One Health – a Business Opportunity for World Health
In a recent post in the World Bank’s blog “Investing in Health”, we learn that the estimated total economic losses due to the avian flu, the H5N1 virus, exceed USD 20 billion since 2003. The economic losses from the SARS outbreak in East Asia and Canada were estimated to over 40 billion US. These are only two examples of infections that are transferred from animals to humans. A One Health prevention program, that could effectively prevent and control these outbreaks in low- and middle-income countries, would only cost a fraction of these losses. This is a classical example of what economists call externalities. The problem is not new.
In this interview, Dr. Timothy Bouley, Global Health and Environmental Specialist at the World Bank Group and keynote speaker at Uppsala Health Summit in October, describes the work by the World Bank on comparing costs for prevention of health threats related to climate change, with costs for intervention. And the results are striking. Prevention with a One Health approach is a very profitable business!
Uppsala Health Summit (UHS): How can we use these insights in developing a resilient One Health strategy?
Timothy Bouley (TB): A key take-away from this work is that prevention is considerably more cost effective than response. An investment of $1-2bn in One Health oriented infrastructure can significantly reduce the risk of a $40bn outbreak and save countless lives. Decision-makers rely on economic valuations like this to make informed decisions and so it is important that we provide them with some quantification to use to make budgetary decisions. Lives and livelihoods lost are compelling, but they aren’t easy to compare to other line items that might be a part of overall government investment. Also, as we enter a new era of climate risk and reality, it is critical we develop systems that are resilient. One Health strategies are inherently climate-smart because they include environment and climate considerations in the calculus.
UHS: Which actors should be involved in a One Health strategy and its implementation?
TB: There are different actors depending on level of engagement. Internationally, we have worked with multilaterals, like WHO, OIE, FAO, CBD, and UNEP and other development banks like ADB, IDB, and AFDB. These organisations have been important for our work globally because each offer unique sectoral and regional perspective, and have helped us develop frameworks that can be applied across country.
Within national systems, it is important to engage across ministries: health, environment, agriculture, water, urban, etc. Not every sector needs to be present for the approach to be effective, but a critical mass of diverse perspectives and programming is important to drive truly One Health solutions. Related to, non-governmental and community workers also need to be part of project design because they often bring unique operational experience to inform approach on the ground.
In brief, the tent is very big and inclusive. Involvement needs to be sorted out on a case by case basis, but if One Health principles of multi-sectorality and on-the-ground engagement are maintained, and the project is thoughtfully designed, the right combination of actors should self-select.
UHS: Previous strategies for similar situations, e.g. air pollution, have suggested tradable permits as a tool. Do you see a role for such solutions in this case? Why or why not?
TB: Tradeable permits, carbon pricing, green bonds- each are financial tools that are specific to climate and air quality. They are absolutely relevant to One Health because they connect environmental and health threats to markets, which exert socio-economic forces to reduce their risk. And though not universally applicable to all One Health challenges, economic tools can and should be considered within the spectrum of approaches to improve health and environmental outcomes. Economics is a social science that helps us both understand our world and act upon it. It should not be overlooked just because it isn’t biology or medicine.
UHS: The World Bank has worked with a One Health agenda for long. Already in 2005, you launched the Global Program for Avian Influenza, a program integrating needs in animal, human and environmental health. Which achievements would you like to tell us about? Which are the main challenges?
TB: In recent years, we have worked to develop an “Operational Framework for Strengthening Human, Animal and Environmental Public Health Systems.” It highlights health risks and opportunities at the interface of these sectors, a space central to the World Bank’s twin goals through its bearing on human and animal health, food security and food safety, livelihoods, resilient ecosystems, and sustainable development. Initiated in 2014, the Framework builds on over a decade of One Health engagement, epitomized by the Global Program on Avian Influenza and Human Pandemic Preparedness and Response (GPAI), the economic argument for One Health (in the World Bank report “People, Pathogens and our Planet”), the economic analysis of antimicrobial resistance as well as, most recently, the case for investing in preparedness for pandemics at national level.
Separately, the World Bank has worked in consultation with experts and development partners to establish a new major program addressing climate change and health, one dimension of One Health.
The program has been built with two primary considerations in mind: (i) establishing a knowledge base to inform development lending and (ii) ensuring this work directly supports our clients. In practice, this has meant generation of baseline analytics exploring impacts and risks on both sectoral and geographic scales; creation of an institutional approach to ensure climate and health are dually embedded within our lending portfolio; and direct operational engagement with our client countries.
UHS: In your keynote address at Uppsala Health Summit in October, you will probably mention “multi-sectorial coordination” or similar as one of the challenges to handle. Can you already now give us some ideas on how to overcome such difficulties?
TB: Siloes are always challenging. But they exist for a purpose! Work needs to be delineated by theme…or region…or manager to ensure relevant expertise is on hand and delivery is efficient.
One Health is of course inherently multi-sectoral and requires work across discipline to deliver. This, however, cannot be achieved without strength within silo and awareness from sectoral experts that their work is translatable and sharable. To cultivate best outcomes, we have tried to seek out the best experts, understand their methods and approaches, and encourage them to engage with others who are differently experienced. Rather than translate their work for them, we have helped them to find common entry points, enabling a distillation of best ideas and buy-in that leads to lasting relationships while amplifying the impact of individual’s work.
UHS: Finally, what do you hope we can achieve at Uppsala Health Summit in October?
TB: I look forward to engaging with a new group of practitioners who are working on One Health in a part of the world where the challenges are different.
Much of my work is focused on the Global South, driven by poverty alleviation and development. Nevertheless, connecting environment, animals and humans has value regardless of geography. And though the approaches may be different, the underlying principles remain the same, and the shared experiences can illuminate pathways toward new thinking, progress, and action.
More information on the World Bank's programs
The World Bank Group Approach to Climate Change and Health can be found on the World Bank’s blog, Investing in Health: http://blogs.worldbank.org/health/connecting-climate-change-and-health-better-development
The World Bank’s program on climate, health and development is further presented in three reports, accessible here: