Content uploaded by Anne Snick
Author content
All content in this area was uploaded by Anne Snick on Jul 12, 2022
Content may be subject to copyright.
Goel, N., Barbosa Mendes, A., & Snick, A. (2021). Reclaiming Education for Health. One Health as an Emerging
Paradigm in Response to COVID-19 and other Anomalies [Preprint]. Open Science Framework.
https://doi.org/10.31219/osf.io/qk4at
Reclaiming Education for Health.
One Health as an Emerging Paradigm in Response to COVID-19 and other Anomalies
Naina Goel,1,2,3 Ana Barbosa Mendes,1,4 Anne Snick,1,5,6*
1 Institute for the Future, KU Leuven, Leuven, Belgium
2 Laboratory of Aquatic Biology, Department of Biology, KU Leuven, Campus Kulak, Kortrijk,
Belgium.
3 Blue Growth Research Lab, Ghent University, Campus Oostende, Ostend, Belgium
4 Erasmus School of Philosophy, Erasmus University, Rotterdam, The Netherlands
5 Club of Rome, Winterthur, Switzerland
6 World Academy of Arts and Science, Belgrade, Serbia
*Corresponding author: anne.snick@scarlet.be
2
Abstract
The One Health approach reveals a growing awareness that human health is interdependent with the health
of all living beings and therefore requires keeping the entire planetary ecosystem healthy. The COVID-
19 crisis has made this interconnection undeniable: by intruding into wild ecosystems, driven by the
combined pressures of population growth and extractive economics, the risk of zoonotic diseases for
which human immune systems and health care facilities are unprepared has drastically increased; the
tremendous impact of this unrestrained colonization of nature is now clear worldwide. One Health has
emerged in response to the increasing complexity of health issues. It states that to guarantee the health of
humans, considering the health of other-than-human beings is crucial. Various related disciplines should
collaborate to face the current health challenges. Despite this growing demand for a more systemic
approach, health institutions and professionals appear slow in embracing it; at best, they take a narrow
approach to One Health, limited to interactions between domestic animals and humans. This article
proposes a systemic analysis that explains this slow uptake of One Health. It explores lock-ins in
epistemological and pedagogical patterns, focusing on the university as the site where these are
(re)produced. Universities emerged during the Enlightenment when technical discoveries encouraged a
mechanistic worldview and a separatist approach to knowledge. The structuring of academia in separate
faculties reflects this worldview and paradigm. Even if the issues the planet is facing have become much
more complex, universities have not significantly changed their underlying concepts and practices of
research and education. In order for professionals to adopt a more systemic approach to health, they need
to unlearn this separatist worldview, transcend the disciplinary boundaries, and familiarize themselves
with a ‘relational’ paradigm. The article describes a concrete example of a learning programme that is
learner-driven and fosters transdisciplinary learning. Two vignettes presented by Ph.D. researchers
illustrate the analysis and the response proposed here. The text concludes by proposing leverages needed
to unleash the potential of this kind of transdisciplinary learning about health.
3
Introduction
One Health is an approach that aims to consider the many intricate ways in which the health of humans is
connected with that of other plant and animal species present in the ecosystem (1). Many practitioners
primarily understand this as a concern with human health risks related to domestic animals and livestock.
However, a much more widespread and drastic issue is the overuse of antibiotics in agro-industrial
husbandry, as this promotes the emergence of antimicrobial-resistant bacteria with which the human body
and medical system are unable to cope. COVID-19, furthermore, shows that the unrestrained human
encroachment on wild nature and the globalised economy can bring forth pandemics for which our health
care, cultural patterns, and economic systems are unprepared (2,3).
Human intrusion into wild nature now transcends the boundaries of the exploitation of nature for the
purpose of food production. It is driven by the needs (for housing, energy, mobility, communication, and
so forth) of growing human populations (in turn the outcome of more performative food production and
medical systems), combined with an economic system that sees nature as a mere resource for unrestrained
human intrusion, consumption, exploitation, and alteration (2). This increases the risk of zoonotic
diseases, infections transmitted from animals to humans, including H5N1 avian influenza, MERS, Ebola,
Zika, and, possibly, COVID-19 (4). Moreover, human industrial economic systems destroy biodiversity
at a rate that scientists estimate to be hundreds of thousands times faster than the naturally occurring
‘background’ species extinction prevailing in the last tens of millions of years (5). This loss is irreversible
and creates a threat to human health for which no medical facility can offer relief (6). The agro-industry
focuses on monocultures that yield large crops at low cost; other species are seen as ‘competitors’ and
destroyed with pesticides and insecticides (7,8). As these products deplete the soil, farmers turn to
chemical fertilizers to ensure the productivity of the land, a vicious circle. In a business-as-usual scenario,
this may finally destroy the microbiome ensuring the health of soils and deplete the ecosystems that
pollinators depend on, which may lead to famines and unbalanced diets, further undermining human
health (9). Close to 75 percent of the world’s crops producing fruits and seeds for human consumption
depend, at least in part, on pollinators for sustained production, yield, and quality (10). Finally, if humans
do not manage to keep planetary warming below the 2°C threshold, the planet may reach a hothouse
scenario resulting in the desertification of entire countries (11). The scarcity of potable water this entails
will further exacerbate health risks. These phenomena will manifest themselves differently in various
corners of the globe, which then may lead to geopolitical tensions, as nations may turn towards
increasingly aggressive strategies in their scramble for scarce resources, water, and food.
Even as the broad systemic implications of One Health become evident, it is no surprise that health
professionals are slow in adopting it as the new framework and agenda for their professional activities.
Health workers’ academic training focuses on small, separate parts of this complex system, notably
diseases. It provides veterinarians, general practitioners, or medical specialists with a thorough expertise
4
in one aspect of the system but does not equip them to understand, let alone address, the broader
interdependencies that underlie the current challenges. On the other hand, specialists in other domains
were never trained to design their specific fields with a view to pursuing human health as interconnected
with the health of the ecosystem. Economics, for example, explicitly exclude the damage they inflict from
their models as ‘externalities’.
Academic research and education are based on a paradigm that privileges specialist knowledge on small,
relatively controllable subsystems over more holistic insights into larger, complex, and dynamic realities.
This paradigm is itself based on a Western cultural assumption that man is separate from nature and is
able to know and control life objectively (12,13). As it has proven highly successful in terms of
technological progress increasing human comfort and longevity, this approach has become the dominant
model for scientific research. Academic education is mainly designed to teach this paradigm to the next
generation, thus reproducing and further perfecting it. Academic careers hinge on the capacity of young
researchers to excel in this specialist, narrow focus study of reality. At the same time, since this Western
model is now spreading globally under the banner of human development, progress and growth, its
detrimental impact on the health of the more-than-human planetary ecosystem becomes undeniable.
The Anthropocene marks a geological epoch in which the relatively stable climate of the Holocene has
been unravelled by human industrial systems, impacting almost all the ecosystems (on land and in water)
and the biophysical conditions (moderate temperatures, clean air, potable water, fertile soils) upon which
human civilisations depend (11,14). What once appeared to be the triumph of humankind over the vagaries
of nature now poses a severe threat to human survival; phenomena that were not predicted (or at least not
intended) by the scientific model are called ‘anomalies’ (15). They give rise to the questioning of the
predominant paradigm and create the context for alternative scientific models to emerge. Today we see
this emergence in the growing call for systems theory, Responsible Research and Innovation,
transdisciplinary research, and holistic views on life on Earth. One Health can be seen as an endeavour in
line with this new understanding of life (16). The problem, however, is that the old paradigm is embedded
not only in the structure of academic research and education but has shaped almost all institutions in
society. The same is true for what we call the ‘health sector’, the societal subsystem that is to guarantee
human and ecosystem health, organised not only according to the scientific (specialist) take on health, but
also structured by legislation, financial structures, and cultural expectations concerning health and
healing.
The basic definition of health is the state of wellness of beings, including their physical, mental, and social
well-being, not merely the absence of disease or infirmity (17). A human being is a complete ecosystem
in itself (18). Complete well-being is not attainable in a day; it requires among other things a switch to a
healthy lifestyle, treating the human body with respect and honouring the co-existence of the biome.
5
Synergies of animals, plants, and the environment, including the social context, can help in attaining the
holistic well-being of humankind (19). In traditional medicine in India and many other subcontinents (20),
practitioners used to start their examination of a patient by asking the question: “how’s your gut doing?”
(21) The importance of your diet for your gut and health is understood and honoured through ages of lived
experience. Due to colonialism, this question was lost and taken over by a reductionist approach focusing
on the individual: “how are you feeling?" The outcome of this reductionist approach is severe as for
example the one-sided focus on fighting illness by means of antibiotics leads to Anti-Microbial Resistance
(AMR) and weakens the human immune system (22,23).
Western science separates the human body from other organisms present in the ecosystem and dissects it
into its tiniest building blocks, to then find it impossible to put everything together again in a dynamic
understanding of health. To study human health, it uses model organisms, reflecting the academic urge to
slice reality into more manageable chunks in an attempt to understand it. By reducing life to its separate
building blocks and using model organisms that are less complex than what it actually tries to understand,
the separatist paradigm obfuscates our understanding of the interdependency of all life. While the One
Health approach sets the agenda for science to piece together what was first separated, the Western
research infrastructure is unfit for understanding the dynamic interdependency of all living beings.
Therefore, the main challenge is to find the quickest pathways allowing society - including all sectors that
affect health negatively – to ‘unlearn’ the separatist paradigm, and learn more holistic, complex
approaches to well-being (24). A paradigm is a normative framework accepted by the scientific
community on what questions and methods are valid and which ones are deemed ‘unscientific’. Most
scientists are not even aware they are operating within the constraints of a historically contingent
framework that may be up to revision.
In this article, we will first propose a theoretical analysis on why the dominant – separatist – paradigm is
no longer capable of ensuring human and planetary health. Secondly, we will present a programme that
allows teams of learners (students and post-graduates) to autonomously understand the complexity of
health issues and to cocreate new strategies to support human and planetary well-being. We present two
vignettes of Ph.D.-researchers who participated in this programme. In conclusion, the article explores
potential leverages for making this kind of learning accessible to all.
Explaining the lack of One Health uptake
The academic paradigm is incompatible with One Health
This article explores the idea that the prevailing scientific paradigm hampers the uptake of One Health as
a ‘connected’ approach. Universities emerged in Medieval times and gradually embraced a paradigm
introduced by scientists like Newton and Descartes, describing regularities in nature using mathematical
6
equations (25,26). This mathematical ‘certainty’ created the illusion that scientists reveal objective truths,
that nature functions like a machine, and that humans are primarily rational beings looking at nature ‘from
the outside’, without interfering in its dynamics. This separation between man and nature reflects an
ancient Indo-European belief that humans were created in the image of God, not as part of the animal
kingdom but as the apex of evolution, while nature is a mere resource for them to own, use, and exploit
(13). This separatist paradigm became entrenched in academia in many ways. Firstly, it is reflected in the
architecture of universities, with sciences studying natural and human dynamics housed in separate
buildings and faculties, each with its jargon, publication channels, and methodologies. Academic
publications and careers are evaluated by peers from the same discipline and valorised in terms of their
contribution to this specialist approach (27). Most of higher education is narrowed down to the
transmission of this kind of knowledge to students, which is reflected in the auditorium (with one ‘expert’
teacher in front of a passive ‘audience’ of students) as the standard classroom.
Quantitative data and mathematical equations, though mere abstractions of reality, are considered valid
representations of it, while qualitative methodologies revealing localised, idiosyncratic features are
deemed less rigorous. Since all sciences and sub-specialisms make different abstractions, their analytical
models are not interoperable; they have no common language to describe interdependencies between
subdomains. Since separatism is the norm, more holistic types of knowledge are marginalised. Societal
actors with knowledge of what works in local contexts (for example, the use of local plants or customs)
are excluded from the production of knowledge (28,29). Women, in former centuries crucial transmitters
of traditional knowledge, were persecuted as witches once rationalist universities prevailed (30). Even
today, scientists who pursue a more systemic understanding, including local actors in research, are often
side-lined as their research methods are deemed less scientific. Indigenous cultures embracing ecocentric
worldviews, seeing themselves as members of the natural family which they must treat with respect and
restraint, were looked down upon by Western colonists as ‘primitive’ and encouraged (or forced) to follow
the Western path of development (31).
This paradigm deeply affects how science deals with health. Natural sciences reveal how Western
economic systems destroy ecosystems yet cannot propose pathways for redesigning the economy.
Humanities and social sciences mostly approach the human destruction of nature as an indicator of
progress without critically questioning how that impacts health. Technology and economy are encouraged
to pursue their own ‘progress’ using people and planet as resources (with health questions merely as an
afterthought). Economic indicators disregard health concerns (32). In fact, if an industrial accident occurs
which causes ecological pollution and human injuries, this is good for the economy, as it raises demand
for hospital care, funeral services, or industrial clean-up, and thus boosts the GDP.
Health-blindness of the academic system in practice
7
The consequences of this separatist scientific model on health are undeniable. On the one hand, most
academic research and education are health-blind. Sciences like economics, engineering and technology,
for example, are mainly valued for their contribution to economic competitiveness and productivity,
fuelling the commodification of natural resources. Health is not their primary goal, while the negative
impacts industrial processes may have on human and planetary well-being are ignored or externalised.
On the other hand, disciplines that do study health are not concerned with preventing pathologies of
natural ecosystems (including humans), which would require analysing the systemic causes of the big
challenges described above. On the contrary, they mostly limit themselves to curing individual
pathologies of human or animal patients. Health care is, in fact, reduced to disease control. From a
systemic perspective, curing the symptoms of a health-blind (or even pathogenic) socio-technical regime
and calling that ‘health care’ reinforces this very regime. Since the economic system depends on eternal
(exponential) growth, it has no interest in maintaining humans and their environment healthy since under
present rules of how economic value is created, little money can be earned from that. In the capitalist
system, the health sector is an economic branch that structurally depends on the prevalence of diseases
requiring a cure. In that sense, biomedical research is health-blind too. Since this health-blind, separatist
paradigm is dominant in academia, it is to be expected that health workers are unprepared to embrace One
Health’s more holistic and systemic approach; they never learned to understand and improve complex
interconnected systems affecting health. Hence, multifactorial diseases like celiac (33) and irritable bowel
syndrome (34) are severe challenges for highly specialised health workers.
The following vignettes, presented by two Ph.D.-researchers, illustrate how the separatist paradigm
obfuscates a holistic approach to health. They reveal in detail in what ways underlying rationalist
assumptions influence academic research and education. Higher education is reduced to transmitting
knowledge about health-blind specialisms, leaving no room to deconstruct the underlying assumptions or
design more holistic systems. The first vignette (Ana) describes research in a non-health-related
discipline, while the second one (Naina) zooms in on how the separatist paradigm influences biology,
ecology, and evolutionary research. Both cases offer a more concrete understanding of how learners feel
the need for a change of paradigm.
Vignette Ana
My research investigated how research synthesis methods can be used for theory testing and theory
development in psychology. Since it was a methodological research project, it did not have direct links
with health or other societal issues. However, by developing better methods to connect empirical
investigation with theory in psychology, this research aimed to increase the robustness of the knowledge
making process in such a way that experiments and observational findings can be translated back into
theory to better inform how such knowledge can be used in practical settings; this, then, may also be
relevant for health-related disciplines.
8
My research involved surveying the literature for how researchers use methods in theory-focused
research, and developing novel methods that would later be used in that same type of research. As in most
methodological research in psychology, my work involved little formal (or informal, for that matter)
interaction with my main stakeholders – researchers in psychology. Methodologists tend to specialise in
one specific type of method and attempt to develop this kind of method for different types of problems;
this, however, might be far from what applied researchers actually need to solve the problems they face
while doing their work.
Indeed, methodological research in psychology takes the knowledge transfer paradigm to an extreme
because it focuses on producing several methods that are to be first published, next translated into
accessible tools, and only then taken up by substantive researchers working on specific themes. This
process can take years, and methodological development is often a lot more technically complex than
what substantive researchers are trained to do, which again delays the uptake of these methods. To remedy
this gap, there is increasing demand for further training for substantive researchers, rather than a demand
for in-depth reflection and methodological cocreation between applied researchers and methodologists.
Research synthesis methods (used for synthesising specific kinds of data) are often used to guide practice
and policymaking, and many experts consider them the gold standard of scientific evidence. However,
these methods completely ignore the complexity of the problems they investigate, particularly when they
are not used for evaluating specific interventions or therapies but for investigating the mechanisms and
processes underlying certain phenomena. These methods are also unidimensional, in the sense that they
only take into consideration published evidence in scientific journals, often confined to one or a few
closely related disciplines. Therefore, these methods are no longer appropriate to help society make
decisions that would allow it to address complex problems.
This realisation came to me by working on developing methods for synthesising specific types of data
used in education studies. The amount of simplification and the arbitrary decisions a researcher needs to
make to be able to arrive at a result, to the point where the findings are not easily translated back into the
context in which they would be applied, made me question the usefulness of my research and my field as
a whole. Moreover, it is frustrating that many researchers who do see the limitations I describe here
attempt to address them by pursuing more objectivity and by reducing bias to the extent possible instead
of embracing the complexity of the problems we are investigating and trying to incorporate that
complexity into the methods we use.
Vignette Naina
9
My study aims to unravel the mechanisms behind DNA methylation, a biological process through which
environmental changes modulate the expression of genetic material, and to understand how these
mechanisms are influenced by the gut microbiome via external factors such as diet. Organisms are
involved in uninterrupted biotic interactions leading to strong co-evolutionary dynamics, the flourishment
and diversity of life. A growing body of evidence shows that the interactions, which can be protagonistic
(favouring each other) or antagonistic (working against each other), between the environment and the
microbiome may affect host health.
The effects of the microbiome on host performance can be described at the molecular level (as modulation
in gene expression or as post-transcriptional and epigenetic modifications, phenotype changes that do not
involve alterations in the DNA sequence) but also at the phenotypic level (as changes in host physiology,
life span, and fecundity). However, the expression of epigenetic changes and post-transcriptional factors
due to interactions between the host and the microbiome are linked in complex cause-and-effect loops,
which are difficult to unravel in a comprehensive way. My specific research question is to understand
how host-microbiome interactions influence DNA-methylation in the presence of a toxic diet, and what
role micro-RNAs (miRNAs) play in this process.
Crucial is to study how changes in microbiomes due to stress (for example, exposure to toxins) are
associated with interactions with the host genotype and are related to miRNAs expression and whole-
genome methylation. To understand the role of miRNAs in this, I am using high throughput sequencing
technologies such as metagenomics (functional level analysis of all the genes from gut microbiome),
bisulfite sequencing (DNA methylation studies to make a link between DNA sequences and phenotype),
and transcriptomics (miRNA targeted sequencing).
These methodologies are among the most advanced in biology. Especially the multiple sequencing may
give researchers working on the community-aspects of biology a holistic picture of the co-existence and
co-interaction of multiple species in the ecosystem. Including environmental factors to understand the
functional aspects of individuals bring us one step closer to the One Health perspective. However, this
sequencing technology also leads to an enormous waste of data since bio-informaticians are only able to
decipher around 20-30% of sequenced data due to a lack of appropriate analysis pipelines. Moreover,
there is a huge gap between the high cost of these methodologies and the budget allocated to my research.
This forces me to make trade-offs in terms of the number of time points, replicates, sample size, or
factorial combination of my experiment. Indirectly, this means my research lacks the necessary depth and
thus remains at the abstract, theoretical level without any practical impact in terms of improving health.
My research field is in one of the fastest-growing research niches of the 21st century; its focus on co-
evolution between host and microbiome means a revolution in understanding fundamental health
10
questions. At the same time, what makes me excited about my research is precisely its bottleneck. On the
one hand, it allows for a personalised approach towards understanding the idiosyncratic development of
an organism; it reveals what makes each one of us unique. On the other hand, trying to extrapolate this
personalised knowledge to a community level is where science fails, for it remains blind to the multitude
of interactions; therefore, this approach is not helpful to really understand how human life evolves as part
of an ecosystem.
As a responsible citizen, I want my science to be of high quality and relevant to society. However, due to
the lack of appropriate infrastructure and the pressure to publish in a highly competitive context, I am
forced to conduct research at an abstract level that does not allow me to address the potential influencers
of health at a systemic level. This discourages me from aspiring to a research career. Moreover, such
interdisciplinary and vast studies within a separatist paradigm require multiple researchers to dedicate
their lifetime to produce quality therapeutics for fighting diseases.
One Health requires a shift of academic paradigm
Both vignettes illustrate how the academic approach to knowledge development and education hampers
a policy promoting a holistic approach to health. Today, the COVID-19 pandemic is recognised by many
experts as the result of human expansionism and intrusion into wild nature, allowing diseases to spread
from animals to the entire human population (2). Consequently, the call to ‘build back better’ is growing
strong (35,36). Students feel the university no longer prepares them for the complexity of the future.
Global health organisations pursue a more integrative approach to health, and the European Green Deal
calls for transformational change across the economy to restore natural ecosystems and human health.
These developments create a window of opportunity for the emergence of an alternative approach to
academic learning. The second part of the article will discuss a concrete proposal of how this paradigm
shift could be achievable.
Promoting One Health through transdisciplinary learning
Learning (in) a holistic paradigm
Given the urgency of the health challenges the world is facing, the response we propose here does not
require a time-consuming restructuring of the research system or curriculum reform but creates additional
learning spaces allowing learners at the graduate and postgraduate levels to explore the ‘interconnected’,
holistic dimensions of health and well-being. Rather than criticising the mono-disciplinary focus of
academic education, we propose to create complementary settings that allow students and societal actors
(including health professionals) to learn in a holistic, systemic way. This approach does not focus on
health as a separate sector or discipline but as a societal goal that requires the deconstruction of pathogenic
systems and the cocreation of health-promoting models and practices. The paradigm we propose here can
also be called ‘sustainable’ and ‘postcolonial’, as it responds to the health-blindness of the current
11
development model and aims to sustain (human) life on Earth by revalorising the more holistic
(ecocentric) worldviews that were marginalised by Western rationalism and colonialism.
The authors elaborated a learner-driven project based on a transdisciplinary pedagogy, i.e., fostering
mutual learning in teams including various disciplines and non-academic actors who share the goal of
integral well-being (37,38). This education does not address the individual learner but facilitates the
cocreation of insights in teams from heterogeneous backgrounds. Team members ideally differ in terms
of their discipline (including biomedical, natural sciences and engineering, humanities and social
sciences), gender, country of origin (from the West and other continents), etcetera. The programme we
propose takes one academic year and requires about four hours of work weekly (covering meetings, field
trips, homework, and reading). The programme builds on three methodological principles.
Firstly, all themes on which the learners choose to work are approached from a complex systems
perspective, i.e., analysing how various (ecological, cultural, technical) subsystems interact with each
other to produce increasing complexity, which results in emerging system behaviour and characteristics
that cannot be derived from the previous subsystems (39). The behaviour of a beehive cannot be
understood by analysing single bees but requires an analysis of their interactions and reactions to the
environment. Similarly, the working of the global system cannot be understood by looking at only one
(for example, technical, political, biophysical) subsystem but requires analysing how they interact with
each other and affect (the health of) the planetary system. Similarly, health cannot be studied from the
medical perspective only. Some mandatory reading gives the learners a common vocabulary concerning
the increasing complexity and interdependence of natural and cultural systems (2,25). Systems thinking
skills are introduced by a workshop and then practiced as a mental reflex through weekly discussions or
playful exercises (38).
Secondly, education is learner-driven, based on the questioning, exploration, and cocreation by learners
themselves, and facilitated by a coach who has previous experience with complex thinking and resilience.
Tellingly, after one year of participation in this programme, learners feel ready to coach a new team of
students; this shows that a learner-driven transdisciplinary approach can grow relatively rapidly. The
‘classroom’ or ‘laboratory’ is outside of the university, viz. in sites (niches) pioneering a more holistic
approach, where human health and ecosystem regeneration are honoured as transversal values underlying
all activities, narratives, and infrastructures. Visiting a community-supported agro-ecological farm or a
zero-waste shop, for example, allows learners to understand in an experiential way (engaging not only the
head but also the heart and the hands) how these initiatives integrate physical, mental, and ecosystem
health in a transversal way. They also learn how this can be further supported and accelerated by
innovative financial systems, collaborative business models, and prevention-oriented policies.
12
Thirdly, learner teams develop systemic maps of complex issues (for example, using a visual platform
like MIRO); however, the map (knowledge) is never mistaken for the territory (reality) but is recognised
as a tool for navigating complexity in an ongoing, iterative way. It reveals in a probabilistic way what the
future can be like if society would embrace the regenerative pathway, avoiding the pitfall of science
stating what the future ‘will’ or ‘should’ look like (27). The more actors from across the system are
involved in cocreating knowledge, the more useful the map will be. Not only specialist expertise is
relevant, but also knowledge of non-academic actors (from business, civil society, or policy, including
traditional knowledge). Informing people of scientific insights is insufficient to change cultural habits,
lifestyles, and business practices; this requires a learning process at all levels. Cocreating knowledge in
transdisciplinary settings is necessary if we want to understand how to foster healthy diets, habits,
lifestyles, and more respectful and regenerative relationships with the natural environment, and learn how
to redesign economic and technological innovations to foster health (40).
This programme does not ‘teach’ the more systemic and holistic paradigm in a rational, theoretical way
but introduces it through practical, hands-on workshops, assignments, and challenges (41). One workshop,
for example, proposes a methodological framework called ‘Mapping Innovations on the Sustainability
Curve’ (MISC), which is based on a combination of process ecology and systems thinking (42).
Sustainable systems (in the technical, social as well as biological spheres) are shown to depend on a
balance between two opposite characteristics, viz. resilience (the availability of redundant, alternative
pathways) and ascendency (the capacity to streamline processes for greater efficiency). Sustainable
systems keep both parameters in balance, and in multiple habitats and environments, they show a
surprising consistency in their degrees of ascendency at around 40% (43) (see figure 1).
Figure 1 Process Ecology Sustainability Curve (adapted from (44))
System sustainability
100%
0%
Resilience
Diversity & connectivity
Ascendency
Streamlining & monoculture
Governance
System goal
(window of viability)
13
The MISC builds on those insights to map the sustainability (or ‘healthiness’) of a system by firstly
defining a goal (for example, ‘restoring natural ecosystems and improving human health’ as in the
European Green Deal) and brainstorming with a heterogeneous team on all the (economic, cultural,
technical, financial, and other) mechanisms that currently keep society from achieving that goal. Mixed
teams can produce rich and nuanced maps, including the various subsystems and their interdependencies,
even if learners had no previous theoretical introduction to systems thinking. The most important outcome
is not so much a ‘complete’ map of all drivers and feedbacks in the system but a growing understanding
of the complex interdependence of biophysical, economic, technical, and cultural dimensions. In the next
step, learners investigate where ‘resilience’ can be found by looking for niches set up to achieve the
desired goal but may currently lack the ascendency to impact the system behaviour. Niches can include,
for example, regenerative food systems (avoiding the use of antibiotics), community health centres (not
financially dependent on the prevalence of disease), zero-waste shops (avoiding pollution, promoting
short supply chains, and so on). The teams have the assignment to elaborate a proposal on how the goal
can be better achieved; this implies envisioning governance measures that increase the ascendency of the
niches and that stimulate the established regime to change course. The focus thereby is mainly on the
process of cocreating ‘sustainable’ or ‘health promoting’ alternatives, not on finding the ‘right’ solution
(or product), since, in a complex non-linear context, the process of continuously adapting and redesigning
practices is vital.
The learners in this programme can decide for themselves on which issue they want to work (such as food,
money, education, science, or nature), and what form their cocreative mapping or assignment will take (a
travel guide to the future, a game, a reflection tool, and so on). Using a design approach (‘failing is
learning’), they are encouraged to take the learning steps of their choice, with no ‘standardized’ learning
outcomes imposed. The first results of this approach reveal its potential for learning about complex and
interconnected issues (such as health) and empowering the learners to tackle the complex and daunting
issues of the 21st century (37). The fact that learners of one year feel confident to coach a new group of
learners the next year shows the (exponential) scalability of this pedagogy. It also shows that in a learner-
driven approach, the boundary between ‘teacher’ and ‘student’ are blurred, while cocreation of knowledge
within the proposed framework creates a huge potential for mutual learning.
The experience with this programme over the last two academic years shows that a group of solely Ph.D.-
researchers find it harder to unlearn the entrenched academic approach than groups of mixed BA, MA,
and Ph.D.-level learners. The vignette below is based on a transdisciplinary research (TDR) challenge
proposed and run by a Ph.D.-researcher (Ana) and attended by Naina and seven other Ph.D.-level learners;
the topic on which they worked was ‘open science’, i.e., a self-reflection on how academia can be
encouraged to leave its silo and engage with societal actors to address the challenges of the 21st century.
Since the focus was on mutual learning, the following vignette is a joint reflection by Ana and Naina on
14
how they experienced the programme and how it allowed them to overcome the frustrations with the
separatist paradigm described in the individual vignettes above.
Joint vignette Ana and Naina
New learnings
We participated in an interactive workshop about systems-thinking, an approach we had never been
exposed to in our earlier academic trajectory, but which allowed us to recognize the interdependency of
various fields. Workshops in cocreative methodologies and digital collaboration helped us develop a new
set of skills to work in a transdisciplinary project. Reading a book on why the increasing complexity of
life on Earth also requires a cocreative epistemology; discussing this material with our team allowed us
to internalise the vocabulary necessary to shift our way of working towards a more transdisciplinary
research method. However, the most essential aspect of the programme was unlearning our pre-formed
ideas of what research should be and working with our team and with stakeholders to form a new notion
of how transdisciplinary research could work more openly.
Initially, transdisciplinary learning was a painful process where we were mainly confused and conflicted,
not only about the process and the topic we were exploring but also about where we stood regarding the
way in which we were working. However, as we went through the process of unlearning and broadening
our horizon about how knowledge could be produced, our interest in research was renewed, and our
motivation to continue working as researchers and instigate change in the current knowledge production
system was also reinforced.
Participating in the programme made us question the quality of our individual research project and
redefine what it means to conduct good research. While our involvement in this project about open science
increased our confidence in working in ways that are more aligned with societal needs, it also increased
our frustrations with the current system that, due to the hierarchical organisation of our research
institutions, does not allow us to enact change in our immediate environment. For one of us (Ana), this
even resulted in quitting the methodological research project described in the first vignette and starting a
new Ph.D.-project on methodological and ethical aspects of more inclusive scientific practices, research
truly connected with societal needs and incorporating principles of transdisciplinarity and cocreation.
Overcoming the limitations of disciplinary research
The transdisciplinary insights programme provided us with a platform to challenge the current
conventional science and research process and explore alternatives. The power of cocreation helped us
define the situation while integrating a multitude of other perspectives and, on top of that, stimulated us
to use a systemic thinking approach to achieve a pragmatic analysis of the problem. Our team not only
included learners from multiple disciplinary backgrounds but also showed diversity in gender and
15
ethnicity. Some participants came from countries in the Global South (Africa, the far East, India, and
Latin America) that were colonized by European powers and have seen their own (societal, cultural,
knowledge, and health supporting) systems marginalised and superseded by the Western paradigm. The
systemic process the programme offered helped us identify why none of our disciplines can tackle the
global problems in a sustainable way and why we all need to learn from and with each other. The same
goes for (learning about) One Health; designing cocreative and systemic approaches towards improving
the planetary health situation can help us restructure the situation and redefine the problem at multi-
dimensional levels.
The MISC-framework described above is a powerful tool to make a check on potential alternatives, as it
facilitates an ecologically and socially sustainable approach with a long-term perspective. The process
includes defining the desired long-term aim of a system, and that then allows the team to include in the
map everyone who is directly or indirectly affected by the issue at hand, even future generations. The next
step is defining the involvement of stakeholders coming from different societal sectors, including
policymakers, and integrating their perspectives and capacities (or lack thereof) during the problem
definition phase. Defining and listing the niches that reveal societal resilience is the next step in MISC;
these have an essential role in experimenting with radically innovative approaches for achieving the stated
goal. MISC results in cocreating a mind map that shows the many interactions (reinforcing and balancing
loops) created by the involvement of various stakeholders and niches in attaining the ultimate aim of the
system. It allows to include the externalities of the current system by redefining these interactions so that
the proposed systematic, sustainable alternatives can have an everlasting positive impact on society and
the environment at both the ecological and evolutionary front. Implementing the MISC approach helped
us bring in all the main pillars of 21st-century research: societal engagement, open science, governance,
sustainability, and innovation. In our experience, this is the most holistic way to tackle a complex situation
like the One Health challenge.
Looking into inspirational materials from actors active in holistic, transdisciplinary, and open research
initiatives was very impactful, as this (virtual) ‘dialogue’ with non-academic actors offered key learning
moments. Most meaningful for us were the contacts with initiatives in the decolonisation of science. While
we were already very familiar with different initiatives within the open science movement, this was our
first contact with decolonising knowledge, and it helped shape how we see knowledge production today.
The dialogue among the team members about these initiatives were amazingly rich and inspiring. We
discussed the perception of good versus bad science, the stronger motivation among researchers in the
Global South to work towards local well-being despite a lack of infrastructure, and the exclusion of tribal
populations and their ways of understanding reality from the research process. These discussions were
enlightening, making us realise this whole pool of research is really focused on the capitalist economy
rather than a health-promoting economy.
16
Ours hopes for the future
After completing this programme, we feel that all students and researchers should be encouraged to learn
in a systemic and transdisciplinary way for academia to become more responsive to society's needs and
valorise and integrate the knowledge societal actors can bring to the table. An active transdisciplinary
community, building on both researchers’ and other interested parties' involvement, should be stimulated
to engage in transdisciplinary teams in order to transcend the current operational approach to One Health.
Such a platform can stimulate researchers to work together towards opening up knowledge in all its stages
and from all depositaries and developing a new philosophy encouraging scrutiny by a broader range of
contributors, critics, beneficiaries, etcetera.
Working towards concrete deliverables was a vital part of the learning. Being part of this learning
programme is like joining a relay race where we pass on the torch from one year to the next. At the end
of this one year, the motivation to pass on those learnings and creating a ripple effect is remarkable. In
fact, after participating in the programme, we felt empowered not only to continue our transdisciplinary
learning by coaching new teams but also by proposing new collaborative projects and securing seed-
funding for building communities for transdisciplinary research on open science.
Discussion
The vignettes we presented demonstrate that the paradigm currently prevailing in academia is indeed an
obstacle for fostering a One Health approach and that a feasible alternative is available. Given a solid
pedagogical framework, heterogeneous teams of learners can be empowered to transcend the narrow
perspective of their disciplinary background or professional specialism and engage in cocreating a more
holistic understanding of health as an interconnected issue. Once they are able to zoom out and see the
broader systemic dynamics of (the destruction or restoration of) health, they will be able to broaden their
professional perspective and support One Health as a collective agenda. What is required to foster the
uptake of One Health is a strategy for organising projects where relevant actors (researchers,
representatives of civil society organisations including marginalised populations, research centres,
innovation networks, as well as value-driven industry and policy stakeholders) can engage in mutual
learning and cocreation of innovative, more preventive and holistic approaches to health. This goal can
be achieved through learner-driven workshops, hackathons, and other initiatives where participants can
avail of networking and collaboration opportunities.
Also, such initiatives may provide an opportunity for community members and societal actors to
participate in open research spaces where researchers can receive early feedback on potential societal
impact, openness, quality, reproducibility, and uptake of their research and fine-tune their approach
towards inclusivity and implementation of One Health. For instance, academia could periodically open
17
up its (virtual) doors for an open health day to cultivate newcomers’ interest, listen to their concerns, and
work through some of the anxieties hindering their participation in One Health labs. Also, a critical lever
could be the periodic organization of an ‘unconference’, i.e. a gathering that purposefully steers away
from formal academic conference formats and includes industry, civil society, government, and research
to discuss novel ideas, and work hand-in-hand to explore innovative pathways to foster the uptake of One
Health. In that context one could launch a call for contributions giving practitioners the opportunity to
share their experiences in different formats, allowing for critical reflection, and inviting volunteers and
passionate contributors to One Health initiatives as well as external open health enthusiasts. However, the
most potent leverage would be if all institutions for Higher Education would make transdisciplinary
learning for sustainable development - including One Health - available to all their learners and valorise
this (or even make it mandatory) as part of their learning trajectory.
Transdisciplinary learning creates opportunities to transcend the limitations of a mechanistic and
separatist approach to health. Since the programme we tested and presented here is learner-driven, we do
not depend on academic authorities to change the curriculum, but we can self-organize to create holistic
and systemic learning spaces. After one year of participating in this programme, several learners feel
capable, empowered, and motivated to coach a new group of students, which can be a quick way of
transitioning towards a more holistic paradigm. Concretely, we can think of the following future
perspectives for fostering the uptake One Health.
The One Health theme could become the backdrop for all transdisciplinary learning programmes,
aiming at achieving the well-being of people while restoring the health of the ecosystem and
exploring how economic and technical regimes must be transformed to achieve this.
This kind of programme allows promoting a systemic view of health that includes researchers not
only working on health-related topics but also helping other researchers understand how their
seemingly unrelated topics connect to the health of living beings and the planet.
Universities or other societal actors could propose cocreative platforms that stimulate all scientists
to include the One Health perspective at a very early stage of their research since every science
is directly or indirectly connected with One Health.
Engagement with pioneering initiatives and collaboration with of social ambassadors from sectors
like education, medicine, community, researchers, and industry promoting One Health in
academia could be encouraged.
Today, the idea to mobilize healthy ‘lifestyles as medicine’ is gaining track worldwide, especially since
the outbreak of the COVID-19 pandemic. However, this idea remains dramatically underestimated and
underused because it is not immediately patentable and marketable. Therefore, fostering the uptake of
One Health will require a shift of paradigm across the entire system, including the economy. In this article,
we have discussed a methodology that empowers all learners in higher and adult education to embrace a
18
more systemic approach to science and education, and we have argued that it can contribute significantly
to the aims of One Health. The programme described here is supported by the Club of Rome in the context
of its Emerging New Civilization(s) Initiative.
Acknowledgments
The authors thank Carlos Alvarez Pereira, Kishore Sivakumar, and Inge Smeers for their insightful
comments on an earlier version of this article. They are grateful to the Club of Rome for supporting the
learning programme presented in this article.
Contributions
All three authors were responsible for writing the original draft, reviewing and editing of the manuscript.
Anne Snick was responsible for providing resources and supervision of the manuscript.
19
References
1. One Health [Internet]. [cited 2021 Jul 6]. Available from: https://www.who.int/news-room/q-a-
detail/one-health
2. Crist E. Abundant Earth. Chicago, IL: University of Chicago Press; 2019.
3. Kiros M, Andualem H, Kiros T, Hailemichael W, Getu S, Geteneh A, et al. COVID-19 pandemic:
current knowledge about the role of pets and other animals in disease transmission. Virol J. 2020
Oct 2;17(1):143.
4. World Health Organization. New international expert panel to address the emergence and spread of
zoonotic diseases [Internet]. 2021 [cited 2021 Jun 22]. Available from:
https://www.who.int/news/item/20-05-2021-new-international-expert-panel-to-address-the-
emergence-and-spread-of-zoonotic-diseases
5. Pimm SL, Jenkins CN, Abell R, Brooks TM, Gittleman JL, Joppa LN, et al. The biodiversity of
species and their rates of extinction, distribution, and protection. Science. 2014 May
30;344(6187):1246752–1246752.
6. Ceballos G, Ehrlich PR, Raven PH. Vertebrates on the brink as indicators of biological annihilation
and the sixth mass extinction. Proc Natl Acad Sci USA. 2020 Jun 16;117(24):13596–602.
7. Reid WV, Mooney HA, Cropper A, Capistrano D, Carpenter SR. Ecosystems and human well-
being: synthesis. Millennium Ecosystem Assessment, editor. Washington, DC: Island Press; 2005.
137 p.
8. Shepard M. Restoration Agriculture. Greeley CO: Acres USA; 2013.
9. Shiva V. Soil Not Oil: Environmental Justice in an Age of Climate Crisis. Berkeley CA: North
Atlantic Books; 2008.
10. IPBES. Assessment Report on Pollinators, Pollination and Food Production [Internet]. Zenodo;
2016 Dec [cited 2021 Jun 19]. Available from: https://zenodo.org/record/3402856
11. Steffen W, Rockström J, Richardson K, Lenton TM, Folke C, Liverman D, et al. Trajectories of the
Earth System in the Anthropocene. Proc Natl Acad Sci USA. 2018 Aug 14;115(33):8252–9.
12. Deloria Jr. V. Evolution, creationism and other modern myths. Golden CO: Fulcrum Publishing;
2002.
13. Lent J. The patterning instinct: A cultural history of humanity’s search for meaning. Amherst, NY:
Prometheus Books; 2017.
14. Rockström J, Steffen W, Noone K, Persson Å, Chapin FS, Lambin EF, et al. A safe operating space
for humanity. Nature. 2009 Sep;461(7263):472–5.
15. Kuhn T. The structure of scientific revolutions. 1st ed. Chicago – London: Chicago University Press;
1962.
16. US Institute of Medicine. Rebuilding the Unity of Health and the Environment: A New Vision of
Environmental Health for the 21st Century [Internet]. Washington (DC): National Academies Press;
2001. (Human Health and the Natural Environment). Available from:
https://www.ncbi.nlm.nih.gov/books/NBK99584/
17. Sartorius N. The meanings of health and its promotion. Croat Med J. 2006;47(4):662–4.
20
18. Relman DA. The human microbiome: ecosystem resilience and health. Nutr Rev. 2012;70(Suppl
1):S2–9.
19. Jablonka E, Lamb MJ. Evolution in Four Dimensions: Genetic, Epigenetci, Behavioral, and
Symbolic Variation in the History of Life. Cambridge, MA/London, UK: The MIT Press; 2014.
20. Jaiswal YS, Williams LL. A glimpse of Ayurveda - The forgotten history and principles of Indian
traditional medicine. J Tradit Complement Med. 2016;7(1):50–3.
21. Wallace RK. The Microbiome in Health and Disease from the Perspective of Modern Medicine and
Ayurveda. Medicina (Kaunas). 2020;56(9):462.
22. Jorwal P, Bharadwaj S, Jorwal P. One health approach and COVID-19: A perspective. J Family
Med Prim Care. 2020;9(12):5888–91.
23. McEwen SA, Collignon PJ. Antimicrobial Resistance: a One Health Perspective. Microbiol Spectr
[Internet]. 2018;6(2). Available from: https://pubmed.ncbi.nlm.nih.gov/29600770/.
24. West S, Haider LJ, Stålhammar S, Woroniecki S. A relational turn for sustainability science?
Relational thinking, leverage points and transformations. Ecosystems and People. 2020 Jan
1;16(1):304–25.
25. Chapman K. Complexity and Creative Capacity. New York, NY: Routledge; 2015.
26. Hossenfelder S. Lost in math. New York, NY: Basic Books; 2018.
27. Jasanoff S. Can science make sense of life? Cambridge: Polity Press; 2018.
28. Mignolo WD, Walsh CE. On decoloniality. Durham, England: Duke University Press; 2018.
29. Piot P. Beating Ebola. Nature. 2016 09;537:484–5.
30. Taleb M. L’écologie vue du Sud. Paris, France: Editions Sang de la Terre; 2014.
31. Patton MQ. Developmental Evaluation: Applying Complexity Concepts to Enhance Innovation and
Use. New York, NY: Guilford Press; 2011.
32. Raworth K. Doughnut Economics. London, England: Random House; 2017.
33. Tye-Din JA, Galipeau HJ, Agardh D. Celiac Disease: A Review of Current Concepts in
Pathogenesis, Prevention, and Novel Therapies. Front Pediatr. 2018;6:350.
34. Fani B, Stasi C, Caserta A, Nisita C, Cortopassi SB, Salvadori S, et al. The complex interplay
between gastrointestinal and psychiatric symptoms in irritable bowel syndrome: A longitudinal
assessment. J Gastroenterol Hepatol. 2019;34(4):713–9.
35. Hawker E. New Paths for Investors on Biodiversity - ESG Investor [Internet]. 2021 [cited 2021 Jun
19]. Available from: https://www.esginvestor.net/new-paths-for-investors-on-
biodiversity/?mc_cid=b354d5a184&mc_eid=cd081a55ca
36. UN. What does ‘build back better’ really mean? One of the world’s top CEOs give us his take
[Internet]. 2020 [cited 2021 Jul 6]. Available from: https://news.un.org/en/story/2020/06/1066152
37. Grancitelli L, Himpens J, Smeers I, Snick A. Unlearning human-centrism: a bumpy road. Ecological
Citizen. 2020;4(1):11–3.
21
38. Smeers I, Himpens J, Grancitelli L, Snick A. Co-creating a Young Persons’ Guide to a Sustainable
Future: Analysis of Learning Steps in a Transdisciplinary Honours Course. Transdisciplinary
Insights. 2020 Dec 28;4(1):25–47.
39. Prigogine I, Stengers I. Order out of chaos: Man’s new dialogue with Nature. London, England:
Verso; 2017.
40. Özdemir V. Dr. René von Schomberg, Directorate General for Research and Innovation of the
European Commission, Discusses Responsible Innovation, Open Science, and Game Changers.
OMICS: A Journal of Integrative Biology. 2021 Jun 1;25(6):333–5.
41. Lozano R, Barreiro-Gen M, editors. Developing Sustainability Competences Through Pedagogical
Approaches: Experiences from International Case Studies [Internet]. Springer International
Publishing; 2021 [cited 2021 Jun 21]. (Strategies for Sustainability). Available from:
https://www.springer.com/gp/book/9783030649647
42. Snick A. MISC: Mapping Innovations on the Sustainability Curve [Internet]. 2015 [cited 2021 Jun
22]. Available from: https://cidd2015.sciencesconf.org/browse/authorbe7d.html?authorid=289131
43. Ulanowicz R. Process ecology: Philosophy passes into praxis. Process Studies. 2016;45(2):199–
222.
44. Goerner S, Lietaer B, Ulanowicz R. Quantifying economic sustainability. Ecological economics.
2009;69(1):76–81.
