One Health Newsletter one health Section Of The American Public Health Association

Sanitation as Part of a One Health Approach to Antibiotic Resistance

By Fatima Elgarguri, APHA One Health Supporter

“Without urgent, coordinated action, the world is headed for a post-antibiotic era, in which common infections which have been treatable for decades can once again kill.”

- Dr. Keiji Fukuda, former WHO Assistant Director-General for Health Security

Antibiotic resistance is one of the most pressing global health threats of the 21st century. Approximately 1.27 million deaths per year are attributable to resistant bacteria, with the highest burden in low- and middle-income countries (LMICs) (Murray et al., 2022). Underscoring the need for a One Health approach, the primary causes and subsequent impacts of antibiotic resistance are felt across human, animal, and environmental health. Efforts to combat antibiotic resistance have historically focused on reducing antibiotic overuse. However, higher rates of resistant bacteria in LMICs where per-capita consumption of antibiotics is lower than in high-income countries suggest that other factors are contributing to the crisis (Collignon et al., 2018). Enabled by deficient sanitation infrastructure, human fecal pollution is an underacknowledged driver of bacterial resistance. Human excrement can carry traces of previously consumed antibiotics and antibiotic-resistant bacteria, with the potential to directly transfer drug-resistant elements and infections to downstream humans and animals.

According to the Centers for Disease Control and Prevention (CDC), globally, most human waste is discharged directly into the environment (CDC, 2022). This includes open defecation and discarding untreated waste into waterways. Antibiotic-resistant bacteria shed in feces have the potential to contaminate receiving waters, which can be further disseminated in the environment when it rains or floods. People can become infected with resistant bacteria after engaging with contaminated water for food, bathing, or recreational purposes. In regions where livestock roams freely, open defecation can lead to fecal-oral transmission of resistant bacteria from humans to livestock, and the amplification of resistance when these animals are consumed. In addition, untreated sewage may be used to fertilize subsistence crops, creating further opportunities for the exchange of resistant bacteria.

The environmental load of drug-resistant bacteria is most significant in regions with poor sanitation systems. In an analysis of global fecal biomass containing ESBL-producing Escherichia coli, a bacterium of critical importance to human health, over 10% of total biomass was openly defecated, and another 14% was discharged into unimproved systems (Berendes et al., 2020). This suggests that low-technology steps can help stem the dissemination of resistant bacteria. Cost-benefit analysis indicates that moving up the “sanitation ladder” from open defecation to improved sanitation in LMICs will have the greatest net benefit in reducing global antibiotic resistance due to fecal pollution, with additional reductions when moving from secondary to tertiary treatment of wastewater (Graham et al., 2019).

As the global threat of antibiotic resistance ramps up, it is critical to implement comprehensive solutions. While Water, Sanitation, and Hygiene (WASH) is mentioned in the World Health Organization’s global action plan for antimicrobial resistance, it is classified under infection prevention, and environmental transmission is not acknowledged. In conjunction with WASH strategies that prevent infection (and thus reduce the need for antibiotics), efforts to improve sanitation systems should be central to our battle against antibiotic resistance - especially in LMICs, which face the most disastrous impacts of antibiotic resistance due to already strained healthcare resources. By breaking the chain of transmission of resistant bacteria between people, animals, food, water, and the environment, sanitation is a key One Health strategy to mitigate the global antibiotic resistance crisis.

References

Murray, C. J., Ikuta, K. S., Sharara, F., et al. (2022). Global Burden of Bacterial Antimicrobial Resistance in 2019: A Systematic Analysis. Lancet, 399(10325), 629-655.

Collignon, P., Beggs, J. J., Walsh, T. R., Gandra, S., & Laxminarayan, R. (2018). Anthropological and Socioeconomic Factors Contributing to Global Antimicrobial Resistance: A Univariate and Multivariable Analysis. Lancet Planetary Health, 2(9), e398-e405.

Centers for Disease Control and Prevention (2022, March 15). Antibiotic resistance spreads in the environment. CDC. Accessed April 24, 2022, from https://www.cdc.gov/drugresistance/environment.html

Berendes, D., Kirby, A., Brown, J., & Wester, A. L. (2020). Human Faeces-Associated Extended-Spectrum β-lactamase-producing Escherichia coli Discharge into Sanitation Systems in 2015 and 2030: A Global and Regional Analysis. Lancet Planetary Health, 4(6), e246-e255.

Graham, D. W., Giesen, M. J., & Bunce, J. T. (2019). Strategic Approach for Prioritizing Local and Regional Sanitation Interventions for Reducing Global Antibiotic Resistance. Water, 11(1), 27.

The Impact of Wildfires and Vulnerable Communities in California

By Katianna Parisis, APHA One Health Supporter

Wildfires, defined as uncontrolled fires that spread quickly, have become more intense each year, destroying homes and surrounding ecosystems in the state of California. Environmental conditions, such as droughts, winds, and extreme heat, often lead to these extreme events (NOAA SciLinks, 2021). Wildfires pose a threat to both rural and urban communities, causing a variety of impacts, including an increased risk of smoke-related diseases, psychological stress, and direct physical injury. To address this One Health issue, public health officials and their associates in California need to take action to know which communities are affected and their socioeconomic differences (McDermott et al., 2005).

Taking a closer look at this environmental risk, air pollution is caused by tiny particles in smoke that cause irritation to eyes, noses, throats, and lungs, even exacerbating respiratory symptoms like asthma (Asthma and Allergy Foundation of America, 2020). Notably, black children are disproportionately affected by asthma and are more likely to be hospitalized for moderate and severe complications, including fatalities. Social vulnerabilities, which are influenced by an array of social, cultural, and economic factors, may limit access to material and informational resources. Without this information, communities may have increased susceptibility to catastrophic loss by reduced opportunities to prepare for, mitigate, adapt to, and recover from disaster events. This could result in more low-income communities located in fire-prone areas (due to affordable housing) and are less likely to have fire insurance (due to high costs). Studies have shown a strong negative correlation between income and fire rates, where increased incomes were associated with significantly decreased fire rates (U.S. Fire Administration, 1997).

To address this One Health challenge in California, increasing health literacy about wildfires and enhancing community resilience will be priorities to national strategic plans. Implementing knowledge and plans of action are a requirement of the partnership between the California state and local governments. First, the assignment of the Community Assistance Planning for Wildfires (C-PAW) to incorporate wildfire risk into land plans can provide technical assistance to communities. Second, according to local and state policies, firefighters can perform prescribed fires (or controlled burns) to reduce the risk of big, dangerous wildfires (U.S. Forest Service, 2004). Lastly, residents and landlords of fire prone areas can adopt the most recent building materials for retrofitting homes to withstand future wildfires. As such, the insurance industry can continue providing incentives for preparedness activities through premium discounts (University of Nevada, Reno, 2020). These calls to actions may help vulnerable communities to be less susceptible to the physical, financial, and emotional damage of California wildfires.

As a nation, public health practitioners can apply their knowledge and skills and identify relevant resources to mitigate risk to the vulnerable communities of California. We should advocate for local and state policies that enforce the residents of these communities to obtain relevant resources (including educational materials) that can enhance community resiliency in these wildfire conditions. Research, policy development, and communications that penetrate all levels will determine the level of health gains, from those who directly manage and fight fires to those who manage the health consequences of smoke inhalation. As California residents, we need to act quickly to prevent residents from experiencing increased risk of physical and mental health consequences as well as loss of housing and valuables due to these environmental risks.

References

Asthma and Allergy Foundation of America. (2020). Wildfire Season Has Begun – and It Affects Air Quality and Asthma. Retrieved June 23, 2022, from https://community.aafa.org/blog/wildfire-season-has-begun-and-it-affects-air-quality-and-asthma

Masri, S., Scaduto, E., Jin, Y., & Wu, J. (2021). Disproportionate Impacts of Wildfires Among Elderly and Low-income Communities in California from 2000–2020. International Journal of Environmental Research and Public Health, 18, 3921.

McDermott, B. M., Lee, E. M., Judd, M., & Gibbon, P. (2005). Posttraumatic Stress Disorder and General Psychopathology in Children and Adolescents Following a Wildfire Disaster. Canadian Journal of Psychiatry, 50, 137-143.

NOAA SciJinks. (2022). How do wildfires spread? Retrieved June 23, 2022, from https://scijinks.gov/wildfires/

University of Nevada, Reno. (2020). Wildfire home retrofit guide: extension. Retrieved June 22, 2022, from https://extension.unr.edu/publication.aspx?PubID=3810

U.S. Fire Administration. (1997). Socioeconomic factors. Retrieved June 23, 2022, from https://www.usfa.fema.gov/downloads/pdf/statistics/socio.pdf

U.S. Forest Service. (2004). Prescribed fire. Retrieved June 22, 2022, from https://www.fs.usda.gov/managing-land/prescribed-fire

Transparent Window Filters as a Tool to Reduce Indoor Particulate Matter in Bangladesh

By Theresa Nair and Colby Sinclair, APHA One Health Supporters

Air pollution poses a major threat to health and climate across the world. Contaminants in the atmosphere primarily enter the body via the respiratory tract and can penetrate the bloodstream, impacting vital organs and inciting disease among humans and animals. Clean air quality is critical for a healthy ecosystem, and without collaboration among all sectors and society, true One Health cannot be achieved (Schneider et al., 2019). In humans, exposure to high levels of fine particulate matter (PM2.5) concentrations is associated with increased pediatric asthma, respiratory infections, and the development of chronic obstructive pulmonary disease (COPD). Recognizing the dangers of (PM2.5) on respiratory health, the question remains: What can be done at the household level to protect residents from outdoor air pollution? Since electronic filtration systems are expensive, and alternatives like respirators may have challenges with individual compliance, a more cost-effective and feasible approach is urgently needed.

Beginning in Beijing in 2015, new research emerged regarding the use of transparent polyacrylonitrile (PAN) window screen filters with microstructures engineered to capture PM2.5 particles from the air before entering the home environment (Liu et al., 2015). These screens can be attached to windows and screen doors as a simple method of reducing air pollution inside the home without the use of electricity. However, initial attempts at applying this technology were difficult to produce and inhibited airflow, resulting in diminished overall air quality. In 2019, a team of researchers made a significant breakthrough in this technology by developing a method of mass-producing filtration screens, using a spinning bead spinneret, that were engineered to remove 99.654% of PM2.5, from the air, while maintaining 60% of optical transparency (Liang et al., 2019). Further studies are needed to determine screen effectiveness over time. However, if the production costs can be minimized, this technology may become an affordable solution for low-income families to protect themselves from outdoor air pollution.

In 2021, Bangladesh was named the most polluted country by standards of annual average fine PM2.5, with levels measuring seven times higher than what is recommended by the World Health Organization (WHO, 2021). These rogue levels, which result from endless construction of roads and buildings, brick kiln emissions, and pollution from thousands of substantial industrial factories, contribute to more than 46,000 deaths each year due to acute respiratory infections (Basu, 2022). Additionally, the Bangladesh population often experiences electricity blackouts, resulting in homes without access to continuously running fans or electric-base stoves, thus increasing PM2.5 concentrations within a home. The combination of these factors makes Bangladesh a primary candidate for the installation of window screen filters made from using a spinning bead spinneret, should efficiency be determined and production costs be controlled. However, installation of the window filter screens would only be the first step when intervening in such highly polluted areas. Providing the population of Bangladesh with the support needed to implement effective prevention measures that will minimize the number of contaminants released into the atmosphere is equally as important as the installation of filtration screens.

While the recent developments in filtration screens provide a temporary solution to reducing indoor air pollution for low-income families, it does not address the damaging exposure to all residents who work or play in outdoor environments. To address this global burden, ongoing efforts should incorporate a more rigorous approach to implementing aggressive standards to reduce air pollution and improve air quality and long-term health across continents. Using urban Bangladesh communities as an example of how deadly ungoverned air pollutants can be, governments and economic leaders must work to comply with international agreements and other common clean air solutions that reduce emissions and greenhouse gasses while also promoting One Health.

References

Basu, J. (2022, February 23). Bangladesh PM2.5 Levels 7 Times Higher Than WHO Limit: Study. Down To Earth. https://www.downtoearth.org.in/news/air/bangladesh-pm2-5-levels-7-times-higher-than-who-limit-study-81658

Liang, W., Xu, Y., Li, X., Wang, X.-X., Zhang, H.-D., Yu, M., Ramakrishna, S., & Long, Y.-Z. (2019). Transparent Polyurethane Nanofiber Air Filter for High-efficiency PM2.5 Capture. Nanoscale Research Letters, 14(1), 361.

Liu, C., Hsu, P.-C., Lee, H.-W., Ye, M., Zheng, G., Liu, N., Li, W., & Cui, Y. (2015). Transparent Air Filter for High-efficiency PM2.5 Capture. Nature Communications, 6, 6205.

Schneider, M. C., Munoz-Zanzi, C., Min, K., & Aldighieri, S. (2019, April 26). “One Health” from concept to application in the global world. Oxford Research Encyclopedia of Global Public Health. Oxford University Press.

World Health Organization. (2021). WHO global air quality guidelines: Particulate matter (‎PM2.5 and PM10)‎, ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide. Geneva: WHO. https://www.who.int/publications-detail-redirect/9789240034228

Announcing the Community Science Exchange platform

By Shobhana Gupta, APHA One Health Supporter

A central tenet of One Health is recognizing the value of multi-disciplinary, collaborative scientific work – exploring the interrelatedness of human, animal, and environmental health domains to improve health outcomes for all people, animals, plants, and our environment. Parallel to our interconnected world, the microcosm of science is also a rich network of observers and data gatherers, data interpreters, and decision-makers who apply insights for positive outcomes. Advancing collaborations not just across disciplines but also across institutions and individuals in this scientific network is vital to making new discoveries and advancements that can be applied for high impacts. A novel effort to support collaborations between researchers and community members is the Community Science Exchange.

In 2022, the Community Science Exchange was formed as a joint endeavor by the American Anthropological Association (AAA), American Geophysical Union (AGU), American Meteorological Society (AMS), American Public Health Association (APHA), Citizen Science Association (CSA), and Unión Geofísica Mexicana (UGM). This platform aims to support and advance participants of the growing field of community science, recognized as the equitable collaboration of scientific research with communities aimed at outcomes for the benefit of communities and science. Community science is particularly relevant in the One Health domain, where outcomes depend on practical frameworks that allow implementation of research insights into action (Henley et al., 2021). Encouraging community expertise in the surveillance of and the development of feasible risk-reduction and response strategies to address human, animal, and environmental health threats, empowers those individuals who are most vulnerable to their negative impacts.

It is well recognized that the social determinants of health need to be regarded with as much importance as the genetic, behavioral, and environmental determinants in research, practice, and policy. Communities themselves are unique experts on their identities, geographical regions, challenges, and goals (Crosse et al., 2021). Leading with their priorities, preferences, and limitations, and engaging community members in the design and development of both research and policies focuses attention on critical challenges faced by these real communities, and leads the co-creation of solutions that are implementable and sustainable. As such, the Community Science Exchange platform values both academic knowledge and community experiences, and offers two venues for people to share their community-relevant work, insights, and learn from others – an online Exchange Hub and a peer-reviewed, open-access journal Community Science. Knowledge created by community members (different from communities of professional scientists or citizen scientists), co-created and co-led by community members and scientists, created at the request of local communities, or with demonstrably readily usable community-led applications are to be highlighted. We invite contributions to both the Community Science Exchange Knowledge Hub (in the form of project descriptions and resources such as case studies guides, datasets, videos, art, blogs, community comments, or news items) and the Community Science journal. As a first step, please send a pre-submission inquiry to communitysci@agu.org.

Disclosure statement: The views expressed herein are those solely of the author and do not reflect the official policy or position of Agile Decision Sciences or any related entities, National Aeronautics and Space Administration, the United States government.

References

Crosse, A. M., Barry, M. M., Lavelle, M. J., & Sixsmith, J. (2021). Bridging Knowledge Systems: A Community-Participatory Approach to EcoHealth. International Journal of Environmental Research and Public Health, 18(23), 12437.

Henley, P., Igihozo, G., & Wotton, L. (2021). One Health Approaches Require Community Engagement, Education, and International Collaborations—A Lesson from Rwanda. Nature Medicine, 27(6), 947–948.

Power Crisis in Puerto Rico

By Maya Arrington, Biruktawit Tibebe, and James McCarty, APHA One Health Supporters

In Puerto Rico, a Caribbean island territory of the United States, long-standing policies have led to economic and social distress compounded by natural disasters. Many residents are still struggling with the aftermath of prolonged service disruptions due to Hurricanes Maria and Irma. Blackouts have affected daily lives for many years and slowed economic growth because of high electricity prices. Due to these disruptions, public health emergencies remain highly prevalent in Puerto Rico, affecting access to food, clean water, and medical care. To address these current challenges, Puerto Rico can transform its electric grid into a resilient system that promotes the One Health concept and provides communities with clean, affordable, and reliable power for years to come.

Puerto Rico's electric grid is managed by the Canadian-American private company, LUMA. Although LUMA has a 15-year contract, it has struggled to maintain reliable service and affordable rates for its customers, resulting in dissatisfaction among Puerto Ricans (Lunney, 2022). However, the Puerto Rico Energy Public Policy Act (PREPA) has outlined their strategy to become 100% renewable by 2050, with intermediate goals of 40% renewable by 2025 and 60% by 2040 (Energy Information Administration, 2023). This goal, while ambitious, requires more attention because as of the second quarter of 2022, they were at merely 3% renewable (Energy Information Administration, 2023). Puerto Rican leaders clearly have work to do, but once they reach their goals, their population, animals, and environment will all reap the rewards of a cleaner, healthier world.

One of the most promising short-term solutions for Puerto Rico’s energy crisis is residential rooftop solar with storage. This option is highly modular, relatively low cost, and can be distributed to rural communities that are disproportionately impacted by service disruptions following natural disasters. According to the Energy Information Administration (2023), Puerto Rico’s long-term solution is entirely renewable energy, with 60% coming from solar and the remaining 40% from wind, providing residents with a reliable source of clean energy. Both of these solutions align with the UN Sustainable Development Goals of affordable and clean energy, sustainable cities and communities, climate action, responsible consumption and production, reduced inequality, no poverty, and quality education (United Nations, n.d.).

Ultimately, Puerto Rico can mitigate the negative impacts of its current unreliable electrical infrastructure by switching to clean energy sources. The sustainable energy solution to address Puerto Rico's energy crisis with solar polar will be essential in achieving the One Health concept that aims to foster well-being and tackle threats to health and ecosystems. Ongoing efforts to achieve the targets of the 2030 UN Agenda for Sustainable Development pave a path towards a more balanced and maintainable power structure that benefits global citizens.

References

CBS News. (2022, September 20). Why does Puerto Rico’s energy grid keep failing? Retrieved February 3, 2023, from https://www.youtube.com/watch?v=7YmSSEmX0xU

Lunney, K. (2022, September 30). Why Puerto Rico has struggled to stabilize is electricity grid. Bloomberg Government. https://about.bgov.com/news/why-puerto-rico-has-struggled-to-stabilize-its-electricity-grid/

U.S. Energy Information Administration. (2023, January 19). Puerto Rico Analysis. Retrieved February 3, 2023, from https://www.eia.gov/beta/states/states/RQ/analysis

United Nations. (n.d.). The 17 Goals. United Nations. Retrieved February 3, 2023, from https://sdgs.un.org/goals

One Health Fellowship Opportunities

By Katharyn Kryda, One Health Newsletter Editor

A recurring section in our newsletter, One Health Fellowship Opportunities will feature professional development opportunities for early career professionals interested in One Health topics. Everyone's career path is unique, and below you'll find a few launching points to get started. Click on the button below each description to visit the program's site for more details.

CDC Epidemic Intelligence Service - EIS is a highly competitive, 2-year post-graduate fellowship in applied epidemiology. This CDC program, established in 1951, is a unique combination of on-the-job-learning and service. Investigating outbreaks in the field is integral to the EIS experience. As CDC’s disease detectives, EIS officers are among the agency’s first-line rapid responders. EIS officers help public health officials investigate and control infectious disease outbreaks and respond to natural disasters and other threats to the public’s health.

California Epidemiologic Investigation Service (Cal-EIS) Fellowship Program - The California Department of Public Health shall provide a grant to and for the benefit of the Grantee; purpose of the grant is to provide the Grantee training/experience in applied epidemiology and public health during placements with governmental health agencies. The Grantee agrees to perform research in the area of epidemiology and gain hands-on experience working with an epidemiologist preceptor(s) in either local or state health departments in CA.

Association of Schools and Programs of Public Health Fellowships (ASPPH) - ASPPH fellowship and internship programs offer opportunities for current masters and doctoral level students and recent graduates to round out academic training and gain hands-on public health experience while continuing to develop professional skills and expertise in public health. On-site mentoring from public health professionals provides valuable career guidance and networking opportunities.

Council of State and Territorial Epidemiologists (CSTE)/CDC Applied Epidemiology Fellowship - CSTE, in collaboration with CDC, the Association of Schools and Programs of Public Health (ASPPH), and the Health Resources and Services Administration (HRSA), established the Applied Epidemiology Fellowship to train recent graduates in the expanding field of applied epidemiology. The goal of the Fellowship is to provide a high quality training experience and to secure long-term career placement for Fellows at the state or local level. Participating fellows will receive two years of on-the-job training at a state or local health agency under the guidance of an experienced mentor. The Fellowship’s mission is to meet the nation’s ongoing need for applied epidemiology workforce capacity in state and local health departments through a national fellowship-training program.

National Institutes of Health (NIH) National Biosafety and Biocontainment Training Program Fellowship - The National Biosafety and Biocontainment Training Program (NBBTP) was conceived as a partnership between the Division of Occupational Health and Safety (DOHS) and the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health in Bethesda, Maryland. As of January 2020, the NBBTP became part of the NIH Intramural Research Training Award (IRTA) program and is now known as the NIH NBBTP/IRTA Fellowship. The NBBTP/IRTA offers two-year postbaccalaureate and postdoctoral fellowships. The mission and vision of the NBBTP/IRTA Fellowship is to prepare biosafety and biocontainment professionals of the highest caliber to meet the needs of the biomedical, emerging disease and civilian biodefense research communities through the 21st century.

Association of Public Health Laboratories (APHL) and CDC Laboratory Fellowships - APHL and CDC partner to offer a variety of laboratory fellowship programs to train and prepare scientists for careers in public health laboratories and support public health initiatives. There are currently six APHL-CDC fellowship programs: Antimicrobial Resistance Laboratory Fellowship, Environmental Public Health Laboratory Fellowship, Bioinformatics Fellowship, Infectious Diseases Laboratory Fellowship, Laessig Memorial Newborn Screening Fellowship, and Newborn Screening Bioinformatics and Data Analytics Fellowship.

American Association for the Advancement of Science (AAAS) Science & Technology Policy Fellowships (STPF) - AAAS Science & Technology Policy Fellowships (STPF) provide opportunities to outstanding scientists and engineers to learn first-hand about policymaking while contributing their knowledge and analytical skills to the federal policymaking process. Fellows serve yearlong assignments in the executive, legislative and judicial branches of the federal government in Washington, DC. Each year, the program adds to a growing corps over 3,400 strong of policy-savvy leaders working across academia, government, nonprofits and industry to serve the nation and the world.

Winston Health Policy Fellowship - This twelve-month fellowship offers a postgraduate immersion experience in health policy development by working directly with policy-makers in both the public and private sectors. Current graduate students in their final year of study for a masters or doctoral degree are eligible to apply. The Winston Health Policy Fellowship is located in Washington, DC.