Publication: Interconnections between the food system and antimicrobial resistance: A systems-informed umbrella review from a One Health perspective
Authors: Chloe Clifford Astbury, Catherine Hu, Krishihan Sivapragasam, Arabi Rajan, Mandy Geise, Cécile Aenishaenslin, Arne Ruckert, Kathleen Chelsea Togño, Mary Wiktorowicz, Tarra L. Penney
Introduction
Antimicrobial resistance (AMR) is a serious and growing threat to human, animal, and environmental health. One major driver of AMR is the food system, including how food is produced, processed, and consumed. However, the connections between different parts of the food system and the spread of AMR are highly complex. This review was conducted as part of the Designing AMR Governance project, which brings together researchers from different disciplines to strengthen policy and governance for antimicrobial stewardship. The project aims to design innovative solutions for both national and global AMR governance using a One Health approach.
Methods
We reviewed 80 existing systematic reviews to understand how AMR emerges and spreads in and from the food system. We focused on identifying interactions, including how antimicrobial use (AMU) in animals or crops can lead to resistance in humans, or how environmental contamination contributes to the problem. We mapped these interactions using a causal loop diagram, a systems thinking tool that illustrates how human, animal, ecosystem, and economic systems are connected to identify points for intervention.
Findings
- AMR in the food system is driven by a complex web of interrelated factors.
- AMU is influenced by economic pressures, animal welfare concerns, and productivity goals.
- AMR can spread between animals, humans, food products, soil, water, and wildlife, potentially creating ongoing cycles of transmission.
- Regulations, improved practices, and better awareness can help reduce AMU, but there are important trade-offs:
- Using fewer antimicrobials might lower productivity.
- It could also negatively impact animal welfare.
- Significant investment may be needed for new infrastructure or training.
Policy Implications:
The insights from this review helped inform a series of stakeholder workshops in Canada, the Netherlands, Hungary, and Senegal. At these workshops, participants from policy, research, and practice mapped out how AMR emerges and spreads in their own country context. They expanded and contextualised the map of the system, and identified priority policy actions.
This review and the broader Designing AMR Governance project aim to support the development of more effective, context-specific strategies to address AMR globally and nationally, ensuring solutions reflect the complexity of the problem and the diversity of local needs.
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