Every year, nearly 2 million young Americans experience homelessness. which can be both a crucial source of emotional support and a barrier to receiving services such as housing or medical care. Studies have shown that Some may choose veterinary care for their animals over obtaining health care for themselves. Ěý

The Seattle One Health Clinic was designed to address those barriers. Led by the operated in collaboration with the Washington State University College of Veterinary Medicine, and supported by two nonprofit organizations, the clinic offers free veterinary care alongside its medical services. A paper Ěýin the Journal of Primary Care & Community Health found that the integrated approach increased access to preventative medical care for both people and their pets.Ěý

“It’s truly integrated — human and animal providers working together is a unique approach,” said , lead author of the paper and a postdoctoral researcher in the Center for One Health Research.Ěý

At the One Health Clinic, a nurse practitioner and veterinarian, often accompanied by veterinary students, provide primary care services while UW students volunteer as patient navigators, helping to coordinate care and address shared health needs such as extreme weather, environmental contaminants and zoonotic disease. The clinic also helps clients document their pets as emotional support animals, which enables them to access a wider range of housing and other services. Ěý

“The data clearly shows that this model of care is building trust,” Rejto said. “It’s special to see holistic care that takes into account the environment, the animal, the person and their relationships in society, to provide care to these young people. It’s incredibly important for people to have preventative care, and that in turn has a great impact on public health.” Ěý

The study analyzed medical and veterinary records of clinic visits between 2019 and 2022. The majority of human participants were 23 years old or younger. Of the 88 human clients who visited the clinic during that period, 75 saw a health care provider at least once, and 40 patients established care for the first time in at least the past two years. Most of those patients returned for at least one follow-up appointment within two years of their first visit.Ěý

Most significantly, nearly 80% of all visits to the One Health Clinic resulted in clients receiving human health care. That includes 69% of visits where clients initially intended to seek care only for their pets.Ěý

“Adding veterinary care to a primary care clinic creates a supportive environment that is vastly different from a typical medical care facility”, said co-author , one of the founders of the One Health Clinic and director of the UW Center for One Health Research, who is also a UW professor of environmental and occupational health sciences and an associate professor of medicine in the UW School of Medicine. “This unique atmosphere encourages clients to seek care for themselves as well as their animals.”ĚýĚýĚý

A fully integrated model may be a new concept to many, requiring novel partnerships between human health and veterinary professionals, Rejto acknowledged. But the results suggest that health care providers should give greater consideration to the health impact of the human animal bond between people and their pets.ĚýĚý

“Potentially a good start would be to increase collaboration and communication between animal and human health care, to have human health facilities that are in communication with veterinary facilities. That could help identify diseases and shared environmental risks,” Rejto said. “It’s about expanding providers’ and human health care workers’ framework for addressing health.”Ěý

Other authors include , senior research coordinator and center manager at the Center for One Health Research; , a UW assistant professor of global health and of epidemiology and deputy director of the Center for One Health Research; Hannah Fenelon, Michael Xie, Alice Tin and Erin Tabor of the UW Center for One Health Research; of the Washington State University College of Veterinary Medicine; Kate Schneier and Andrew Nee of Neighborcare Health; and Amanda Richer of Uplift Consulting.Ěý

This research was funded by the National Institutes of Health, National Institute of Nursing Research Training Program in Global Health Nursing at the UW, the New Tudor Foundation, and by a gift from the now-shuttered Y/YA Shelter “Peace for the Streets by Kids from the Streets.” Funding for the publication of this study was provided by the American Society for the Prevention of Cruelty to Animals’ (ASPCA) Open-Access Publishing Fund.

Four years ago, as attention locked onto COVID-19, another virus began circling the globe. A major outbreak of a new strain of bird flu — formally named — has since killed millions of wild birds and infected poultry, dairy cattle, and a small number of humans.ĚýĚý

In the United States, four people have contracted the virus. The most recently confirmed , a dairy worker in Michigan, was the first to experience flu-like respiratory symptoms. For now, federal health officials have deemed the virus a low risk to public health, while and monitoring the virus’s spread.Ěý

But what exactly are public health officials looking for? How is this virus different from previous H5N1 outbreaks? And how can a bird flu become humanity’s problem, anyway?ĚýĚý

UW News brought these questions and more to ĚěĂŔÓ°ĘÓ´«Ă˝ experts Peter Rabinowitz, a professor of environmental and occupational health sciences and of family medicine, and , an assistant professor of epidemiology and of global health. They are director and deputy director, respectively, of UW’s , which studies the connections between the health of people, animals and our shared environment.

Peter, you recently . What makes this outbreak different, and why is it drawing so much attention from health officials?ĚýĚý

Peter Rabinowitz: Thirty years ago, outbreaks of highly pathogenic avian influenza were rare in birds. Beginning around 2003, a deadly strain of H5N1 avian influenza started spreading widely, but mostly impacted domestic poultry. Now this recent strain of H5N1 that has been circulating worldwide for the past two years is unprecedented in its ability to affect mammals.Ěý

The H5N1 virus started with birds before “jumping” to dairy cattle and now a handful of humans. How does a virus “jump” between species like that, and what makes certain species vulnerable while others seem to resist the virus?Ěý

PR: As they circulate, influenza viruses are continually changing some of their genetic material, acquiring new mutations in a process known as “” Sometimes when two different strains of a virus are present in the same host human (or animal), they can “recombine” to create a quite different strain.ĚýĚý

Health officials have said the chances of H5N1 becoming a major threat to humans are minimal, but that they’re monitoring the situation for any changes. What are they looking for?ĚýĚý

PR: Health officials are looking for evidence of mammal-to-mammal transmission in non-human mammals, and any evidence of person-to-person transmission, which could be a definite warning about H5N1’s potential to become an epidemic.ĚýĚý

The earliest cases of H5N1 in humans were mild — two dairy workers with eye infections — but the most recent case appears to be . That’s triggered alarm, of course, but what does that say about how the virus is evolving?ĚýĚý

Julianne Meisner: The location of symptoms can sometimes — though not always — tell us something about transmission. When symptoms are restricted to just the eye, it’s likely that transmission would require contact with the tissues around or fluids from the eye, similar to how pink eye (conjunctivitis) is transmitted.Ěý

When health professionals see respiratory symptoms, we get concerned about transmission through droplets or aerosols. Because breathing is something every one of us needs to do, all of the time, respiratory transmission is incredibly efficient, and difficult to avoid. Also, some respiratory symptoms, such as coughing, can propel virus particles further, increasing the efficiency of transmission.ĚýĚý

Much has been made of H5N1 as the next possible pandemic. Should that happen, are there lessons we’ve learned from the COVID-19 pandemic that could help us navigate this one?ĚýĚý

PR: Yes, the lessons learned from COVID-19 in terms of rapid development of vaccines and the effectiveness of control measures such as masks would allow us to respond quickly. Unfortunately, everyone is quite tired of hearing about pandemics, so a challenge would be to capitalize on the helpful lessons learned and find a way to avoid misinformation and public backlash to a public health response.ĚýĚý

JM: While COVID has been very divisive in many ways, it has also familiarized many people with public health: People now know how to navigate dashboards on the health department’s website, and we have muscle memory regarding social distancing, mask wearing, handwashing, etc. Basic epidemiology principles such as quarantine, isolation, transmission rate, etc. are familiar to the general public now. But there is also a lot of fatigue, as Peter mentions, which may make it harder to implement public health countermeasures if they become necessary.ĚýĚý

You both study the connection between human and animal health. It’s easy for people to understand that animal diseases can spread to humans, but how else should we consider that relationship?Ěý

PR: We should raise awareness about the terrible impact of the current avian influenza outbreak on wild and domestic animal populations: millions of poultry dying because of spreading infections, also hundreds of thousands of wild birds and mammals, including sea mammals such as sea lions and seals. An event like this represents a threat to biodiversity and the health of ecosystems, which we have learned is extremely important for human health. The concept of “One Health” stresses these vital connections between the health of humans, other species, and our shared ecosystems.ĚýĚý

To reach Rabinowitz or Meisner, contact Alden Woods of UW News at acwoods@uw.edu.ĚýĚý

Update (Oct. 17, 2024): In an article , the researchers behind Medicine for a Changing Planet make the case that physicians should ask about patients’ environmental exposures when taking their histories. The UW’s Dr. Peter Rabinowitz and Stanford’s Dr. Michele Barry explain why it’s important to consider these factors and how physicians can incorporate them into their practice in the above video. Video credit: Stanford University

Changes to our environment are creating new challenges: emerging disease patterns, threats to mental health, malnutrition and unpredictable natural disasters. These developments are unprecedented. Their impacts are felt across the world, most intensely in communities traditionally excluded from accumulating wealth. Ěý

What health professionals see in hospitals and clinics is shifting, requiring new approaches to diagnosis, treatment and advocacy.ĚýĚý

To address this growing need, the ĚěĂŔÓ°ĘÓ´«Ă˝’s and the Stanford Center for Innovation in Global Health are launching , a collection of clinical case studies supporting health professionals in providing more effective care for patients living with climate change.ĚýĚý

These case studies, collated from clinical encounters around the world, support health professionals in recognizing and treating a variety of health-related conditions that can be traced to environmental stressors. Topics include infectious diseases, non-communicable diseases, malnutrition, heat stress, physical trauma and mental health concerns.ĚýĚý

“We want the skills emphasized in the Medicine for a Changing Planet case studies to empower health care providers to play a more active role in the response to global environmental change,” said , a UW professor of environmental and occupational health sciences who co-led the development of these case studies. “We encourage health professionals to focus on their role as disease detectives, identifying sentinel cases of environmentally induced disease, and steps that they could take to manage such cases, both in and beyond the clinic.”Ěý

Rabinowitz is also a physician in UW Medicine’s Infectious Diseases and Tropical Medicine Clinic and director of the UW Center for One Health Research.Ěý

Among other things, the cases call for an expanded approach to taking a patient’s medical history. Clinicians already are trained to look out for social determinants of health, considering a patient’s occupation, lifestyle and other key factors. Now, in a rapidly changing environment, clinicians must also go a step further. The cases encourage health professionals to consider how environmental stressors, such as extreme heat, wildfires, food access and widespread pollution may impact a patient’s health.ĚýĚý

Each case includes a call to action, describing ways in which clinicians can take action to advance global health. Cases encourage health professionals to work with public health authorities and other key stakeholders, and to consider ways to leverage their roles as trusted voices of authority to advance change in response to a planetary crisis.ĚýĚý

This includes action in the clinic, within local communities, and at a larger societal level — advancing sustainability, developing stakeholder networks, advocating for policy changes and galvanizing grassroots efforts.Ěý

The cases also prompt health professionals to consider how to help patients protect themselves from additional health consequences. This can mean identifying potential environmental stressors and planning steps to reduce exposure.Ěý

“Listening closely to one’s patients to understand the many factors impacting their health has always been a physician’s core responsibility,” said Dr. Michele Barry, Shenson Professor and Director of the at Stanford University’s School of Medicine, and co-lead of this project. “This is even more important now, in a time when the human-altered environment is placing unprecedented pressures on our health and well-being.”Ěý

This project deepens the UW’s longstanding commitment to address the world’s most pressing challenges to health and well-being. The Population Health Initiative unites the entire UW community in that mission by fostering a collaborative approach to improving human health, environmental resilience, and social and economic equity.

, chair of the Department of Environmental and Occupational Health Sciences, said Rabinowitz is a living example of that mission.ĚýĚý

“Since launching the Center for One Health Research at the UW, Dr. Rabinowitz has established a rich global network of researchers and clinicians investigating emerging environmental challenges and diseases,” Yost said. “His role in assembling this new material demonstrates the UW’s commitment to improving population health around the world.” Ěý

Medicine for a Changing World’s core partners include the Global Consortium of Climate and Health Education and their new collection of , as well as the Planetary Health Alliance’s initiative.Ěý

Adapted from a press release by Stanford University.Ěý

For more information, reach Rabinowitz by contacting Vickie Ramirez: ramirezv@uw.eduĚý

The ĚěĂŔÓ°ĘÓ´«Ă˝ will build “pop-up galleries” in public spaces around Seattle in October that will use autobiographical photographs taken by people experiencing homelessness with their companion animals. The photos will be accompanied by quotes from the participants about the challenges and the important bonds they share with their animals and other information from related research.

Pop-up gallery schedule:

• Oct. 4 on UW’s Red Square
• Oct. 7 in Occidental SquareĚýin Seattle’s Pioneer Square district
• Oct. 10 in Seattle’s Cal Anderson Park
• Oct. 13 in the Ballard Commons Park.

UW researchers available at the gallery events:

• Vickie Ramirez, senior research and program coordinator at the Center for One Health Research in the UW School of Public Health
• Gemina Garland-Lewis, photographer and research coordinator in the Center for One Health

About the project:

The galleries are the latest event by the , a center in the UW School of Public Health’s Department of Environmental and Occupational Health Sciences, as part of their long-running project to help improve the health and lives of people experiencing homelessness with their service animals, emotional support animals and pets.

Earlier this summer, the researchers created pilot clinics for including animals into healthcare for the homeless. They joined with veterinarians from Washington State University to establish the One Health Clinic.

For this part of the One Health project, Gemina Garland-Lewis, creator of the website, put disposable cameras and notebooks into the hands of nearly twenty people to document their life experiences. The galleries feature personal moments in their lives and will also feature data visualizations and community maps by Vickie Ramirez created from her research.

For more information, contact:
Vickie Ramirez, ramirezv@uw.edu
UW News video producer Kiyomi Taguchi atĚýktaguchi@uw.edu.

Sparked by a grant from theĚýUW Population Health Initiative,Ěýthe UW’s has created a series of pop-upĚýgalleries featuring autobiographical photographs made by people experiencing homelessness with their animal companions.

The first gallery was Oct. 4 in UW’s Red Square. Other pop-up gallery events are 11 a.m. to 5 p.m. on Monday, Oct. 7, at Occidental SquareĚýin Seattle’s Pioneer Square district; Oct. 10 in Seattle’s Cal Anderson Park; and Oct. 13 in the Ballard Commons Park.

The events also feature data visualizations and community maps based on research conducted during the One Health project. In addition to the center, which is part of the UW Department of Environmental & Occupational Health Sciences in the School of Public Health, collaborators include UW School of Law, School of Social Work and School of Nursing.

The center’s photo galleries will provide windows into the lives of people experiencing homelessness as they navigate the complexities of getting through their days and nights with a service animal, emotional support animal or pet.

“It made sense to start a foundation in storytelling, because this is an issue that is so heavily polarized, especially in Seattle, that data alone wouldn’t necessarily be the first way you were going to start the conversation,” saidĚý, a photographer and One Health research coordinator.

So Garland-Lewis, whose own photos and stories of people experiencing homelessness with their animals can be found at , put disposable cameras and notebooks into the hands of nearly 20 people to document their life experiences. The participants had the cameras for an average of 32 days and created a total of 800 images.

She hopes that when pet-loving Seattleites see the human-animal bond evident in these photos and stories, they will recognize “that they have something in common with someone they thought they had nothing in common with. That’s the door to the data, to look at the data, to look at the issue and think about solutions.”

Earlier this year, One Health researchers tested pilot clinics for including animals in health care services for the homeless. And just this past summer, they joined with veterinarians from Washington State University and Neighborcare Health to establish theĚýOne Health Clinic. At the clinic, a person could see a doctor and have their animal seen by a veterinarian.

, senior research and program coordinator at the center, also collected data through 44 qualitative and quantitative interviews to develop an understanding of the needs and gaps in services for people experiencing homelessness with their animals.ĚýAmong her findings:

• 76 percent of people experiencing homelessness reported barriers to resources due to having an animal
• 64 percent reported being harassed for having an animal
• 55 percent indicated their pets were designated service animals or emotional support animals

Collaborators from the UW School of Law also explored the matrix of city, state and federal laws around animals designated as service or emotional support animals.ĚýThe Law School group created aĚýKnow Your RightsĚýdocument to help a homeless person navigate the legal complexities and be able to assert their rights when it comes to, for example, getting on a city bus with an animal.

Ramirez hopes the One Health Clinic approach to incorporating animals into health care for the homeless will catch on.

“We are getting calls from all over the country from service providers who want to learn how they can replicate our model,” she said. “We want to be able to build a protocol for how to set this up and how it works for other communities to use.”

Other organizations that supported the research include New Horizons, PSKS, Teen Feed, Youth Care, Roots, Street Youth Ministries, the Paws Project and Seattle Dogs Homeless Program.

The gallery had additional financial support from the schools of Social Work and Law.

For more information, contact Ramirez at ramirezv@uw.edu.

Facebook: Center for One Health Research @COHR.UW;ĚýOne Health Clinic @OneHealthClinic