Assessment of integrated health of human, animal and environment: a holistic and stratified analysis based on global One Health index
Authors: GUO Zhaoyu , Feng Jiaxin , Ai Lin , Xue Jingbo , Liu Jingshu , Zhang Xiaoxi , Cao Chunli , Xu Jing , Xia Shang , Zhou Xiaonong , Chen Jin , Li Shizhu 
Published: June 2022

Abstract
Background
One Health has been increasingly applied to health-related issues decision-making. As part of the global One Health index, the global One Health Intrinsic Drivers index (GOH-IDI) is a framework for evaluating the baseline conditions of human health, environmental health, and animal health. This study aim to provides a potential policy assessment tool for policy makers to help them better understand what can be enhanced in the future. This study is to assess the global performance in terms of GOH-IDI, analysis the difference under the world bank regional classification, and evauate the relationship between GOH-IDI and national economic levels.
Methods
The raw data among 146 countries worldwide were collected from authoritative databases and official reports in November 2021. The spatial and classificatory distribution of GOH-IDI were evaluated and identified by descriptive statistic analysis, data visualisations and shaping, Shapiro normality test and ridge map. The GOH-IDI was divided into five levels in the form of heat maps and visualised with regular heat maps and global maps. The differences under the world bank regional classification are analysed. The relationship between GOH-IDI and gross national income per capita was assessed using quadratic regression model. World Bank country classifications by income level are used to evaluate the differences in GOH-IDI performance between countries of various economic levels.
Results
We evaluated the performance of One Health Intrinsic Driver in 146 countries. The mean (SD) score of GOH-IDI is 52.58 (5.30). The mean (SD) values of different regions are North America (59.85, 2.34), Europe and Central Asia (56.60, 3.50), Middle East and North Africa (55.29, 2.62), East Asia and Pacific(52.72, 5.49), Latin America and The Caribbean (52.61,2.05), South Asia is (50.52,2.52) and Sub-Saharan Africa (46.21, 2.49). Of the 20 worst performing countries in GOH-IDI, 19 are from Sub-Saharan Africa. Gross national income per capita was moderately correlated with GOH-IDI(r = 0.744, P < 0.001). High-income countries (HICs) and other economic levels are statistically different from each other(P < 0.001). LICs have the best performance in some secondary indicators, including Non-communicable diseases and Mental Health and Health risks. Five indicators are not statistically different at each economic level, including Animal epidemic disease, Animal biodiversity, Air quality and climate change, Land resources and Environmental biodiversity.
Conclusions
The GOH-IDI is a crucial tool to evaluate the situation of One Health. There are inter-regional differences in GOH-IDI significantly at the worldwide level. The best performing region for GOH-IDI was North America and the worst was Sub-Saharan Africa.There is a positive correlation between the GOH-IDI and country economic status, with High-income countries (HICs) performing well in most indicators. GOH-IDI facilitates researchers' understanding of the multidimensional situation in each country and invests more attention in scientific questions that need to be addressed urgently.