The 2010 epidemic of childhood lead poisoning in Northwestern Nigeria is just one example showing the aftermath of human activity in the form of small-scale artisanal gold mining and how changes in animal health and behavior can serve as early indicators of major environmental hazards before they have detrimental effects on human health. The eventual linking of the children's illness and deaths to lead exposure by Médecins sans Frontières was serendipitous, and subsequent interventions were not implemented early enough.
This case also serves as a model in which the One Health concept can be illustrated. To prevent this kind of widespread health catastrophe, regional or global systemic surveillance, part of a true One Health initiative, will need to be instituted by capable and resourceful entities. In this respect, the United States is in a position to spearhead initiatives to incorporate animal health as part of surveying human health. The Centers for Disease Control and Prevention oversees NHANES, which is one of the most comprehensive and extensive health surveys in the United States. Obvious human health topics covered in the NHANES questionnaire include smoking, alcohol use, sexual behavior, and physical activity, as well as topics less directly related to health, such as occupation, income, and health insurance status. However, no questions are asked about possible exposure to animal species that may transmit zoonotic diseases (eg, pigs and trichinosis and pork tape worm; mosquitos and arboviral infections) or observed local wildlife illnesses and deaths in large numbers.
To begin to benefit from the One Health concept and gain a better understanding of the relationship between human and animal health, questionnaire topics related to exposure to animals and zoonotic diseases and observed mass animal illness and deaths should be included in future NHANES questionnaires. Although the National Outbreak Reporting System collects reports on waterborne, foodborne, and enteric disease outbreaks due to contact with human, animal, or environmental sources, local, state, or federal agencies are not required to use this system to report outbreaks. Regardless of the agency involved or the instrument used, ongoing surveillance of human, animal, and environmental pathogens and toxins can provide early warnings in similar instances of environmental exposure in the future. In the current case, although the recognition by the Médecins sans Frontières was fortunate, it was too late for effective interventions to be implemented.
Physicians must be constantly vigilant to identify evidence of an illness that seems out of the ordinary and could be caused by exposure to environmental toxins. Osteopathic physicians in particular are trained to consider multiple aspects of their patients’ health, including their environment. To take full advantage of the One Health concept, the initiative should be introduced at the level of medical education. Certainly, the current emphasis on interprofessional education is a major step in the right direction. However, to fully exploit these educational gains, interprofessional education must evolve into interprofessional practice for true One Health interventions to occur.
It is worth noting that the preparation of this review revealed a disconnect between the human and animal literature concerning lead poisoning. For example, many of the reports published between 2000 and 2010 on lead poisoning in wildlife and other animal species do not show up in PubMed searches.
23-25,28 We found that using the Google.com search engine was a more useful alternative. However, the creation of a search engine that pulls published reports on both humans and wildlife could advance the One Health concept and lead to more research on human-animal-environmental interrelationships.