Presented by Delia Grace and Johanna Lindahl at a National One Health Symposium, New Delhi, India, 25 November 2013.

1. Regional consultation on
Onehealth/Ecohealth
Session one: Identifying the challenges
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)

2. 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

3. Human health in the 21st century
• 7 billion people 2011
30
25
Deaths (millions)
– 1 billion hungry;
– 2 billion with hidden hunger;
– 1.5 billion overweight / obese
20
15
• 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
10
5
0
04
15
30
High-income
04
15
30
04
15
30
Middle-income Low-income

4. 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

5. •
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

6. Spillover!
Pathogen flow
Secondary
Host (livestock)
Spill-over
Habitat change
Biodiversity
Host density
Sylvatic cycle
Vector density
Reservoir
Host (wildlife)
Type of pathogen: mutation,
heterogeneity, host specificity
•Increasing human
population and density
•Human behaviour
•Expansion of agriculture
•Intensification of livestock
production
Spill-over
Vector
Spill-over
Secondary
Host
(human)
Sustained transmission:
- peri-domestic or urban cycle
- sub-clinical, epidemic, pandemic

8. Greatest burden of endemic zoonoses falls on on
billion poor livestock keepers
• Unlucky 13 zoonoses sicken 2.4 billion
people, kill 2.2 people and affect more
than 1 in 7 livestock each year

9. 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

10. Mortality: global projection, 2004-2030
30
Intentional injuries
Other unintentional
Road traffic accidents
Deaths (millions)
25
20
Other NCD
15
Cancers
10
CVD
Mat//peri/nutritional
5
Other infectious
HIV, TB, malaria
0
2004
2015
2030
High-income
countries
2004
2015
2030
Middle-income
countries
2004
2015
2030
Low-income
countries

11. Fungal toxins in maize, peanuts, rice, sorghum, milk
AB1
Corn/feed
purchased
Treatments
AB1-> AM1
AB1
Corn/feed
produced
at farm
AM1
AB1
AM1
Farmer
Milk produced at
farm
Consumer

12. 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. •International organisations
•Regional organisations
Human
health
Animal
health
Plant
health
AgroEcosystems
•Private sector health provision
•Public health
•Veterinary public health
•NGOs & CBOs
•Conservation
•Environment
Agriculture associated
human disease
International
agricultural health
research
13

14. Top Zoonoses (multiple burdens)
• Assessed 56 zoonoses from Deaths - annual
6 listings:
responsible 2.7 billion cases, 2.5 million deaths
• “Unlucky 13” responsible for 2.2 billion
illnesses and 2.4 million deaths
2000000
1800000
140000
1600000
120000
1400000
100000
1200000
80000
1000000
800000
600000
– All 13 have a wildlife interface
– 9 have a major impact on livestock
– All 13 amenable to on-farm intervention
60000
40000
400000
200000
20000
0
0
Top 13
zoonoses
Next 43

15. PRIORITY DISEASES
1: Avian influenza
2: Rabies
3: Leptospirosis
Priority diseases don’t reflect importance
ability to control
Driven by media, donors, misperceptions

16. Official reporting systems
Reporting Zoonoses Scope
system
WAHID
33
Animal
TAD Info
2
Animal
Pro Med
All
All
GLEWS
19
All
Health
Map
All
All
Source: HealthMap
Africa
•
•
•
•
253 million SLU
25 million lost annually
12-13 million from notifiable disease
80,000 reported == 99.8% un-reported

17. 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

18. Agriculture Associated Diseases
http://aghealth.wordpress.com/