Why One Health struggles: A critical analysis

Abstract

The One Health approach has become a prominent paradigm in global health, promoting integrated action across human, animal, and environmental systems. Despite its conceptual strength and broad institutional endorsement, its translation into sustained governance and practice has been uneven. This viewpoint argues that the main challenges faced by One Health are not conceptual but structural. Drawing on critical analysis, it examines how sectoral governance arrangements, depoliticised notions of integration, operational ambiguity, siloed professional education, and crisis-oriented policy logics constrain implementation. The paper further argues that treating integration as a primarily technical task obscures underlying issues of power, accountability, and epistemic boundaries. As an alternative, One Health is reframed as articulation work, emphasising the deliberate construction of interfaces, communication infrastructures, and shared practices across enduring institutional boundaries. Approached as a maturing project, One Health requires long-term investment in education, organisational learning, and governance mechanisms that enable collaboration to become routine rather than exceptional.

1. Introduction

The One Health approach has emerged as one of the most influential paradigms in contemporary global health discourse [1], [2]. By explicitly recognising the interdependence between human health, animal health, and environmental systems, it seeks to overcome the limitations of reductionist, sector-based approaches to health threats that are increasingly complex, global, and systemic [3]. Zoonotic diseases, antimicrobial resistance, climate-related health risks, and ecosystem degradation are frequently cited as domains in which One Health offers not merely an added value, but a necessary reframing of how health problems are understood and addressed [3], [4].

Despite this conceptual appeal and widespread institutional endorsement [5], One Health has struggled to achieve the transformative impact it promises [6]. While it has succeeded in shaping narratives, influencing strategic documents, and generating pilot initiatives, its capacity to reshape health governance and everyday practice remains limited. This viewpoint argues that the main challenges faced by One Health are not conceptual but structural. More specifically, its implementation is constrained by political, institutional, and epistemological systems that remain misaligned with the integrative logic the approach seeks to promote.

1.1. One Health as a challenge to modern health governance

At its core, One Health challenges the dominant architecture of modern health governance. Contemporary health systems are organised around sectoral mandates, professional jurisdictions, and disciplinary epistemologies that emerged from a modernist logic of specialisation [7]. Human health, veterinary health, and environmental management evolved as distinct domains, each with its own regulatory frameworks, funding mechanisms, and professional identities.

One Health implicitly questions this separation by proposing that health threats cannot be effectively understood or managed within isolated domains. However, while the paradigm questions fragmentation, it does not dismantle the structures that sustain it.

Ministries remain divided, budgets remain earmarked for sector-specific goals, and accountability mechanisms reward sector-specific (vertical) performance, measured within individual sectors, programmes, or hierarchical chains, rather than cross-sector (horizontal) collaboration. For example, a ministry of health may be evaluated on vaccination coverage in humans, while veterinary services are assessed on livestock disease control. Even when zoonotic risks require coordinated action, funding streams, reporting systems, and performance indicators remain sector-specific, providing little institutional incentive for sustained cross-sector collaboration. As a result, One Health initiatives are often layered onto existing systems rather than embedded within them.

This creates a fundamental tension: One Health is promoted as a systemic solution yet implemented as an add-on [6], [8]. Intersectoral collaboration is encouraged, but rarely institutionalised. In many contexts, it depends on informal networks, short-term projects, or individual champions rather than stable governance arrangements. When political priorities shift or funding cycles end, One Health activities are often the first to disappear.

1.2. The illusion of integration

One of the most persistent assumptions underlying One Health is that integration is primarily a technical problem, one that can be solved through better coordination, data sharing, or joint surveillance systems [9], [10]. While these elements are undoubtedly important, they obscure the deeper political and epistemological dimensions of integration.

Integration requires more than aligning databases or establishing inter-ministerial committees. It requires negotiating power, redefining authority, and confronting professional hierarchies. Decisions about which knowledge counts, whose expertise is prioritised, and which risks are deemed acceptable are inherently political. Yet One Health discourse often presents integration as a neutral, win–win process, thereby depoliticising what constitutes contested terrain.

This depoliticisation contributes to the persistence of silos. Without mechanisms that actively redistribute power and resources across sectors, integration remains superficial. Information may be shared, but decisions continue to be made within sectoral logics. The result is a form of “coordinated fragmentation,” where actors are aware of one another but continue to operate independently.

1.3. Operational ambiguity and the problem of accountability

Another critical limitation of One Health lies in its operational ambiguity. While conceptually expansive, it often lacks clear implementation and evaluation criteria. Many initiatives adopt the One Health label without specifying how integration is operationalised, what success entails, or how impact is measured.

This ambiguity is evident in efforts to operationalise One Health surveillance. Despite formal endorsement, human and animal health data are frequently collected and governed through separate sector-specific systems with distinct legal mandates, reporting thresholds, and technical infrastructures. This limits interoperability and delays coordinated responses, meaning that “integration” often relies on ad hoc communication rather than shared operational systems [11]. Similar challenges are reported in low- and middle-income settings, where fragmented governance, donor-driven funding, and limited workforce capacity constrain multisectoral collaboration. Even where national strategies exist, the absence of routine data-sharing mechanisms results in parallel rather than integrated surveillance systems [12].

The limited use of existing evaluation tools further reinforces operational ambiguity. Although frameworks for assessing multisectoral surveillance have been proposed, they remain inconsistently applied, limiting comparability and accountability [13]. As a result, integration is often asserted at the policy level but weakly institutionalised in practice.

This ambiguity allows contextual flexibility but weakens accountability. When roles and responsibilities are unclear, responsibility for outcomes or failures becomes diffuse. Consequently, One Health risks functioning as a rhetorical shield rather than a driver of change, with lessons learned remaining fragmented and non-cumulative.

1.4. Education, professional identity, and epistemic boundaries

The success of One Health ultimately depends on professionals' capacity to think and work beyond disciplinary boundaries. However, professional education remains deeply siloed. Health, veterinary, and environmental disciplines are socialised into distinct epistemic cultures, each with its own language, values, and problem-solving approaches [14].

This early professional socialisation shapes not only what individuals know, but how they interpret reality and perceive legitimacy [15], [16]. Interdisciplinary collaboration, when it occurs, often reveals underlying tensions rather than seamless integration. Differences in risk perception, evidence hierarchies, and ethical priorities can hinder collaboration when they are not explicitly addressed.

Without a deliberate effort to cultivate transdisciplinary competencies, One Health remains dependent on exceptional individuals who are willing to cross boundaries. Such reliance is neither scalable nor sustainable.

1.5. Prevention and health promotion in a world oriented toward crisis

One Health is often framed as inherently preventive because it focuses on upstream determinants before they translate into avoidable morbidity and mortality [17], [18]. Yet reducing it to prevention is conceptually limiting. One Health also has a health-promoting ambition: not only averting outbreaks or mitigating risk, but enabling conditions for sustainable wellbeing across human, animal, and environmental systems [2]. In this sense, it belongs as much to the vocabulary of health promotion as to prevention, because it asks what environments, livelihoods, and multispecies relations make health possible in the first place.

The problem is that prevention and health promotion are structurally undervalued in crisis-oriented governance systems. Health policy often rewards visible, short-term outputs, while upstream benefits are diffuse, delayed, and politically difficult to claim. This asymmetry is sharper in under-resourced contexts, where fragile service delivery forces chronic triage and prioritises clinical care and emergency response. One Health may appear aspirational or externally driven, especially when governance, workforce, and infrastructure are insufficient for implementation. Crucially, the constraint is also temporal and political: One Health requires long horizons, whereas crisis management operates through short-term imperatives and reactive legitimacy. This misalignment helps explain why One Health often remains a strategic aspiration rather than an institutional routine.

1.6. One Health as articulation work

Addressing the limitations of One Health does not require dismantling existing health, veterinary, and environmental systems in favour of a unified architecture. Such an approach would be unrealistic and counterproductive, given that these systems are historically embedded, professionally legitimised, and institutionally resilient. While the intellectual roots of One Health are longstanding, its contemporary institutionalisation as a policy and governance framework remains relatively recent and should therefore be understood as gradual rather than revolutionary [19], [20].

A more viable response lies in reframing One Health as a practice of articulation rather than integration. Instead of merging systems that were never designed to function as one, the focus should be on building durable bridges, stable communication channels, and shared practices that enable meaningful interaction while preserving institutional autonomy. This shift is substantive: integration implies unification and standardisation, whereas articulation works with difference, making boundaries permeable, intelligible, and actionable.

Operationally, articulation requires institutionalised interfaces, formal liaison roles, shared surveillance touchpoints, and predefined procedures for joint decision-making, rather than reliance on informal relationships. Communication must be treated as infrastructure, sustained through routine, low-intensity exchanges that build shared situational awareness beyond crises. Recurrent “rituals of coordination,” such as joint risk assessments and cross-sector reviews, further normalise collaboration and support mutual recognition.

Rather than comprehensive standardisation, One Health would benefit from minimal common frameworks that define when coordination is required and how responsibilities are distributed, while respecting institutional diversity. Understood as boundary work, One Health depends on the capacity to operate at interfaces—translating across domains and sustaining dialogue over time. Reframing it in this way aligns ambition with institutional realities, enabling transformation without systemic rupture.

2. Conclusion

One Health remains a compelling and necessary paradigm; however, its implementation has often been constrained by the structural, institutional, and political conditions within which intersectoral collaboration must operate. When integration is treated primarily as a technical and consensual task, deeper issues of power, accountability, professional boundaries, and temporal misalignment between crisis-oriented governance and upstream action are often overlooked. This viewpoint suggests that progress may depend less on pursuing idealised forms of integration and more on strengthening articulation work: the deliberate development of interfaces, communication infrastructures, shared practices, and professional capacities that enable sustained coordination across enduring institutional boundaries. Approached as a maturing project, One Health may benefit from long-term investment in education, organisational learning, and governance arrangements that make collaboration routine rather than exceptional.

CRediT authorship contribution statement

Júlio Belo Fernandes: Writing – review & editing, Writing – original draft, Conceptualization.

Funding

This work was supported by FCT - Fundação para a Ciência e Tecnologia, I.P. by project reference UID/4585/2025 and DOI identifier https://doi.org/10.54499/UID/04585/2025

Declaration of competing interest

The author declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Data availability

No data was used for the research described in the article.