One Health Workshop

Sponsored by the Arctic Human Health Experts Group (AHHEG)

Arctic Council, Sustainable Development Working Group

October 20, 2015, Anchorage, Alaska

Moderator: Tom Hennessy, MD, MPH

AHHEG co-chair, and Director, CDC Arctic Investigations Program

tbh0@cdc.gov

1

Thanks to …

• US Department of State• Funding support for meeting and refreshments

• Josh Glasser, Ann Meceda, Marilynne Bonner

2

Objectives

• Introduce the “One Health” approach and the Arctic Council initiative

• Highlight some examples where One Health has been used in Alaska

• Discuss ways One Health can be applied or enhanced • In Alaska

• In the Arctic Region

3

Agenda

• Introductions• 920 – 1000 Arctic Council One Health Initiative

• Bruce Ruscio, US Dept of State

• Examples of One Health Activities in Alaska• Jim Berner, Alaska Native Tribal Health Consortium (ANTHC)• Mike Brubaker, ANTHC• David Driscoll, University of Alaska

• Break 1030- 1045• 1045- 1200 Round Table Discussion• 1200 – 100 Lunch• 100- 230 Open House

4

New Project Proposal:Promote a “One Health”

Approach in Arctic Health

5

Arctic Council

Arctic Country Representatives, Permanent Participants (Indigenous Peoples Organizations Observers, (NGO’s,

Countries)

ACAP Arctic

Contaminants Action Plan

AMAP

Arctic Monitoring & Assessment Program

HHAG

Sustainable Development

Working Group

AHHEG

International Circumpolar Surveillance

Water and Sanitation for

Health

Mental Behavioral

Health

Research Ethics and Indigenous

Coummunites

One Health

EPPR Emergency Prevention

Preparedness & Response

PAME Preservation of

the Marine Environment

CAFF Conservation of

Arctic Flora & Fauna

The Arctic Council, US Government and Circumpolar Health Relationships

MembersAmerican Society for Circumpolar HealthCanadian Society for Circumpolar Health

Danish/Greenlandic for Circumpolar HealthNordic Society for Circumpolar Health

Siberian Branch Russian Academy Medical Sciences

International Union for Circumpolar Health

US RepresentativeDepartment of State

Office of Ocean & Polar Affairs

Arctic Research Commission

Goals & Objectives

Interagency Arctic Research Policy Committee

6

Health Concerns Where a One Health Approach could be used: -Animal-to-Human Infectious Diseases. -Environmental Contaminants, Wildlife health and Subsistence foods.

7

One Health and AHHEG, Options

• Collect information about existing One Health programs and projects• Use for education, advertisement in Arctic populations

• Catalog of activities

• Compare results, share best practices

• Analysis of One Health activities in Arctic• “Mapping” intersectoral networks and stakeholders

• Analyze to identify ways to strengthen systems

• Create, endorse or fund a new project or projects• Collaboration with other partners?

8

• Blank Slide between presentations

Arctic One Health

10

PreventionDetection

Resilience

Presentation to the Arctic Human Health Expert GroupAnchorage, AlaskaOctober 20, 2015

Bruce Ruscio, DrPH, MPHU.S. Department of StateOffice of International Health and Biodefense (OES/IHB)

What is One Health?

Arctic Perspectives on One Health

One Health & resilience in a changing Arctic

Regionalizing Circumpolar One Health

Next Steps

Summary

11

Outline

An approach:

1. For developing and sustaining multi-discipline collaborations and partnerships

2. To address complex health issues at the environment, human and animal interface

3. To advance the early identification, prevention and mitigation of health risks

12

What is One Health?

Not new; greater acceptance prior to specialization of medicine

Counter to current medical training and education

Recognizes our interconnected world

People, animals and the environment are intricately and inseparably linked

Acceleration & intensification of H-A interface is a Global phenomenon

Increased emphasis on moving “up stream” in prevention

13

What is One Health?

14

Arctic Health Challenge

Climate Change

Arctic Region

Weather

• Extreme weather events

• Precipitation• Heatwaves• Temperature

extremes

Arctic Region

Ecosystem/environment

• Sea level changes• Glacial loss• Ice melting• Agro-ecosystem hydrology

changes• Sea ice shifts• Sea ice decreases in sea ice

extent and cover• Permafrost

thawing/changes • Forests and tundra

alterations• Increases in lake

temperatures• Changes to migration

patterns• Socioeconomics and

demographics• Exotic species introduction• Changes in vector biology• Changes in transmission

dynamics

Arctic Region Health

Impacts

• Extreme weather related

• Contamination exposures

• Water and food borne disease

• Vector borne diseases• Rodent borne

diseases• Food and water

shortages• Stress on plant &

animal population• Animal displacement• Respiratory diseases• NTDs• malnutrition

Effects are complex and

difficult to predict with

certainty

15

Arctic Health Challenge and One Health

Complex health threats require regional and international partnerships to share best practices

One Health approach already evident in the Arctic Programs & systems working with multidisciplinary

stakeholders Recognized need for a holistic framework for assessing

and responding to health risks Track record of policy makers receptive to, and

influenced by, scientific research

16

Operationalizing One Health

Under the US Chairmanship the Arctic Council will undertake a process to further the a One Health approach across the Arctic

region as a strategy to enhance resiliency

GoalBuild on and expand existing networks and collaborative efforts of diverse scientific disciplines and stakeholders to advance a regional One Health approach to better understanding the impacts of climate change on the health of humans, animals and ecosystems of the Arctic and circumpolar north.

17

A Strategy for Resiliency

Endorsed by the Sustainable Development Working GroupUS and Canada Co-Sponsors

Builds on existing efforts advancing circumpolar cooperation at the Arctic human-animal-environment interface

Synergies with other resiliency efforts

Advances efforts to understand climate-driven health risks

Enhances early identification, prevention, and response

Capacities to response to public health emergencies

18

Operationalizing One Health: Process

Phase 1: Baseline Survey Assessment

Develop a baseline assessment of one health activities/programs across the region – create inventory

Assess the interest in the One Health approachIdentify One Health champions/leaders

Establish One Health Leadership TeamDiverse range of scientific disciplines and permanent participants

and other stakeholdersDevelop strategy to implement activities in phases

19

Operationalizing One Health: Process

Phase 2:Conduct a series of regional Knowledge-sharing

workshops/forums for cross-section dialogueIdentify partners and community of practiceGather stakeholder guidance on implementation strategyDevelop timeline and metrics to measure progressBolster commitments from key national and community

institutions to designate One Health hubs

20

Operationalizing One Health: Process

Phase 3

Conduct One Health Systems Mapping and Analysis exercise (table top exercises -TTXs)

Initiate cross-agency collaborations at the local, regional, and national levels.

Determine where animal, human and environmental health services can align more closely to meet common One Health goals.

Initiate development of action plan specific to ArcticIdentify successes/best practices and gaps to address Identify specific actions to address the gapsProvides a benchmark for planning and evaluating

progress of future One Health activities

21

Operationalizing One Health: Process

Phase 4

Designate One Health Hubs

Link by agreements

Establish One Health Network System of the Arctic

Develop framework for future capacity building and activities

22

Operationalizing One Health: Process

Phase 5

Initiate Arctic One Health Collaborative Investigation

Project(s)

23

Arctic One Health: A Strategy for Resilience

SummaryArctic One Health: arctic health resilience

Arctic Council is undertaking a process to regionalize the practice of One Health across the Arctic region

Valuable strategy to understand the complex nature of climate change

One Health approach is already evident in the arctic

Enhance scientific understanding of threats, vulnerability prevention and screening strategies

Contribute to effective policies, threat reduction and community reliance strengthening

Economic and higher efficiency opportunities

24

Next Steps

Identify additional Co-Sponsor(s) for SDWG

Identify Arctic Region One Health Leaders

Program outreach awareness

Draft Survey Instrument development

Identify and evaluate tool/instrument for operationalizing One

Health

25

Thank you!

• Blank Slide between presentations

A Useful Model For The Development Of A Village-Based

Environmental Monitoring Program To Detect Established And

Emerging Environmental Threats To Food And Water Security In

Rural Alaska Communities

“One Health”Presented to: The AHHEG One Health WorkgroupOctober 20, 2015Anchorage, Alaska

Presented by:James Berner, MDAlaska Native Tribal Health ConsortiumAnchorage, Alaskajberner@anthc.org

Climate Warming

Rapid Cultural Change

Anthropogenic Contaminants

Food and Water Security

Major Threats for Rural Alaska Natives

Alaska Native Food / Water Security

AN residents monitoring local harvest for known and emerging contaminants (metals) and pathogens (parasites).

Alaska Native Biomonitoring Programs

Two biomonitoring programs, and one village based observer program are currently gathering data in rural Alaska.

• The Alaska Native Maternal Organics Monitoring Study (MOM Study)

-Supported by EPA STAR GRANT RD83370501-

• The Rural Alaska Monitoring Program (RAMP)-Supported by EPA STAR GRANT RD83559701-

• The Local Environmental Oberserver (LEO) Program

The polar front influences global ocean currents

Arctic Influence on Ocean Circulation

The Arctic plays a fundamental role in circulation of water in the oceans of the world. When warm, salty North Atlantic water reaches the cold Arctic around Greenland and Iceland and in the Labrador Sea, it becomes denser as it cools, and therefore sinks to deeper layers of the ocean. This process of forming deep water is slow, but takes place over a huge area. Every winter, several million cubic kilometers of water sink to deeper layers, which move water slowly south along the bottom of the Atlantic Ocean.

0.

5.

10.

15.

20.

25.

Toxaphene PCBs p,p DDE HCB Chlorodanes PFOs

Geo

metr

ic M

ean

Personal Communication A. Matz, FWS, 2010

Alaska Native Biomonitoring ProgramRamp Study

June 2005 – Community Water Source Disappeared in Kwingillingok

MECHANISMS OF MULTIPLE INTERACTIONS

• Increased contaminant transport, with increased tissue levels of contaminants in Arctic wildlife may increase susceptibility to active infection with endemic or new pathogens.

• This could result in mortality in these species, and possibly increased risk of exposure in human consumers to zoonotic diseases, and increased levels of contaminants.

• Increased tissue levels of contaminants in subsistence species will negatively impact immune response to endemic zoonotic diseases (e.g. brucella, toxoplasma).

Alaska Native RAMP BiomonitoringInitiative

Village-based, resident-operated monitoring program. Program

metrics are based on an individual village assessment of environmental

change, after the community prioritizes the findings.

Alaska Native Biomonitoring ProgramsRAMP Study

EXAMPLES OF ENVIRONMENTAL METRICS:

• Permafrost temperature around infrastructure and source water ponds.

• Shoreline camera; village source water cyanotoxin, and methyl mercury measurements.

• Bivalve saxitoxin and domoic acid levels.• Filter paper blood from subsistence mammals for

zoonotic antibodies and metals.• Filter paper blood for organohalogen analysis is under

development.• Mosquito monitoring for Franciscella Tularensis

(tularemia).

Alaska Native Biomonitoring Program Objectives

• Systematic collection, analysis and interpretation of information.

• Provide data for risk reduction strategy.• Detection of emerging threats.• Follow trends in exposure.• Evaluate interventions.• Create a specimen bank to allow

retrospective analysis of newly emerging threats.

Alaska Native Biomonitoring Program Data Application

Track trends in contaminant levels. Track trends in zoonotic pathogen prevalence

share data with other communities, regions, and agencies.

Improve knowledge about impact of climate regime change on contaminant and pathogen circulation in the circumpolar north.

Raise awareness in regional medical providers.

The most immediate application of RAMP data is the creation of a community-specific adaptation plan, allowing residents to reduce exposure to the subset of vulnerable residents, including pregnant mothers, infants, elders, immunosuppressed residents, and those with chronic diseases.

Alaska Native Biomonitoring Program Village Adaptation Planning

• Blank Slide between presentations

A One Health Approach in Alaska

October 20, 2015

Michael Brubaker

Director, Community Environment and Health

Alaska Native Tribal Health Consortium

Alaska Native

Medical Center

Environmental Health

and Engineering

Community Health

Services

Alaska Native Tribal Health Consortium

OUR VISION: Alaska Native

people are the healthiest people in the world.

Erosion in Kivalina

affects travel and

source water quality.

Fairbanks Daily News Miner

Wildfire on

Moose Mountain.

Fish drying racks

are empty in some

parts of Alaska.

Erosion turns

stream water the

‘color of coffee’.

Ice storm damage to

a subsistence camp

in Golovin.

Center for Climate and Health

To assist the tribal health system in understanding the connections between climate change, environmental impacts and health effects. To raise awareness and

encourage responses that protect community health.

Climate Events Significant Local Events

Emerging Threats Surveillance

One Health Experts

1. Track Climate Change Sensitive Events

Scan and map relevant articles from northern news media

2. Track Significant Local Environmental EventsConnecting keepers to help document and respond to change.

1. Local Experts2. Topic Experts3. Technology

Local and Traditional Knowledge Experts

Bert Greist – Selawik, Alaska

LEO Network includes hundreds of local observers who share observations about unusual environmental events.

A network of topic experts that engage with observers and provide event specific consults.

Hajo Eicken - UAF

Dr. Bob Gerlach - ADECMillie Hawley – Native Village of Kivalina

LEO APP – Observations of Environmental Change

Web and Mobile App Technology

LEO s share observations about unusual events, posted on public maps. LEOs then connect with technical experts for consultation.

One Health Group

EPA

DECAK and YT

DFGAK and YT

USFWS

NMFS / NOAA

Sea Grant

UAA / UAF / APU

USDA

NOAA

USGS

BOEM / BLM

Local and Regional Govts

USARC

Tribal Organizations

Wildlife and Livestock

Regional / Community

Environment

Tribal Health

Public Health

DHSSAK and YT

CDC

Homeland Security

One Health Group Map

(L) LEO Network / (N) News Media / (O) One Health Group

Photo Courtesy of COASST

Seabird die-off in

Aleutian Islands

King Cove7-17-15

Sand Point7-25-15

Seldovia7-30-15

Port Heiden7-30-15

One Health Group – Providing Trend Determination Guidance and Analysis

The Take Home

Operationalizing One Health requires good information about local conditions and emerging challenges at the local, regional and international level.

Local and traditional knowledge and observational data is a good starting point, and there are natural partnership with science to understand events and to plan research and other responses.

In Alaska, the One Health community includes keepers of local and traditional knowledge; clinical, public health and environmental health providers, environmental and natural resource and health agency managers, and the academic, science and research community.

By expanding One Health, northern populations can improve understanding, preparedness and response to emerging health threats.

Goog le Us : “Cente r fo r C l imate and Hea l th ”

For more about One Health Group

• Blank Slide between presentations

Using Community-based Surveillance to Assess Health Effects of Climate Change: Implications for One Health

David Driscoll, Ph.D., M.P.H.

Janet Johnston, Ph.D., M.P.H.

One Health Workshop

Anchorage, Alaska

October 20, 2015

Institute for Circumpolar Health Studies ● 3211 Providence Drive ● Anchorage, AK 99508

Phone 907-786-6581 ● Fax 907-786-6576

www.ichs.uaa.alaska.edu

84

Primary Data Collection

Data encrypted web

surveys

Packet of 12 surveys

and self-addressed

stamped envelopes

Toll-free telephone

number

Environmental changes

• Local weather/exposure

• Cold-related injuries/fatalities

• Mental health/Stress-related

Hunting & Harvesting

• Foodborne Diseases

• Vectorborne and Zoonotic

Food & Water Safety

• Nutrition

• Food/water security

General health & air quality

• Sources of outdoor air pollution

• Allergic allergies

• Asthma

ICHS CLIMATE CHANGE &

HUMAN HEALTH COLLOQUIUM

OCT. 7-8, 2010

Develop surveillance metrics

Attendees

• Community members and

liaisons

• State and federal govt. agencies

• Tribal health agencies

• Environmental scientists

• Public health scientists

• Clinicians

Developing Surveillance Metrics

85

One Health Surveillance Questions

In the past 30 days, how often have you (or

people you know in the community) seen any

unusual changes to local plants and/or animals,

compared to what you normally expect?

86

For people who harvested and/or butchered wild

game or prepared wild meat to eat, have you (or

people you know in the community) observed

any physical abnormalities on or in wild game,

aside from bite marks and scars from other

predators?

87

One Health Surveillance Questions

For people who have eaten fermented or dried

foods, have you experienced three or more of the

following five symptoms: Nausea or vomiting;

trouble swallowing; double vision; dilated or

unreactive pupils; dry throat or mouth.

88

One Health Surveillance Questions

8989

Results: Frequency of One Health Outcomes

Interior Northwest Southeast Three Regions Combined

One Health Outcome n % n % n % n %

Unusual changes to local

plants and/or animals

146 55.3 124 39.5 101 30.4 371 40.8

Physical abnormalities on

or in wild game, aside from

bite marks and scars from

other predators

2 1.9 25 12.0 7 5.4 34 7.7

Eating fermented or dried

foods…

37 16.1 266 89.6 88 30.8 391 48.1

…Nausea or vomiting;

trouble swallowing; double

vision; dilated or unreactive

pupils; dry throat or mouth

0.0 0.0 13 5.1 2 2.4 15 4.0

• Community-based sentinel surveillance systems represent an effective

strategy for tracking local environmental events and outcomes.

• Of all outcomes measured in this study, residents reported unusual

changes to local plants and/or animals most frequently; 40.8%.

• One Health-related outcome differ by region, with the Interior seeing

most changes, and Northwest seeing most abnormalities.

• No seasonal differences in outcomes.

Conclusions

90

• Ecological study design

• Small numbers

• Self-reported exposures and outcomes

Limitations

91

David L. Driscoll

ddriscoll@uaa.alaska.edu

907-786-6581

Thank you!

People of Alaska

Our Alaskan communities

Centers for Disease Control and Prevention

Community organizers

ICHS office staff

PROJECT HOTLINE (toll free)

1-855-786-6598

www.ichs.uaa.alaska.edu

Acknowledgements