Building the Future One Health Workforce
This session’s two plenary presentations focused on effectively training and educating the next generation of One Health professionals. Lonnie King, dean emeritus of the College of Veterinary Medicine at Ohio State University, reviewed progress in building a One Health workforce, detailed the required competencies, and outlined educational shifts needed to develop these competencies. He identified gaps in the workforce and recommended transformative changes to address them. Woutrina Smith, professor and associate director of the One Health Institute at the University of California, Davis (UC Davis), detailed current experiential-learning initiatives in Africa and Asia and described opportunities for collaboration and innovation. The session was moderated by Eva Harris, professor of infectious diseases and director of the Center for Global Public Health at the University of California, Berkeley.
THE ONE HEALTH WORKFORCE: RECONCILING COMPETENCIES WITH OPPORTUNITIES
Lonnie King, The Ohio State University
King reviewed the current status, required competencies, and anticipated future needs of the One Health workforce, with the following objectives: (1) review recent progress in building the workforce, (2) explore the most pressing needs remaining in education and the gaps in linking these needs with practical field applications, and (3) recommend transformative changes to address these issues that can be accomplished now. King quoted
Admiral Thad Allen: “Leadership is the ability to reconcile opportunity and competency” (Allen, 2010). He added that reconciling opportunities and challenges with competency is essential for an effective workforce.
Progress in Building a One Health Workforce
Currently, 45 academic programs grant One Health degrees in the United States, the majority of which have been established over the last decade (Togami et al., 2018). King remarked that global advances are even more robust, with progress in defining an effective workforce and essential competencies being demonstrated in work conducted by the U.S. Agency for International Development (USAID) in its RESPOND and PREDICT projects, the U.S. Centers for Disease Control and Prevention, the World Health Organization (WHO), the World Organisation for Animal Health (OIE) with the “Day 1 Competencies” recommendations (OIE, 2012), and One Health Institute at UC Davis with the “One Health Workforce—Next Generation” project.1,2
King noted that the number of scientific papers on the One Health workforce, meetings and online trainings, and assessments measuring results via tools such as the OIE Performance of Veterinary Services and the WHO Joint External Evaluation have all increased. He added that social sciences are also becoming engaged in One Health initiatives.
One Health Workforce Competencies
King remarked that “competencies” and “skills” are not interchangeable terms. A competency is an observable capability that integrates knowledge, skills, values, and attitudes. It is the “how” in effective performance. Competencies can be categorized as core, advanced, or sub-, all of which span a continuum from beginning to proficiency. In contrast, a skill is a specific ability that—when applied to a specific setting—leads to a predetermined result. In essence, it is the “what” in performance, and it may lead to proficiencies. Skills are often categorized as technical or interpersonal (“soft” skills). Investigation is under way to better operationalize and measure competency to create milestones through which students can progress across their professional curriculum, said King. A continuum of professional skills and core competencies includes the stages of novice, advanced beginner, competent, and proficient.
1 The One Health Workforce—Next Generation project is funded by USAID. More information can be found here: https://ohi.vetmed.ucdavis.edu/programs-projects/one-health-workforce-next-generation (accessed May 31, 2021).
2 King also acknowledged work performed in One Health offices across many agencies and international organizations that are not individually listed here.
In analyzing and evaluating papers written on One Health, King generated a list of key knowledge areas for the workforce. These include epidemiology, risk assessment, ecology of disease, preventive medicine, infection prevention, zoonoses, emerging infections, environmental health, health determinants, wildlife and conservation medicine, informatics, public health, surveillance, outbreaks and spillovers, global health, and understanding the dynamics at the interface of the One Health domains. King culled skill sets specified in papers and background materials to identify core competencies in an effective One Health workforce: communications, the ability to form and work in teams, systems thinking, and the ability to collaborate. Other critical skill sets include leadership at all levels; situation analysis; risk assessment; risk analysis; analytical capabilities, especially with large datasets; interpersonal skills; emotional intelligence; cultural awareness; and conflict resolution. King added that One Health employers also value problem solving, project management (being able to design a research study and take it to conclusion), stakeholder engagement, leadership ability, and change management.
Building a One Health Workforce in a Complex World
A focus on competencies is evident in a revolutionary shift in education toward competency-based curriculum that is currently taking place in the fields of medicine and veterinary medicine, said King. In the past, experts developed a curriculum and then retrofitted it to meet needs. In contrast, King noted, a competency-based curriculum begins with the needs of society and health systems, then maps these needs to the critical competencies required to meet them. At that point, a curriculum is developed to build those competencies, with attention given to the most effective ways to impart knowledge and skills. King remarked that this method of of crafting curricula starting with an environmental analysis—performed within the context of globalization, speed, and connectivity—is starkly different from traditional methods. One Health is a holistic and integrated approach, but attempts are often made to try to retrofit it into vertically oriented, siloed systems. Drawing on a term coined by the U.S. Army War College, King noted that the “VUCA” world—an environment that is volatile, uncertain, complex, and ambiguous—presents challenges to soldiers and One Health workers alike. In the current global setting, competency requires the ability to address uncertainties. King stated that “wicked problems” are those that cannot be adequately dealt with by old interventions; they require redesigned strategies or new solutions. He remarked that in a world that is rapidly changing in terms of economics, trade, health, and immigration, it can seem as if no one is in charge. Preparing a workforce with the competencies to handle this complex effort requires a paradigm shift. Independence has
traditionally been common across a large number of medical sciences, but a shift toward interconnectedness is needed, King posited. Interdependence (people’s mutual dependence and reliance on one another) is at the heart of the One Health approach.
Understanding and building the skills needed in a complex environment warrants a reexamination of the pedagogy, said King. Pedagogy is the method and practice of teaching and the means of imparting knowledge and skills to learners. A traditional format of a teacher-centric lecture series does not lend itself to building a One Health workforce, he remarked. A more effective pedagogy might involve experiential work carried out in transdisciplinary teams and settings, an approach that is being used in global health summer institutes. This approach lends itself to the exploration of relevant topics via case studies of antimicrobial resistance (AMR) or emerging infectious diseases, for example. A nurturing, collaborative network can also be created through these activities. Twinning programs are another form of effective pedagogy, in which faculty, staff, and students engage in a long-term immersion experience. Programs of study should be competency based, learner centered, and flexible, said King. Furthermore, interprofessional practice and education (IPE) can contribute to increasing capacity. This model has existed for half a century but has grown substantially in the last two decades. As part of a national strategy, IPE features 16–20 health science groups working collaboratively to learn and develop together while improving health outcomes in individuals and populations. Currently, 140 national centers are connected with IPE and have core competencies and goals similar to those defined in One Health. King explained that One Health is working in parallel with IPE pedagogy, offering the opportunity to combine forces to strategically improve capacity in both areas.
Workforce Gaps and Future Work Skills
King outlined current gaps in the One Health workforce. Scalability is needed to substantially enlarge the workforce at a faster rate. Training and education across life sciences can be expanded. The concept and workforce should be strongly embedded into the national security agenda and in efforts addressing health equity, he stated. Strategic involvement in these areas can foster new possibilities, understandings, partners, and resources for One Health. Additionally, key competencies and basic knowledge can be imparted to the lay workforce in order to increase understanding of and ways to use One Health professionals. Awareness of One Health concepts and utility can be expanded to other professions, employers, and the public. King suggested implementing the aforementioned pedagogical methods, with efforts to shift the focus of education from knowledge to applications. Lastly, new and relevant competencies and sub-competencies can be
identified and imparted to the developing workforce to better address the challenges of the future.
King highlighted a set of driving forces identified by the Institute for the Future (IFTF)3 as impacting the skills necessary for the future workforce, many of which are relevant to future One Health work skills. These drivers, and the associated relevant skills, include the following:
- Artificial intelligence, requiring sense-making and adaptive thinking;
- New media ecology, requiring social intelligence and new media literacy;
- Globally connected world, requiring transdisciplinary and “T-shaped” workers (those with a deep understanding of one field and the capacity to converse in a broader range of disciplines);
- Supersized social organizations, requiring cross-cultural competency, virtual collaboration, and a design mindset; and
- Computational world, requiring computational thinking, cognitive load management, and predictive modeling.
King remarked that these skills are applicable to the One Health workforce. He added that IFTF suggests that as many as one-third of currently required skills will change within the next 5 years. If this premise holds true, it implies that key skills for the One Health workforce are likely to shift as well. A skill that may become particularly relevant is the ability to use information technology for learning and for applications mastering large, disparate data flows to solve problems and gain new insights. Increasing proficiency will involve responding to unexpected, persuasive communication strategies and new media, design thinking, translating large databases, and discriminating and filtering necessary information from the noise of the system, and being a “T-shaped” worker, said King.
Big Solutions for Big Problems
King suggested that Rosabeth Moss Kanter’s textbook, Think Outside the Building, uses an appropriate metaphor for addressing complex, intractable problems for which adequate solutions have not yet been developed (Kanter, 2020). For such issues, individuals can move beyond the confines of their “buildings” to form cross-sector coalitions that use systems thinking to generate innovative ideas and strategies. King also suggested that innovation for low- and middle-income countries can lead to substantial breakthroughs. One Health involves working across professions,
3 More information about the Institute for the Future can be found at https://www.iftf.org/home (accessed on April 16, 2021).
institutions, organizations, and disciplines. Holistic dialogues can help connect the academic, medical, and agricultural silos by building collaborative, non-hierarchical relationships across sectors. The professionals in these relationships—whom King referred to as “tightrope walkers” traveling between silos—can become effective teams. He noted that this collaborative work is in progress and will continue.
King attributed a quote to Rahm Emanuel (2020), “Never waste a good crisis.” The current COVID-19 pandemic is a global event that could cause losses upward of $14 trillion. An event of this magnitude requires new approaches that include consideration of actions previously deemed impossible, King remarked, and this is not the time for fundamental, incremental thinking; the current moment calls for transformative thinking and for preparing a workforce of the future that is able to take aggressive action. The World Bank has estimated that the total annual cost of building and operating One Health systems for effective disease control in all low- and middle-income countries would be $1.9–$3.4 billion (World Bank Group, 2018). King remarked that in the midst of the costly pandemic, this figure seems a bargain. He continued that the workforce of tomorrow must be built without looking backward. Harvard’s meta-leadership model emphasizes the ability to lead where one does not have authority, across organizations and the private sector (Marcus et al., 2006). King called relationship building the “skill for the decade,” which is pertinent within the One Health community, between health sciences, and especially in forming a new relationship of understanding and working with natural systems.
Actions That Can Be Taken Today
King presented four areas of potential actions that could build the future workforce that effective One Health practice requires. The first area is education transformation. This involves moving toward the competency-based curriculum, a step that King highlighted as critical. Increasing online global certificate programs can build capacity, and adjusting standards and accreditation encourages change. The pedagogical options discussed earlier, including IPE, are the mechanisms by which a One Health–embedded curriculum can be effectively delivered. Lastly, increased public awareness of One Health can strengthen education transformation.
In the area of relationship building, King remarked that IPE can serve as the missing link needed to build positive working relationships and collaborative networks. Relationship building can facilitate integration of strategies being brought forth by planetary health and convergence science. Rather than reinforcing silos, professionals should collaborate to combine these strategies into one cohesive future strategy—with AMR as a fulcrum—that links with health systems to sustain and protect natural
systems, said King. The next action area is upskilling. This involves meta-leadership, leading across organizations and agencies without the authority to do so. The “T-shaped” experts play a role in generating upskilling capacity. Furthermore, cultural awareness is needed to build teams with diverse ideas and backgrounds. King said that the need for innovation, implementation strategies, and project management leadership cannot be overemphasized in countering a volatile, uncertain, complex, and ambiguous world.
Capacity is the fourth action area. To address many employers’ unfamiliarity with the One Health workforce, he suggested creating new positions for advanced One Health experts that are specific to today’s needs, such as national preparedness and response officers, specialists in reducing risks at the human–animal–environmental interface, resilience resource experts, and pandemic prevention officers. The need for One Health workers in agriculture cannot be overstated, said King. The competencies to address crop issues and infectious disease in animals are aligned with One Health workforce competencies and can be the next extension of the concept. He also recommended creating national centers of foresight, prediction, and preparation.
King asserted that the greatest barrier to systematizing One Health is trying to reconcile technological changes, economic and global integration, and emerging health threats with traditional political structures, institutional arrangements, and habitual ways of doing things. He noted that it would be unwise to formalize structures within a system that is not receptive to One Health. In designing and preparing the One Health workforce, establishing and enabling a knowledgeable One Health workplace must also be attended to, said King.
UNIVERSITY NETWORKS ON THE FRONT LINES FOR COMMUNITY ENGAGEMENT AND ONE HEALTH INNOVATION
Woutrina Smith, University of California, Davis
Smith discussed general methods of collaboration and encouraging innovation, then outlined specific activities carried out in Africa and Asia through the One Health Workforce—Next Generation (OHW-NG) project, which partners with Africa One Health University Network (AFROHUN; formerly known as One Health Central and Eastern Africa) and the Southeast Asia One Health University Network (SEAOHUN).
Practices and Possibilities
Smith noted although the current global focus is on coronavirus disease 2019 (COVID-19), another future outbreak is inevitable—it could be
a different coronavirus, Ebolavirus, an arbovirus, or the like. To highlight current endeavors and possibilities in contending with the ongoing threat of outbreaks, she posed a series of scenarios and asked participants to consider whether the situations described are currently taking place or are not yet happening. The first scenario was being a phone call or e-mail away from communicating with colleagues on every continent. Smith stated this is currently taking place, and that efforts should continue in building a global network of health professionals committed to a One Health approach. Next, she presented the scenario of students regularly attending class with students based in other countries. This is not happening often. However, just as this workshop featured speakers from around the world connecting, such classes are a possibility that could become reality. Smith suggested that regularly bringing students together worldwide would help foster global citizenship and enable students to thrive. Furthermore, students could be encouraged to innovate and to share ideas via competitions for innovation. She remarked that holding innovation competitions provides a local context for applying and adapting ideas to make them effective. Students are the future, and the field can help them become leaders and systems thinkers through application-based competitions. Team-based problem solving being the norm was the next scenario. Smith argued that it is not yet the norm but is an achievable goal, with momentum building in that direction. She posited that teams collaborating across sectors and disciplines will be most effective in finding sustainable solutions. Finally, Smith introduced a scenario in which finding and working with colleagues from government, academia, and the private sector is easy. Despite challenges involved in realizing this scenario, ideas are being generated to overcome them, which is an important step toward implementing this best practice.
COVID-19 is a tragic wake-up call, and we need to be ready for the next pandemic, said Smith. Stories of resilience and innovation have emerged, and professionals are working to capture lessons learned to prepare for the future. The One Health approach considers connections among humans, animals, plants, and their shared environments in generating integrated solutions. She remarked that this will not be the last pandemic, so the One Health approach will be invaluable in moving forward effectively together as a global community during the next crisis.
One Health Workforce—Next Generation
Smith highlighted USAID’s contributions, including the Emerging Pandemic Threats program and PREDICT, which focused on surveillance and on-the-job training, and the One Health Workforce project. Currently, the OHW-NG project, an $85 million training arm funded for 2019–2024, focuses on pre-service education and experiential learning. A global team
works with AFROHUN and SEAOHUN at international, regional, and local levels. The goal of OHW-NG is to empower One Health university networks to sustainably develop and deliver world-leading model programs for equipping professionals with transdisciplinary skills to address complex global health issues. Smith noted that this involves creating space to innovate and providing networks with frameworks for adaptation and success into the future.
The OHW-NG project supports SEAOHUN, AFROHUN, and member universities in workforce empowerment, knowledge management, organizational sustainability, and gender issues. Workforce empowerment involves developing and delivering trainings in alignment with prioritized One Health core competencies and technical skills. Smith noted that in this effort, OHW-NG is working to decolonize global health. This living experiment involves shifting project leadership from primarily being based in the United States to the regional One Health university networks over the 5-year span of the project. This includes much twinning and operationalizing of business practices. Knowledge management includes establishing systems and strategies to evaluate performance and track workforce placements. Organizational sustainability is achieved by strengthening the capacities of regional One Health university networks for direct donor funding acquisition and management. The project supports gender integration as a core competency and includes gender considerations as a crosscutting theme. The training in the One Health approach is critical to the program, said Smith. She highlighted the need to empower local leadership to strengthen capacities in the long term, as some U.S.-based funders and organizations may not remain in the system indefinitely.
Training the Next Generation of One Health Leaders
Smith stated that SEAOHUN is operating in eight countries with 87 member universities and ministries and 28 One Health student clubs. Operating in nine countries with 18 member universities and 16 student One Health clubs, AFROHUN is expanding and developing a greater presence in West Africa, fostering collaborations, and recruiting faculty and students for many different types of training. Highlighting the recent work by student groups, Smith presented a video featuring a student reporting on Uganda’s Students One Health Innovations Club response to the COVID-19 pandemic (see Box 5-1). Smith remarked that these students are active, highly motivated, and serving on the front lines in their communities. As the pandemic developed, OHW-NG was working to build a global One Health community of practice. Many countries across Africa, Asia, Europe, and North America participated in interactive online sessions. The student role in local-level work and in community engagement has been critical, Smith noted.
Echoing King’s earlier presentation, Smith stated that competent One Health practice “is not just about what you know, it’s what you know how to do.” Using the competency approach, OHW-NG is developing an AFROHUN and SEAOHUN One Health Workforce Academy that will become live in 2021. She highlighted One Health innovations that are already taking place in Africa and Southeast Asia in areas including robotics, reducing exposure and contact in health care settings, and developing innovation and training approaches at the local community level. Virtual platforms and e-learning are used to both connect students across many countries in classroom instruction and create field-based experiential learning opportunities. Student One Health clubs are an avenue for delivering hands-on training; over the past year, this has taken place on the frontlines of the pandemic response, with students leading COVID-19 risk communication and community-engagement campaigns. Using the One Health approach, students conduct needs assessments and raise awareness about COVID-19 and other health issues. Smith noted that this is an active area of work, and OHW-NG plans to continue updating methods, incorporating innovations, and strengthening partnerships with local organizations and ministries of health, all of which foster sustainability of this One Health innovation project. Partnerships involve fellowships and internships,
in which students gain real-world experience working with COVID-19 response teams. Mentoring activities include students and faculty collaborating to create COVID-19 awareness videos, posters, and flyers. Smith shared that One Health digital awareness challenges have fueled these activities. A student competitor reflected on the experience: “We learned to be open minded to the opinion of others, to collaborate with each other. We also learned a lot about COVID-19 and how to influence others through online platforms.” Smith remarked that it is not possible to train everyone to be experts, but it is feasible to train people to be observant and use their experiences to come up with locally relevant solutions.
Another initiative, One Health Champions, was created to foster leadership and acknowledge innovation. Smith noted that many annual reports and publications feature practitioners’ successes, such as faculty members who recognize and promote the value of the approach and students demonstrating leadership in One Health clubs. Smith added that some One Health Champions work in Rwanda, a nation that has long committed to a One Health approach from the top down; this provides students with new opportunities for surveillance and training.
In spite of limitations created by COVID-19, in the past year OHW-NG has trained 22,569 individuals, mentored 46 student clubs, and conducted 51 activities increasing capacity to respond to the pandemic. The project has reach and plans to achieve scalability in applying best practices to new areas, said Smith. One Health puts technical knowledge and innovation into a social context—with crosscutting themes of economics and culture—that can elucidate how myriad diverse aspects of an issue relate to one another and inform the development of effective solutions, Smith emphasized.
The Role of Citizen Science in One Health
Harris asked whether citizen science might play a role in priming students of today to become good One Health agents of public health in the future. Additionally, she queried how the existing resources of pooled data and an interested public might be leveraged to strengthen the One Health approach. King remarked that the current moment provides an opportunity to engage stakeholders and the public to be more involved in One Health. He elaborated that citizen science does not merely provide researchers with valuable yet inexpensive data; it can improve a society’s broader involvement in, engagement with, and understanding of issues related to One Health efforts. Smith added that citizen science approaches are becoming more common, noting that the observational powers of the public can be helpful, with experiential learning offering an avenue for
engaging the public and helping them understand that they are part of the solution.
Overcoming Funding Shortages
A workshop participant noted that while academia and public education have valuable roles to play in building a future One Health workforce, schools and universities are struggling to pay for existing programming during the current funding crisis. The participant asked how One Health advocates might navigate the potential lack of receptiveness to new initiatives that educational institutions may have at this juncture. Smith acknowledged that the funding challenges are real, yet One Health can be part of the solution. As an example, she suggested that it can assist with building a diversified business model for finding innovative methods to access funding sources. She remarked that public–private partnerships can be explored for added value and collaboration beyond the public and academic spheres. In the OHW-NG project, specific private-sector partners are coming forward and offering support, such as fellowships for intern placements. Whenever possible, these types of relationships should be encouraged to broaden the inclusivity of One Health efforts, said Smith. King commented that the COVID-19 pandemic has demonstrated how video meetings can help to build capacity, because they enable collaboration without requiring participants to convene in one physical location. He added that Smith is using video meetings in OHW-NG activities, proving that capacity building does not necessarily require significant increases in funding to merit results. Exemplifying this, a program was recently hosted by Cornell University’s College of Veterinary Medicine, a local health system, and the New York department of public health, which trained 1,000 people with One Health competencies to address COVID-19.4 While this activity was carried out quickly and relatively inexpensively, it effectively develops beginning-level expertise, said King.
Increasing Public Trust in Scientific Experts
Another participant asked how to address the general public’s skepticism or unwillingness to listen to expert advice on infectious diseases. King remarked that the current polarization of the United States has had an
4 This series of online training courses for the New York State Public Health Corps drew on the Master of Public Health program in the College of Veterinary Medicine at Cornell University and collaborated with Northwell Health System. More information can be found at https://news.cornell.edu/stories/2021/01/cornell-help-train-states-pioneering-public-health-corps (accessed May 31, 2021).
impact on many individuals’ beliefs in science, resulting in trust deficiency. He stated that forcing ideas on people who are not ready to receive them only adds to polarization. Instead, time should be spent expanding the groups that do believe in expert scientific advice. Additionally, the speaker delivering a message affects receptivity, said King. Smith added that while this dynamic may be more apparent in the United States currently than in previous times, it is not a new phenomenon. For instance, some people have doubted the existence of Ebola for many years. Locally credible and knowledgeable individuals with access to communities can be effective in sharing messages in digestible ways. Students and faculty have made progress in effectively engaging with community leaders and groups, said Smith. People will not change behaviors unless they believe in the need to do so, and the One Health approach places technical knowledge into social contexts in digestible ways.
Grade-School Education Efforts
Harris asked about the role that primary and secondary school education might play in One Health’s sustainability efforts. Noting a comment that Kent Kester, vice president and head of translational science and biomarkers at Sanofi Pasteur and moderator of an earlier workshop session, made about the potential to spread One Health messaging through schoolchildren as has effectively been done in the past with education efforts on recycling, King remarked that grade-school education can be a useful strategy. Children in elementary and middle schools are captive audiences that often take in messaging and then share it with their parents. In this way, grade-school students can become a collective force for changing habits and behaviors. Smith stated that similar efforts are taking place in the food safety and infectious disease sectors, where children in the United States and other countries are taught in the classroom and given homework assignments that bring those lessons into their home environments. For instance, they may be asked to count the eggs their chickens produce or be tasked with keeping a notebook of chickens’ disease symptoms. Such real-life applications can help children understand these concepts at an early age; this understanding can then become internalized by the time they grow into adulthood. Smith suggested that “working upstream” in this way can be effective.
One Health Certificate
A participant asked if a One Health degree program would offer an advanced degree geared toward upper management positions or if it would be a professional certification designed for early career individuals and
students. Noting the concept of the “T-shaped” professional, Smith stated that professionals must have expertise in one area and a general awareness of the importance of collaboration and interdisciplinary work to have a role within a One Health team. Thus, a One Health certificate serving as an advanced credential might be most effective. Such a certificate would not replace One Health awareness efforts at earlier stages of education; rather, it would serve as an additional layer to be earned by professionals. A certificate would indicate soft skills that are valued by One Health employers, such as integrating ideas, working well on a team, and using systems thinking. King added that One Health degree programs are also attractive in early careers. Furthermore, employers need to become knowledgeable about the benefits these competencies bring to the organization. He remarked that building skills and knowledge is a lifelong pursuit of continual improvement, as it is with leadership skills.
Addressing Opportunity Inequality in Health Care
Harris asked about the role that One Health can play in deracializing, decolonizing, and improving equity in health care professions, given the lack of diversity in high-level health care careers in the United States and the financial and opportunity barriers to attaining such positions. Smith replied that this important question does not have clear answers but suggested expanding the current methods of extending One Health opportunities in knowledge, experience, and collaboration. Successes in these efforts can be used to establish best practices moving forward. Currently, veterinary schools in the United States are building on efforts made in the human health sector to increase diversity in incoming cohorts of students. Health professionals are beginning to consider needed steps in this area, but this work is in early stages, said Smith. King added that One Health emphasizes prevention and early detection. Approximately one billion people in the world’s lowest-income countries depend on plant and animal agriculture, so efforts to prevent infectious diseases and bolster nutrition are critical to achieving health equity. One Health focuses on preventing infections, which can have a profound impact within populations that are more likely to be severely infected by infectious diseases.
Role of Modeling Expertise in Expanding Prediction Capability
A participant stated that improving predictive capabilities and prevention at the source involves engaging infectious disease and landscape ecologists and mathematical modelers to merge complicated methodologies. The participant asked whether One Health education efforts include these disciplines to strengthen prediction and prevention. Smith replied that in
her work on the PREDICT project, on-the-job training approaches were used with country-level teams in collecting data, applying it to predictive models, and using the predictions to improve readiness moving forward. As OHW-NG is a training arm, the program routinely carries out this work. However, expansion of efforts in this area is needed to reach university and in-service audiences, said Smith. Foundational knowledge must be established before highly sophisticated methods can be learned, creating a spectrum of learners at various stages and levels of competency. Smith suggested that projects should continue to focus on increasing these capabilities.
King remarked that over the past 5 years, impressive advances in data analytics have resulted in new resources and opportunities for exploring datasets such that data analytics has become an additional area of proficiency for One Health professionals. He added that increasing focus on foresight and protection—by creating three national centers on foresight, prediction, and preparedness—is a feasible step toward optimizing the use of data analytics.
Environmental Justice and One Health
Harris asked the panelists for suggestions about how to incorporate conversations about environmental justice into One Health education. Smith noted that in the classes she teaches, students have some choice in the topics they address, and environmental justice issues are becoming more popular. Initially, this area was not a central One Health focus, she explained. However, One Health is a responsive, collaborative approach in which faculty and students learn from one another, so professionals should give this area of increasing demand more attention. King emphasized that One Health should first define societal needs and problem areas, then design competencies and curricula based on those needs. Interest is increasing in environmental science, environmental health, and equity, so One Health should incorporate this area into its purview, said King.
Preventing the Siloing of One Health Education
A participant noted that the aim of One Health is to combine disciplines, but the Western education system is likely to relegate it to a single specialty within a discipline rather than take a more holistic, cross-disciplinary approach. The participant asked if the One Health education’s ability to achieve its ultimate integrative goal necessitates changes in the overall way science is taught. King noted a Massachusetts Institute of Technology paper that identified three major transformation areas in science: molecular biology, genomics, and convergence science (Sharp et al., 2016). Convergence science brings together disciplines to create new opportunities,
and the National Science Foundation has allocated $30 million to growing convergence research as one of the organization’s “10 Big Ideas” for pioneering research and pilot activities.5 This focus on convergence science is an opportunity for One Health to avoid a singular disciplinary approach, said King. Smith added that One Health is an approach, not a discipline. Rather than designing a specific course or degree program, educators can incorporate One Health as a crosscutting theme. At UC Davis, funding was invested in a multi-campus effort to build topics related to sustainability, health, and the environment into the curricula of schools of medicine, pharmacy, and nursing. This effort did not mandate new courses. Instead, specific examples of the One Health approach can be used in conveying the concepts courses already address, updating curricula to incorporate the One Health approach.
REFLECTIONS ON DAY 2
Harris highlighted key themes and concepts from the panel discussions and plenary presentation session, and Peter Daszak, president of EcoHealth Alliance and member of the planning committee, summarized the presentations heard on day 2 of the workshop. The first panel discussed long-practiced efforts that fit within the One Health model yet are only recently being referred to as One Health practices, such as research on food-borne illness that uses an interdisciplinary genetics approach and the area of plant health that can serve as a model system for human health in terms of aerial surveillance and modeling communities and populations. The role of plant health and the impact of environmental disruptions on new diseases were discussed, with emphasis placed on the need to include plant health within One Health.
Panelists discussed an understudied area in the use of systems thinking and data analytics to understand the complexity of how components of an issue fit together. During-action reviews conducted in the midst of a crisis were discussed as helpful tools that can identify new resources in surge capacity, risk evaluation capacity, and epidemiology across sectors; they can also be leveraged to develop policies and resource sharing. Harris pointed out that community-based efforts were exemplified through engaging the Maasai population in Tanzania in the design of data collection tools. Involvement of the private sector, with Harris highlighting the use of natural history collections, such as the Outbreak: Epidemics in a Connected
5 More information about the National Science Foundation’s 10 Big Ideas can be found at https://www.nsf.gov/news/special_reports/big_ideas/index.jsp (accessed April 18, 2021).
World exhibit.6 Panelists explored the importance of breaking down silos and cautioned that even One Health programs have a risk of developing silos of animal, public, and ecosystem health.
In the second panel session, panelists focused on the need to expand One Health approaches both upward into leadership levels and downward into the workforce. Modernization of antiquated ideas and data collection systems and strategies for institutionalizing collaboration integration, including the establishment of data-sharing policies and standard operating procedures across agencies, were discussed. Additionally, the need to look at root causes and build resilience with equity was emphasized. Panelists considered the benefits of incorporating ecological and environmental dimensions and noncommunicable diseases into the One Health approach. Harris noted that the overarching themes of this panel discussion were mainstreaming, commitment, collaborative leadership, and integration.
King and Smith spoke on the competencies, skills, and milestones; the concept of competency-based education and curriculum; experiential pedagogy; and interprofessional education and practices that can build the future workforce. King pointed out that gaps in scalability, expansion across education sectors, embedding key competencies, and shifting knowledge to application exist in the current workforce. Addressing these gaps will require de-siloing, transformative thinking, relationship building, upskilling, and capacity building. The discussion addressed the role of citizen science, primary- and secondary-school education as an avenue for One Health awareness, becoming a “T-shaped” professional with both expertise and cross-disciplinary knowledge and competency, using One Health to decolonize and deracialize education and the workforce, and the concept of convergence science. Harris noted the emphasis on One Health being an approach, rather than a discipline.
Daszak expanded on Harris’s reflections by highlighting the theme of connectivity in the panel discussions and presentations. This connectivity is between people, livestock, and wildlife, and the current framework of rapid socioeconomic and environmental changes fuels a breakdown of interactions between them. He noted that some countries are making greater progress than others in using One Health as a central planning strategy for major health threats, such as emerging diseases, and that this progress has often been made in the context of experiencing repeat issues in recent years. The need for prominent use of a One Health approach in all countries and at all levels, from local to global, has emerged as a theme in this workshop, he added. Daszak described the COVID-19 pandemic as a One Health
6 A digital version of the exhibit was created in response to the COVID-19 restrictions and can be found at https://naturalhistory.si.edu/exhibits/outbreak-epidemics-connected-world (accessed May 31, 2021).
issue, because the virus spread through the interface of people, livestock, wildlife, and the environment. A more structured One Health approach may enable outbreaks to be stopped early on or even prevented entirely; one that is applied in every country and supported by global cooperation and collaboration could prevent some critical issues, such as pandemics, Daszak suggested.