Sub-theme 7. Global health commons between pandemics and glocal health
Panel 7.1.
Towards a game theory of integrated approaches to health
Health of humans and animals is multifacetted. It has a purely private dimension, it is probably the highest private asset in our life. Our own health is thus our highest private good. But health has also clearly an important public and a common dimension. By being infected by another person, or by infecting another person with a preventable (or non-preventable disease) health becomes eminently public and global . We can consider freedom of disease in its non-rivalrous and non-excludable quality as a common good in Ostrom’s understanding.
By analogy, un hindered spread of diseases, leading to outbreaks or endemic stable transmission of disease can be considered as a “tragedy of the commons” in Hardin’s sense. For example, ongoing transmission of rabies in many West and Central African countries is indeed a tragedy, causing the death of several ten thousand people, mostly children every year. In contrast, if all people exposed to rabies suspected animals could be protected with post-exposure prophylaxis (PEP), human death could be avoided and if successful dog mass vaccination campaigns at sufficient coverage would be done, rabies could even be eliminated and its cumulative cost would be lowest. Such a high level of cooperation across the levels of social organization, which is needed to eliminate dog mediated rabie requires transdisciplinary participatory process between all actors of civil society, authorities and academic actors.
This panel will discuss a generic approach to One Health as a commons.
Panel 7.1. A
1. The distribution of human brucellosis in the Armenian population relative to the livestock cases of brucellosis and cost analysis of brucellosis control in Armenia: A One Health approach
Swiss Tropical and Public Health Institute, Switzerland
Brucellosis is a well-known contagious disease transmitted from infected animals to humans through direct contact with animals and indirectly from consuming dietary products such as unprocessed milk and milk products. Aside from the economic losses from livestock brucellosis cases, the disease reduces the quality of life for infected humans. No study has spatially related human and livestock brucellosis cases, including the economic benefits and cost-effectiveness of the national brucellosis test-and-slaughter control program in Armenia.
Using a transdisciplinary approach, we aim to geospatially and epidemiologically analyze the relationships in human and livestock brucellosis cases across the Armenian provinces. In addition, a cost analysis for the next ten years will be conducted to estimate the cost-effectiveness and cost-benefits of optimized test-and-slaughter brucellosis control in the public health and agriculture sectors. To achieve this, a livestock population matrix model for 2012–2021 and a computed brucellosis DALY based on the duration of illness in humans will be matched to survey data comprising market unit costs of livestock products, including the cost of disease and management among Armenian brucellosis patients.
The spatial relationship of the human-livestock cases by provinces, as well as the evidence from the benefit-cost assessment of the intervention in livestock and humans, will inform Armenian decision-makers about policies on the control of brucellosis, which are expected to benefit public health, the agricultural sector, and consequently the Armenian economy.
2. Conviviality and composting as Afro-Brazilian forms of resistance and re-existence in times of climatic, environmental and pandemic crises
CETRAB- Center for the Study of Afro-Brazilian Traditions, Brazil
The multiple crises – environmental, climatic and pandemic – intersect with situations of pre-existing inequalities, with which they form a multidimensional weave that aggravates situations of precariousness and physical, psychological and social suffering and put the survival of populations and communities at risk. In Brazil, ecocide and ethnicide policies and the Covid-19 pandemic particularly affect Indigenous and traditional African-derived peoples, whose way of existence and survival are based on a vital relationship with the territory and other more-than-human beings.
Focusing on Candomblé communities, I explore how these multiple crises have been interpreted, experienced and addressed, as a manifestation of a single problem, namely an unbalanced relationship with the Earth and other more-than-human-beings.
A hybrid ontology, in which all more-than-human beings participate in a mesh of forces, flows and participations and are endowed with consciousness, and traditional forms of living in conviviality and in relationships of mutual becoming with other more-than-human beings stimulate forms of resistance and re-existence, compositions, alliances and composting.
The research is based on a ethnographic study with Candomblé practitioners in Rio de Janeiro and a survey of publications on local journals, blogs and social media.
3. Making Food Safer in Palestine: a One Health Approach to Antimicrobial Resistance
Swiss Tropical and Public Health Institute, Switzerland
A One-Health and transdisciplinary perspective, considering human-animal-environmental interfaces, is central to food safety as it embeds food production systems in their environmental, socioeconomic, and public health context, which is rooted in common health.
This research used a mixed-methods design (qualitative, quantitative, and laboratory designs) to find a critical methodology to foster food safety by better understanding zoonotic foodborne illness transmission and their resistance to antimicrobials in complex socio-ecological systems like those in Palestine. Broiler production was chosen as a prime example of food production in Palestine.
In the qualitative part, the multi-stakeholder discussion groups pointed out various challenges along the food production chain in Palestine, such as a striking scarcity of public slaughterhouses, insufficient coordination between authorities, a gap between public and private sectors, and inconsistent application of the law. A semi-structured observational study shows that public slaughterhouses and meat markets have effective hygiene, unlike traditional broiler production, while large-scale farms implement biosecurity measures. In phenotypic and genotypic analysis, we found a high frequency of Campylobacter and Salmonella in the chicken meat production chain with multiple antimicrobial resistance. This supports a substantial public health burden associated with Salmonella and Campylobacter from chicken sources.
This project recommends urgently building an integrated national surveillance system in Palestine to efficiently and sustainably monitor and manage zoonotic disease outbreaks, the spread of AMR, and other health threats.
4. Health Professional and Pastoralist Knowledge, Attitude, and Practice about Antimicrobial Resistance and Climate Change in Somali Region, Eastern Ethiopia: A Qualitative Study
Swiss Tropical and Public Health Institute, Switzerland
Antimicrobial resistance (AMR) and climate change (CC) threaten the global health and economy, yet most people are unaware that it is common health. This qualitative research aimed to understand the knowledge, attitude, and practice (KAP) about AMR and CC on communities and health professionals in Ethiopia.
A qualitative study was conducted in three sites in Ethiopia. Forty-four in-depth interviews were performed with health professionals in urban, semi-urban, and rural settings. Additionally, 12 focus groups involving rural populations were held. A content and theme analysis was performed.
Regardless of the settings (rural or urban), the majority of health professionals and communities had poor knowledge of AMR, with the exception of doctors and pharmacists. Most participants had never heard of CC and widely misunderstood the terms “CC” and “weather”. After simple explanations of the term “CC” the rural communities and health professionals understood it better than urban health professionals and recounted their experience with the negative impacts of CC. For the AMR determinants, the majority of health professionals blame the community for antimicrobial misuse, the pharmacy for selling antimicrobials without prescriptions, and themselves for overprescribing antimicrobials. Overall, participants advised educating health professionals and communities, enforcing legal limitations on antibiotic sales, and strengthening health facility diagnostics should reduce the problem.
AMR knowledge gap was by profession, not by setting, while CC knowledge was by setting. Different stakeholders blamed each other for AMR’s spread, demonstrating a lack of shared responsibility. Understanding AMR and CC as common health challenges requires a multidisciplinary one-health approach.
5. Global health commons between pandemics and glocal health
Swiss Tropical and Public Health Institute, Switzerland
Health of humans and animals is multifaceted. It is probably the highest private asset in a person’s life. But health has also an important public and common dimension. By being infected by another person, or by infecting another person with a preventable (or non-preventable) disease, health becomes eminently public and global. We postulate that freedom of disease in its non-rivalrous and non-excludable quality as a common good or public good. By analogy, unhindered spread of disease, leading to outbreaks, or endemic stable transmission of disease can be considered as a ‘tragedy of the commons’, as described by Hardin (1968). For example, uncontrolled dog transmitted rabies in many West and Central African countries is indeed tragic, causing the deaths of tens of thousands of people, mostly children, every year. Protecting humans with post-exposure prophylaxis (PEP) prevents human death. But PEP alone will never eliminate the disease because dogs are the reservoir host. Dog mass vaccination campaigns could eliminate rabies and prevent human death. This however requires high level of collaboration across the levels of social organization, from household to national governments and between governments. Transdisciplinary participatory processes, negotiating consensus between all actors of civil society, authorities and academic actors may lead to the required high level of collaboration. Presentations in this panel report on experiences on the development of integrated approaches of human and animal health collaboration within a One Health context adapted to the paradigm of governing the commons by Elinor Ostrom.
Panel 7.1. B
1. One Health as a common good – only realisable in multilingual transdisciplinary collaboration
Swiss Tropical and Public Health Institute, Switzerland
One Health should be understood here as the linkage of the health of humans, animals and their environment. Thus, One Health is always interdisciplinary and to be seen as a common good – for humans, animals and the environment. We all need health and only together can we be sustainably healthy. In order to achieve this, the work in the field of One Health is increasingly transdisciplinary, meaning the cooperation (integration) of academic researchers from different disciplines with non-academic participants, often between different cultures and languages, in co-creating new knowledge and theory to achieve a common goal for One Health as commons. This creates incremental added value, insights or benefits that are not gained in interdisciplinary collaboration alone. One Health, as understood here, is based on a multi-epistemic approach with values and concepts manifested in language (embedded in various communicative practices and strategies), which contradicts the use of a common language. Even when using a lingua franca, so-called intralingual multilingualism occurs due to the different technical languages and dialects within a language: One Health is therefore always multilingual, which has also ethical implications. We anlayse qualitatively communication examples of different international and transdisciplinary projects in the field of One Health.
This conference presentation will show the multiepistemic collaboration in One Health and its specificities regarding communication and consensual intercultural hermeneutics. It will become clear that only through joint, ethically acceptable and strategically planned multilingual communication in transdisciplinary cooperation will we achieve our common goal – one health as a common good.
2. Management of diseases in a ruminant livestock production system: an appraisal of the performance of veterinary services delivery, and utilization in Ghana
1Swiss Tropical and Public Health Institute, Switzerland, 2Faculty of Medicine, University of Basel, Switzerland, 3Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Ghana, 4Faculty of Science, University of Basel, Switzerland, 5Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Côte d’Ivoire
Sustainable livestock production remains crucial for attaining food security globally. Ineffective control of livestock diseases often reduces livestock productivity. This study assessed management strategies employed by farmers for priority diseases, the utilization rate, and performance of veterinary services. We conducted a mixed-method study in three districts in Ghana involving surveys of 350 livestock farmers and 13 veterinary officers (VOs). We also conducted 7 FGD involving 65 farmers.
The survey data were analyzed, and management strategies and performance of veterinary services described. FGD transcripts were analyzed deductively.
Majority (98%) of farmers reared small ruminants, with 25% also rearing cattle. The prevalent diseases were Pestes-des-Petits-Ruminants and Mange, and Contagious-Bovine-Pleuropneumonia and Foot-and-Mouth-Disease in small ruminants and cattle respectively. Majority (82%) of farmers used treatment, while only 20% used vaccination services. Antimicrobials used in managing diseases are poorly regulated by the veterinary system (VS), and wrongly applied by farmers in treatments. Farmers mainly use informal providers services (51%), with only 33% utilizing VOs. VOs performed highly on medicine availability and quality, treatment effectiveness, education, service affordability, and competence, while informal providers were better in proximity and popularity with farmers.
Vaccine-preventable diseases constrain livestock productivity in Ghana. Although VOs performed better in service delivery, they are seldom used. The VS inability to control antimicrobials in animal production contribute to their misuse by farmers. New efforts to improve VS governance, antimicrobial stewardship, and adoption of vaccination by farmers are needed to food security.
Keywords: Diseases management, Antimicrobials, Veterinary Services Governance, Ruminant livestock, Livestock diseases, One Health
3. Impact of COVID-19 on women entrepreneurs in the MSME sector in Kerala
1T John College, Bengaluru, India, 2Presidency University, Bengaluru, India
There is a lot of evidence that COVID-19 has different effects on women and other groups. Covid-19 is the most harmful pandemic that has ever hit the global economy and the small and medium-sized business (MSME) sector in particular. This study, “Impact of COVID-19 on women entrepreneurs in the MSME sector in Kerala,” is meant to look at how the COVID-19 pandemic affected women entrepreneurs and their businesses on a macro level. The sample size was chosen based on a proportional random sampling method. The collected sample only shows the types of businesses that women in the region start and the problems they face. Some of the most important findings from the study include a drop in orders and sales, income, and jobs. Changes can happen when research findings are widely shared, people learn about them, they learn how to do things better, and different voices are heard.
4. The distribution of human brucellosis in the Armenian population relative to the livestock cases of brucellosis and cost analysis of brucellosis control in Armenia: A One Health approach
Swiss Tropical and Public Health Institute, Switzerland
Brucellosis is a well-known contagious disease transmitted from infected animals to humans through direct contact with animals and indirectly from consuming dietary products such as unprocessed milk and milk products. Aside from the economic losses from livestock brucellosis cases, the disease reduces the quality of life for infected humans. No study has spatially related human and livestock brucellosis cases, including the economic benefits and cost-effectiveness of the national brucellosis test-and-slaughter control program in Armenia.
Using a transdisciplinary approach, we aim to geospatially and epidemiologically analyze the relationships in human and livestock brucellosis cases across the Armenian provinces. In addition, a cost analysis for the next ten years will be conducted to estimate the cost-effectiveness and cost-benefits of optimized test-and-slaughter brucellosis control in the public health and agriculture sectors. To achieve this, a livestock population matrix model for 2012–2021 and a computed brucellosis DALY based on the duration of illness in humans will be matched to survey data (2022-2023) comprising market unit costs of livestock products, including the cost of disease and management among Armenian brucellosis patients.
The spatial relationship of the human-livestock cases by provinces, as well as the evidence from the benefit-cost assessment of the intervention in livestock and humans, will inform Armenian decision-makers about policies on the control of brucellosis, which are expected to benefit public health, the agricultural sector, and consequently the Armenian economy.
