Moving Toward an Agenda on Ocean Health and Human Health in Europe

The integrated study of ocean health and human health is an emerging area of increasing global importance. Growing evidences demonstrate that the health of the ocean and the health of humans have always been and will continue to be, inextricably linked. Our actions toward the oceans will importantly influence the future of the whole planet and, in turn, our own health. The stream inspection of these issues arose from a summer school in San Sebastian ( Spain ), from 5th to 7th June, 2019. An interdisciplinary group of researchers discussed cardinal risks ( for example, microbial befoulment, pharmaceuticals, harmful algal blooms, fictile contamination ) and benefits ( for example, bathing waters, refreshment, tourism ) of the seas and global ocean for humanness ; and debated the future priorities and electric potential actions for a joint Oceans and Human Health research and administration program in Europe. The draw a bead on of this review is to contribute to the emerging scientific agenda on ocean health and human health, deoxyadenosine monophosphate well as organize efforts with stakeholders, policy makers and the cosmopolitan populace. This agenda operates within the larger context of the approaching United Nations Decade of Ocean Science for Sustainable Development : 2021–2030, which strives to achieve the Sustainable Development Goals ( SDG ), including goodly ( human ) lives and wellbeing ( SDG3 ) and conserving and sustainably using the oceans ( SDG14 ), among others. In addition to summarizing some of the winder risks and benefits, consequently, we describe the government of oceans and health interactions ( specially in Europe ), and we finish by proposing a number of elements for electric potential future research priorities on oceans and homo health .


The health of the environment has been, and always will be, critical for human health ( Whitmee et al., 2015 ). Our seas and global ocean are no different ( Inniss et al., 2016 ; Gascón et al., 2017 ; Elliott et al., 2018 ; Gollan et al., 2019 ). however, despite the steer importance of ocean health on the health of billions of people globally, the interaction between the two is hush relatively under-studied ( european Marine Board, 2013 ; Depledge et al., 2017, 2019 ; Fleming et al., 2019 ; World Health Organization [ WHO ], 2019 ). The stream review of these issues draws on a summer school that took invest in San Sebastian ( Spain ), from 5th to 7th June, 2019. With a chiefly european focus, an interdisciplinary group of researchers discussed key risks and benefits that the seas and global ocean provide humanity ; and debated the future priorities and potential actions for the joint Oceans and Human Health ( OHH ) research and government. Below we outline the setting to both the subject and the workshop, and summarize some of the winder issues that emerged. Our draw a bead on then, and immediately, was to put these issues hard on the agenda and highlight the full of life importance of the oceans to the medical, and in particular the populace health, communities .
Oceans have historically provided livelihoods, barter, food, and other resources, known as “ ecosystem goods and services, ” recently valued at $ 24 trillion ( Barbier et al., 2012 ; Hattam et al., 2015 ; WWF, 2015 ). however, quickly increasing and aging human populations globally, and the resulting anthropogenically driven environmental changes are increasing press on coastal waters, the seas and ball-shaped ocean, and the ecosystem services they provide ( Pecl et al., 2017 ). In finical, human activities increasingly involve continued and accumulative pressures, producing negative impacts ( for example, befoulment, habitat destruction and overfishing ), which affect not lone ecosystem health, but besides homo health ( Depledge et al., 2019 ). homo interactions with the ocean and seas can be inherently hazardous ( as shown in incision “ Yes, Oceans are Risky… ” ). conversely, human health and wellbeing may be promoted through positivist interactions with the coasts and oceans ( as shown in section “ …But Humans Can Benefit From Blue Spaces ! ” ), with the sustainable use of the natural resources and through the renovation and conservation of coastal and marine ecosystems ( De Groot et al., 2013 ; Pueyo-Ros et al., 2018 ; Pouso et al., 2019 ) .
In this context, human health and wellbeing are considered a physical, social and mental state, subject, at least in separate, upon marine and other ecosystems services, provided by the natural world ( Alexandrova, 2012 ). Ecosystem services include corporeal ( food, transportation, economic benefits ) and non-material outputs those consisting on cultural services promoting physical and genial health and having positive effects on social relationships ( Ghermandi et al., 2012 ; Ghermandi and Nunes, 2013 ; Bullock et al., 2018 ).

Marine and coastal ecosystems are separate of a wide network of aquatic environments, including fresh water systems, which are generically referred to as “ blue spaces ” ( White et al., 2010 ; Gascón et al., 2017 ). Despite the acknowledged interactions between healthy blue spaces and human health and wellbeing ( Völker and Kistemann, 2011 ; Wheeler et al., 2012 ; Nutsford et al., 2016 ; Bullock et al., 2018 ), taxonomic research on this subject is relatively late, and important cognition gaps have been identified ( Grellier et al., 2017 ; Fleming et al., 2019 ). These research gaps imply a weaker understanding of how marine aristocratic spaces produce cultural and other relevant ecosystem services, how these are used, and their implications for homo health and wellbeing .
These gaps are credibly due to the fact that the study of ocean health and human health needs to be inherently interdisciplinary and trans -sectoral ( Knap et al., 2002 ; European Marine Board, 2013 ; World Health Organization [ WHO ], 2019 ), requiring joint collaboration between the checkup and public health fields with economic, ecological, marine, social and behavioral sciences, american samoa well as divers stakeholder communities. Reviewing the history, policies, and both known and possible risks and the benefits of these interactions, provides insights into raw avenues of global cooperation. This will allow for electric potential collaborations to address the local anesthetic and ball-shaped challenges of the interactions of humans with the Ocean. These interactions are occurring now and will increase in the future, with the expansion of the homo population living in the coastal zones ( Barragán and de Andrés, 2015 ) and the increasing habit of the oceans, ascribable to the increasing promotion of “ blue increase ” or “ blasphemous economy ” ( Eikeset et al., 2018 ) .
This review initially arose from a summer school delivered in San Sebastian ( Spain ), from 5th to 7th June, 2019. With a primarily european stress, but a global interest adenine good, an interdisciplinary group of researchers discussed key risks and benefits that the seas and ball-shaped ocean provide humanness ; and debated the future priorities and potential actions for the joint Oceans and Human Health ( OHH ) research and administration program. The draw a bead on of this newspaper is to contribute to the emerging agenda on ocean health and human health scientific research and coordination with stakeholders, policy makers and the general populace. This agenda operates within the larger context of the approaching United Nations ( UN ) Decade of Ocean Science for Sustainable Development – 2021–2030 – ( UNESCO, 2018 ), which strive to achieve the Sustainable Development Goals ( SDG ), including healthy lives and wellbeing ( SDG3 ) and conserving and sustainably using the oceans ( SDG14 ), among others ( United Nations, 2016 ; Ryabinin et al., 2019 ) .

Yes, Oceans are Risky…

Elliott et alabama. ( 2014 ) identified a typology of 14 natural and anthropogenetic marine hazards, including : hydrological ( floods ), physiographic removal by natural processes or human actions, climatological ( low-lying rise ), tectonic ( seismic, tsunami ), anthropogenetic microbial and macrobial, anthropogenic-introduced and extractive technical, and anthropogenetic chemicals. These hazards can be acute or chronic, and their respective degree of risk relates to the measure of assets, natural or social, which may be affected. Some hazards can cause locally-derived problems producing risks at small-scale, and/or have large-scale effects ( for example, climate switch, low-lying rise and isostatic recoil ), which cause risks at the global tied .
For millennium, humans have used the oceans to dispose of wastes, including organic matter, nutrients, chemicals, litter, and so forth, in depart based on an erroneous belief that the seas and ball-shaped ocean have the capacity of absorbing and recycling all those contaminants. In addition, oil tanker accidents, atomic weapon tests and other homo activities have impacted the oceans, producing increasing risks both for the environment and homo health. To date, the results of these activities have informed commend management approaches, and reduced the effects of some contaminants ( for example, metals, TBTs, microbial ). The major topics have been oil spills, contamination ( including anthropogenetic chemicals and microbial wastes ), and eutrophication ( Figure 1 ). however, in holocene years, there has been a dramatic addition in research on macro-, micro- and nano-plastics and other forms of marine bedding material ( for example, Science Advice for Policy by european Academies [ SAPEA ], 2019 ; Figure 1 ) .

Figure 1. Evolution of the phone number of papers published in one of the indicate pollution topics in a year. Search in SCOPUS, for the period 1963–2018, and following terms : radioact* OR radiact* OR metal* OR oil-spill OR oil spill OR eutroph* OR plastic* OR microplast* OR nanoplast* OR pharmaceut* OR noise OR litter* OR TBT AND pollut* AND nautical. For details, see Borja and Elliott ( 2019 ). TBT : tributyltin. bill that the vertical scales are different in both figures .

The follow department explores just some of the bad effects of important pollutants and biotoxins found in the oceans on human and ocean health, for demonstrative purposes .

Traditional and Emerging Risks: Microbial Pollution, Pharmaceuticals, and Antimicrobial Resistance

sewage spills and discharge of insufficiently treated barren containing microbes, nutrients ( for example, nitrates and phosphates ), and non-nutrient pollutants ( for example, pharmaceutical residues ) can have multiple adverse impacts on both ocean health and homo health. The introduction of these pollutants to coastal areas results in eutrophication, impacts on the biota of marine animation by chemicals, and versatile illnesses acquired from exposure to seawater containing infective microorganisms ( Wade et al., 2003 ; Agardy et al., 2005 ; Yau et al., 2009 ; Iwamoto et al., 2010 ; Gaw et al., 2014 ; Arnold et al., 2016 ; Leonard et al., 2018a ). Despite the acknowledge harms of microbial befoulment on ocean and human health, this character of contamination regularly affects surface waters worldwide, whether from untreated human waste, effluent treatment plant effluents, sewer overflows, or from circulate sources of pollution, such as bring overflow .
recently, there is increasing refer about the presentation into the environment of bacteria that are immune to anti-microbials, aboard substances with anti-microbial properties that select for and maintain genes conferring resistance to clinically important antibiotics among human-associated bacteria ( Gullberg et al., 2011, 2014 ; Rutgersson et al., 2014 ; Singer et al., 2016 ; Murray et al., 2018 ). Unlike many other pollutants, which degrade in the environment, bacteria regurgitate and can amplify these antibiotic resistance genes ( ARGs ) and pass them to early members of the microbial residential district via versatile horizontal gene transfer mechanisms ( Pruden et al., 2006 ) .
coastal environments are an significant site where people can be exposed to both infective microorganism and antibiotic tolerant bacteria. recreational function of coastal waters and water sports expose water users ( bathers, surfers, etc. ) to antibiotic immune bacteria in the water column. inquiry in the United Kingdom has shown that levels of the bacteria, Escherichia coli, resistant to a group of critically crucial antibiotics are high adequate to be an exposure risk to amateur water users. This exposure risk is particularly high among those who participate in high-contact body of water sports, such as surf and swim, which tend to involve ingesting big volumes of water ( Leonard et al., 2015 ). analysis of E. coli metagenomes revealed that exposure to E. coli harboring respective ARGs is possible evening during low-contact water sports in bathing waters categorized as being of good microbiological timbre ( Leonard et al., 2018b ). Furthermore, frequent bathe in coastal waters has been shown to be associated with gut colonization by ( for model ) cefotaxime-resistant E. coli harboring the plasmid-borne ARGs, blaCTX-M, which are easily mobilized among bacteria via horizontal gene transfer, and which confer resistance to clinically authoritative antibiotics ( Leonard et al., 2018c ). many of these tolerant E. coli colonizing player guts were characterized as E. coli sequence type 131, which can cause urinary tract infections that are difficult to treat .
Contaminants carried by sewage to marine waters can besides reach the food chain. Pharmaceuticals compounds, from pharmaceuticals that have been ingested but not fully metabolized in the human intestine, have been detected in seafood, including finfish and mollusks ( Alvarez-Muñoz et al., 2015 ) along with infective microorganisms ( Iwamoto et al., 2010 ). Seafood harvested from microbially polluted seawater can expose consumers to these harmful agents, normally causing gastrointestinal illness, angstrom well as dangerous conditions. Bivalve mollusks, like mussels and oysters, are particularly bad because as filter feeders, they bioconcentrate environmental pollutants, including antibiotic resistant bacteria in their tissues ( Bighiu et al., 2019 ). many such filter feeders are often consume bare-assed or lightly cooked ; and consumers might be exposed to pathogenic insubordinate bacteria, like E. coli and Vibrio parahaemolyticus ( Heuer et al., 2009 ) .
It is utilitarian to detect, prevent and remediate microbial befoulment in order to protect ocean and human health. It is recommended that sensitive marine waters, such as those used for bathing and mollusk production, are monitored for the indicators of water timbre, including microbial pollution ( World Health Organization [ WHO ], 2003 ; European Union [ EU ], 2006a, bel ). This helps to detect promote levels of contamination that might be harmful for bathers, workers and consumers. however, these monitor activities are not performed global ; and data on bacteria repellent to antibiotics in these waters are not routinely collected. far exercise needs to be done to select allow indicators, and to develop methods for their measurement before environmental levels of antibiotic immune bacteria can be regulated .
approximately 77 % of pollutants in coastal waters come from terrestrial sources, for example, via rivers, and atmospheric deposition ( Agardy et al., 2005 ). Preventing and managing the risks associated with faecal contamination and antimicrobial resistance will require identify authoritative land-based processes introducing microorganisms and selective agents to marine environments which can be targeted for intervention. These processes and the factors determining their relative contribution will vary spatially. They may be affected in the future by changes in local homo and animal populations ( increased urbanization, migration ), vitamin a well as by changes to the hydrological bicycle and increases in global ocean temperatures induced by climate change ( Vezzulli et al., 2016 ). Therefore, an integrated approach path involving environmentally sound and economically viable solutions will be needed to reduce risk to human and ocean health posed by sewage in the oceans .

Harmful Algal Blooms as a Paradigm of the Interconnection Between Human Health and Oceans Health

A “ Harmful Algal Bloom ” ( HAB ) is a discrete consequence associated with a proliferation of microalgae, cyanobacteria or macroalgae that is perceived by humans as harmful to their health or ecosystem services. “ Bloom ” is defined as an increase in abundance of a particular organism relative to its normal background level ( which may be “ low ” or “ high ” depending on the species ). For exemplify, excessive algal biomass accumulation can cause damage to aquatic organisms due to decreased sunlight and to oxygen decrease in the urine when the blooming degrades. high biomass blooms of microalgae that synthesize ichthyotoxins or physically damage pisces gills can cause massive pisces kills ( in aquaculture or natural fisheries ). other microalgae produce potent toxic compounds that cause damage to humans by direct contact, inhalation or consumption of contaminated seafood. Food wear poisonings ( most normally paralytic Shellfish Poisoning ( PSP ), Diarrheic Shellfish Poisoning ( DSP ), Amnesic Shellfish Poisoning ( ASP ), and Ciguatera Fish Poisoning ( CFP ) ; see e.g., Berdalet et al., 2015 ) constitute the main menace to human beings .
The HAB toxins ( thermostable and chemically identical diverse ) are transferred and bio-concentrated through marine food webs up to humans ( Figure 2 ) who can experience acute or chronic symptoms, and in severe cases, death. The presence of toxic organisms and/or their toxins in the water result in bans on finfish and mollusk collection and commercialization, resulting in important economic losses in different sectors including tourism ( for example, Adams et al., 2018 ) .

Figure 2. Microalgal blooms may have unlike impacts on the environment and human health. (A) Some microalgae are ichthyotoxic ( for example, Pseudo-chattonella, Chrysochromulina ), causing massive pisces kills in aquaculture sites or lifelike fish populations. High microalgae cell concentrations can aggregate at the water surface and form floating foams that decrease urine bath quality and easy handiness for other aquatic organisms. In some cases, from the ( floating or not ) aggregates compounds causing respiratory irritation are aerosolized by wind and waves ( as in the subject of Karenia and Ostreopsis ). In general, when the blooms decay, bacterial decay of the high microalgal biomass can decrease oxygen handiness to the other organisms in the ecosystem. Some planktonic microalgae ( for example, Alexandrium, Pseudo-nitzschia ) are ingested by percolate feeders such as culture or naturally growing shellfish. Toxic benthic microalgae grow attached to corals of macroalgae. (B) Biotoxins bioaccumulate and are transferred through the food web causing seafood digest poisonings in human. PSP, DSP, and ASP can occur from consumption of contaminate shellfish, while different fish species can cause CFP .

Socio-cultural impacts ( for example, change on dietary patterns and traditional seafood – professional and recreational – collection activities ) are peculiarly relevant in the case of CFP, endemic in tropical areas ( Friedman et al., 2017 ), or due to especial blooms such as those of the domoic-acid ( ASP ) manufacturer, Pseudo-nitzschia in 2015 in the Pacific coasts of America ( Ritzman et al., 2018 ). Estimating the total cost of HABs is unmanageable and complex. A conservative total annual send cost of HABs could account for about 100 billion US $, excluding costs for homo health manage ( Bernard et al., 2014 ; Trainer and Yoshida, 2014 ) .
harmful Algal Blooms are a especial exemplar of phytoplankton ( and phytobenthos ) dynamics controlled by complex combination of physical ( temperature, hoist, waves, atmosphere-ocean interactions ), chemical ( inorganic and organic nutrients ), and biological ( predation, rival, allelochemistry, parasitism ) processes that operate at different spatio-temporal scales ( GEOHAB, 2001 ). Climate change may besides influence HAB events, saturation and impacts. In finical, ocean warm can favor the biogeographic extension of tropical and subtropical organisms, such as Gambierdiscus species, to more temperate latitudes, increasing the threat of CFP. Nevertheless, future trends are uncertain ( for example, Wells et al., 2019 ), while the identification of newly toxins can complicate the risks to human health ( see for example, rewrite in Berdalet et al., 2015 ) .
harmful Algal Blooms occur in all aquatic environments and latitudes and because they are basically natural phenomena, their occurrence can not be wholly avoided or eliminated. however, sealed anthropogenetic forcings ( for example, eutrophication, revision of the water circulation patterns by harbor construction, habitat destruction, gap of harmful organisms through ballast waters, or transport of culture organisms ), particularly in the coastal zone, can benefit some HABs ( Masó and Garcés, 2006 ). technically, in the twenty-first Century, it is possible to minimize those activities, and to address the sustainable use of natural resources, which in turn will decrease in separate the probabilities of HAB occurrence .
In the last 50 years, the protection of human health and wellbeing from HAB impacts has been achieved through intensive and better monitoring of harmful organisms and their toxins coordinated with european food safety regulations ( O ’ Mahony, 2018 ) ; and by significant investment in the sympathy of blooms dynamics, which can in some cases help to predict their occurrence and design extenuation strategies ( Bricker et al., 2008 ). due to the complexity of HAB dynamics, major advances have been achieved through interdisciplinary regional, and national and international coordination .
One exercise of this type of coordination includes the multi-agency and multi-institutional interdisciplinary collaboration over many years to investigate the perennial massive blooms of the neurotoxin and fish-killing HAB, Karenia brevis ( Florida red tide ), in the Gulf of Mexico and Florida ( for example, Fleming et al., 2011 ). Progresses concern toxin detection in water and air, and homo health prevention protocols and medicine approaches. Another example is the Accord RAMOGE that coordinates the strategies of Monaco, Italy, France, and Spain for monitoring Ostreopsis blooms in some beaches where the proliferation of this benthic dinoflagellate is associated to mild respiratory distress in humans. RAMOGE besides facilitates communication between scientists, stakeholders and general populace .
At global international scale, the SCOR and IOC UNESCO programs GEOHAB ( 2000–2013 ) and GlobalHAB ( 2016–2025 ) foster coordination on interdisciplinary, international and interinstitutional inquiry of HABs. Among the 12 Themes of GlobalHAB, that of “ HABs and Human Health ” aims to increase collaborations among scientists with medical, veterinarian, public health, economic, and other social skill expertness to help understand and minimize the risk of HAB impacts to human health and animal health, with a particular global change perspective. These GlobalHAB scientific objectives are implemented through interactions with other international programs and projects. The overall set about followed by the research on HABs, can inspire analogous strategies to address other challenges posed to oceans and human health .

Marine Plastic Pollution: Changing Behavior and Engaging Communities

Plastic pollution on the coast and in the ocean is another example of anthropogenetic activities posing considerable hazard to the environment and besides, potentially, to human health and wellbeing. Plastic befoulment is entirely caused by the human output of formative materials, manipulation and administration ( Pahl et al., 2017 ). Plastic is a relatively new material ; it has alone been used widely since the 1960s, so the measure and the swerve of this corporeal escaping into the natural environment globally are astonishing ( Jambeck et al., 2015 ), producing different impacts ( Galgani et al., 2019 ) .
It is useful to think about formative use as a system where fictile moves from the economy to the environment, with many stakeholders and sectors involved making decisions on materials and consumption. For exemplar, a manufacturer might decide to use plastic as packaging because it is durable, bum and protects against moisture. however, consumers might decide against this merchandise because it is using fictile packaging, having seen media report of damage to wildlife. Increased report of injury to wildlife has been documented in scientific articles and in the wide-eyed media ( Science Advice for Policy by european Academies [ SAPEA ], 2019 ). In fact, the European public report card high gear concern about this wildlife affect, but lower concern about economic costs or homo health impacts ( for example, Hartley et al., 2018 ). Beaumont et alabama. ( 2019 ) have recently provided the first ball-shaped appraisal of marine credit card pollution, using an ecosystem services border on that takes into consideration social ( including health ) impacts, in addition to ecological and economic impacts .
furthermore, while some media reports have recently discussed potential human health impacts, particularly of microplastics, there is presently not enough scientific evidence to establish risks conclusively, whether it is via consumption or inhalation ( Science Advice for Policy by european Academies [ SAPEA ], 2019 ). It seems that in populace discourse the presence of microplastics in the environment ( which has been established conclusively ) is sometimes conflated with the presence of risk ( for which assessment is missing ). This decision does not indicate an absence of hazard. Future research is needed on effects of exposure to different size ranges ( besides compared to natural particles ) and the role of credit card carrying additives and microorganisms and pathogens ( compared to such concentrations in the absence of formative ; Science Advice for Policy by european Academies [ SAPEA ], 2019 ; Vethaak and Leslie, 2016 ) .
Newman et alabama. ( 2015 ) have observed that, in most cases, the price of credit card is disconnected from the true cost of disposal, and that the costs of recycling and administration are presently borne by society. This encourages the production and pulmonary tuberculosis of plastic at low prices, while waste management after family collection is typically hidden from the consumer, posing another unplug between the experienced benefits of the corporeal and the end-of-line costs and impacts. While such a complex system subject on many unlike actors might seem difficult to change, at the same fourth dimension it poses a range of opportunities. top-down and bottom-up pressures can work in concert, combining, for example, policy change and NGO campaigns with self-organized community activities and individual leadership. right now, there appears to be senior high school “ problem awareness ” ( for example, Dilkes-Hoffman et al., 2019 ) and consensus that together form the momentum for change unprecedented in the context of other environmental challenges ( for example, compared to climate switch ) .
so, how can we build on this momentum to maximize transfer ? In inquiry terms, we need to apply interdisciplinary perspectives to both the issue itself and to potential solutions. We need to understand the perceptions, motivations and intentions of different stakeholders to design solutions and alternative systems that will be satisfactory and effective. These campaigner solutions then require taxonomic minor trials and evaluation to avoid unwanted side effects ( for example, increase carbon footprint ) before they are rolled out more wide. such evidence-based approaches require social and behavioral science methods ( see Pahl and Wyles, 2017 ), aboard economic, technical foul and lifecycle analyses and environmental skill assessments of damage .
Behavioral science inquiry, in detail, has demonstrated the limited effect of just increasing cognition in motivating behavior change. While better cognition can help facilitate change, other factors have been shown to be more mighty [ see Pahl and Wyles ( 2017 ) for a summary ]. social norms and a sense of efficacy or restraint over actions are among the most important predictors of demeanor switch ; while emotions, values and sociable identity can help or hinder action above and beyond the presence of cognition. future activities should go beyond entirely communicating facts and targeting cognition to apply more comprehensive models of behavior transfer and community betrothal .
In kernel, plastic contamination is very much the concentrate of attention in terms of the current public hold forth, inquiry and policy action, but it is less clean whether this attention is wholly justified, compared with other existing risks to ocean and human health. On the flipside, this attention could be used to engage individuals and communities with wide environmental issues that go beyond plastic pollution. ultimately, and despite these varied concerns, it is besides important to remember that fictile remains a utilitarian material in many aspects of modern life, from healthcare to transport ( Thompson et al., 2009 ). arguably the key trouble is not the material itself, but how we use and manage it .

…But Humans Can Benefit From Blue Spaces!

Bathing in coastal areas explicitly for health and wellbeing has been practiced with “ Sea Bathing ” hospitals and clinics popular around Europe from the mid-18th Century forth ( Wheeler et al., 2014 ). In the early days, many of the “ treatments ” focused on clamber complaints and intestinal issues, whereas nowadays the focus is more on mental health and wellbeing ; and how spend clock in and around marine environments can help reduce stress, anxiety, and low related disorders which are flying becoming the independent leading causes of disability in middle to high income countries ( Kassebaum et al., 2016 ) .
The quality of these places matters and the benefits depend on accessible, clean, and dependable coastal settings for the benefits to accrue. In addition, to good water timbre for washup, cleanse uncontaminated water system is required for healthy ecosystems sustaining biodiversity and functioning, and to support economic activities such as tourism and sustainable aquaculture .

Use and Evolution of Bathing Waters in Europe

Bathing water quality is a campaign for business for public health, as swim at beaches contaminated with chemicals, faecal bacteria and other organisms ( viruses, parasites, etc. ), or even playing in the sediments and sands where faecal matter can accumulate, can result in illness, as discussed in section “ Traditional and Emerging Risks : microbial Pollution, Pharmaceuticals, and Antimicrobial Resistance. ” The major sources of befoulment responsible for microbial befoulment are urban sewage and water draining from farms and farmland, while chemical contamination can result from improper treatment and disposal of waste from production plants. such pollution increases during heavy rain and floods, when contaminants are washed into rivers and seas, and as a solution of overflowing sewer networks and farm run-off .

Development of Bathing Water Legislation

deoxyadenosine monophosphate recently as 40 years ago, boastfully quantities of by and large uncontrolled, untreated or partially treated municipal effluent were discharged into many of Europe ’ s surface waters ( a practice that still continues in many undeveloped places around the world ). At the same time, an increasing count of beach visitors, along with the dirty and degraded submit of many beaches, raised concerns about the health of beach users and environmental awareness, which paved the way for the inaugural european Union ( EU ) Bathing Water Directive ( European Union [ EU ], 1976 ) .
The Directive defined bathing waters as “ those fresh or sea waters where bathing is either explicitly authorized or is not prohibited, and is traditionally practiced by large numbers of bathers. ” The Directive listed 19 physical, chemical and microbiological parameters for which specify values had to be defined. Some of them were “ imperative mood ” values, whilst others were “ road map ” values. Member States had to set values for bathing water that were no less than the imperative values, whilst the road map values were seen as desirable targets. The Directive besides stipulated minimum sampling frequencies and reference methods of analysis. Member States were obliged to take all necessary measures to ensure that, within 10 years of the publication of the Directive, the choice of washup water would conform to the limit values .
however, that Directive reflected the state of our cognition and behavior in the early 1970s. Patterns of bathing water use have changed subsequently, as has the department of state of scientific and technical cognition. Hence, the revised Bathing Water Directive ( European Union [ EU ], 2006a ), used scientific testify from the most dependable indicators to predict microbiological health hazard and achieve a higher degree of protection. This Directive is implemented in coordination with other Community legislation on water, such as directives on urban effluent discussion ( European Union [ EU ], 1991a ), protection of waters against befoulment caused by nitrates from agricultural sources ( European Union [ EU ], 1991b ), and articulation actions with the Water Framework Directive ( European Union [ EU ], 2000 ). The retool Bathing Water Directive puts greater emphasis on the integrate management of bathing waters, which, if implemented in an effective way, should lead to appropriate washup water choice .

Bathing Waters Quality and Trends

As a leave of the EU ’ s Bathing Water Directives, Europe ’ s bathing water quality has improved markedly over the concluding 40 years. effective monitor and management ( e.g., investment in the sewage system, better effluent treatment and the decrease in befoulment from farms ), introduced under the Directives, led to a drastic reduction in pollutants released through untreated or partially treated urban and rural wastewaters. The execution of the Urban Wastewater Treatment Directive ( European Union [ EU ], 1991a ) and a focus on reducing overflow from sewers, have been instrumental in reducing befoulment and in improving the quality of several low-quality bathe waters ( Europena Environment Agency [ EEA ], 2019 ). As a result, more and more bathe sites are not only meeting the minimum “ sufficient ” quality standards, but have reached “ excellent ” timbre ( Figure 3 ) .

Figure 3. Evolution of the quality in > 15,000 european beaches, under the Bathing Water Directive. source : hypertext transfer protocol : // .

however, there are even poor-quality bathe waters ( Figure 3 ). The major sources of pollution responsible for microbial contamination in bathing waters today are still insufficiently treated or untreated effluent .
Weather is an extra gene that affects bathe water quality. In wet summers, big amounts of rain induce storm water bubble over, resulting in the release of dilute sewage into bathing waters or streams that discharge close to or onto beaches. This is not merely force majeure, however, since the failure besides lies within what the sewage systems are designed to accommodate and with increasing weather extreme point predicted under future climate variety, engineering systems need to be prepared for shorter, heavier rain events ( McMichael et al., 2006 ). In years with downstairs median cheerfulness, water quality is besides affect, as the sun ’ south ultraviolet rays can kill faecal bacteria found in the urine ( Aragonés et al., 2016 ) .
In order to further improve cases of inadequate bathe water choice, it is imperative that the sources of pollution be assessed. The bathe water profiles prepared under the Bathing Water Directive should provide an indication of pollution sources in the catchment area of the bathe water ; and, together with historical data on rain, current flow and sea currents, provide information on the upstream sources of befoulment to be targeted with measures. Management measures are chiefly implemented for sufficient or poor-quality bathing waters .
Water samples are collected at bathing sites throughout the bathe season ( by and large end of May to end September ). The samples are then analyzed for two types of bacteria, namely intestinal enterococci and E. coli, indicators of befoulment from sewage. Depending on the levels of bacteria detected, the bathe water quality is classified. After the end of the bathe season, and based on 4 years of data, bathing waters are classified into one of the bathing water quality classes ( “ excellent, ” “ good, ” “ sufficient ” or “ poor ” ). Some bathing waters have not been classified because there were insufficient samples, or because they are fresh or have undergone changes potentially affecting water timbre .
At the end of the bathing water season EU Member States report the observations at their bathe water sites to the Commission and the European Environment Agency. Before the startle of the adjacent bathe season an annual composition on the choice of bathing areas is prepare, being the main messages from the most holocene ( Europena Environment Agency [ EEA ], 2019 ) :
• More than 22,000 bathing waters were monitored throughout Europe ( 28 EU Member States, plus Albania and Switzerland ). Two thirds of all sites were coastal bathe waters, while one third were situated at rivers and lakes .
• Globally, 95.4 % of EU bathing sites met the minimum “ sufficient ” quality requirement and 85.1 % of bathing water sites met the Bathing Water Directive ’ s most rigorous “ excellent ” quality standards. This gives a good indication of where to find good quality bathing body of water during the coming summer .
• only 290 ( 1.3 % ) EU bathing urine sites were rated as having “ hapless ” water system quality, which is slenderly lower than in 2017. such poor quality, pollute water can have impacts on human health, causing gastroenteritis, respiratory, skin, ear, and center infections .
• All reported washup urine sites in Austria, Cyprus, Greece, Latvia, Luxembourg, Malta, Romania, and Slovenia achieved at least “ sufficient ” quality in 2018 – i, thus no bathing waters with inadequate choice. In four countries, 95 % or more of bathing waters were assessed as being of “ excellent ” quality : Cyprus ( 99.1 % ), Malta ( 98.9 % ), Austria ( 97.3 % ), and Greece ( 97 % ) .
Of note, with the exploitation of cheap, effective wetsuits, bathing seasons are efficaciously extending way beyond the traditional May-September time period, with sealed groups such as surfers spending time in bathing waters across the stallion year. Thus, there is an increasingly strong controversy that bathing waters should be monitored all year round .

Assessing the Links Between Seas, Ocean, and, Human Health and Well-Being in Europe in the 21st Century

Although there is a long history of research into the risks to health and wellbeing from our seas and ball-shaped ocean ( see section “ Yes, Oceans are Risky… ” ), the taxonomic analyze of potential benefits is more late. In order to look at potential associations it is utilitarian to utilize a range of approaches, to account for the strengths and weaknesses inherit with each in isolation ( table 1 ) .

mesa 1
Table 1. Overview of strengths and limitations of different research approaches to exploring health and wellbeing from blue environments .

Analyses of population-based surveys such as the United Kingdom Census suggest the closer people live to the seashore, the more likely they were to self-report good health, particularly among more socio-economically deprive communities ( Wheeler et al., 2012, 2015 ). such analyses are limited, however, in that they use sphere aggregates of both exposure and outcomes and are open to the criticism of “ ecological fallacy, ” i, the mistake of making assumptions about individuals from group-based data. consequently, other research has used repeat-cross sectional surveys such as the Heath Survey for England ( HSE ) that are able to compare person floor exposures with individual horizontal surface outcomes. These data have not only replicated the basic convention that people who live on the coast, particularly those on lower incomes, have better mental health ( Garrett et al., 2019a ), they have besides been used to investigate the mechanisms through which these effects emerge, e.g., greater physical activity ( Pasanen et al., 2019 ) .
however, the cross-sectional nature of even these data mean that it is not possible to assume causality since people with better health may choose to live on the coast, a “ survival effect. ” Analysis of longitudinal cohorts is therefore required to explore how people ’ mho mental and physical health changes as they move home plate between inland and coastal settings. analysis of the longitudinal “ British Household Panel Survey, ” for case, has shown that, after controlling for a number of individual and area-level factors, participants report significantly better general health and mental health in years when they lived closer to the seashore ( White et al., 2013 ). This is stronger attest of a causal nerve pathway but placid relies on self-report data .
cross-section analyses of the english 1958 parturition cohort ( > 17,000 over > 50 years ) have besides been used, consequently, to explore the long-run effects of exposure to the slide on physiologic biomarkers of health. In one study, individual ’ sulfur vitamin D status ( derived from deduction of UV light and considered protective for many chronic diseases ), was explored in relation to proximity of live near the coast. After controlling for a act of potential confuse factors ( for example, diet, outdoor action ), coastal mansion was associated with greater solar irradiance ; and individuals living close to the slide had higher vitamin D levels than those inland, particularly in fall ( Cherrie et al., 2015 ) .
however, living near the slide is often alone a proxy for target reach, under the assumption that people who live near it, spend more time in and around it ( White et al., 2014 ). More matter to, is how people spend their time in nautical environments, and how the activities engaged in involve their genial and physical health. To explore these questions researchers have used the English “ Monitor of Engagement with the Natural Environment ” ( MENE ) sketch which asks around 40,000 adults a year about their interactions with the natural world, including the seas and coasts. not only are coastal visits reported as being better than other settings for stress reduction ( White et al., 2013 ), they are besides the locations where most energy is expended ( Elliott et al., 2015 ) ; in early words, they provide two important health-related functions. coastal settings such as beaches besides attract a army for the liberation of rwanda broader spectrum of the population than inland sites such as woodlands and this may explain why coastal areas are lower in health inequalities ( Elliott et al., 2018 ). More holocene inquiry using MENE datum has found that feelings of connection to coastal/marine sites is besides higher when they have a designated condition ( for example, ascribable to high levels of biodiversity ), suggesting that management and quality of such sites matter directly for people ’ south concerns about them ( Wyles et al., 2019 ) .
Surveys can never fully unpack causality which is why different types of experiment have besides been conducted, including both naturalistic field-experiments and even more control lab studies. An model of the erstwhile was conducted at the United Kingdom ’ s National Marine Aquarium ( Cracknell et al., 2017 ). During a restock, individuals were asked to sit and watch the aquarium ’ south largest tank for 10 minute at periods when the tank had different levels of biodiversity. broadly speaking, higher levels of biodiversity were associated with better physiologic ( for example, heart rate ) and psychological ( for example, temper ) outcomes. A second report tested how “ walk ” along a virtual reality ( VR ) beach ( using a headset and hand accountant ) affected know pain during substantial dental discussion. Patients were randomized to nature ( coastal ) VR, urban VR, and usual alveolar consonant care. Those randomized to either type of VR reported reduced know and recollected pain compared with no VR. Furthermore, the content of the VR mattered : coastal nature VR was reportedly better for annoyance reduction than urban VR ( Tanja-Dijkstra et al., 2018 ) .
In two lab studies the preferences ( for example, attractiveness ), feign and perceived restorativeness ratings of views from the lapp conjectural “ hotel room ” were explored for participants looking at photograph of 120 different views ( White et al., 2010 ). Both natural and built scenes containing water were associated with higher preferences, with greater plus affect and higher perceived restorativeness than those without water. In a similarly controlled study using videos and children aged 8–11, researchers found that children showed better self-regulation ( e.g., the ability to delay gratification ) after watching a video of a local anesthetic beach than a local urban set ( Jenkin et al., 2018 ) .
qualitative studies can go beyond boastfully surveys and experiments by having in-depth conversations with a smaller total of individuals. In one, both parents and children reported that the coast encourages families to play actively together, compared to inland places ( Ashbullby et al., 2013 ). In another, in-depth interviews were undertaken about specific trips to coastal settings for recreational purposes using advanced geo-location techniques ( Bell et al., 2015 ). specifically, people ’ s locations during the visits were recorded using a satellite geo-locator and then a map of their activeness recorded and presented back to them after the inflict to be discussed in-depth. This proficiency enabled people to enjoy the visit without hindrance at the meter, while at the lapp time being able to reflect on why they stopped at a certain point for respective minutes, with responses such as “ the inner light on the body of water was fascinating and I equitable had to stop and watch. ” Although generalizability is difficult from such studies, they offer a far richer picture of people ’ s personalized casual lived experiences, emotions and thoughts than can achieved from either generic surveys or highly control experiments .
finally, as the number of studies in the area increases, systematic reviews and tell syntheses of multiple studies can be performed. One late recapitulation of 35 epidemiologic studies examined the relationships between coastal residence and respective health outcomes and concluded that the poise of evidence supported a positive association between animation in areas with more blue sky outer space and benefits to both mental health and wellbeing. however, the tell for a plus association with general health, and reduce fleshiness, cardiovascular disease, and refer outcomes, was less coherent ( Gascón et al., 2017 ). Another review of 33 intervention studies ( for example, that used watersports among at hazard communities for health and wellbeing promotion purposes ) concluded that cautiously structured interactions with the sea/ocean could help both personal and social wellbeing ( Britton et al., 2018 ) .
There is still much research to be done in this area. For model, there are issues around how best to measure “ exposure, ” and far exploit is needed on the mechanism of benefit, and whether these beneficial effects are only found in certain countries and not others. The Horizon 2020 BlueHealth Study is examining a many of these issues. In particular, the International BlueHealth Survey has recently been run in 14 european Countries, a well as Hong Kong, Australia, California, and Canada ; and will begin to examine whether the beneficial effects can be found in countries beyond United Kingdom. Additional research is besides needed about the risks and benefits for coastal populations in developing countries, particularly given the increasing impacts of climate and other environmental change on these potentially vulnerable communities .

Case Study of Collaboration and Engagement to Foster Research and Knowledge Transfer in OHH

presently, new state-of-the-art tools to study and disseminate the importance of marine ecosystems on homo health and wellbeing are needed. Living marine resources have potent links with homo health and wellbeing that are building complex, still not well understand ( Lloret et al., 2016 ). An advanced cock to engage stakeholders and citizens is the “ Oceans and Human Health Chair ”, which was established in 2017, thanks to a pioneer collaboration between the University of Girona, the City of Roses, the Fishers Association of Roses, and the Fishmongers ’ Guild of Catalonia. The Chair is the inaugural in Spain, and one of only a few in Europe, that focuses on the topic of oceans and human health ( OHH ). The Chair provides a alone bank of cognition on the subject, integrating different stakeholders from universities, research centers, health centers, environmental administrations, commercial companies, and society. This combination of cognition and expertness means that the Chair is in a singular position to contribute in the growth of authoritative work, not only from an academic orient of position but besides for society as a hale .
The OHH Chair promotes and carries out studies on the complex relationships that exist between marine ecosystems and the health of people, a well as the transfer of this cognition to company. In this room, the Chair not merely contributes to a better agreement of the links between marine ecosystems and human health, but besides helps informing people about a relatively little-known aspect : how protecting and preserving marine ecosystems can protect and preserve the health and wellbeing of people. Hence, the Chair organizes lectures, courses, conferences and exhibitions aimed at specific audiences ( for example, fishers, fishmongers, affected role associations, tourism companies, environmental and health technicians and university students, among others ) equally well as the general public – both local and tourist, young and erstwhile – to spread information on the links between the ocean and people ’ south health and wellbeing .
The Chair is based in Roses in the north-western Mediterranean, which is part of the “ Cap de Creus Natural Park ”, one of the most emblematic nautical reserves on the Catalan coast. This marine protected area ( MPA ) is an excellent test ground for the Chair for studying how marine reserves, through an active voice management to preserve marine habitats and resources, can contribute to human health and wellbeing. Furthermore, the fact that the Chair is situated in a Mediterranean area affected over many years by human activities constitutes another testing reason to study the impacts of tourism and fishing in the Mediterranean on human health and wellbeing ( Lloret and Riera, 2008 ; Lloret, 2010 ; Lloret et al., 2019 ) .
The Chair shares the 17 SDGs of the UN 2030 Agenda for Sustainable Development ( United Nations, 2016 ). Among the goals are the conservation of the seas and oceans and the sustainable use of the nautical resources, the promotion of a goodly life, and the preservation of people ’ s wellbeing. The Chair besides endorses the “ One Health Initiative ”, which is a global strategy for expanding interdisciplinary collaborations and communications in all aspects of health care for humans, animals and the environment. In this way, the OHH Chair is contributing to forge inclusive collaborations between marine and fisheries biologists, oceanographers, physicians from difference disciplines ( oncology, allergology, cardiovascular risk, epidemiologists, etc. ) angstrom well as veterinarians, social scientists and marine ecosystem managers .
The future development of chairs such as the OHH Chair in Roses could give way to new collaborations and synergies between universities and research centers studying OHH topics and other non-academic entities including fishers ’, consumers ’, and patient ’ sulfur associations, hospitals and primary care centers and tourism industry, among others, to foster sustainable maritime activities and healthy lifestyles. The OHH Chair could serve as an case of efficient tool to build strong relations with all the regional agents operating in the field of OHH, to generate efficient interactions and to create trust between company and the academia .

Weaving Alliances Between Blue Tourism and OHH Research, Through Citizen Science

coastal tourism is one of the pillars of the Blue Economy, and a key driver of economic development and jobs in Europe ( European Union [ EU ], 2015 ) and beyond. Every class, millions of tourists visit coasts worldwide. Enjoying clock time by the beach is even the number one rationality for tourists to go on holiday among european citizens ( TNS Political & Social, 2015 ) .
The seasonal concentration of tourism in coastal areas can have a negative impact on the environment ( Davenport and Davenport, 2006 ), and, as a consequence, on the health of those living or spend meter by the sea ( Fleming et al., 2006 ). however, it besides opens a window of opportunity to boost Ocean literacy amongst citizens, and to make them mindful of the consequences of poor environmental management ( Uyarra and Borja, 2016 ). Given the educational and interpretational dimension of ecotourism, those operators offering ecotourism activities by the slide or at ocean ( “ blue ecotourism ” ) can support education and awareness on the relationship between the OHH, vitamin a well as contributing to advances in research these interactions through citizen skill engagement ( Pocock et al., 2018 ) .
Citizen science is emerging as a very utilitarian ally of both research and education efforts directed at better understanding our natural environment and managing our relationship with it ( Vann-Sander et al., 2016 ). Within this broad framework, the emerging discipline of OHH can benefit enormously from the engagement of civil company in data solicitation efforts, supporting inquiry and decision-making processes. actually, OHH needs that engagement to facilitate the implementation of measures geared at minimizing the risks and maximizing the benefits of people ’ s interaction with the ocean .
While there are many examples of successful citizen science initiatives that are contributing to gather research data on biological variables ( such as those focusing on recording sightings of marine life, amongst others ) ( Crain et al., 2014 ), the “ blue health ” property of spend time by the coast or at ocean remains largely untapped by citizen science efforts. The H2020 SOPHIE project is seeking to fill in this opening, piloting a Citizen Science Programme to activate tourism operators and their customers as “ citizen sensors ” that contribute to build cognition on OHH .
Two SOPHIE citizen skill initiatives have been launched in the European Atlantic and Mediterranean basins, namely “ Blue spaces and Well-being ” –looking at the relationship between exposure to blue spaces through ecotourism activities and mental wellbeing and environmental awareness- and “ Mapping Ostreopsis spp. ” ( a HAB ) –seeking to work with tourism operators of the WILDSEA Europe network who live and knead by the coast all year round, as an early detection system in their areas of blooms of Ostreopsis spp. [ a harmful microalga with meek effects on beach users, for example, Vila et aluminum. ( 2016 ) ]. To date, 96 tourism operators have proactively signed up to contribute to both citizen science initiatives through SOPHIE ’ s Citizen Science Program .
Although the results of the Program will not be demonstrated until belated 2020, the successful engagement of tourism operators speaks to the disposal and willingness to contribute to OHH research of tourism stakeholders connected to blue ecotourism. SOPHIE ’ s Pilot program will help to identify barriers and critical success factors to address when rolling-out citizen skill initiatives on OHH at a larger scale in Europe .

Governance of Oceans and Health Interactions, in Europe

The inventory of risks and benefits related to oceans and health, as described in the previous sections, highlights the importance of this OHH subject, but to date, it does not have an denotative place in european policy make. The EU nautical policy and legislative framework is designed to regulate human activities in the marine environment and to underpin marine environmental auspices ( Boyes and Elliott, 2014 ). only a modest number of EU maritime instruments take specific bill of human health aspects ( for example, the Bathing Water Directive ( European Union [ EU ], 2006a ), the mollusk Waters Directive ( European Union [ EU ], 2006b ), the Water Framework Directive ( European Union [ EU ], 2000 ), and the EU Maritime Security Strategy ( european Commission [ EC ], 2014 ) ; and these are specifically targeted at dealing with risks to health ( for example, due to chemical befoulment or waterborne pathogens ) preferably than health forwarding. Most of the EU ’ s nautical legislative instruments, however, do not take explicit account of the connections between nautical environmental health and homo health, including flagship policy instruments such as the Marine Strategy Framework Directive ( MSFD ; European Union [ EU ], 2008 ), the Maritime Spatial Planning Directive ( European Union [ EU ], 2014 ) and the Blue Growth Strategy ( european Commission [ EC ], 2012 ) .
European Union health policy aims to protect and improve health of EU citizens and complements national policy since Member States are primary creditworthy for health services and medical caution. however, cross-border health threats may be subject to a european approach. therefore far, there seems to be little focus on health benefits at the EU level. The EU Third Health Programme ( 2014–2020 ) ( european Union [ EU ], 2014 ) addresses the critical yoke between environment and health, but does not refer to the particular benefits of coastal or blue environments or how these could be realized .
In european urine policy, a transfer from politics to governance can be identified in the last decades ( european Commission [ EC ], 2001 ). Governance approaches, with the participation of multiple actors at multiple levels, and particularly bottom-up approaches, are often regarded as more effective in dealing with building complex urban water issues, compared to conventional legal frameworks with top-down central steering mechanism ( Lee, 2009 ; Howarth, 2017 ). In 2016, the european Commission and the High Representative of the Union for Foreign Affairs and Security Policy launched an agenda for international ocean government ( JOIN, 2016 ) and is partially of the EU ’ s response to the UN SDGs, in particular SDG 14 “ to conserve and sustainably use the oceans, seas and marine resources. ”
The agenda aims to strengthen external ocean government in order to manage and use the world ’ sulfur oceans and their resources in ways that keep our oceans healthy, productive, safe, impregnable and resilient. The agenda calls for a cross-sectoral, rules-based international approach. Although some ( indirect ) linkages to health risks can be found in agenda, the potential benefits of oceans to human health and wellbeing are lacking .
To bring the oceans and health theme to EU policy postpone, might need specific conditions of administration. Conditions of government are defined as the elements and activities that are necessity in a administration approach to realize the objectives aimed for. So far, administrative bodies on oceans and health manoeuver at analogue tracks that do not inevitably interact, both at national and european levels. To improve potency, interactions need to be established, both from national and european communities. An incentive, likely benefit or shared vision could be a vehicle to get this started. Understanding the oceans as separate of the ball-shaped hydrological cycle ; how it is influenced by versatile drivers and pressures ; the benefits and risks to human health ; and the potential effects of interventions, all contribute to capacity build for those who have the authority and means to act. so far, the distribution of cognition among authorities, early stakeholders and citizens is fragmented. Citizen awareness of the benefits of oceans and health would support policy debates ( for example, “ right to urine ” enterprise ), american samoa well as data and testify to support the consider and to monitor the effects of any interventions agreed upon .

Impacts of Future Trends on OHH

The intricate relationship between the health of both the oceans and humans is far complicated because the nautical environment is under increasing blackmail from human activities, for example, nautical conveyance, industrial processes, fish, maritime tourism and agrarian and barren practices deoxyadenosine monophosphate well as the growing impacts of global change. other trends that could impact the relationship between oceans and health concern demography, economy, social-cultural aspects, migration across the sea ( e.g., the actual refugee crisis in the Mediterranean ), technological developments, and policy development. Examples are the increasing human life anticipation, the increasing share of chronically ill, so far active people, the addition of tourism global, and the use of engineering for awareness raising and healthy behavior .
then far, the assessment of the attendant impacts, on both marine ecosystems themselves and on human health and wellbeing, have largely been undertaken as branch activities, under the auspices of different disciplines with no obvious interactions ( Fleming et al., 2015 ; Depledge et al., 2019 ). Furthermore, the impacts of these trends have been studied at a continental or national horizontal surface ; and policy development is much based on these high-level studies. The implications of global trends on a local level are scantily understood indeed army for the liberation of rwanda. however, local authorities need to take action now to anticipate the impacts of future trends to keep their citizens healthy and condom .
To identify challenges at a local anesthetic flush arising from ball-shaped trends, a participatory approach has been developed to discuss the relevance of different trends for different european ocean basins with local stakeholders, their perspectives on how to deal with these trends and potential research gaps. Box 1 shows the results of such a discussion during the AZTI ’ s Summer School 2019, focusing on the Atlantic Ocean and specially the Basque coastline. Although these workshop results are influenced by the issue of player representation and should therefore be treated with care, the interactional and integral approach resulted in viewpoints on local relevant issues, trends, impacts and inquiry gaps, that are distinct from the more generic observations regarding oceans and homo health .

BOX 1.
global trends, local impacts for oceans and health and research gaps focusing on the Basque coastline of the Atlantic Ocean. The San Sebastián area is contribution of the Basque Autonomous Region ( northerly Spain ), and it can be characterized as a area with a relatively eminent economic emergence. Employment is chiefly in the services sector [ tourism ( beach/surf/gastronomy ), congresses and festivals ], with an ongoing feat to welcome visitors but avoid batch tourism. The fish sector is declining. firm currents, waves, temperature and hydrographic conditions limit the possibilities for aquaculture. population in the region is slightly growing and is increasingly ageing. Due to climate change, the risk of flood and “ explosive cyclogenesis ” ( strong storms generating identical senior high school waves ) are expected to increase, potentially causing damage to infrastructure, beaches and the previous town .
With regard to future outlooks, participants of the AZTI ’ south 2019 summer school identified : the far loss of biodiversity and other ecological impacts ; the development towards a round economy ; transitions in healthcare and energy ; and the increasing use of blue spaces for diversion, as the most relevant trends for the region. Changes in consumer food preferences, changing institutional and administration structures, and further passing of biodiversity and other ecological impacts were regarded as the most uncertain trends for the region with a electric potential high gear affect .
Impacts of these trends on the relationship between oceans and homo health and potential inquiry gaps were discussed during the end of the workshop. The increasing recreational use of blue spaces for example was expected to contribute to improved genial and physical health for all, but implies requirements in terms of management ( litter, contamination [ noise, vent, water, impacts on local infrastructure ), awareness of risks and local anesthetic inheritance for different groups, and the security of biodiversity ( benthic communities ). Research gaps identified for this drift focused on behavioral change ( “ clean ” habits, perception of risks ), integrative execution strategies, inclusiveness in the use of blue spaces, assessment of the sustainable refreshment capacity, and research on the minus aspects of diversion on the environment. other relevant trends were discussed in a like way .

Conclusion/Priorities for Future Research

In the present wallpaper we posit that there is increasing tell that healthy oceans are providing crucial ecosystem services, which benefit humans in different ways, including better physical and mental health, adenine good as a general wellbeing. Hence, achieving “ beneficial environmental status, ” sensu the Marine Strategy Framework Directive ( MSFD ) in Europe ( Borja et al., 2013 ), and conserving and sustainably using the oceans ( sensu the SDG14 ; United Nations, 2016 ), will result in an increasing and sustainable provision of ecosystem services, which can contribute besides to achieve human goodly lives and wellbeing ( as required by SDG3 ) .
however, this would need a inquiry and policy agenda on OHH, understanding the complex relationships existing between oceans and human health, in multiple cognition areas and across sectors. Because human health is intrinsically linked to the health of the oceans, some of the present priorities on the ocean, and by extension, the planet ’ s health determines the priorities on the OHH agenda. finally, this agenda could be used in the discussions for the approaching United Nations ( UN ) Decade of Ocean Science for Sustainable Development – 2021–2030 – ( UNESCO, 2018 ), contributing to a better cognition of the complex relationships between oceans health and human health. board 2 get up from the 3-day summer school in San Sebastián and could serve as an initial tilt of elements for discussion among the scientific community and other stakeholders, regarding the research break on OHH, based in respective topics of importance identified by the participants .

table 2
Table 2. list of priorities for inquiry in Oceans Health and Human Health, as identified by the authors of this revue, for a series of topics and trends .

• Climate change : climate change is already having palpable effects and will pose increasing risks and impacts to the coasts, seas, and global ocean in different ways ; and these risks and impacts will increasingly affect homo lives and health ( table 2 ). There is a need to know today ’ randomness baseline and future projections to define adaptive and extenuation strategies to guarantee good ocean and homo health .
• Sustainable use of ecosystem services : The provision of ecosystem services is directly linked with human wellbeing in different ways ( table 2 ). There is a need to objectively identify the flush of ecosystem services available nowadays at local anesthetic and global scales and explore future scenarios differently affecting OHH .
• contamination : progress has been made in addressing some pollutants and pathways and impacts of certain pollutants have been reduced, but other pollutants, specifically plastics and pharmaceuticals still need attention and new risks are emerging equally well as complex combinations of substances and pathways ( table 2 ) .
• Ecosystem conservation : In a planet under change, with quickly decreasing biodiversity, there is a motivation to conserve not only the species, but the habitats and the whole ecosystem ( table 2 ). skill, stakeholders and end users should work together for the conservation of lifelike habitats as an essential condition of good OHH .
• Cross-cutting issues : To make progress in addressing the complex system of inputs, pathways and impacts a cross-cutting approach is needed that can integrate expertness across sectors and disciplines, and encourage working in partnership between individual and populace organizations ( board 2 ) .
• Solution focus : Problems should always be well described, by collecting information, assessing risks and impacts. But the field should besides consider researching interventions and solutions more than it has traditionally been done ( Borja and Elliott, 2019 ) .
From the discussions in the summer school, the theme emerged that the OHH agenda should include more interdisciplinary research and train, which could be integrated in national and international research priorities, but besides in the context of the UN Decade of Ocean Science for Sustainable Development – 2021–2030 – ( UNESCO, 2018 ; Ryabinin et al., 2019 ). In particular, the research agenda should be co-created and connected to the society, stakeholder and policymaker concerns at both local and ball-shaped levels. We hope that this review can contribute to achieving those objectives .

Author Contributions

AB developed the mind of the summer school and the manuscript with CE and LF. Each generator wrote one of the sections under his/her expertness. AB wrote the first draft of the manuscript. All authors contributed evenly to the discussion of the future priorities and in writing the final manuscript .

Conflict of Interest

JP was employed by the company Travelecoology .
The remaining authors declare that the research was conducted in the absence of any commercial or fiscal relationships that could be construed as a potential conflict of pastime .


This manuscript is the consequence of an AZTI ’ mho Summer School, celebrated in San Sebastian ( Spain ), from 5th to 7th June, 2019, funded by AZTI ( ), the Aquarium of San Sebastian, European Union ’ s Horizon 2020, Grant/Award Number : 774567 ( SOPHIE Project hypertext transfer protocol : // ) and 666773 ( BlueHealth Project hypertext transfer protocol : // ) ; SCOR and IOC/UNESCO GlobalHAB course of study ( hypertext transfer protocol : // ) ; the Oceans and Human Health Chair/University of Girona ( ) ; and the European Environment Agency ( EEA ). AB was supported through a convention between AZTI and the Basque Water Agency, for monitor and ass marine waters .


This is contribution count 954 from AZTI ’ s Marine Research Division .



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