Okello Anna L, Bardosh Kevin, Smith James, Welburn Susan C
Division of Pathway Medicine and Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom.
Centre of African Studies, School of Social and Political Science, The University of Edinburgh, Edinburgh, United Kingdom.
PLoS Negl Trop Dis. 2014 May 22;8(5):e2884. doi: 10.1371/journal.pntd.0002884. eCollection 2014 May.
The recent emergence of zoonotic diseases such as Highly Pathogenic Avian Influenza (HPAI) and Severe Acute Respiratory Syndrome (SARS) have contributed to dominant Global Health narratives around health securitisation and pandemic preparedness, calling for greater co-operation between the health, veterinary and environmental sectors in the ever-evolving One Health movement. A decade later, One Health advocates face increasing pressure to translate the approach from theory into action.
METHODOLOGY/PRINCIPAL FINDINGS: A qualitative case study methodology was used to examine the emerging relationships between international One Health dialogue and its practical implementation in the African health policy context. A series of Key Informant Interviews (n = 32) with policy makers, government officials and academics in Nigeria, Tanzania and Uganda are presented as three separate case studies. Each case examines a significant aspect of One Health operationalisation, framed around the control of both emerging and Neglected Zoonotic Diseases including HPAI, Human African Trypanosomiasis and rabies. The research found that while there is general enthusiasm and a strong affirmative argument for adoption of One Health approaches in Africa, identifying alternative contexts away from a narrow focus on pandemics will help broaden its appeal, particularly for national or regionally significant endemic and neglected diseases not usually addressed under a "global" remit.
CONCLUSIONS/SIGNIFICANCE: There is no 'one size fits all' approach to achieving the intersectoral collaboration, significant resource mobilisation and political co-operation required to realise a One Health approach. Individual country requirements cannot be underestimated, dismissed or prescribed in a top down manner. This article contributes to the growing discussion regarding not whether One Health should be operationalised, but how this may be achieved.
高致病性禽流感（HPAI）和严重急性呼吸综合征（SARS）等人畜共患病的近期出现，促成了围绕卫生安全化和大流行防范的全球卫生主导叙事，呼吁卫生、兽医和环境部门在不断发展的“同一健康”运动中加强合作。十年后，“同一健康”倡导者面临着将该方法从理论转化为行动的越来越大的压力。
方法/主要发现：采用定性案例研究方法，考察国际“同一健康”对话与其在非洲卫生政策背景下的实际实施之间新出现的关系。作为三个独立的案例研究，呈现了对尼日利亚、坦桑尼亚和乌干达的政策制定者、政府官员和学者进行的一系列关键信息人访谈（n = 32）。每个案例都考察了“同一健康”实施的一个重要方面，围绕包括高致病性禽流感、人类非洲锥虫病和狂犬病在内的新出现的和被忽视的人畜共患病的控制展开。研究发现，虽然在非洲普遍热衷于并强烈主张采用“同一健康”方法，但确定远离狭隘的大流行关注的替代背景将有助于扩大其吸引力，特别是对于通常不在“全球”范围内处理的具有国家或区域重要性的地方病和被忽视疾病。
结论/意义：实现“同一健康”方法所需的部门间协作、大量资源调动和政治合作，不存在“一刀切”的方法。不能低估、忽视或自上而下地规定个别国家的需求。本文有助于就“同一健康”是否应该实施，而是如何实现这一问题展开的日益激烈的讨论。
