At the periphery: Applying One Health to explore joint provision of human and animal healthcare in marginalised communities

This study presents a paradigmatic shift in application of One Health, moving away from disease surveillance and exploring ways in which human and animal healthcare professionals can apply One Health thinking to address the global concern of health disparity in marginalised communities. The literature was reviewed to identify examples of co-provision (‘joint’) of human and animal healthcare. All examples entailed marginalised communities. Half of the examples related to provision of care to people experiencing homelessness (PEH), up to 20% of whom have companion animals. The empirical research investigated the healthcare needs and challenges of PEH with companion animals in the UK and whether joint healthcare would be a desirable and feasible prospect in this context. The study used a collective case-study approach, using semi-structured interviews with participants representative of different stakeholder groups relevant to homelessness to provide a multi-perspective study. Thirteen participants were purposively selected, as service users or service providers, including human healthcare and veterinary professionals, from different geographical locations and organisations. Interpretative phenomenological analysis was used to determine common themes across the cohort. Maintaining the humananimal bond, addressing animal health, coping with trauma, and building trust were healthcare needs. Challenges included managing stigmatisation and inconsistencies in care provision, healthcare access issues, incorporating the third sector, Covid-19 impact and individual limitations of service providers. Joint healthcare is being practised in limited ways, largely via ad-hoc collaboration between service providers. There are strong indications for the development of joint healthcare but logistical and ethical barriers. The study concludes that this context presents an excellent example of application of One Health. Education through continuing professional development is essential to develop transdisciplinary approaches for PEH and their companion animals. Further qualitative research with a larger sample size, including participants from a greater number of geographical locations, organisations and at different stages of a service user journey is recommended.