Two researchers at the University of Pennsylvania School of Veterinary Medicine are advancing the concept of One Health, the idea that the health and well being of humans, animals and the environment are interconnected. Penn Vet’s Stephen Cole, a postdoctoral fellow, and Shelley Rankin, an associate professor of microbiology, have recently developed two case studies for use in health education that highlight these cross-disciplinary connections.

“In the veterinary field we talk about One Health almost every single day, but there are few people in the medical profession who actually understand what that means,” Rankin said. “With these case studies, we can really demonstrate why One Health is a meaningful concept for clinicians across fields.”

In medical training, a case study approach to learning asks students to imagine that they are already practicing professionals and walk through how they would handle a challenging scenario. 

Cole, who graduated from Penn Vet with a V.M.D. in 2015, felt that students could benefit from more exposure to case studies in their education as a chance to truly engage with the material they learn in lectures.

“I wanted to put together case studies to make the material more tangible and really bring the One Health concept to life,” Cole said.

Last year, the Association of American Veterinary Medical Colleges, together with the Association for Prevention, Teaching and Research and the Healthy People Curriculum Task Force put out a call for such case studies as part of their One Health Interprofessional Education Initiative, which aims to increase collaboration across health professions.

Cole and Rankin submitted four case studies and had two accepted for further development, and the scientists were named One Health Scholars. As part of the honor, Cole presented the case studies at theAAVMC conference in Washington, D.C., earlier this month. Those cases, along with 13 others, are available on the AAVMC website for use by instructors in a variety of health professions.

The first winning proposal, which Rankin and Cole coauthored with the University of Washington’s Peter Rabinowitz, centered on lead poisoning.

In it, the researchers present the following scenario: a poultry veterinarian performs a necropsy on four dead pigeons, a 10-year-old girl’s pets. The results show that the pigeons had high blood lead levels, and it is discovered that the shed in which they are kept is the source. Students are asked to consider the roles and responsibilities of veterinarians and physicians in this case and how communication could be effectively carried out across professions. Contrasting with this household instance of lead poisoning, the case study also presents a community level case, based on a true event in which mass die-offs of waterfowl led to investigations that revealed widespread lead poisoning in both wildlife and children in villages in northern Nigeria.

“I thought it would be interesting to contrast the possible lead exposure of one child to that of a massive public health problem,” Cole said. “It’s the same problem, at different scales, both involving One Health.”

For the second case study, the researchers touched on an issue of rising concern in many health care fields, the veterinary profession included: mental health. It explores the consequences of an HIV diagnosis on pet ownership, bringing up the need to balance the risks of zoonotic, or animal-borne, disease transmission against the mental health benefits of owning a pet.

“As someone who has focused a lot on infectious disease, my initial reaction used to be that immunocompromised individuals shouldn’t have pets,” said Cole. “But in many cases the mental health benefits of pet ownership can outweigh the risks.” 

Rankin and Cole note that the interactive nature of case studies allows students to confront and explore challenges that could arise in practice that they might not otherwise encounter in the classroom. And using an interprofessional approach allows them to appreciate the limitations and obstacles that other professionals may face. For example, a physician may not be aware that a veterinarian cannot legally ask clients about their health status.

“It raises the idea that we need to come up with different channels of communication between health professions so we can protect the health of an entire household or an entire community as opposed to animals and people as completely separate entities,” Cole said.

Eventually, Rankin and Cole hope to feature the case studies — their own as well as the others selected by the AAVMC — in a new course offering at Penn, one that may be open to both veterinary and medical students.

“Often times in the various health professions we’re all talking in our own boxes,” Rankin said. “We’re trying to coax people out of their separate boxes to come together to take on health challenges. We’re stronger together.”