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Abstract Aim The aim of the study was to reach consensus on modifiable risk factors for a novel system of care to address Manifestations of Frailty in hospitalized older adults. Design Consensus study. Method A modified nominal group technique, incorporating expert group face‐to‐face interaction, review of existing evidence and pre/post‐meeting questionnaire completion was undertaken November 2019–February 2020. Results Seventy‐one risk factors, within seven risk factor domains (pain, medication, fluid and nutrition intake, mobility, elimination, infection, additional patient factors) were considered. It was agreed that 44 risk factors incorporating patient, organizational and environmental risk factors were modifiable and should be included in a novel system of care.

Abstract One Health recognises the interdependence between the health of humans, animals, plants and the environment. With the increasing inclusion of One Health in multiple global health strategies, the One Health workforce must be prepared to protect and sustain the health and well-being of life on the planet. In this paper, a review of past and currently accepted One Health core competencies was conducted, with competence gaps identified. Here, the Network for Ecohealth and One Health (NEOH) propose updated core competencies designed to simplify what can be a complex area, grouping competencies into three main areas of: Skills; Values and Attitudes; and Knowledge and Awareness; with several layers underlying each. These are intentionally applicable to stakeholders from various sectors and across all levels to support capacity-building efforts within the One Health workforce. The updated competencies from NEOH can be used to evaluate and enhance current curricula, create new ones, or inform professional training programs at all levels, including students, university teaching staff, or government officials as well as continual professional development for frontline health practitioners and policy makers. The competencies are aligned with the new definition of One Health developed by the One Health High-Level Expert Panel (OHHLEP), and when supported by subjectspecific expertise, will deliver the transformation needed to prevent and respond to complex global challenges. One Health Impact Statement Within a rapidly changing global environment, the need for practitioners competent in integrated approaches to health has increased substantially. Narrow approaches may not only limit opportunities for global and local solutions but, initiatives that do not consider other disciplines or social, economic and cultural contexts, may result in unforeseen and detrimental consequences. In keeping with principles of One Health, the Network for Ecohealth and One Health (NEOH) competencies entail a collaborative effort between multiple disciplines and sectors. They focus on enabling practitioners, from any background, at any level or scale of involvement, to promote and support a transformation to integrated health approaches. The updated competencies can be layered with existing disciplinary competencies and used to evaluate and enhance current education curricula, create new ones, or inform professional training programs at all levels-including for students, teachers and government officials as well as continual professional development for frontline health practitioners and policymakers. The competencies outlined here are applicable to all professionals and disciplines who may contribute to One Health, and are complimentary to, not a replacement for, any discipline-specific competencies. We believe the NEOH competencies meet the need outlined by the Quadripartite’s (Food and Agriculture Organisation, United Nations Environment Programme, World Health Organisation, World Organisation for Animal Health) Joint Plan of Action on One Health which calls for cross-sectoral competencies.

Abstract One Health has been gaining acceptance as an approach to addressing complex health challenges. Due to the multifactorial nature of disease emergence, pandemic prevention efforts benefit from a transdisciplinary approach to identifying risk factors, effective mitigation strategies and control points, hence making One Health attractive. When considering a zoonotic disease with pandemic potential, such as Ebola Virus Disease (EVD), gaining an understanding of the factors that can contribute to an increased risk of disease spillover occurring allows for early intervention, decreasing the risk of initial transmission from animal to human. However, despite the advantages that the One Health approach offers, there remain challenges to adopting and operationalising it effectively, including barriers of status, bias and power between professions and the effective integration of environmental health and social science expertise. One Health Impact Statement The SARS-CoV-2 pandemic has brought into sharp focus the interrelated nature of human, animal and environmental health. There is renewed focus on the importance of pandemic prevention efforts and an acknowledgement that human health cannot be viewed in isolation. By drawing on a wide variety of professional disciplines and embracing traditional and indigenous knowledge regarding diseases and social determinants of health, a much richer understanding of potential intervention points can be generated. Additionally, a deeper understanding can be gained concerning actions with the greatest potential to prevent the emergence and establishment of diseases with pandemic potential within a human population. This desk study highlights that there is value in harnessing the transdisciplinary One Health approach to increase knowledge regarding the currently poorly understood risk factors for Ebola Virus Disease (EBV) spilling over from animals to humans. It also highlights some of the challenges to effective implementation of the approach.

Abstract The term One Health encompasses the medicine of humans, animals, the environment and the interrelations between them. There has been substantial progress in recognising the importance of collective agreements and thinking in healthcare and preventative medicine, particularly in the wake of the COVID-19 pandemic, with amplified acknowledgement of the role zoonoses increasingly play in our global health system. The 2021 Royal Society of Medicine’s One Health: The Missing Link conference brought together subject experts from across medical specialties to discuss cultures of coworking, key challenges and the future vision of One Health both nationally and on a global scale. This perspective article aims to summarise the discussions arising from the event, and highlights particular challenges in medical education, public and global health policy, antimicrobial resistance and stewardship and environmental medicine. This article will serve to consolidate the outcomes of this event and generate dialogue between clinical and non-clinical stakeholders within the One Health space. One Health Impact Statement This article summarises the discussions and contributions of the 2021 Royal Society of Medicine One Health symposium and linked events. Major discussion points are described including antimicrobial resistance, training of human and animal clinicians, the link to environmental medicine, and positioning one health efforts within the wider third sector. We outline current challenges in unifying a One Health approach as well as offering perspectives for collaboration and interdisciplinary work.