One Health’s Hidden Patient: Why Human Health Still Dominates the Framework

One Health has become one of the most influential frameworks in contemporary global health, promising an integrated vision in which human, animal, and environmental health occupy equivalent positions within a shared system. From zoonotic outbreaks to antimicrobial resistance, biodiversity loss, and climate change, the framework has been rapidly adopted by international agencies, governments, research institutions, and scientific journals as a strategic path to address complex socio-ecological challenges. Yet a fundamental question remains insufficiently explored: are the three dimensions of One Health truly receiving equal attention from the scientific, ethical, and political fields? A new discussion article published in Environmental Science and Pollution Research by Flavio Manoel Rodrigues da Silva Júnior and colleagues at the Universidade Federal de Alagoas and the Universidade Federal do Rio Grande in Brazil argues that the principal challenge facing One Health may no longer be conceptual, but institutional.

The researchers combined an exploratory assessment of 490 articles indexed in the Web of Science containing the term One Health in their titles and published in 2026, evaluating them according to research areas, Sustainable Development Goals, departmental affiliations, and an article-level assessment of their substantive human, animal, and environmental health beneficiaries. The results reveal a clearly asymmetrical structure favoring human health across every dimension examined. Research areas classified as exclusively related to human health accounted for 227 occurrences, corresponding to 30.0 percent of the 757 Web of Science area occurrences and 46.3 percent relative to the 490 articles. In comparison, areas exclusively related to environmental health represented 81 occurrences (10.7 percent) and animal health 72 occurrences (9.5 percent). When considering the interfaces between more than one axis, human-environmental interfaces represented the largest category with 161 occurrences (21.3 percent), the human-animal interface contributed 30 occurrences (4 percent), while animal-environment interfaces accounted for only 12 occurrences (1.6 percent). No research area was explicitly classified as simultaneously integrating all three pillars.

The article-level content assessment reinforced this asymmetry. A clearly identifiable health beneficiary was found in 364 of the 490 records (74.3 percent). Human health alone was the predominant beneficiary in 175 records (35.7 percent), compared with 29 records (5.9 percent) focused predominantly on animal health and 23 (4.7 percent) on environmental health. Among studies in which two dimensions were substantively represented, the human-animal combination was the most frequent (n = 80; 16.3 percent), followed by human-environmental health (n = 35; 7.1 percent), whereas the animal-environmental interface accounted for only 11 records (2.2 percent). Most notably, only 11 publications (2.2 percent) could be classified as substantively addressing human, animal, and environmental health simultaneously. When only records with an identifiable beneficiary were considered, the human-health dimension was substantively represented in 301 publications (82.7 percent), compared with 131 (36.0 percent) involving animal health and 80 (22.0 percent) involving environmental health. Even among the 126 studies involving two health dimensions, 115 (91.3 percent) included the human-health axis.

The asymmetry became even more evident when the Sustainable Development Goals associated with the articles were examined. Of the 490 records, 198 (40.4 percent) contained at least one SDG assignment in Web of Science. Of these, 91.9 percent were associated with SDG 3 (Good Health and Well-being), while SDG 14 (Life Below Water) was identified in only 6.1 percent of the records, SDG 15 (Life on Land) in 3.5 percent, and SDG 13 (Climate Action) in 3.0 percent. This pattern suggests that environmental and animal components are frequently framed as factors or determinants that modulate the dynamics, occurrence, and severity of a central axis—human health—rather than being recognized as topics of interest with equivalent intrinsic value.

A third perspective was conducted based on the analysis of departmental affiliations. Of the 490 articles, 201 (41.0 percent) did not contain information on departmental affiliation and were excluded from this stage. Among the 721 departmental affiliations identified in the remaining records, departments exclusively linked to human health represented the largest share of classifiable affiliations, accounting for 44.8 percent of the records (70.3 percent of affiliations involving health), while animal health departments accounted for 3.2 percent and environmental health departments for 5.8 percent. Furthermore, no departmental affiliation explicitly incorporated all three dimensions simultaneously—for example, dedicated One Health departments. The researchers note that this observation should not be interpreted as a criticism of human health research itself, nor as evidence that the environmental or animal dimensions are completely absent from One Health studies. Instead, it suggests that animal and environmental systems are frequently incorporated due to their influence on human health, rather than being recognized as autonomous dimensions of health deserving equivalent consideration.

This tension reflects a longstanding debate within sustainability theory and environmental ethics. The Brundtland formulation of sustainable development placed the needs of present and future human generations at the center of sustainability, while the Rio Declaration subsequently stated explicitly that human beings are at the centre of concerns for sustainable development. These formulations have been associated with anthropocentric interpretations in which nature is protected primarily because of the services, resources, and conditions it provides to human societies. The distinction between weak and strong sustainability—whereas weak sustainability permits the substitution of natural capital by other forms of capital, strong sustainability emphasizes the preservation of critical natural systems that cannot simply be replaced—parallels the contrast in environmental philosophy between shallow ecology, oriented toward environmental protection largely in relation to human welfare, and deep ecology, which attributes intrinsic value to non-human life and ecological systems. Seen from this broader perspective, the question of whether animals and ecosystems are protected for their own sake or primarily because they benefit humans represents a recurring normative tension that One Health inherits rather than creates.

Within the One Health literature itself, Johnson, Ferdowsian, and Pierce have argued that the framework often instrumentalizes non-human animals, assigning them value primarily as reservoirs, sentinels, vectors, or barriers against threats to humans. According to the authors, this approach reproduces a predominantly anthropocentric logic that limits the transformative potential of the One Health paradigm and weakens its ethical foundations. A similar concern has been raised through the concept of ecological equity, which challenges the traditional anthropocentric orientation of health sciences and argues that ecosystems and non-human species should not be valued solely according to their usefulness to human societies. The notion suggests that health frameworks should evolve beyond human-centered benefit analyses and recognize the intrinsic importance of ecological integrity and multispecies well-being.

The identified asymmetries in publication patterns are not merely observations restricted to the academic environment. They are capable of influencing research agendas, institutional structures that shape decision-making processes, and funding priorities, determining which questions are asked and which remain unexplored. If most knowledge production is concentrated in institutions associated with medicine, public health, and biomedical sciences, it is reasonable to expect that the priorities emerging from this system will also be oriented toward human health outcomes. Under these circumstances, environmental degradation, biodiversity loss, ecosystem disruption, and animal health become important especially when they pose risks to human populations. This dynamic does not necessarily result from deliberate exclusion, but rather from the institutional and epistemological structures through which scientific problems are defined and addressed.

The consequences extend to governance. Although One Health is often described as an integrated framework, most countries continue to organize health-related decision-making through highly compartmentalized institutions. Ministries of health monitor human diseases, veterinary agencies oversee animal health, and environmental agencies manage ecological indicators through largely independent systems. Data collection, surveillance networks, financing mechanisms, and policy implementation often remain fragmented across sectors, limiting the capacity for truly integrated responses. Collaboration often emerges reactively rather than structurally—intersectoral coordination tends to intensify during zoonotic outbreaks, environmental disasters, or food security crises, only to revert to traditional administrative boundaries as soon as the immediate threat diminishes. Evidence from the COVID-19 pandemic highlighted how fragmented governance structures, weak coordination mechanisms, and limited intersectoral collaboration hampered timely responses and reduced the effectiveness of preparedness strategies. Similarly, analyses of climate health governance have identified insufficient integration of health considerations into climate policies, weak intersectoral collaboration, and limited stakeholder engagement as persistent barriers to adaptation and resilience development.

The researchers argue that the future of One Health may depend less on refining its definitions and more on transforming the governance structures responsible for its implementation. Effective integration depends on institutional arrangements capable of supporting long-term cooperation, shared surveillance systems, integrated databases, joint financing mechanisms, and decision-making processes that transcend traditional administrative sectors. A truly integrated framework requires not only collaboration between sectors but also a more balanced distribution of influence among the actors responsible for setting priorities and evaluating success—meaning that ministries and agencies linked to the environment, agriculture, livestock, and food security should be protagonists in policies, strategies, and funding for initiatives that use the One Health approach. Future evaluations should go beyond measuring human health outcomes and incorporate indicators capable of assessing whether the environmental and animal health dimensions are being meaningfully represented in governance structures, research agendas, and funding priorities. The long-term relevance of One Health may ultimately depend on its ability to confront a fundamental question: can a framework built on interconnectedness continue to operate through institutional hierarchies that systematically privilege one form of health over others? If One Health is to become more than an operational tool for managing risks to human populations, it may need to evolve into a model grounded in ecological equity, multispecies justice, and genuinely balanced governance. Otherwise, the One Health triangle may remain conceptually complete, but structurally unbalanced.

Subject of Research: Anthropocentric asymmetry in One Health scientific production and governance

Article Title: Who is the patient of One Health?

Article References: Who is the patient of One Health?. (n.d.). https://doi.org/10.1007/s11356-026-38312-8

Image Credits: AI Generated

DOI: 10.1007/s11356-026-38312-8

Keywords: One Health, anthropocentrism, health governance, ecological equity, environmental health, multispecies justice, patient, Health, scientific research