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Time and tide
OPEN ACCESS
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 Earth’s surface,
and over half the world’s 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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BMJ 2019;366:l4671 doi: 10.1136/bmj.l4671 (Published 17 July 2019) Page 1 of 2
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
(2021–30) 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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BMJ 2019;366:l4671 doi: 10.1136/bmj.l4671 (Published 17 July 2019) Page 2 of 2
EDITORIALS
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