The One Health Concept: 10 Years Old and a Long Road Ahead

The article frames the One Health concept within accelerating global environmental change, biodiversity loss, and increased mobility that drive the emergence and re-emergence of infectious and non-infectious diseases. Originating from the One Medicine concept, One Health adds the ecosystem dimension and calls for a holistic, transdisciplinary approach integrating human, animal, plant, and ecosystem health. The authors argue that, despite a decade of progress, One Health has been biased toward zoonoses and underintegrates ecological, evolutionary, and environmental sciences. The purpose of this review is to highlight why incorporating these sciences is crucial to understand disease dynamics (infectious and chronic non-communicable), to confront antimicrobial resistance, and to design innovative, sustainable control strategies. The work also aims to identify operational barriers and outline ambitions and recommendations to advance One Health.

The review synthesizes scholarship on One Health and EcoHealth, highlighting ministerial and WHO positions on environmental determinants of health, and critiques the limited ecological integration in many One Health publications. It draws on evidence that most emerging infectious diseases are zoonotic and frequently originate in wildlife, and that global changes (land use, climate, industrialization, trade) alter pathogen, vector, and reservoir distributions. It also compiles literature on antimicrobial and insecticide resistance, ecological resilience, biodiversity–disease relationships, eco-inspired interventions (e.g., phage therapy, antimicrobial peptides, Wolbachia-based vector control), and the rising burden of multifactorial non-communicable diseases linked to pollution and urbanization. The review further integrates ecotoxicology literature on immunotoxicity, biodiversity impacts, and interactions between toxicants and pathogens, advocating a harmonized framework merging eco-epidemiology, eco-physiology, and ecotoxicology.

Narrative, conceptual review drawing on interdisciplinary literature and illustrative case studies. The authors integrate findings from ecology, evolution, environmental sciences, medicine, veterinary sciences, and social sciences to analyze infectious and toxic risks, discuss eco-inspired control strategies, and identify operational barriers. No primary experimental methods or systematic review protocol are reported.

• Global environmental change, biodiversity erosion, industrialization, and increased mobility are linked to the emergence and re-emergence of infectious and non-infectious diseases; understanding ecosystem dynamics is essential for risk assessment and control.
• Most emerging infectious diseases of public health concern are zoonotic, with nearly three-quarters originating in wildlife, underscoring the need to study wildlife host–pathogen–environment networks.
• Environmental factors are major health determinants: European ministers and WHO Europe recognized that avoidable/eliminable environmental factors cause 1.4 million deaths per year in the WHO European Region.
• Land use change, habitat fragmentation, pollution, and climate change catalyze epizootics, epidemics, and zoonoses, shifting pathogen/vector/reservoir ranges (e.g., schistosomiasis and chikungunya emergence in Europe).
• Industrialization of agriculture/aquaculture and globalization intensify movement of hosts and pathogens, increase organismal stress, and select for insecticide and antibiotic resistance in vectors and bacteria.
• Eco-inspired control strategies show promise: bacteriophages, antimicrobial peptides and their immunomodulatory derivatives, and symbiont-based vector control (e.g., Wolbachia) may reduce reliance on conventional antibiotics/insecticides and slow resistance evolution; phage cocktails and host-defense peptide analogs are highlighted as lower-resistance-risk options.
• Resilience concepts advocate system-based, diversity-supporting approaches to enhance community capacity to absorb disturbances and maintain function; biodiversity can dilute or amplify transmission in scale- and context-dependent ways.
• Toxic risk is widespread, involving natural toxins, legacy and emerging pollutants (e.g., micro/nanoplastics), including in remote regions; pollutants exert immunotoxic and endocrine effects that elevate infectious disease risk and alter biotic interactions and food webs, threatening biodiversity and ecosystem functioning.
• Multifactorial diseases are rising across taxa (invertebrates and vertebrates), often triggered by combined stressors (nutrition, temperature, salinity, pH, pollutants, radiation). Transgenerational and epigenetic effects of environmental stress are noted.
• A harmonized framework integrating eco-epidemiology, eco-physiology, and ecotoxicology is needed to jointly address biological and chemical contaminants, including adaptive monitoring of co-exposures and shared modeling tools.
• Urbanization reshapes exposures (exposome) and social networks affecting both infectious spread and non-communicable disease patterns; mobile sensing and network analytics can inform urban planning and public health.
• Case examples demonstrate ecosystem integration benefits: (1) Land-use shifts in France and China influenced small mammal dynamics and Echinococcus multilocularis transmission; (2) Schistosomiasis outbreaks in Corsica (~300 estimated cases) traced to a hybrid parasite with African origin, requiring coordinated medical, veterinary, ecological response; (3) Social network modeling in primates informs targeted interventions based on network position and structure.
• Economic analyses support prevention-at-source: an integrated One Health approach may cost USD 1.9–3.4 billion/year versus historical average epidemic losses of USD 6.7 billion/year, indicating favorable cost-benefit.
• Operational recommendations: integrate ecology/evolution into medical and veterinary training; build interdisciplinary, international networks including Global South; improve data sharing and long-term monitoring; strengthen biosecurity; dismantle sectoral partitioning across public health, agriculture, environment; include plant health and ethics (e.g., Nagoya Protocol) within One Health.

By reframing health issues within socio-ecological systems, the review shows that integrating ecological, evolutionary, and environmental sciences into One Health provides mechanistic insight into pathogen dynamics, host-switching, and resistance evolution, and clarifies how global changes reshape disease risks. This integration also reveals how pollutants and biological agents interact to modulate immunity, biodiversity, and transmission, informing more comprehensive risk assessments. The presented eco-inspired interventions leverage natural regulatory processes (phages, host-defense peptides, symbioses) and resilience principles to design control strategies potentially less prone to resistance and collateral ecological damage. Case studies demonstrate that multi-scale, cross-sector collaboration can resolve unexpected emergence events (e.g., schistosomiasis in Europe) and that network-informed strategies can optimize targeting in epidemics. The synthesis underscores the broader relevance to public policy, urban planning, agriculture, and conservation, arguing that dismantling disciplinary and sectoral silos is essential to realize One Health’s promise for both infectious and chronic disease prevention and control.

Ecological, evolutionary, and environmental sciences are crucial to understand and manage the emergence and re-emergence of infectious and non-communicable chronic diseases and to develop innovative, sustainable control strategies. Achieving the One Health vision requires breaking down interdisciplinary and intersectoral barriers separating human and veterinary medicine from ecological and environmental sciences, strengthening training and collaborative networks, improving data access and long-term monitoring, and integrating plant health, social sciences, legal frameworks, and ethics. Demonstrating and communicating the added value of integrated One Health approaches to governments, funders, and stakeholders will be key, alongside developing operational frameworks that translate integrative knowledge into practice.

This is a narrative, conceptual review that does not implement a systematic review methodology or present new empirical data. Conclusions are based on selected literature and illustrative case studies, which may limit generalizability across contexts and taxa. Quantitative effect sizes and standardized indicators for ecosystem health are not established here, and some recommendations require further empirical validation and operational piloting.