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This article provides insights gained during a four-year project funded by the European Cooperation in Science and Technology (COST) named «Network for Evaluation of One Health», which brought together over 250 scientists, decision-makers and practitioners with expertise and/or interest in One Health to investigate the added value of One Health and elaborate and evaluation protocol for One Health. Here, we present our reflections on the significance of these findings for our common practice as health professionals. Two initial findings lie at the core of this analysis, namely the observation that 1) One Health integrates knowledge from various sources in a transdisciplinary way and that there are as many concepts of health as participants in a specific initiative; and 2) the nature of complex One Health problems necessitates systems thinking and consideration of emergences as a One Health initiative is implemented. An analysis of eight case studies, i.e., evaluations of different One Health initiatives, found that the capacity of an initiative to facilitate knowledge integration improves with the age of the initiative, political boundaries of any nature hinder knowledge integration, and the prevailing competitive mentality in academia may be a serious obstacle to trusted collaboration required for interdisciplinary progress. The COST project also revealed a number of important knowledge gaps, namely the need for: a scalable definition of health, balancing expert advice and citizen participation to tackle health challenges, bridging the scission between the benefits and risks arising from nature, discussing whether egoism will define the boundary to sustainable health, a biocentric social justice framework, and comparative values associated with health of people, animals, plants and ecosystems. Furthermore, methodological challenges were identified such as participatory methods that are scalable to large populations, a specific skill set to facilitate transdisciplinary research, and governing mechanisms alternative to legislation and markets. Finally, as a rather unexpected outcome, the project has revealed the tension between the academic and societal demands for infallibility and predictability versus the need for honesty, authenticity, humbleness and emotion to permit the full unfolding of human creativity.

One Health (OH) positions health professionals as agents for change and provides a platform to manage determinants of health that are often not comprehensively captured in medicine or public health alone. However, due to the organization of societies and disciplines, and the sectoral allocation of resources, the development of transdisciplinary approaches requires effort and perseverance. Therefore, there is a need to provide evidence on the added value of OH for governments, researchers, funding bodies, and stakeholders. This paper outlines a conceptual framework of what OH approaches can encompass and the added values they can provide. The framework was developed during a workshop conducted by the "Network for Evaluation of One Health," an Action funded by the European Cooperation in Science and Technology. By systematically describing the various aspects of OH, we provide the basis for measuring and monitoring the integration of disciplines, sectors, and stakeholders in health initiatives. The framework identifies the social, economic, and environmental drivers leading to integrated approaches to health and illustrates how these evoke characteristic OH operations, i.e., thinking, planning, and working, and require supporting infrastructures to allow learning, sharing, and systemic organization. It also describes the OH outcomes (i.e., sustainability, health and welfare, interspecies equity and stewardship, effectiveness, and efficiency), which are not possible to obtain through sectoral approaches alone, and their alignment with aspects of sustainable development based on society, environment, and economy.

The current fragmented framework of health governance for humans, animals and environment, together with the conventional linear approach to solving current health problems, is failing to meet today's complex health challenges and is proving unsustainable. Advances in healthcare depend increasingly on intensive interventions, technological developments and expensive pharmaceuticals. The disconnect grows between human health, animal health and environmental and ecosystems health. Human development gains have come with often unrecognised negative externalities affecting ecosystems, notably loss of resilience, mostly through biodiversity loss and land degradation. Reduced capacity of the ecosystem to serve humanity threatens to reverse the health gains of the last century. A paradigm shift is urgently required to de-sectoralise human, animal, plant and ecosystem health and to take a more integrated approach to health, One Health (OH). The sustainable development goals (SDGs) offer a framework and unique opportunity for this and we argue the need of an OH approach towards achieving them. Feasibility assessments and outcome evaluations are often constrained by sectoral politics within a national framework, historic possession of expertise, as well as tried and tested metrics. OH calls for a better understanding, acceptance and use of a broader and transdisciplinary set of evaluation approaches and associated metrics, which is a key objective of NEOH. We need to shift our current sectoralised, linear focus to a more visible balanced health investment with more global benefits to all species. This is encapsulated in the movements for OH, EcoHealth, Planetary Health and Ecological Public Health, which are essentially converging towards a paradigm shift for a more integrated approach to health. ; peer-reviewed

Challenges calling for integrated approaches to health, such as the One Health (OH) approach, typically arise from the intertwined spheres of humans, animals, and ecosystems constituting their environment. Initiatives addressing such wicked problems commonly consist of complex structures and dynamics. As a result of the EU COST Action (TD 1404) "Network for Evaluation of One Health" (NEOH), we propose an evaluation framework anchored in systems theory to address the intrinsic complexity of OH initiatives and regard them as subsystems of the context within which they operate. Typically, they intend to influence a system with a view to improve human, animal, and environmental health. The NEOH evaluation framework consists of four overarching elements, namely: (1) the definition of the initiative and its context, (2) the description of the theory of change with an assessment of expected and unexpected outcomes, (3) the process evaluation of operational and supporting infrastructures (the "OH-ness"), and (4) an assessment of the association(s) between the process evaluation and the outcomes produced. It relies on a mixed methods approach by combining a descriptive and qualitative assessment with a semi-quantitative scoring for the evaluation of the degree and structural balance of "OH-ness" (summarised in an OH-index and OH-ratio, respectively) and conventional metrics for different outcomes in a multi-criteria-decision-analysis. Here, we focus on the methodology for Elements (1) and (3) including ready-to-use Microsoft Excel spreadsheets for the assessment of the "OH-ness". We also provide an overview of Element (2), and refer to the NEOH handbook for further details, also regarding Element (4) (http:// neoh.onehealthglobal.net). The presented approach helps researchers, practitioners, and evaluators to conceptualise and conduct evaluations of integrated approaches to health and facilitates comparison and learning across different OH activities thereby facilitating decisions on resource allocation. The application of the framework has been described in eight case studies in the same Frontiers research topic and provides first data on OH-index and OH-ratio, which is an important step towards their validation and the creation of a dataset for future benchmarking, and to demonstrate under which circumstances OH initiatives provide added value compared to disciplinary or conventional health initiatives. ; peer-reviewed

Research and policy processes in many fields, such as sustainability and health, are increasingly relying on transdisciplinary cooperation among a multitude of governmental, nongovernmental, and private actors from local to global levels. In the absence of hierarchical chains of command, multistakeholder governance may accommodate conflicting or diverse interests and facilitate collective action, but its effectiveness depends on its capacity to integrate systems, transformation, and target knowledge. Approaches to foster such governance are nascent and quickly evolving, and methodological standards to facilitate comparison and learning from best practice are needed. However, there is currently no evaluation approach that (i) comprehensively assesses the capacity for knowledge integration in multistakeholder governance, (ii) draws on the best available knowledge that is being developed in various fields, and (iii) combines a systematic and transferable methodological design with pragmatic feasibility. We brought together 20 experts from institutions in nine countries, all working on evaluation approaches for collaborative science–policy initiatives. In a synthesis process that included a 2-day workshop and follow-up work among a core group of participants, we developed a tool for evaluating knowledge integration capacity in multistakeholder governance (EVOLvINC). Its 23 indicators incorporate previously defined criteria and components of transdisciplinary evaluations into a single, comprehensive framework that operationalizes the capacity for integrating systems, target, and transformation knowledge during an initiative's (a) design and planning processes at the policy formulation stage, (b) organization and working processes at the implementation stage, and (c) sharing and learning processes at the evaluation stage of the policy cycle. EVOLvINC is (i) implemented through a questionnaire, (ii) builds on established indicators where possible, (iii) offers a consistent and transparent semiquantitative scoring and aggregation algorithm, and (iv) uses spider diagrams for visualizing results. The tool builds on experience and expertise from both the northern and southern hemispheres and was empirically validated with seven science–policy initiatives in six African and Asian countries. As a generalized framework, EVOLvINC thus enables a structured reflection on the capacity of multistakeholder governance processes to foster knowledge integration. Its emphasis on dialog and exploration allows adaptation to contextual specificities, highlights relative strengths and weaknesses, and suggests avenues for shaping multistakeholder governance toward mutual learning, capacity building, and strengthened networks. The validation suggests that the adaptive capacity of multistakeholder governance could be best enhanced by considering systems characteristics at the policy formulation stage and fostering adaptive and generic learning at the evaluation stage of the policy cycle. ; ISSN:1708-3087

This article is based upon work from COST Action (TD 1404, Network for Evaluation of One Health, NEOH), supported by COST (European Cooperation on Science and Technology), and the State Secretariat for Education, Research and Innovation via the Swiss National Science Foundation (grant IZCNZ0-174587). ; Research and policy processes in many fields, such as sustainability and health, are increasingly relying on transdisciplinary cooperation among a multitude of governmental, nongovernmental, and private actors from local to global levels. In the absence of hierarchical chains of command, multistakeholder governance may accommodate conflicting or diverse interests and facilitate collective action, but its effectiveness depends on its capacity to integrate systems, transformation, and target knowledge. Approaches to foster such governance are nascent and quickly evolving, and methodological standards to facilitate comparison and learning from best practice are needed. However, there is currently no evaluation approach that (i) comprehensively assesses the capacity for knowledge integration in multistakeholder governance, (ii) draws on the best available knowledge that is being developed in various fields, and (iii) combines a systematic and transferable methodological design with pragmatic feasibility. We brought together 20 experts from institutions in nine countries, all working on evaluation approaches for collaborative science– policy initiatives. In a synthesis process that included a 2-day workshop and follow-up work among a core group of participants, we developed a tool for evaluating knowledge integration capacity in multistakeholder governance (EVOLvINC). Its 23 indicators incorporate previously defined criteria and components of transdisciplinary evaluations into a single, comprehensive framework that operationalizes the capacity for integrating systems, target, and transformation knowledge during an initiative's (a) design and planning processes at the policy formulation stage, (b) organization and working processes at the implementation stage, and (c) sharing and learning processes at the evaluation stage of the policy cycle. EVOLvINC is (i) implemented through a questionnaire, (ii) builds on established indicators where possible, (iii) offers a consistent and transparent semiquantitative scoring and aggregation algorithm, and (iv) uses spider diagrams for visualizing results. The tool builds on experience and expertise from both the northern and southern hemispheres and was empirically validated with seven science–policy initiatives in six African and Asian countries. As a generalized framework, EVOLvINC thus enables a structured reflection on the capacity of multistakeholder governance processes to foster knowledge integration. Its emphasis on dialog and exploration allows adaptation to contextual specificities, highlights relative strengths and weaknesses, and suggests avenues for shaping multistakeholder governance toward mutual learning, capacity building, and strengthened networks. The validation suggests that the adaptive capacity of multistakeholder governance could be best enhanced by considering systems characteristics at the policy formulation stage and fostering adaptive and generic learning at the evaluation stage of the policy cycle. ; publishersversion ; published

One Health (OH) positions health professionals as agents for change and provides a platform to manage determinants of health that are often not comprehensively captured in medicine or public health alone. However, due to the organization of societies and disciplines, and the sectoral allocation of resources, the development of transdisciplinary approaches requires effort and perseverance. Therefore, there is a need to provide evidence on the added value of OH for governments, researchers, funding bodies, and stakeholders. This paper outlines a conceptual framework of what OH approaches can encompass and the added values they can provide. The framework was developed during a workshop conducted by the "Network for Evaluation of One Health," an Action funded by the European Cooperation in Science and Technology. By systematically describing the various aspects of OH, we provide the basis for measuring and monitoring the integration of disciplines, sectors, and stakeholders in health initiatives. The framework identifies the social, economic, and environmental drivers leading to integrated approaches to health and illustrates how these evoke characteristic OH operations, i.e., thinking, planning, and working, and require supporting infrastructures to allow learning, sharing, and systemic organization. It also describes the OH outcomes (i.e., sustainability, health and welfare, interspecies equity and stewardship, effectiveness, and efficiency), which are not possible to obtain through sectoral approaches alone, and their alignment with aspects of sustainable development based on society, environment, and economy.

One Health (OH) positions health professionals as agents for change and provides a platform to manage determinants of health that are often not comprehensively captured in medicine or public health alone. However, due to the organization of societies and disciplines, and the sectoral allocation of resources, the development of transdisciplinary approaches requires effort and perseverance. Therefore, there is a need to provide evidence on the added value of OH for governments, researchers, funding bodies, and stakeholders. This paper outlines a conceptual framework of what OH approaches can encompass and the added values they can provide. The framework was developed during a workshop conducted by the "Network for Evaluation of One Health," an Action funded by the European Cooperation in Science and Technology. By systematically describing the various aspects of OH, we provide the basis for measuring and monitoring the integration of disciplines, sectors, and stakeholders in health initiatives. The framework identifies the social, economic, and environmental drivers leading to integrated approaches to health and illustrates how these evoke characteristic OH operations, i.e., thinking, planning, and working, and require supporting infrastructures to allow learning, sharing, and systemic organization. It also describes the OH outcomes (i.e., sustainability, health and welfare, interspecies equity and stewardship, effectiveness, and efficiency), which are not possible to obtain through sectoral approaches alone, and their alignment with aspects of sustainable development based on society, environment, and economy.