One Health

Last month GEAR up’s Rosie Steege presented on gender, equity and AMR at the 8th Global Symposium on Health Systems Research in Nagasaki, as part of a session on social, environmental and ecological justice concerns.

Rosie opened by highlighting the fact that ‘One Health’ centres the interconnectedness of animals, humans and the environment. In doing so, it rejects a reductionist approach, removes binaries and there is therefore significant overlap between One Health and intersectional, feminist thought.

Rosie then used AMR, as a quintessential One Health issue, to highlight the importance of an intersectional & bio-social approach to equitable healthcare.

 AMR is it driven and shaped by environmental factors such as climate change, rapid urbanisation and environmental degradation. It also intersects with conflict which results in widespread disruption to healthcare systems, contamination from heavy metals and the establishment of refugee camps. In this way, it intersects with issues of environmental racism for those experiencing poor living conditions globally – including those living in urban informality who face crowded environments, poor access to water and sanitation and live and work in close proximity to animals and wastewater.

The current biomedical approach focusses on AMR surveillance data at facility levels. While we want to celebrate and recognise the amazing efforts in surveillance data globally, we also know that infrastructure has more impact on health than hospitals. So, we need to recognise a biomedical approach doesn’t pay due attention to the structural inequities that shape susceptibility, exposure, access to facilities and experiences of AMR.

Rosie also noted the biomedical approach doesn’t value the knowledge or agency of the communities it most affects. This knowledge is critical as One Health as an approach has been embodied by Indigenous communities for centuries.  Therefore, this is also an issue of epistemic injustice, exacerbated by short term funding cycles that create knowledge hierarchies and power imbalances.

Through GEAR up we will be trying to uncover some of these structural inequities that shape AMR globally and work with communities and build a community a practice in this area.  

Rosie added that while she had used the example of AMR to highlight this environmental injustice, it likely applies to many other areas in health. 

She left attendees with a question, as well as a proposed solution…

What can we do to embed both social and environmental justice into One Health?

1. We need to support a knowledge shift towards truly transdisciplinary, biosocial, anti-colonial, intersectional approaches that recognise structural inequities. This requires:
   • reflecting on our own positionalities
   • questioning our assumptions and
   • engaging with critical social science work – including ethics, safeguarding and the nature of rights
2. A collaborative approach is essential but we need to expand our collaborations and recognise there are other types of scientific knowledge – valuing community and indigenous knowledge through co-design and participation to advance both social and environmental justice.