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Institute of Medicine (US). Improving Food Safety Through a One Health Approach: Workshop Summary. Washington (DC): National Academies Press (US); 2012.

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Improving Food Safety Through a One Health Approach: Workshop Summary.

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The concept of One Health is not new but it has reemerged as an important concept to both understand and help address our contemporary challenges and threats to our health.

We live in a world that is rapidly changing, complex, and progressively more interconnected. The convergence of people, animals, and our environment has created a new dynamic—one in which the health of each group is now profoundly and inextricably linked and elaborately connected.

Inherent in this new dynamic is the changing interface between people and animals, including animal products. The human–animal interface is accelerating, expanding, and becoming increasingly more consequential. Over the past three decades, approximately 75 percent of new human infectious diseases have been zoonotic. The global population has now exceeded 7 billion people, and an estimated 30 billion food animals were produced to help feed this population and meet its growing demand for protein from animal sources. The result is a phenomenal global food system that is both a major agricultural and business accomplishment and an unparalleled challenge that is creating major societal issues that, to some extent, threaten human, animal, and environmental health (FAO, 2006).

As a further consequence, the safety of our food is being increasingly scrutinized and questioned by the public, and food-borne illnesses are significant, costly, and a global problem. There continue to be differences of opinion on how to improve food safety, and we lack an integrated and holistic strategy for implementation in the United States and much of the world. While we acknowledge some success in controlling and ameliorating food-borne illnesses and food contamination, these achievements are uneven, often transitory, and especially difficult. Ensuring a safe food supply will likely demand new levels of collaboration, understanding, and thinking. The application of a One Health model where potential solutions are viewed and delivered more holistically and with an emphasis on prevention is a compelling and timely strategy.

One Health Defined

One Health is the collaborative effort of multiple disciplines—working locally, nationally, and globally to attain optimal health for people, animals, and our environment (King et al., 2008). The scale and complexity of food safety issues demand that scientists, researchers, and others move beyond the confines of their own disciplines, professions, and mindsets and explore new organizational modes of team science, and the One Health concept embodies this declaration. The scope of One Health is impressive, broad, and growing. Much of the recent focus of One Health has been limited to emerging infectious diseases, yet the concept clearly embraces environmental and ecosystem health, social sciences, ecology, noninfectious diseases and chronic diseases, wildlife, land use, antimicrobial resistance, biodiversity, and much more. While these components are appreciated within our understanding of the broad dimensions of health, they also add to the complexity of One Health and the difficulty in implementing strategies, building effective coalitions, and mobilizing scientific communities who embrace One Health yet who have been trained and think in much narrower scope and scale. Although there may be disagreement on the exact definition of One Health there is broad consensus that a new framework for preventing food-borne diseases is essential rather than the alternative of constantly responding to them reactively.

“Wicked” Problems

We now live in a world that is complex, interconnected, and uncertain, with growing dilemmas and unprecedented societal problems. These problems have been referred to as “wicked problems” and are contrasted with “tame problems,” which can be solved with existing modes of inquiry, technological knowledge, and decision making. Wicked problems are complex, do not have yes-or-no answers, can generate unexpected consequences, may be symptomatic of other problems, and are unique in that past experiences and thinking are not helpful in addressing them. In addition, wicked problems and issues often crop up as organizations face constant change and unparalleled challenges, and they often occur in a social context with diverse opinions from numerous stakeholders who lack consensus in both identifying the total problem and how to resolve them (Brown et al., 2010).

Issues and problems connected with food safety, food security, sustainable production systems that ensure environmental protections, and the capacity to help feed more than 7 billion people collectively qualify as a societal and wicked dilemma. Ensuring safe, accessible, affordable, and nutritious food is increasingly difficult, especially in a global context. Central to this challenge is the development of a One Health strategy and a new level of thinking and acting.

The world population has a growth rate of 1.2 percent per year and the next century will represent a period of exponential growth. There is also a significant demographic fault line between the population growth in developed versus developing countries. Approximately 90 percent of the world's population growth is occurring in the developing countries of the world. In addition almost 1 billion people live in peri-urban or slum settings in the developing world's largest cities, and these sites are where the most rapid growth in our human populations will continue (Smith and Kelly, 2008).

While there is also legitimate concern about the approximately 800 million people who are undernourished, we are concurrently observing a relative increase in wealth in the developing world and as per capita incomes rise; people eat more calories and consume different products, including a demand for meat and protein from animal sources. Today, 3 to 4 billion people consume very little meat but will consume more, should incomes increase. Thus, a new agricultural phenomenon is emerging: the Livestock Revolution. With relative increases in wealth and technological advances in livestock and poultry production, global increases in production and consumption of livestock products are unavoidable. The Food and Agriculture Organization (FAO) estimates that there will be a demand for a 50 percent increase for animal proteins in the next one to two decades. Thus, the entire global food system will adjust into a more intensive, specialized, and integrated system, and production systems will progressively shift to the developing world (Delgado et al., 1999).

As the Livestock Revolution ushers in a rapidly expanding animal agriculture production system in the developing world, there is real concern regarding the animal and public health infrastructures available to support this revolution. The United States now imports approximately 15 percent of its food, but it imports a much higher percentage of seasonable fruits, vegetables, and seafood (Acheson, 2010). The need for inspecting these products is growing much more quickly than the regulatory system now in place to implement such safeguards.

Concurrently, there is unprecedented immigration and movement of people worldwide. Unique diasporas have emerged, and there are large numbers of immunocompromised individuals dispersed throughout the United States and global populations who are especially susceptible to infections including food- and water-borne illnesses. In many countries, the population of seniors is one of the fastest growing cohorts.

There is also a disconnect between global commerce and the remarkable movement of food in trade channels and the commensurate emphasis and assurance of safe food. There is a significant gap between an emphasis on the rapidly growing commerce and business of global food companies and an equal emphasis and investment to address the potential health consequences generated by global food and animal commerce (Kimball, 2010). The 21st century has created a great mixing bowl of people, animals, and animal products and a group of wicked problems, including the protection and safety of our food, that demands a transformation of thought and actions to address these contemporary challenges, threats to our health and well-being, and threats to animal and environmental health that are under increasing pressure. A holistic and integrated approach considering these domains in a One Health strategy is both logical and essential to further success.

Food Safety: Trends and Concerns

The Centers for Disease Control and Prevention (CDC) now estimates that, in the United States, there are 48 million food-borne illnesses, 128,000 hospitalizations, and 3,000 deaths each year (Scallan et al., 2011). Thus, one out of six Americans will have at least one episode of a food-borne illness annually. Although we lack similar global data, a rough extrapolation would suggest that there could be at least 1 billion such illnesses worldwide each year. This would qualify as a global public health epidemic by any definition; however, there are few surveillance systems that can help us track and define the global burden of food-borne illnesses. With these estimates of the burden of illness, the global food system continues to grow increasingly more vulnerable and potentially riskier and progressively connects our global communities daily through our growing imports and exports of food.

Today, microbes can traverse the globe faster than their incubation period; our great convergence offers unique opportunities for them to cross species lines, become resistant to antimicrobial agents, adapt, change, and find new niches, and emerging and reemerging diseases result. Our current era of emerging infections and pace of emergence is accelerated with changing ecosystems, risky human behavior, poverty, travel, trade, globalization, population growth, and our interconnectiveness. Food as a potential vehicle for disease transmission is embedded in this complex system; food safety has taken on a growing importance and has become a critical public health imperative.

As we learn more about the burden of food-borne illness, we also appreciate and learn about new pathogens transmitted by food and the expansion of the types of food that can transmit potential food-borne pathogens. We are reminded that bacterial contamination of food is a critical issue; however, viruses, parasites, toxins, prions, chemicals, metals, and allergens may also be transmitted by food and water and result in an expanded burden of illness and growing spectrum of threats.

CDC studies have also demonstrated changing patterns of attribution. Plant-derived foods such as leafy greens, tomatoes, and sprouts have been implicated in more and more food-borne disease outbreaks. In the recent past, transmission has been linked to peanut butter, pizza, spinach, ice cream, cookie dough, pet food, melons, peppers, and carrot juice. We are also concerned about the concept of “stealth” vehicles in transmission. There are numerous food ingredients that are often mixed in with foods, such as spices, which can be vehicles for transmission. It is estimated that 75 percent of our food that has been processed has an ingredient from an international source (Doyle and Erickson, 2008).

In addition to the traditional food-borne pathogens such as Escherichia coli, Salmonella, Campylobacter, Listeria, and so on, new outbreaks often reveal new agents. The FoodNet system that analyzes outbreaks has revealed adenoviruses, sapoviruses, saffoldviruses, and picobirnaviruses as potential pathogens (Tauxe, 2008). To further complicate our understanding of the safety of our food, transmission vehicles can change when microbes are given new opportunities. For example, the Nipah virus first found in a zoonotic disease outbreak in Malaysia that killed pigs and people associated with them has recently been found as a contaminant in date palm sap, a food source in Bangladesh. Pteropus fruit bats are the asymptomatic carriers. Trypanosoma cruzi is the parasite that causes Chagas disease and is usually transmitted to people via reduvid insects, yet it has recently been found in sugar cane juice in Brazil. There is a remarkable spectrum of foods and pathogens involved in food-borne illnesses, and this is an ever-changing dynamic. There is a growing importance of produce as a vehicle for food-borne pathogens, yet animal reservoirs are often the origin of these infections. One Health gives us the proper lens to view and better understand this linkage and, more importantly, to develop new insights for changing our interventions and prevention strategies. In many instances, ill people are the end point of a complicated epidemiological cycle and serve as indicator hosts; however, if we continue to focus exclusively on food-borne illness by responding to human outbreaks and just conducting retrospective analyses, then we will miss the true sites and origins of these diseases and we will forgo critical prevention strategies. To a certain extent, ill people serve as sentinels of a larger ecological problem and, as such, may not be the best focal point for our interventions. One Health is a mindset that is proactive and preventive and helps to shift our attention “upstream” to the ecological, animal, and environmental sources and influences responsible for these illnesses and helps us to identify the most effective points for the initiation of food safety actions.

According to Jared Diamond, in his book Guns, Germs, and Steel, diseases such as measles, smallpox, influenza, and tuberculosis likely evolved from animal diseases as the first group of zoonotic diseases (Diamond, 1999). The advent of agriculture and the domestication of animals approximately 8,000 to 10,000 years ago were drivers of a new human–animal interface and the first era of emerging zoonotic diseases. Although animal agriculture is much more sophisticated today, it is also growing more intensified and complex. Domestication has resulted in the development of new and more efficient food-animal species, and the human–animal interface has accelerated and multiplied through the globalization of our food system and has created the potential exposure of billions of people to potential pathogens. As our food-animal production and ecosystems continue to change to produce more and more, microbes are given further opportunities to adapt and find new niches. Transboundary diseases have again emerged at an alarming rate, suggesting that our new era of disease emergence has a troubling similarity to the past era that was created 8,000 to 10,000 years ago.

One Health Lens to View and Improve Food Safety

Dr. Gro Brundtland, former Director of the World Health Organization, stated, “In the modern world, bacteria and viruses travel almost as fast as money. With globalization, a single microbial sea washes all of humankind. There are no health sanctuaries.” In actuality, that microbial sea washes not only over all humankind, but also across our animal and environmental domains. This dynamic exposes and connects the human, animal, and environmental domains in ways never previously experienced. Positive and negative actions and impacts in one domain now may significantly impact the others, and solutions to address threats in any single domain may have multiplier effects in the others. This is the essence of One Health, and the safety of our food must also be considered using this mindset.

Yet as our food systems grow ever more complex, larger, and more vulnerable, our scientific, medical, agricultural, environmental, and health systems and studies remain too isolated and entrenched. Perhaps our greatest challenge today may be our ability to reconcile the changes and challenges of our global convergence with our traditional thinking and habitual ways of working. For many zoonotic diseases, including certain food-borne illnesses, we focus on the risk to human health while the most effective control strategies are in animals, animal products, and the environment. There are divided constituents and responsibilities for animal and human health that must be integrated in order to make significant progress in the reduction of many food-borne illnesses. The microbes seldom distinguish among species as they just seek opportunities to survive and multiply. Our own bias and artificial separation between veterinary and animal health and public health is a critical barrier to the acceptance of One Health.

I have discussed the concept of wicked problems and the need to view many contemporary problems as interconnected issues that have created larger societal dilemmas. Patterns of thought of a previous era may not be useful to address current problems. Because wicked problems are part of the society that creates them, future solutions and actions must be based in that society. We can no longer focus on a single domain of health or any singular inquiry; we now must be open to new ways of thinking and be receptive to new ideas and directions that match our challenging times. The status quo in food safety must be replaced by a new transdisciplinarity and a new collective understanding of food safety characterized by a One Health mindset and approach. A One Health emergent community of practice now exists where new views, approaches, and knowledge can inform each other synergistically and more productively.

In Thomas Kuhn's seminal book The Structure of Scientific Revolution (Kuhn, 1962), he discussed new paradigms and the conditions and factors that create them. A paradigm shift is often manifested because old models to solve problems do not work as well and new models have yet to be created or substantiated. Basic assumptions are questioned, and the evidence to change is not uniformly accepted. While we acknowledge that progress has been made in making our food safer, especially in the United States, breakthrough thinking is minimal. Kuhn suggested that changing mindsets can be difficult and protracted and that new paradigms are not necessarily led by a scientific community. In the case of food safety, much of the force for change is being led by con sumers and more recently retailers. Also new paradigms often lead to new fields of study, inquiry, and work. One Health, although not new, is certainly a renewed field of inquiry and transdisciplinary thinking.

The convergence of people, animals, and our environment has created a new dynamic in which the health of each domain is inextricably interconnected. The challenges associated with this new reality are demanding, profound, and unprecedented. This remarkable convergence is a critical factor in disease emergence, and there is nothing on the horizon to suggest that this dynamic will be altered or abated. The safety of our food supply is a microcosm of this larger dynamic, and our food is increasingly vulnerable to both intentional and unintentional contaminations and changing microbial communities. Working successfully to address these threats will require new thinking, changing partnerships, and shifting our emphasis “upstream,” closer to the origin of pathogens in other domains. A One Health paradigm shift holds great promise but is also a new mindset that will be disruptive to the status quo; thus, old systems, habitual thinking, and working with old modes of inquiry that are sharply divided among diverse cultures and interests and that compete for resources and are part of strongly embedded belief systems remain as challenges.

Dr. Josh Lederberg, a Nobel Laureate and founder of this Forum, published an article in Science in 2000 titled “Infectious History.” He stated, “An axiomatic starting point for progress is the simple recognition that humans, animals, plants and microbes are cohabitants of this planet. That leads to refined questions that focus on the origin and dynamics of instabilities within this context of cohabitation. These instabilities rise from two main sources loosely definable as ecological and evolutionary” (Lederberg, 2000). I suggest that our dynamic, complex food system, and the challenge of its safety, is about controlling and preventing instabilities and using One Health as the construct to understand this ecological dilemma and as the foundation to devise new solutions and interventions. Dr. Lederberg further remarked that the future of humanity and microbes will be based on “our wits versus their genes.” This is a prophetic statement underpinning One Health's application to food safety.


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The Ohio State University.

Copyright © 2012, National Academy of Sciences.
Bookshelf ID: NBK114498


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