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One Health initiatives have advanced zoonotic disease management by recognizing the interconnectedness of three sectors of governance (human, ecosystem, and animal) and by identifying options that can improve full‐system health. Although One Health has had many successes, its full realization may be inhibited by a lack of strategies to overcome simultaneous impediments in decision making and governance. Decision impediments that hinder management may include uncertainty, risk, resource limitations, and trade‐offs among objectives. Governance impediments arise from disparities in costs and benefits of disease management among sectors. Tools and strategies developed from decision science, collaboration, and negotiation theory can help articulate and overcome coinciding decision and governance impediments and enhance multisectoral One Health initiatives. In cases where collaboration and negotiation are insufficient to address disparities in cross‐sector costs and benefits, altering incentive structures might improve disease‐specific outcomes and improve the realization of One Health.
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Governance structure affects transboundary disease management under alternative objectives
Abstract BackgroundThe development of public health policy is inextricably linked with governance structure. In our increasingly globalized world, human migration and infectious diseases often span multiple administrative jurisdictions that might have different systems of government and divergent management objectives. However, few studies have considered how the allocation of regulatory authority among jurisdictions can affect disease management outcomes. MethodsHere we evaluate the relative merits of decentralized and centralized management by developing and numerically analyzing a two-jurisdictionSIRSmodel that explicitly incorporates migration. In our model, managers choose between vaccination, isolation, medication, border closure, and a travel ban on infected individuals while aiming to minimize either the number of cases or the number of deaths. ResultsWe consider a variety of scenarios and show how optimal strategies differ for decentralized and centralized management levels. We demonstrate that policies formed in the best interest of individual jurisdictions may not achieve global objectives, and identify situations where locally applied interventions can lead to an overall increase in the numbers of cases and deaths. ConclusionsOur approach underscores the importance of tailoring disease management plans to existing regulatory structures as part of an evidence-based decision framework. Most importantly, we demonstrate that there needs to be a greater consideration of the degree to which governance structure impacts disease outcomes.
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- Award ID(s):
- 2028301
- PAR ID:
- 10306013
- Publisher / Repository:
- Springer Science + Business Media
- Date Published:
- Journal Name:
- BMC Public Health
- Volume:
- 21
- Issue:
- 1
- ISSN:
- 1471-2458
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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