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One Health Workshop
Sponsored by the Arctic Human Health Experts Group (AHHEG)
Arctic Council, Sustainable Development Working Group
October 20, 2015, Anchorage, Alaska
Moderator: Tom Hennessy, MD, MPH
AHHEG co-chair, and Director, CDC Arctic Investigations Program
1
Thanks to …
• US Department of State• Funding support for meeting and refreshments
• Josh Glasser, Ann Meceda, Marilynne Bonner
2
Objectives
• Introduce the “One Health” approach and the Arctic Council initiative
• Highlight some examples where One Health has been used in Alaska
• Discuss ways One Health can be applied or enhanced • In Alaska
• In the Arctic Region
3
Agenda
• Introductions• 920 – 1000 Arctic Council One Health Initiative
• Bruce Ruscio, US Dept of State
• Examples of One Health Activities in Alaska• Jim Berner, Alaska Native Tribal Health Consortium (ANTHC)• Mike Brubaker, ANTHC• David Driscoll, University of Alaska
• Break 1030- 1045• 1045- 1200 Round Table Discussion• 1200 – 100 Lunch• 100- 230 Open House
4
New Project Proposal:Promote a “One Health”
Approach in Arctic Health
5
Arctic Council
Arctic Country Representatives, Permanent Participants (Indigenous Peoples Organizations Observers, (NGO’s,
Countries)
ACAP Arctic
Contaminants Action Plan
AMAP
Arctic Monitoring & Assessment Program
HHAG
Sustainable Development
Working Group
AHHEG
International Circumpolar Surveillance
Water and Sanitation for
Health
Mental Behavioral
Health
Research Ethics and Indigenous
Coummunites
One Health
EPPR Emergency Prevention
Preparedness & Response
PAME Preservation of
the Marine Environment
CAFF Conservation of
Arctic Flora & Fauna
The Arctic Council, US Government and Circumpolar Health Relationships
MembersAmerican Society for Circumpolar HealthCanadian Society for Circumpolar Health
Danish/Greenlandic for Circumpolar HealthNordic Society for Circumpolar Health
Siberian Branch Russian Academy Medical Sciences
International Union for Circumpolar Health
US RepresentativeDepartment of State
Office of Ocean & Polar Affairs
Arctic Research Commission
Goals & Objectives
Interagency Arctic Research Policy Committee
6
Health Concerns Where a One Health Approach could be used: -Animal-to-Human Infectious Diseases. -Environmental Contaminants, Wildlife health and Subsistence foods.
7
One Health and AHHEG, Options
• Collect information about existing One Health programs and projects• Use for education, advertisement in Arctic populations
• Catalog of activities
• Compare results, share best practices
• Analysis of One Health activities in Arctic• “Mapping” intersectoral networks and stakeholders
• Analyze to identify ways to strengthen systems
• Create, endorse or fund a new project or projects• Collaboration with other partners?
8
• Blank Slide between presentations
Arctic One Health
10
PreventionDetection
Resilience
Presentation to the Arctic Human Health Expert GroupAnchorage, AlaskaOctober 20, 2015
Bruce Ruscio, DrPH, MPHU.S. Department of StateOffice of International Health and Biodefense (OES/IHB)
What is One Health?
Arctic Perspectives on One Health
One Health & resilience in a changing Arctic
Regionalizing Circumpolar One Health
Next Steps
Summary
11
Outline
An approach:
1. For developing and sustaining multi-discipline collaborations and partnerships
2. To address complex health issues at the environment, human and animal interface
3. To advance the early identification, prevention and mitigation of health risks
12
What is One Health?
Not new; greater acceptance prior to specialization of medicine
Counter to current medical training and education
Recognizes our interconnected world
People, animals and the environment are intricately and inseparably linked
Acceleration & intensification of H-A interface is a Global phenomenon
Increased emphasis on moving “up stream” in prevention
13
What is One Health?
14
Arctic Health Challenge
Climate Change
Arctic Region
Weather
• Extreme weather events
• Precipitation• Heatwaves• Temperature
extremes
Arctic Region
Ecosystem/environment
• Sea level changes• Glacial loss• Ice melting• Agro-ecosystem hydrology
changes• Sea ice shifts• Sea ice decreases in sea ice
extent and cover• Permafrost
thawing/changes • Forests and tundra
alterations• Increases in lake
temperatures• Changes to migration
patterns• Socioeconomics and
demographics• Exotic species introduction• Changes in vector biology• Changes in transmission
dynamics
Arctic Region Health
Impacts
• Extreme weather related
• Contamination exposures
• Water and food borne disease
• Vector borne diseases• Rodent borne
diseases• Food and water
shortages• Stress on plant &
animal population• Animal displacement• Respiratory diseases• NTDs• malnutrition
Effects are complex and
difficult to predict with
certainty
15
Arctic Health Challenge and One Health
Complex health threats require regional and international partnerships to share best practices
One Health approach already evident in the Arctic Programs & systems working with multidisciplinary
stakeholders Recognized need for a holistic framework for assessing
and responding to health risks Track record of policy makers receptive to, and
influenced by, scientific research
16
Operationalizing One Health
Under the US Chairmanship the Arctic Council will undertake a process to further the a One Health approach across the Arctic
region as a strategy to enhance resiliency
GoalBuild on and expand existing networks and collaborative efforts of diverse scientific disciplines and stakeholders to advance a regional One Health approach to better understanding the impacts of climate change on the health of humans, animals and ecosystems of the Arctic and circumpolar north.
17
A Strategy for Resiliency
Endorsed by the Sustainable Development Working GroupUS and Canada Co-Sponsors
Builds on existing efforts advancing circumpolar cooperation at the Arctic human-animal-environment interface
Synergies with other resiliency efforts
Advances efforts to understand climate-driven health risks
Enhances early identification, prevention, and response
Capacities to response to public health emergencies
18
Operationalizing One Health: Process
Phase 1: Baseline Survey Assessment
Develop a baseline assessment of one health activities/programs across the region – create inventory
Assess the interest in the One Health approachIdentify One Health champions/leaders
Establish One Health Leadership TeamDiverse range of scientific disciplines and permanent participants
and other stakeholdersDevelop strategy to implement activities in phases
19
Operationalizing One Health: Process
Phase 2:Conduct a series of regional Knowledge-sharing
workshops/forums for cross-section dialogueIdentify partners and community of practiceGather stakeholder guidance on implementation strategyDevelop timeline and metrics to measure progressBolster commitments from key national and community
institutions to designate One Health hubs
20
Operationalizing One Health: Process
Phase 3
Conduct One Health Systems Mapping and Analysis exercise (table top exercises -TTXs)
Initiate cross-agency collaborations at the local, regional, and national levels.
Determine where animal, human and environmental health services can align more closely to meet common One Health goals.
Initiate development of action plan specific to ArcticIdentify successes/best practices and gaps to address Identify specific actions to address the gapsProvides a benchmark for planning and evaluating
progress of future One Health activities
21
Operationalizing One Health: Process
Phase 4
Designate One Health Hubs
Link by agreements
Establish One Health Network System of the Arctic
Develop framework for future capacity building and activities
22
Operationalizing One Health: Process
Phase 5
Initiate Arctic One Health Collaborative Investigation
Project(s)
23
Arctic One Health: A Strategy for Resilience
SummaryArctic One Health: arctic health resilience
Arctic Council is undertaking a process to regionalize the practice of One Health across the Arctic region
Valuable strategy to understand the complex nature of climate change
One Health approach is already evident in the arctic
Enhance scientific understanding of threats, vulnerability prevention and screening strategies
Contribute to effective policies, threat reduction and community reliance strengthening
Economic and higher efficiency opportunities
24
Next Steps
Identify additional Co-Sponsor(s) for SDWG
Identify Arctic Region One Health Leaders
Program outreach awareness
Draft Survey Instrument development
Identify and evaluate tool/instrument for operationalizing One
Health
25
Thank you!
• Blank Slide between presentations
A Useful Model For The Development Of A Village-Based
Environmental Monitoring Program To Detect Established And
Emerging Environmental Threats To Food And Water Security In
Rural Alaska Communities
“One Health”Presented to: The AHHEG One Health WorkgroupOctober 20, 2015Anchorage, Alaska
Presented by:James Berner, MDAlaska Native Tribal Health ConsortiumAnchorage, [email protected]
Climate Warming
Rapid Cultural Change
Anthropogenic Contaminants
Food and Water Security
Major Threats for Rural Alaska Natives
Alaska Native Food / Water Security
AN residents monitoring local harvest for known and emerging contaminants (metals) and pathogens (parasites).
Alaska Native Biomonitoring Programs
Two biomonitoring programs, and one village based observer program are currently gathering data in rural Alaska.
• The Alaska Native Maternal Organics Monitoring Study (MOM Study)
-Supported by EPA STAR GRANT RD83370501-
• The Rural Alaska Monitoring Program (RAMP)-Supported by EPA STAR GRANT RD83559701-
• The Local Environmental Oberserver (LEO) Program
The polar front influences global ocean currents
Arctic Influence on Ocean Circulation
The Arctic plays a fundamental role in circulation of water in the oceans of the world. When warm, salty North Atlantic water reaches the cold Arctic around Greenland and Iceland and in the Labrador Sea, it becomes denser as it cools, and therefore sinks to deeper layers of the ocean. This process of forming deep water is slow, but takes place over a huge area. Every winter, several million cubic kilometers of water sink to deeper layers, which move water slowly south along the bottom of the Atlantic Ocean.
0.
5.
10.
15.
20.
25.
Toxaphene PCBs p,p DDE HCB Chlorodanes PFOs
Geo
metr
ic M
ean
Personal Communication A. Matz, FWS, 2010
Alaska Native Biomonitoring ProgramRamp Study
June 2005 – Community Water Source Disappeared in Kwingillingok
MECHANISMS OF MULTIPLE INTERACTIONS
• Increased contaminant transport, with increased tissue levels of contaminants in Arctic wildlife may increase susceptibility to active infection with endemic or new pathogens.
• This could result in mortality in these species, and possibly increased risk of exposure in human consumers to zoonotic diseases, and increased levels of contaminants.
• Increased tissue levels of contaminants in subsistence species will negatively impact immune response to endemic zoonotic diseases (e.g. brucella, toxoplasma).
Alaska Native RAMP BiomonitoringInitiative
Village-based, resident-operated monitoring program. Program
metrics are based on an individual village assessment of environmental
change, after the community prioritizes the findings.
Alaska Native Biomonitoring ProgramsRAMP Study
EXAMPLES OF ENVIRONMENTAL METRICS:
• Permafrost temperature around infrastructure and source water ponds.
• Shoreline camera; village source water cyanotoxin, and methyl mercury measurements.
• Bivalve saxitoxin and domoic acid levels.• Filter paper blood from subsistence mammals for
zoonotic antibodies and metals.• Filter paper blood for organohalogen analysis is under
development.• Mosquito monitoring for Franciscella Tularensis
(tularemia).
Alaska Native Biomonitoring Program Objectives
• Systematic collection, analysis and interpretation of information.
• Provide data for risk reduction strategy.• Detection of emerging threats.• Follow trends in exposure.• Evaluate interventions.• Create a specimen bank to allow
retrospective analysis of newly emerging threats.
Alaska Native Biomonitoring Program Data Application
Track trends in contaminant levels. Track trends in zoonotic pathogen prevalence
share data with other communities, regions, and agencies.
Improve knowledge about impact of climate regime change on contaminant and pathogen circulation in the circumpolar north.
Raise awareness in regional medical providers.
The most immediate application of RAMP data is the creation of a community-specific adaptation plan, allowing residents to reduce exposure to the subset of vulnerable residents, including pregnant mothers, infants, elders, immunosuppressed residents, and those with chronic diseases.
Alaska Native Biomonitoring Program Village Adaptation Planning
• Blank Slide between presentations
A One Health Approach in Alaska
October 20, 2015
Michael Brubaker
Director, Community Environment and Health
Alaska Native Tribal Health Consortium
Alaska Native
Medical Center
Environmental Health
and Engineering
Community Health
Services
Alaska Native Tribal Health Consortium
OUR VISION: Alaska Native
people are the healthiest people in the world.
Erosion in Kivalina
affects travel and
source water quality.
Fairbanks Daily News Miner
Wildfire on
Moose Mountain.
Fish drying racks
are empty in some
parts of Alaska.
Erosion turns
stream water the
‘color of coffee’.
Ice storm damage to
a subsistence camp
in Golovin.
Center for Climate and Health
To assist the tribal health system in understanding the connections between climate change, environmental impacts and health effects. To raise awareness and
encourage responses that protect community health.
Climate Events Significant Local Events
Emerging Threats Surveillance
One Health Experts
1. Track Climate Change Sensitive Events
Scan and map relevant articles from northern news media
2. Track Significant Local Environmental EventsConnecting keepers to help document and respond to change.
1. Local Experts2. Topic Experts3. Technology
Local and Traditional Knowledge Experts
Bert Greist – Selawik, Alaska
LEO Network includes hundreds of local observers who share observations about unusual environmental events.
A network of topic experts that engage with observers and provide event specific consults.
Hajo Eicken - UAF
Dr. Bob Gerlach - ADECMillie Hawley – Native Village of Kivalina
LEO APP – Observations of Environmental Change
Web and Mobile App Technology
LEO s share observations about unusual events, posted on public maps. LEOs then connect with technical experts for consultation.
One Health Group
EPA
DECAK and YT
DFGAK and YT
USFWS
NMFS / NOAA
Sea Grant
UAA / UAF / APU
USDA
NOAA
USGS
BOEM / BLM
Local and Regional Govts
USARC
Tribal Organizations
Wildlife and Livestock
Regional / Community
Environment
Tribal Health
Public Health
DHSSAK and YT
CDC
Homeland Security
One Health Group Map
(L) LEO Network / (N) News Media / (O) One Health Group
Photo Courtesy of COASST
Seabird die-off in
Aleutian Islands
King Cove7-17-15
Sand Point7-25-15
Seldovia7-30-15
Port Heiden7-30-15
One Health Group – Providing Trend Determination Guidance and Analysis
The Take Home
Operationalizing One Health requires good information about local conditions and emerging challenges at the local, regional and international level.
Local and traditional knowledge and observational data is a good starting point, and there are natural partnership with science to understand events and to plan research and other responses.
In Alaska, the One Health community includes keepers of local and traditional knowledge; clinical, public health and environmental health providers, environmental and natural resource and health agency managers, and the academic, science and research community.
By expanding One Health, northern populations can improve understanding, preparedness and response to emerging health threats.
Goog le Us : “Cente r fo r C l imate and Hea l th ”
For more about One Health Group
• Blank Slide between presentations
Using Community-based Surveillance to Assess Health Effects of Climate Change: Implications for One Health
David Driscoll, Ph.D., M.P.H.
Janet Johnston, Ph.D., M.P.H.
One Health Workshop
Anchorage, Alaska
October 20, 2015
Institute for Circumpolar Health Studies ● 3211 Providence Drive ● Anchorage, AK 99508
Phone 907-786-6581 ● Fax 907-786-6576
www.ichs.uaa.alaska.edu
84
Primary Data Collection
Data encrypted web
surveys
Packet of 12 surveys
and self-addressed
stamped envelopes
Toll-free telephone
number
Environmental changes
• Local weather/exposure
• Cold-related injuries/fatalities
• Mental health/Stress-related
Hunting & Harvesting
• Foodborne Diseases
• Vectorborne and Zoonotic
Food & Water Safety
• Nutrition
• Food/water security
General health & air quality
• Sources of outdoor air pollution
• Allergic allergies
• Asthma
ICHS CLIMATE CHANGE &
HUMAN HEALTH COLLOQUIUM
OCT. 7-8, 2010
Develop surveillance metrics
Attendees
• Community members and
liaisons
• State and federal govt. agencies
• Tribal health agencies
• Environmental scientists
• Public health scientists
• Clinicians
Developing Surveillance Metrics
85
One Health Surveillance Questions
In the past 30 days, how often have you (or
people you know in the community) seen any
unusual changes to local plants and/or animals,
compared to what you normally expect?
86
For people who harvested and/or butchered wild
game or prepared wild meat to eat, have you (or
people you know in the community) observed
any physical abnormalities on or in wild game,
aside from bite marks and scars from other
predators?
87
One Health Surveillance Questions
For people who have eaten fermented or dried
foods, have you experienced three or more of the
following five symptoms: Nausea or vomiting;
trouble swallowing; double vision; dilated or
unreactive pupils; dry throat or mouth.
88
One Health Surveillance Questions
8989
Results: Frequency of One Health Outcomes
Interior Northwest Southeast Three Regions Combined
One Health Outcome n % n % n % n %
Unusual changes to local
plants and/or animals
146 55.3 124 39.5 101 30.4 371 40.8
Physical abnormalities on
or in wild game, aside from
bite marks and scars from
other predators
2 1.9 25 12.0 7 5.4 34 7.7
Eating fermented or dried
foods…
37 16.1 266 89.6 88 30.8 391 48.1
…Nausea or vomiting;
trouble swallowing; double
vision; dilated or unreactive
pupils; dry throat or mouth
0.0 0.0 13 5.1 2 2.4 15 4.0
• Community-based sentinel surveillance systems represent an effective
strategy for tracking local environmental events and outcomes.
• Of all outcomes measured in this study, residents reported unusual
changes to local plants and/or animals most frequently; 40.8%.
• One Health-related outcome differ by region, with the Interior seeing
most changes, and Northwest seeing most abnormalities.
• No seasonal differences in outcomes.
Conclusions
90
• Ecological study design
• Small numbers
• Self-reported exposures and outcomes
Limitations
91
David L. Driscoll
907-786-6581
Thank you!
People of Alaska
Our Alaskan communities
Centers for Disease Control and Prevention
Community organizers
ICHS office staff
PROJECT HOTLINE (toll free)
1-855-786-6598
www.ichs.uaa.alaska.edu
Acknowledgements