“We mustn’t let One Health remain purely intellectual and rhetorical.”

An interview with Davide Ziveri, environmental health specialist at Humanité & Inclusion – Handicap International and member of the OSH Forum

© FAO/Lydia Limbe. The dairy cow is an important asset in rural villages, synonymous with wealth and an important form of nutrition.

Davide Ziveri, environmental health specialist at Humanité & Inclusion – Handicap International, agreed to answer a few questions for Défis Humanitaires about integrating the One Health approach into humanitarian activities. HI is developing a Global Health approach to address the complexity of the links between environment and health, and the impact this has on its operations. The organization is active in several international networks to learn, exchange and work together with other humanitarian actors to tackle the climate crisis. The NGO is thus a partner of the One Sustainable Health Forum, presented in a previous article, and took part in the symposium organized by the University of Geneva in November 2023 on the operationalization of the One Health approach in humanitarian contexts.

An interview conducted by Madeleine Trentesaux

Madeleine Trentesaux: Hello Davide, thank you for agreeing to give us your point of view on One Health and humanitarian aid. Why integrate a One Health approach into humanitarian activities?

Davide Ziveri: There are three main reasons for adopting a One Health approach to humanitarian action. Firstly, the countries in which NGOs operate are particularly exposed to the risk of disaster. They are less resilient, due to already weakened or overburdened health systems, for example. All the Disaster Risk Reduction (DRR) and Climate Change Adaptation (CCA) projects already underway are perfectly suited to these areas. They would benefit from being enriched by the One Health approach, which focuses on human and animal health (for example, the risk of zoonoses after flooding).

Secondly, NGOs carry values of justice and equality that must shape One Health services to make them inclusive. When we explore the consequences of the climate crisis, we see that the problem is not just technical and technological, but also raises social and ethical issues. Reports by Oxfam and the World Inequality Database, published in 2023, highlight climate inequalities between countries, or between social classes within the same country, where NGOs are mainly active.

Finally, One Health focuses on the consequences of the climate crisis on health and mental health. This link is not always taken into account in humanitarian programs, which are accustomed to working in two distinct sectors, the first dealing with human health and the second with the environment. Yet, as numerous studies have shown, our health is influenced by the local and global environment in which we live. The One Health approach, which opens up to a more systemic and holistic analysis, is pushing organizations to take health into consideration.

Madeleine Trentesaux: One of the major difficulties with the One Health approach today is its operationalization. In situations of emergency, conflict or environmental disaster, how does the One Health approach work? Do you have any examples of specific projects?

Davide Ziveri: There are practices that contribute to the One Health approach in that they aim for positive impacts on health and the environment at the same time. However, the idea is not to have a project that would be labeled “One Health” and implemented by an NGO specialized in One Health, if such a thing existed. On the contrary, it’s a complex approach that involves taking all aspects of the same system into consideration, by setting up collaborations. Emerging from a transdisciplinary field of study, One Health programs will by definition be the result of innovative partnerships around a shared vision of the link between health and the environment in a specific territory.

In Nepal, villages are anxiously preparing for a worsening monsoon. © UNEP/Artan Jama

The first step is to understand the problems with a systemic assessment that grasps the complexity of the situation. Then, specialized players come in to deal with the same situation according to their expertise. For example, in Libya, during the floods, there was this disaster with its immediate effects and then short- and medium-term consequences in terms of health, with epidemics, zoonoses, water-related diseases, etc. So, in these situations, humanitarian actors need to collaborate to ensure that the situation is properly managed. So, in these situations, humanitarian actors need to work together so that each specializes in its own task, while thinking of the problem as a whole. We can no longer afford to do just our part, we need systemic assessments.

Another example comes from a study carried out by the University of Geneva on snakebites in Nepal. They showed that, as a result of human activity and climate change, snakes were finding their way into new ecosystems where they had previously had little presence. Their new presence has an impact on people and livestock, who are more exposed to the risk of being bitten. When farms are decimated by snakes, the impact becomes economic and social, weighing heavily on farmers. It’s a new cycle, generating a rather complex and far-reaching problem, with around 400,000 deaths a year worldwide. It’s an emblematic example of the One Health approach, because we’re dealing with a human health issue – deaths from snakebites – and an animal health issue, for both wild and domestic animals, which has a social and economic impact. This needs to be understood together, in a systemic and transdisciplinary way, and that’s what the One Health approach is all about.

Madeleine Trentesaux: Thank you, Davide, for these examples. You’re an environmental health specialist at HI. What’s your role in projects, and what angle of approach do you try to influence to ensure that the environment is better taken into account?

Davide Ziveri: At HI, we have a three-pronged approach. Firstly, we assess our carbon footprint so that we can implement activities to reduce it. Secondly, we run inclusive risk reduction programs. Finally, and more recently, we are implementing indicators and activities directly linked to global health. These three aspects all contribute to the same One Health objective, and force us to improve our internal coordination to act on the different points of a problem that are completely connected.

Madeleine Trentesaux: How do you assess whether a project is in line with the One Health approach you advocate?

Davide Ziveri: One of the main indicators we use is the cost-benefit of a project for health and the environment. Some donors are already asking that activities to strengthen health systems be resilient and sustainable. We are in the process of developing this dimension in our inclusive health programs. For example, we need to understand how to take account of the consequences of the climate and environmental crisis in our mental and psychosocial health and sexual and reproductive health programs. Then it’s a question of multiplying pilot actions to aim for a double benefit for health and the environment, which is not always easy to measure. But I realize that the first step is undoubtedly to take the time to listen to the local community, its perception of risks and its resources and knowledge for change.

Farming communities in Senegal restore degraded land to counter the effects of climate change. © PAM/Evelyn Fey

Madeleine Trentesaux: How do you build these One Health projects? How can we ensure that they are appropriate?

Davide Ziveri: I think the key to this is social dialogue. The One Health approach urges us to think of climate change for what it is: a social crisis, because of all the social and societal changes it implies. Projects that adopt a One Health approach must therefore be co-constructed with local populations. If we come up with solutions based on our own knowledge system, it’s unlikely to work. So we need to listen, respect and co-construct solutions based not just on Western science, but also on indigenous knowledge. That’s why there isn’t a list or a top-down manual for everyone on the One Health approach, because it’s really linked to this dialogue with populations. And this dialogue is all the more important in countries where humanitarians are working to be part of the movement to decolonize global health. Future One Health programs will inevitably have to be carried out with partners, linked to specific territories, and co-constructed with communities.

Madeleine Trentesaux: I’d now like to come back to the One Sustainable Health Forum, of which HI is a partner member. How does humanitarian aid fit into the OSH forum? Where does humanitarian thinking-One Health-come from?

Davide Ziveri: One Health is an approach that originated with academics and health professionals, so it didn’t necessarily touch on the specifics of the humanitarian world. However, many of the players at the OSH Forum are international NGOs who wanted to see the emergence of a reflection specifically on this issue. The importance of the One Health approach in research has had an impact in terms of policy. One of the best recent examples is the presence on the official agenda of COP28 of a reflection combining health and the environment. So, in terms of research and policy, we’ve made significant progress. But the issue that the NGOs wanted to raise at the OSH Forum is the operationalization of the One Health concept, what we call the “knowledge to action gap”.

In November, the University of Geneva, at the invitation of the OSH Forum, organized a two-day workshop on the challenges of operationalizing One Health in humanitarian contexts. The workshop’s recommendations and reflections will be published shortly. As I said earlier, the point is not to have a manual of One Health actions to be carried out in a humanitarian context, but to provide food for thought, concrete examples and tools to feed humanitarian programs. There’s a real momentum around One Health at the moment. We need to seize it, and donors need to fund pilot projects that are original, cross-functional and long-term.

Madeleine Trentesaux: The OSH Forum published its first recommendations in December 2023 and will be launching new working groups in 2024. Will there be one on humanitarian contexts? What themes would you like to see addressed?

Davide Ziveri: New working groups will indeed be launched in 2024. The topics to be chosen are subject to the approval of OSH Forum members. We are therefore awaiting the results of this consultation. What’s important is that the countries of the South are well represented in the OSH Forum, which has given rise and will give rise to reflections on the implementation of One Health in development contexts. The next OSH Forum will take place in Dakar, and there have been consultations in Lebanon, Bangladesh and Brazil over the past two years. The important thing is to listen to the voices of the South on an equal footing.

Cattle breeding in Tunisia © Agri durable

What I think is key for a working group on humanitarian issues is that it should give rise to concrete experiences. There are two barriers to taking action. Firstly, within NGOs, we still operate very much in silos. But the One Health approach aims to break down silos and think differently about complex problems. So we need to work internally to create synergies between sectors. Secondly, we need to break down the silos between NGOs, within the humanitarian aid sector. We need to find the agility to create partnerships with associations that don’t have the same mandate or the same expertise and, sometimes, not necessarily the same language. I therefore hope that the OSH Forum working group will facilitate these partnerships and enable certain players to launch pilot projects together. One Health mustn’t remain purely intellectual and rhetorical.

Madeleine Trentesaux: Would you like to conclude with a few words?

Davide Ziveri: There are three theoretical aspects of One Health that I think are worth highlighting here. Firstly, we started out with the idea that the climate crisis is a humanitarian crisis. This is true, and will become even more so. But it’s also possible to look at it from another angle, which allows us to say that the climate crisis can put aid systems in crisis, because needs are increasing exponentially and funds are lacking. So One Health puts classic aid and development models on the table, offering a new vision of the future and therefore of what humanitarian aid will be and do.

On the other hand, One Health encourages us to question what humanity and humanism are. A study published in the Lancet opens up the One Health concept to include non-humans and ecosystems within humanity. In New Zealand, for example, a river has been given the status of a legal entity. This changes our approach to law and humanity, and represents a real ethical challenge.

Finally, the climate crisis and related health issues affect the whole world. So we need to think about how humanitarians can develop their work in the most polluting countries too, in a common struggle for a common future – that of human and planetary health.

 

Bibliography :

 

Davide Ziveri

Davide Ziveri, Ph.D. in Social Psychology at Complutense University of Madrid, is the Planetary Health focal point at the Inclusive Global Health Direction of Humanity & Inclusion NGO, based in Brussels (Belgium). He recently obtained a diploma in Global Health Policies at the London School of Hygiene and Tropical Medicine. He advocates for the Planetary Health approach via international working group and networks as, among others, the One Sustainable Health forum and the Be-Cause Health platform.
With over 20 years of experience in health and mental health programs, mainly in Low and Middle Income Countries (LMICs) and protracted crisis settings, he focuses his research and action on the environment and health nexus, namely on the impact of climate crisis and biosphere depletion on mental health and wellbeing, promoting dialogue with indigenous knowledge.

 

Madeleine Trentesaux

After studying anthropology and humanitarian policy at Nanterre University and Sciences Po Paris, Madeleine Trentesaux specialized in health anthropology and the evaluation of local development policies. In spring 2023, she carried out a field study in Lebanon, with Fondation Mérieux and Médecins Sans Frontières (MSF), on practices in the fight against antimicrobial resistance. Madeleine Trentesaux also works on research missions with various organizations in the healthcare sector.

 

 

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