Hygiene Holds an Underused Key to One Health, Researchers Argue

Hygiene could play a far larger role in tackling zoonotic disease, antimicrobial resistance and food safety than current programs allow, but it remains trapped in silos that separate human, animal and environmental health, according to a perspective article published in BMC Global and Public Health. The paper, led by Max T. Eyre and colleagues including Kelly Baker, argues that hygiene is a critical yet under-recognized component of One Health, the collaborative approach that recognizes the interconnection between human, animal and ecosystem health. Drawing on structured sessions at three international conferences, the authors map gaps and priorities for aligning hygiene with One Health across research, policy and practice, and set out six cross-cutting recommendations for closing the divide.

Hygiene, as defined in the article, covers the practices and conditions that reduce or prevent exposure to pathogens and other health hazards, particularly through cleanliness. That includes handwashing, safe management of human and animal waste, cleaning of shared spaces such as homes, farms and markets, environmental management and biosecurity measures. These practices operate squarely at the human-animal-environment interface, interrupting the transmission pathways that link people, animals and ecosystems. Yet the authors note that hygiene is predominantly framed within human-oriented water, sanitation and hygiene efforts or infection prevention, and hygiene programs rarely adopt a perspective that considers animal and biodiversity concerns. When hygiene measures are not applied across species and shared environments, pathogens and hazards can persist and circulate through contaminated water, food systems and shared spaces, shifting One Health efforts toward downstream reactive responses that are often more costly and less sustainable than prevention.

The evidence base for the perspective comes from three sessions convened by the authors: at the 2023 University of North Carolina Water and Health Conference in October 2023, the 2023 Global Hygiene Symposium organized by the Reckitt Global Hygiene Institute and Chatham House in January 2024, and an interactive symposium at the 2024 American Society of Tropical Medicine and Hygiene Annual Meeting in November 2024. Participants represented epidemiology, environmental public health, WASH, veterinary and animal health, social science, policy and implementation, and came from academia, government, non-governmental organizations and community practice across the Americas, Europe, Africa, Asia and Australia. At the first conference, a World Café format asked participants to reflect on research gaps, methodology, intervention development, evaluation and translation into practice; later sessions foregrounded stakeholders and scale, from community to global levels. The viewpoints presented reflect the authors’ interpretations alongside the collective input of session participants.

The most prominent evidence gap identified concerns the environment. Efforts to reduce zoonotic risks have traditionally focused on human and animal health, with strategies targeting human-animal interactions such as disinfection, safe animal waste management, biosecurity and physical separation. The environmental dimension remains under-addressed despite its recognized importance as a determinant of ecosystem health and disease transmission, and the pathways mediated by the environment are less well understood than human-animal routes. Participants argued that conceptual clarity is essential: the environment is often treated as an omnibus category covering everything outside human and veterinary medicine, or as a passive transmission site, when it should be viewed as a dynamic system mediating multispecies interactions and ecosystem health. Identified gaps include health risks for animals and their needs for clean food and water, the effects of seasonality, extreme weather and climate change on transmission and hygiene conditions, and a heavy research focus on households that neglects peridomestic and public spaces such as airports, train stations, forests and wetlands.

Antimicrobial resistance emerged as a consistent research priority across all three sessions. Participants highlighted the need for stronger evidence on how hygiene interventions across the animal-based food chain can reduce foodborne and zoonotic disease risks and interrupt AMR transmission pathways, and on how hygiene, sanitation and animal husbandry practices influence antibiotic use in food production. A key question raised was whether hygiene can realistically substitute for antibiotics or vaccines in practice. From the authors’ viewpoint, hygiene cannot replace these interventions, but it can play complementary roles in disease prevention and control, and by lowering infection incidence may reduce demand for antibiotic use, especially in resource-limited settings where access to veterinary care and healthcare is challenging. Participants emphasized the need for research evaluating the effectiveness, feasibility and incentives required to support hygiene-based strategies in livestock production and food systems, alongside coordinated policies, infrastructure investments and surveillance systems.

Methodological gaps formed a second major theme. Participants identified five key problems: the lack of standardized tools for measuring fecal contamination; limited availability of integrated and affordable diagnostics for pathogen detection; challenges in assessing human exposure to fecal contamination and measuring hygiene behaviors; fragmented data systems; and a need for integrated transdisciplinary study designs. Environmental hygiene monitoring tools are well established in regulated industries such as food production but are inconsistently applied and often unsuitable for households, farms, schools, markets and shared public spaces, where contamination pathways are diverse and sources are mixed. Microbial source tracking, which uses genetic markers to distinguish human from animal contamination, shows promise but remains technically complex and difficult to scale in resource-constrained settings. Most studies of human exposure to animal fecal contamination rely on proxy survey indicators such as animal ownership or proximity to livestock, which do not capture the specific pathways through which exposure occurs, though tools such as the FECEZ Enteropathogens Index are beginning to address these gaps through validated, multi-dimensional survey-based measures.

Measuring hygiene behaviors presents its own difficulties, since self-reports are vulnerable to social desirability bias and structured observation is constrained by acceptability, short observation periods and high cost. Participants recommended triangulating data through combinations of surveys, structured direct observations, geo-tracking and activity diaries, and highlighted qualitative and mixed methods for their ability to reveal contextual drivers of persistent risky behaviors. Data fragmentation across sectors was another major barrier: human, animal and environmental agencies often collect and store information separately using incompatible protocols and platforms, preventing analysis of shared exposure pathways and cumulative risks. Participants called for shared digital platforms, standardized data collection methods and coordinated data-sharing across health, agriculture and environmental sectors. They also underscored the value of transdisciplinary designs such as eco-epidemiological studies that integrate human, animal and environmental data within a single study, and of large-scale, mixed-methods longitudinal studies, citing the PATHOME study in Kenya as an example of combining longitudinal pathogen detection, behavioral observation, environmental sampling and spatial analysis.

On interventions and implementation, participants identified four themes: engaging local stakeholders for culturally relevant, cross-sectoral interventions; balancing infrastructure upgrades with behavior change while adapting existing programs; incorporating ecosystem restoration into hygiene efforts; and broadening evaluation to include diverse outcomes. The authors caution that household-level interventions relying on individual behavior change in settings without accessible services can place disproportionate burdens on poor households and risk reinforcing gender inequalities, given that women are frequently the household caregiver and hygiene manager. Existing interventions should be adapted to incorporate human, animal and environmental components rather than designing new ones; for example, WASH programs could partner with veterinary services to integrate animal vaccinations and waste management into a single intervention. Implementation priorities included localized program design and decision-making, regional cooperation for cross-border threats such as zoonoses and AMR driven by human and animal movement, and leveraging existing pandemic preparedness infrastructure such as genomics labs and wastewater testing platforms to support broader hygiene surveillance.

Policy priorities centered on reducing institutional fragmentation, harmonizing standards and embedding hygiene into existing frameworks. Participants noted that hygiene policy for live animal and food markets varies widely between countries, and that veterinary access to antibiotics is highly restricted in some regions while human access through unregulated pharmaceutical markets remains widespread, leading to cross-use in animals. While hygiene is embedded in SDG 6 and elements of animal and ecosystem health appear in other SDGs, the goals do not explicitly address interconnections between human, animal and ecosystem health, limiting visibility and accountability. Many AMR National Action Plans explicitly grounded in One Health offer a strategic entry point for institutionalizing hygiene within cross-sectoral governance, though hygiene at shared human-animal-environment interfaces remains unevenly operationalized. Participants recommended embedding hygiene-One Health goals into existing policy mechanisms such as Codex food safety standards rather than creating new frameworks, and noted that community values should inform policy while regional or national stakeholders lead its development.

The article closes with six recommendations: strengthening the environmental dimension across hygiene and One Health; strengthening transdisciplinary research on hygiene-related transmission; linking hygiene-related surveillance across sectors using common measures and shared data; co-designing practical hygiene interventions with local stakeholders at high-risk interfaces; integrating hygiene standards into existing One Health policy and regulatory frameworks; and using AMR prevention as a practical starting point for alignment. The authors acknowledge limitations: participants were predominantly from WASH and human health backgrounds, with limited representation from food systems and ecosystem health, and discussions were likely biased toward infectious disease and AMR, with respiratory, vector-borne and direct contact transmission pathways notably absent. They also cite recent reviews finding that roughly two-thirds of One Health platforms in low- and middle-income countries included environmental sector representation, often in a subordinate role, and that in one scoping review none of the reviewed One Health studies involved the human-environment or animal-environment sectors. As an example of what alignment can achieve, the authors point to Brazil’s integrated response to highly pathogenic avian influenza, which involved environmental, agricultural and human health institutions in surveillance of domestic and wild birds, biosecurity checkpoints, disinfection stations and coordinated sample processing, implemented through existing infrastructure rather than parallel structures.

Subject of Research: Alignment of hygiene practice with One Health approaches to zoonotic disease, antimicrobial resistance and ecosystem health

Article Title: Priorities and opportunities for strengthening hygiene and One Health alignment in research, policy and practice

Article References: Eyre, M. T., Thomas, E. D., Gutema, F. D., Li, H., & Baker, K. (2026). Priorities and opportunities for strengthening hygiene and One Health alignment in research, policy and practice. BMC Global and Public Health, 4(1), Article 102. https://doi.org/10.1186/s44263-026-00337-z

Image Credits: AI Generated

DOI: 10.1186/s44263-026-00337-z

Keywords: One Health, hygiene, antimicrobial resistance, zoonotic disease, WASH, food safety, ecosystem health, surveillance, policy, transdisciplinary research, conference consultations, BMC Global and Public Health