KATHMANDU, MARCH 25

As Nepal is undergoing a major shift in public health, experts have called for adopting a 'One Health' approach as an integrated strategy linking human, animal, and environmental health to tackle the country's evolving public health challenges.

Speaking at the "One Health Framework: Multi-stakeholder Consultation for Intersectoral Action" in Lalitpur today, they emphasized the need for urgent and coordinated action across multiple sectors to effectively address emerging risks and improve overall health outcomes.

The consultation was held to facilitate multi-stakeholder dialogue on the wider determinants of health and to identify and map the roles and responsibilities of different sectors in addressing the country's population health with changing burden of disease (BoD) and premature mortality. It was organized by HERD International as a part of the probability of premature death (PPD) analytical component of the Nepal Chapter of The Lancet Commission on Investing in Health (Nepal CIH), in coordination with the Ministry of Health and Population (MoHP) and Nepal Health Economics Association (NHEA). It is supported by the British Embassy Kathmandu, in partnership with the Bergen Centre for Ethics and Priority Setting in Health (BCEPS) at the University of Bergen (UiB), Norway.

Sharing findings and results from BoD/PPD analyses, public health researcher and a PhD scholar at BCEPS, UiB, Achyut Raj Pandey, highlighted that over the past three decades the country has made notable progress in extending life expectancy with from 58.1 years in 1990 to 73.5 years in 2023. "However, healthy life expectancy has not kept pace, meaning more people are living longer with illness and disability. "On an average, a Nepali citizen spends 10 years in poor health and this has been increasing. It has a huge implication for the health care demand," he said. The analyses were conducted by HERD International (HERDi) and NHEA with support from BEK in partnership with BCEPS.

The analysis shows Nepal is undergoing a major shift in disease patterns, with non-communicable diseases such as cardiovascular conditions and cancer now causing around 70 percent of deaths, overtaking infectious diseases. Despite health gains, premature mortality remains high, with more than 102,000 early deaths (before 70 years of age) recorded in 2023, and one in three Nepalis still dying before age 70. It also finds that healthcare services alone are insufficient, as up to 80 percent of health outcomes are driven by factors like air pollution, tobacco use, poor diet, and high blood pressure; improving air quality alone could prevent about 27,000 deaths annually. Emerging threats such as antimicrobial resistance, alongside environmental degradation, unsafe water, and poor sanitation, are further intensifying public health challenges.

Social science researcher Binaya Chalise, consulltant at NHEA and HERDi, also sharing the analyses, said most factors influencing health lie outside the health sector, yet fragmented responsibilities between sectors have created gaps and jurisdictional friction in addressing health challenges. "Health data mainly captures outcomes like deaths and diseases, but fails to reflect broader drivers such as environmental conditions, animal health, and transmission pathways," he said, adding that an integrated One Health approach addresses these gaps and future risks.

Dr. Sushil Chandra Baral, Managing Director of HERDi, said that new data have raised alarm over the underlying causes of deaths across sectors. He added that without innovative approaches beyond the health sector, risks could escalate and that there is a need for a holistic One Health strategy linking health, education, the environment, and agriculture.

The participants representing several federal government ministries such as MoHP, Ministry of Agriculture and Livestock Development (MoALD), and Ministry of Education, Science and Technology (MoEST) stated that coordinated policies across sectors such as health, agriculture, urban development, and environment are essential to improving long-term health outcomes.

"We will incorporate those analyses and key suggestions from the experts into our annual programs to address the changing pattern in the disease burden and the premature death," said Dr. Bhim Prasad Sapkota, Chief of Health Coordination Division at MoHP.

Suresh Kumar Joshi from MoEST said that the One Health framework helps his ministry incorporate topics such as hygiene, the environment, and disease prevention into schools to build a healthier society. Officials from MoALD noted that the framework is key to improving animal health, food safety, and farming practices to prevent diseases that can spread from animals to people.