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

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15

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25

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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

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2004 2015 2030 2004 2015 2030 2004 2015 2030

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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

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Deaths - annual

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400000

600000

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1000000

1200000

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1600000

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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/