Green infrastructure improves environmental health in cities, benefits human health, and provides habitat for wildlife. Increasing urbanization has demanded the expansion of urban areas and transformation of existing cities. The adoption of compact design in urban planning is a recommended strategy to minimize environmental impacts; however, it may undermine green infrastructure networks within cities as it sets a battleground for urban space. Under this scenario, multifunctionality of green spaces is highly desirable but reconciling human needs and biodiversity conservation in a limited space is still a challenge. Through a systematic review, we first compiled urban green space's characteristics that affect mental health and urban wildlife support, and then identified potential synergies and trade-offs between these dimensions. A framework based on the One Health approach is proposed, synthesizing the interlinkages between green space quality, mental health, and wildlife support; providing a new holistic perspective on the topic. Looking at the human-wildlife-environment relationships simultaneously may contribute to practical guidance on more effective green space design and management that benefit all dimensions.

Inter-sectoral collaborations are now recognized as key importance for health system strengthening and health system integration, globally; however, its application in the domain of One Health remains unclear. Over time, as the complexity of the health system has increased within the domain of One Health approach, there is an urgent need for developing collaboration for successful implementation of the One Health. This review focuses on the global One Health collaboration strategies and discusses which type of collaboration might work for the health system of India. We conducted a review in the following three steps: identification of key One Health Collaboration strategies, documentation of the global initiatives and scoping into the initiatives of India in the domain of One Health. We found three major types of collaborations discussed in the One Health literature: level-based collaboration (individual, population or research), solution-based collaboration, and third-party-based collaboration. Twenty-five key global and six Indian One Health initiatives or collaboration strategies are documented in the present review. Although, many initiatives are being undertaken globally for disease prevention and control from the viewpoint of One Health; however, in India, solution-based approaches during emergencies and outbreaks and some sort of level-based collaborations are in place. It is high time to develop a sustainable level-based collaboration integrated with third-party based collaboration within the larger domain of One Health for a resilient health system.

Water pollution is a major issue in Ghana with direct impacts on human health. However, the underlying drivers of exposure and risks are not comprehensively explored and understood, while the diseases continue posing huge burdens. The key question addressed is: what are the key drivers influencing the water–health nexus, particularly water-borne disease risks in the Odaw River basin, Ghana? Multiple approaches were integrated: qualitative system dynamic modeling and urban land-use change assessment. Multi-level stakeholder participation, including household surveys, focus group discussions, and workshops were employed in developing and identifying indicators and feedback loops. The results revealed that communities have access to water and sanitation, but water-borne diseases are still prevalent. Flooding influenced by poor land use planning and solid waste disposal are key risk factors, contributing to water pollution and disease outbreaks. The major land-use change is the conversion of natural to built-up areas, resulting in decreased urban vegetation cover and increased soil sealing, partly contributing to flood risk. Complex linkages and multiple feedback loops between land use, flooding, water pollution, and water-borne disease risks were identified. In addition to supplying safe drinking water and sanitation, multi-sectoral collaborations are required to co-design and implement integrated interventions, including flood risk reduction, urban land use plans, and improved waste management to reduce disease risks and promote health.

Antibiotic resistance (ABR) and the spread of multidrug-resistant and extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli via wastewater to environmental compartments are of rapidly growing global health concern. Health care facilities, industries and slaughterhouses discharge high loads of ABR bacteria with their wastewater. However, the general community is often the biggest indirect discharger. Yet, research focusing explicitly on this important diffuse source is rather scarce raising questions about variations in the occurrence of ESBL-producing E. coli in wastewater from different communities and over time. Between April 2019 and March 2020, wastewater from three socio-spatially different districts in the Ruhr Metropolis, Germany, and the receiving wastewater treatment plant was sampled monthly and analysed for the occurrence of ESBL-producing E. coli via culture-based methods. Isolates were validated with matrix assisted laser desorption ionization time of flight mass spectrometry and antibiotic resistance profiles were analysed via microdilution. Results were interpreted using the European Committee on Antimicrobial Susceptibility Testing criteria. The German Commission for Hospital Hygiene and Infection Prevention criteria were used for multidrug-resistance categorization. Phenotypic ESBL-producing E. coli could be isolated from every wastewater sample demonstrating that the general community is an important indirect discharger. The socio-spatially disadvantaged area displayed higher absolute loads of ESBL-producing E. coli compared to the other two areas, as well as higher adjusted loads for domestic discharge and inhabitants, particularly during winter, indicating a higher ABR burden. Thirty-two isolates (28.6%) were characterized as multidrug-resistant Gram-negative bacteria (3MRGN). Resistance profiles varied only for those antibiotics, which can be administered in outpatient care. Resistance levels tended to be around 10% lower in the socio-spatially advantaged area. This study shows that spatial and seasonal influences regarding the occurrence of ESBL-producing E. coli in wastewater from socio-spatially different communities are identifiable.

Prioritizing zoonotic diseases is one of the emerging tasks for developing multi-sectoral collaboration within One Health. Globally, many efforts have been made to prioritize zoonotic diseases at national levels, especially in low resource settings. Prioritization of zoonoses has been conducted in different countries at different levels (i.e. national, regional and local) for different purposes. India has also initiated prioritization of zoonotic diseases at the national level. However, in a country like India with wide climatic variations, different animal-human and vector densities, it is important to look at these zoonotic conditions in local settings too. The present study aims to determine which zoonoses should be prioritized for collaboration between stakeholders in the Indian city of Ahmedabad. The present study followed a participatory research method, entailing a stakeholder workshop for prioritizing zoonotic diseases in Ahmedabad. It was carried out through a facilitated consultative process involving 19 experts in zoonoses from the human and animal health systems during a one-day workshop in September 2018. To prioritize the zoonotic diseases, the One Health Zoonotic Disease Prioritization (OHZDP) tool of the U.S. Centers for Disease Control and Prevention was adopted. The Analytical Hierarchical Process (AHP) and decision-tree analysis were used to rank the diseases. Out of 38 listed zoonotic diseases, 14 were selected for prioritization. These were scored and weighed against five criteria: severity of disease in humans, potential for epidemic and/or pandemic, availability of prevention and/or control strategies, burden of animal disease existing inter-sectoral collaboration. The top five diseases that have been prioritized for Ahmedabad are Rabies, Brucellosis, Avian Influenza (H5N1), Influenza A (H1N1) and Crimean-Congo Hemorrhagic Fever. Sensitivity analysis did not indicate significant changes in zoonotic disease prioritization based on criteria weights. Prioritization of zoonotic diseases at the local level is essential for development of effective One Health strategies. This type of participatory disease prioritization workshop is highly recommended and can be replicated in other Indian cities, as well as in other low and middle-income countries.

Inadequate and excessive use of antibiotics in humans, animals, and plants has been identified among the key drivers of antibiotic resistance (ABR). In human medicine, the great majority of antibiotics are prescribed in the outpatient sector with profound differences in antibiotic consumption across various geographical scales and between health care sectors; raising questions around the underlying drivers. Moving beyond individual patient-related determinants, determinants of antibiotic use in the outpatient sector were categorized as compositional, contextual and collective, enabling an analysis of potential area effects on antibiotic use. 592 variables identified in 73 studies were sorted into 46 determinant groups. Compositional determinants provided the strongest evidence with age, education, employment, income, and morbidity exhibiting a clear influence on antibiotic use. Regarding contextual and collective determinants, deprivation, variables around health care services, Hofstede's dimensions of national culture and regulation affect antibiotic use. The results are biased towards high-income and western countries, often relying on secondary data. However, the findings can be used as signposts for associations of certain variables with antibiotic use, thereby enabling further research and guiding interventions.