Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

Cite as:
Rock, MJ; Rault, D; Degeling, C. 2017. Dog-bites, rabies and One Health: Towards a coordinated agenda for
research, policy and practice. Social Science & Medicine 187: 126-133
DOI: 10.1016/j.socscimed.2017.06.036

Manuscript Title:
Dog-bites, rabies and One Health:
Towards improved coordination in research, policy and practice
Melanie J. Rock,1,2,3 Dawn Rault,1,4 Chris Degeling,5
1

Department of Community Health Sciences, Cumming School of Medicine, University of
Calgary
2
O’Brien Institute for Public Health, University of Calgary
3
Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of
Calgary
4
Department of Economics, Justice and Policy Studies, Faculty of Arts, Mount Royal University
5
Centre for Values, Ethics and the Law in Medicine, School of Public Health, University of
Sydney

Corresponding author:
Melanie Rock, MSW, PhD, RSW
Email: mrock@ucalgary.ca

Acknowledgements: We sincerely thank the research participants for their valuable insights, the
reviewers for their contributions, and Dr Panter-Brick for editorial guidance. We also thank
Corrinne Wilson and Jovan Lottis for assistance with interview transcription, as well as Lydia
Vaz for assistance with research administration and Ann Toohey for editorial assistance. This
research was made possible by funding from the Canadian Institutes of Health Research [CIHRMOP-130569; UCalgary/CHREB13-1101]. The interviews with veterinarians took place under
the auspices of a related project [CIHR-MOP-123380; UCalgary/CHREB14-1347]. In addition,
Chris Degeling’s contributions were enabled by a grant from the National Health and Medical
Research Council of Australia [NHMRC-1083079], which concerns polices for rabies
prevention. Dawn Rault held an Indigenous Graduate Award from the Province of Alberta and
the Captain Nichola K.S. Goddard Memorial Graduate Scholarship from the University of
Calgary. Our analysis benefited from presentations to the Alberta Association of Community
Peace Officers, in November 2015; to the Alberta Municipal Enforcement Association, in May
2015, May 2016 and May 2017; at a symposium hosted by the Group for Research with
Indigenous People in the O’Brien Institute for Public Health at the University of Calgary, in May
2016; and at the University of Edinburgh’s Centre for Medical Anthropology, in April 2016 and
June 2016. The June 2016 presentation at the University of Edinburgh was made possible by a
CIHR/IPPH Visiting Scholar Award [CIHR-ICT-146829].

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

Abstract
Dog-bites and rabies are neglected problems worldwide, notwithstanding recent efforts to
raise awareness and to consolidate preventive action. As problems, dog-bites and rabies are
entangled with one another, and both align with the concept of One Health. This concept
emphasizes interdependence between humans and non-human species in complex socioecological systems. Despite intuitive appeal, One Health applications and critiques remain underdeveloped with respect to social science and social justice. In this article, we report on an
ethnographic case-study of policies on dog bites and rabies, with a focus on Calgary, Alberta,
Canada, which is widely recognized as a leader in animal-control policies. The fieldwork took
place between 2013 and 2016. Our analysis suggests that current policies on rabies prevention
may come at the expense of a ‘bigger picture’ for One Health. In that ‘bigger picture,’ support is
needed to enhance coordination between animal-control and public-health policies. Such
coordination has direct relevance for the well-being of children, not least Indigenous children.
Keywords:
Canada; rabies; injuries; health promotion; dogs; medical anthropology; veterinary medicine;
criminology

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

Introduction
In this article, we point to a need for inter-sectoral and multi-jurisdictional coordination
with respect to rabies and dog-bites. In doing so, we build on the observation that the social
sciences remain under-represented in the One Health literature (Friese & Nuyts, 2017), even as
this journal has played leadership roles in elevating social science in One Health research. As a
concept, One Health refers to interdependence between humans and non-human species in
complex socio-ecological systems (Zinsstag et al., 2011). Social Science & Medicine began to
publish contributions regarding One Health, social science and social justice in 2009 (Rock et al.,
2009; Singer, 2009), and a One Health special issue appeared in 2015 (Craddock & Hinchliffe,
2015). That special issue focused on efforts to halt the spread of zoonotic infections, reflecting
current trends in One Health applications and critiques (Friese & Nuyts, 2017).
The present article expands the scope of social science contributions to One Health
scholarship, by considering dogs, rabies, human injuries, and public policies as entangled
phenomena. In other words, none of these things truly exists as discrete entities or variables, such
that ‘life is the ongoing, dynamic result of human and nonhuman interactions over time’
(Nading, 2013, 60). Dog-bites can spread rabies and other zoonoses; dog-bites routinely cause
injury; and the risks for rabies and for dog-bites are unevenly distributed, geographically and
socio-economically, largely due to policy influences. By implication, policies addressing dogs,
rabies and dog-bites ought to complement one another.
Below, we present an ethnographic case-study in which we seek to assess the extent of
policy complementarity as regards dog-bites and rabies. By attending to the current situation in
Canada, we seek to illustrate the value of relational coordination (Gittell, 2011) with respect to
the tasks entailed in both rabies prevention and dog-bite prevention. We also call for ontological

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

coordination (Mol, 2002), so that professional practice and information systems duly reflect
overlapping risks within living systems (Hinchliffe & Whatmore, 2006). But first, we provide
some background information on rabies and injuries from dog-bites.
Background
Under the auspices of the United Nations’ Millennium Development Goals, infectious
diseases such as HIV, tuberculosis and malaria have dominated global health policies and
programs. As the United Nations has sought to reorganise its activities around the recentlyratified Sustainable Development Goals, ‘neglected diseases’ are now firmly on the agenda (UN,
2015). Accordingly, the WHO (2016a) recently endorsed a plan to eliminate human cases of
rabies by 2030. And yet, given that rabies is a zoonotic disease, such a plan cannot be effectively
deployed without drawing upon the One Health concept and without attending to the multispecies entanglements that surround rabies.
One Health has intuitive appeal, but applications will never be straight-forward. To date,
most One Health applications have targeted non-human species, so as to reduce the incidence of
infectious disease in human populations (Friese & Nuyts, 2017). Prevention of infectious
diseases in people is complicated enough, but insufficient, both practically and ethically. Hence
we extend the distinction in public health between ‘mere prevention’ and ‘health promotion’ to
One Health. Unlike most efforts to stop people from developing zoonotic infections, One Health
promotion entails policy-guided programs and services to alter interactions throughout complex
systems, for mutual benefit amongst humans and non-human species (Rock, 2016; Rock et al.,
2015; Rock & Degeling, 2015, 2016). That said, when seeking to promote One Health, a series
of challenges beset coordination across academic disciplines, professions and policy realms
(Degeling et al., 2015; Hinchliffe, 2015; Rock et al., 2009).

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

In keeping with conceptualizing One Health promotion in terms of complex systems, the
WHO (2016a) has recommended improved coordination for the sake of rabies prevention. More
specifically, the WHO (2016a) has pressed for concerted efforts to improve access to postexposure prophylaxis (PEP), but also to decrease reliance on PEP by expanding the reach of
programs to vaccinate dogs against rabies. A related WHO (2015b) report has endorsed dog-bite
prevention as essential to rabies prevention. This latter report endorsed educational interventions
as well as veterinary services, specifically rabies vaccinations and sterilization surgeries (to help
prevent dog-bites, via dog population control). We reference this holistic approach throughout
the analysis that follows, by considering rabies and dog-bite policies in Canada. Our approach to
One Health promotion, however, explicitly attends to animal welfare along with social welfare
(Rock et al., 2015; Rock & Degeling, 2015).
The World Health Organization (WHO, 2013a) justifiably characterizes rabies as a
‘neglected disease of poor and vulnerable populations.’ Globally, more than 55,000 people die
annually from rabies (Hampson et al., 2015; WHO, 2013a). Rabies deaths are gruesome, and
about 40% of the fatalities occur in children (WHO, 2016a). Worse yet, deaths from rabies
represent needless suffering, given that ‘[r]abies elimination is feasible by vaccinating dogs’
(WHO, 2013a). The WHO takes this stance on prevention because dog-bites almost always
account for rabies incidence in people. In fact, experts believe that dog-bites account for more
than 99% of all instances of human exposure to rabies (WHO, 2013a).
Each year, to prevent rabies, more than 15 million people worldwide receive PEP following
dog-bites (WHO, 2016a). PEP for rabies is efficacious (Crowcroft & Thampi, 2015; Hampson et
al., 2015), yet PEP is not always available or completed, especially in low-income and remote
settings (Hampson et al., 2015). Besides the expense of PEP supplies, PEP administration is

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

time-sensitive and time-consuming for professionals, patients and families. The WHO (2013b)
recommends immediate cleansing of the wound followed by vaccine therapy, then administration
of rabies immunoglobulin; current standards call for at least four intramuscular doses to be
administered by a trained professional over a period of four weeks. Patients, families and
providers may feel distress during the course of post-exposure risk assessment and PEP
administration (Cleaveland et al., 2006), adding to the reasons why systematic vaccination of
dogs against rabies is preferable to systematic reliance on PEP to prevent rabies in people
(WHO, 2013a). Furthermore, unvaccinated dogs suspected of rabies exposure, as well as dogs
whose vaccination status is uncertain, may be killed to prevent further spread of the disease.
Ethical questions regarding animal welfare and culling are therefore relevant to rabies control
(Cleaveland et al., 2006; Degeling et al., 2016).
The WHO (2015a) estimates that dog-bites account for injuries in the tens of millions, year
after year. And as with rabies, most dog-bite victims are children (WHO, 2015a). In
biomedicine, the term ‘injury’ refers to energy transfers in amounts or at rates that exceed the
threshold for tissue damage (Baker et al., 1992, v; Haddon Jr, 1980). We acknowledge, however,
that this way of thinking about injury downplays psychosocial impacts (Langley & Brenner,
2004), which can be profound in dog-bite threats or injuries (Boat et al., 2012; Boyd et al.,
2004). Nevertheless, dog-bite surveillance is so rudimentary that the WHO (2015a) cannot report
on the global incidence of injuries from dog-bites, never mind point to policies and scalable
programs to prevent their occurrence. By public health surveillance, we mean the ‘systematic
ongoing collection, collation and analysis of data and the timely dissemination of information to
those who need to know so that action can be taken’ (Last, 2001, 174). Accordingly, the WHO
(2015a) recommends initiatives to ‘determine the burden and risk factors’ for dog-bites, to

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

strengthen ‘emergency response services,’ and to promote ‘research…on effective prevention
interventions and populations most affected.’
Even in countries such as Australia and Canada, where the infrastructures to support
healthcare and public health are sophisticated, dog-bite surveillance and research remain underdeveloped (Ozanne-Smith et al., 2001). Preventive education is routinely recommended to lessen
the incidence and impact of dog-bites (e.g., WHO, 2015b), but evaluations have tended to be
small in scale. A systematic review of educational interventions targeting children and youth
identified only two studies that met the inclusion criteria on research design (i.e., randomized
controlled trials or controlled before-after studies); and neither study measured dog-bite
incidence as an outcome (Duperrex et al., 2009). The authors concluded, ‘Education of children
and adolescents should not be the only public health strategy to reduce dog bites and their
dramatic consequences’ (Duperrex et al., 2009, 2). Policy research and reforms also deserve
consideration (Ozanne-Smith et al., 2001).
Methodology
This article derives from an ethnographic approach to case-study research on public
policy (Agar, 2006; Wedel et al., 2005). By ‘public policy,’ we mean ‘a formal decision or plan
of action that has been taken by, or has involved, a state organisation’ (Richards & Smith, 2008,
1). More specifically, we report on research that aimed to distil best practices for promoting One
Health via animal-control policies. By ‘animal control,’ we mean efforts to regulate interactions
amongst humans and non-human animals within a defined territory (Aronson, 2010). The
University of Calgary’s Conjoint Health Research Ethics Board approved this study.
Three cities and five towns in the Canadian province of Alberta participated in our study.
In Alberta, municipal councils may adopt and enforce bylaws on domestic animals (Rock, 2013).

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

(In some places, such as the United States, bylaws are called ‘ordinances.’) MR and DR
examined bylaws on dogs and related policy documents for each municipality in our study
(Altheide, 1987). Next, DR observed and informally interviewed front-line officers (n=8) during
regular shifts (i.e., ride-alongs), and then DR scheduled a series of in-depth interviews with
front-line enforcement officers and managers (n=13) in these municipalities (Spradley, 1979).
DR personally conducted all of these interviews and documented them in fieldnotes (Emerson et
al., 1995). The formal interviews with front-line officers and managers were digitally recorded,
and then DR transcribed these recordings verbatim in a naturalistic style.
The importance of inter-sectoral and multi-jurisdictional coordination emerged early on
in our study. Of particular relevance to this article, a dog unexpectedly tested positive for rabies
in the research setting (Mema et al., 2012). Agar (2006, 64) calls situations like these ‘rich
points’ because they signal ‘a difference between what you know and what you need to learn.’
To learn more about inter-sectoral and multi-jurisdictional coordination in relation to animalcontrol policies and public health, we expanded our protocol in several ways that pertain to this
paper. MR and DR examined local, provincial, national and international policies regarding
animal welfare, animal bites and rabies prevention; MR and DR conducted in-depth interviews
with physicians specializing in public health and preventive medicine, who assess rabies risk
following animal bites in Alberta (n=2); MR interviewed an animal-control officer with expertise
in assessing dog behaviour and risk to public safety, alongside this officer’s supervisor (n=2);
and together, MR and CD carried out in-depth interviews with veterinarians who have played
leadership roles in expanding access to veterinary services for low-income communities, in
Alberta as well as in northern Canada (n=5). Below, we emphasize coordination between animalcontrol and public-health policies. To do so, we focus on the City of Calgary, a municipality of

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

about 1.3 million people and 120,000 dogs (Rock, 2013). This city has earned a national and
international reputation for leadership in animal-control policies (Caulfield, 2011; City of
Calgary, 2009; Parliament of Victoria, 2016).
Our analysis, which proceeded in tandem with data collection, crystallized insights
through immersion in the research setting and in the dataset (Borkan, 1999). We used NVivo® to
assist with organizing our dataset, and we refined our understanding iteratively within the
research team and directly with participants (Spradley, 1979). In addition, DR presented and
discussed emergent findings at four conferences attended by officers who enforce a variety of
bylaws, including animal-control bylaws, throughout Alberta. As with all ethnographic research,
we continually engaged in processes of comparison and contextualization (Agar, 2006). The
concepts of ‘relational coordination’ and ‘ontological coordination’ enriched our comparisons
and our appreciation for contextual characteristics. The literature on ‘relational coordination’
suggests that communication between people whose roles depend on one another should be
frequent, timely, accurate, and problem-solving in orientation (Gittell, 2011). Hence ‘relational
coordination’ entails interpersonal interactions alongside a high-level view on priorities and
processes, as people use technologies to perform tasks (Gittell, 2011). This emphasis on
technological and task integration resonates with Mol’s (2002) conceptualization of ‘ontological
coordination’ in modern medicine and epidemiology. Because similar problems take different
forms across settings, such as homes, hospitals, and even databases, ‘[t]he drawing together of a
diversity of objects…involves various modes of coordination’ (Mol, 2002, 83, emphasis added).
In contexts where ‘relational coordination’ and ‘ontological coordination’ are lacking, policies
may be misconceived and policy implementation may be misaligned.

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

Findings and Context
Animal-control policies pertain to the promotion of One Health, especially in contexts
where their implementation explicitly seeks to improve both human and non-human lives.
Historically, local governments’ animal-control policies stem from struggles to prevent the
spread of infectious diseases, notably rabies, and to protect the animals themselves from harm
(Beers, 2006; Pemberton & Worboys, 2013). During the twentieth-century, as rabies and other
infections declined in Western countries, local governments redirected their animal-control
policies toward the threat of dog-bite injuries, as well as toward public nuisances associated with
dogs, including barking, fouling and roaming (Aronson, 2010). As a result, animal-control
policies increasingly focus on dog-owners and their behaviour (Borthwick, 2009). Put simply,
people undergo regulation through policies on pets.
The City of Calgary exemplifies these international trends (Rock, 2013; Rock, 2017;
Rock et al., 2015). ‘Responsible pet owner regulations are necessary to balance an individual’s
right to own a pet with the responsibility to ensure that the pet does not become a nuisance or
danger in the community,’ or so states the City of Calgary’s Responsible Pet Ownership Policy
(2006, 1). To ensure that domestic animals do not become a public nuisance or threat, the
‘Calgary model’ for animal-control policy emphasizes four domains and synergies amongst
them: 1) licensing and identifying pets; 2) meeting the emotional and physical needs of pets; 3)
procuring pets ethically; and 4) providing veterinary services to pets, especially sterilization
surgeries (Rock et al., 2015). Implementation of the Responsible Pet Ownership Bylaw (2016
[2006]), we have learned, extends to coordination with governmental and non-governmental
organizations, including the Calgary Humane Society and Calgary Police Services. We point to a
few such examples below. Yet as we will show, despite the City of Calgary representing a ‘best-

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

case scenario’ when it comes to One Health promotion at the local level, we found little evidence
of coordination with health professionals. We also found that dog-bites and rabies risk have
socio-economic components that current policies and implementation strategies have done little
to redress. As a result, inequities persist in risk exposure as well as in access to preventive
veterinary services. Furthermore, despite extensive utilization of emergency services for dog-bite
injuries in children, we found the public-health response to rabies continues to exceed the
response to dog-bites. Moreover, the response to rabies remains reactive, with an emphasis on
assessing dog-bite cases for rabies risk and PEP after the fact. Animal-control officers do
intervene to prevent dog-bites from occurring in the first place, but without recognition or
support from public-health officials.
Animal-control policies and dog-bite prevention
Under the Responsible Pet Ownership Bylaw, dog-bites as well as being chased or struck
by a dog are offences (City of Calgary, 2016 [2006]). Rules like these are typical features of
animal-control policies (Aronson, 2010). What is unusual is that animal-control officers in
Calgary systematically classify dog-aggression incidents by severity, with reference to a rubric
known as the Dunbar (2016) scale. In incidents involving multiple punctures, or worse, animalcontrol officers with specialized training then assess the offending dogs’ behavioural tendencies.
And whenever animal-control officers deem that dogs cannot be safely returned to their owners,
the officers strive to rehome these animals. As explained by an animal-control officer who
specializes in behavioural assessments,
So, I mean one of the options we give is that they can transfer ownership to the
City. If I can place it, I will. And I can show you the back of my office door, it's
all of them. We call them “blue survivors” because they have survived the blue

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

juice. They should’ve died but the stars aligned. And we’re able to take the
Border Collie that bites little kids when he gets out and put him on a sheep farm.
He's just fine. And those are the success stories. So to be able to sit here and say
that to a dog owner, honestly that if I can home your dog properly, I'll do it.
[Intv#14032016_01]
Euthanasia orders are rare (Rock, 2013), and we learned that the City routinely refers owners of
aggressive dogs to certified trainers at the Calgary Humane Society. Municipal animal-control
officers routinely refer dog-bite victims to Alberta Health Services for medical treatment, but
cooperation usually ends there. As one animal-control officer explained in an interview, ‘we tell
the person to go to the hospital if the skin is broken’ [Intv#16102015_01].
Without biting anyone, aggressive dogs can still have negative impacts on people’s
health. In particular, aggressive dogs may deter outdoor play amongst children as well as
walking, jogging and cycling amongst adults in urban areas (McCormack et al., 2010; Toohey &
Rock, 2011). Furthermore, intimidating behaviour in dogs may presage dog-bites (WHO,
2016b), so early intervention may avert injury and trauma. Indeed, the lowest level on the
Dunbar (2016) scale refers to incidents in which a dog may growl, lunge or snarl, but without the
dog’s teeth coming into contact with the target’s skin (see also: Wrubel et al., 2011).
Accordingly, Calgary’s animal-control officers take complaints about intimidating dogs
seriously. During a ride-along, an animal-control officer described a memorable case involving
an aggressive dog ‘at large’ [FN_10062015_01]. The incident eventually involved the
deployment of two animal-control officers, eight police cars (each staffed by two officers with
Calgary Police Services), and a Calgary Police helicopter to track down the dog. After one of the
animal-control officers discharged a C02 cartridge (using a device that resembles a fire

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

extinguisher), the dog ran back to the owner’s yard. There, the animal-control officers were
finally able to contain the dog.
Systematic investigation of dog-aggression complaints and ticketing appear to be
effective in preventing dog-bites (Clarke & Fraser, 2013), and in Calgary, complaints about
intimidating dogs have declined precipitously since the 1980s. At the same time, the size of the
human and dog populations have grown exponentially (Rock, 2013). Put another way, statistical
evidence for the City’s approach to One Health promotion has accumulated for more than a
quarter of a century. Currently, the City (2016 [2006]) may fine owners between CAD$200 and
CAD$2,000 following confirmation of a dog-aggression incident.
When investigating dog-related complaints, the City’s database on dog licensing assists
with efficient tracing. Calgary’s Responsible Pet Ownership Bylaw stipulates that owners must
purchase a licence for their dogs, and compliance is remarkably high, at about 90% (Rock,
2013). To encourage citizens to license their pets, the City reinvests the revenue in ways that
promote One Health (Rock, 2013). Examples include: returning dogs ‘at large’ to their rightful
owners by driving them home right away; operating a modern shelter to house impounded
animals; rehoming impounded animals; educating the public; and subsidizing sterilization
surgeries for pets belonging to low-income citizens. Such services may help in minimizing stress
levels amongst dogs, in ensuring that dogs enter homes that meet their needs, in improving
public awareness of dog-bite risks and reporting, in reducing the number of unwanted puppies,
and in facilitating proper care and socialization for all puppies. For these reasons, animal-control
services that are subsidized by licensing fees may prevent dog-bites from occurring (Rock et al.,
2015).

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

Even as animal-control policies may promote One Health and avert dog-bite injuries, the
City of Calgary’s comprehensive data on dog-ownership and dog-bites have yet to be closely
compared, nor linked, with data from Alberta Health Services on dog-related injuries.
Nonetheless, Alberta Health Services keeps systematic records of treatment for dog-bites. A
related project entailed analysing medical records for dog-bites and related injuries in emergency
departments throughout Alberta (Jelinski et al., 2016). That project unearthed substantial
differences in utilization of emergency services across the province. For example, the utilization
rate for dog-related injuries was 64/100,000 in Calgary, versus 90/100,000 in Edmonton.
Nevertheless, these cities closely resemble each other in population size and socio-demographic
profile. Such differences merit further investigation, for example, in relation to municipal
animal-control policies in the City of Calgary and the City of Edmonton, respectively.
Overall, dog-bite surveillance remains under-developed throughout Canada, which
detracts from One Health. To begin, Canada lacks basic statistics on dog-bite incidence.
According to the Canada Safety Council (2005), ‘Our [dog-bite] problem is likely as serious as
that of our southern neighbour,’ and based on telephone surveys, the annual incidence of dogbites in the United States has been estimated at 1.5% to 2% (Gilchrist et al., 2008; Sacks et al.,
1996). Across Canada, 43 people died from injuries caused by dog-bites between 1980 and 2002,
with an adjusted mortality rate of 0.05/100,000 amongst children 1-4 years old (PHAC, 2005).
And in 2002-2003, the adjusted hospitalization rate due to dog-bites was 1.57/100,000 for the
Canadian population and 5.87/100,000 amongst children 1-4 years old (PHAC, 2005). Up-todate information on dog-bite morbidity, mortality and hospitalizations are not publicly available.
Detailed data on dog-bite injuries are available through from the Canadian Hospitals
Injury Reporting and Prevention Program (CHIRPP). CHIRPP tracks injuries treated in the

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

emergency departments from a selection of paediatric and general hospitals. Together, these
hospitals serve as sentinel sites for the purposes of public health surveillance (Mackenzie &
Pless, 1999). To capture information about what the patient was doing when injured, what went
wrong, and the setting, both emergency staff and patients (or their care-givers) complete 1-page
questionnaires. CHIRPP personnel then enter the responses into a multi-site database (PHAC,
2016). Despite continual updating, CHIRPP data on dog-bites have not been released for over a
decade (PHAC, 2005).
Between 1990 and 2003, data on 17,745 dog-related injuries were entered into the
CHIRPP database (PHAC, 2005, 2). Of these, 13,921 (78.4%) were dog-bites; the remainder
resulted from being struck by a dog (PHAC, 2005, 2). During this time, dog-bites accounted for
more emergency visits to CHIRPP hospitals (n=4,333) than did ice-hockey injuries (n=3,198)
amongst children between 5 and 9 years old (PHAC, 2005, 9). Over the last decade, paediatric
injuries in ice-hockey have become research and prevention priorities across Canada (e.g.,
Emery et al., 2010; McKay et al., 2014), partly in relation to CHIRPP data (Macpherson et al.,
2006), and to an extent that paediatric dog-related injuries have not. Whereas CHIRPP data
suggest that dog-bites rank within the top-10 causes of pediatric injury (PHAC, 2005), a 2010
Delphi study on priorities to prevent injuries in Canadian children did not even mention dogs
(Pike et al., 2010).
The lack of coordination between animal-control services and health services is
particularly concerning for Indigenous children, who live with higher risks for dog-bites than do
their peers in Canada. Indeed, a 2014 Delphi study ranked dog-bites as a top-10 priority for
injury prevention amongst Indigenous children in Canada (Pike et al., 2014). Participants in this
Delphi study also ranked animal-control services as a top-10 priority, due to their potential value

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

for injury prevention, as well as for the prevention of rabies and other infections (Pike et al.,
2014, Appendix).
The likelihood of being injured by a dog appears to increase with latitude in Canada, and
Indigenous people comprise a greater proportion of the human population in northern Canada
than in southern Canada, notwithstanding the politics of Indigenous status in statistical portraits
(Andersen, 2016; Elias et al., 2015). An analysis of dog-bite hospitalizations in Manitoba found a
north-to-south gradient (Raghavan et al., 2014). Similarly, our recent analysis of dog-bites
treated in emergency departments across Alberta found a north-to-south gradient (Jelinski et al.,
2016). In addition, Health Canada (2014) has flagged dog-bites as a concern for Indigenous
communities in Alberta.
Whereas improved coordination between animal-control policies and public health in
places like Calgary would entail stronger relationships amongst protagonists, and might extend
to data-sharing agreements, animal-control services are absent altogether in many northern and
Indigenous communities in Canada (Pike et al., 2014). The lack of investment in animal-control
services is long-standing and the negative impacts are far-reaching. For example, partly due to
‘hundreds of stray dogs,’ government officials determined that a particular Indigenous
community in the Northwest Territories ‘was not an appropriate site for the development of a
school’ in the 1960s (Davison & Hawe, 2012a, 217). In response, government officials
authorized the construction of a school nearby. Today, that distance represents a barrier to
student attendance and engagement, while also impacting inter-generational contact and family
ties within the community (Davison & Hawe, 2012b). In the words of one elder,

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

The school being out of the community, you know being 13 km away, is quite
difficult. The kids leave in the morning, it is dark, they come back and it is dark
and their life is in the school (cited in Davison & Hawe, 2012b, 69).
At the time of writing, our team is adapting ‘the Calgary model’ for One Health promotion in
collaboration with local communities, charitable organizations, and governmental agencies in the
Northwest Territories. This initiative reminds us that ‘the Calgary model’ pivots on the Western
notion that people should regard pets simultaneously as private property and as tantamount to
nonhuman persons (Rock & Degeling, 2013). One Health may have global reach as a concept,
but in practice, One Health hinges on local knowledge, suppositions, and contingencies
(Hinchliffe, 2015).
Animal-control policies and rabies prevention
Dog-related injuries remain far more common than rabies exposure. Indeed, more people
died from dog-bite injuries between between 1980 and 2002 alone (n=43) than have died from
rabies since 1924 (n=24) in Canada (PHAC, 2005, 2011). Hence we have felt discouraged by the
extent of resources available for rabies prevention, compared with dog-bite prevention. This
disjuncture worries us because dog-bites remain the main vector of potential exposure to rabies
in people. By implication, rabies policies tend to emphasize the prevention of human disease,
rather than One Health promotion (Rock & Degeling, 2015). Little is being done to help people,
notably Indigenous and low-income people, in exercising a collective form of control over dogrelated risks in accordance with their values. Nevertheless, such an approach to One Health
promotion could augment well-being in a multitude of human and canine lives.
Throughout Canada, rabies is a reportable disease, and a federal agency must receive
notification whenever rabies is suspected (Government of Canada, 1990 [2015], 1990 [2016]).

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

Rabies investigations, however, fall under the jurisdiction of the provincial and territorial
governments in Canada. As stated on its website, Alberta Health Services ‘provides follow-up
for animal bites (dogs, cats, bats, and other animals) to make sure people don’t get rabies’ (2016,
emphasis added). By implication, employees of Alberta Health Services do not aim to prevent
dog-bites from occurring in future by collating ‘lessons learned’ in the process of rabies
investigations. An animal-control officer described the division of labour with Alberta Health
Services as follows:
As for Alberta Health Services, when it comes to dog bites they have to do
a quarantine, and they normally call and talk to the parents and stuff and
they kind of do their own investigation. We just let them know what
happened, and then we handle our part, and they handle theirs, and their
part that they’re concerned about is only disease, quarantine, things like
that….. [Intv#15102014_01]
Moreover, unlike some jurisdictions (Aronson, 2010), Alberta Health Services does not operate a
program to help ensure that all dogs in the province receive rabies vaccinations. Furthermore,
Alberta Health Services does not subsidize the sterilization of dogs belonging to low-income
owners, which could reduce the likelihood of dog-bites and thus rabies exposure. The City of
Calgary does subsidize the sterilization of dogs in low-income households (Rock, 2013), yet our
interviews with veterinarians revealed that demand for subsidized veterinary services outstrips
supply in Calgary.
Human exposure to the rabies virus has become uncommon in Canada, but vigilance is
still necessary. First, rabies remains endemic in several species of Canadian wildlife, notably
bats, racoons, skunks, and foxes (Tataryn & Buck, 2016). Whenever people report being bitten

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

by wildlife, public health authorities assess risk and, if warranted, they authorize PEP (Tataryn &
Buck, 2016). The following example from Alberta illustrates the public-health significance of
endemic rabies in wildlife. In 2007, a 73-old man died from rabies following a bat-bite that
occurred just outside Calgary (Johnstone et al., 2008). This individual did not seek medical
treatment until he became symptomatic, many months later. Contact-tracing identified nineteen
people at risk. They each received PEP, with the exception of a healthcare professional who
received booster injections to supplement prior vaccination (Johnstone et al., 2008).
A second reason for vigilance is that by coming into contact with wildlife, dogs may be
exposed to rabies (Tataryn & Buck, 2016). For example, the rabid bat whose bite ultimately
killed an Albertan near Calgary could have bitten someone’s dog, thereby exposing additional
people to rabies. In another Canadian example, drawn from southern Ontario, ‘two large dogs –
Lexus and Mr. Satan – got into a fight with a sick raccoon in the back of an animal services van’
(Casey, 2016). These dogs were inoculated and then quarantined as a matter of public safety.
This example from Ontario illustrates the pertinence of local governments and their animalcontrol services for rabies prevention, along with dog-bite prevention.
A third reason for vigilance is that rehoming dogs may spread the risk of rabies. This risk
is illustrated by a positive test result for canine rabies in Calgary, after a puppy was rehomed
from northern Canada without being vaccinated against rabies (Mema et al., 2012). ‘The fivemonth-old puppy had come from Nunavut,’ CBC News (2013) reported. ‘Health officials say the
incident is a good reminder to pet owners to keep vaccines up to date.’ A similar situation arose
the following year (Curry et al., 2016). In both incidents, testing revealed the variant of rabies
associated with Arctic fox (Curry et al., 2016; Mema et al., 2012).

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

In the Calgary incident, contact-tracing identified 14 people who been in contact with the
rabid puppy (Mema et al., 2012). The 8 contacts who received PEP due to high-risk exposure
included a veterinarian who had treated the puppy in Calgary (Mema et al., 2012). In addition,
contact-tracing revealed that the rabid puppy had bitten an unvaccinated dog, whose owners
opted for euthanasia over quarantining their pet for at least 6 months (Mema et al., 2012). Publichealth officials devised a communication strategy and handled media inquiries (Mema et al.,
2012). This communication strategy did not include the City of Calgary and its animal-control
managers, to the best of our knowledge. Indeed, media coverage did not quote animal-control
managers, despite advising that off-leash dogs were at some risk for exposure to rabies from
wildlife, such as bats (CBC News, 2013). Yet, off-leash dogs and public parks fall under the City
of Calgary’s jurisdiction.
In an interview for this research project, the public-health physician who led contacttracking after a puppy tested positive for rabies in Calgary reflected:
For a dog to have rabies is really not news. For a dog to have rabies in Alberta, it
is news. But the rescue piece, right, like this is a problem somewhere else, and
now we are seeing this welfare [issue] – animal welfare groups bringing dogs into
here. [Intv#04112014_01]
As implied by this quote, exposure to rabies is a daily possibility in northern Canada. There,
dogs usually spend their lives outdoors, so contact with wildlife is perennial. In remote
communities where veterinary services are inaccessible, which is the situation for most of
northern Canada, the federal government has waived the stipulation that rabies vaccination must
be performed by a licensed veterinarian (Curry et al., 2016). Nevertheless, uptake is far from
optimal.

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

For instance, when Calgary-based veterinarians began offering outreach clinics in a
handful of remote communities in the Northwest Territories, only 37% of the treated dogs had
previously received the rabies vaccine (Brook et al., 2010, 1120). Furthermore, these dogs
disproportionately belonged to professionals from southern Canada, such as teachers. Recently,
public-health officials contacted the veterinarian who has spearheaded these outreach clinics,
after a rabid fox had been sighted near one of the communities. This veterinarian confirmed that
an exposed dog’s rabies vaccination was up to date. As a result, the dog’s life was spared, to the
relief of all concerned [FN#20161125_01]. This example highlights that rabies vaccinations not
only prevent the spread of rabies, but also the killing of dogs, and concomitant distress in people.
Hence, policies and programs that enable widespread vaccination of dogs against rabies
instantiate One Health promotion.
With respect to Canadian policy on rabies, representatives from multiple levels and
sectors of government, together with representatives from non-governmental organizations,
collectively developed a management plan that was released in 2009 (Tataryn & Buck, 2016). To
incorporate some recent changes in federal policy along with ‘lessons learned’ about multijurisdictional coordination (Curry et al., 2016), an expert panel is revising the plan (Tataryn &
Buck, 2016). The key point is that despite low risk to humans in most places throughout Canada,
any legitimate threat of rabies triggers coordination amongst officials and official records (as per
Gittell, 2011; Mol, 2002). Nonetheless, these coordinated responses do not consistently involve
local governments and their animal-control services.
In future, public-health responses to rabies in the Calgary area might benefit from
coordination with the City in contact-tracing as well as in strategic communications. Recall that
90% of all dogs in Calgary have been licensed, which means that the City maintains descriptive

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

information for all these dogs along with mailing addresses and contact information for their
owners in a searchable database. The City already uses this database to educate dog-owners
about its Responsible Pet Ownership Bylaw and dog-bite prevention (Rock, 2013). Furthermore,
news stories concerning off-leash dogs and other dog-related issues in Calgary frequently cite
animal-control managers, as a matter of public education (Toohey & Rock, 2015).
At the same time, local governments might do more to help in protecting public health by
ensuring that all dogs receive vaccinations for rabies and other serious infections. Animalwelfare organizations also have roles to play when it comes to preventive veterinary services.
Already, the City of Calgary as well as the Calgary Humane Society vaccinate all dogs prior to
rehoming. Also, like many local councils (Aronson, 2010), the City of Calgary charges less to
license sterilized dogs than to license intact dogs (2016 [2006]). And as mentioned already, the
City uses licensing revenue to subsidize veterinary sterilization of pets belonging to low-income
owners (Rock, 2013). The City could consider extending such incentives and subsidies to
vaccinations. A broader issue is inequitable access to preventive veterinary services, which local
governments and animal welfare organizations may mitigate but cannot resolve, even by
coordinating their efforts. To the extent that preventive veterinary services protect and promote
human health, provincial and territorial governments in Canada should consider the potential
benefits of subsidized programming.
Discussion
Our ethnographic study of local governments paid close attention to the City of Calgary,
as a ‘model city’ for animal-control policy and services. Rather than sterling examples of One
Health promotion through multi-jurisdictional coordination between local and provincial
agencies, we found heavy reliance on PEP for rabies prevention, a weak commitment to

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

systematic vaccination of dogs against rabies, and a relative neglect of dog-bites with respect to
policy and practice within public health. The neglect of dog-bites is particularly problematic in
low-income communities as well as in northern Canada, where residents tend to be Indigenous
(Pike et al., 2014). Indigenous and low-income communities also experience challenges in
accessing basic veterinary services, such as sterilization and vaccination of dogs against rabies.
Discussions regarding health equity should broaden to include One Health promotion, animalcontrol policies and veterinary services.
Poor coordination with respect to rabies and dog-bites may stem partly from
conceptualizing these problems in linear cause-effect terms, rather than as complex socioecological systems characterized by multi-species entanglements. Accordingly, to follow Mol
(2002), dog-bites do not tend to ‘cohere’ with rabies in statistical portraits, nor in policy
statements, nor in practical interventions stemming from policy statements. Furthermore, treating
rabies and dog-bites as discrete problems extends into asymmetrical surveillance. Rabies
prevention commands far more attention and resources than dog-bite prevention, even though
these problems are inextricably linked in actual lives.
Based on participant-observation, interviews and policy-related statements in the
Canadian context, we found evidence of relational coordination (as per Gittell, 2011) in
assessing rabies risk and in administering PEP, but not in extending rabies prevention to
encompass dog-bite prevention as a broader concern for One Health promotion. Rabies
prevention and dog-bite prevention are separate enterprises – both organisationally and as
institutional practices. Our research has led to speculations about ways to strengthen responses to
dog-bites in research and policy, but our study did not involve quantifying relational
coordination, nor concerted efforts to improve relational coordination (Gittell, 2011). That said,

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

we believe that research and interventions to enhance policy alignment and task integration
between animal-control and public-health services should be pursued. To that end, our team has
shared results from this study and related research with animal-control officers and public-health
officials in a variety of settings. Most recently, in May 2017, we hosted a symposium on dogbites at the Alberta Municipal Enforcement Association’s annual conference. We invited a
collaborator, a physician-epidemiologist, to present preliminary results from a chart-review of
pediatric injuries from dogs. The dialogue following this presentation identified privacy
legislation and related concerns as an obstacle to closer collaboration in dog-bite cases. More
generally, we have noticed a lack of familiarity with municipal animal-control policies amongst
healthcare professionals and scant attention within health promotion to the enforcement of such
policies. Indeed, despite the acknowledged importance of smoking bans in tobacco control, to
name but one example, researchers in public health have largely ignored the matter of
enforcement. We are aware of just one in-depth study of how and the extent to which smoking
bans are enforced. This study of enforcement took place in Calgary, and highlighted divergent
worldviews between health promotion and enforcement practitioners, as well as a lack of
appreciation for the work of enforcement amongst healthcare professionals (Patterson et al.,
2009). In our own study, we have noticed that animal-control officers and managers seem to see
themselves as upholding ‘public safety,’ as compared with ‘public health.’
Conclusion
Overall, we find that public-health surveillance is lacking for dog-bites in Canada. Given
the extent of resources that are already invested in rabies surveillance, and the potential for
interventions targeting dog-bites to reduce reliance on PEP and associated burdens (for patients,
providers and systems), we believe that preventive programs for rabies should encompass

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

vaccination of dogs as well as dog-bite prevention. Greater coordination is urgently needed to
reduce the negative impacts of both dog-bites and rabies, especially in disadvantaged
communities.

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Dog-bites, rabies and One Health: Towards a coordinated agenda for research, policy and practice

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