Spencer Julia, McRobie Ellen, Dar Osman, Rahman-Shepherd Afifah, Hasan Nadeem, Hanefeld Johanna, Khan Mishal
Centre on Global Health Security, Chatham House, London, UK.
London School of Hygiene & Tropical Medicine, London, UK.
BMJ Glob Health. 2019 Feb 8;4(1):e001102. doi: 10.1136/bmjgh-2018-001102. eCollection 2019.
The global health field has witnessed the rise, short-term persistence and fall of several movements. One Health, which addresses links between human, animal and environmental health, is currently experiencing a surge in political and financial attention, but there are well-documented barriers to collaboration between stakeholders from different sectors. We examined how stakeholder dynamics and approaches to operationalising One Health have evolved further to recent political and financial support for One Health.
We conducted a mixed methods study, first by qualitatively investigating views of 25 major policymakers and funders of One Health programmes about factors supporting or impeding systemic changes to strengthen the One Health movement. We then triangulated these findings with a quantitative analysis of the current operations of 100 global One Health Networks.
We found that recent attention to One Health at high-level political fora has increased power struggles between dominant human and animal health stakeholders, in a context where investment in collaboration building skills is lacking. The injection of funding to support One Health initiatives has been accompanied by a rise in organisations conducting diverse activities under the One Health umbrella, with stakeholders shifting operationalisation in directions most aligned with their own interests, thereby splintering and weakening the movement. While international attention to antimicrobial resistance was identified as a unique opportunity to strengthen the One Health movement, there is a risk that this will further drive a siloed, disease-specific approach and that structural changes required for wider collaboration will be neglected.
Our analysis indicated several opportunities to capitalise on the current growth in One Health initiatives and funding. In particular, evidence from better monitoring and evaluation of ongoing activities could support the case for future funding and allow development of more precise guidelines on best practices.
全球卫生领域见证了多个运动的兴起、短期持续和衰落。“同一健康”理念旨在解决人类、动物和环境健康之间的联系，目前正受到政治和资金方面的高度关注，但不同部门利益相关者之间的合作存在诸多有据可查的障碍。我们研究了利益相关者动态以及实施“同一健康”理念的方法是如何随着近期对“同一健康”的政治和资金支持而进一步演变的。
我们开展了一项混合方法研究，首先定性调查了25位“同一健康”项目的主要政策制定者和资助者对支持或阻碍加强“同一健康”运动的系统性变革的因素的看法。然后，我们通过对100个全球“同一健康”网络的当前运作情况进行定量分析，对这些结果进行了三角互证。
我们发现，近期高层政治论坛对“同一健康”的关注加剧了主要的人类和动物健康利益相关者之间的权力斗争，而此时缺乏对合作建设技能的投资。为支持“同一健康”倡议注入资金的同时，在“同一健康”框架下开展各种活动的组织也有所增加，利益相关者将实施工作转向与其自身利益最相符的方向，从而导致该运动碎片化并被削弱。虽然国际社会对抗菌素耐药性的关注被视为加强“同一健康”运动的独特机会，但存在这样一种风险，即这将进一步推动一种孤立的、针对特定疾病的方法，而更广泛合作所需的结构变革将被忽视。
我们的分析指出了利用当前“同一健康”倡议和资金增长的几个机会。特别是，对正在进行的活动进行更好的监测和评估所获得的证据，可以为未来的资金申请提供支持，并有助于制定更精确的最佳实践指南。
