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Investing in One Health
A concerted approach to address shared risks to humans, animals,
and the environment
Policy Brief
Health disasters like Ebola in West Africa, H5N1 Avian Influenza in Asia and Europe, and Zika virus in Latin America have
significantly harmed both health and economies. Many of these countries afflicted by diseases of pandemic potential also
face a persistent burden of endemic diseases such as rabies, Lassa virus, and brucellosis, and are challenged by bacteria
increasingly resistant to antibiotics. Zoonotic diseases (transmitted between animals and humans) account for over a
billion human cases and a million deaths annually. These disease threats compound poverty and obstruct development.
Ecosystem alteration, climate change, and inadequate biosecurity are also disproportionately present in the developing
world, and exacerbate existing and emergent disease risk.
Strong, environmentally considerate, public health systems are needed to prevent, reduce, and manage risks to humans,
animals, and the environment and are critical to achieve the World Bank’s twin goals of ending extreme poverty and
boosting shared prosperity. The One Health concept recognizes these connections and promotes coordination to better
understand and manage risks. This approach can help countries achieve progress on national and global priorities including poverty alleviation, economic growth, food security, health, and well-being, toward achievement of the Sustainable
Development Goals (SDGs).
One Health: What It Is and Why It Matters
Public health challenges at the human-animal-environment interfaces are inherently multi-sectoral, and therefore warrant
whole-of-society solutions.
The One Health concept recognizes the connections between humans, animals, and the environment and promotes
coordination to better understand and manage risks. By improving understanding of animals and/or ecology, it informs risk
management and can prevent disease threats. Its application can also reinforce other health objectives, such as maternal
and child health, food and nutrition security, pollution management, and sanitation. An increasing number of countries
are taking measures to develop One Health coordination mechanisms to support multi-sectoral surveillance, laboratories,
risk assessment, communication, and policy development activities.
Humans, Animals, and the Environment: What Are the Connections?
• Pandemic and epidemic threats: Over 60% of infectious diseases in humans are of animal origin (e.g., Avian Influenza, Ebola, MERS-CoV, and Rift Valley fever viruses, even HIV/AIDS). Changes in land use, climate, food production,
trade, and travel are among the drivers of disease emergence and spread.
• Antimicrobial resistance: There is evidence of adverse human health consequences due to resistant microorganisms
resulting from nonhuman usage of antimicrobials, including in animal agriculture. Improper waste management from
manufacturing and application may also enable environmental dissemination of residues and resistant strains.
• Loss of ecosystem services: Land degradation often results in loss of ecosystem services that support human health
and agriculture (e.g., safe water and food, pest control, and disaster resilience).
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2 Policy Brief January 2018
In addition to direct health benefits, the economic
argument for investing in One Health is compelling
(see examples of multi-sectoral impacts in the figure on
page 3). The West African Ebola outbreak, for example,
resulted in a loss of 12% combined GDP growth in
Guinea, Liberia, and Sierra Leone. Zoonoses frequently
account for acute and persistent disruptions in education, routine health care, and livelihood generation.
While economic impacts are considerable, investments
in capacity to mitigate risk are still very limited. One
Health strategies are highly cost effective, not only for
reducing pandemic and antimicrobial resistance risks,
but also endemic diseases.
Annual investment of approximately US$1.9–3.4
billion to raise human and animal health system
capacity in World Bank client countries is expected
to return upwards of $30 billion per year in avoided
losses.
This is a high return on investment even if only a portion
of pandemics are prevented, while also generating gains
for agricultural production and control of endemic diseases
(World Bank 2012).
Similarly, assuming that just 50% of antimicrobial resistance
(AMR) costs will be avoided by vigorous AMR containment
efforts, between $10 trillion and $27 trillion could be saved
between 2017–2050 in expected cumulative global benefits,
far greater than the investment costs of $0.2 trillion (World
Bank 2017a).
Strengthening public health systems at the human-animalenvironment interface is necessary to protect health,
agricultural production, and ecosystem services (ranging
from food and nutrition security to disaster resilience and
ecotourism)—all of which contribute to economic development and are critical foundations for growth.
One Health is integral to the success of multi-sectoral
national action plans for health security and to address
antimicrobial resistance and promote disaster risk reduction. It can optimize pandemic preparedness planning and
enhance climate change vulnerability assessments.
The One Health approach promotes synergies for progress
on and balances possible trade-offs of the Sustainable Development Goals, and is endorsed by international agencies
(e.g., the WHO-OIE-FAO tripartite agreement and recent
decisions on health and biodiversity by the UN Biodiversity
Convention that specifically recognize the value of One
Health for mainstreaming biodiversity to help protect species and ecosystems).
How to Invest in One Health
Defining the scope, identifying entry points, and mapping
stakeholders are key first steps to understanding relevant
actors and identifying gaps to address hazards. Each sector has its own contributive tools and guidance resources;
stronger multi-sector coordination can better harness existing efforts and generate knowledge that could otherwise
not be yielded from single sectoral approaches. As public
health systems are dynamic and require continuous feedback
loops, implementation may occur at different stages based
on resources and priorities, but should reinforce overall
public health systems strengthening to reduce resource
intensive responses.
Animal Health
Systems
Human Health
Systems
Collaboration
Collaboration Collaboration
Collaboration
One
Health
Environmental
Health and
Management
Systems
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Investing in One Health Investing in One Health
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The World Bank has worked for over a decade to promote
and operationalize One Health approaches supported by
country partners, technical institutions, international organizations, and development funders. The World Bank has
established a considerable knowledge base on the topic,
with reports and studies addressing various One Health
dimensions such as ‘People, Pathogens, and Our Planet’,
the ‘Investing in Climate Change and Health’ series, and
the economic impacts of antimicrobial resistance. This
analytical work has underpinned country operations
like the Global Program for Avian Influenza and Human
Pandemic Preparedness and Response (GPAI), and the
Regional Disease Surveillance Systems Enhancement
program (REDISSE).
An Operational Framework for Strengthening Human,
Animal and Environmental Public Health Systems at
their Interface (“One Health Operational Framework”)
now builds on this experience and provides guidance to
help optimize One Health operations. Several lessons have
emerged, some of which are summarized below.
Lessons for One Health Operations
• Starting points for One Health vary by context, disease,
and objectives. Public health systems must be agile
enough to address all hazards; to do this, countries need
strong human, animal, environmental health/management systems and coordination between them to even
determine which sectors are relevant to understand and
manage risk.
Examples of Economic Impact of Infectious Disease Outbreaks
Estimated Cost
Agriculture Travel
Tourism and
public events Mining
2002
$10 bn
$20 bn
$30 bn
$40 bn
$50 bn
Figures are estimates and are presented as relative size. Based upon BioEra, World Bank, and UNDP data. Chart updated
by EcoHealth Alliance.
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Ebola
West Africa
$10 bn
H1N1
Worldwide
$45–55 bn
H5N1
Avian Flu
Worldwide
$30 bn
SARS
China, Hong Kong,
Singapore, Canada
$30–50 bn
Zika
Latin America
& the Caribbean
$7–18 bn
2016 2017
Estimates represent medical and non-medical costs; icons depict highly affected industries.
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4 Policy Brief January 2018
• Strengthening institutional and governance mechanisms is critical for the sustainability of One Health
approaches. Beyond project-related interventions, these
underpin longer term planning capacity as well as exante and ex-post monitoring and evaluation which are
associated with policies and projects.
• One Health approaches should be built into project
design from the onset. Engaging all relevant stakeholders
early on helps optimize project success by developing
a common understanding of issues and joint solutions
to address them, anticipating risks, targeting key gaps
and reducing duplication, and facilitating relevant coordination channels.
• Wildlife and environmental health services should
be systematically included when considering national
investments in public health systems.
• There is a growing body of operational experience
and tools among the World Bank and key technical
partners that provide solid grounds to develop sound
One Health operations.
• Communication is a key priority for One Health approach
understanding and implementation. Planning ahead
for disease events and maintaining strong multi-sector
coordination channels at all times helps ensure consistent and effective messaging to manage risk, enhance
efficiency, and promote credibility of all sectors.
The Operational Framework for Strengthening
Human, Animal and Environmental Public
Health Systems at their Interface (“One Health
Operational Framework”)
The One Health Operational Framework supports a stepwise
approach and provides a practical methodology for applying
One Health in development operations. It outlines activities
and interventions to target disease threats at the humananimal-environment interface, highlighting mechanisms
for institutional and technical implementation to build
more collaborative public health systems. It emphasizes
elements that are critical to include in projects, including
specific country requests for national priority issues. It
presents steps and provides technical guidance for actions
and capacity that can be taken at country levels along the
prevent-detect-respond-recover spectrum.
The Framework also embeds One Health economic and
development considerations into an applied approach to
policy and lending and provides examples of successful One
Health projects that can be borrowed from and replicated.
It creates a platform for engagement amongst international
organizations, development lending institutions, and national
governments. Finally, the One Health Operational Framework
encourages greater technical engagement and high-level
political support to mainstream One Health considerations
into development policy and lending.
For more information, please contact: Franck Berthe (fberthe1@worldbank.org), Timothy Bouley (tbouley@worldbank.org)
or Caroline Plante (cplante@worldbank.org).
References: Jones, et al., 2008. Nature; Karesh, et al., 2012. The Lancet; World Bank, 2012. ‘People, Pathogens and Our
Planet: Volume II, the Economics of One Health’; World Bank, 2017a. ‘Drug Resistant Infections: A Threat to Our Economic
Future’; World Bank, IWG report, 2017b. From ‘Panic and Neglect to Investing in Health Security: Financing Pandemic
Preparedness at a National Level.’
Deadly infectious pandemics will mark humanity’s future,
as they have shaped its past. Neither individual
governments nor the global community can entirely
prevent the emergence of infectious threats.
But we can be much better prepared.”
(World Bank, 2017b)
The Framework is available online at: http://documents.worldbank.org/
curated/en/703711517234402168/Operational-framework-for-strengtheninghuman-animal-and-environmental-public-health-systems-at-their-interface
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