Kieran Walsh: One health, one love, one curriculum

One health is “the collaborative effort of multiple disciplines—working locally, nationally, and globally—to attain optimal health for people, animals, and the environment.” The One Health Congress is a place for experts and learners to come together and “showcase recent advances in pathogen discovery, diagnostics, drivers for emerging infections, vaccinology, and political and social science.” I was at the congress last week and learned a great deal about the overlap between human health, animal health, and the environment and climate change. One health has the potential to affect a wide range of areas within medicine. Examples include antibiotic resistance, avian influenza, and continually rising rates of obesity. I attended a lot of talks at the congress—many of them ended with the speaker calling for more education in their area of interest. This is not peculiar to one health—it is common for speakers to end their talk by saying that this is an important clinical area, but that students in their country only receive one hour of education on it in their entire curriculum. And that they should receive more. They may have a point, but the problem is that lots of other experts at other conferences are saying the same thing.  

Designers of medical curricula will be familiar with this. At meetings on the curriculum, everyone always wants to add more content to the curriculum. No one ever wants to take anything out. Suggesting that medical students or postgraduate doctors in training should learn about animal health or environmental health might not get a warm welcome. And yet they still need to recognise the importance and implications of these things. How will we square the circle?

The answer probably lies in integrating different aspects of the curriculum rather than adding in new components. The issue of antimicrobial resistance makes a good example. Antimicrobial resistance in humans and animals is a major part of one health—and represents a growing risk to patients and populations around the world. But the answer might not lie in more education. Providing online support to doctors and other healthcare professionals when they are making clinical decisions will likely be more effective and efficient. The best clinical decision support tools will only recommend antibiotics when they are really needed and will only recommend antibiotics that are least likely to generate further resistance. They will also recommend the right duration and dose of antibiotics—that once again are least likely to lead to resistance.

Climate change is another example. Climate change will cause changes in what diseases will become prevalent in different countries. But the number of infectious diseases and the number of countries that might be involved will make it impossible for students or doctors to know of all the moving parts. Once again clinical decision support which is continually updated and which is smart enough to recognise where the user is and alter results in light of this will surely help. Once again it can fit into the clinical workflow and so will not take up more time in the curriculum.

This is true of one health and of many other clinical areas that are squeezed into overloaded curricula. So, what should go into the curriculum? Maybe education on how to use clinical decision support. Maybe education on the limitations of curricula. Curricula have only limited influence on the learners. What has a far greater influence is the behaviours of those who deliver the curriculum. If they practice safely and in teams and continually check that what they are doing is correct, then that is how their learners will behave.

At the conference I also learned that in the Caribbean the one health movement is called the one health one love movement. Its proponents say that a healthy Caribbean is about “clean beaches, happy children, vibrant reefs, prosperous communities”. It is about thinking about and caring about “ourselves, the animals we farm, the birds in the forest and the reefs in the sea.” These should be on the curriculum everywhere.

Kieran Walsh is clinical director of BMJ Learning and BMJ Best Practice. He is responsible for the editorial quality of both products. He has worked in the past as a hospital doctor—specialising in care of the elderly medicine and neurology. 

Competing interests: Kieran Walsh works for BMJ Learning and BMJ Best Practice which produce a range of resources on infectious and non-infectious diseases.