(Part 1, Veterinary Public Health and Food Safety, VPE)
Topics: Aims and scope of Veterinary Public Health. Role of veterinarians in public health. One Health concept and initiatives. Veterinary Public Health administration.
Veterinary Public Health - Aims, Scope, Veterinarians Role, Administration and One Health Concept
Introduction
Health is multifaceted, it gives rise to multiple perceptions, each perception contributes to the understanding of health in one way or the other. Some of these perceptions may be reproduced as under:
- Health is the most important asset, the priceless possession of man.
- Health is a major social investment, central to development.
- Health is essence of productivity and the key to quality of life.
- Health is a universal social goal, a social responsibility and a fundamental human right.
So, there is nothing to be wondered that health has been defined variously by various authorities. According to WHO (1948) “Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity”.
In contrary a state of altered structure and function of host’s tissues, organs and systems is known as disease.
Public Health
The WHO Expert Committee on Public Health Administration (1952) has defined public health as “the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts.” The section of human medicine that deals with individual patients (like chronic cough or tumor patient) where the medical practitioner carries out clinical examination and investigates to find out the cause of the disease and prescribe accordingly to alleviate the disease is known as general medicine. In contrast, there are number of health-related problems of individuals (like diarrhoea in children) which cannot be managed unless concerted efforts are made by sanitation engineers, community administrators and the family to ensure sanitary water supply to the community. Diarrhoea in this case will be called a public health problem.
Background of Veterinary Public Health
Man and animals have interacted with each other since time immemorial. In fact, the association of the two has been truly symbiotic. While man derives enormous economic benefits from animals, animals received protection and tender care at the hands of humans. The intimacy of human and animal relationship evolved over centuries and conceptualized into what is being called now as intensive rearing of livestock. This shift in our approach to animal rearing and agricultural management as a whole has provided avenues for the passage of agents and vectors of animal diseases from animals to man through direct contact, foods or other environmental agencies. Human health, therefore, remains at a constant threat from animals-domestic or wild.
The concept of Veterinary Public Health was evolved in the USA in late 1940s and was further expanded over the years. The importance of establishment of Veterinary Public Health was felt by the European countries before 1950 and as a result WHO established a Veterinary Public Health unit in 1949. Since 1950, several expert groups having interest in Veterinary Public Health have discussed together and reported on problems involving the zoonoses and the related matters. And in 1950 for the first time WHO and FAO expert group jointly formulated a definition as- “Veterinary Public Health comprises all the community efforts influencing and influenced by the Veterinary-Medical arts and sciences applied to the prevention of diseases, protection of life and promotion of the well-being and efficiency of mankind.”
In 1955, again a joint FAO & WHO expert groups met together and discussed on the major problems in the region and thereafter in 1956 they made a wide accepted definition as- “Veterinary Public Health is the field of activities which protects and advances the human well-being by utilizing the combined knowledge and resources of all those concerned with human and animal health and their interrelationships.”
FAO & WHO again jointly redefined it in 1975 as- ‘Veterinary Public Health is a component of public health activities devoted to the application of professional veterinary skills, knowledges and resources to the protection and improvement of human health.”
Finally, in 1999 the joint WHO/FAO expert group defined Veterinary Public Health as- “The contribution to the complete physical, mental and social well-being of human through an understanding and application of veterinary medical sciences.”
Genesis of Veterinary Public Health in India
Realizing the importance of Veterinary Public Health all over the world and considering the huge number of livestock and their intimate and close contact and coexistence with the human beings in rural areas of India, with every possibilities of spreading zoonoses, efforts to organize veterinary public health services in India were initiated in 1964 with the establishment of a Division of Zoonoses at the National Institute of Communicable Diseases (NICD). This was followed by institution of a Master’s Degree course in Veterinary Public Health at the College of Veterinary Sciences at Pantnagar in 1965. Again, in1968 WHO & FAO sent an expert team led by Dr. Calvin W. Schwabe to observe the feasibility of expanding the post graduate study of Veterinary Public Health and to produce the qualified public health veterinarians in India. Accordingly, after visiting all the veterinary & medical institutions, directorates and administrative personnel all over India, Dr. Schwabe recommended that the post graduate study in Veterinary Public Health should immediately be started in India. As a result, Master in Veterinary Public Health course started in 1970 in All India Institute of Hygiene and Public Health in Kolkata and in 1971 in Indian Veterinary Research Institute in collaboration with Calcutta University. This course is still going on and producing qualified public health veterinarians.
Some other Definitions
- Epidemiology: It is the branch of science that – deals with the study of distribution and determinations of diseases in a population and the application of the study to prevent and control the health related issues of the same population.
- Milk Hygiene: It is defined as all the measures adopted in every aspects of milk production, transport, processing and distribution in order to make it safe and suitable to the consumers.
- Meat Hygiene: It is defined as all the measures adopted in every aspects of meat production, transport, processing and distribution in order to make it safe and suitable to the consumers.
- Food Safety: Food safety can be defined as the assurance that food will not cause harm to the consumers when it is prepared and or eaten according to its intended use.
Scopes of VPH / Domains of VPH
- Zoonoses (i) Diagnosis (ii) Surveillance (iii) Epidemiology (iv) Control (v) Prevention (vi) Elimination
- Food Protection (mainly animal origin) – to protect the food from any kind of contamination.
- Management of Health Aspects of Lab. Animals Facilities of Diagnostic Lab.
- Biomedical Research
- Health Education & Extension
- Production and Control of Biological Products and Medical Devices.
- Management of Domestic & Wild Animal Population.
- Protection of Drinking Water and the Environment.
- Management of Public Health Emergency (Flood, Earthquake, Disease Outbreaks etc.).
Functions of Qualified Public Health Veterinarians
A joint FAO & WHO expert committee on Veterinary Public Health (1975) has categorized the principal functions of Veterinarians as:
(i) Animal related functions It includes
- (a) The human health aspects of production, processing and marketing of foods of animal origin.
- (b) Health related problems of other animal industries including safe disposal of animal wastes.
- (c) Zoonoses, their diagnosis, surveillance and control
- (d) Technical consultations on human health matters related to animals and their diseases.
- (e) Investigations of the dangers to man posed by biting, toxic, venomous and other hazardous or objectionable animals.
- (f) Supervision of experimental animal colonies maintained by Public Health Lab.
- (g) Comparative studies on the epidemiology of noninfectious diseases in animals and man influenced by environmental and other influences.
- (h) Interchange of research information b/w Veterinary Scientist and human health experts with a view to augment community health.
(ii) Biomedical functions It includes
- (a) Epidemiology
- (b) Health Lab. Services
- (c) General environmental health, including radiological health and environmental physiology.
- (d) Protection of foods.
- (e) Production and control of biological products
- (f) Drug evaluation and control.
- (g) Most aspects of Public Health research, including research in reproductive physiology and fertility control.
(iii) Generalist Functions Beyond the above-mentioned potential areas of responsibility in public health, the Public Health Veterinarians can also serve in general Public Health as administrator, planners and coordinators.
Veterinary Public Health Administration in India
Despite a strong feeling of importance of initiation of Veterinary Public Health in India, it has not been possible to implement VPH programmes to the extent required. Still there are various agencies and local bodies at different levels that are functioning in their own capacity from their own positions. These are as detailed below:
(i) Central Government Bodies
Several initiatives have been taken at the Central Government level to deal with issues related to VPH in India. For example – the Ministry of Health & Family Welfare and the Ministry of Agriculture formulated a National Committee on Zoonoses in 1978 (NCZ), With active support from WHO, these ministries, also formed a Joint Monitoring Group on Avian Influenza in 2004 and a National Influenza Pandemic Committee for the prevention and control of Avian Influenza in 2005.
(ii) State Level
Agriculture and Animal Husbandry in India are, by and large, controlled by the State Government and most states have a well-established animal Husbandry and Animal Health Sector. However, inter sectoral collaboration on VPH issues is largely missing in most Indian states. Two noted exceptions are North – Eastern State of Mizorum, which formed a State level ‘Standing committee on Zoonoses’, and the Western state of Goa, which has a stated mandate on Public Health. Nevertheless almost all the states of India have laboratories for disease diagnosis. These laboratories issue animal health certificate for Food Export purposes, certifying that certain categories of food items or ingredients are fit for human consumption. Some laboratories of ICAR and State Agricultural or Veterinary Universities occasionally serve the same purpose.
(iii) Veterinary Public Health activities at Municipal Level
At the local Government level, municipalities specially the larger ones, play an important role in the activities, in the form of meat inspection in the slaughter houses under their jurisdiction. Even privately owned and operated slaughter houses, engage veterinarians to meet export inspection requirements. However, at the municipal level broad based modern program are lacking and veterinary supervision of most abattoirs is hampered by inadequate financial support and out dated facilities.
Municipalities in many Indian cities are involved in controlling stray dog populations, chiefly for rabies control. The earlier practice of capturing and poisoning stray dog is now being replaced by Animal Birth Control (ABC) Program.
(iv) Role of Professional Associations and NGOs in VPH Activities
A number of professional organizations are involved in promoting Veterinary Public Health in India. Prominent professional association engaged in Veterinary Public Health activities include -
The Indian Association for Veterinary Public Health specialists, the Veterinary Public Health Association of India, The Association of Public Health Veterinarian (APHV), The Association for the Prevention and Control of Rabies in India (APCRI) and the Public Health Foundation of India. The recent ‘Roadmap to Combat Zoonoses in India’ (RCZI) initiatives of the PHFI aims to create a broad based collaborative platform integrating professionals from various sectors to combat zoonoses through a ‘One health’ approach. However, these organization mainly focuses on the academic aspects of Veterinary Public Health.
(v) International Organizations
WHO (South East Asian Regional Office, New Delhi) SEARO of WHO in New Delhi served as the platform for various early VPH activities in India. The organization sponsored important activities notably a WHO inter-regional seminar on ‘Veterinary Public Health Manpower development’ in New Delhi in 1978 and a WHO inter-country seminar on the “Planning of National and Regional Program for surveillance, prevention and Control of Zoonoses and Related Food-borne diseases” also held in New Delhi in 1979. At various times SEARO has supported VPH activities in India by for example funding fellowships to study zoonotic disease programs and organizing seminar, training and workshops on the surveillance and control of zoonoses such as Rabies.
FAO (Food and Agricultural Organization) of United Nations, New Delhi. This organizations worked mostly with the Ministry of Agriculture to manage zoonotic diseases especially Avian Influenza. In fact, the Indian action plan for AI was developed in Active Consultation with the New Delhi Office of FAO.
(vi) Milk Co-operatives
In India, milk co-operatives like Gujrat Co-operative Milk Marketing Federation Limited (GCMMF), under the brand name ‘AMUL’ (Anand Milk Union Limited), other cooperative societies in various Indian states also contribute towards Veterinary Public Health by improving their milk hygiene practices. As a result of theirwell organized and supervised establishment of milk handling, processing and marketing procedures, these institutions have significantly assisted in raising the quality of marketed milk and milk products in India.
(vii) Personalities
In the formative years of Veterinary Public Health development in India, a number of professionals from India and abroad made significant contributions. Among them were Dr. C. M. Singh, Director of IVRI and Advisor to WHO and Dr. Celvin W. Schwabe, Prof. of Epidemiology (School of Veterinary Medicine, Davis) and WHO consultant. Dr. Schwabe prepared the ‘Assignment Report on Training in VPH in India’ for WHO in 1968. Other experts who contributed to VPH in India in the early years include Dr. Cohen, who compiled the ‘Assignment Report on strengthening of services (epidemiology), India.’ for WHO, James H Steele, Assistant Surgeon General of the United States Public Health and WHO Consultant etc.
Concept of One Health and One Health Initiatives
One Health
The term ‘One health’ could be defined as the inter disciplinary approaches and actions involving strong co-operation primarily between physician and veterinarian so that health of people and animals could be ensured including the safety of the environment through improved co-operation between physicians and veterinarians.
The concept of ‘One health’ represents a unique and significant opportunity for veterinary medicines to be in a leadership role and to work collaboratively for eco-system health for the greater good of the society.
Brief History
‘One helath’ is a new phrase but the concept was originated as far back as to the time of Aristotle in 500 BC and Hippocrates in 340 BC. Aristotle wrote the ‘Historia Animalium’ to elaborate on the natural zoonotic history of animals. Effect of environmental factors on human health could be traced back by the Greek physician Hippocrates in his text ‘On Airs, Water and Places’. The Italian physician Lancini also taught on the role of environment in the spread of disease in animals and humans in 17th century. In fact, Lancini was one of those few people who first suggested on the mosquito nets for prevention of Malaria in humans and was also a pioneer in the control of Rinder Pest in cattle. Although the human medicine developed many years back, the veterinary medicine appears as a distinct discipline in China during the dynasty of Zhou between 11th to 13th century. However, in 1762 the first Veterinary School was established in Lion, France. The term ‘zoonosis’ was first used by the German physician and pathologist Rudolph Virchow in 19th century. Canadian physician Sir William Osler (1849-1919) was one of the pioneers appointed as faculty combinedly to work in the Montreal Veterinary college and Medical School of Mc. Gill University.
In USA, James H Steele, a Veterinarian with DVM degree first established the VPH section at the CDC (Centre for Disease Control) in 1947. [Father of VPH – JH Steele]. The term ‘One medicine’ was developed and promoted by Veterinary Epidemiologist and Parasitologist C. W. Schwabe in 1984. The work of visionaries like Steele and Schwabe began to slowly influence Veterinary Medical and Medical School Curricula and Public Policy, as well as the approach to research of both groups.
In 2003, the term ‘One health’ draw the attention across the globe since it was mentioned in ‘Washington Post’ (Magazine) by Dr. William Karesh to describe the outbreak of ‘Ebola’ hemorrhagic fever in Africa. He said, “human or livestock or wild life health cannot be discussed in isolation anymore. There is just ‘One health’. And the solution requires everyone working together on all the different levels”. This was followed by a series of conferences across the globe with the theme of ‘One World – One health’.
Role of Veterinary Professionals to achieve the ‘One health’
In the last 30 years, the prevalence of infectious diseases has increased such that 75% of the emerging infectious diseases in humans are of animal origin. The increasing occurrence of emerging infectious diseases indicate that bridging animal, human and environmental health through the ‘One health concept’ is becoming even more critical. Veterinarians can ideally provide this bridge with their in-depth understanding of biological systems, knowledge of diseases processes and epidemiology, experiences with diagnosing and managing diseases in large populations of animals and success in eliminating and preventing infectious diseases. Veterinarians can be and often are the first line of defense for ‘zoonotic’ diseases as well as for various toxicants that occur naturally or by intentional terrorist attack. Veterinarian are in contact with a wide variety of domestic and free ranging animals, effective and efficient diagnostic system, and local and national regulatory systems for animal health, food safety and public health.
Besides the role of Veterinarian to control zoonotic diseases a more integrated approach would identify the factors that prevents infectious diseases emergence as well as noninfectious diseases like cancer, cardio vascular diseases, obesity, orthopedic conditions which are developed primarily by veterinarian in animals, continue to serve as significant models for human surgical replacements of knees, hip replacement and other joints. Also, the first flexible coil balloon expandable intracoronary stent was developed for humans by a research team including an interventional physician cardiologist (former veterinarian) and a pathologist veterinarian in the early 1990s.
One health approach provides the opportunity for the veterinarian to collaborate intimately with the physician, Public Health officials, Wildlife and environmental health professional for better understanding of diseases affecting human being and animals.
Role of Medical Professionals to achieve ‘One health’
Medical experts tend to be more focused on their own and public health needs than on other species. But now after the introduction of ‘One health’ concept they are focusing on things that were overlooked earlier, particularly, concern with Veterinary Public Health and Food Hygiene, zoonosis etc. Today’s medical schools need to incorporate more courses on zoonotic diseases and zoonoses. In fact, it will be good to share courses and practical exposures between these two professionals and could be achieved through comparative medicine approach.
Role of Environmental Professionals to achieve ecosystem
The term ‘ecosystem approaches’ to health or ‘eco-health’ refers to inextricable linkages between ecosystems, society and health of animals and humans. Environment impacts the emergence of several diseases. Several recent studies have indicated that ‘El Nino (Environment change / Climatic change) is a major climatic factor for controlling the occurrence of many disease events worldwide, Similarly, the climate variability has influenced on the diseases like Malaria and Dengue. Since the human activities play a major role in the climate change, the environmental professionals could play a vital role along with other health professionals, in adopting measures to decrease the effect of human activities on climate change; so that one health approaches could be easily adopted.
Selected achievements of one health in past 10 years
Although over the period of time, the epidemics of many diseases such as H5N1 influenza, Ebola Hemorrhagic fever, SARS etc. has been receded, the coordination established across the globe under the principles of ‘one health’ remains in place and active to combat emergence of new epidemics. For example, with regard to pandemic influenza, the world is now better protected through one health initiation. The main concept of one health is based on multidimensional integrated collaborative efforts involving various disciplines working locally, nationally, regionally and globally to generate optimal health for humans, animals and the environment. Without an integrated approach involving humans, pet animals, other livestock, wildlife and their social and ecological environment; it is not possible to ensure their optimum performance.
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