Ecology, Economy and Society–the INSEE Journal 8(1): 5-11, January 2025 COMMENTARY An Indian Perspective on One Health Prescriptions Madhuri Ramesh  , Sheetal Patil, Adithya Pradyumna Abstract: This commentary offers a critical engagement with the Environment– Health Nexus Policy Guide released by the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP) and the International Institute for Sustainable Development (IISD) in 2022–23. We find that it strikes a hitherto- elusive balance between concerns centred on human and environmental health. It can be also credited with adopting an intersectoral approach—essential for addressing current and emerging infectious diseases, especially those of zoonotic origin. We contend that it does not adequately engage with the implementation challenges faced by countries with resource constraints or dense human populations, such as those in South Asia, and typified by India. We hope that a perspective from India will help the global policy discussions on One Health to diversify itself. Keywords: South Asia, One Health, Environment-health nexus, Holistic health, Zoonotics 1. INTRODUCTION As demonstrated by the COVID-19 pandemic, health crises often renew policymaking interest in managing the intersections of economy, ecology, and society—an approach known as One Health. This framework recognises that human, non-human, and environmental health are interconnected, and hence, it advocates integrated management across these domains. Many One Health policies are directed at the Global South, where dense human, livestock, and wildlife populations, coupled with overburdened public health services, make these regions particularly  Azim Premji University, Burugunte Village, Survey No 66, Bikkanahalli Main Rd, Sarjapura, Bengaluru, Karnataka, India 562125 (APU); madhuri.ramesh@apu.edu.in   Indian Institute for Human Settlements, 16th Cross Rd, Sadashiva Nagar, Armane Nagar, Bengaluru, Karnataka, India 560080; spatil@iihs.ac.in  APU; adithya.pradyumna@apu.edu.in Copyright © Ramesh, Patil, Pradyumna 2025. Released under Creative Commons Attribution © NonCommercial 4.0 International licence (CC BY-NC 4.0) by the author. Published by Indian Society for Ecological Economics (INSEE), c/o Institute of Economic Growth, University Enclave, North Campus, Delhi 110007. ISSN: 2581–6152 (print); 2581–6101 (web). DOI: https://doi.org/10.37773/ees.v8i1.1481 mailto:madhuri.ramesh@apu.edu.in mailto:spatil@iihs.ac.in mailto:adithya.pradyumna@apu.edu.in https://doi.org/10.37773/ees.v8i1.1481 Ecology, Economy and Society–the INSEE Journal [6] vulnerable to the additional strain imposed by pandemics. One of the most comprehensive policies in this area is the Operationalising the Environment– Health Nexus in Asia and the Pacific: A Policy Guide on Opportunities for Enhancing Health, Biodiversity, Food System and Climate Action, released in 2022–23 by the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP) and the International Institute for Sustainable Development (IISD) (hereafter, the ESCAP-IISD policy guide). This, alongside economic support such as the recent USD 170 million loan from the Asian Development Bank to the Government of India, signals an important phase for advancing One Health initiatives in countries such as India. In this article, we highlight the key contributions of the ESCAP-IISD policy guide and briefly compare the initiatives taken by the Indian government thus far. We conclude by identifying three guiding principles for the successful implementation of One Health policies in the Global South. 2. KEY FEATURES OF THE ESCAP-IISD POLICY GUIDE, 2022 The ESCAP-IISD Environment–Health Nexus Policy Guide, 2022, represents a significant advancement in establishing a framework for international and intersectoral collaborations in the Asia-Pacific region. In this article, we provide an overview of its key features. This guide begins by acknowledging the importance of ecosystem services in maintaining human and animal health across the terrestrial, aquatic, and marine realms. It further differentiates between holistic and episodic plans and emphasizes the former approach. A holistic plan promotes planned intersectoral collaboration to achieve comprehensive outcomes, whereas an episodic plan focuses on intersectoral collaboration primarily as a crisis response measure. A striking feature of the ESCAP-IISD policy guide is its departure from conventional understandings of health. Instead of viewing health and well- being as isolated factors, the guide conceptualises them as outcomes shaped by social and environmental processes. This approach avoids the common pitfall of prioritizing ecological concerns at the expense of social justice—a problem that pervades biodiversity conservation to date (for example, see Wilson (2016) and the response by Buscher et al. (2016)). By adopting this holistic framing, the guide incorporates ecological concerns as a core feature of health initiatives. Additionally, it alerts us to the dangers of framing any debate within One Health as a zero-sum game, and instead, it [7] Ramesh, Patil, Pradyumna advocates for a careful combination of integration and trade-offs based on national or regional requirements. Another useful feature of the ESCAP-IISD policy guide is its emphasis on implementing time- and cost-effective measures, such as establishing integrated datasets to prioritize highly vulnerable communities or regions. It also highlights how tools such as integrated health–environment impact assessments can be used to plan interventions effectively. Further, it endorses a rights-based approach to health and well-being, which underscores the importance of capacity-building. This approach aims to improve the participation of local communities in a variety of roles, ranging from frontline surveillance and disease monitoring to the implementation of national strategies. 3. ONE HEALTH IN INDIA In India, dedicated One Health policies are a relatively recent development, but concerns relevant to this domain have been addressed by a wide range of human, animal, and environmental health policies (Figure 1). Some examples of each are described here: With respect to public health, the National One Health Mission (NOHM), 2024, stands out as it focuses on integrated surveillance, data-sharing, and response. However, its effectiveness could be enhanced through better integration with the older National Health Policy, 2017. The National Programme on Climate Change and Human Health, launched in 2019, aligns with the principles of One Health by integrating environmental and animal health considerations with public health interventions. The programme covers a range of areas, including zoonotic disease surveillance, research on climate-driven health risks, and capacity-building for cross- sectoral One Health collaboration. In the domain of animal health, several national programmes contribute significantly to the One Health framework, such as the National Animal Disease Control Programme, 2019, the National Livestock Health and Disease Control Scheme, 2019, and the National Animal Disease Reporting System, launched in 2013. These initiatives focus on domestic animals and their interlinkages to One Health. The current National Wildlife Action Plan, 2017–31, plays a corresponding role with respect to managing wildlife species. Although it does not explicitly mention the One Health approach, it highlights the importance of long-term studies on wildlife diseases, including zoonotic ones. Ecology, Economy and Society–the INSEE Journal [8] Figure 1: Key policies, programmes and institutions related to One Health in India Source: Authors On the environmental front, the Environment (Protection) Act, 1986, aims to safeguard people from environmental hazards, including air and water pollution, but its implementation requires significant improvement. Other initiatives, such as the National Mission on Sustainable Habitat, 2010, the National Water Mission, 2011, the Clean Air Mission, 2019, and the Clean India Mission, 2014, also seek to improve the linkages between environmental and public health. Environmental health • Environment Act, 1986, and pollution control boards • Biological Diversity Act, 2002, and biodiversity au- thorities • Environment Impact As- sessment Notification, 2006 • Forests-related regulations Human health • National Health Mission; Governmental health services • Government health insurance schemes • Integrated disease surveillance programme • National Programme for Prevention and Control of Non- Communicable Diseases, 2010 • Maternal and child health-related programmes • National Programme on Climate Change and Human Health, 2019 • Health research institutes National One Health Mission Animal health • Wildlife Protection Act, 1972 • National Animal Disease Control Programme, 2019 • National Livestock Health and Disease Control scheme, 2013 • National Wildlife Action Plan, 2017 • (Proposed) Centre of Excellence in Wildlife Health • Reporting systems One Health in India [9] Ramesh, Patil, Pradyumna 4. GUIDING PRINCIPLES FOR DEVELOPING COUNTRIES Overall, the ESCAP-IISD policy guide reiterates that the One Health approach is about recognizing and managing the intersections between environmental and health factors for both humans and non-humans. As a result, it emphasizes the need to focus on long-term priorities rather than limiting efforts to episodic responses following outbreaks. However, several lacunae still exist in terms of implementation. We suggest three guiding principles to drive implementation efforts, particularly in countries such as India, which contend with resource constraints and dense populations: 4.1. Focus on Pragmatic Goals First, the policy guide lacks clarity regarding the operational approach for implementation. In this regard, it appears that the ESCAP-IISD policy guide prioritizes idealistic goals over pragmatic solutions. This has been a repeated stumbling block, as it is unrealistic to expect countries to restructure their existing national bureaucracies to support the holistic interventions required to implement One Health. Instead, a more feasible approach would involve using integrated assessment tools, establishing data management platforms, and designating nodal officers at the provincial level. In India a recent announcement of the One Health and Climate Hub by the State Government of Tamil Nadu is a step towards an approach to tackling climate-induced health challenges by enhancing preparedness for emerging health risks, strengthening resilience, and promoting sustainable health systems (Government of Tamil Nadu, 2024). 4.2. Focus on the Right to Healthcare The second area of concern is that the policy guide does not sufficiently emphasize the right to healthcare. This should be prioritized, especially in rural and forested areas, from both a pragmatic and justice-oriented perspective. Strengthening healthcare systems in such regions would garner public support for One Health initiatives and thereby improve reporting, detection, and management of zoonotic diseases. Further, it would prevent additional burdens on forest-dependent communities, many of whom already face restrictions on dietary and livelihood choices due to strict biodiversity conservation laws. In other words, an explicit acknowledgement of the rights of these communities to access both forests and healthcare services is important to ensure equitable outcomes. This would also align the One Health approach with existing national policies for tribal welfare and development. Ecology, Economy and Society–the INSEE Journal [10] 4.3. Focus on Community Participation Finally, community-based training programmes are essential to ensure that disease surveillance networks are both extensive and cost-effective in these regions. These programmes should be designed to reach culturally and linguistically diverse communities with low literacy levels. They should also establish points of connection with the public healthcare system for both humans and animals, including testing centres, clinics, and hospitals. Nevertheless, this does not detract from the valuable contributions made by the ESCAP-IISD policy guide to ongoing discussions on One Health. Moreover, there remains a clear need for national policies to closely consider environmental determinants of diseases and integrate them into health planning, both in India and the Asia-Pacific region at large. ACKNOWLEDGEMENTS: We thank our respective institutions, Azim Premji University and the Indian Institute for Human Settlements, for supporting this work. However, the content and opinions expressed are ours and do not necessarily reflect the views of our institutions. Ethics Statement: This study complies with requirements of ethical approvals from the institutional ethics committee for the conduct of this research. Conflict of Interest Statement: No potential conflict of interest was reported by the author. REFERENCES Buscher, Bram, Robert Fletcher, Dan Brockington, Chris Sandbrook, William Adams, Lisa Campbell, et al. 2017. “Half-Earth or Whole Earth? Radical Ideas for Conservation, and their Implications.” Oryx 51(3): 407-410. https://doi.org/10.1017/S0030605316001228 ESCAP and IISD. 2022. Operationalizing the Environment-Health Nexus in Asia and the Pacific: A Policy Guide on Opportunities for Enhancing Health, Biodiversity, Food System and Climate Action. Economic and Social Commission for Asia and the Pacific. https://www.unescap.org/kp/2022/policy-guide-environment-health-nexus Government of India. n.d. National One Health Mission. Office of Principal Scientific Advisor to the Government of India. https://www.psa.gov.in/innerPage/psa- initiatives-covid/one-health-mission/4053 _________. 2017. National Health Policy 2017. Government of India. _________. 2022. National Programme on Climate Change and Human Health. Government of India. https://doi.org/10.1017/S0030605316001228 https://www.unescap.org/kp/2022/policy-guide-environment-health-nexus https://www.psa.gov.in/innerPage/psa-initiatives-covid/one-health-mission/4053 https://www.psa.gov.in/innerPage/psa-initiatives-covid/one-health-mission/4053 [11] Ramesh, Patil, Pradyumna Government of Tamil Nadu. 2024. Establishment of “One Health and Climate Hub” under the Health and Family Welfare Department. G.O. (Ms) No. 385, Dt. 22.11.2024. Ministry of Environment, Forest and Climate Change. 2017. India's National Wildlife Action Plan 2017-2031. Government of India. https://wii.gov.in/nwap_2017_31 Wilson, Edward O. 2016. Half-Earth: Our Planet's Fight for Life. Liveright Publishing. https://wii.gov.in/nwap_2017_31