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date: 19 September 2017

The Oceans and Human Health

Summary and Keywords

The interdisciplinary study of oceans and human health is an area of increasing global importance. There is a growing body of evidence that the health of the oceans and that of humans are inextricably linked and that how we interact with and affect our oceans and seas will significantly influence our future on earth. Since the emergence of modern humans, the oceans have served as a source of culture, livelihood, expansion, trade, food, and other resources. However, the rapidly rising global population and the continuing alterations of the coastal environment are placing greater pressure on coastal seas and oceans. Negative human impacts, including pollution (chemical, microbial, material), habitat destruction (e.g., bottom trawling, dredging), and overfishing, affect not only ecosystem health, but also human health. Conversely, there is potential to promote human health and well-being through sustainable interactions with the coasts and oceans, such as the restoration and preservation of coastal and marine ecosystems.

The study of oceans and human health is inherently interdisciplinary, bringing together the natural and social sciences as well as diverse stakeholder communities (including fishers, recreational users, private enterprise, and policymakers). Reviewing history and policy with regard to oceans and human health, in addition to known and potential risks and benefits, provides insights into new areas and avenues of global cooperation, with the possibility for collaboratively addressing the local and global challenges of our interactions with the oceans, both now and in the future.

Keywords: seas, well-being, health, ecosystem services, blue growth, blue energy, anthropogenic pollution, marine biotechnology, ocean literacy

Introduction

The range and complexity of interactions between the seas and oceans and human health and well-being are increasingly acknowledged by researchers, policymakers, and even the general public. Historically, attention has focused on the predominantly negative impacts of the oceans and seas on human health (e.g., drowning, injury from extreme weather events or from fishing). More recently, however, there has been recognition that human populations and their activities have profound effects on the health of the oceans (e.g., plastics pollution), not just on human health. These impacts can be seen at both the local scale (e.g., microbial pollution on specific beaches) and the global scale (e.g., ocean acidification associated with higher atmospheric carbon dioxide). Furthermore, it has become apparent that many of these ocean impacts will inevitably affect human health and activities into the future (Bowen, Depledge, Carlarne, & Fleming, 2014; Bowen, Halvarson, & Depledge, 2006; Fleming et al., 2006; Fleming & Laws, 2006; Knap et al., 2002; Walsh, Smith, Fleming, Solo-Gabriele, & Gerwick, 2008). For example, nutrient pollution from agriculture and sewage can bring about an increasing frequency and extent of coastal harmful algal blooms (HABs), which in turn affect the marine food chain and human health (Davidson, Gowen, Harrison, Fleming, & Hoagland, 2014).

At the same time, there is a growing realization that the interactions between humans and the oceans can have both benefits and risks. For example, although marine ecosystems contain creatures that can cause harm to human health and well-being (e.g., jellyfish, lionfish), these same ecosystems also support organisms that can serve as the source of future medicinal products (e.g., conotoxin from sea snails, for the treatment of chronic pain). Destruction of these ecosystems, through pollution, unsustainable fishing practices, and extractive industries, for instance, threatens important health-related discoveries. Other examples are as follows: (a) the growing recognition of the importance of Oceans in serving as a “sink” for the increasing levels of carbon dioxide, which may mitigate global climate change but which also results in greater ocean acidification and possibly profound effects on marine biota and the marine food chain; (b) algae and other phytoplankton (single-celled plants) are the basis of the entire marine food chain, yet some species are able to produce potent natural toxins harmful to humans and other animals; (c) the oceans and seas are sources of fossil fuels (the basis of the energy economy in the early 21st century), but release of these fuels into the oceans can cause widespread ecosystem damage and human well-being impacts (e.g., the Deepwater Horizon oil spill in the Gulf of Mexico) (Bowen et al., 2014; Fleming et al., 2006; Fleming and Laws, 2006; Koelmans, Gouin, Thompson, Wallace, & Arthur, 2014; Walsh et al., 2008).

It is clear that to address the complex and potentially “downstream” interactions of humans and the oceans, a new, truly interdisciplinary and integrated approach is needed, among not only scientists, but also policymakers and other stakeholders (European Marine Board, 2014a; Laws, Fleming, & Stegeman, 2008; Walsh et al., 2008). Traditionally, in the physical and natural sciences, the oceans have been the purview of oceanographers, engineers, physicists, chemists, biologists, and marine biologists working in related disciplines and active within their defined domains. In response to the evident strengths and weaknesses that these disciplines present individually, there is an increasing recognition of the need for a new metadiscipline that will use their strengths with purpose, while offering a context in which they can interact for greater clarity on issues rooted in the relationships that humans have with oceans. This metadiscipline, oceans and human health (often referred to by its acronym, OHH), necessarily also incorporates perspectives from medicine, psychology, public health, geography, economics, and sociology as well as the law, business, and the arts and humanities.

At the same time, the physical integration of the oceans and seas around the world forces both scientists and policymakers to think beyond local and regional scales to the international and global as well as acknowledging the fundamental interactions that take place between the oceans and terrestrial and atmospheric ecosystems. A growing number of diverse groups are also realizing that they are stakeholders in oceans and human health, from the rising number of city dwellers in coastal locations around the globe, to the businesses that serve them (e.g., tourism, aquaculture and fisheries, pharmaceuticals, transport, energy sectors), to non-governmental organizations (e.g., Ocean Conservancy, World Wildlife Fund, Surfrider Foundation, Pew Foundation) and other, similar groups.

The issues that derive from our interactions with the oceans directly affect huge numbers of people and have a significant economic impact. In the European Union (EU), for example, 22 of 28 member states have a coastline, and two thirds of European frontiers are coasts; 43% of the EU’s population (approximately 218 million people) lives in coastal regions, including 194 cities. The so-called EU blue economy represents, in the early 21st century, an estimated 5.4 million jobs and a gross added value of approximately €500 billion per year, with 75% EU external trade and 37% internal trade within the EU via the seas and oceans (Ecorys, Deltares, & Oceanic Développement, 2012). A similar concentration of human populations along coastal margins is also evident across the globe; for instance, in the United States an estimated 90 million people live by or near the 153,646-kilometer-long coastline (Bowen et al., 2014; Depledge et al., 2013; Martínez et al., 2007). Regardless of how these figures change going forward, they represent immense risks and opportunities and point to the need for investment in structure and infrastructure and for truly interdisciplinary science to broaden exploration and vision.

We briefly review the history of the relationship between oceans and human health, how we have understood that relationship to date, discuss the range of issues that this relationship embraces, and identify future challenges. Our perspective is that of Europe and the United States, with an understanding that this is a global issue, with even greater current and future impacts from interactions between humans and the oceans and seas in the developing world.

History and Conceptual Framework

Globally, there has been a long history of research and policy activities concerning the oceans and seas policy being especially significant in Europe) (Depledge et al., 2013; Walsh et al., 2008). For example, there have been large, multiyear research collaborations between natural and oceanographic scientists to explore the extent and impacts of anthropogenic pollution, fishery depletion, exotic species invasion, and other ecosystem degradation in such areas as the Baltic and Mediterranean Seas the Gulf of Mexico, and the Arabian and Indian Seas. There has also been a long tradition of using marine animals as laboratory models of human disease and physiology, leading to a range of Nobel Prize–winning research; for example, Hodgkin and Huxley (1939) performed experiments on the squid giant axon to explore nerve action potentials in the United Kingdom; more recently, Kandel’s (1976) research on neurophysiology and neurological development used the sea slug (Aplysia) in the United States. These activities can now be viewed through the lens of oceans and human health; however, at the time, the focus was on ecosystem degradation, in the case of large, collaborative projects, or on a particular human disease or physiologic function being modeled, in the case of marine models—not on how the interactions between humans and marine and coastal environments can affect both human and ecosystem health.

The explicit connection between the health of the oceans and humans is a relatively recent development. In the United States the publishing of the National Research Council’s (1999) report From Monsoons to Microbes: Understanding the Ocean’s Role in Human Health is considered the beginning of the oceans and human health metadiscipline, whereas, internationally, the United Nations’ declaring 1998 the “International Year of the Ocean” and the accompanying events worldwide celebrated the importance of the oceans and their interconnections with humans. This was followed by the appearance of many research publications from a range of academic institutions and governmental and non-governmental organizations, with study continuing on both sides of the Atlantic in the early 21st century (Table 1).

Table 1. Reports on Oceans and Human Health

Year

Organization/Title

1998

United Nations. International Year of the Ocean

1999

2003

Pew Oceans Commission, America’s Living Oceans

2004

U.S. Commission on Ocean Policy, An Ocean Blueprint for the 21st Century

Oceanography, The Oceans and Human Health

2007

Interagency Oceans and Human Health Research, Implementation Plan (with Law 2012)

National Research Council, Oceans and Human Health

2008

EU, Marine Strategy Framework Directive

2012

UNESCO, BluePrint for Ocean and Coastal Sustainability

EU, Blue Growth Agenda and Strategy

2013

National Ocean Council, National Ocean Policy Implementation Plan

2014

European Marine Board, Linking oceans and human health: A strategic research priority for Europe

European Marine Board, Rome Declaration (European Marine Board, 2014b)

Also important to the relatively rapid growth of both the science and the community of oceans and human health has been the development of international research and training funding and forums. In the United States significant funding for research and training in oceans and human health has come from the National Science Foundation (NSF), the National Institute of Environmental Health Sciences (NIEHS), and the National Oceanographic and Atmospheric Administration (NOAA). This funding has limited the research and training areas to harmful algal blooms (HABs), microbial pollution, anthropogenic chemicals, climate change, and marine natural products; nevertheless, the specific funding requirements for collaborations between biomedical and oceanographic researchers have led to new interdisciplinary collaborations and approaches to oceans and human health as well as a unique interdisciplinary training environment for young researchers.

In response to a 2011 survey of 10,000 EU citizens from 10 European countries carried out as part of the EU Seventh Framework Programme project Climate Change and Marine Ecosystem Research (EU FP7 CLAMER), which found that the European public was most concerned about coastal and marine issues but that it was not well informed, there has been a call for proposals under the EU Framework Programme for Research and Innovation, Horizon 2020, to promote “ocean literacy,” focusing on the broad area of oceans and human health, with specific requirements that a range of stakeholders be involved (Buckley and Pinnegar, 2011). Of note, many businesses both affect and are affected by the health of ecosystems as well as their subsequent impacts on human health and well-being (e.g., coastal tourism; fisheries, including aquaculture). Therefore, there is a significant, as yet unrealized potential for interdisciplinary collaboration and shared funding between businesses, researchers, policymakers, and other stakeholders in the area of ocean and human health (Ecorys, Deltares, and Oceanic Développement 2012).

Since the late 20th century a growing number of international interdisciplinary events on oceans and human health have been held, including the 1999 NIEHS-UNESCO Meeting on Indicators of Oceans and Human Health, in Bermuda; the 2003 Oceans and Human Health workshop, in Sardinia; the biannual Gordon Research Conference on Oceans and Human Health, initiated in 2008; and, more recently, in Europe, the 2014 Oceans and Human Health Conference, in Cornwall, and a dedicated session on oceans and human health at the EurOcean 2014 Conference, in Rome. These events serve multiple functions, allowing diverse groups of researchers and other stakeholders to share research findings and interdisciplinary approaches, while providing a supportive training environment and helping build the international oceans and human health community.

It is also interesting to consider the various theoretical frameworks used by the different scientific communities when considering the topic of oceans. Since the late 20th century there has been rapid expansion among environmental scientists of the use of the ecosystem service approach with regard to the oceans, seas, coasts, and other ecosystems. Although inherently anthropocentric, in terms of translating ocean resources into potential direct and indirect benefits for humans, only in the early 21st century has there arisen an appreciation of the potential health and well-being benefits to humans from interactions with the coasts and oceans as a form of ecosystem services (Austin & Malcolm, 2011; Bowen et al., 2014; Millennium Ecosystem Assessment [MEA], 2005; Reis et al., 2013).

In the public health community, if considered at all, the “environment” has been seen in terms of risks from exposure (e.g., to heavy metals, radiation), usually with negative impacts on human health. Growing appreciation of the importance of the built environment (e.g., positive effects of urban green and blue spaces on health and well-being [Wheeler, White, Stahl-Timmins, & Depledge, 2012]) and the “One Health” movement (i.e., the idea that human, animal, and environmental health are interconnected [Zinsstag, Schellin, Waltner-Toews, Whittaker, & Tanner, 2015]), as well as the potentially profound and global effects of climate change on human health and well-being, have led to a new, ecological public health approach. This concept expands the definition of the environment in public health to include both the individual and the ecosystem and views human health and well-being within a much larger, even planetary, ecosystem context (Lang & Raynor, 2012). There are increasing efforts to bring these two frameworks together, such that environmental scientists and public health scientists can engage with each other and with other stakeholders more productively in dealing with the complex challenges of environment and health, including interactions with the oceans (Reis et al., 2013).

Scope: Risks and Benefits

Just as oceans and human health has grown as a metadiscipline, so too has grown the range of challenges and interactions embraced (Table 2). Initially, the emphasis was primarily on direct risks to human health and well-being, although an appreciation of selected benefits from the oceans has always been included (e.g., seafood as an important source of protein, omega-3 fatty acids, and other nutrients; natural products from the seas as important pharmaceuticals, such as chemotherapy drugs). More recently, it has become clear that every interaction can provide a combination of risks, benefits, and opportunities and that, particularly with the oceans, these interactions are experienced not singly, but rather in “mixtures” (e.g., coastal waters polluted with a “soup” of microbes, harmful algal blooms [HABs], anthropogenic chemicals, and nutrients after an extreme weather event) (Bowen et al., 2014; Depledge et al., 2013; European Marine Board, 2014a; Fleming et al., 2014; Moore et al., 2013; Redshaw, Stahl-Timmons, Fleming, Davidson, & Depledge, 2013).

Table 2. Oceans and Human Health Challenges and Interactions

Interconnections

Health and Well-Being Impacts

Interconnections

Established interconnections

Climate change, extreme weather, natural events (e.g., tsunamis)

Drowning, injury, mental health, migration; oceans as carbon dioxide buffer slowing progression of climate change

Harmful algal blooms (HABs)

Neurological, respiratory, dermatological, carcinogenic

Microbes, antibiotic resistance

Gastrointestinal, respiratory, dermatological

Anthropogenic chemicals

Immunologic, cancer

Sustainable fisheries, aquaculture, seafood, food security

Nutrition, chronic disease prevention; anthropogenic chemicals

Coastal communities (including cities) and sustainability, resiliency and adaptation, tourism, trade

Cultural history, employment, commerce; occupational morbidity and mortality

Sustainable marine biotechnology, pharmaceuticals, natural products

Treatments for cancer and other diseases, nutrition, energy production

Marine models, sentinel species, biodiversity, and one health

Understanding disease mechanisms, warnings of future diseases and exposures

Modeling/Forecasting weather and other natural events

Warnings of extreme weather and natural events with prevention of morbidity and mortality

Potential interconnections

Blue gym recreation, health and well-being interactions with the coasts

Increased exercise, physical and mental health and well-being; mechanisms

Anthropogenic chemicals: marine plastics and litter and nanomaterials

Food chain disruption, increased exposure to chemicals

Ocean acidification

Food chain disruption, increased delivery chemicals

Marine protected areas (MPAs) and the efficacy of marine regulations

Unknown potential protection of areas of natural beauty and marine resources

Exotic species and biodiversity loss

Stings, poisonings; loss of food sources

Blue carbon and MPAs

Unknown; oceans as carbon dioxide buffer slowing progression of climate change

Marine renewable energy

Unknown; decreased use of fossil fuels

Marine geoprospecting (including at the Poles)

Oil spills; unknown (see terrestrial fracking)

Polar exploration and exploitation

Unknown; increased use of fossil fuels; increased sea level rise

Interactions between oceans and human health occur at the same time and in the same space; it is difficult to describe these mixtures in a table. Reprinted from “Oceans and Human Health: A Rising Tide of Challenges and Opportunities for Europe,” by L. E. Fleming, N. McDonough, M. Austen, L. Mee, M. Moore, M. H. Depledge, et al., 2014, Marine Environment Research, 99, p. 18. Adapted with permission.

The major risk to human health and well-being identified since the beginnings of oceans and human health (and, ironically, the most significant example, in the early 21st century, of how human interactions with the environment can come back to haunt us) is man-made global atmospheric and climate change and the associated challenges of sea level rise, extreme weather, and ocean acidification. The effects of climate change on sea level and weather can cause health effects ranging from drowning, injury, and severe mental health impacts (e.g., depression) from flooding to mass population migration and economic impacts. Downstream, or indirect, effects of climate change on human health are also significant. For example, ocean warming appears to be changing the distribution and frequency of HAB organisms (as well as many other species, including commercial fish stocks), with short- and long-term impacts on human livelihood and food security. With the oceans’ acting, importantly, as a sink for the growing levels of carbon dioxide driving man-made climate change, the potential impacts of ocean acidification on the stability of the marine food chain are just starting to be explored. Continuing global population growth in coastal areas is increasing the number of people vulnerable not only to extreme weather events, but also to natural events, such as tsunamis. Finally, the intersection of climate change (including ocean acidification), pharmaceutically active products, and the rapid aging of human populations (also called “the ageing demographic”) worldwide may pose even greater future threats to human health and well-being. As populations age, there is increased consumption of pharmaceuticals, further augmented by the potential impacts of climate change (e.g., more infections from vector-borne diseases), and the greater amounts of pharmaceutically active products entering the marine environment from sewage and agriculture will interact in new and as yet unknown ways secondary to ocean acidification effects on their chemical structures and behavior. For instance, the decreased pH associated with ocean acidification may lead to effects on survival, calcification, growth, and reproduction (particularly in calcifying organisms) as well as to changes in the uptake of anthropogenic chemicals by organisms in the food chain, making these chemicals more bioavailable to humans and other animals (Bowen et al., 2014; European Marine Board, 2014a; Fleming et al., 2014; Kroeker, Kordas, Crim, & Singh, 2010; Redshaw et al., 2013; Walsh et al., 2008).

Ocean impacts from human activity that in turn affect human health and well-being are evidenced in the various forms of pollution that humans have directly and indirectly allowed to enter the marine environment, with subsequent global distribution (Backer, Kish, Solo-Gabriele, and Fleming, 2011; Bowen et al., 2014; Walsh et al., 2008;). These activities range from the direct generation and release of anthropogenic chemicals and microbial pollution into the oceans through sewage and industrial outflows to human activities on land. Deforestation and agriculture, for example, which lead to soil erosion and nutrient runoff into coastal waters, can augment the frequency and distribution of algal blooms (including HABs), ultimately resulting in hypoxia (oxygen depletion) of coastal waters and altering of ecosystem function. Anthropogenic chemicals include the persistent organic pollutants (e.g., pesticides, such as DDT; PCBs) and certain heavy metals that have been released by human activities (e.g., mercury, through the burning of fossil fuels) and that have entered many marine food chains secondary to marine dumping and atmospheric deposition. As a result of their storage and metabolism characteristics, these persistent pollutants have been found to be substantial body burdens of top predators (such as marine mammals and human populations) through a process known as biomagnification (Walsh et al., 2008) (Figure 1). Exposure to these chemicals has been linked to immunologic diseases and cancer in humans and other organisms.

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Figure 1. Inuit child eating whale blubber.

Photo by Eric Dewailley.

More recent pollutants, whose potential ecosystem and human health impacts are only beginning to be explored, include pharmaceutically active products (e.g., antimicrobial-resistant bacteria originating from the environment as a result of the release of antibiotics), nanoparticles, and plastics (including micro- and nanoplastics). Potential health implications may be direct (in the case of antimicrobial resistance, potentially untreatable, life-threatening infection) or indirect (e.g., decreased seafood production caused by nanoparticle damage to reproduction and growth of marine organisms) (Walsh et al., 2008). Plastic pollution is an interesting example, because plastic use is ubiquitous globally in human societies, and its many benefits include being inexpensive, lightweight, and versatile. Yet, the sheer scale of plastic production, plastic’s extreme longevity, its tendency to fragmentation in the environment (e.g. nano plastic particles), and the discovery of plastic sinks in remote areas (such as the deep seas and the Arctic) raise serious questions for ocean and human health in the future (Figure 2).

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Figure 2. Dead seabird with ingested plastics.

Linking oceans and human health: A strategic research priority for Europe, by the European Marine Board, 2014, p. 32. Reprinted with permission.

Microbial pollution (e.g., bacteria, viruses, parasites) is derived from the disposal of human sewage (either treated or untreated) into the ocean and from runoff from terrestrial sources of human and animal sewage (particularly agricultural and aquaculture activities) all over the world. Additional sources include feces from animals that frequent the shoreline (Wright, Solo-Gabrielle, Elmir, & Fleming, 2009) and humans, who can shed microbes during bathing activities (Elmir et al., 2009). Although infectious pathogens multiply within the human host, some are also well known for multiplying in the environment; the most notable of these are Vibrio species, which multiply under warm estuarine conditions (Grimes et al., 2014). These pathogens can cause gastrointestinal, respiratory, and dermatological diseases in humans through direct skin and aerosol contact and incidental ingestion during swimming as well as through the food chain (Fleisher et al., 2010; Colford et al., 2007; Sinigalliano et al., 2010). The issue of antimicrobial-resistant bacteria (such as methicillin-resistant Staphylococcus aureus [MRSA)] derived from environmental (not hospital) exposure, including the oceans, has also become a major human and animal health concern (Plano et al., 2013).

HABs are caused by microscopic phytoplankton at the base of the marine food chain. HABs differ from microbial pollutants, in that they are not infectious in humans, but rather multiply outside the human host. Some HAB organisms can produce in the ocean environment potent natural toxins that, through a variety of exposure routes, can cause a range of human health effects (from skin and respiratory irritation to neurological disease and even death). The cause of algae blooming often derives from terrestrial nutrient inputs, such as agricultural runoff and sewage. Environmental factors, including flow conditions in the ocean, are also suspected t of increasing the probability of certain HAB blooms (Huhn, Von Kameke, Pérez-Muñuzuri, Olascoaga, & Beron-Vera, 2012).

HABs, microbial pollution, and anthropogenic chemicals can all be present in marine waters and food chains together as mixtures resulting from different exposures, with as yet unknown long-term effects on both ecosystem and human health, especially with a long period of chronic exposure (Boxhall, 2012; Depledge et al., 2013; Moore et al., 2013;Walsh et al., 2008) (Figure 3a, 3b). Furthermore, research on these mixtures and interactions is just beginning, with prior approaches “siloed” by having focused on single exposures rather than mixtures, often over short periods, and on ecosystem or human health, not the effects on both together, over long periods.

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Figure 3a, 3b. Multiple warnings for coastal water use.

The benefits and opportunities from the myriad of interactions between humans and oceans are clear from millennia of human trade, exploration, tourism, and historical and cultural uses of the oceans (Bowen et al., 2014; National Research Council, 1999; Walsh et al., 2008). Through seafood, the oceans and seas have also served (and continue to serve) as an important source of protein and other nutrients (e.g., omega-3 fatty acids, which can contribute to heart health). More recently, products derived from marine ecosystems have been recognized as a major benefit to human health and well-being. These include marine pharmaceuticals (e.g., cancer chemotherapy drugs) and, potentially, energy and food produced from marine biomass. Various marine organisms have fortuitously served as “sentinel species,” warning of potential exposures and health effects from the oceans (e.g., persistent organic pollutants in marine mammals). Furthermore, marine models of human disease and physiology in the laboratory have also helped warn of such dangers (e.g., Tsien’s [1998] work on jellyfish fluorescent proteins led to the discovery of green fluorescent protein, one of the most widely used molecular markers in cell biology in the early 21st century). Finally, improved modeling and forecasting have been important outgrowths and functions of the ocean sciences, leading to identifiable benefits, such as hurricane and cyclone forecasting, which can save millions of lives, as well as increasingly sophisticated modeling of global climate change, as demonstrated by the Nobel Prize–winning international collaborative efforts of the Intergovernmental Panel on Climate Change (IPCC) (Depledge et al., 2013; Fleming et al., 2006;Fleming & Laws, 2006; Laws et al., 2008; Walsh et al., 2008).

Although recognized since at least the Victorian era, leisure-related interactions between humans and the coasts, seas and oceans, dubbed “blue gym” activities, can be beneficial to human physical and mental health (Figure 4a, 4b, 4c). For instance, evidence from the United Kingdom has shown that people report better mental and overall health, the closer they live to the coasts (especially in more deprived communities). People who live near the coast tend to exercise more, and visits to the coast are described as being more stress reducing than visits to other natural places. Given the growing obesity and mental health epidemics worldwide, these data could have important implications, in terms of future disease prevention and health interventions as well as medical cost savings (Wheeler et al., 2012; White, Alcock, Wheeler, & Depledge, 2013a; White, Pahl, Ashbullby, Herbert, & Depledge,2013b; White, Wheeler, Herbert, Alcock, & Depledge, 2014; Wyles, Pahl, & Thompson, 2014). This finding may add to the already high use of coastal and marine areas as part of global marine tourism, with the potential for greater appreciation of these areas.

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Figure 4a, 4b, 4c. The many recreational uses of marine and coastal waters.

As with the more overt risks, benefits also can have their own risks to human or ecosystem health, or both. For example, with the growth of coastal tourism, there is the potential risk for increasing direct damage to fragile coastal ecosystems as a result of more visits and for greater restriction of access to these health-generating coastal environments as the perceived economic and social value of the coasts rises (the latter may be a risk for more deprived communities in particular) (Wheeler et al., 2012). The rapid global expansion of aquaculture, in part a reaction to the dwindling of the world’s wild fisheries, is a classic complex combination of risks and benefits to both human and ecosystem health (European Commission, 2009). The promise of aquaculture is the rapid production of seafood, possibly sparing the wild seafood supply. However, the reality of unsustainable aquaculture can be significant local ecosystem degradation and seafood that is contaminated with pharmaceuticals and other chemicals with the potential for human health effects. Aquaculture also can contribute to polluted coastal waters and have genetic and other impacts on wild seafood (e.g., the harvesting of wild species for aquaculture fish meal). Therefore, like the other challenges of the oceans and human health, coastal tourism and aquaculture must be approached in a holistic and truly interdisciplinary manner that takes into account the long-term health and sustainability of both humans and ecosystems (Cao et al., 2007; Liao & Chao, 2009; McCoy, Morriso, Cook, Johnston, Eblen, & Guo, 2011; European Commission, 2009).

Future Scan

With each year, new challenges and opportunities are being identified that are relevant to the metadiscipline of oceans and human health. One important area is the potential downstream impacts resulting from the oceans’ serving as a sink for and buffer against the planet’s increasing levels of carbon dioxide (see the section “Scope: Risks and Benefits”), a process that possibly slows climate change progression and impacts (e.g., “blue carbon”), yet at the same time causes greater ocean acidification, as the dissolving carbon dioxide decreases ocean pH, with impacts on the marine food chain (e.g., through pH effects on the physiology and anatomy of marine organisms as well as on the structure and behavior of the anthropogenic chemicals already in the marine environment) (Redshaw et al., 2013).

Oceans and seas have served as international borders for millennia, yet many of the interactions of the oceans and human health spread easily beyond these borders through physical, chemical, and atmospheric processes as well as human activity. Therefore, an ongoing challenge is determining the appropriate legal, regulatory, and policy approaches for preventing or mitigating negative transborder interactions (Bowen et al., 2014). This has led to a proliferation of local, national, regional, and even global regulations on issues relevant to oceans and human health, ranging from microbial pollution of bathing water in the EU (EU Bathing Water Directive) to the global dumping of persistent organic pollutants (Stockholm Convention). There is also an increasing movement to assign various degrees of protection and limitation of access to highly valued coastal and marine areas (e.g., marine protected areas [MPAs]) (Aburto-Oropez et al., 2011); these actions may have long-term positive effects on ecosystems and their inhabitants but may deprive humans (particularly local communities) of access to the health-generating benefits of these areas (West, Igoe, & Brockington, 2006). The efficacy and long-term impacts of these activities need to be evaluated in terms of immediate and distant risks and benefits to both humans and ecosystems (Bowen et al., 2014; European Marine Board, 2014a; InterAcademy Panel, 2009; Moore et al., 2013). Furthermore, these complexities underline the importance of interdisciplinary research that incorporates the social sciences as well as the natural sciences in the exploration of risks and opportunities.

In addition, areas have been identified for development (i.e., increased human–ocean interaction) with potentially profound but as yet unknown consequences for humans and marine environments. For instance, the EU Blue Growth strategy has put forward five key areas for expansion: aquaculture, coastal tourism, blue energy, marine biotechnology, and marine mining (including polar exploration) (Ecorys, Deltares, & Oceanic Développement, 2012).These efforts do not explicitly acknowledge potential impacts on human health and well-being, although marine ecosystem sustainability is mentioned. There is incipient exploration of the human and ecosystem impacts from aquaculture, coastal tourism, and certain aspects of marine biotechnology (e.g., marine natural products and pharmaceuticals) (Figure 5). However, very little is known about the potential impacts from investment and expansion in “blue energy” (e.g., wind farms, tidal energy) and marine prospecting (e.g., marine mineral mining, marine fracking). From these terrestrial activities, valuable lessons can and should be learned and applied, although exporting the activities to the oceans and seas will undoubtedly create new complexities and challenges (Bowen et al., 2014; Kovats et al., 2014). Furthermore, no research is being done on the cumulative effects on both human health and well-being and ecosystem health, in Europe or globally, of a rapid and simultaneous ramping up of development in the five blue growth areas.

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Figure 5. Blue growth: Blue energy and coastal tourism.

Linking oceans and human health: A strategic research priority for Europe, by the European Marine Board, 2014. Reprinted with permission.

The area of stakeholder engagement and ocean literacy will be key to the future health of ocean and sea ecosystems and therefore to human health and well-being (Reis et al., 2013). This aspect is particularly important, given the complex and mixed messages of oceans and human health research, which can be confusing and contradictory for all stakeholders (including researchers), as they represent a weighing of risks and benefits as they emerge from ocean–human interactions. For example, seafood is discussed as both a source of healthful nutrients and a route of exposure to anthropogenic and other chemicals, whereas global wild fisheries are crashing, and aquaculture can be unsustainable. Another example is the call, in the early 21st century, to limit carbon generation to mitigate and slow the progression of climate change, while increasing our dependence on fossil fuels through the expansion of technologies such as fracking rather than use of alternative, cleaner fuel sources.

The 2011 survey of 10, 000 EU citizens from 10 European countries carried out as part of the EU Seventh Framework Programme project Climate Change and Marine Ecosystem Research (EU FP7 CLAMER) found that the European public was most concerned about coastal and marine issues that are not directly linked to climate change (e.g., pollution, overfishing, habitat destruction) (Buckley and Pinnegar, 2011) (see the section “History and Conceptual Framework”). Support was highest for EU and national policy responses’ making coastal and marine environments more resilient (e.g., through tightening controls on pollution) rather than for mitigation or adaptation. Furthermore, in all the coastal and marine issues identified, there was substantially less reported knowledge about these issues than reported concern; that is, respondents showed a lack of ocean literacy. On the whole, there was a clear link between awareness of ocean issues and top perceived research priorities. Therefore, an informed public and other stakeholders are critical factors in addressing current and future challenges for oceans and human health (Fleming et al., 2014). As just one example of good practice, the EU Marine Litter in European Seas Social Awareness and Co-Responsibility (MARLISCO) project has developed the Science-in-Society Programme to reduce quantities of marine litter by integrating stakeholders and engaging the public throughout.

Based on experience with oceans and human health interactions and challenges, only an integrated and interdisciplinary approach with a broad and long-term vision will identify and potentially manage both the risks and the benefits to human and ocean health from current, new, and as yet unknown interactions. In Europe, for instance, one hopeful sign of the increasing support for oceans and human health research and training has been explicit recognition by the European Marine Board (2014b) report the Rome Declaration, adopted at the EurOCEAN 2014 Conference, in Rome. The declaration called for “a coordinated, cross-disciplinary and integrated programme on Oceans and Human Health, targeted at understanding and managing the risks and benefits to human physical and mental wellbeing from interactions with the seas” (European Marine Board, 2014b, p. 3). In the past EurOCEAN declarations have led to substantial new funding and policy interest in their identified focus; it is hoped that similar resources and attention will be given to support oceans and human health as an important and interdisciplinary research and training area with future global impacts.

Finally, to truly grapple with the complexity and enormity of the interactions between oceans and human health, there needs to be a profound change in how we view these interactions and their significance, now and into the future:

At a fundamental level, we need to reconceive our relationship with water including the oceans and seas [italics added] itself to ensure that the integrating frameworks and economic tools that we employ in decision-making processes reflect not just the industrial and economic values of water, but also reflect the social and ecological benefits that underpin many livelihoods and our general well-being. (Bowen et al., 2014, p. 294)

Acknowledgements

The authors would like to dedicate this article to two important researchers and leaders in the world of oceans and human health, Eric Dewailly, of Laval University, and Laurence Mee, of the Scottish Association for Marine Science. Their interdisciplinary research approach; creativity; inclusiveness; and international, horizon-scanning perspectives have enriched all whose lives they touched and have contributed directly to oceans and human health.

This work was supported in part by the European Marine Board; the European Regional Development Fund and European Social Fund Convergence Programme for Cornwall and the Isles of Scilly (University of Exeter Medical School); the EU Seventh Framework Programme (EU FP7), under grant number 289042 (Marine Litter in European Seas Social Awareness and Co-Responsibility project [MARLISCO]); and the National Science Foundation (NSF) and the National Institute of Environmental Health Sciences (NIEHS) (NSF 0CE0432368/0911373/1127813, NSF OCE-1314642; NIEHS P50 ES12736, NIH P01ES021923).

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