Bridging One Health and Sustainability: The anatomy of a socioethical issue

One Health thrives in several practical areas, such as food safety, antimicrobial resistance, and zoonotic epidemiology. In each, it advocates for a broader scope and addresses complex issues. Its initiative embraces an ever-growing disciplinary inclusiveness and seeks to bridge science and society by including social and human science lenses (Miao et al. 2022, The Lancet 2023, Aguiar et al. 2024). Recognizing the translational gap between theory and practice, there is a growing interest in harmonizing One Health’s lexicon (Boudreau LeBlanc et al. 2022, Aguiar et al. 2024, Ruckert et al. 2024). We must make explicit ethical trade-offs among the values, disciplines, and knowledge inherent in One Health’s operationalization (Li 2020) while acknowledging the associated stakes. This Viewpoint outlines the practical and ethical challenge of negotiating daily priorities between health impetus and the ecological cascade of effects for concerned scientists, professionals, and citizens.

One Health, planetary health, and ecohealth are integrated approaches arising from diverse academic and sectoral settings in response to growing civil, political, and scientific concerns regarding well-being and the environment. Despite their distinct foundations leading to their own set of terminologies, priorities, and methodologies, they each pursue similar goals (Boudreau LeBlanc 2023). They all seek to translate the understanding of concepts from the philosophy of complexity, such as interconnectivity and interdependence, into the reality of species, societies, and other entities (Lerner and Berg 2017), including the complexity of sciences, calling for greater integration across disciplines, sectors, localities, and generations (Boudreau LeBlanc 2023). Initiated in the mid-1980s, the biomedical shift toward health promotion has sparked political interest in the health–environment relationship (de Leeuw et al. 2024). This exposed health to the multifaceted, complex, and escalating environmental challenges highlighted by concerned scholars, such as Aldo Leopold and Rachel Carson, alongside a growing body of literature today (Norton 2017, Millstein 2018, Cena and Labra 2024).

Instead of promoting a confrontational perspective, we encourage a constructive dialogue among approaches, using our One Health understanding as a catalyst for engaging conversation (Boudreau LeBlanc 2023). Although One Health scholars acknowledge the wicked problems inherent in systems thinking and managing complex issues, they struggle to untie ethical dilemmas in practice (Waltner-Toews 2017). A political force drives One Health internationally by developing its concept in recommendations (Gruetzmacher et al. 2021). Initially led by public health veterinarians, the COVID-19 pandemic has prompted reflections across practices, sectors, and disciplines within universities and beyond. More recently, the 2021 international Quadripartite One Health definition has emphasized “building interdisciplinary bridges to health” (Zinsstag et al. 2011, Destoumieux-Garzón et al. 2018, WHO et al. 2022, Lefrançois et al. 2023). However, fostering “interdisciplinary bridges [beyond] health”—that is, engaging with sustainability scholars—remains a major challenge (Boudreau LeBlanc et al. 2022).

One Health as a negotiating environment

The challenge arises from the narrow meaning still attributed to interdisciplinarity. The architecture of One Health’s integrative and multifaceted operationalization requires substantial theoretically driven efforts and a transcendence beyond the political sphere framed by the Quadripartite definition (Norton 2000, Odenbaugh 2016, Rademacher et al. 2019), which still overlooks the Convention on Biological Diversity. If critical thinking stands implicitly in its definition, we should not underestimate the required rational work (Antoine-Moussiaux et al. 2019). Conceptualization (e.g., integrating, unifying, sustaining, balancing, recognizing, or mobilizing, as used in the definition) demands more than just goodwill (Ehling-Schulz et al. 2024). An One Health textbook should make explicit the pressing need to study contexts, facilitatory actors, actionable leverages, and points of passage that deepen tools, training, and competencies to help its professionals negotiate values and perspectives in the field (Boudreau LeBlanc 2023).

As stated in the 2022–2026 One Health joint action plan, “One Health coordination” implies to “address issues holistically; [to] deal with complexity and ambiguity; [to] negotiate trade-offs and identify win–win solutions; and [to] agree on priorities, funds, and collective actions (including monitoring and evaluation)” (WHO et al. 2022). However, it does not acknowledge the challenge of conceptualizing the know-how needed to manage local trade-offs within a broader organizational thinking: “act local; think global” (Rock et al. 2009, Boudreau LeBlanc et al. 2022, de Maack et al. 2024). For example, a considerable burden falls on the shoulders of professionals who may feel alone in negotiating the compromise of prescribing antibiotics to sick patients, contextualized within the dynamics of pharmaceutics and the planetary ecological cascades involving the genesis of microbial resistance, chemical by-products and contaminants, or carbon emissions (Boudreau LeBlanc et al. 2022).

Political discourses tend to prioritize emblematic species or landscapes over the protection of ecosystems and their inhabitants, focusing on either useful or dangerous species and ecological functioning (Tsing 2009, Moreno-Mateos et al. 2015, Rademacher et al. 2019). In contrast, pathogen control and management are seen as acceptable and often vital for improving human health and sustaining agriculture (Shurson et al. 2022). For instance, the rationale for vector reduction is grounded in its measurable impact, which can either strengthen or destabilize ecological resilience (Procopio et al. 2024). However, the complexity arises from the discourses on ecology, which range from an anthropo- or pluri- to acentric focus (Latour 1996, Kimmerer 2002, Blue and Rock 2011, Rademacher et al. 2019, Boudreau LeBlanc 2023). Political ecology centers on a logic of prioritization, mainly the dilemma opposing human goals and habitat functioning. When a trade-off emerges, we must prevent long-term compromise to the environment, because this increases uncertainties and intensifies risks (Rademacher 2015, Boudreau LeBlanc et al. 2022, Aguiar et al. 2024, de Maack et al. 2024).

Such an ambitious One Health paradigm is complex to articulate in practice, because it leads to constant ethical negotiation, trade-offs, and compromise justifications. An ethical dilemma arises when we recognize that all foreseeable action paths lead to harm, but a decision and a structured course of action (a norm) must still be systematized (Beever and Morar 2019, Morar and Bohannan 2019). With its anthropocentric optimism (or positivism) about health, One Health is commendable in envisioning better futures but fails to recognize the inherent consequences of any trade-off in practice. Therefore, studies on negotiation and philosophical investigations should be integrated into One Health research and its education curriculum (Antoine-Moussiaux et al. 2019, Laing et al. 2023).

Beyond existential risks in health

Ethics scholars increasingly highlight the existential stakes involved (Morar and Bohannan 2019). Human activities tend to promote short-term individual flourishing over ecosystem resilience, which reduces the stability of the habitat conditions for living beings (Potter 1988, Beever and Morar 2019). This decreased stability affects long-term planning, as is now understood, because of climate changes and accentuates inequity because of the scarcity and uneven distribution of resources (Zhang et al. 2024). For example, any health and biodiversity trade-offs while operationalizing One Health should be approached through a reflexive, collaborative, and adaptive effort (Boudreau LeBlanc et al. 2022, de Maack et al. 2024). Therefore, we need an open and constructive forum across sectors and disciplines focused on health and biodiversity while challenging this constructed dichotomy (Dietz and Stern 1998, Romanelli et al. 2014, Boudreau LeBlanc 2023). Addressing this dilemma, sometimes biodiversity should prevail, and other times, health should be prioritized. Ultimately, One Health is doomed to fail if one systematically overshadows the other.

This Viewpoint underlines the urgent need for translational studies in One Health. It means applying a capacity for philosophical negotiation to ethically address trade-offs (de Maack et al. 2024). This entails ethics analysis to unpack dilemmas, deepen dialogues, and generate safe spaces for thinking, planning, and evaluating decisions (Boudreau LeBlanc et al. 2022)—ultimately leading to systematized actions in our complex, intertwined world (Zhang et al. 2024). Drawing on a long-lasting involvement in One Health, both within its community and through its literature, we have observed an emerging political discourse permeating the scientific community. Exercising power, work teams, and resources without recognizing ethical dilemmas, such as the one opposing health and biodiversity, necessitates sustained, individualized, and critical reflexivity (Boudreau LeBlanc 2023). We aim to raise awareness of this trend, which hinders the operationalization of One Health, especially when the community calls for an ever more inclusive one (Rodriguez 2024).

Increasing awareness of the asymmetrical privileges in medicine and ecology, as is reflected in political and administrative discourses and economic power, will deepen our understanding of the social dynamics within the One Health community (Boudreau LeBlanc et al. 2022). Medicine typically receives greater institutional support and public funding. Meanwhile, ecology struggles in advocating for its representation despite several Earth Summits and the formation of numerous international committees, programs, and initiatives focused on biodiversity (Legagneux et al. 2018, Pascual et al. 2022). Human health relies on numerous environmental attributes because the sustainability or degradation of habitats delineates existential risks and threats, for both humans and nonhumans.

Definition is a source of power (Ålund 1988, Zarefsky 2014, Cisney and Morar 2015, Skerrat 2016, Boudreau LeBlanc et al. 2022). We must recognize the limits of the reductionism inherent in science, because a mechanistic, technical understanding creates a sense of biological normativity (Giroux 2010). Scholars in the humanities have long emphasized that integrating knowledge implies prioritizing concepts that confer political power, leading to practical implications for health (Kimmerer 2012). But all power comes with its biases, flaws, and assumptions (Kimmerer 2002). In this way, One Health should evolve into a reflexive autocriticism that includes a broader range of disciplines (Boudreau LeBlanc 2023). This means opening the curriculum to the human, subjective aspects of natural sciences—the scientists and institutions behind the One Health approach, techniques, and interventions.

Acknowledgment

Special thanks are due to the network of researchers and administrative bodies for facilitating dialogue through the Initiative Une Seule Santé (the One Health Initiative) at the Université de Montréal (UdeM). This initiative is designed to promote intersectoral collaboration and to support research, training, and partnerships in One Health. Discussions around One Health that had made this article project possible are structured within dynamic research bodies at the UdeM such as the Groupe de Recherche en Epidémiologie des Zoonoses et Santé Publique, the Centre de Recherche en Santé Publique, the Canada Excellence Research Chair in One Urbain Health, the Centre de Recherche en Éthique, and the One Health research lab.

The research, discussions, and opportunities that led to the development of this Viewpoint were financially supported by the One Health Initiative at Université de Montréal.

Author Biography

Antoine Boudreau LeBlanc ([email protected]) is a postdoctoral researcher in innovation ethics funded by the Institute of Data Valorization, at the Université de Montréal and McGill University, in Montréal, Québec, Canada. Jérôme Pelletier ([email protected]) is a postdoctoral researcher in epidemiology at the Université de Montréal, in Saint-Hyacinthe, Québec, Canada. Cécile Aenishaenslin is a professor in veterinary epidemiology, public health and intervention research, and codirector of the One Health Research Laboratory at the Université de Montréal, in Saint-Hyacinthe, Québec, Canada. Olivier Beauchet is a professor and clinician-researcher, neurologist, and geriatrician at the Université de Montréal, in Montréal, Québec, Canada. Manon Boiteux is a PhD student in One Health at the Université de Montréal, in Montréal, Québec, Canada. Michèle Bouchard is a professor in the Department of Environmental and Workplace Health and vice dean for research (One Health aspect) at the Université de Montréal, Montréal, Québec, Canada. Evelyne de Leeuw is a professor of public health, cities and policies and the Canada Excellence Research Chair in One Urban Health at the Université de Montréal, in Montréal, Québec, Canada, and is also a professor at the University of New South Wales Cities Institute, in Sydney, Australia. Ryoa Chung is a professor in the Department of Philosophy and also teaches medical ethics at the Faculty of Medicine and codirector of the Centre for Research in Ethics (Centre de Recherche en Éthique) at the Université de Montréal, in Montréal, Québec, Canada. Charles Dupras, is professor of ethics and director of the Programme de Bioéthique at the School of Public Health in the Department of Social and Preventive Medicine at the Université de Montréal, in Montréal, Québec, Canada. Xavier Gravend-Tirole is a professor of ethics and spirituality at the Université de Montréal, in Montréal, Québec, Canada. Timothée Poisot is a professor of computational ecology at the Université de Montréal, in Montréal, Québec, Canada. Jean-Philippe Rocheleau is a professor in epidemiology, codirector of the One Health Research Laboratory and a professor and coordinator of the Department of Animal Health at Saint-Hyacinthe College, in Saint-Hyacinthe, Québec, Canada. Nicolas Macia is the senior coordinator of the strategic institutional project for the One Health Initiative at the Université de Montréal, in Montréal, Québec, Canada. Luc Stafford is a professor of physics and holds the Canada Research Chair in the Physics of Highly Reactive Plasmas and is also deputy vice rector of research and codirector of the One Health Initiative at the Université de Montréal, in Montréal, Québec, Canada.