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      Is the current surge in political and financial attention to One Health solidifying or splintering the movement?

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          Abstract

          Introduction

          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.

          Methods

          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.

          Results

          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.

          Conclusion

          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.

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          Most cited references34

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          Generation of political priority for global health initiatives: a framework and case study of maternal mortality.

          Why do some global health initiatives receive priority from international and national political leaders whereas others receive little attention? To analyse this question we propose a framework consisting of four categories: the strength of the actors involved in the initiative, the power of the ideas they use to portray the issue, the nature of the political contexts in which they operate, and characteristics of the issue itself. We apply this framework to the case of a global initiative to reduce maternal mortality, which was launched in 1987. We undertook archival research and interviewed people connected with the initiative, using a process-tracing method that is commonly employed in qualitative research. We report that despite two decades of effort the initiative remains in an early phase of development, hampered by difficulties in all these categories. However, the initiative's 20th year, 2007, presents opportunities to build political momentum. To generate political priority, advocates will need to address several challenges, including the creation of effective institutions to guide the initiative and the development of a public positioning of the issue to convince political leaders to act. We use the framework and case study to suggest areas for future research on the determinants of political priority for global health initiatives, which is a subject that has attracted much speculation but little scholarship.
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            A Comparison of Three Holistic Approaches to Health: One Health, EcoHealth, and Planetary Health

            Several holistic and interdisciplinary approaches exist to safeguard health. Three of the most influential concepts at the moment, One Health, EcoHealth, and Planetary Health, are analyzed in this paper, revealing similarities and differences at the theoretical conceptual level. These approaches may appear synonymous, as they all promote the underlying assumption of humans and other animals sharing the same planet and the same environmental challenges, infections and infectious agents as well as other aspects of physical—and possibly mental—health. However, we would like to illuminate the differences between these three concepts or approaches, and how the choice of terms may, deliberately or involuntary, signal the focus, and underlying values of the approaches. In this paper, we have chosen some proposed and well-known suggestions of definitions. In our theoretical analysis, we will focus on at least two areas. These are (1) the value of the potential scientific areas which could be included and (2) core values present within the approach. In the first area, our main concern is whether the approaches are interdisciplinary and whether the core scientific areas are assigned equal importance. For the second area, which is rather wide, we analyze core values such as biodiversity, health, and how one values humans, animals, and ecosystems. One Health has been described as either a narrow approach combining public health and veterinary medicine or as a wide approach as in the wide-spread “umbrella” depiction including both scientific fields, core concepts, and interdisciplinary research areas. In both cases, however, safeguarding the health of vertebrates is usually in focus although ecosystems are also included in the model. The EcoHealth approach seems to have more of a biodiversity focus, with an emphasis on all living creatures, implying that parasites, unicellular organisms, and possibly also viruses have a value and should be protected. Planetary Health, on the other hand, has been put forward as a fruitful approach to deal with growing threats in the health area, not least globally. We conclude that there are actually important differences between these three approaches, which should be kept in mind when using any of these terms.
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              Operationalizing the One Health approach: the global governance challenges.

              While there has been wide-ranging commitment to the One Health approach, its operationalisation has so far proven challenging. One Health calls upon the human, animal and environmental health sectors to cross professional, disciplinary and institutional boundaries, and to work in a more integrated fashion. At the global level, this paper argues that this vision is hindered by dysfunctions characterising current forms of global health governance (GHG), namely institutional proliferation, fragmentation, competition for scarce resources, lack of an overarching authority, and donor-driven vertical programmes. This has contributed, in part, to shortcomings in how One Health has been articulated to date. An agreed operational definition of One Health among key global institutions, efforts to build One Health institutions from the ground up, comparative case studies of what works or does not work institutionally, and high-level global support for research, training and career opportunities would all help to enable One Health to help remedy, and not be subsumed by, existing dysfunctions in GHG.
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                Author and article information

                Journal
                BMJ Glob Health
                BMJ Glob Health
                bmjgh
                bmjgh
                BMJ Global Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2059-7908
                2019
                8 February 2019
                : 4
                : 1
                : e001102
                Affiliations
                [1 ] departmentCentre on Global Health Security , Chatham House , London, UK
                [2 ] London School of Hygiene & Tropical Medicine , London, UK
                [3 ] departmentDepartment of Infectious Disease Epidemiology , Imperial College London , London, UK
                [4 ] departmentDepartment of Global Health and Development , London School of Hygiene & Tropical Medicine , London, UK
                [5 ] departmentFaculty of Public Health and Policy , London School of Hygiene & Tropical Medicine , London, UK
                Author notes
                [Correspondence to ] Dr Mishal Khan; mishal.khan@ 123456lshtm.ac.uk

                JS and EM are joint first authors.

                Author information
                http://orcid.org/0000-0001-9487-2333
                Article
                bmjgh-2018-001102
                10.1136/bmjgh-2018-001102
                6407571
                30899558
                6a178737-f437-4006-baec-07f121364f88
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 09 August 2018
                : 20 December 2018
                : 21 December 2018
                Categories
                Research
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                one health, b> health policy

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