Presentation at 3rd GRF One Health Summit 2015 Session Integrative Health Risk Management

1. Section of Veterinary Epidemiology
One Health impacts on
Clincal Decisions
Simon Rüegg
Section of Veterinary Epidemiology
University of Zürich
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2. Cell Cell
Cell Cell
Cell
Life as a complex system
tissue
organ
organ system
organism
population
habitat
ecosystem
global ecology

3. global ecosystem
Habitat 1
Marsh
Habitat 2
Forest
Habitat 3
Subalpine
Habitat 4
Grassland
Habitat 5
Alpine
Hare population
Fox population
Escherichia
coli
population
Human
population

4. Decisions in One Health
Clinical decisions are made in
complex enviornemnts including
• psychological,
• socio-economic,
• and biomedical parameters.
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5. The paradox of scale
human individual
perspective
public health
perspective
ecosystem
perspective
cell’s perspective

6. The «ethical» trap
 A medical assumption is that solving the patient’s
condition is the most ethical action.
 We need to acknowledge:
 This is not a merely biomedical issue!
 It is up to the patient/owner to take a weighted
ethical decision.
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7. A pragmatic proposition
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Impact on Positive Negative
My organs
My organ systems
Me
My family
My society
The global population
The environment
Life Cycle Analysis for
 Drugs
 Medical interventions
 Behavioural changes
Scaled Cost-Benefit-Analysis

8. A crude decision making model
Benefit Deficit
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9. What’s missing?
 Decision making models
 e.g. game theory, agent-based modelling,
constructivism, collective intelligence
 Education in ethical decision making
 Awareness about own implicit assumptions
 Other view points
• Social, Cultural, Sectorial, Ecological
 Impact measurements for learning process
 Feedback to patient
 Feedback to practitioner
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Thank you!