Integrated health approaches: beyond health labels

Recognising the interconnections between the health of humans, animals, and the environment is not a new idea. Across historical periods and cultural contexts, this integrated perspective has been part of many traditional cultures and knowledge systems. In Western traditions, the conceptual boundaries between these health domains have shifted over time [1]. Notably, during the 17th and 18th centuries, significant medical advances emerged from close collaboration among naturalists, veterinarians, and physicians—at a time when these professions often overlapped [2].

However, transformations to the concepts of health in the 18th century gradually shifted to a more compartmentalised view by the mid-19th century—treating human, animal and environmental health as separate concerns. In response, the 20th century saw a re-emergence of integrative frameworks—such as One Health, EcoHealth, Planetary Health, and Ecological Public Health—that called for a more holistic understanding of health. These frameworks emphasise the deep interdependence between humans, biodiversity, and their ecological and socioeconomic systems [3].

Health as an emergent property of socio-ecological systems

Understanding health as an emergent property arises from appreciating the inherent complexity of socio-ecological systems, where human society and nature are deeply interlinked [4].

Global environmental changes—biodiversity loss, emerging contaminants, climate change, and the degradation of ecosystems—pose escalating threats to all species [5]. These environmental pressures interact with social and economic inequalities, generating context-specific risk cascades. Community-level factors—like infrastructure, sanitation, and living conditions—combine with individual behaviours and biological susceptibilities to shape health outcomes [6]. Health, then, is not an isolated state but an emergent property of a dynamic socio-ecological system—a system in which a multiplicity of factors interact [7]. Infectious disease offers a clear example of this interdependence. For instance, climate change hazards [8] can unexpectedly alter host-pathogen dynamics, enabling zoonotic spillover events and aggravating the risks of infectious disease, while marginalised communities, disproportionately exposed to degraded environments, face compounded vulnerabilities [9].

This perspective challenges us to go beyond seeing human, animal and environment health domains as overlapping or merely interconnected compartments. Instead, they are interdependent, co-constitutive assemblages entangled in a single system—structurally and functionally inseparable [10]. This system contains ecological and socioeconomic processes that are active across multiple scales, where feedback loops, synergies, and non-linear interactions shape the health outcomes. Not understanding these intrinsic dynamics can lead to misguided or overly narrow interventions. For example, the reuse of untreated or partially treated wastewater for agricultural irrigation—though proposed as a climate change adaptation strategy—has been shown to increase the spread of antimicrobial resistance genes in agricultural soils [11].

To respond effectively, we must move beyond a notion of mere interconnectedness toward one of true interdependence: a condition in which systems are not only interactive but also structurally and functionally inseparable—so that changes in one domain inherently and immediately affect the others [12]. Embracing the resulting complexity reframes health interventions as dynamic processes requiring continuous monitoring and flexibility to navigate emergent challenges.

From systems thinking to systemic action

The complexity of socio-ecological systems is not only reflected in the multitude of interacting factors but also in the diversity of scales, domains, and actors involved [13]. To address contemporary challenges in public health, adopting a systemic perspective that acknowledges this complexity is essential [13]. However, the key question remains: How can integrated health approaches be effectively operationalised?

Understanding health as an emergent property requires that multiple valid viewpoints—biological, ecological, sociological, cultural/anthropological, psychological, historical and economic—be combined to represent the system holistically. However, systemic analysis is contextual and iterative. It seeks to identify and focus on the most influential factors or anomalies within a given context, where interventions can drive transformative change.

Applying such an approach presents practical and methodological challenges. The multiplicity of perspectives demands transdisciplinary collaboration, where disciplines not merely intersect but multiple agents collaboratively co-create knowledge and solutions. This entails developing a shared language, shared concepts and shared values—balancing technical precision with accessibility and mutual understanding. This requires a shift from knowledge transfer to knowledge co-production.

Co-creation, communication, and iterative collaboration

Transdisciplinary collaboration must begin at the earliest stages of a project—from the formulation of research questions to the design of methods, criteria, and data analysis—as the intention is not merely to share knowledge but to co-create it. For this reason, effective communication between all actors is central, both in developing a shared understanding of the main issues at stake and in formulating context-specific interventions. Effective strategies of collaboration, communication, and co-creation require time, resources, commitment, and the development of trust [14].

Towards institutional and political transformation

As global environmental change accelerates, the shift to a socio-ecological system perspective of health is urgent. This requires institutional transformation— a rethinking of governance structures, funding mechanisms, and research incentives to support long-term, adaptive, cross-sectoral collaboration rather than short-term, reactive interventions. The transition toward integrated health approaches calls for overcoming institutional inertia, disciplinary silos, administrative rigidity, risk aversion, and funding constraints.

Policymakers, researchers, and practitioners are encouraged to embrace this paradigm shift, ensuring these approaches move beyond conceptual aspiration and evolve into practical pathways toward resilient, sustainable socioecological systems. Addressing current health challenges effectively depends on our ability to think, feel—and act—from a systems perspective. Recognising the deep interdependence between people, the planet, and its biodiversity is essential to building healthy systems capable of withstanding future uncertainties.