From Vision to Action: Prioritizing in One Health

Abstract

One Health is an integrated, unifying approach that aims to sustainably balance and optimize human, animal, and environmental health by recognizing their interdependence and encouraging collaboration across sectors and disciplines. While progress has been made in applying One Health to complex health issues, putting these strategies into practice remains difficult due to resource (eg, funds), structural (eg, governance) and situational (eg, political) constraints and gaps in infrastructure and capacity. These limitations often force decisionmakers to prioritize certain health issues over others. Prioritization by its nature counters the ethos of One Health, reducing the complexity of health systems to a few key outcome goals or actions. To leverage the strengths of One Health, while recognizing the rigidity of real-world health systems, we propose key considerations and strategies for prioritization within this framework. We advocate for cross-sectoral communication structures that support proactive, collaborative networks. Effective collaboration must extend beyond professional circles to include meaningful engagement with communities, ensuring that local context and lived experience inform decisionmaking. We highlight the importance of multisolving—identifying interventions that provide cobenefits across sectors—and the need for adaptive strategies that address both immediate needs and long-term goals. As we navigate a polycrisis of health threats (such as pathogens) and threat multipliers (such as climate change and antimicrobial resistance), embracing flexibility and adaptive thinking is essential for translating One Health ideals into practical applications that are feasible, politically viable, and socially relevant.

Keywords

Cross-sector collaboration Health prioritization Integrated decisionmaking One Health Systems thinking Transdisciplinary approaches

Introduction

One Health is an evolving field that addresses complex health challenges by recognizing the interconnectedness of humans, animals, and the environment.^1,2 Its strength lies in its integrated, collaborative, multisectoral, and transdisciplinary approach to promote holistic health, operating across local, regional, national, and global scales.³ To do this, it seeks to bridge traditionally siloed disciplines and sectors, including veterinary medicine, public health, and environmental science.⁴ In recent years, efforts to operationalize One Health have expanded significantly, reflecting its growing recognition as a critical framework for addressing emerging and persistent health threats.⁵

Despite progress, applying One Health in practice—while remaining true to its core principles—remains challenging. Due to its multifaced scope and comprehensive nature, efforts to operationalize One Health may become overly broad or intangible, reducing our ability to derive targeted interventions. Further, implementation is often hindered by structural, logistical, and institutional barriers that limit systems-level action.^6-8

The challenges of prioritization are not unique to One Health—they are true of many health system decisions. Limited resources and capacities necessitate difficult choices about where to allocate resources. One Health frameworks can support this process by mapping systems to identify issues, their urgency, and their connections to the upstream factors and determinants that impact health, such as land use change and changing climates. For example, Kahn (2021) describes a multidimensional One Health matrix tool that facilitates systems thinking by systematically examining complex interrelated issues like antimicrobial resistance and food insecurity.⁹ The One Health approach also incorporates the sociopolitical context—including power dynamics, political agendas, and historical inequities—to critically assess the role of policies in shaping these systems.¹⁰

Prioritization in One Health is an exercise in reconciling competing truths. The challenge is both practical and philosophical. How do we decide which issues deserve immediate action when issues are entangled? How do we weigh the needs of the present against long-term actions? Who has the power to make these decisions, and what criteria guide their choices? In this sense, prioritization in One Health is not just about ranking threats, but about deciding which narratives shape our understanding and actions, whose health we value, and in which futures we are willing to invest. Recognizing these challenges, we propose key considerations for applying One Health frameworks in ways that leverage their strengths, while navigating systems not designed for such broad, integrative approaches.

Proposed Pathways to Prioritizing in One Health

Networks at the Nexus to Identify Shared Priorities

As health disciplines and sectors have become increasingly specialized—often separated by methodology, governance, funding, and reporting—entrenched silos pose significant barriers to collaboration in One Health.^11,12 At provincial or state levels, governments are divided into specialties, such as Ministries of Health, Agriculture, or Environment, further complicating collaboration. This separation extends to health researchers and practitioners—the “2-communities” theory underscores this disconnect, suggesting that researchers and practitioners operate in separate circles, hindering effective knowledge exchange.¹³ Mistrust between sectors can exacerbate this divide, often stemming from hierarchical positions that devalue certain professions, such as on-the-ground community health workers.^14,15 For prioritization to align with the tenets of One Health, it is essential that decisions are equitably informed by expertise from all pillars, fostering a collaborative, integrated approach to health.

However, collaborative networks are frequently established reactively, only after a crisis has occurred. During the 2014-2016 Ebola outbreak in West Africa, gaps in coordination between international health agencies, national governments, and local communities delayed an effective response. Large-scale collaborations—bringing together the World Health Organization, Centers for Disease Control, Médecins Sans Frontières (Doctors Without Borders), and regional health ministries—were only fully mobilized after the outbreak had escalated.^16-18 This response underscored the consequences of not having cross-sectoral collaboration and preparedness mechanisms established in advance. Proactive relationship-building, by contrast, enables diverse groups to collectively identify priorities, strengthening their validity and enhancing feasibility through shared ownership and accountability.^19-21 Establishing standing local networks that bring together representatives from environmental, animal, and human health would not only facilitate coordination in addressing emerging threats but would also ensure that broader systemic drivers of health risks are considered from the outset. For those engaged in One Health research, this can be achieved by developing cross-sectoral advisory boards that inform project development and implementation, ensuring that disciplinary priorities are represented and integrated into recommended actions.^22,23

Cross-Sectoral Communications

Although several countries have endorsed the One Health approach, this has not been accompanied by the necessary infrastructural changes to support its implementation.²⁴ Without clear communication pathways, opportunities for collaboration are missed and prioritization efforts risk being fragmented or misaligned. To strengthen priority setting, practitioners and researchers require a shared language, accessible information-sharing mechanisms, and communication technologies that facilitate knowledge exchange across disciplines and sectors. One recent effort to address this need is the Food and Agriculture Organization’s formation of the Community of Practice on Information and Communication Technologies for One Health, which is creating a collaborative platform for information sharing across interest-holders in human, veterinary, and environmental health.²⁵ However, communication efforts must extend beyond professional networks to meaningfully engage with communities. A disconnect between communities and decisionmaking structures has contributed to an erosion of public trust, apathy, and limited the uptake of One Health solutions.^26,27 Those directly affected by One Health challenges bring essential perspectives on local realities, resource needs, and implementation barriers.^28-31 Participatory epidemiology approaches, which involve local communities in disease surveillance and response, have proven effective in identifying region-specific health threats and mobilizing timely interventions.^32,33 This approach was central to the Global Rinderpest Eradication Program, where pastoralists with an in-depth understanding of the local context played a key role in the identification of outbreaks and disease control.³⁴

By fostering inclusive decisionmaking that bridges expertise with lived experience, we create more equitable, effective, and sustainable One Health strategies. This requires communication platforms that allow for multidirectional information flow, as well as structures that empower communities to contribute to priority setting in meaningful ways. Investing in locally driven codeveloped risk communication strategies can ensure that One Health priorities are both scientifically sound and socially relevant.

Multisolving to Maximize Impact

In resource-limited spaces, decisionmakers face the challenge of identifying actions that will yield the greatest positive outcomes. Multisolving is gaining recognition as an effective strategy to enhance impact by prioritizing interventions that address multiple challenges simultaneously.³⁵ Multisolving is grounded in sustainability and ensuring the most efficient use of resources.³⁶ Community gardens, for example, are a common, yet innovative multisolving tool. They not only foster a sense of community connection but may also aid in reducing food insecurity at a local level.³⁷ Similarly, community-based spay/neuter and vaccination programs offer a strong example of multisolving within veterinary public health. These initiatives simultaneously address pet overpopulation, control of zoonotic diseases such as rabies, access to veterinary care in underserved communities, animal welfare, and public health education. By integrating services into a single coordinated effort, these programs improve animal and community health outcomes, as well as build trust between communities and health professionals—supporting long-term engagement and more inclusive and sustainable approaches to care.³⁸

Multisolving allows for the pooling of investments across interest-holders, which increases the availability of resources and enhances overall capacity. For instance, addressing livestock health and welfare benefits animal wellbeing, and has positive implications for human health and the environment.³⁹ Ensuring the health of livestock directly improves food safety, thereby reducing the risk of transboundary diseases. With a lower risk of disease spillover, farmers also have less need for antimicrobials, which helps preserve treatment options and supports responsible antibiotic use. This integrated approach highlights how multisolving can enhance outcomes across multiple sectors while optimizing the allocation of resources for sustainable solutions.

Sustainable Strategies

While a pandemic may be the most immediate crisis, longer-term issues like habitat destruction and biodiversity loss fundamentally alter the foundations on which health rests. Deforestation and habitat fragmentation are major drivers of biodiversity loss and environmental change. While deforestation reduces forest cover, fragmentation divides ecosystems into smaller, isolated patches, altering conditions critical for species survival and interactions.⁴⁰ These changes increase human–wildlife contact, raising the risk of zoonotic diseases. In Central and West Africa, for example, deforestation has been linked to Ebola outbreaks as habitat loss forces wildlife and humans into closer proximity.^41,42 Similarly, a 1% reduction in forest cover has been associated with a 10% rise in malaria incidence, as altered landscapes create ideal conditions for mosquito proliferation near human settlements.^43,44 Urbanization further reshapes ecological dynamics by shifting species composition, disrupting predator–prey relationships, and increasing disease transmission risks. As cities expand, adaptable species such as rodents and mosquitoes thrive, while less adaptable wildlife declines.^45,46 This shift enhances the presence of disease vectors and reservoirs, heightening the risk of zoonotic spillover. Additionally, standing water and poor waste management in urban areas create ideal breeding conditions for mosquitoes, while high population density and mobility typical of urban areas accelerate the spread of both vector-borne and directly transmitted diseases.^47,48 These processes do not happen all at once; instead, they occur steadily over time and therefore do not easily fit within frameworks of urgency.

Our current approach to crisis management is unsustainable. It often reacts to emergencies without addressing the underlying issues that contribute to these crises in the long term. Solutions must be future-oriented to achieve both short- and long-term goals. This long-term strategic planning requires strong coordination and communication to ensure sectors work toward a shared objective.⁴⁹ For example, Rwanda has incorporated One Health principles into the country’s national strategic health plan, demonstrating the potential for integrated health governance.⁵⁰ Effective strategic planning also necessitates input from all relevant sectors to bolster buy-in and foster accountability.⁵¹ Short-term action plans can be developed as road maps for achieving longer-term goals. For example, a 1-year mass dog vaccination campaign aimed at achieving 70% coverage can serve as a short-term action plan within a broader One Health strategy to establish coordinated roles, mobilize resources, and build local capacity. Over time, these short-term efforts contribute to long-term objectives, such as reducing human dog-bite incidents, use of postexposure prophylaxis, and human rabies cases, as well as fostering sustainable One Health collaboration across sectors.⁵¹ By aligning immediate actions with overarching goals, we can create more resilient and responsive health systems.

Despite the foundational principle of One Health as valuing human, animal, and environmental health, decisionmaking often prioritizes human health without recognizing the inherent value of improving animal and environmental health independent of people. In so doing, we are limiting our options and reducing our potential for sustainable impacts. To move away from human centrism, One Health must undergo a paradigm shift.⁵² One way to achieve this is through the integration of posthumanist thinking, which encourages the recognition of the intrinsic value of nonhuman entities and the ecosystems they inhabit and serves as both an ethical justification for human–animal–environmental solidarity and an actionable path forward.^53,54

Moving Forward: Adaptable Approaches to Prioritization

One Health is as much an aspiration as it is a framework for action. Prioritization forces us to confront our limitations—not just in resources, but in knowledge. The health crises we face are dynamic, shaped by ecological shifts, political pressures, and the unforeseen consequences of our own interventions. Prioritization, then, is not merely about making decisions, but about fostering the conditions in which better decisions can be made. It is about shifting from a reactive mindset to one that is anticipatory, inclusive, and adaptable to ensure that prioritization enhances—not undermines—the practical application of One Health by embracing uncertainty, bridging the ideal and the achievable, and ensuring equity.

Embracing Uncertainty

Prioritization in One Health takes place within a landscape of scientific uncertainty, political constraints, and competing interests. Traditional public health frameworks consider risk assessments and cost-benefit analyses, but these tools can only capture part of the picture.^55,56 Prioritizing in One Health needs to acknowledge uncertainty not as an obstacle, but as an inherent condition of decisionmaking. This is where adaptive thinking becomes essential. Instead of finding fixed answers, flexibility allows for iterative decisionmaking that can shift as new information emerges. To do this, decisionmakers must:

Appreciate the unknown: Recognizing that no decision is perfect, and that prioritization is an ongoing, reflexive process rather than a 1-time determination. For example, Canada has historically relied on widespread culling of poultry flocks to control highly pathogenic avian influenza (HPAI). While this approach has been effective in many cases, the unprecedented scale and duration of the recent outbreak and international movements towards exploring vaccination as an additional control tool, prompted a reevaluation. In response, the Canadian Food Inspection Agency (CFIA) established the HPAI Vaccination Task Force with representatives from industry, veterinary medicine, academia, and government to explore the feasibility, challenges, and opportunities associated with implementing a national vaccination program—an adaptive shift in strategy, reflecting evolving science, public concern, and the need for more flexible approaches to disease control.⁵⁷

Anticipate trade-offs: Acknowledging that every intervention has consequences—intended and unintended—and that recognizing these trade-offs is a critical part of the decisionmaking process. By incorporating mechanisms to evaluate impacts over time, decisionmakers can build adaptability into decisionmaking structures, remaining responsive to new information and adjusting strategies as needed, rather than being constrained by an initial course of action.

Bridging the Ideal and the Achievable

To make decisions that are feasible, effective, and politically viable while working towards healthier systems, a strategic, adaptive approach is essential. This requires compromise, while ensuring that compromises do not dilute the core principles of One Health, to move beyond a conceptual framework and translate into policies and interventions that work in real-world contexts. To do this, decisionmakers can:

Prioritize actionable entry points: Instead of waiting for the perfect cross-sectoral alignment, focus on leverage points where collaboration is feasible. Zoonotic disease surveillance can be an entry point for broader environmental health discussions by revealing links between disease emergence and environmental factors such as habitat destruction, biodiversity loss, and climate change.^58-60 The Canadian Lyme Disease Research Network (CLyDRN) illustrates this approach by bringing together experts from academia, public health, clinical practice, and industry to address the growing threat of Lyme disease in Canada. The network operates through a multidisciplinary, multisectoral framework that engages patients, caregivers, healthcare providers, and public health professionals. Through this coordinated model, CLyDRN not only advances Lyme disease surveillance, diagnostics, and treatment, but also supports collaborative research on the ecological and climatic drivers of tick-borne disease risk in Canada.⁶¹

Embed One Health in existing systems: Integrating One Health into existing policy, funding, and governance frameworks—rather than establishing parallel structures—strengthens systemwide coordination and cross-sectoral efficiency. The United Nations Quadripartite Alliance illustrates how embedding One Health into global mechanisms can strengthen coordination across human, animal, and environmental health domains.⁵² At the national level, Namibia’s rabies control strategy aligned government leadership with veterinary and community systems, significantly reducing human fatalities and enhancing intersectoral data sharing.⁶² Beyond improved health outcomes, integrating One Health offers a pragmatic economic advantage, particularly in low-resource settings, by enabling shared infrastructure, logistics, and personnel, thereby reducing costs and enhancing service delivery across sectors.^63,64

Focus on actions over threats: By identifying specific actions that effectively address multiple health threats, we reveal opportunities for overlap that maximize impact and resource investment. Initiatives that improve community resilience to climate-related health risks, for instance, can also enhance responses to zoonotic diseases.

Balance long-term vision with short-term gains: Some One Health challenges require generational change, such as antimicrobial resistance, while others, like outbreak response, demand immediate action. Strategies must acknowledge this dual reality by establishing clear priorities that balance short-term gains with long-term goals. For instance, the One Health Understanding Through Bacterial Resistance to Antibiotics Knowledge (OUTBREAK) initiative in Australia demonstrates this balance by employing AI-powered surveillance for real-time prediction and rapid response to antibiotic-resistant infections, while simultaneously informing broader, long-term mitigation strategies through integrated economic and resource data analysis. This approach ensures immediate threats are swiftly managed and contributes to sustainable, generational improvements in antimicrobial stewardship and health system resilience.⁶⁵

Ensuring Equity

Recognizing that certain groups are disproportionately affected by health challenges, priority setting must account for social and economic inequities to avoid reinforcing disparities.^66-68 In current systems, health security is often framed in ways that reinforce existing hierarchies. An equitable One Health approach will center those most affected by health threats in decisionmaking processes.¹⁰ To achieve this, decisionmakers should:

Center marginalized voices: Indigenous knowledge systems, rural communities, and frontline health workers hold critical insights into One Health challenges yet are often excluded from decisionmaking. Their inclusion should be a priority. This is exemplified by the Sahtu settlement area in the Northwest Territories, where Indigenous communities collaborated on the design and sustained delivery of a community-based wildlife health monitoring program. Elders, hunters, and youth were active members of the monitoring and research process, ensuring that surveillance efforts addressed community needs and priorities.^28,32

Account for power asymmetries: Recognizing and addressing power imbalances between sectors (eg, public health vs. agriculture, industry vs. environmental groups) ensures that One Health remains genuinely transdisciplinary. As shown by Snijder et al (2023), power asymmetries can be deliberately challenged through coleadership models, power mapping, and participatory governance structures that redistribute influence and build more equitable collaboration.⁶⁹

Build capacity in underserved regions: Investments in One Health should not be concentrated in high-resource settings; capacity-building in lower-income and remote regions is essential for global and national resilience. The Wildlife Health Bridge initiative offers a clear example: through targeted training for wildlife professionals, especially in low- and middle-income countries, the program has strengthened frontline capacity and led to lasting improvements in surveillance, outbreak response, and conservation practice.⁷⁰

Conclusion

One Health is a living framework. To foster resilient health systems, this framework emphasizes the importance of addressing upstream prevention rather than reactive responses. It advocates for training practitioners across the fields of environmental, animal, and human health in effective communication, collaboration, and interdisciplinary thinking. Additionally, it highlights the need to cultivate a culture of continuous learning and iteration to refine and adapt policies and practices as new knowledge emerges. The challenge is not to choose between principle and practicality, but to create systems where they reinforce each other. By embracing adaptability, prioritizing equity, and integrating One Health into existing structures, we can ensure that the concept does not remain just an ideal, but a guiding force that strengthens health security in the future.

Footnotes

Acknowledgments

We thank our research team, including Drs. Claire Jardine, Emily Newhouse, and Anne-Marie Nicol, along with trainees Erica Dong and Ryan Yazdani, for their contributions in shaping these ideas. We gratefully acknowledge the support and collaboration of Fraser Health, Northern Health (British Columbia), and Wellington-Dufferin-Guelph Public Health (Ontario). We also thank our national, cross-sector advisory board for their guidance and support, including Cécile Aenishaenslin, Université de Montréal; Kevin Afra, Fraser Health; Terri Aldred, National Collaborating Centre for Indigenous Health; Lupin Battersby, Simon Fraser University; Erin Fraser, BC Centre for Disease Control; Raina Fumerton, Northern Health; Jolene Giacinti, Environment and Climate Change Canada; Sean Hillier, York University; Stefan Iwasawa, BC Centre for Disease Control; Melissa Lem, Canadian Association of Physicians for the Environment; Gigi Lin, BC Ministry of Agriculture and Food; Nicola Mercer, Wellington-Dufferin-Guelph Public Health; Andrea Osborn, Community for Emerging and Zoonotic Diseases; Katherine Paphitis, Public Health Ontario; Heather Richards, Ministry of Health (Ontario); Lisa Ronald, Northern Health; and Kerry Schutten, Faculty of Veterinary Medicine, University of Calgary.

We respectfully acknowledge the unceded, ancestral, and traditional territories x^wməθk^wəy̓əm (Musqueam), Sḵwx̱wú7mesh Úxwumixw (Squamish), səlilwətaɬ (Tsleil-Waututh), q̓ic̓əy̓ (Katzie), k^wik^wəƛ̓əm (Kwikwetlem), Qayqayt, Kwantlen, Semiahmoo, Tsawwassen, and Mississaugas of the Credit (Michi Saagiig Nishnaabeg) peoples on whose lands our team works.

Funding for this project has been made possible through a contribution from the Public Health Agency of Canada (# 2425-HQ-000073). KAB and SJR are funded by Michael Smith Health Research BC Research Scholar (SCH-2023-3130) and Trainee (RT-2024-03804) awards, respectively.

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