革，这意味着随着当前不可持续的资金增长速度的变化，需要不同程度的护理和期望。

21 世纪的大规模移民通常是由于贫困、疾病或食物和水短缺引发的政治不稳定，当地环境不再支持不断增长的人口。将负担转移到另一个地方通常无法解决致病因素，而且实际上会耗尽各国对需要解决的问题的智力和解决问题的能力。

与反应性介入医疗保健相比，可持续、整体和合乎逻辑的全球疾病预防策略最终可能会成为在这个相互依存的生物系统中维持人类健康的更负担得起的手段。这只有在了解环境和动物健康的作用时才会发生；关注人类侵占生物多样性栖息地的后果，这不可避免地会导致破坏性后果；更公开地挑战受政治正确文化限制的当前信仰体系的能力，以及与以下价值观相称的人口控制：物种多样性；环境条件；随着人口的增长、融合和迁移，个人自由往往会下降。

参考文献： 1. Reeve – Johnson, L. (2023)。同一个健康——在人类健康系统失败的背景下，人、动物和环境之间的协同作用。全体演讲。过程。澳大利亚抗菌药物协会，2023 年 2 月 24-26 日。布里斯班会议中心。

2. 里夫-约翰逊 (L.) (2023)。一种健康，人类、动物和环境方法的综合。国家医学检测和注册实验室。利沃夫。乌克兰 2019 年 7 月 9 日至 12 日。

3. 里夫 - 约翰逊，L. (2019)。One Health 和 AMR：世卫组织 AMR 全球行动计划获批 4 年后进行盘点。单一健康抗菌素耐药性国际会议。荷兰乌得勒支。2019 年 4 月 17-19 日。

4. 里夫-约翰逊。(2016)。One Health：需要医疗和兽医合作来控制新发和地方病。疾病控制中心。美国大使馆。印度新德里。2016 年 1 月 20 日。