One health the future of rural health?

Rural communities are more exposed to the effects of climate change than our urban-dwelling communities. Yes, bush fires may try and encroach on the outer metropolitan suburbs, floods may occasionally cause problems in our state capital cities, but in general it is our regional, rural and remote communities that experience climate change more immediately, and in more devastating ways. The droughts, fires, floods, infestations of locusts, mice and camels are not experienced by our city-dwelling residents. Sure, they feel the effects of these with changing prices of foods, but there is little direct experience of these events. Whereas, our rural communities and industries experience these effects with ever increasing frequency and intensity. These issues are just one of the many that hang over the heads of rural communities like the sword of Damocles. Our challenge in rural health research is to find a way, a paradigm, that allows us to look at the issues of rural health in ways that acknowledge the interconnected complexity of these issues. One approach that brings these issues together and offers a way potential positive way forward is referred to by some as One Health. The CDC describes One Health as ‘an approach that recognizes that the health of people is closely connected to the health of animals and our shared environment’.1 This is not just about recognising the fact that the health of our environment and land, the health of animals (wild or domesticated), and our own physical health and mental health are intricately connected. One Health is about recognising that work on improving our physical environment and those that live in it will improve our health. Until recently, One Health as an approach, has been focused predominantly on quite biological approaches based in veterinary science and public health such as the connection between the environment, animal welfare and humans, in relation to things like the development of zoonotic diseases, anti-microbial resistance and the effects of contaminants in water on human health.2 However, One Health is increasingly being realised as an approach which brings together a diversity of approaches, to realise synergistic benefits for the health of our lands, its animals and us. Whilst there are similarities between the One Health, Planetary Health and EcoHealth perspectives,3 the One Health perspective, in its more broad definitions, brings a more holistic view of the interconnected nature of human, animal, plant, land and climate health. Obviously, this approach connects closely to the world views of many first nations peoples.4 Here, we see the growing evidence base that caring for country, whether physically, culturally and spiritually, is not only good for the land, but also good for the individuals who do this work and the communities connected with the land.5 The Indigenous peoples of Australia have known for tens of thousands of years how important our connection to country is for all aspects of health and well-being. One Health is arguably white western sciences belated realisation and acceptance of this reality and may provide a framework for uniting these different knowledges, for synergistic effects. In this context, it is arguable that it is rural communities that are taking the lead in showing us how One Health can work in action, and I would posit that it is rural health researchers who should be leading the One Health paradigm. After all, rural resident health researchers sit closely to the interface between human, animal, plant and land interactions. Consider the work on regenerative agriculture. This is showing us that changes in farming practices focused on more sustainable or even regenerative practice can have significant effects on land quality, biodiversity and animal welfare. These practices may enhance the nutritional quality of food6 with resulting human health benefits. Qualitative research also suggests that there may be positive impacts of natural resource management practices for farmer well-being, although large scale quantitative research is lacking in the area.7 Thus, it would seem that caring for country, whether its productive land or not, and whether you are Indigenous or not, might be good for land, animals and humans. Our rural towns and cities are also leading the way in taking actions that could be part of an integrated One Health approach for improving rural health. Consider Shepparton, a regional city in Victoria. Shepparton appears to be leading the way in the global One Tree Per Child Initiative. The children of Shepparton recently planted their 100 000th tree. This is the work of 33 schools across more than 100 sites.8 There is a reasonable literature pointing to the benefits of the urban greening and tree planting for individual and communities' health, including projected reductions in premature deaths.9, 10 Whether this would translate to regional cities and rural towns is unclear. With one international survey of 10 000 children indicating that 45% of children reported that “their feelings about climate change negatively affected their daily life and functioning.”11 Thus it could be that engaging children and adults in these activities, or just having them taking place in your community, will reduce fatalism about climate change, increase peoples’ sense of efficacy, connect communities and work to enhance mental health,12 with its flow on effects for physical health. These benefits may not arise just from regreening activities such as tree planting. Consider the Tasmania tourism industry commitment to be a Carbon Neutral Destination by 2025.13 As part of this initiative, EllisRichmond, a rural company based in rural Tasmanian has developed a ‘Local Carbon’ service.14 This enables tourist operators to get feedback on their carbon emissions. It also connects local businesses who are generating carbon credits with those who want to purchase offsets, locally. This initiative brings rural communities and business together to support each other to make a real difference on climate change, using local, rural, sustainable enterprises with transparency and integrity. These initiatives may have similar health value to employers and communities, as they can get carbon-emission feedback on their activities. Another mechanism that might lead to improve mental health, through reduced negativity about future, increased sense of control and value in their work and empower positive action. Another tool that may enhance rural people's mental health. These are just examples, where rural communities are taking the initiative, working in ways that impact health, through the indirect pathways that One Health and/or First Nations perspective outline. The themes of Healthy Environments And Lives (HEAL) Network themes (Indigenous Knowledge Systems, Data & Decision Support, Health System Resilience and Sustainability, Bushfires & Air Pollution, Food, Soil & Water Security, Biosecurity & Emerging Infections, Urban Health & Built Environment, Rural & Remote Health, At-risk Populations & Life Course Solutions) suggest that this network is skirting on the edges of using a One Health approach, although it is not overtly stated in their vision or aims.15 With 17 universities and 5 research institutes involved with the HEAL network, there is a clear recognition of the importance of taking this interconnect approach. Thus, it maybe that rural health research needs to priorities and utilise a One Health perspective as an approach to reducing the burden of illness, disease and disability in rural areas.