SEEKING WIN-WIN-WIN SOLUTIONS FOR HEALTHY PUBLIC POLICY

There are many examples of a policy success in one of the three domains of One Health that resulted in negative or unanticipated effects in the other (Table 10.3 provides some examples). The push for affluence as a major goal of human development has been one of the main drivers of the declining quality, quantity, and sustainable of nature (Dietz et al„ 2007). Destruction of mangrove swamps in the global rush to develop jobs, revenue, and food from shrimp farming (Martinez-Alier, 2001) and deformities and deaths in wildlife due to agricultural chemicals (Kohler and Triebskorn, 2013) are two examples that quickly come to mind when contemplating the many ways where good intentions in one sector lead to tremendous harms in another. When policymakers stay sharply focused on the goals and needs of their own issues, without consideration of the implications of a policy change for other parts of their own sector or broader impacts outside of their sector, unanticipated and unintended consequences can follow. Managers have three options when faced with conflicting goals: (i) manage one goal and accept the collateral damage, (ii) abandon management of their goal and accept its impacts, and (iii) seek a strategy that allows both goals to be attained (Buckley and Han, 2014).

Fortunately, there is a growing case load of win-win and even win-win-win outcomes between people, animals, and ecosystems. The United Nations 2030 Agenda for Sustainable Development produced 17 interrelated and interconnected goals (Figure 10.1). These goals recognize the dependencies between resilient biodiversity, healthy ecosystems, and human well-being. Although the ideal of collaborative, concurrent, and equitable delivery on all 17 goals is yet to be fully realized and implemented, the creation of these goals communicated the need for a reciprocal care approach to policymakers and heightened awareness on the necessity of coordinate action around the world. The UN’s Convention on Biological Diversity goals of conserving biological diversity, the sustainable use of its components, and the fair and equitable sharing of its benefits strives to manage health of people, animals, and ecosystems as an integrated

TABLE 10.3

Win-Lose Examples of Public Policy Outcomes Benefiting One Domain of One Health While Harming Another

The Issue

Winners

Losers

Waste management and pathogen translocation (Chipman et al., 2008)

One state imports solid waste from surrounding American states to alleviate waste disposal limitations in the region and to generate local revenue

Seven of the states exporting waste to Ohio had endemic racoon rabies and raccoons were translocated long distances in waste disposal vehicles, risking significant impacts on the local rabies situation in Ohio

New conservation opportunities and impacts on local communities (Bocarejo and Ojeda. 2016)

Creation of a national park in Columbia provided conservation benefit and new ecotourism revenue

Peasants living in the park were categorized as illegal occupants and invaders, leading to eviction from the park and loss of crops

Recommendations in economically developed countries to eat more fatty fish and secondary' public health and conservation impacts

(Brunner et al., 2009)

The low-saturated fatty acids, selenium, and long-chain omega-3 fatty acids in some fatty fish species provide heart health benefits to people

Fatty fish are also a source of methylmercury and polychlorinated biphenyls, which are a health risk. Increased demands for fish protein put pressures on fish stocks and limited access to fish for poorer people

Early warning in response to an emerging infection and impacts on animal hosts

(Wetli. 2020)

New genetic methods allow rapid identification of potential sources of new zoonotic diseases, allowing prompt isolation measures to reduce public exposure

The early association of pangolins as possible sources of the COVID-19 virus caused conservation concerns that a fearful public would kill this species, further pushing these threatened animals towards extinction

Global fisheries and emerging zoonotic infections

(Khan and Sesay, 2015)

West Africa fish stocks generate income and employment for African and European companies

Food insecurity increased as fish were sent to external rather than local markets. This drew people to wildlife as sources of protein, which increases opportunities for exposure to pathogens like Ebola virus

whole. Chapter 19 illustrates this approach through a case study wherein local efforts of a small group of dedicated individuals protected the habitat of uncharismatic, yet endangered species, which in turn promoted better climate change planning for water security, new recreational opportunities, and sustained habitat protection that benefited a wide suite of wild species and people. The explicit reference to sustainability in food guides produced by Germany, Brazil, Sweden, the United Kingdom, and Qatar help consumers make choices

The 17 UN sustainable development goals

FIGURE 10.1 The 17 UN sustainable development goals. (From https://www.un.org/ sustainabledevelopment/sustainable-development-goals/. The content of this publication has not been approved by the United Nations and does not reflect the views of the United Nations or its officials or Member States.)

that can decrease their ecological footprint, climate impacts, and effects on biodiversity when they make their food choices (Lee et al., 2017). Making health and well-being the motivation for responding to the climate emergency has the potential to build social consensus for climate action that would benefit people, animals, ecosystems, and economies (Comeau, 2019). Urban forests and green spaces can help offset wildlife habitat loss while at the same time provide cooling, storm water, and pollution control services to a city’s human inhabitants (Livesley et al., 2016).

Despite the increasing research and social preference for win-win-win solutions, they are hard to develop and harder to implement. It is rarely someone’s job to worry about what happens outside of the purview of their policy domain. Policy planning tends to deal with individual problems assigned to organizations with narrowly defined responsibilities. Implementing Health in All Policies is like implementing many, if not all, intersectoral actions (Molnar et al., 2016). Elements of success include increasing awareness and confidence that the policy actions are acceptable and feasible, developing a shared language to facilitate communication between different sectors, recognizing and communicating the costs and benefits to all three of the One Health domains, using multiple types of evidence to give confidence in the need for and effectiveness of the win-win-win approach, and using systematic and integrated assessments to give credibility to policies being collaboratively developed by diverse policy sectors. The development of a language shared between sectors and embedding multiple outcomes into projects can facilitate conversations to find synergies and previously unrecognized opportunities (Kokkinen et al., 2019). Five guiding questions can help those leading efforts to promote

TABLE 10.4

Five Guiding Questions to Help Find Win-Win-Win Solutions

What are the main goals of the different interests and parties who are debating or can be affected by the different policy options?

What are the alternatives for action for the groups dealing with the problem(s)?

What are the relationships between the various alternatives and goals?

Are there alternatives that when implemented collaboratively and cooperatively can result in better outcomes than if the alternatives were implemented in isolation? (i.e. the win-win-win alternative)

Is the proposed win-win-win alternative feasible and acceptable given the existing circumstances?

win-win-win solutions facilitate and direct these conversations (Table 10.4 adapted from Nagel, 2000). When conversations fail to find solution, conflict management comes into play.

UNINTENDED POLICY CONSEQUENCES

How can one develop a policy for something previously thought to be impossible or unimaginable? In some cases, we might have certainty about a threat but uncertainty about its impact. In other cases, we lack knowledge of the possibility of the unimagined or unintended threat. Multiply these uncertainties across numerous species sharing the same landscape, and the likelihood of not thinking about an unintended consequences seems inevitable.

The first step in avoiding harmful unintended or unanticipated consequences is to be alert to their possibility. Increased understanding of the origins, impacts, and consequences of a policy decisions on non-policy targets requires an understanding of the influences of policy actions on the determinants of health of the non-targets actors before policies are implemented. The second step is to be open to the signals and clues from outside of your sector.

There are three common scenarios wherein the relationships and attitudes needed for you to be aware of and open to signals outside of your sector breakdown: (i) bureaucratic conflicts and inadequate protocols make your organization unreceptive to warning signals outside of its usual scope of practice, leading to the breakdown of cross-sectoral communication; (ii) politics and overcrowded agendas discourage collaborative actions on determinants of vulnerability that extent beyond immediate interests; and (iii) insensitivity to new' information, perceived power dynamics, cognitive overload, and wishful thinking lead to failure to recognize and act on very early warning signals (Stephen. 2019). Overconfidence in big science and artificial intelligence to provide warning early enough and convincing enough to result in action creates additional vulnerabilities when trying to prepare for a surprising and rapidly changing world. Human intelligence is still needed to link surveillance of threats and outcomes with reconnaissance of population relationships and vulnerabilities to recognize situations prone to harm.

An unanticipated event occurs when there is a gap between one’s expectations about w'hat is plausible and what occurs. Experience shapes expectations, and incompletely informed expectations produce surprises. New forms of cross- sectoral co-learning to better anticipate threats and consequences require people embedded within a health agency to facilitate transdisciplinary intelligence gathering by promoting collaboration and knowledge exchange across fields and between knowledge generators and knowledge users. This will allow for better anticipation of consequences across and among populations and species and the implementation of rapid responses.

No person or organization can anticipate and prepare for all unintended and unimaginable outcomes of a policy decision. The best way to cope with an unanticipated event is to improve coping mechanisms, either in preparation for surprise or for a response to the surprise once it occurs (Streets and Glantz, 2000). Mounting evidence recognizes the role for healthy ecosystems and resilient communities for risk reduction, recovery, and resilience to unanticipated threats. The ecological services provided by nature are critical for community resilience. Future One Health leaders will require broad cross-cultural competencies to be build collaborative policies between multiple actors at multiple administrative levels to allow different aspects of a problem to be seen and managed. By exploring these differences, impacts and actions that go beyond traditional health perspectives may be found. The likelihood of innovative policy responses will increase as leaders diversify their professional network and in doing so increase their exposure to non- redundant information, skills, and support (Tortoriello et al., 2015).

REALIZING RECIPROCAL CARE HEALTHY PUBLIC POLICY

Policies shape the social environments that allow and enable people to make win-win-win choices. But policies only shape the intention for action. They only make a difference if they are effectively implemented. Policies must be turned into actions that influence how we act and the decisions we make. If the ideals of One Health, EcoHealth, or related fields are to be realized, there needs to be a shift from making polices in isolation to a policy agenda that explicitly looks across sectors to find opportunities and efficiencies and avoid obstacles to action that build health for animals, people, and ecosystems. Rare is the case, and many are the challenges to having one sector win without another sector losing something. But by being attentive to the implications and opportunities for policies to promote actions that create benefits beyond an individual sector, less harms and more wins will be realized. The long-term goal of creating public policy for the reciprocal care of human, animal, and environmental health is dependent on sustained policy advocacy for a new view of healthy public policy.

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