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More than 60% of human infectious diseases are caused by pathogens shared with wild or domestic animals. Zoonotic disease organisms include those that are endemic in human populations or enzootic in animal populations with frequent cross-species transmission to people. Some of these diseases have only emerged recently. Together, these organisms are responsible for a substantial burden of disease, with endemic and enzootic zoonoses causing about a billion cases of illness in people and millions of deaths every year. Emerging zoonoses are a growing threat to global health and have caused hundreds of billions of US dollars of economic damage in the past 20 years. We aimed to review how zoonotic diseases result from natural pathogen ecology, and how other circumstances, such as animal production, extraction of natural resources, and antimicrobial application change the dynamics of disease exposure to human beings. In view of present anthropogenic trends, a more effective approach to zoonotic disease prevention and control will require a broad view of medicine that emphasises evidence-based decision making and integrates ecological and evolutionary principles of animal, human, and environmental factors. This broad view is essential for the successful development of policies and practices that reduce probability of future zoonotic emergence, targeted surveillance and strategic prevention, and engagement of partners outside the medical community to help improve health outcomes and reduce disease threats.

Andy Haines and colleagues describe how new research platforms present an opportunity to advance understanding of how to safeguard health in the face of global environmental change

Liberia faces a critical shortage of palliative care services, particularly for persons with advanced-stage HIV/AIDS, tuberculosis, diabetes, and cancers. Access to healthcare services is especially limited in rural areas, along with a lack of supportive social and economic resources. Home of Dignity (HoD) Health Center was established in 2013 in Yarbah's Town to fill a last-option palliative care gap. The mission emphasizes patient wellbeing and worth. HoD integrates health, agriculture, and education on-site for immediate medical needs, broader sustainable development, and reducing disease-associated stigma in local communities. We aimed to describe the Center's integrated approach and conduct a descriptive analysis of the HoD patient population. We reviewed patient characteristics (sex, age distribution, mobility status, and CD4 count on arrival) and outcomes (survival rate and community reintegration) for patients with HIV seeking care at the Center between 2013-2017. Of 182 patients (ages 3 months-50 years), over half arrived to the facility bedridden and over 82% had CD4 counts between <100-350. Of the 182 patients, 66% survived, 27% died, and 7% were lost to follow-up. Of surviving patients, 90% were successfully reintegrated into their communities. The clinic also served over 365 chronically ill patients that had been rejected by other health providers during the 2014-2015 Ebola outbreak. The Center is providing last-option palliative care services in the country. As a trusted healthcare center, patients also seek care for acute conditions, resulting in unanticipated resource demands. HoD's experience underscores the need for development of training programs for medical professionals, supply chains, community outreach, and resourcing channels to ensure adequate and sustainable service provision for hospice and palliative care services and reduce stigma in the country. There is an urgent need to invest in holistic palliative and overall healthcare services in Liberia.

The increase in both the number of events and diversity of emerging infectious diseases is threatening public and animal health.1 Over the last decade alone, the global community has experienced the repeated burden of emerging diseases, from pandemic influenza to Ebola and Zika virus epidemics. Other pathogens, notably influenza A (H7N9), Middle East respiratory syndrome coronavirus and Nipah virus, have demonstrated their capacity to become global threats. In parallel, the increasing incidence of multidrug-resistant pathogens has become a pressing global health threat that challenges both the human and animal health sectors. The prospect of a post-antibiotic era prompted a high-level consultation on antimicrobial resistance at the 2016 United Nations General Assembly. It was only the fourth such occasion Member States convened and issued a declaration associated with a developing health crisis.2Infectious disease emergence and multidrug-resistant pathogens are among this century's defining global health challenges. The magnitude of their present and potential impact is sobering. In addition to the disease burden and social impact on families and communities, economic losses due to epidemics and pandemics are often more significant than the direct immediate and longer-term medical expenses. The World Bank estimates the global cost of the 2003 severe acute respiratory syndrome pandemic at 30 billion United States dollars (US$).3 The 2013-2016 Ebola virus disease outbreak was associated with US$ 2.2 billion in lost economic growth for Guinea, Liberia and Sierra Leone alone.4 Total costs attributable to both income loss and premature mortality from a moderately severe influenza pandemic are projected at US$ 570 billion annually, which is within the range of the annual cost associated with global climate change.5 Without intervention, the cumulative economic impact of antimicrobial resistance through 2050 is anticipated to exceed US$ 100 trillion, two-thirds of which would be in low- and middle-income countries, substantially more than current annual global economic output.

Infectious disease outbreaks pose major threats to human health and security. Countries with robust capacities for preventing, detecting and responding to outbreaks can avert many of the social, political, economic and health system costs of such crises. The Global Health Security Index (GHS Index)—the first comprehensive assessment and benchmarking of health security and related capabilities across 195 countries—recently found that no country is sufficiently prepared for epidemics or pandemics. The GHS Index can help health security stakeholders identify areas of weakness, as well as opportunities to collaborate across sectors, collectively strengthen health systems and achieve shared public health goals. Some scholars have recently offered constructive critiques of the GHS Index’s approach to scoring and ranking countries; its weighting of select indicators; its emphasis on transparency; its focus on biosecurity and biosafety capacities; and divergence between select country scores and corresponding COVID-19-associated caseloads, morbidity, and mortality. Here, we (1) describe the practical value of the GHS Index; (2) present potential use cases to help policymakers and practitioners maximise the utility of the tool; (3) discuss the importance of scoring and ranking; (4) describe the robust methodology underpinning country scores and ranks; (5) highlight the GHS Index’s emphasis on transparency and (6) articulate caveats for users wishing to use GHS Index data in health security research, policymaking and practice.

Outbreaks of animal and zoonotic diseases in South Africa are costly and raise concerns about national biosecurity. The interconnectedness of humans, livestock, wildlife and their social and ecological environment necessitates a holistic approach to prevention, preparedness and response to zoonotic and animal diseases. One Health is an increasingly accepted approach in contemporary science and policy spheres, but with limited consideration for economic dimensions. To more fully estimate costs of animal and zoonotic diseases in the country and to explore further scope for applying a One Health economics lens, the Agricultural Research Council of South Africa, in collaboration with partners, held a One Health Economics mini-congress to provide a platform where multidisciplinary stakeholders discussed practical examples, primarily from the Southern African region. Discussions at the mini-congress centred around One Health economics and opportunities, economic insights on prevention and control of Rift Valley fever (RVF), avian influenza and other zoonotic diseases, return on investment for One Health approaches, and insights from the natural resources and animal and human health sectors. Regional and international perspectives on multi-sectoral economic analysis and financing were also shared. Key recommendations from the mini-congress included promoting coordination, co-creation and co-implemented efforts to minimize effects of One Health challenges, and including economic aspects of multi-sectoral engagement to identify and reduce trade-offs and maximize co-benefits of strategies and programmes. Integration of economics in One Health fora, research and collaboration, and promotion of communities of practice and applied training to enhance learning and knowledge exchange were also identified as important.

Multidisciplinary and multisectoral approaches such as One Health and related concepts (e.g., Planetary Health, EcoHealth) offer opportunities for synergistic expertise to address complex health threats. The connections between humans, animals, and the environment necessitate collaboration among sectors to comprehensively understand and reduce risks and consequences on health and wellbeing. One Health approaches are increasingly emphasized for national and international plans and strategies related to zoonotic diseases, food safety, antimicrobial resistance, and climate change, but to date, the possible applications in clinical practice and benefits impacting human health are largely missing.

Concurrent with the sustainable development goals adoption and the UN Climate negotiations, 2015 also marked the formal establishment of the Future Earth scientic platform, envisioned as a 10-year research program for global sustainability. Future Earth merges previous scientic programs in the global environmental change realm including biodiversity science from DIVERSITAS, the International Geosphere-Biosphere Programme, and the International Human Dimensions Programme.