H. Rodríguez Frausto* 2
One Health is a holistic paradigm that recognizes the interdependence of human, animal, and environmental health (1,2). Global Health similarly seeks to improve health equity worldwide. Yet, these frameworks often overlook the political-economic structures that shape health outcomes. This chapter develops a theoretical framework to enrich One Health and Global Health with “healthy economics,” a concept proposing that an economy organized around equity, democratic participation, and care is foundational for health. Drawing on Marxist economics, activity theory, the concept of “mode of life,” Gramsci’s theory of intellectuals, Silvia Federici’s analysis of social reproduction, Richard D. Wolff’s democracy at work, and Grace Blakeley’s ideas on community empowerment, we outline a socially transformative approach to One Health grounded in Latin American realities. We illustrate with examples from Latin America’s farm animal production – from precarious smallholders to industrial agribusiness – public health initiatives, human-animal bonds – especially pets – pest control, and wildlife management. We then discuss implications for education, research, and extension in veterinary and health sciences. The goal is to embed critical economic thinking into One Health/Global Health frameworks to advance health and social justice.
Theoretical Foundations: Critical Social-Economic Perspectives on Health
Marxist Economics and the “Mode of Life”
Marxist political economy provides insight into how capitalist modes of production can undermine health. Karl Marx and Friedrich Engels argued that the way people produce their subsistence is also “a definite mode of life on their part” (3). In other words, economic systems shape everyday life and well-being. Industrial capitalism’s drive for profit often externalizes costs to workers, animals, and environments – creating what some call a “metabolic rift” in human-nature relations. For example, rapid agribusiness expansion has intensified livestock production at the expense of environmental balance, selecting for dangerous pathogens. Evolutionary epidemiologist Rob Wallace notes that “agribusiness is probably the worst – or the best – model one can come up with for selecting the deadliest pathogens imaginable.” (4). Indeed, capitalist agribusiness has contributed to the emergence of avian influenzas, swine flu, Zika, and other zoonoses. Wallace famously dubbed the 2009 H1N1 swine flu in Mexico the “NAFTA flu,” linking its origin to trade policies that enabled multinational firms – e.g. Smithfield Foods – to introduce industrial hog factories in Latin America. Such examples illustrate how global capitalist dynamics and modes of production directly influence pathogen flows, labor conditions, and ecosystem health – ultimately shaping the mode of life and health risks of communities. A “healthy economics” approach rooted in Marxist analysis would thus address exploitative production arrangements and aim for equitable, sustainable modes of life that promote health rather than undermine it.
Activity Theory and Systemic Analysis
To integrate these complex factors, we turn to activity theory, a framework for analyzing human practices as developmental, socially-situated processes (5). Activity theory considers an entire activity system – including individuals, communities, mediating tools, rules, and division of labor – as the unit of analysis. This systemic perspective is well-suited to One Health, which inherently spans multiple sectors and knowledge domains. For example, a One Health intervention to control a zoonotic disease can be seen as an activity system: the subject might be a multidisciplinary One Health team; the object – goal – is disease control; tools include scientific knowledge, tests, and vaccines; the community involves villagers, farmers, clinicians, veterinarians, and ecologists; rules include cultural norms and regulations; and division of labor assigns roles – e.g. community health workers, animal health technicians, researchers. Activity theory alerts us to contradictions that can hinder collective outcomes – such as tensions between global policies and local practices, or between economic imperatives and health goals. By identifying and addressing these structural contradictions, One Health initiatives can be reoriented towards more transformative outcomes. A systemic-structural variant of activity theory (6) further emphasizes analyzing the structure of activities in a society – for instance, how health-related practices are structured by institutional and economic forces. Adopting an activity theory lens encourages One Health practitioners to go beyond siloed approaches and view problems in context: understanding how a farming practice that causes deforestation – and hence vector proliferation – is driven by economic pressures, or how community beliefs – part of the cultural “rules” – affect disease reporting. In sum, activity theory provides a conceptual toolkit for holistically mapping the human–animal–environment interactions and the socio-economic context, thus informing interventions that align with local realities and engage stakeholders as co-creators of solutions.
Gramsci’s Organic Intellectuals and Health Praxis
Italian Marxist Antonio Gramsci introduced the idea of “organic intellectuals” (7) – thinkers who emerge from and remain connected to the struggles of their social class, in contrast to “traditional intellectuals” who regard themselves as autonomous or allied with the status quo. One Health and Global Health professionals can be reconceptualized as organic intellectuals working with communities to achieve health equity. In Latin America, there is a rich tradition of health professionals serving as “medicos sociales” or public intellectuals advocating for the poor. For Gramsci, every social group “creates its own organic intellectuals” to articulate its experience. Veterinarians, physicians, and community health workers can become organic intellectuals of marginalized rural and urban communities – translating critical understanding of diseases, food systems, and environment into emancipatory action. This involves moving beyond purely technical roles to also address issues of power, education, and organization. For example, a veterinarian working with peasant farmers in Brazil or indigenous pastoralists in the Andes might help them document how agribusiness or mining affects their animals and water, thereby co-producing knowledge that challenges dominant narratives. By doing so, the vet becomes an organic intellectual fostering a counter-hegemonic understanding of health – one anchored in the community’s mode of life and aimed at empowering that community. Gramsci’s theory also reminds us that building a new hegemony – e.g. a One Health paradigm centered on social justice – requires a network of such organic intellectuals to lead moral and intellectual reform (8). Healthy economics thus entails cultivating professionals and local leaders who understand and challenge the economic and ideological forces harming health, and who work as allies of the people most affected. In this sense, veterinarians in Latin America perceive the connections between animal welfare and One Health. Awareness is growing but there are also gaps in policy integration. Noticeably, there is a need for public policies that jointly address animal, human, and environmental well-being (9), a fact that underscores the need for health professionals to align in favor of welfare policies.
Social Reproduction and Care Economy
Feminist scholar Silvia Federici highlights that much of the labor that sustains society – raising children, caring for the sick, cooking, cleaning, and maintaining communities – is unpaid and performed largely by women (10). This social reproductive labor is the invisible foundation of the formal economy (11). Federici argues that under capitalism, tasks in the home and community are mystified as expressions of love or duty rather than recognized as work – “what goes on in the home… wasn’t seen as work… making it difficult to value, and even to see.” (11). The result is that care work is systematically undervalued, even though it is essential for producing and maintaining a healthy workforce and population. In a One Health context, social reproduction includes, for example, a mother in Peru ensuring her children and livestock are nourished and vaccinated, or a community in Mexico organizing to clean up trash that breeds disease-carrying mosquitoes. These activities typically don’t count in GDP or attract much institutional support, yet they are cornerstones of health. A “healthy economics” approach insists on bringing social reproduction to the center: valuing caregiving, preventive health activities, and ecosystem stewardship as key economic activities that must be supported and shared more equitably. Federici’s perspective pushes One Health to address gender and labor inequities – for instance, acknowledging how rural women’s unpaid work caring for animals can be supported through extension programs, or how the mental health burden on community caregivers after a disease outbreak need addressing. It also opens the door to reimagining health systems: what if healthcare and animal care were structured as commons, supported by public investment, rather than as commodities or unpaid burdens? In Latin America, the concept of “buen vivir” – living well collectively – resonates here, calling for an economy oriented to collective well-being rather than profit. By integrating social reproduction into One Health, we ensure that policies do not inadvertently exploit caregivers but rather empower and remunerate them – thereby strengthening the very fabric of health resilience.
Economic Democracy and Community Empowerment
American heterodox economist Richard D. Wolff advocates “democracy at work,” envisioning workplaces run by workers themselves rather than hierarchical bosses (12). He argues that to have a truly democratic society, democracy must extend to the realm where adults spend much of their lives – the workplace (13). In Wolff’s proposal, worker self-directed enterprises would replace top-down capitalist firms, allowing workers to collectively decide on production, investment, and use of surplus. How does this relate to One Health? Economic democracy can transform sectors crucial to health: for instance, a worker-run meat processing cooperative in Argentina might prioritize employee safety and food quality far more than a multinational corporation would, thus reducing occupational hazards and foodborne illness. Wolff writes that workers “must become the collective decision-makers in productive enterprises, no longer the directed wage and salary receivers” (12). If veterinary and public health services were organized democratically by their workers and users, these services could become more responsive to community needs – focusing on prevention, education, and equity rather than narrow metrics or profit. Grace Blakeley, a British economist, complements this with her emphasis on community wealth building and local empowerment (14). Blakeley observes that taking control of resources at the community level – through initiatives like participatory budgeting, cooperatives, municipal enterprises, and tenant associations – is key to challenging inequality (15). In her vision, a “democratic economy” is essential for an egalitarian society (15). Applied to One Health, community empowerment means that communities are not just passive recipients of health interventions but co-owners of health initiatives and the local economy. For example, a town in Colombia might establish a community-owned clinic and animal health center, funded by local cooperative businesses, thereby aligning economic activity with holistic health goals. Or an indigenous community in Bolivia might co-manage a wildlife reserve, deriving income from ecotourism while conserving biodiversity and controlling zoonoses – a form of community wealth building that ties directly into One Health. Blakeley’s and Wolff’s ideas guide us toward an economy where health and wellbeing are explicit goals of production, and where those most affected by health decisions have a real say in them. This democratization of the economy – “healthy economics” – would mean, in practice, empowering communities and workers – including health and veterinary workers – to direct resources towards preventive care, environmental sanitation, safe food systems, and other One Health priorities. Figure 1 illustrates the integrative framework of “healthy economics” within One Health. The traditional One Health Venn diagram – human–animal–environment health overlap – is enriched with socio-economic dimensions: the outer layer represents the political-economic context – e.g. mode of production, labor conditions, community control of resources – and cross-cutting foundational layers represent social reproduction – care work, education, cultural practices – sustaining the triad. The arrows indicate flows of influence – for instance, how economic policies affect environmental conditions and thus animal/human health, or how community empowerment feeds back to improve economic decisions.
Figure 1: One Health conceptual diagram. Traditionally, One Health examines the overlap between human health, animal health, and ecosystem conditions – as shown in the Venn diagram. Our framework adds that political-economic structures – e.g. capitalist vs. cooperative models – and social reproductive activities underpin these health domains. A “healthy economics” approach seeks to align economic structures with the goal of optimizing this entire system for health and equity. Taken from the (16).
Building on these theoretical pillars, we propose that One Health and Global Health can be fundamentally strengthened by embracing healthy economics: transforming the economic drivers of health problems and leveraging economic democracy, feminist care ethics, and community power to create sustainable health for all. In the next sections, we explore concrete Latin American cases exemplifying this approach and discuss practical implications for education, research, and extension.
Latin American Realities: Cases from Farm to Wildlife
Latin America offers fertile ground to apply this critical One Health framework, given its stark social inequalities, rich biodiversity, and histories of collective action. We examine several domains – farm animal production, public health, human–animal bonds, pest control, and wildlife management – highlighting regional examples that illustrate the interplay of economics, culture, and health.
Farm Animal Production: Precarious Peasants and Industrial Agribusiness
Agriculture and livestock production in Latin America range from small family farms – campesinos – with precarious livelihoods to massive industrial operations integrated into global supply chains. This sector starkly demonstrates why One Health must address economic structures. Small-scale farmers often live in poverty, lacking access to veterinary services, land tenure security, or markets. Their mode of life is one of subsistence and uncertainty, which impacts herd health and human nutrition. For example, many small dairy farmers in the Andes struggle with low milk prices set by processors, pushing them to overwork their cattle or cut corners on animal health (17). In contrast, large industrial farms, some foreign-owned, operate on economies of scale but introduce new health and environmental risks: crowded feedlots that can breed disease, heavy antibiotic use driving antimicrobial resistance, exploitation of farm workers, deforestation for pasture, and huge manure waste impacting waterways (4). The 2009 swine flu pandemic – H1N1 – provides a cautionary tale: it was first detected in a rural community in Veracruz, Mexico, near a large industrial pig farm partly owned by a US corporation. Investigations linked the emergence of this virus to the densely packed conditions and global genetic mixing of swine in that industrial system (4). As Rob Wallace noted, NAFTA-led market changes had forced Mexican farmers to either exit or emulate U.S.-style concentrated animal feeding operations, facilitating the genetic “reassortment” that spawned H1N1 (4). Thus, trade policies and capitalist consolidation literally had pathogenic consequences – a textbook One Health scenario where economics, animal health, and human health collided. A healthy economics approach in this domain means supporting agroecological, equitable models of livestock production. Latin America has promising examples: cooperatives and indigenous communities practicing sustainable animal husbandry that protects both livelihoods and land. In Brazil, the Landless Workers’ Movement – MST – has established cooperative farms where families collectively decide farming practices, often incorporating organic methods and animal welfare (18). These cooperatives prioritize local food needs and environmental care, aligning economic activity with human and animal health goals – for instance, reducing pesticide exposure and improving diet quality. In Mexico, some campesino organizations have revived the traditional milpa integrated farming system (19) – mixed crops and animals – which not only preserves biodiversity but also buffers communities against market shocks and disease outbreaks by diversifying food sources. These bottom-up approaches contrast with the top-down agribusiness model and exemplify Gramsci’s idea of organic intellectuals: peasant leaders and their NGO allies acting as intellectual-organizers to create a new “mode of life” in farming. Veterinary extension can play a critical role here as an ally – not just delivering technical advice, but facilitating farmer-to-farmer learning and cooperative organization. For example, in Chile, university veterinary programs have sent students to work with small dairy farmers on improving animal health through participatory methods, finding that when farmers collectively assess problems – like mastitis outbreaks – and negotiate solutions, they implement changes more sustainably than when they are simply told what to do by an external expert (1). This participatory extension approach treats farmers as co-knowledge producers – echoing activity theory – and often leads to innovations blending scientific and traditional knowledge. In short, addressing farm animal production through healthy economics in Latin America involves land reform, cooperative business models, fair trade, and public policies that favor small-scale producers, combined with vet/public health support that is culturally appropriate and empowering. The outcome can be win–win: reduced risk of zoonoses and foodborne illness, improved animal welfare, enhanced incomes, and resilience against climate change and market volatility (1).
Public Health: Community-Based Approaches and Social Medicine
Latin America has been a cradle of “collective health” and social medicine movements, which explicitly link health outcomes to social and economic structures. Pioneering Latin American epidemiologists like Jaime Breilh and Asa Cristina Laurell have critiqued narrow “social determinants of health” frameworks and instead advanced a paradigm of “social determination of health,” emphasizing how health is produced or undermined by the broader political-economic formation (20,21). This perspective aligns with Marxist economics: rather than treating factors like poverty or housing as static risk factors, it asks how poverty itself is produced – e.g. through land dispossession or labor exploitation – and how that process can be transformed to improve health. A classic example is the approach to chronic malnutrition and infectious disease in Northeastern Brazil. Instead of viewing malnutrition as a mere lack of food – to be fixed by supplements – social medicine physicians in the 1980s pointed to land inequality and the export-oriented plantation economy that left peasants without enough to eat. They worked with peasant leagues to push for land redistribution and community gardens – an upstream solution attacking the root cause of poor nutrition. This reflects a politically engaged public health practice where doctors and health workers acted as organic intellectuals in Freirean “culture circles” with villagers, raising critical consciousness about the causes of illness and empowering communities to demand change. The result in some areas was not only better nutrition but greater social cohesion and political voice, contributing to health in a holistic sense. Another hallmark of Latin American public health is community health workers and participatory primary care. Countries like Brazil and Cuba have long employed community-based approaches. Brazil’s Estratégia de Saúde da Família – Family Health Strategy – deploys teams with community health agents who visit households regularly, integrating prevention and health education into everyday life. These agents, often local women with high school education, receive a stipend and training, effectively valuing reproductive/care labor in a formal way (22). By being embedded in the community, they can address the social context of disease – connecting families to social assistance, advocating for sanitation infrastructure, and mediating between biomedical services and local culture. During the Zika virus outbreak – 2015 - 2016 – Brazil’s community health workers were instrumental in educating families about mosquito control and assisting mothers of infants with Zika-related microcephaly. However, austerity measures threatened this program, illustrating how neoliberal economics can undermine even successful One Health efforts. In contrast, Cuba’s public health system – despite limited resources – achieved remarkable outcomes in part due to its socialist orientation, prioritizing primary care and prevention in every neighborhood. Cuban epidemiologists also explicitly link health with environmental sanitation and literacy, exporting such expertise – e.g. Cuban doctors helped Haiti with a cholera epidemic by combining medical treatment with water infrastructure advice (23). These cases underscore that public health gains in Latin America often stem from community empowerment and state support for social welfare, not just biomedical advances. The healthy economic framework would encourage scaling up participatory, intersectoral public health models. For example, in El Salvador and Nicaragua, recent initiatives have adopted a “One Health, One Welfare” approach in poor rural communities, simultaneously tackling human health – e.g. child diarrhea – animal health – livestock vaccination – and environmental sanitation – building latrines, protecting water sources – with full community involvement. An illustrative project in Central America trained local people as “brigadistas” to improve housing conditions to combat Chagas disease, a parasitic illness transmitted by insects dwelling in adobe walls and thatched roofs. Rather than relying only on insecticide spraying, communities were organized – with support of NGOs and researchers – to plaster walls, install cement floors, and move domestic animals into separate corrals – simple upgrades that dramatically cut infestations. These interventions were low-cost, relied on local materials and labor, and were sustainable, with infestation rates dropping to zero in some areas and remaining low years later. Importantly, the process built local capacity and job skills – construction, health education – – reflecting an economic empowerment dimension. The success led health ministries to adopt this approach as a best practice for Chagas prevention (24). It exemplifies how engaging communities in improving their physical environment and housing – a social determinant) also strengthens social fabric and yields health benefits, embodying the principle that healthy communities must have control over the conditions of their lives. Thus, Latin America’s public health innovations teach that merging critical social theory with practice – e.g. viewing a slum’s lack of sewerage as an injustice to be rectified through collective action – can lead to meaningful health improvements. Education for health professionals should therefore include these social science insights and methods – we return to this in the implications section.
Human–Animal Bonds: Pets, Stray Animals, and Urban Health
Throughout Latin America, human relationships with companion animals – pets – are deeply culturally significant, and they carry both positive health benefits and public health challenges. On one hand, strong human–animal bonds have been observed across the region. Surveys indicate Latin Americans have some of the highest pet ownership rates in the world: for example, about 80% of people in Argentina and Mexico own a pet, one of the highest rates among 22 countries surveyed (25). Figure 2 shows the distribution of species in these countries. Moreover, over 70% of Latin American pet owners consider their pets as family members (26), the highest such sentiment of any region. These bonds can provide significant psychosocial benefits – companionship for the elderly, improved mental health, security in high-crime neighborhoods, and even physical health benefits – as pets encourage exercise. There is a burgeoning field of One Welfare that recognizes these interconnections between animal welfare and human well-being. For instance, programs in Chile have used therapy dogs to support children with autism and patients in hospitals, leveraging the human–pet bond for therapeutic outcomes. During the COVID-19 pandemic, many Latin Americans turned to their pets for emotional support, and some cities – like Bogotá – even considered pet needs in lockdown rules – e.g. allowing dog-walking – recognizing their importance for human mental health.
10.5281/zenodo.17516998