Regional consultation on
Onehealth/Ecohealth
National One Health Symposium
November 25, 2013
Hotel Royal Plaza, New Delhi
Delia Grace & Johanna Lindahl
International Livestock Research Institute
CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)
Session one: Identifying the challenges
Overview
• Zoonoses: the lethal gifts of livestock
– Emerging infectious disease
– Neglected zoonoses
• Other agriculture associated disease
– Under and over nutrition
– Diet associated disease: diabetes, cancer, CVD
– Food borne disease (many zoonotic)
• Challenges in managing agriculture associated diseases
– Multiple burdens and multi-sectoral management
– Lack of evidence for prioritisation and management
– Lack of incentives for surveillance and control
Human health in the 21st century
• 7 billion people 2011 – 1 billion hungry;
– 2 billion with hidden hunger;
– 1.5 billion overweight / obese
• In 2011 55 million died – 18 million from infection
– 7 million deaths in under fives (2/3 infectious)
– One in four of the deaths in under five children occur in India
0
5
10
15
20
25
30
Dea
ths
(mill
ion
s)
High-income Middle-income Low-income
04 15 30 04 15 30 04 15 30
Where do we get our diseases?
• Few are Legacies – Paleolithic baseline: yaws, staph, pinworms, lice, typhoid, tb
• Most are Earned – Degenerative diseases: heart failure, stroke, diabetes, cancer
– Allergies, asthma, autoimmune diseases
– Sexually transmitted infections such as HSV-2, gonorrhea
• Many are Souvenirs – Around 60% of human diseases shared with animals
– 75% of emerging infectious disease zoonotic
• One billion PLK depend on 19 billion livestock
• 4 countries have 44% of PLK
• 75% rural, 25% urban poor depend on livestock
• Livestock contribute typically 2-33% income
• Livestock contribute typically 6-36% protein
Secondary
Host (livestock)
Secondary
Host
(human)
Reservoir
Host (wildlife)
Vector
Sylvatic cycle
Sustained transmission:
- peri-domestic or urban cycle
- sub-clinical, epidemic, pandemic
Type of pathogen: mutation,
heterogeneity, host specificity
Habitat change
Biodiversity
Host density
Vector density
Spillover! •Increasing human population and density •Human behaviour •Expansion of agriculture •Intensification of livestock production
Pathogen flow
Spill-over
Spill-over Spill-over
• Unlucky 13 zoonoses sicken 2.4 billion
people, kill 2.2 people and affect more
than 1 in 7 livestock each year
Greatest burden of endemic zoonoses falls on on billion poor livestock keepers
Hotspots
• Poor livestock keepers: South Asia 600 m, sub-saharan Africa 300 m
• Zoonoses burden: India, Myanmar, Bangladesh, Pakistan
• Emerging disease risk: West Europe, West USA
• BIG SIX Countries for all risk factors – S Asia: India, Bangladesh, Pakistan
– Africa: Ethiopia, Nigeria, Congo
HIV, TB, malaria
Other infectious
Mat//peri/nutritional
CVD
Cancers
Other NCD
Road traffic accidents
Other unintentional
Intentional injuries
0
5
10
15
20
25
30
2004 2015 2030 2004 2015 2030 2004 2015 2030
Dea
ths
(mill
ion
s)
High-income countries
Middle-income countries
Low-income countries
Mortality: global projection, 2004-2030
Farmer Consumer
AB1
AB1
AB1-> AM1
AM1
Corn/feed produced at farm
Corn/feed purchased
Milk produced at farm
AB1 AM1
Treatments
Fungal toxins in maize, peanuts, rice, sorghum, milk
Overview
• Zoonoses: the lethal gifts of livestock
– Emerging infectious disease
– Neglected zoonoses
• Other agriculture associated disease
– Under and over nutrition
– Diet associated disease: diabetes, cancer, CVD
– Food borne disease (many zoonotic)
• Challenges in managing agriculture associated diseases
– Multiple burdens and management in multiple sectors
– Lack of evidence for prioritisation and management
– Lack of incentives for surveillance and control
13
Human health
Agro- Ecosystems
Animal health
•International organisations •Regional organisations •Private sector health provision •Public health •Veterinary public health •NGOs & CBOs •Conservation •Environment
Plant health
Agriculture associated human disease
International agricultural health research
Top Zoonoses (multiple burdens)
• Assessed 56 zoonoses from 6 listings: responsible 2.7 billion cases, 2.5 million deaths
• “Unlucky 13” responsible for 2.2 billion illnesses and 2.4 million deaths
– All 13 have a wildlife interface
– 9 have a major impact on livestock
– All 13 amenable to on-farm intervention
0
20000
40000
60000
80000
100000
120000
140000
Deaths - annual
0
200000
400000
600000
800000
1000000
1200000
1400000
1600000
1800000
2000000
Top 13zoonoses
Next 43
PRIORITY DISEASES 1: Avian influenza 2: Rabies 3: Leptospirosis
Priority diseases don’t reflect importance ability to control Driven by media, donors, misperceptions
Official reporting systems
Reporting system
Zoonoses Scope
WAHID 33 Animal
TAD Info 2 Animal
Pro Med All All
GLEWS 19 All
Health Map
All All
Africa • 253 million SLU • 25 million lost annually • 12-13 million from notifiable disease • 80,000 reported == 99.8% un-reported
Source: HealthMap
Overview
• Agriculture associated disease
– A major health problem in developing countries
– South Asia a hot spot for zoonoses & diet associated disease
• Need for solutions that:
– Are multi-sectoral and multi-disciplinary
– Are evidence and science-based
– Include incentives for surveillance and control
Agriculture Associated Diseases http://aghealth.wordpress.com/