PowerPoint Presentation

Actualization of an interdisciplinary curriculum for One-Health in West Africa - (Lessons from the PENAPH, ProMED and NFELTP examples)

An invited plenary session Lead Speaker presentation at the 2nd Centre for Control and Prevention of Zoonoses CCPZ Annual Conference and One-Health exposition Improving Zoonoses Surveillance in West Africa: The One-Health Approach. 30th June to 4th July 2013

2nd CCPZ ConferenceActualization of an interdisciplinary curriculum for One-Health in West Africa (Lessons from the PENAPH, ProMED and NFELTP examples)An invited plenary session Lead Speaker presentation at the 2nd Centre for Control and Prevention of Zoonoses CCPZ Annual Conference and One-Health exposition Improving Zoonoses Surveillance in West Africa: The One-Health Approach. 30th June to 4th July 2013

2nd CCPZ ConferencePresenterDr Olutayo O. Babalobi (DVM, MPVM, PhD; FCVSN). Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria GSM Nos. : +234-816-753-8536; +234-805-530-1991. E-mail: tayobabalobi@gmail.com; oo.babalobi@mail.ui.edu.ng Key Terms:Actualization: making real or giving the appearance of reality. Actualizing: To describe or portray realistically. Definition of termsHealthInterdisciplinary: Of, relating to, or involving two or more academic disciplines that are usually considered distinct

culminating in death at the other end.A condition of physical, mental, and social well-being and the absence of disease or other abnormal condition. http://medical-dictionary.thefreedictionary.com/Human+healthThe opposite of Health isDis-ease: Dis ease: anything that makes a living being not to be at ease Ease:.The condition of being comfortable or relieved.Un-ease: 1.Lacking a sense of security; anxious or apprehensiveStress: Stressis a person's response to a stressor such as an environmental condition or a stimulus.Stressis a body's way to react to a challenge. Distress: Distressmay refer to:Distress(medicine), occurring when an individual cannot adapt to stress; Suffering Current views of health and illness recognize health as more than the absence of disease. The need for a more realistic definition of the word Health was expressed by stn & Jakob in 2005 in an article titled: Re-Defining Health which appeared in the Bulletin of the WHO 83:802. (http://www.who.int/bulletin/bulletin_board/83/ustun11051/en/) in which they quoted Australian Aboriginal people who generally define health thus Health does not just mean the physical well-being of the individual but refers to the social, emotional, spiritual and cultural well-being of the whole community. This is a whole of life view and includes the cyclical concept of life-death-life (National Health and Medical Research Council. Promoting the health of Indigenous Australians. A review of infrastructure support for Aboriginal and Torres Strait Islander health advancement. Final report and recommendations. Canberra: NHMRC, 1996: part 2:).5Definition of terms

Health:"A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." (WHO 1946)Health does not just mean the physical well-being of the individual but refers to the social, emotional, spiritual and cultural well-being of the whole community.

The word health was derived from the old English word hoelth, which meant a state of being sound, and was generally used to infer a soundness of the body (Dolfman M. The concept of health: an historic and analytic examination. Journal of School Health 1973; 43:491-7.)Health[hoelth] is a relative state in which one is able to function well physically, mentally, socially, and spiritually in order to express the full range of one's unique potentialities within the environment in which one is living. In the words of Ren Dubos, health is primarily a measure of each person's ability to do and become what he wants to become.

Realizing that humans are dynamic beings whose state of health can change from day to day or even from hour to hour, leaders in the health field suggest that it is better to think of each person as being located on a graduated scale or continuous spectrum (continuum) ranging from obvious dire illness through the absence of discernible disease to a state of optimal functioning in every aspect of one's life. High-levelwellnessis described as a dynamic process in which the individual is actively engaged in moving toward fulfillment of his or her potential.A common concept of health as a continuum ranging from optimal wellness at one end to illness 6

Existing terms in Health

Global health:Global Health is thehealthof populations in a global context and transcends the perspectives and concerns of individual nations It is the area of study, research and practice that places a priority on improving health and achieving equity inhealth for allpeople worldwide'Global health is typified by the international activities of the World Health Organization

International HealthInternational Health: International health is defined as a well-established branch of public health, with origins in the health situation of developing nations and the efforts of industrialized countries to assist themUS-CDC started as International Health

Public Health:Public Health: Interdisciplinary an d multidisciplinary preventive education, research and extension ion measures against health problems and threats at local and foreign communities to improve human well-being involving professionals mainly epidemiologists,biostatisticians,community health and environmental health officers but also physicians public health nurses,medical microbiologists, Ecologists, environmental health officers/public health inspectors,pharmacists,dental hygienists,dietitiansandnutritionists,veterinarians, public health engineers, public health lawyers,sociologists, community development workers, communications experts, and others

Veterinary Public Health (VPH)Veterinary Public Health (VPH) is defined as The contributions to the physical, mental and social well-being of humans through an understanding and application of veterinary science [WHO/FAO/OIE definition 1999]. Human health, animal husbandry and animal health are closely connected and VPH is a fundamental part of public health whereby human health and well-being are the main objectives.Veterinary Public Health (VPH)VPH is multidisciplinary and contributes to many areas of public health that are not always related to animals. In order to integrate veterinary public health into the goals of public health, it is essential to improve collaboration between human and veterinary medical science, environmental science and other related fields in accordance with one health principles.

ONE HEALTH

ONE HEALTHIt is a multidisciplinary strategy to prevent, control and eliminate the challenge of diseases, where possible, within a larger ecological context that includes humans, animals and plants interacting in a complex ever-changing natural environment recognizing that 60% of all human pathogens are zoonotic (http://nigeria-feltp.net/prog_desc.php)

Definition of terms

One Health:"the collaborative effort of multiple disciplines working locally, nationally, and globally to attain optimal health for people, animals and the environment"

The One Health concept arose from the realization that human health and animal health are inextricably linked and that a holistic approach is needed to understand, protect, and promote the health of all species. One Health seeks to improve communication and encourage collaboration between veterinarians, physicians, environmental scientists and public health professionals to find multidisciplinary solutions to the shared challenge of public and environmental health. It is a multidisciplinary strategy to prevent, control and eliminate the challenge of diseases, where possible, within a larger ecological context that includes humans, animals and plants interacting in a complex ever-changing natural environment recognizing that 60% of all human pathogens are zoonotic (http://nigeria-feltp.net/prog_desc.php)

15Definition of terms

My comprehensive definition:All collaborating efforts of various human activities, occupations and professions; labouring as companions, working together, united to achieve a common mandate, purpose and responsibility of making man to be at ease with other biological and non-biological components of the earth and its environment.DisciplinesAdiscipline(orspecialism) is knowledge or wisdom associated with one academic field of study or profession. A discipline incorporates types of knowledge, expertise, skills, people, projects, communities, problems, challenges, studies, inquiry, approaches, and research areas that are strongly associated withacademic areas of studyor areas ofprofessional practice. Multidisciplinary Multidisciplinary: of, relating to using several disciples at the same time multidisciplinary (m l t -d s -pl -n r , -t -). adj. Of, relating to, or making use of several disciplines at once: amultidisciplinaryapproach to teaching. A multidisciplinary community or project is made up of people from different disciplines and professions who are engaged in working together as equal stakeholders in addressing a common challenge.Interdisciplinary:

Interdisciplinaryknowledge is the knowledge extensions that exist between or beyond existing academic disciplines or professions. The new knowledge may be claimed by members of none, one, both, or an emerging new academic discipline or profession.An interdisciplinary community or project is made up of people from multiple disciplines and professions who are engaged in creating and applying new knowledge as they work together as equal stakeholders in addressing a common challenge.InterdisciplinaryThe key question is what new knowledge (of an academic discipline nature), which is outside the existing disciplines, is required to address the challenge. Aspects of the challenge cannot be addressed easily with existingdistributed knowledge, and new knowledge becomes a primary sub goal of addressing the common challenge.Difference between multidisciplinary and interdisciplinaryMultidisciplinarityis a non-integrative mixture of disciplines in that each discipline retains its methodologies and assumptions without change or development from other disciplines within the multidisciplinary relationship.

Aninterdisciplinaryfield is a field of study that crosses traditional boundaries between academic disciplines or schools of thought, as new needs and professions have emerged.

One Health: Inter or MultiIs One Health multidisciplinary or interdisciplinary or both?

Disciplines involved in OH Disciplines involved in OH include:Professions : Agricultural, Biomedical health, Ecological/Environmental, Laboratory, Medical and Veterinary Health Academic and Research Institutions: University Faculties/Schools/Colleges of Agriculture, Animal health and Production; Environmental Sciences; Biomedical, Medical, Nursing, Public Health, Community and Social Medicine; Veterinary Biomedical, Clinical and Pathological Medicine, Public Health and Preventive Medicine; Biomedical, Environmental and Veterinary Research Institutes) Relevant professional students/trainees: (agricultural, biomedical, environmental health, laboratory, medical, nursing, public health, veterinary etc.Other non-professional/ occupational traineesConservation medicineis an emerging, interdisciplinary field that studies the relationship betweenhumanandanimalhealth, andenvironmentalconditions. Also known asecological medicine,environmental medicine, ormedical geology.

CURRICULUM : WHAT IS CURRICULUM?

A curriculum is a planned guided learning experience of a student. From Latin, literally running, course, it is the subjects taught at an educational institution, or the elements taught in a particular subject. The curriculum is really the entire program of the schools' work. It is the essential means of education. It is everything that the students and their teachers do.

Curriculum ComponentsEssentially, the curriculum should contain four main components or elements: the objectives or purpose, the content or subject-matter, the method or ways of passing on knowledge, and evaluation or assessment (i.e. the procedure for testing whether or not the pupils or students have benefited from the instructions given).

CurriculumThe knowledge of the environments in which the trainees will work and the task they will face as well as getting the appropriate training strategies including the field exposure are factors highly influential in designing a curriculum.

ONE HEALTH CURRICULUM COURSES

A typical One Health Curriculum (OHC) should involve the following courses:Basic One Health Concept: Definition, Concepts, History , General Introduction to the One Health /Collaborative/Comparative Medicine conceptBasic Epidemiology: - Host-Agent-Environment interactions and Disease Transmission. Outbreak Investigation and Disease Reporting. Ecology/Environment Health. Wildlife / Zoo MedicineDisease Surveillance, Monitoring, Prevention and Control. Disease Emergency Preparedness ResponseONE HEALTH CURRICULUM COURSES

Epidemiology of Zoonotic diseases. Emerging, Infectious, Neglected and Re-occurring Zoonoses Diseases. Animal: Human Interface in a Pathogenic EnvironmentNon-Zoonotic/Non-communicable Animal and Human Public Health Issues e.g. Food Hygiene and Food Safety; Transboundary/Exotic/Foreign/Tropical Diseases. Livestock Livelihood and Socio-Cultural/ Traditional and Socio-Economic factorsLaboratory Clinical Diagnostic issues in One Health- biochemical, immunological, microbiological and molecular medicine.

Examples of One Health CurriculumNFELTP-OHCCCIn 2011, African Field Epidemiology Network (AFENET), Kampala, Uganda engaged the presenter as a Veterinary Academics Consultant during his sabbatical leave. Working in conjunction with Dr Lora Davis, the Chief Veterinary Medical Officer of the Animal-Human Interface Project, AHIP Nigeria, Centers for Disease Prevention and Control CDC- Atlanta One Health Office

NFELTP-OHCCCThe presenter assumed the lead role in organizing a collaborative working group to review existing NFELTP curricula and course content and recommend a One Health curriculum and standardized course content OHCCC template that may be used by AFENET for establishing additional One Health training programs in Africa.

NFELTP-OHCCCThe report of has since being submitted in 2012 as a 55 page Technical Report and Recommendation for a One Health standardized curriculum and course content in Field Epidemiology Training Programs July 2012. 55pp.

ProMED-mailA more efficient and effective disease reporting/ surveillance systems for diseases is one of the envisage benefit of One Health. A One Health activity needed to be promoted to permit a rapid response to disease outbreak, control and surveillance is operating a joint collaborative outbreak reporting list along the lines of Program for Monitoring Emerging Diseases (ProMED-mail) ProMED-mail since its inception, has espoused the One Health concept. (See PROMED AND ONE HEALTH http://www.onehealthinitiative.com/publications/ProMED%20article2.pdf)

EPIDEMIOLOGY

Epidemiology/Epizootiology, the branch of medicine that deals with the incidence, distribution, and control of diseases (in human populations), is a major vehicle for One Health. Though used for animal populations, Epizootiology orveterinary epidemiology, is the study ofdiseasepatterns within animal populations.

EPIDEMIOLOGY/PARTICIPATORY EPIDEMIOLOGYParticipatory epidemiology is the application of participatory methods to epidemiological research and disease surveillance. It is a proven technique which overcomes many of the limitations of conventional epidemiological methods, and has been used to solve a number of animal health surveillance and research problems (Jost CC,Mariner JC,Roeder PL,Sawitri E,Macgregor-Skinner GJ (2007): Participatory epidemiology in disease surveillance and research. Rev Sci Tech.2007 Dec; 26(3):537-549).

Participatory EpidemiologyParticipatory Epidemiology (PE) integrates human and veterinary medicine into a common approach and is a powerful tool in international public healthPARTICIPATORY EPIDEMIOLOGYInitiated in 2007, the Participatory Epidemiology Network for Animal and Public Health (PENAPH) connects groups and individuals who apply PE methods in controlling emerging and existing diseases. The concept arose as a result of applying participatory epidemiology to some of ILRIs projects which bridge human and livestock health.

CONCLUSION

What are some challenges to creating One Health partnerships and collaborations?CoordinationLeadershipIndividualityProfessional suspicion/ Mutual mistrustProfessional arroganceProfessional ignorance

WHAT IS THE ROLE OF UNIVERSITIES IN INSTUTIONALIZING ONE HEALTH IN NIGERIA

University roles from pre-degree to preclinical to postgraduate levels: Training, Research and community and social extension servicesOne Health general studies courses for 100L undergraduate agricultural, biomedical, environmental health, medical, science and veterinary studentsJoint pre-clinical -200L One Health course for biomedical, medical and veterinary studentsJoint teaching of zoonosis courses by medical and veterinary lecturers Recognition and adequate respect of the role of technologists and biomedical professionals in public health training

One Health postgraduate degrees for students of diverse professional backgroundAdmission of qualified students of various professional backgrounds to courses such as MPH, MSc Epidemiology/Epizootiology, MSc Immunology, MSc Virology and other clinical and field- based postgraduate degreesOne Health extension and community services to clients, patients and livestock farmers level at rural, suburban and urban levelsCreation of University One Health Continuous Education, Distant Learning, E-Learning and Research Centres or Units One Health extension and community services to clients, patients and livestock farmers level at rural, suburban and urban levels

Joint comparative research (e.g. on Avian/ Swine Influenzas, Brucellosis, Lassa fever, Rabies, Rift valley fever, Tuberculosis and other zoonosis and environmental diseases) at undergraduate and postgraduate levels involving agricultural, biomedical, environmental health, medical and veterinary students and lecturers; and across universities at local, national and international links levels

ConclusionThe issue of One Health is more and beyond just Zoonosis, even though zoonosis is a major itemThe history of One Health in Nigeria shows it began from the University of Ibadan, the first University in NigeriaEfforts to have a National OH Coordinating Center at the Dr Nasidi headed Nigeria CDC have been frustratingStill the first and the best, there is need for One Health National Coordinating Center which UI should be readyto host

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