We’ll only make progress by working together

I was invited to speak at the 2021 British Veterinary Orthopaedic Association (BVOA) conference and did so on November 19th. When I accepted the invitation in July, it seemed a long way off and my brief was to give a give a breed club perspective of canine health. This was a 3-day conference and was face-to-face, having not been able to run in 2020. 

The conference was fully booked with around 130 delegates and, apparently, they had to turn away 40 people simply because the venue was full at 130. When I arrived, I realised that I was probably the only person there who didn’t have a veterinary qualification. A few delegates put me right on that by saying these weren’t just vets, they were orthopaedic vets. I’m not quite sure how different that made this audience or whether a group of cardiologists would also have been rather different! Whatever, I didn’t get much sleep the night before my presentation, wondering quite how it would go down with this audience.

To make things even more challenging, my presentation followed one from Dr Dan O’Neill (Royal Veterinary College) who runs the VetCompass project. Dan’s an epidemiologist and anyone who has heard him speak will know how engaging and interesting he is to listen to.

I had spoken with a few of the delegates about their knowledge of the Kennel Club and Breed Clubs and it was pretty clear that most people would probably know very little about the role of these in improving the health of pedigree dogs. To that extent, I had a blank canvas to work with.

I don’t like making presentations that are simply a one-way download of content from a set of slides and my (early morning) session needed to generate some discussion for the Q&A panel later in the morning. I started by asking if there were any Dachshund owners in the room and just one hand went up. Asking about whether any of them had been presented with a Dachshund at their surgery in the past 2 weeks raised about 10% of hands. Surprisingly, when I asked if any of them were aware of the Kennel Club’s Dachshund IVDD screening programme (which only launched in May this year), many more hands went up. That was great to see and my talk would be followed by Dr Mark Lowrie who is one of the IVDD programme scrutineers, so we’d have 100% awareness by the end of the morning.

The UK canine landscape

I began my presentation by discussing the UK canine landscape and where the KC sits within that. Depending on whose estimate you go with, there are about 9-10 million dogs in the UK. The KC registers about 250,000 p.a. So that probably means there are 3 million KC registered pedigree dogs living in the UK. Estimates also suggest there’s a similar number of non-registered pedigree dogs. These are bred and owned outside the KC system, with no involvement in KC-regulated activities. The balance are crossbreeds (known to be growing in popularity) and mongrels. Despite what we might think about the importance of the show world, size-wise, it involves just a tiny fraction of UK dog owners, maybe 0.3% of owners.

We’ve all probably got tired of hearing the phrase “following the science” over the past 2 years but it’s highly relevant to the way the KC addresses health matters. I described the role of the Dog Health Group in setting overall strategy and its 4 subgroups that contribute specific expertise on aspects of canine genetics, epidemiology, health screening, health and welfare.

The role of Breed Clubs is more complicated and quite variable from breed to breed but there are recurring themes of activities the more proactive clubs get involved with. I was able to use the KC’s Health Strategy toolkit to illustrate the many things a “good” breed would be doing. 

The most practical demonstration of KC and Breed Club focus on health improvement is the development of Breed Health and Conservation Plans. Well over 100 BHCPs are now in place and these cover around 80% of KC breed registrations. I’ve written about the value of these before so I won’t cover that ground again but my point to the veterinary audience was that these are developed collaboratively by the KC and breed clubs in order to provide a single source of up-to-date evidence and plans for each breed. In the case of Dachshunds, we have taken the BHCP and customised it for a veterinary audience, highlighting the priority conditions and screening programmes we think vets should be aware of.

Diverse voices and polarised opinions

Of course, it’s important to recognise that there are many different views on canine health, particularly in relation to the role of Kennel Clubs, Breed Clubs and the show community. There are diverse voices and polarised opinions from many different interest groups, vets being just one.

On the first day of the conference there were presentations where comments were made about “couch potato” Labradors and they were contrasted with those used for working activities. It’s very easy for extreme examples of any pedigree breed to be used to condemn the whole of a breed and breeders. During the panel discussion in which I participated, I took the opportunity to explain the role of the KC’s Breed Standards and Conformation Group in collecting feedback from judges on visible points of concern (Breed Watch) and how Breed Standards are regularly reviewed.

During my talk, I touched on the topic of Human Behaviour Change and emphasised that it’s not just breeders and exhibitors whose behaviour might need to change, but also that of puppy buyers and vets. I used a couple of examples of what we have achieved in Dachshunds to illustrate how a systematic approach to health improvement, with appropriate human behaviour changes had delivered quantifiable benefits. The first example was how we have reduced the incidence of Lafora Disease in Miniature Wirehaired Dachshunds since 2012. That is an example where we have a DNA test for a simple recessive condition. The second example is the complex, multifactorial condition Intervertebral Disc Disease (IVDD). Here our improvement programme is based on a well-researched screening programme plus evidence on lifestyle factors that breeders, owners and vets can address to reduce IVDD risk.

I was pleased to get positive feedback on my presentation and I hope I helped raise awareness among this group of vets about how they can collaborate with the KC and breed club communities. I left them with a quote from astronaut Chris Hadfield: “You can’t change the bricks, and together, you still have to build a wall”. In other words, we are where we are but we’ll only make progress by working together.

Breed-specific Health Strategies – my presentation at IDHW4

When I spoke at the 3rd International Dog Health Workshop in Paris in 2017, I started by saying that breed health improvement is not a conformation problem, a genetics problem, or a veterinary problem. It’s a change management and a continuous improvement problem.

For IDHW4 held in the UK recently, I said the challenge is not “are you improving?” but (a) “how fast are you improving?” and (b) “can you prove it?”.

We now know what a Breed-specific Health Strategy looks like. There are examples from the Nordic countries (RAS & JTO) and the UK now has its Breed Health and Conservation Plans. All these are based on the principle that a strategy is an action plan with a rationale.

Of course, we need to ask what is driving the development of breed strategies and I think there are 2 forces at work. Firstly, there is pressure for change and secondly, there is vision for change. Breeds will end up with strategies either because they are told to do it or because they want to do it; reactive or proactive. It’s a choice.

We also have to understand the landscape of breed strategy drivers. Both pressure and vision for change can come from one or more of:

  • Governments/Legislators
  • Kennel Clubs
  • Breed Clubs
  • Veterinary Surgeons
  • Scientists & Researchers
  • Breeders
  • Owners & Buyers
  • Campaigners
  • Media

Brenda Bonnett, CEO of the International Partnership for Dogs said:

“For many years, lecturing about breed-specific issues in dogs, even before the existence of IPFD, in discussions with the breeding community, veterinarians and others, it was becoming self-evident that if concerns were not addressed by the dog community, society would likely impose ‘solutions’ on them.  This is coming to fruition in many areas, and society and the media wants to move at a much faster pace than many in the pedigreed dog world.

A couple of my favourite quotes on planning come from General Eisenhower and the management guru Peter Drucker. Eisenhower said: “Plans are nothing, planning is everything”. He meant that the thought process and engagement of the right people in producing plans is more important than the document that pops out at the end. Drucker said, “Eventually, plans must degenerate into hard work”. If Breed Strategies sit on a shelf (or website) and nobody does anything different, we shouldn’t be surprised if canine health doesn’t improve.

Spray and pray!

One of the models I use when working with my clients to plan and implement projects and programmes makes the connection between the work that needs to be done and how benefits will be achieved. For dogs to benefit, i.e. become healthier, we need to establish new behaviours. Plenty of organisations are defining projects and processes and creating outputs such as breed strategies, legislation, toolkits, websites and so on. However, if there is no support for them because of the way plans have been developed, people’s behaviour is unlikely to change. All too often, the groups designing the projects, processes and outputs are not the same ones as will have to change their behaviour for dogs to benefit. Outputs get “lobbed over the wall” in the hope that breeders/owners/judges/buyers will change their behaviour. If the people who have to change their behaviours are involved in the design of the solutions, they are far more likely to support them. Otherwise, it’s just “spray and pray”.

It might be a bit of an exaggeration to say that the people designing the solutions aren’t involving the people who have to implement them because there are some excellent examples of very collaborative approaches. Those are the models we should follow; for example the Brachycephalic Working Group in the UK.

At the heart of breed improvement is human behaviour change. When it comes to behaviour change, we need to answer 2 questions: Can people change and will people change?

Canine health and welfare improvement are not unique in having to achieve human behaviour change and, surprise surprise, there is plenty of peer-reviewed evidence of what works in other fields. Complex problems such as Adult Social Care, Criminal Justice, Obesity and Smoking are all being tackled with interventions requiring behaviour change.

Behaviour change techniques

One of my favourite frameworks is the COM-B Model developed by Susan Michie and colleagues at University College London. In her 2011 paper which reviewed 19 behaviour change models from other studies, she identified Capability, Opportunity and Motivation as the 3 sources of behaviour. The Behaviour Change Wheel that she produced summarises a range of interventions and policy tools that can be used to influence Capability, Opportunity and Motivation. There is even a Taxonomy of 83 Behaviour Change Techniques available as an online toolkit. We don’t need to be starting from a blank sheet of paper. In a recent paper, Michie also reported on which interventions were most successful in changing behaviours for human health problems. Significantly, coercion and threat were the least likely to work; beating people up and telling them they have to change is of little value. She also reported that, for many of the health problems, around 9 or 10 different intervention types were required to implement successful change. In other words, a single, one-size-fits-all solution will be unlikely to achieve sustainable behavioural changes.

I reflected on an example from my breed, Dachshunds. Over the past 7 years, we have achieved an important improvement in the health of Mini Wire Dachshunds by tackling Lafora Disease, which is a form of epilepsy. A DNA test is available and we have moved from 55% of litters being bred with “at risk” puppies in 2012 to the position now where only around 5% are affected. That has been achieved by adopting techniques from 8 of the 9 COM-B intervention categories and 6 of the 7 policy categories. Our work has involved breeders, buyers, owners, vets and our clubs and breed council.

In Dachshunds, our approach to Lafora Disease has been part of our wider breed health strategy and the process we follow is based on a guide developed by our Kennel Club. It has 4 stages: Lead, Plan, Engage and Improve. All 4 stages are required for a breed health strategy to become sustainable and I prepared a poster that was on display at IDHW4 to illustrate some of the work we have been doing.

In my opinion, breed health strategies need more focus and effort on leadership and engagement in order to get better and quicker improvement results. There are lots of plans in many forms but, without leadership and engagement, dog health will not improve.

I ended my presentation with 3 quotes:

“The ‘tell, sell, yell’ strategy for Change Management never works.”

“Culture change happens in units of 1.”

“And that is how change happens. One gesture. One person. One moment at a time.”

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An international approach to breed health improvement

This year, the International Partnership for Dogs will be holding its 4th workshop. Our Kennel Club is hosting the event which will take place from 30th May to 1st June, near Windsor. The Kennel Club was a founding partner of the IPFD since its inception in 2014 and hosted the first ever meeting of the IPFD Board that same year. Kennel Club Secretary, Caroline Kisko, is the Vice Chairman of the IPFD and our KC also provides the secretariat for board meetings.

A major goal of the International Dog Health Workshops (IDHW) is to promote collaboration and networking. This begins with the reception on the Thursday evening and continues throughout the next 2 days. All attendees are expected to share expertise/experiences and to participate actively in discussions in breakout sessions.

I attended the 3rd IDHW in Paris in 2017 and was privileged to be invited to make a short presentation on our work in the Dachshund Breed Council to develop and implement a breed health strategy. I also took part in the breed-specific health strategies workshop and this year I have been asked to help with the design and facilitation of that part of the programme.

As with previous IDHWs, the majority of time is spent in interaction: limited plenary talks have been chosen to highlight Themes; most time is spent in smaller group breakout sessions.

There are 5 main themes being tackled this year:

1)   The concept of ‘Breed’ and how it influences health and welfare in dogs. How attitudes to the definition and understanding of breed affect actions for health; the history and future of outcrossing; public perception; conservation vs. development of breeds; the role/ influences of breed standards; judging for health/function not just appearance; experience in other species.

2)   Supply and Demand. The reality of sourcing – national vs. registered/pedigree populations; commercial breeding: the reality; new developments in health and welfare management; ‘rescues’ / marketing; the role of different stakeholders.

3)   Breed-Specific Health Strategies: By breed, nationally and internationally. Defining and sharing tools to support the work of breed clubs.

4)   Genetic Testing for Dogs: Selection, evaluation and application of genetic testing: building expert resources for genetic counselling / IPFD Harmonization of Genetic Testing for Dogs (HGTD) initiative; coordinating across stakeholder groups; latest developments in genetics and genomics.

5)   Exaggerations and Extremes in Dog Conformation:

a)   Health, welfare and breeding considerations; review of national and international efforts, on all fronts (consumers, show world, breeders, judges, vets, etc) since 2012 – what has been achieved?; brachycephalics; other existing and emerging issues; overcoming polarization and conflict, resolving science and emotion.

b)   Education and Communication – Past practices may not have achieved desired outcomes. What are tools and techniques to promote human behaviour change? What can we learn from other fields?

“In God we trust, everyone else must bring data” – Dr. Edwards Deming

In 2017, one of the themes was “Show me the numbers” and some people might wonder why this has been dropped for 2019. It was obvious from the discussions within that theme in 2017 that it was actually cross-cutting, meaning it was a key aspect running through all the other themes. So, we can take it as read that improvement in any of the themes on the 2019 agenda will have to be underpinned by the availability of good data and evidence.

The format of this year’s workshop is slightly different from 2017; there are 4 interactive plenary sessions taking up a large part of the agenda on 31st May. These include short presentations by renowned experts from around the world. Nick Blaney, who heads up our KC’s Dog Health Group is among the speakers.

All change please!

I’ll be particularly interested to hear the presentation by Suzanne Rogers who is a Director of a consultancy: Human Behaviour Change for Animals (HBCA). I’m pleased to see she will be speaking about communication to promote change. When I spoke in 2017, I started by saying that dog health improvement was not a scientific, veterinary or genetic problem. My view was (and still is) that dog health improvement is a continuous improvement and change management problem. It is something we have to work on continuously and we can expect to see incremental improvement (rather than step-change) only if people behave differently. By “people”, I mean owners, breeders, exhibitors, judges, vets and everyone who directly impacts on the dog system. That is why it’s a change management issue. It’s also no good each of those groups acting independently in their own silos without thinking about how they could be collaborating with others in the system. The Brachycephalic Working Group is one example where a multi-stakeholder approach has been taken in order to produce a plan that has a broad consensus of support. We’ve seen too many campaigns by individuals and groups that simply alienate the people who have the potential to make improvements happen. That is still happening and it feels like lessons aren’t being learnt. I therefore hope Suzanne will be able to bring some new thinking to this year’s workshop. The HBCA website lists 4 pillars for change: the process of change; the psychology of change; the environment for change; and ownership of change. The importance of these has, in my opinion, not been sufficiently well recognised, understood or addressed in many breed health improvement efforts.  

Breed-specific health strategies

At the 3rd IDHW, participants in this theme agreed that effective and sustainable implementation of health strategies requires innovative solutions to many different challenges. Provision of sufficient reliable information was agreed as critical, for both situational assessment as well as health screening and DNA testing of dogs. Considering the design of breed health strategies, the group agreed that it was important to identify and balance the major issues for each individual breed and give guidelines on how priorities could be determined for each, while still allowing breeders discretion to make their own decisions within an overall framework of requirements and recommendations.

The general conclusion was that there is no “one size fits all” solution for developing breed-specific health strategies and that the most effective interventions would need to be adapted according to the specific context of each breed, nationally and internationally.

This year, the activities for this theme will include:

  • Clarifying what we mean by a breed health strategy, by reference to currently available examples
  • Understanding the challenges facing breed clubs, such as how to get started with a breed strategy, how to maintain momentum and how to accelerate progress
  • The role of Kennel Clubs in the wider context (national and international), such as advocating for breeds, influencing legislation and providing resources for clubs and breeders
  • Identifying and sharing currently available resources and tools to address these issues
  • Identifying gaps in current capabilities (approaches, resources, tools) and how these might be addressed

It’s a lot of ground to cover in the 3 working sessions but, if 2017 is anything to go by, participants will bring a high level of knowledge and energy and leave with a clear sense of the priorities and tasks to be undertaken over the next 2 years.

You can find out more about IDHW4 here: https://doghealthworkshop2019.co.uk/

International collaboration on dog health – part 2

Previously, I wrote about the Breed-specific Health Strategies workstream that I participated in at the third International Dog Health Workshop. This month, I’m sharing some of the discussions from the other workstreams.

Show me the numbers

This group emphasised the importance of asking “why collect this data?” so that it would be clear how the answers could actually make a difference. Picking up on breed trends and eco-epidemiology (recycling of datasets) could also increase the speed at which improvements could actually be realised. Some of the issues flagged by this group included:

  • the need to prioritise data requirements
  • the importance of a unique ID for every dog
  • the potential value of national registration systems to include non-pedigree dogs, although there are clearly cultural issues affecting compliance levels

The group felt that one of the biggest scandals is not mining the available data and they agreed to work together to catalogue data resources within their network and to coordinate objectives across multiple studies (e.g. breed and disorder). They would aim to publish whatever is possible and look to promote fair-access collaboration internationally and inter-disciplinarily.

Dogwellnet.com could act as a dating agency, matching research questions with data owners and analysts. There is always a risk of balancing steering vs. funding; those who fund projects may want particular answers.

The lack of a standard nomenclature hampers collaboration, with various systems already in place (e.g. VeNom, SnoMed, Petscan, Agria). However, there is the potential to establish “jigsaw projects” with linked databases.

It is always important to understand the uses and limitations of data and to be clear about what analytical methods are appropriate. Ultimately, data should be used to enable change and improvement; the focus should be on dissemination, not just on research.

Extremes in conformation

This workstream focused on brachycephalics and everyone agreed this is the most severe and significant problem related to extremes of conformation in dogs.

However, there is still a need to gather accurate data to quantify the issues in dogs from different sources: KC-registered dogs vs. puppy-farmed dogs. Whatever the source, increasing popularity means more dogs are suffering, even though the evidence suggests many owners don’t realise this. Often, owners see the symptoms as “normal for the breed” (or worse, as “cute”).

Buyers need more information in order to make informed choices; vets have a key role to play here in educating their clients and have to work more closely with Kennel Clubs on this.

Campaigns such as CRUFFA have been instrumental in flagging the issues of flat-faced dogs to advertisers and the media. This awareness-raising needs to continue as it has the potential to reverse (or, at least slow) the trend in popularity of these at-risk breeds.

Overall, an aim to move the mean “health score” so that the population improves is a valid goal and there are options to consider, such as the breeding of new, less extreme, brachy types (retro-pugs) or even cross-breeding. All of this does require a suitable way to measure progress, of course!

The team focused on Brachycephalics and confirmed an action to revisit FCI Breed Standards to clarify wording and to ensure breed-specific instructions are available for 4 priority breeds. They also agreed sub-groups to exchange data, research and implementation. The latter included media communications and effective ways to change buyer/owner/breeder behaviours.

Education and Communication

This workstream took as its particular focus the issue of antimicrobial resistance (AMR) related to the over-prescription of antibiotics. They agreed the establishment of an AMR network would be valuable, together with the development of global guidelines for vets and breeders, based on data to support the utility and achievement of particular approaches.

More “stories” about the dangers of overuse of antibiotics are needed, to counter the numerous anecdotes about the importance of prescribing them (e.g. to get bitches in whelp).

As with many such programmes, the challenges are cash, data, geography, politics and buy-in.

DNA test harmonisation

There are currently no Quality Assurance processes in place for DNA tests. (Almost) anyone can set up a lab and offer DNA testing. The IPFD harmonisation project will establish a framework to validate providers and tests, and in Phase 2 will develop support around genetic counselling.

A web-based resource is under development and will be available via dogwellnet.com. This project is already well underway with IPFD having appointed a project director (Aimee Llewellyn) and building an early proof of concept on the dogwellnet website. Evaluation of the range of available tests using a template of questions will be a priority and further funding to ensure sustainability of the system will also be important, given the rapid rate of change and development in the genetic testing field.

Behaviour and welfare

This workstream stated that “socialisation” was a subset of “welfare” and started in utero. They felt there was a need for positive messages and these could be a way to add value to the sale of well-bred dogs. The 5 Freedoms would be a logical framework upon which to base these marketing messages.

The group confirmed the need for more positive messaging to the general public regarding pedigree dogs and breeding of dogs. Their action plan included identifying currently available messaging on the importance of socialisation and to develop any new resources that might be needed to fill any gaps. In the longer term, they felt it may be necessary to conduct further research into what might be needed to ensure breeders and owners are aware of effective approaches during pregnancy and early weeks of a puppy’s life.

Kennel Clubs could include socialisation as part of their breeding requirements, where they have schemes in place. As with several of the other workstreams, a lack of data and funding were identified as key barriers. In addition, a challenge here is how to reach all the puppy producers, particularly if they lie outside the sphere of influence of Kennel Clubs.

The workshop wrapped-up with thanks to the organisers, hosts and facilitators as well as all the participants who had collaborated over the 2 days.

I really enjoyed the workshop and picked up new ideas to share with Dachshund colleagues and other Breed Health Coordinators. I didn’t really know what to expect as this was the first IDH Workshop I have attended but I made some useful contacts and have a better understanding of what the challenges are around the world as well as some of the good practices that are already available “off the shelf”.

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