The One Health Approach to Antimicrobial Resistance

‘One Health’ is a concept that is receiving increased support as an integrated approach to address wicked problems of biological importance, which includes antimicrobial resistance (AMR). The One Health concept typically considers three environments, human, animal and physical, as the primary compartments, although it is sometimes seen useful to include ‘economy’ as a fourth, including among others the direct and indirect costs of health impacts and the commercial considerations of the private sector.  Implementation of One Health is a purposeful consideration of interdependent compartments, their related interfaces, and forcing variables that determine factorial behaviour within and among compartments and ultimately of health outcomes. AMR is a fitting example of global importance that would benefit from a One Health approach as a risk-based perspective, including risk analysis, containment, avoidance and mitigation. As one example, antimicrobial (AM) use in animal production, supported by economic considerations, can lead to introduction of the AMs into the physical environment to cause AM contamination and further support the generation of AMR in the environmental biota, as well as cause the creation of AMR food safety-related pathogens, resulting in health issues in consumers, and consequent health-related economic losses. This and other examples of complex interrelationships will be presented for discussion. Credible, evidence-based risk models and their recommendations can support interventions targeting the control of AMR and decrease the risk to the human condition.  However, the availability of data is to support such risk models is often inadequate.  One Health-based risk modelling needs to consider inputs and fates of AMs in human, animal and physical compartments, the potential for creating AMR in pathogens, the relative importance of the AMR pathogen within a compartment, the net benefit of use of AMs in both the short and long term, and the direct and societal cost of control measures to the use of AMs, as well as cost benefits in the development of alternatives. This presentation will consider the availability of and requirements for appropriate data to support risk modelling, and will point to areas of sectorial, national and global action in the One Health continuum to benefit the control of AMR as a  managed risk, and in that context validate national frameworks of action.