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Time and tide
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Our future health and wellbeing depend on the oceans
Michael H Depledge professor 1, Mathew P White senior lecturer 1, Bruce Maycock professor 2, Lora
E Fleming professor 1
1European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK; 2School of Public Health, Curtin
University, Perth, Australia
The global ocean covers more than 70% of the Earths surface,
and over half the worlds population live in coastal zones.1
Billions of people depend on marine ecosystems for their
livelihoods, with seafood providing a key source of protein2 and
micronutrients that form the basis of a healthy diet.3 Numerous
novel medications have been extracted from marine organisms,4
including anti-cancer agents from sponges and algae.5 More
broadly, the convalescence benefits of recreational time at
the coast have been recognised by medical professionals for
centuries.6 Time spent at the coast encourages physical activity,
reduces stress, and protects against mental ill health.7
Unfortunately, already degraded marine ecosystems are under
persistent and growing risk of further damage from
microbiological and chemical pollution, overexploitation, and
climate change.8 Rising CO2 emissions threaten the entire marine
ecosystem with acidification3 and whole coastal communities
with more flooding from storms and rising sea levels9, with
implications for critical public health infrastructure (eg, fresh
water and sewage systems). Changing environmental conditions
also encourage the spread of toxic algal blooms.10
Chemical threats to health range from the well documented
dangers of methylmercury poisoning during fetal development11
to toxicity from the complex cocktail of chemicals in the
environment, including endocrine disrupting phthalates and
perfluoroalkyl substances (PFAS), whose diverse autoimmune
effects are especially important for elderly people and those
with compromised immune systems.12 13 These various health
threats are not just occurring in far off places; they affect the
lives of millions of people here and now and, directly or
indirectly, cause diseases that medical practitioners ultimately
have to deal with in their clinics.14
The United Nations report Our Oceans, Our Future made it
clear in 2017 that achieving good health and wellbeing
(sustainable development goal (SDG) 3) depends on SDG 14
(conserve and sustainably use the oceans, seas, and marine
resources).15 The European Marine Board and others have
attempted to bring the environmental science and health
communities closer together, both through its Linking Oceans
and Human Health initiative16 and the inclusion of sessions on
oceans and human health in its two most recent quinquennial
EurOCEAN conferences (http://www.marineboard.eu).
To date, however, it has had little success. Clinicians and health
researchers are essential for unravelling the interconnections
between the state of marine ecosystems and health and
wellbeing. Encouraging and supporting their participation in
this growing field is critical. In an age of greater patient and
public awareness, responding to highly vocal concerns over
health issues arising from environmental damage is not a luxury
but a necessity.
No time to waste
We must hold policy makers to account. Substantial rapid policy
changes are possible, as shown by the response to marine plastic
pollution.17 However, identifying, monitoring, and
communicating the risks to human health and wellbeing from
the degradation of our seas and oceans has so far not been
sufficient to put them firmly on the political and global health
agendas for action.
For instance, although fisheries destruction and ocean
acidification were discussed extensively in the 2015 Lancet
Commission on Planetary Health,2 the more recent Lancet
Commission on Pollution and Health11 and World Health
Organization health and climate change18 reports, barely mention
marine issues specifically. In a world of multiple health threats
and challenges, it is understandable if medical practitioners and
policy makers focus on the most immediate problems they face,
such as cardiovascular disease, diabetes, and depression. Given
that practitioners have a limited pool of worry,19 we need to
better understand and communicate the opportunities for health
promotion that healthy marine environments offer, as well as
the loss of current (underappreciated) benefits that will occur
with increasing degradation.
Correspondence to: M P White Mathew.White@exeter.ac.uk
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Editorials
EDITORIALS
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Insights gained over the past 100 years tell us that what has
been good for humanity in the short term has often been
detrimental to the rest of the planet in the longer term, including
the global ocean.20 We cannot continue to discharge vast
amounts of waste materials into our seas and expect human
health and wellbeing to be unaffected. As yet we lack a clear,
global vision of how to reconcile the health of both oceans and
people, and how to support decision makers in achieving
sustainable marine ecosystems that promote public health.
Global governance will be required to deliver these aspirations.
This might, for example, involve establishing a panel similar
to the Intergovernmental Panel for Climate Change to gather
evidence and promote collaborative action.
With the decade of the ocean for sustainable development
(202130) only 18 months away, we must accelerate research
into the health risks of our rapidly changing oceans and exploit
more fully all existing opportunities to use coastal areas to
improve public health. It is not too late for medical practitioners
and the health community to make their essential contribution.
The current and future state of the global ocean will in large
part determine the current and future sustainability, health, and
wellbeing of everyone. Although coastal communities are on
the front line, ultimately we are all affected by the seas around
us.
Competing interests: We have read and understood BMJ policy on declaration of
interests and have no relevant interests to declare.
Provenance and peer review: Commissioned, not externally peer reviewed.
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EDITORIALS
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... Greater engagement of the ocean health community with medical doctors, nurses, and public health professionals (and vice versa) is needed to engage, motivate, support, and secure buy-in from this influential group (see Case Study 6) [94,95]. ...
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... A concerted effort has been made toward engaging with the international public health and medical communities around the importance of Oceans and human health (Fleming et al., , 2021Depledge et al., 2019). Nevertheless, until very recently, the medical and public health communities have been largely absent from involvement in the interconnections between the health of humans and the natural environment, including the Ocean (Fleming et al., 2021). ...
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These striking trends are driven by highly inequitable, ineffi cient, and unsustainable patterns of resource consumption and technological development, together with population growth. We identify three categories of challenges that have to be addressed to maintain and enhance human health in the face of increasingly harmful environmental trends. Firstly, conceptual and empathy failures (imagination challenges), such as an over-reliance on gross domestic product as a measure of human progress, the failure to account for future health and environmental harms over present day gains, and the disproportionate eff ect of those harms on the poor and those in developing nations. Secondly, knowledge failures (research and information challenges), such as failure to address social and environmental drivers of ill health, a historical scarcity of transdisciplinary research and funding, together with an unwillingness or inability to deal with uncertainty within decision making frameworks. Thirdly, implementation failures (governance challenges), such as how governments and institutions delay recognition and responses to threats, especially when faced with uncertainties, pooled common resources, and time lags between action and eff ect. Although better evidence is needed to underpin appropriate policies than is available at present, this should not be used as an excuse for inaction. Substantial potential exists to link action to reduce environmental damage with improved health outcomes for nations at all levels of economic development. This Commission identifi es opportunities for action by six key constituencies: health professionals, research funders and the academic community, the UN and Bretton Woods bodies, governments, investors and corporate reporting bodies, and civil society organisations. Depreciation of natural capital and nature's subsidy should be accounted for so that economy and nature are not falsely separated. Policies should balance social progress, environmental sustainability, and the economy. To support a world population of 9-10 billion people or more, resilient food and agricultural systems are needed to address both undernutrition and overnutrition, reduce waste, diversify diets, and minimise environmental damage. Meeting the need for modern family planning can improve health in the short termeg, from reduced maternal mortality and reduced pressures on the environment and on infrastructure. Planetary health off ers an unprecedented opportunity for advocacy of global and national reforms of taxes and subsidies for many sectors of the economy, including energy, agriculture, water, fi sheries, and health. Regional trade treaties should act to further incorporate the protection of health in the near and long term. Several essential steps need to be taken to transform the economy to support planetary health. These steps include a reduction of waste through the creation of products that are more durable and require less energy and materials to manufacture than those often produced at present; the incentivisation of recycling, reuse, and repair; and the substitution of hazardous materials with safer alternatives. Despite present limitations, the Sustainable Development Goals provide a great opportunity to integrate health and sustainability through the judicious selection of relevant indicators relevant to human wellbeing, the enabling infrastructure for development, and the supporting natural systems, together with the need for strong governance. The landscape, ecosystems, and the biodiversity they contain can be managed to protect natural systems, and indirectly, reduce human disease risk. Intact and restored ecosystems can contribute to resilience (see panel 1 for glossary of terms used in this report), for example, through improved coastal protection (eg, through wave attenuation) and the ability of fl oodplains and greening of river catchments to protect from river fl ooding events by diverting and holding excess water. The growth in urban populations emphasises the importance of policies to improve health and the urban environment, such as through reduced air pollution, increased physical activity, provision of green space, and urban planning to prevent sprawl and decrease the magnitude of urban heat islands. Transdisciplinary research activities and capacity need substantial and urgent expansion. Present research limitations should not delay action. In situations where technology and knowledge can deliver win-win solutions and co-benefi ts, rapid scale-up can be achieved if researchers move ahead and assess the implementation of potential solutions. Recent scientifi c investments towards understanding non-linear state shifts in ecosystems are very important, but in the absence of improved understanding and predictability of such changes, eff orts to improve resilience for human health and adaptation strategies remain a priority. The creation of integrated surveillance systems that collect rigorous health, socioeconomic, and environmental data for defi ned populations over long time periods can provide early detection of emerging disease outbreaks or changes in nutrition and non-communicable disease burden. The improvement of risk communication to policy makers and the public and the support of policy makers to make evidence-informed decisions can be helped by an increased capacity to do systematic reviews and the provision of rigorous policy briefs. Health professionals have an essential role in the achievement of planetary health: working across sectors to integrate policies that advance health and environmental sustainability, tackling health inequities, reducing the environmental impacts of health systems, and increasing the resilience of health systems and populations to environmental change. Humanity can be stewarded successfully through the 21st century by addressing the unacceptable inequities in health and wealth within the environmental limits of the Earth, but this will require the generation of new knowledge, implementation of wise policies, decisive action, and inspirational leadership.
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Background: A growing number of quantitative studies have investigated the potential benefits of outdoor blue spaces (lakes, rivers, sea, etc) and human health, but there is not yet a systematic review synthesizing this evidence. Objectives: To systematically review the current quantitative evidence on human health and well-being benefits of outdoor blue spaces. Methods: Following PRISMA guidelines for reporting systematic reviews and meta-analysis, observational and experimental quantitative studies focusing on both residential and non-residential outdoor blue space exposure were searched using specific keywords. Results: In total 35 studies were included in the current systematic review, most of them being classified as of "good quality" (N=22). The balance of evidence suggested a positive association between greater exposure to outdoor blue spaces and both benefits to mental health and well-being (N=12 studies) and levels of physical activity (N=13 studies). The evidence of an association between outdoor blue space exposure and general health (N=6 studies), obesity (N=8 studies) and cardiovascular (N=4 studies) and related outcomes was less consistent. Conclusions: Although encouraging, there remains relatively few studies and a large degree of heterogeneity in terms of study design, exposure metrics and outcome measures, making synthesis difficult. Further research is needed using longitudinal research and natural experiments, preferably across a broader range of countries, to better understand the causal associations between blue spaces, health and wellbeing.
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