title: Justice Is the Missing Link in One Health: Results of a Mixed Methods Study in an Urban City State.
abstract: BACKGROUND
  One Health (OH) is an interdisciplinary collaborative approach to human and animal health that aims to break down conventional research and policy 'silos'. OH has been used to develop strategies for zoonotic Emerging Infectious Diseases (EID). However, the ethical case for OH as an alternative to more traditional public health approaches is largely absent from the discourse. To study the ethics of OH, we examined perceptions of the human health and ecological priorities for the management of zoonotic EID in the Southeast Asia country of Singapore.
  
  
  METHODS
  We conducted a mixed methods study using a modified Delphi technique with a panel of 32 opinion leaders and 11 semi-structured interviews with a sub-set of those experts in Singapore. Panellists rated concepts of OH and priorities for zoonotic EID preparedness planning using a series of scenarios developed through the study. Interview data were examined qualitatively using thematic analysis.
  
  
  RESULTS
  We found that panellists agreed that OH is a cross-disciplinary collaboration among the veterinary, medical, and ecological sciences, as well as relevant government agencies encompassing animal, human, and environmental health. Although human health was often framed as the most important priority in zoonotic EID planning, our qualitative analysis suggested that consideration of non-human animal health and welfare was also important for an effective and ethical response. The panellists also suggested that effective pandemic planning demands regional leadership and investment from wealthier countries to better enable international cooperation.
  
  
  CONCLUSIONS
  We argue that EID planning under an OH approach would benefit greatly from an ethical ecological framework that accounts for justice in human, animal, and environmental health.
authors.affiliation: Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore.
authors.forename: Tamra
authors.identifier: http://orcid.org/0000-0002-7125-4206
authors.initials: T
authors.lastname: Lysaght
authors.affiliation: Department of Bioethics, Dalhousie University, Halifax, Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Capps
authors.affiliation: Department of Physiology, National University of Singapore, Singapore, Singapore.
authors.forename: Michele
authors.initials: M
authors.lastname: Bailey
authors.affiliation: Rimba, 4 Jalan 1/9D, Bandar Baru Bangi, Selangor, Malaysia.
authors.forename: David
authors.initials: D
authors.lastname: Bickford
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Coker
authors.affiliation: Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore.
authors.forename: Zohar
authors.initials: Z
authors.lastname: Lederman
authors.affiliation: Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore.
authors.forename: Sangeetha
authors.initials: S
authors.lastname: Watson
authors.affiliation: Department of Medicine, National University Health System, Singapore, Singapore.
authors.forename: Paul Anantharajah
authors.initials: PA
authors.lastname: Tambyah
mesh_terms: D000818:Animals; D021821:Communicable Diseases, Emerging / Q000453:epidemiology* / Q000523:psychology; D004782:Environmental Health / Q000941:ethics; D014943:Global Health / Q000941:ethics*; D006801:Humans; D058873:Pandemics; D011634:Public Health / Q000941:ethics*; D012846:Singapore; D015047:Zoonoses / Q000453:epidemiology* / Q000523:psychology