One Health in Mesoamerica: historical legacies, current challenges, and strategic directions

Abstract

Background

Mesoamerica, a biodiversity hotspot extending from Mexico to Panama, faces intersecting health challenges rooted in colonial-era transformations and amplified by contemporary environmental change. This perspective paper demonstrates how historical legacies interact with current ecological and social drivers to shape zoonotic disease vulnerability across the region.

Approach

We integrate historical analysis of colonial disease introduction with an examination of current environmental, climatic, and social determinants of disease transmission. Findings from a structured multisectoral participatory workshop organized by the GLACIER Project Consortium in Guatemala in 2023, involving participants from academia, government, non-governmental organizations, and community representatives across Mesoamerica, were synthesized together with a narrative review to develop community-centered One Health strategies for the region.

Key findings

European colonization of the Americas during the 15th–18th centuries, introduced devastating pathogens and fundamentally altered disease ecology through the introduction of livestock, human-associated pathogens, vectors, and reservoirs, establishing transmission patterns that persist today. Contemporary vulnerabilities arise from: deforestation and agricultural expansion facilitating vector proliferation and wildlife-human contact; informal and unregulated animal movement enabling the spread of transboundary diseases; climate change altering vector distribution and creating novel health threats; fragmented health systems with inequitable access; and poverty-linked structural conditions amplifying disease transmission. Despite growing One Health discourse regionally, meaningful integration across human, animal, plant, and environmental health sectors remains limited, as evidenced by recent disease resurgences and continued institutional gaps in surveillance and cross-border coordination.

Strategic recommendations

Six priority action lines emerged from the workshop discussions and their thematic synthesis: strengthening intersectoral governance and regional cooperation; implementing integrated surveillance systems; ensuring community participation and intercultural inclusion of Indigenous knowledge; expanding culturally appropriate health education; promoting community-engaged applied research; and integrating sustainable territorial management. Success requires political commitment beyond economic capacity, positioning communities as decision-makers, and alignment with international frameworks including the FAO-WOAH-WHO-UNEP Joint Plan of Action.

Conclusions

Mesoamerica’s interconnected health challenges demand One Health approaches acknowledging historical context while centering vulnerable communities. Regional cooperation, community empowerment, and sustained political will—rather than wealth alone—determine effective disease prevention and health equity.

Graphical Abstract

Introduction

Mesoamerica, a region of remarkable biogeographic and cultural richness extending from southern Mexico to the Darién region of Panama, is recognized as one of the world’s 25 biodiversity hotspots. Its strategic location encompasses over 40 terrestrial ecoregions and a wide array of subtropical and tropical ecosystems. Recent estimates indicate that the region harbors approximately 17,000 species of vascular plants, with around 3,000 endemic species, and more than 440 species of mammals, of which over 65 are endemic to the region [1, 2]. This exceptional richness makes Mesoamerica a global priority for biodiversity conservation and ecosystem-based health strategies which is also highly relevant to zoonotic disease risk because species-rich taxonomic orders are supposed to host a greater diversity of zoonotic pathogens [3], Fig. 1). The region is also known for its rich Indigenous cultural legacy, encompassing diverse Peoples such as the Maya, Garífuna, Ngäbe, Bribri, Cabécar, and Guna, among many others, each with distinct cultural traditions, languages, and relationships with their territories [4, 5]. Throughout this paper, Mesoamerica is treated as a distinct biocultural region within the broader Latin American context. Consequently, although the primary focus is on Mesoamerica, evidence from Latin America is incorporated where appropriate to provide regional context and inform broader One Health discussions.

Fig. 1.

Conceptual representation of the dilution effect in Mesoamerican and temperate landscapes. Although disturbed Mesoamerican landscapes may exhibit higher baseline zoonotic risk due to elevated vector density, they also show a more pronounced dilution effect. As biodiversity increases, ecological filtering by non-competent hosts reduces pathogen transmission and lowers the risk of human spillover more effectively than in temperate systems

In this complex context of ecological, social, and health challenges in Mesoamerica, the One Health approach gains relevance as an integrated and systemic framework. Rather than simply linking human, animal, and environmental health, One Health aims to sustainably balance and optimize the health of people, animals, plants, and ecosystems, recognizing their interdependence while mobilizing multiple sectors, disciplines, and communities to collaboratively address shared risks and underlying drivers (One Health High-Level Expert Panel -OHHLEP [6]). Recent regional assessments indicate that although One Health initiatives have expanded considerably across Latin America and the Caribbean, implementation remains uneven across the region, with persistent challenges related to governance, institutionalization, sustainable financing, and cross-sectoral integration [7]. This includes not only zoonotic disease emergence, but also broader challenges such as land-use change, biodiversity loss, food systems, and climate change, emphasizing prevention, equity, and coordinated action across scales [8, 9].

This perspectives paper aims to demonstrate the interconnectedness of human, animal, and environmental health in disease transmission in Mesoamerica. By i) providing an in-depth narrative review of the historical legacy of colonization and the region’s current ecological and sociocultural threats, and ii) integrating priorities identified through a structured inter- and transdisciplinary multisectorial workshop on zoonotic diseases, the paper seeks to suggest strategies and recommendations for disease prevention and control that not only reduce transmission, but also strengthen local and regional public health within a One Health framework. We particularly advocate for Indigenous and local communities to be active decision-makers in health policies, while respecting the region’s rich cultural diversity and unique ecological contexts.

Historical context: colonial legacy and disease introduction

The European colonization of Mesoamerica brought not only profound political, economic, and ecological disruptions, but also introduced previously absent infectious diseases that proved devastating to immunologically naïve Indigenous populations. Smallpox, measles, and hemorrhagic fevers rapidly spread across the region, triggering demographic collapse on an unprecedented scale. Estimations show that between 60 and 90% of the Indigenous population perished within the first decades of contact due to these epidemics [10, 11]. Historical records and epidemiological reconstructions have documented large-scale outbreaks of hemorrhagic fevers, possibly linked to zoonotic or vector-borne pathogens, during the 16th to 18th centuries [12, 13]. These events, often exacerbated by concurrent megadroughts, intensified the collapse of preexisting socioecological systems [14].

Smallpox played a central role in this demographic catastrophe, with high transmission rates via respiratory droplets and contaminated items, and extreme virulence in naïve populations [15]. The impact of these diseases cannot be overstated, as they not only decimated populations but also restructured landscapes, settlement patterns, and human–animal–environment interactions in ways that would define the region’s disease ecology for centuries.

Introduction of livestock and transformation of disease ecology

Beyond the immediate mortality from introduced pathogens, European colonization permanently altered the region’s disease ecology through the introduction of new domesticated animal species. Prior to European contact, only two domesticated species were widely recognized in Mesoamerica: the dog which has been essential for hunting, and the turkey which was valued for its meat and feathers [16]. Following the conquest, European settlers introduced cattle, pigs, sheep, and horses, fundamentally reshaping both ecological and cultural landscapes [17]. These introductions brought a suite of new infectious agents, many of them zoonotic, which posed health risks to both humans and animals and established novel transmission cycles that persist today.

Among the most significant zoonoses introduced during this period was brucellosis. Cattle became primary reservoirs of Brucella spp. throughout Central America, while pigs and dogs served as secondary hosts. This colonial-era introduction established endemic transmission patterns that would shape the region’s epidemiological landscape for centuries. The transformation of human-animal relationships, from limited contact with dogs and turkeys to intensive interaction with multiple livestock species, created new pathways for pathogen spillover and fundamentally altered disease risk profiles across Mesoamerica [18, 19].

Contemporary impacts of historical legacies

The colonial transformations described above established structural vulnerabilities that continue to amplify disease risk in the face of contemporary environmental and social change. The epidemiological consequences of colonial-era pathogen and livestock introductions remain evident in contemporary disease patterns, with diseases such as brucellosis continuing to pose significant public health challenges across the region. This persistent burden reflects how colonial transformations continue to shape health outcomes through the biological legacy of introduced pathogens and reservoir species, cultural practices such as consumption of unpasteurized dairy products and occupational exposure to infected livestock, and socioeconomic structures that determine access to veterinary services and healthcare [18, 19]. Rural and Indigenous communities who are often those with highest zoonotic disease exposure, face substantial barriers to care due to health system limitations rooted in colonial-era inequalities [20].

Beyond these direct disease legacies, Mesoamerican communities today face compounding health threats from deforestation [21], rapid urban expansion [22], and climate change [23]. These multiple environmental pressures do not affect all populations equally. The pressures interact with colonial-era patterns of land dispossession and marginalization to disproportionately burden Indigenous and rural communities [24]. Deforestation driven by agricultural expansion often occurs in territories occupied by communities that were historically displaced to marginal lands, simultaneously destroying traditional resource bases while increasing contact with wildlife reservoirs and disease vectors [25]. Rapid, unplanned urban growth concentrates populations in areas with inadequate water and sanitation infrastructure, creating conditions favorable for both vector-borne and waterborne disease transmission [26]. Climate change further shifts the geographic range of disease vectors and reservoirs, expanding transmission into communities with limited immunity and healthcare access [27]. These converging pressures place mounting strain on healthcare systems whose spatial distribution of facilities, diagnostic capacity, and personnel still reflects colonial administrative priorities, e.g. such as particularly the historical concentration of services in major urban centers, rather than current epidemiological needs [24, 28].

Socioeconomic inequalities, political and social marginalization rooted in colonial hierarchies, and limited access to healthcare continue to exacerbate vulnerability to both emerging and reemerging diseases [29, 30]. Addressing these interconnected challenges requires comprehensive care models grounded in equity, cultural relevance, and social justice. Such approaches that recognize Indigenous and local communities not only as beneficiaries of health interventions, but also as key stakeholders whose traditional knowledge and lived experience can contribute meaningfully to informing culturally relevant and equitable policy and practice [31, 32]. This perspective is also consistent with recent One Health frameworks that recognize social determinants, equity, and community participation as essential components of effective health interventions [33].

Current environmental and ecological drivers of disease

Land use change, deforestation, and ecosystem disruption

Land-use change processes have profound implications for public health and socio-environmental resilience in Mesoamerica. The human-environment relationships in this region have been studied for decades, revealing a continuous interaction dating back at least 10,000 years [4, 5, 34]. Agriculture profoundly transformed the landscape during the Maya civilization, with up to 75% of the land altered by intensive agricultural practices including forest burning, specialized techniques, and infrastructure such as raised fields, canals, and terraces [35–37].

Many tropical forest areas recovered following the decline of Classic Maya society (1200–1000 BP) and subsequent population decline after the Spanish Conquest. Today’s ecosystems, such as those in Panama’s Darién or Guatemala’s northern Petén, represent mature secondary forests regenerating for approximately 350 years, though still undergoing gradual changes due to long canopy tree life cycles [34, 38]. In contrast to this historical recovery, contemporary deforestation is driven by accelerated socioeconomic changes including agro-industrial expansion, migration, and infrastructure development, generating new ecological and public health threats [39, 40].

As of the late 2000s, natural vegetation covers only 57% of Mesoamerican territory, while 42% is dedicated to agriculture and livestock, and 1–2% to urban areas [34; 38], Fig. 2. These landscape transformations reduce biodiversity and alter disease vector and host dynamics. Deforestation and ecosystem disturbances facilitate interactions between humans, domestic animals, and wildlife, increasing infectious disease transmission risk [41–43]. The scale and pace of current change distinguish it from historical patterns: Mesoamerica exhibits some of the highest deforestation rates worldwide, with Guatemala and Honduras experiencing particularly rapid forest loss. Mexico likewise faces alarmingly high deforestation relative to its land area, has experienced sustained forest loss over recent decades, driven by agricultural expansion, wildfires, and illegal logging in critical biomes [44, 45].

Fig. 2.

Degree of urbanization in Mesoamerica. Spatial distribution of urbanization levels across Mesoamerica based on population density and settlement size (GHS-SMOD R2023A), illustrating regional gradients of anthropogenic pressure from urban centers to low-density rural landscapes

Vector-borne diseases and land-use transformation

The conversion of forests to agricultural and urban landscapes directly facilitates vector proliferation and disease transmission. For arboviruses such as dengue, zika, and chikungunya, forest conversion to monocultures or urban areas promotes vectors like Aedes aegypti and Aedes albopictus [43]. In Costa Rica, these vectors have increased in pineapple-dominated landscapes, where colonizing mosquitoes in fragmented areas feed on accessible hosts including humans and domestic animals, elevating transmission risk [46, 47].

Export-oriented crops such as oil palm and banana have significantly contributed to habitat loss in the Pacific and Caribbean lowlands [48–51], creating favorable conditions for wild vectors including Haemagogus and Sabethes, which transmit yellow fever [52, 53]. The presence of Sa. chloropterus in deforested Costa Rican areas raises concern about yellow fever reemergence in Mesoamerica, where the disease has not been reported since the 1960s [54, 55]. This concern is reinforced by antibody findings in Mexican non-human primates [56]. The proximity of altered habitats to human settlements could facilitate urban transmission cycle reestablishment, directly linking forest cover loss to modified zoonotic pathogen transmission cycles [57, 58].

The transformation of forests into agricultural and livestock areas, combined with intensive pesticide use, has been linked to increased malaria cases across the isthmus. In Panama, Nyssorhynchus spp. (previously Anopheles) as the main malaria vector there, occurs in greater abundance in deforested areas [59]. Since the 1970s, Guatemala, El Salvador, Belize, and Nicaragua have reported insecticide-resistant vector populations, further complicating control efforts [60, 61]. Landscape transformations are also evident in Mexico’s Yucatan Peninsula. Development policies implemented since the 1970s have driven major changes in land use, reducing forest cover and biodiversity [62]. Between 2001 and 2018, forest cover dynamics in southern Quintana Roo were characterized by higher rates of degradation than deforestation. In the Bacalar–Río Hondo region, commercial agriculture and cattle ranching drove a net annual forest loss of 1.6%, whereas in central Quintana Roo with particular areas inhabited and managed by Maya communities, shifting cultivation and community forest management were associated with forest recovery and dynamic cycles of loss and regrowth. Overall, degradation processes exceeded outright deforestation, highlighting complex landscape transformations rather than uniform forest decline [63].

Costa Rica stands as a notable exception due to strict forest protection laws and payment-for-ecosystem-services programs [64, 65], yet even there, land-use changes have had health repercussions, underscoring that conservation advances alone cannot fully mitigate the public health consequences of historical landscape transformation.

Livestock production and rabies Dynamics

Intensive livestock production has significantly impacted interactions between wildlife, domestic animals, and humans, facilitating zoonotic disease spread such as rabies [66]. While historical records suggest bat-associated rabies predated colonization, rabies went largely unnoticed due to low host density and absent documentation. Colonization, deforestation, and livestock introduction enabled bat population growth and rabies virus persistence, as domestic animals provided abundant food for vampire bats (Desmodus rotundus), increasing bite frequency in humans and livestock [67, 68]. These epidemiological changes represent the transition from urban dog-mediated cycles to sylvatic cycles shaped by anthropogenic environmental change [66, 67]. Within this context, vampire bat-cattle interactions have become a key mechanism facilitating rabies spillover into livestock populations [69].

Road infrastructure construction has also profoundly impacted landscape connectivity and disease ecology. The Inter-American Highway opening in 1956 facilitated rabies virus reintroduction into Costa Rica [70]. Several outbreaks between 1956 and the late 1960s prompted coordinated public health responses including mass canine vaccination, stray dog removal, and cross-border control agreements [71]. This case illustrates how historical and contemporary anthropogenic processes, from colonization to infrastructure development, have shaped regional infectious disease ecology.

Conservation responses: biological corridors and their limitations

Biological corridors in Mesoamerica were originally promoted as conservation and sustainable development strategies, rather than as explicit public health interventions. Regional initiatives such as the Central American System of Protected Areas (SICAP) and the Mesoamerican Biological Corridor (CBM) were designed to enhance landscape connectivity, facilitate species movement, and maintain ecological processes across fragmented habitats. By supporting species dispersal, access to resources, and gene flow, these corridors contribute to the maintenance of resilient wildlife populations and overall ecosystem integrity. More recently, the links between habitat fragmentation, biodiversity loss, and infectious disease risk have gained increasing attention; in this context, biological corridors may also provide indirect health-related benefits by regulating ecological interactions among hosts, vectors, and pathogens. Although the evidence is still emerging, improved ecosystem functioning and higher biodiversity may reduce host susceptibility and influence transmission dynamics [72, 73].

However, the effectiveness of these corridors has been limited by weak management structures and lack of coordination among sectors [34, 74–76]. The contrast between the conservation promise of biological corridors and their implementation challenges reflects broader tensions in Mesoamerican environmental governance: while the ecological rationale for connectivity is well-established, translating this into effective disease prevention requires sustained cross-sectoral collaboration and resources that often remain elusive. This gap between conservation planning and public health outcomes underscores the need for integrated approaches that explicitly address both ecological integrity and disease risk—a core principle of the One Health framework discussed later in this paper.

Climate change and disease dynamics

Beyond landscape transformation, climate change amplifies disease risk across Mesoamerica by altering the environmental conditions that govern vector survival, pathogen development, and disease transmission. Climate change has become a major driver of public health outcomes, particularly in vulnerable regions such as the so-called Mesoamerican Dry Corridor, which extends from southern Mexico and Guatemala through Honduras, El Salvador, and potentially into Panama. Prolonged droughts, extreme rainfall events, rising temperatures, and dehydration are among the climate change effects that directly impact the health of local populations [77, 78]. These climatic shifts not only compound challenges in the Dry Corridor, but also jeopardize food security and water availability [77], further deteriorating living conditions in affected communities.

The Mesoamerican Dry Corridor experienced five consecutive years of drought between 2015 and 2019, punctuated by torrential rains. This severely impacted agriculture, increased food insecurity and malnutrition, accelerated urban migration and human displacement, and heightened susceptibility to vector-borne tropical diseases [78]. Vector-borne diseases emerge as a major concern in Mesoamerica, as extreme weather events such as rising temperatures and extreme precipitation promote the reproduction and spatial expansion of mosquito vectors such as Aedes aegypti. This relationship has been documented globally [79] and is increasingly evident across Mesoamerica [80]. These conditions have also likely facilitated the expansion of Oropouche virus (OROV) beyond the Amazon, highlighting the broader impact of climate variability on arboviral disease dynamics [81].

Climate-mediated neglected tropical diseases

The multifactorial relationship between climate change, deforestation, and overcrowding has altered the distribution and seasonality of several neglected tropical diseases throughout Latin America, including Mesoamerica. Malaria transmission has been associated with environmental change and deforestation [41, 82], while climate change related processes have also influenced the distribution of leishmaniasis and Chagas disease [83–85]. These vector-borne illnesses are transmitted by Nyssorhynchus mosquitoes (formerly treated as the Anopheles Nyssorhynchus subgenus), sand flies, and triatomine bugs, respectively. Ecological changes with deforestation in regions such as the Amazon, have created new breeding sites, facilitating the expansion also of malaria risk [82]. Within Mesoamerica, although malaria has declined in some areas, the disease remains a public health concern in countries such as Guatemala and Honduras, where ecological conditions and lack of healthcare access contribute to its persistence [78].

Climate and environmental drivers of rickettsial disease

Environmental change also influences the emergence of rickettsial diseases. Rickettsial diseases are bacterial infections transmitted by arthropod vectors such as ticks and mites. These diseases are strongly shaped by environmental conditions that influence vector abundance, distribution, and host contact. Key drivers include climate variability, vegetation cover, vertebrate diversity, and human activities such as deforestation and agricultural expansion [86, 87]. Environmental alteration increases the likelihood of contact between vectors, wildlife, domestic animals, and humans in both rural and peri-urban settings, thereby elevating the risk of zoonotic disease transmission [88], [89; 90]).

Recent evidence from Mesoamerica demonstrates the region’s vulnerability to emerging rickettsial threats. In Belize, researchers detected Rickettsia sp. of the Atlantic rainforest strain in Amblyomma ovale ticks, with 33.3% of sampled ticks testing positive and with this the first documentation of this pathogen in Central America [91]. Previously known only from Brazil, Colombia, and Argentina [92], this spotted fever-associated strain now represents a potential emerging health risk in Mesoamerica [91]. The same study identified Rickettsia amblyommii for the first time in Amblyomma pacae, as well as endosymbiotic rickettsiae in Ixodes affinis, underscoring the widespread circulation of rickettsial agents in Latin American tick fauna [91].

Evidence from El Salvador further supports this pattern of disease emergence. Five tick species were found infesting domestic dogs, with Rhipicephalus sanguineus sensu lato being the most prevalent. Molecular screening identified three spotted fever group rickettsiae in El Salvador: Rickettsia amblyommatis in Amblyomma mixtum [89], Rickettsia parkeri in Amblyomma ovale [90], and an unidentified Rickettsia agent in Amblyomma cf. parvum [90]. These findings suggest that R. parkeri, a recognized human pathogen in other regions, may also be circulating in El Salvador, highlighting the role of domestic animals and environmental change in shaping zoonotic risk in Mesoamerica.

Social determinants and health system challenges

Healthcare system limitations

Mesoamerica’s social security systems face numerous challenges that hinder access to healthcare and limit population coverage. Despite governmental efforts, a significant portion of the population remains unprotected against disease. Marked disparities persist in access to medical care, particularly in rural and marginalized communities, where health services are scarce [20, 33]. The rise in dengue cases throughout the region is also driven by poor sanitation conditions, poor urban planning, and overcrowding. These factors are compounded by climate change that create favorable environments for disease proliferation [93–95].

Healthcare quality varies significantly across Mesoamerican countries due to resource shortages, limited medical personnel, and inadequate infrastructure. These deficiencies negatively impact diagnostics and treatment outcomes. Additionally, social security systems face persistent financing difficulties, which restrict the expansion of coverage and the ability to improve service quality [8, 96]. The trajectory of dengue in Costa Rica illustrates this dynamic. Between 1993 and 2016, dengue incidence rose from 14 to 48 cases per 10,000 inhabitants, partly reflecting improvements in diagnostic capacity and disease surveillance. Despite this threefold increase in detected cases, the overall case fatality rate remained extremely low at 0.62 deaths per 10,000 confirmed cases, demonstrating that enhanced surveillance and clinical management prevented rising incidence from translating into higher mortality [97]. This pattern, initially observed for dengue, is also relevant for other zoonotic diseases with complex transmission cycles involving domestic and wild animals. Rabies and leptospirosis illustrate how veterinary and public health interventions directly influence disease dynamics [98, 99], while brucellosis, cysticercosis, and toxoplasmosis continue to require coordinated surveillance across human and animal health sectors [100–102]. For SARS-CoV-2, although the virus can infect carnivores, deer, and other animals, and there are anecdotal reports of animal-to-human transmission, its main transmission cycle remains human-to-human [103, 104].

Prevention and health promotion have historically received limited investment, despite growing recognition that preventive, multisectoral approaches are essential for strengthening health systems in Latin America and the Caribbean [7]. Non-communicable diseases (NCDs) such as cardiovascular disease, diabetes, and cancer pose significant challenges due to difficulties in diagnosis and long-term management. Despite progress in reducing maternal and infant mortality, gaps persist in access to quality prenatal and obstetric care, underscoring the need to strengthen public health strategies [8, 20, 96].

Social human poverty and endemic diseases

The relationship between poverty and disease transmission is exemplified by Chagas disease in Mesoamerica. Central America is estimated to host approximately 385,000 individuals infected with Trypanosoma cruzi, with persistent vector-borne transmission foci, particularly in socially and politically vulnerable settings. Although vector-borne transmission remains the predominant route in Mesoamerica, foodborne transmission through contaminated food and beverages has also been documented, highlighting the diversity of transmission pathways and reinforcing the need for integrated prevention strategies. Migration, poverty, and limited access to healthcare exacerbate vulnerability to zoonotic diseases, linking human movement and social inequities to the ongoing risk of Chagas transmission [33, 105–107]. Mexico ranks third globally in terms of Chagas disease burden, with an estimated 876,000 people infected. This high prevalence reflects the country’s ecological diversity and the presence of multiple reservoirs and vectors [108]. The majority of the approximately 300,000 people infected with T. cruzi in the United States are migrants from Mexico, Central America, and South America, although autochthonous cases have also been documented in the southern U.S. which seems to be a sign that local transmission may have been historically underestimated [106, 109].

Poverty, substandard housing and limited access to medical care are well-recognized drivers of Chagas disease transmission, particularly among socioeconomically vulnerable populations [85, 110]. Oral transmission of Chagas disease illustrates why One Health prevention in Mesoamerica should not be limited to vector control, but should also consider food safety, wildlife–human interactions, reservoir ecology, cultural food practices, and community-level prevention. Although confirmed outbreaks of orally acquired Chagas disease have been reported mainly in South America, WHO and PAHO recognize foodborne transmission through food or beverages contaminated with Trypanosoma cruzi as an important route capable of causing outbreaks and deaths, and PAHO recommends best practices in food handling and preparation as part of prevention strategies [111–114]. For Mesoamerica, direct contemporary evidence remains limited; however, a putative 14th-century outbreak in Coyoacán, central Mexico, has been proposed as a possible foodborne Chagas outbreak associated with food shortage, disrupted fish supply, and the hunting and consumption of alternative reservoir animals, particularly infected opossums (Didelphis spp.) [115]. This pattern of vulnerability and the way migration shapes disease spread are reflected in a 2017 study that screened 389 migrants for Chagas disease, finding a 3.1% positivity rate for T. cruzi. Most migrants came from highly endemic countries such as Guatemala, Honduras, and El Salvador. Although seropositive individuals were more knowledgeable about the disease, significant gaps remained. For instance, only 56% could identify triatomines as the vectors, underscoring the urgent need for improved education and prevention strategies in vulnerable populations to reduce disease transmission [116].

These poverty-driven conditions including inadequate housing, limited access to safe drinking water, poor sanitation infrastructure, and weak public health services extend beyond vector-borne diseases to facilitate outbreaks of waterborne infections, including amebiasis and giardiasis [117, 118]. Giardiasis, an intestinal parasitic infection, particularly affects low-income communities and is transmitted through the ingestion of water contaminated with feces containing the parasite [117–119]. This convergence of structural determinants creates conditions where multiple transmission pathways overlap in the same vulnerable populations, amplifying disease burden [120, 121]. Such transmission pathways are for example vector-borne through triatomine bugs, and waterborne through contaminated water sources.

Migration and disease transmission

Migration dynamics play a critical role in disease transmission patterns across Mesoamerica. Human trafficking routes through forested regions like La Mosquitia, along the Honduras–Nicaragua border, increase the risk of malaria reemergence, including severe Plasmodium falciparum infections [122, 123]. Migration corridors often overlap with deforestation fronts driven by illegal activities such as drug trafficking and mining, creating converging ecological and epidemiological pressures that amplify disease risk [121].

The Central American isthmus and Mexico form a major migratory corridor connecting thousands of people from Latin America and the Caribbean, Africa, and Asia with the United States and Canada. Irregular transit along this corridor generates humanitarian and public health crises, particularly at the U.S. southern border. In 2020, more than 450,000 people from the Northern Triangle (Honduras, Guatemala, and El Salvador) applied for asylum in other countries, primarily in the United States [124]. Drivers of migration include poverty, violence, insecurity, family reunification, political instability, and natural disasters [125, 126]. Migrant populations are highly vulnerable to infectious diseases due to malnutrition, lack of immunity, disrupted medical treatments, and broader social determinants that influence exposure and access to healthcare [33]. Unsanitary and overcrowded conditions during transit or at destination points promote disease outbreaks. Many migrants originate from regions with high burdens of infectious diseases and may carry pathogens not endemic in the countries they reach [127].

Climate change, occupational health, and chronic disease

The convergence of climate change, poverty, and occupational vulnerability has given rise to novel health threats in Mesoamerica. Mesoamerican nephropathy as a form of chronic kidney disease exemplifies this intersection of social and environmental determinants. This poorly understood condition primarily affects agricultural workers along nearly 1,000 kilometers of the Pacific coast of Central America, from southern Mexico through El Salvador, Nicaragua, Honduras, and Costa Rica [78]. The condition disproportionately impacts young male workers in physically demanding occupations, e.g. particularly sugarcane harvesters who labor for extended hours under extreme heat with limited access to water and rest. Although the precise etiology of Mesoamerican nephropathy remains unresolved, growing evidence links the condition to recurrent heat exposure, dehydration, and strenuous labor. These factors are increasingly exacerbated by climate change [78]. Chronic kidney disease has been reported as a leading cause of death in El Salvador and Nicaragua, particularly among working-age males [128].

Exposure to agrochemicals and other environmental contaminants is also being investigated as a contributing factor, as several studies suggest that chronic contact with such substances may cause long-term kidney damage, particularly in genetically susceptible individuals [129–132]. The condition illustrates quintessential aspects of climate-sensitive disease: prevalence grows with environmental exposures directly influenced by climate change, the condition disproportionately affects socially and economically vulnerable populations, and is exacerbated by poor healthcare, limited public health infrastructure, and incomplete surveillance.

This occupational health crisis demonstrates how the structural determinants discussed throughout this section including poverty, inadequate access to healthcare, hazardous working conditions, and marginalization interact with environmental change to create new disease burdens. Like the infectious diseases described above, Mesoamerican nephropathy reflects the profound ways in which social inequalities shape health outcomes in the region, underscoring the need for comprehensive interventions that address both immediate occupational hazards and the underlying social and environmental determinants of health. This perspective aligns with the One Health framework, which increasingly recognizes that environmental change, occupational exposures, and social determinants jointly influence health outcomes and should therefore be addressed through integrated, multisectoral interventions [33].

Broader social determinants and disease spread

The outlined structural factors that drive Chagas disease, waterborne infections, and Mesoamerican nephropathy are increasingly recognized as fundamental social determinants within the One Health framework [33]. These conditions conducive to the spread of tuberculosis, leprosy, HIV/AIDS, and other diseases strongly influenced by social determinants. Although not all are directly linked to environmental changes like vector-borne diseases, these conditions are amplified by poverty. Poor living conditions, including overcrowding and malnutrition, weaken immune function and increase susceptibility to infectious diseases [133, 134]. Environmental degradation and resource scarcity further exacerbate these conditions, facilitating disease transmission and reinforcing health inequities [135–137].

Tuberculosis exemplifies these dynamics. Lack of access to healthcare, malnutrition, and coinfection with HIV significantly worsen outcomes, making TB a persistent public health concern in the region [138, 139]. HIV/AIDS similarly reflects the intersection of biological, behavioral, and structural determinants. In Costa Rica, a 2014 assessment indicated a prevalence of 0.027% (2.7 per 10,000 inhabitants) with transmission associated with limited awareness, early sexual debut, and social inequalities [140]. Limited sexual education, migration, and restricted access to health services facilitate HIV spread across the region. While control programs emphasize prevention, early diagnosis, and antiretroviral therapy availability, addressing the underlying structural and social determinants remains essential for epidemic control [141].

The challenges documented in this section subsummarized as inadequate health system coverage to climate-driven occupational diseases to poverty-amplified infectious disease transmission underscore a fundamental reality: health outcomes in Mesoamerica are profoundly shaped by social inequalities rooted in colonial-era structures and perpetuated by contemporary economic and political systems. Effective interventions must therefore address not only immediate disease risks but also the structural determinants that make certain populations systematically more vulnerable than others.

Transboundary animal health threats and One health gaps

Although human migration across Mesoamerica has been widely studied for its social and health implications, the movement of animals, particularly the informal or illegal transport of domestic and wild species, remains comparatively underexplored. As discussed in the preceding sections, animal movements linked to informal livestock practices, environmental change, and limited veterinary oversight can facilitate the cross-border spread of zoonotic diseases, representing an important but insufficiently documented pathway of disease emergence in the region [142, 143]. The region’s high biodiversity, structural weaknesses in sanitary control systems, and sociopolitical instability that facilitates unregulated mobility make Mesoamerica highly vulnerable to the introduction and reemergence of infectious agents that impact public health, animal health, and regional economies [7].

Despite growing regional discourse around the One Health approach, meaningful integration of human, animal, and environmental health remains fragmented across Mesoamerica [76, 144] due to multiple challenges [9]. Several emerging and re-emerging animal health threats—such as avian influenza, foot-and-mouth disease, bovine tuberculosis, brucellosis, canine distemper, and the reappearance of the New World screwworm—pose serious risks to animal health, food production systems, and international trade. Some of these conditions are zoonotic, yet comprehensive and coordinated planning remains limited, weakening early detection and response mechanisms [145]. Two recent cases—the resurgence of New World screwworm and the spread of canine distemper virus—illustrate both the consequences of these institutional gaps and the urgent need for coordinated regional surveillance.

New World screwworm Resurgence

The New World screwworm (Cochliomyia hominivorax) exemplifies the consequences of fragmented One Health integration. This parasitic fly represents a significant transboundary One Health threat to both animal and human health, causing severe myiasis and considerable economic losses [146]. Although it was previously eradicated from Mexico and Central America through a successful eradication campaign initiated in 1957, the parasite has made a dramatic comeback. Since 2021, more than 7,000 outbreaks and at least 24,000 confirmed cases in domestic animals have been reported. The resurgence began in Panama and had since spread across Costa Rica, Nicaragua, Honduras, Guatemala, and even reached Mexico once again [147–150].

Analysis of the dispersal pattern reveals an advance of approximately 1,500 km from the endemic region in Darién, Panamá to southern Mexico which is a far greater area as what would have been expected from natural dispersal alone. These dispersal pattern strongly suggests that the primary driver of regional spread is the unregulated movement of domestic animals, also reflecting persistent weaknesses in animal traceability and cross-border sanitary controls. A threshold of 50 km has been proposed to distinguish atypical dispersal events likely linked to informal transport lacking sanitary controls [147]. The detection of outbreaks in southeastern Mexican states such as Chiapas, Tabasco, and Campeche confirms reintroduction of the parasite into previously screwworm-free zones, placing livestock production areas in Mexico and beyond at risk [149].

The current outbreak has also documented screwworm infections in wild animals in Central America (e.g., Costa Rica; SENASA, 2025) [148]. This interspecies transmission raises growing concerns about the risk of infectious diseases spilling from domestic to wild fauna, threatening already vulnerable wildlife populations. The pattern of long-distance parasite dispersal driven by unregulated animal movement demonstrates the urgent need to strengthen regional surveillance, animal traceability, cross-border coordination, and sanitary movement controls to contain this and other diseases spreading across countries and regions.

Canine distemper virus and wildlife conservation

Canine distemper virus (CDV; Morbillivirus canis) further illustrates how inadequate management of domestic animals can facilitate pathogen transmission across multiple species, with implications for animal health, biodiversity, and ecosystem integrity. This globally distributed morbillivirus primarily affects domestic dogs but is also capable of infecting a wide range of wild terrestrial and aquatic mammals, demonstrating its capacity for cross-species transmission. In Mesoamerica, CDV has been detected in wild carnivores, including wild felids, raising concerns about its impact on wildlife conservation [151, 152].

Beyond carnivores, recent evidence from South America indicates that CDV can also infect neotropical primates. Natural infections and lethal outbreaks have been documented in free-ranging marmosets (Callithrix spp.) in Brazil, including cases of coinfection with yellow fever virus and outbreaks associated with neurological disease and high mortality [153, 154]. These findings highlight the expanding host range of CDV and underscore its relevance from a One Health perspective particularly in regions where domestic animals, wildlife, and humans coexist in close proximity. The findings also emphasize the importance of integrated wildlife and domestic animal surveillance for early pathogen detection and prevention of cross-species transmission. Transmission is facilitated by irresponsible pet ownership, illegal wildlife trade, and lack of regulation in animal transport.

The region’s ecological connectivity amplifies these risks. As discussed earlier in the context of conservation responses to habitat fragmentation, Mesoamerica features ecological corridors such as the Jaguar Corridor and the Mesoamerican Biological Corridor, which connect populations of large carnivores and other sensitive species across countries [74, 155]. While these corridors are essential for maintaining ecological connectivity and genetic exchange, they may also facilitate pathogen spread when infected wildlife move naturally across connected habitats. This risk is then further amplified by anthropogenic factors such as human migration and informal domestic animal transport [156]. The spread of the “South America/North America-4” lineage of CDV, detected from Ecuador to the United States [157], illustrates an active continental transmission route that connects Mesoamerica to broader disease dynamics.

Implications for regional One health integration

Together, these examples illustrate how contemporary health threats in Mesoamerica increasingly transcend disciplinary and national boundaries, reinforcing the need for integrated One Health approaches capable of addressing the interconnected human, animal, and environmental drivers of disease emergence. Both screwworm and CDV demonstrate how the absence of coordinated surveillance, weak enforcement of animal movement regulations, and limited integration between veterinary and public health sectors create vulnerabilities that transcend national borders. The resurgence of a previously eradicated parasite and the continental spread of a viral pathogen underscore the urgent need to strengthen health surveillance and regional cooperation. Without sustained cross-border collaboration, improved animal traceability systems, and institutional frameworks that explicitly integrate human, animal, and environmental health dimensions through effective stakeholder engagement and multisectoral governance [158], Mesoamerica will remain vulnerable to recurring cycles of disease emergence and reemergence that threaten both public health and wildlife conservation.

International and regional responses

The disease challenges documented throughout this paper from colonial-era pathogen introductions to contemporary climate-driven health crises have prompted responses from international organizations, national governments, and community actors. However, the persistence and reemergence of zoonotic diseases across Mesoamerica reveal critical gaps between institutional mandates and implementation capacity, consistent with recent regional assessments highlighting persistent challenges in governance, institutionalization, financing, and cross-sectoral implementation of One Health across Latin America and the Caribbean [7]. This section examines current response frameworks and argues that effective One Health strategies require not only international technical support but also deep community engagement and political commitment that transcends economic constraints.

Institutional actors and current limitations

International organizations and global One Health initiatives can play important roles in addressing Mesoamerica’s interconnected health challenges. Recent global One Health initiatives including Preventing Zoonotic Disease Emergence (PREZODE), the UNEP Nature for Health (N4H) initiative, and the Alliance against Health Risks in Wildlife Trade illustrate the growing international commitment to strengthening One Health implementation through multisectoral collaboration, prevention, and coordinated action across the human–animal–environment interface. The Food and Agriculture Organization of the United Nations (FAO) focuses on improving animal health, promoting responsible agricultural practices, and strengthening surveillance systems in collaboration with regional partners [159, 160]. The US Centers for Disease Control and Prevention (CDC) emphasizes surveillance, prevention, and control strategies for zoonotic diseases, recognizing the complex interactions among humans, animals, and the environment as key to preventing outbreaks [161, 162]. International research initiatives examine how climate change influences vector distribution, disease emergence, and population vulnerability across the region.

Yet these efforts, while valuable, continue to face structural constraints, including weaknesses in governance, institutionalization, financing, and cross-sectoral coordination, which remain persistent barriers to One Health implementation across Latin America and the Caribbean [7]. International organizations typically work through national governments, whose capacity and political will vary substantially. Technical recommendations may not translate into policy action when domestic priorities diverge or when implementation requires resources that exceed available budgets. Surveillance systems remain fragmented across sectors and national borders, impeding the coordinated regional response that transboundary threats demand [76]. The screwworm resurgence and canine distemper spread documented earlier exemplify how institutional gaps—weak animal movement regulations, limited cross-border coordination, insufficient integration between veterinary and public health sectors—enable disease emergence despite international technical guidance.

Community engagement as essential foundation

Vulnerable populations in rural and low-resource areas face the highest exposure to risks driven by environmental degradation and vector proliferation. As outlined above, in many of these settings, poverty, inadequate housing, and limited access to healthcare increase susceptibility to infectious diseases, including Chagas disease and waterborne infections [110, 117–119]. Limited community participation and health education continue to constrain the effectiveness of disease prevention strategies [85, 116, 120]. Effective disease prevention therefore requires moving beyond top-down technical assistance toward collaborative approaches that position communities as active participants rather than passive beneficiaries, consistent with recent One Health implementation frameworks emphasizing stakeholder engagement and participatory governance [158]. Community engagement and educational programmes prove essential for promoting preventive practices, delivering culturally appropriate health education, strengthening local surveillance systems, and improving living conditions. Only through comprehensive approaches that combine international technical support, national policy frameworks, local government action, and community participation can disease transmission risks be effectively mitigated ([163, 164], Fig. 3).

Fig. 3.

Biotic pressure, zoonotic risk, and the mitigating effect of the One health approach. Increasing biotic pressure—driven by environmental degradation and vector proliferation—leads to a nonlinear rise in zoonotic spillover probability (magenta line). Integrated One health interventions reduce the slope of this trajectory (orange line), highlighting the role of coordinated action, community participation, and multilevel governance in mitigating transmission risk

A qualitative study from Guatemala demonstrates this principle in practice. Researchers at the Laboratory of Entomology and Applied Parasitology at the University of San Carlos documented how integrating social innovation into household improvement strategies for Chagas disease control generated positive changes in community health [165]. Through interviews and direct observation, the study showed that improvements such as wall and floor repairs promoted new social dynamics supporting household economies and hygiene practices. Active community participation and dialogue between traditional and public health approaches proved key to intervention success.

From a One Health perspective, this case highlights the value of community-based, interdisciplinary, and intersectoral approaches that integrate human health, animal health, and environmental dimensions to promote sustainability and local empowerment. Such approaches recognize communities as key actors in disease prevention, surveillance, and risk mitigation at the human-animal-environment interface. The findings suggest this model could be adapted to strengthen community health across Latin America while also providing valuable lessons for other regions, including the Global North, particularly where zoonotic and environmentally mediated diseases pose similar challenges. However, the study also underscores that addressing complex disease transmission dynamics requires more than local action alone. Effective One Health implementation depends on strong governmental commitment, clear institutional mandates, and coordinated regional leadership to support, scale, and integrate community-driven initiatives into broader public health and environmental governance frameworks. Without these enabling structures, community-based interventions risk remaining fragmented and unsustainable [166, 167].

Political will and health system performance beyond economic capacity

Mesoamerican countries exhibit marked heterogeneity in economic development and socioeconomic conditions, which profoundly shape health system capacity and population health outcomes [168, 169]. However, economic constraints alone do not fully explain differences in public health investment or performance across the region. Evidence from Latin America demonstrates that even resource-limited countries can achieve substantial health gains when strong political commitment, public investment, and equitable health policies are prioritized.

Recent studies on SARS-CoV-2 testing capacity and transfusion-transmitted infection surveillance demonstrate that Cuba has maintained robust public health infrastructure and diagnostic capacity despite limited economic resources, underscoring the role of governance, social equity, and health system organization beyond national wealth [166, 167]. This example illustrates that the persistent health challenges documented throughout this paper reflect not only resource scarcity but also political choices about health system priorities, intersectoral coordination, and the degree to which marginalized populations are included in health planning and service delivery.

The gap between technical capacity and implementation emerged consistently from both the narrative literature review and the discussion held during a structured multisectoral workshop with results outlined below. Together, these sources indicate that Mesoamerica possesses substantial scientific expertise, established international partnerships, and growing awareness of One Health principles [7, 144]. What often remains insufficient is the sustained political will to translate this knowledge into policy action, the institutional frameworks to coordinate across sectors and borders, and the commitment to center the most vulnerable communities in intervention design and implementation. Addressing the region’s interconnected health threats therefore requires not only continued technical cooperation but also fundamental shifts in governance structures, resource allocation, and the recognition of health as a shared responsibility spanning human, animal, and environmental domains.

Workshop-derived One health strategy for Mesoamerica

Developing a One Health strategy for the Mesoamerican region requires a comprehensive approach that recognizes the region’s cultural, social, economic, ecological, and environmental complexity. Rather than relying on isolated interventions, effective One Health implementation demands a shared vision of health as a common good, intrinsically linked to people, animals, plants, and ecosystems.

To complement the narrative review presented in this perspective, we incorporate the outcomes of a structured participatory multisectoral workshop organized by the GLACIER Project Consortium (German Latin-American Center for Infection and Epidemiology Research) during the WDA Latin America meeting held in Guatemala in late 2023. The one-day workshop brought together 67 participants from 13 countries, including Guatemala, Mexico, Costa Rica, Chile, Colombia, Brazil, Ecuador, Honduras, El Salvador, the Dominican Republic, Argentina, Germany, and the United States. Participants represented universities, governmental institutions, non-governmental organizations, international research centers, undergraduate and graduate students, community representatives, and also Indigenous communities and community-based organizations. The participants’ expertise encompassed ecology, veterinary medicine, public health, environmental sciences, biology, education, social sciences, communication, and public policy.

The workshop followed a structured participatory design. The program combined thematic presentations delivered by invited experts with facilitated multidisciplinary working groups addressing ecological, biological, social, educational, and governance dimensions of One Health in Mesoamerica. Following each thematic block, participants worked in small interdisciplinary groups using predefined guiding questions to identify major regional challenges, key stakeholders, disciplinary needs, and potential implementation strategies. The outputs from each working group were subsequently presented during plenary discussions, where common themes were collectively discussed and integrated. The organizing team then grouped the recurring themes identified across the working groups and synthesized them through thematic analysis into six strategic action lines that form the basis of the recommendations presented in this manuscript.

Although the workshop was not designed as a formal consensus exercise, it provided a structured platform to capture perspectives from diverse sectors and countries. To reduce potential bias associated with participant composition, workshop outcomes were interpreted together with the evidence synthesized in the narrative literature review, allowing recommendations to emerge from both empirical discussion and published evidence.

Workshop discussions consistently highlighted that the principal barriers to One Health implementation in Mesoamerica extend beyond technical capacity. Participants emphasized the need to strengthen intersectoral coordination, improve communication among academia, governments, communities, and international organizations, expand access to funding for applied research and implementation, and institutionalize One Health through coordinated regulatory and operational frameworks. These priorities are consistent with recent regional assessments identifying governance, surveillance, intersectoral collaboration, and veterinary public health as major priorities for One Health implementation across Latin America and the Caribbean [76].

Across discussions, participants also recognized that these priorities were interconnected and operated across multiple governance levels, from local communities to regional and international institutions. The recurring themes were subsequently synthesized into the six strategic action lines presented in Table 1, which provide the conceptual basis for the proposed One Health framework for Mesoamerica.

Table 1.

Summary of strategic action lines for implementing the One health approach in Mesoamerica

Action Line	Key Priorities
1. Intersectoral Governance and Regional Cooperation	Establish permanent collaboration spaces integrating governments, academia, civil society, and international organizations into regulatory frameworks and public budgets through multisectoral working groups and ecosystem health observatories
2. Surveillance, Prevention, and Disease Control	Implement regional integrated surveillance for zoonoses, vector-borne, and environmental diseases; strengthen rapid outbreak response; integrate wildlife health monitoring; establish animal registries and traceability systems
3. Community Participation and Intercultural Inclusion	Integrate ancestral knowledge into health systems; train personnel in intercultural competencies; ensure Indigenous language use in services; engage health promoters as implementation allies
4. Education, Communication, and Behavior Change	Design environmental health campaigns from schools through universities; promote culturally grounded behavior change interventions; strengthen community leadership in health promotion
5. Applied Research and Local Knowledge	Promote context-specific research with community participation; apply innovative technologies (eDNA, remote sensing, spatial modeling); build regional scientific capacity
6. Territorial Management and Sustainability	Integrate ecosystem health with sustainable production; encourage chemical-free agricultural practices; restore habitats and strengthen governance in biological corridors; create economic incentives for good practices

Conclusions and strategic recommendations

This study highlights that addressing health challenges in Mesoamerica requires an integrated One Health approach that explicitly incorporates historical, ecological, and social dimensions. Building on the narrative review, recent regional evidence, and multisectoral dialogue, we propose key strategic actions to strengthen prevention, coordination, and health equity across the region.

Strategic framework and key stakeholders

Effective implementation of a One Health strategy requires the active participation of diverse sets of stakeholders: organized communities, Indigenous Peoples, researchers from multiple disciplines, decision-makers at all levels (from community leaders to public policy authorities), government officials, educators, grassroots organizations, and international bodies. Interdisciplinary collaboration is essential, integrating perspectives from human and veterinary medicine, biology, law, social sciences, communication, education, psychology, economics, territorial governance, and environmental management. Each discipline brings unique tools for understanding, addressing, and transforming health and ecosystem systems in a synergistic manner.

Based on structured multisectoral workshop discussions, recurrent themes were identified and synthesized through thematic analysis, and subsequently integrated with the findings from the narrative review. This process resulted in six strategic action lines for implementing the One Health approach in Mesoamerica, addressing governance, surveillance, community participation, education, research, and territorial management—each representing a critical dimension of integrated health strategy. These are summarized in Table 1, with key implementation components detailed below.

Core components of the strategy

Surveillance and disease prevention

A fundamental component is the development of integrated epidemiological surveillance systems capable of monitoring zoonoses, vector-borne diseases, and other health problems linked to environmental factors. These systems should be participatory, incorporate traditional and local knowledge, and function in a decentralized manner to ensure early outbreak detection and rapid response.

Recognizing the role of domestic and wild animals in disease emergence, the workshop proposed establishing national registries for companion animals and enhanced monitoring of wildlife health. Such registries would facilitate identification of zoonotic hotspots, support outbreak tracking, promote responsible pet ownership, and help manage exotic or invasive species, including illegally traded wildlife. This is particularly relevant in Mesoamerica, where porous borders and limited enforcement enable wildlife trafficking including exotic birds up to large mammals maintained in private collections. Integrating human, animal, and environmental health data through these systems supports proactive interventions and broader One Health goals [170].

Healthcare access and cultural competence

Improving access to medical and veterinary care in rural and peripheral communities is equally essential. Ensuring that both people and animals receive adequate preventive and curative care not only builds community resilience to outbreaks but also serves as a mechanism for social inclusion. Health education across all levels including schools, communities, institutions, and media should foster broad understanding of the interconnection between human, animal, and ecological systems.

One of the workshop’s most valuable contributions was the emphasis on respecting and revitalizing ancestral knowledge, including the incorporation of Indigenous languages into health services. This approach enhances communication and care quality while promoting epistemic justice and intercultural equity. It is particularly important when working with Indigenous communities, where traditional knowledge systems including those maintained and transmitted by women play a central role in environmental stewardship, food security, and community health [171]. Successfully implementing culturally appropriate and intercultural One Health approaches requires action across three structural dimensions: (1) political: ensuring legal recognition and protection of traditional practices; (2) organizational: adapting health services to cultural diversity; and (3) educational: training health personnel in intercultural competencies and reducing staff turnover in Indigenous communities.

Disease prevention and communication

For transmissible disease prevention, evidence-based control measures are essential, including integrated vector management and rapid response protocols for zoonotic emergencies. Communication campaigns must be culturally appropriate and multilingual, using accessible channels for different population groups and strengthening the role of community leaders and intercultural health promoters.

Strategic alliances and environmental action

Building strategic alliances among research centers, government institutions, community organizations, and private sector actors is critical for co-creating innovative, sustainable solutions adapted to local realities. The participation of scientists in policy development and sustained dialogue between knowledge producers and decision-makers emerged as priorities.

The environmental dimension must be closely linked to agroecological practices that reduce harmful agrochemical use and foster harmonious relationships with ecosystems. This linkage means actively conserving biological corridors, protecting water sources, and restoring degraded habitats. Such actions directly support zoonotic disease prevention while enhancing ecosystem health.

Addressing social determinants

A critical aspect identified was the need to understand and address social determinants of health, including educational level, poverty, housing conditions, gender, ethnic discrimination, and social support networks. These social determinants are increasingly recognized as fundamental components of One Health implementation because they directly influence exposure, vulnerability, and access to prevention and healthcare interventions [33]. Incorporating these determinants into intervention design allows strategies to be tailored to specific contexts, enabling sustainable changes in daily practices. These findings are consistent with broader evidence showing that exposure to zoonotic diseases in rural Latin America is strongly shaped by interacting social, ecological, and cultural determinants [121]. Behavioral studies have demonstrated that many health-related actions are socially learned, opening opportunities for interventions aimed at transforming collective habits [172]. Integrating these approaches into prevention programs significantly enhances their effectiveness, especially when combined with educational, regulatory, and strategic communication efforts [173].

To encourage community ownership of One Health strategies, economic incentives should support local initiatives focused on health prevention and sustainable environmental management. Such incentives may include subsidies, access to funding, tax benefits, or technical assistance, creating favorable environments for community action and strengthening co-responsibility mechanisms.

Evaluation and regional cooperation

Establishing systematic mechanisms for evaluation and feedback is essential for monitoring progress, identifying obstacles, and adjusting actions based on empirical evidence. Continuous evaluation reinforces strategy sustainability and ensures adaptability to changing contexts.

Workshop participants emphasized the importance of involving research centers in generating in-depth knowledge on biodiversity loss and the interconnectedness of human, animal, and environmental health. Collaboration between research institutions and communities enables development of evidence-based, locally relevant solutions. Moreover, clear communication to society about holistic health and environmental impacts of human activity is essential for building broad support. Participants further emphasized that sustained collaboration requires mechanisms for continuous stakeholder engagement and feedback to ensure that priorities remain responsive to local needs and regional realities.

Regional cooperation emerges as a cornerstone of the One Health approach in Mesoamerica. Sharing experiences, knowledge, tools, and resources among countries facilitates coordinated responses to common threats and strengthens the foundation for a regional health agenda based on equity, resilience, and sustainability.

Alignment with international and regional strategic frameworks

The proposed One Health strategy for Mesoamerica must explicitly align with guiding principles, priorities, and action frameworks defined within international and regional governance spaces related to human, animal, plant, and environmental health. This alignment ensures technical coherence, facilitates interinstitutional coordination, and enhances mobilization of strategic resources.

The strategy aligns with the FAO–WOAH–WHO–UNEP Joint Plan of Action on One Health (2022–2026), which establishes a collaborative, multisectoral, and transdisciplinary framework for prevention, detection, preparedness, and response to threats impacting multiple health dimensions [174]. At the regional level, the strategy must align with the Pan American Health Organization’s Strategy for International Health Cooperation for Central America and the Dominican Republic, which recognizes the interdependence of health, environment, and social systems [175, 176]. The strategy should also incorporate guidelines from the Regional Health Plan for Central America and the Dominican Republic, developed by the Council of Ministers of Health of Central America and the Dominican Republic (COMISCA), addressing transboundary health risks, strengthening institutional capacities, and promoting environmental health as a pillar of sustainable development [175].

The ecological and biodiversity dimensions require effective articulation with instruments such as the Mesoamerican Biological Corridor and the Regional Environmental Strategy of the Central American Integration System (ER-SICA) [177]. These platforms provide enabling frameworks for integrating sustainable ecosystem management and biodiversity conservation into health strategies while recognizing that deforestation, habitat fragmentation, and climate change amplify emerging infectious disease risk.

Finally, the strategy must align with the 2030 Agenda for Sustainable Development and its Sustainable Development Goals (SDGs) and in particularly with those SDGs that are related to good health and well-being (SDG 3), zero hunger (SDG 2), clean water and sanitation (SDG 6), climate action (SDG 13), life on land (SDG 15), reduced inequalities (SDG 10), and partnerships for the goals (SDG 17) [178].

Abbreviations

One Health

Integrated approach to human, animal, plant, and environmental health

OHHLEP

One Health High-Level Expert Panel

GLACIER

German Latin-American Center for Infection and Epidemiology Research

CDV

Canine distemper virus

FAO

Food and Agriculture Organization of the United Nations

WOAH

World Organization for Animal Health

WHO

World Health Organization

UNEP

United Nations Environment Programme

PAHO

Pan American Health Organization

COMISCA

Council of Ministers of Health of Central America and the Dominican Republic

ER-SICA

Regional Environmental Strategy of the Central American Integration System

SDGs

Sustainable Development Goals

CDC

Centers for Disease Control and Prevention

OROV

Oropouche virus

Author contributions

BC-C: Writing – review & editing. ML: Writing – review & editing, AF: Writing – review & editing, JO-G: Writing – review & editing. CNI-C: Writing – review & editing. NK: Writing – review & editing. JFD: Writing – review & editing. GS: Conceptualization, Supervision, Writing – review & editing, AC: Conceptualization, Writing – original draft, review and editing.

Funding

This work was supported by German Academic Exchange Service (DAAD) through the GLACIER project. This work was further supported by European Union through the project ZOE – Zoonosis Emergence across Degraded and Restored Forest Ecosystems (101135094). Views and opinions expressed are, however, those of the author(s) only and do not necessarily reflect those of the European Union or European Research Executive Agency (REA). Neither the European Union nor the European Research Executive Agency (REA) can be held responsible for them.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

Jan Felix Drexler is an Associate Editor for One Health Outlook; however, this manuscript was handled independently by another Associate Editor in accordance with the journal’s editorial procedures. The authors declare that they have no other competing interests.