A relational turn in one health: A systematic review of environmental determinants, equity, and governance frameworks

Abstract

Background: 

The One Health framework, originally developed for zoonotic disease prevention, has faced criticism for insufficient engagement with environmental and social determinants of health. As transnational crises from climate change, pollution, and biodiversity loss accelerate worldwide, there is an urgent need to re-vision One Health as a more equity-oriented and systems-based approach.

Methods: 

Following PRISMA 2020 guidelines, this systematic review examined peer-reviewed review articles published between January 2021 and May 2025 that explicitly applied a One Health lens to environmental determinants of health. The review combined elements of the Mixed Methods Appraisal Tool (MMAT) and the Scale for the Assessment of Narrative Review Articles (SANRA) for quality appraisal. A hybrid synthesis process was employed to identify conceptual innovations and thematic domains.

Results: 

Seven studies were included. The most commonly identified environmental determinants of One Health were climate change, biodiversity loss, and water insecurity. Three themes were identified: (i) Taking One Health beyond zoonoses; (ii) Building relational and context-specific approaches centered in equity and Indigenous knowledges; and (iii) Ongoing governance silos and marginalization of environmental actors in favour of biomedical and veterinary voices. Building on these insights, we propose a Relational One Health Framework, which centres justice, governance, and interdependence for health.

Conclusions: 

This review conceptualises a Relational One Health Framework which reconceptualises health as an emergent property of interdependent human–animal–environment relationships, through equity and participatory governance. Buoyed by global momentum for “one health governance,” the framework provides a timely pathway for policymakers, practitioners, and researchers to embed environmental determinants within holistic governance of health.

Recommendation: 

Future research should expand coverage of databases, integrate empirical case studies, and create integrative metrics that assess both environmental and health equity benefits. In policy platforms, environmental knowledge should be incorporated as a core interest in One Health implementation.