Two pandemics in China, One Health in Chinese.

The term ‘One Health’ was coined in 2003 to describe the interdependence of healthy ecosystems, animals and people, soon after the emergence of SARS broke out. The philosophy of One Health is now widely accepted by the international community, due to the COVID-19 pandemic, which was first reported in China, but its origin is far from certain.

China has suffered two major pandemics during the 21st century. The ‘One Health’ philosophy and principals are dearly needed in China; therefore, it is critical to ensure a correct Chinese translation so that its holistic meaning could be fully grasped, and actions could be orchestrated across the globe.

In China, two completely different Chinese characters are used as the translation of ‘One’ in One Health. Both sides have distinguished scholars from the field, and have reasonable arguments.

The opportunities to contribute to Health at the ‘World’ scale, on the ‘International’ stage and with ‘Global’ spirit certainly sound inspirational especially for the young generations. But we argue that the acronym WIG (world, international, global) paints a more realistic picture of what is needed to be done. Under a wig in health salons, there is a hairless problem to be fixed. Under a wig in justice courts, there is a fairness problem to be tackled.

Introduction

The term ‘One Health’ was coined in 2003 soon after the emergence of SARS.1 In 2004, the Wildlife Conservation Society organised a symposium titled “Building Interdisciplinary Bridges to Health in a Globalized World’’, where a group of human and animal health experts discussed the movement of diseases among humans, domestic animals and wildlife. The symposium set 12 priorities (known as the ‘Manhattan Principles’) to combat health threats to both human and animals and called for an interdisciplinary approach known as the ‘One Health, One World’ concept.2

The concept of One Health is evolving and getting more attention, while the most commonly used definition is from the US Centers for Disease Control and Prevention (CDC) and the One Health Commission. It defines One Health as ‘a collaborative, multisectoral, and transdisciplinary approach—working at the local, regional, national, and global levels—with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment’.3 On 1 December 2021, the One Health High-Level Expert Panel, developed an operational definition of One Health as ‘an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems’.

Although the concept of ‘One Health’ did not originate from China, China is vulnerable to zoonotic disease transmission due to a large agricultural work force, sizeable domestic livestock population and a highly biodiverse ecology. Since the outbreak of COVID-19, China’s 1.4 billion people have fought with one heart and one mind against the disease. China has realised the importance of ‘One Health’. For example, the most recent United Nations Conference of the Parties (COP-15) Convention on Biological Diversity was hosted in Kunming, Yunnan Province, China. The ‘One Health’ philosophy and principals are dearly needed in China, and it is critical to ensure a correct Chinese translation so that its holistic meaning can be fully grasped, and actions could be orchestrated across the globe.

One Health and the Chinese character ‘同’

The concept of ‘One Health’ is understood the same way in China as it is in the rest of the world, that is, it includes not only the health of humans, but also the health of animals, plants and our shared environments. However, the translation of ‘One Health’ into Chinese is not that straightforward at all.

Right after the Beijing 2022 Winter Olympic Games, let us also bring back memories from the Beijing 2008 Summer Olympic Games. At that time, the motto ‘One World One Dream’ was a profound manifestation of the essence and the universal values of the Olympic spirit—Unity, Friendship, Progress, Harmony, Participation and Dream. The two Ones are translated into ‘一’ in Chinese, which is simply a laid down version of the Arabic number ‘1’. However, the key meaning of ‘One’ herein was expressed by the prefixed Chinese character ‘同’, which literally means ‘same’. It highlights the fact that we belong to the same world, and we share the same aspirations and dreams.

It seems natural to translate ‘One’ in ‘One Health’ as ‘同一’, the same way as that for the ‘One World One Dream’. However, surprisingly, that is not the case. Some including the founding director of China CDC did use the expression of ‘同一’,4 others including the chancellor of Shanghai Jiao Tong University School of Medicine proposed to use a totally different Chinese character ‘全’,5 yet others simply keep the original English expression in the banner.6

The top panel of figure 1 illustrates the etymological origin of the Chinese characters 同. It originates from the image of a plate and a mouth, which vividly reminds all of us the Chinese wisdom related to the sense of connected, shared and togetherness. This ancient wisdom is on full display through the motto of Beijing Winter Olympic Games—‘Together for a Shared Future’. The Chinese character ‘同’ also exists in the lofty slogan of ‘a Community with a Shared Future for Mankind; (Chinese: 人类命运共同体)’, which was first proposed by Chinese leadership in 2017. We therefore argue this is a suitable Chinese character to be used for ‘One Health’. Of note, another common expression that used ‘同’ is ‘同类’, which could be narrowly interpreted as the same species but without dismissing individual differences. The sense of shared destiny, considering individual differences, fits nicely into the context of ‘One Health’.

Figure 1

Etymological origin of the two Chinese characters for ‘One’.

Global Health and the Chinese character ‘全’

Global health as a scientific term first appeared in the literature in the 1940s.7 As noted previously, on 29 September 2004, the Wildlife Conservation Society organised a symposium titled ‘Building Interdisciplinary Bridges to Health in a ‘Globalized World’’. We can clearly see how One Health is related to globalisation and therefore global health. In 2009, Koplan et al defined global health as ‘an area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide’.8 Recently, the importance of both ‘Global Health’ and ‘One Health’ are stressed for China’s new era of public health.4

In contrast with the translation for ‘One Health’, the Chinese translation for the adjective ‘Global’ is unambiguous. Based on our knowledge so far, all global health institutions and projects in China are translated with the Chinese name of ‘全球’. The character ‘球’ literally means ‘ball’, also used to represent the earth. Literally, ‘全’ means ‘all’ and ‘complete’. The bottom panel of figure 1 illustrates the etymological origin of the Chinese characters 全. The top part of this character (ie, ‘人’) means ‘human’, while the bottom part (ie, ‘王’) literally means ‘king’, powered by weapons and forces. While this Chinese character ‘全’ carries some essential meaning of One Health, we argue that a character implying human as the king is not an ideal philosophy for One Health.

As we see from the definition by Koplan et al, global health is ‘for all people worldwide’. Therefore, using the Chinese character ‘全’ seems to be appropriate, which is composed of two Chinese characters that literally mean ‘human’ and ‘king’, respectively. However, for One Health, as seen in COVID-19, the philosophy should change from ‘for all people’ to ‘people for all’. As we become more capable of exploring, if not exploiting, other planetary existence, it is important that we have a sense of shared destiny and connected responsibility in what we humans do. Therefore, the Chinese wisdom embedded in the Chinese character ‘同’ is more appropriate.

Humble but appropriate acronym of WIG and WIGO

In 2004, Tom McArthur, an honorary fellow of the London-based Institute of Linguists, penned an excellent essay on the literal meaning and subtle distinctions between the words ‘World’, ‘International’ and ‘Global’.9 Taking ‘peace’ for example, the author stated that ‘world peace’ contrasts with world war, ‘global peace’ has implication of non-violence that goes beyond formal warfare, while ‘international peace’ is less comprehensive and can be broken if only two nations engage in hostilities. Putting linguistic nuances aside, we express no preference to any of the three words (world, international, global). We simply use the acronym WIG to encompass the concept more fully. Ironically, in common parlance since the days of Shakespeare, ‘wig’ refers to an artificial or human hair appliance used to denote status or to hide a loss of hair, often seen as a sign of ageing or poor health. The term ‘wig’ certainly does not match the grandiose expression of the three terms (world, international, global); it is not inspirational and might even sound somewhat embarrassing. But it can be argued that it is an appropriate acronym, given the fact that a lot of ‘wig’ health issues are severe and cannot be resolved by a cosmetic covering. To solve or even mitigate health issues of global concern, we need to look deeply into the hair loss challenge hiding underneath a wig.

With this new addition of ‘One Health’, WIG health becomes WIGO health. The acronym WIGO is often used to ask the simple yet important question ‘what is going on?’. Indeed, it is essential to explore in depth, examine objectively, and think proactively about ‘what is going on?’ to learn all that the COVID-19 pandemic can teach. The pandemic has provided undisputed evidence that a respiratory virus can periodically spread from animals to humans,10 and easily cross man-made borders and natural boundaries. While COVID-19 is still rampaging, we should not simply ponder on what is going on. Instead, we need to collaboratively act.

Conclusions

COVID-19 provides an unfortunate but invaluable opportunity to demonstrate the fundamental importance of the One Health approach. The academic world also gives a lot of credit and emphasis to the study of nature, and its exploration through natural approaches. The 2021 Nobel Prize in Physics was awarded for understanding Earth’s climate including global warming, and the Nobel Prize in Economic Sciences was awarded for methodological contributions to the analysis of causal relationships through natural experiments. In October 2021, the first part of Convention on Biological Diversity (COP-15) not only shaped the next decade for global biodiversity conservation but also reflected China’s potential as a new ecological leader and more broadly as a contributor to multilateral global governance platforms. There is wisdom hidden in the Chinese characters for ‘One’. Getting the translation correct is the first step to get the philosophy well seeded and rooted.