One Health and Circular Health are two frameworks that are reshaping how medicine thinks about health, no longer as a problem confined to hospitals and laboratories, but as a systemic issue involving the environment, the economy, and society. That is the argument Professor Ilaria Capua, virologist and internationally recognised science communicator, brought to the International PhD Programme in Molecular Medicine at Vita-Salute San Raffaele University. She was invited by the programme’s doctoral researchers to address what the next generation of scientists will need to grapple with: a world that is changing fast, and a healthcare system that can no longer afford to look away from the bigger picture.
To understand Circular Health, it helps to start from its roots in the One Health paradigm. Developed in the 1960s, this approach begins with an observation that seems obvious only in hindsight: human health, animal health, and environmental health are deeply interconnected. Despite the concept’s growing influence, its practical application has long run into a persistent divide between the sciences and the humanities, and a fundamental failure of communication between the two.
«Then the COVID-19 pandemic made it clear just how urgently professionals from very different backgrounds needed to work together to make sense of complexity» Capua observed. That complexity stretched well beyond virology and epidemiology. The virus travelled along trade routes, followed patterns of human mobility, exploited social inequalities, and found in the climate crisis a favourable environment for spreading.
Circular Health builds on One Health but takes a more inclusive approach. It aims to integrate biomedicine, the social sciences, economics, law, and communication in response to health emergencies.
«The cities we live in, the food we eat, the air we breathe, global mobility, climate change, mental health, the way we communicate science. Everything is connected. Everything circulates».
To introduce her thinking on Circular Health, Capua uses the metaphor of terrarium, a miniature model of the interconnections that play out at a much larger scale.
«A terrarium is a closed system. It needs constant maintenance to remain healthy. Like a terrarium, our planet has precise boundaries, and there is no place where the plastic, emissions, or toxic substances we keep producing simply disappear».
Everything released into the environment keeps circulating: through bodies, through ecosystems, across generations. The environmental question and the health question are aspects of the same reality, observed at different scales.
Antimicrobial resistance is the clearest example of what Circular Health means in practice. The WHO ranks it among the leading threats to global public health: in 2019, it was responsible for approximately 1.27 million deaths directly attributable to resistant infections. Projections suggest that, if current trends continue, that figure could exceed cancer deaths by 2050.
How did it come to this? Antibiotics are used excessively and often inappropriately in humans, including for viral infections, against which they have no effect whatsoever. They are also administered in veterinary medicine for therapeutic purposes.
«Pharmaceutical residues enter wastewater, rivers, and soil, where they select for increasingly resistant bacteria. Those bacteria then re-enter the food chain or spread through environmental contamination. The cycle closes back on the human body. None of these stages is comprehensible, let alone solvable, by looking at any one of them in isolation».
Circular Health is more than a conceptual framework: it translates into concrete action, from training programmes to Citizen Science projects and public communication campaigns. One example is L’Antibiotico si cura, a project coordinated by Professor Capua in collaboration with the Fondazione Compagnia di San Paolo. It brings together professionals who rarely share a table: hospital doctors and GPs, vets, pharmacists, nurses, paediatricians, and environmental agencies.
Artificial intelligence has a place in this ecosystem too. «Algorithms that help identify new therapeutic molecules, cutting the time and cost of research; predictive models for disease progression; programmes that map the spread of antimicrobial resistance on a global scale».
Different applications, the same logic: none of them works in isolation. Using AI in healthcare requires integrating computing and technology expertise with ethical and legal competence — precisely the kind of cross-disciplinary thinking that Circular Health puts at the centre.
Addressing the doctoral researchers in the room, Capua was direct: «Stop looking only at the microworld through your microscope and start looking at the bigger picture outside the laboratory.» The Circular Health paradigm asks the medical and research community to place disease in its human, social, and cultural context. To read collective behaviour and communicate risk effectively, to understand the psychological impact of health crises. To be, beyond scientists, people capable of working with complexity.
It is a profile that resonates with how UniSR structures its education: medicine, philosophy, and psychology sharing a project grounded in one conviction — that caring for a human being requires understanding that person in their biological mechanisms, their psychological experience, and their ethical dimension.
Murray, C.J.L. et al. (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet, 399(10325), 629–655. doi.org/10.1016/S0140-6736(21)02724-0
O’Neill, J. (2016). Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. Review on Antimicrobial Resistance, commissioned by the UK Government. amr-review.org/Publications.html
World Health Organization (2021). Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report. Geneva: WHO. who.int/publications/i/item/9789240027336