Linking
European
www.marineboard.eu
M arine Board
Advancing
Seas
& Oceans
Science
European M a rin e Board
The Marine Board provides a pan-European platform f o r its member organizations to develop common priorities, to advance
marine research, and to bridge the gap between science and policy in order to meet fu tu re marine science challenges and
opportunities.
linking Oceans and Human Health:
A Strategic Research Priority for Europe
The Marine Board was established in 1995 to facilitate enhanced cooperation between European marine science organizations towards
the development o f a common vision on the research priorities and strategies for marine science in Europe. Members are either major
national marine or oceanographic institutes, research fu n d in g agencies, or national consortia o f universities w ith a strong marine
research focus. In 2013, the Marine Board represents 35 Member Organizations from 20 countries.
The Board provides the essential components fo r transferring knowledge fo r leadership in marine research in Europe. A dopting a
strategic role, the Marine Board serves its member organizations by providing a forum w ith in which marine research policy advice to
national agencies and to the European Commission is developed, w ith the objective o f prom oting the establishm ent o f the European
Marine Research Area.
European M arine Board Position Paper 19
This Position Paper is based on the activities o f the Marine Board Working Group Oceans and Human Health (WG OHH).
www.marineboard.eu
Coordinating author
European M arine Board M em b er Organizations
Michael N. Moore
Fmo
Contributing authors
I
Michael N. Moore, Craig Baker-Austin, Michael H. Depledge, Lora Fleming, Philipp Hess, David Lees, Paul Leonard, Lise Madsen, Richard
Owen, Hans Pirlet, M athew W hite, Vítor Vasconcelos, Nicholas Boase, Nicholas Osborne, AldoViarengo
term ii KUHif ihi nunrnsntr
be Is p o
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Jan Seys
Irish Marine
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I N S T I T U T E OF M A R I N E RESEARCH
R oyal N e th e rla n d s In s titu t e f o r Sea R esearch
HA VFORSKNINGSINS TITVTTE T
N eth erlan ds O rg a n is a tio n fo r S c ie n tific Research
1.
Jacqueline McGlade (Executive Director) and Eva Royo Gelabert (Senior Advisor Marine Ecosystem Assessments) - European Envi­
ronm ent Agency (EEA)
2.
Tracy Collier (Science Advisor Oceans and Human Health) and Paul Sandifer (Senior Science Advisor) - National Oceanic and A t­
mospheric A dm inistration (NOAA)
Suggested reference
European Marine Board (2013). Linking Oceans and Human Health: A Strategic Research Priority for Europe. Position paper 19 o f the
European Marine Board, Ostend, Belgium.
qí.R.57
X The Reseatcli Council of Norway
www.marineboard.eu
info@marineboard.eu
FCT
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SCIENCE OF THE
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N A T U R A L E N V IR O N M E N T RESEARCH C O U N C IL
Foreword
Table o f Contents
There has been a growing recognition w ith in the scientific com m unity o f the need for a
Executive S u m m a ry .................................................................................................................................................4
more holistic and coherent approach to understanding the complex links between the seas
and oceans on one hand, and human health and well-being on the other. Extreme weather
events such as coastal storms and flooding, and human exposure to marine-borne patho­
1 In tro d u c tio n and p o lic y c o n te x t
1.1
Background and ra tio n a le ................................................................................................................... 9
the seas provide numerous benefits to human health and well-being in the form o f ecosys­
1.2
Policy c o n te x t..........................................................................................................................................14
tem services, including the supply o f resources such as food and raw materials. Biotechnol­
1.B
Towards a European Research Program me on Oceans and Human Health ..............................15
1.4
Scientific challenges and research q u e s tio n s .................................................................................. 16
1.5
A bout th is Position Paper......................................................................................................................20
gens and chemical pollution, pose significant threats to human health. At the same tim e,
ogy is opening opportunities to exploit marine genetic resources w ith potential for new
drugs and nutraceuticals. Research is also b e g inn in g to identify the mental health benefits
o f interacting w ith the coastal environment. Understanding th is com plexity can only be
achieved w ith an interdisciplinary approach, drawing from expertise across a diverse range
o f disciplines w ith in natural, social and economic sciences, public health and medicine.
D uringthe last decade, there has been a significant investment in m ulti-disciplinary oceans
and human health research programmes in the USA. This has included the establishm ent
2 The lin k betw een th e oceans and h um an h ea lth : hazards, risks, b e n e fits and
o p p o rtu n itie s fro m th e sea
2.1 C lim ate change, natural events and hum an h e a lth ........................................................................... 23
o f seven Centers for Oceans and Human Health (COHH) anda complementary National Oceanic and Atmospheric A dm in­
2.2
Marine chem ical p o llu tio n .................................................................................................................... 27
istration (NOAA) Oceans and Human Health Initiative (OHHI) to conduct, coordinate and communicate research in this
2.3
M aterial pollution, including m arine litte r and nanoparticles .....................................................31
ent oceans and human health research fram ew ork and has published this paper as a firs t step in raising the profile o f this
2.4
Biological hazards to hum an h e a lth ................................................................................................... 37
issue amongst policy makers, research funders and the scientific community. The paper identifies the key research needs
2.5
Products from the Sea ...........................................................................................................................46
2.6
Social and behavioural aspects: people and the s e a .......................................................................59
new integrative field. The European Marine Board has recognized th a t Europe does not currently support a similar coher­
and priorities to support the development o f a holistic and coherent transnational oceans and human health research
effort in Europe. For consistency, the paper uses the “oceans and human health” term inology firs t coined in the US, but
it is clear th a t much o f this interaction is at the level o f coasts and coastal seas. Hence, in th is context, “oceans” refers to
the marine and coastal environm ent in its totality.
If there is one key message o f this position paper, it is th a t human health and well-being is intrinsically connected to,
and impacted by, the seas and oceans which surround our continental landmass. To manage this relationship, we need
3 A ddre ssin g th e p u b lic h e a lth challen ge s presented by th e seas and oceans
3.1 Interdisciplinary system s approach inco rp o ra ting environm ental, biomedical,
socio-econom ic and epidem iological m e th o d s ......................................................................................... 65
3.2
Improved tests fo r detecting pathogens in seawater and s e a fo o d ..............................................68
an effective policy fram ework, linking m aritim e and public health policies. W hile Europe has made significant strides in
developing an Integrated M aritim e Policy, we do not yet take sufficient account o f human health aspects in m aritim e
policy-making. Hence the concerted European research e ffo rt advocated by th is paper does not ju s t represent an interest­
ing scientific challenge, but is essential to ensure th a t im proving public health and achieving Good Environmental Status
(GES) in European seas are linked and m utually supporting policy objectives.
I extend sincere thanks to the authors o f this paper, operating under the auspices o f the European Marine Board w orking
group on Oceans and Human Health, for th e ir tim e and com m itm ent in delivering this im p o rta n t publication. I am partic­
ularly grateful to the Chair o f the working group, Professor Michael Moore, fo r his hard w ork and dedication th roughout
3.3 Improved te sts and protocols fo r harm ful nanoparticles and chem ical p ollutants
in s e a fo o d .......................................................................................................................................................... 71
3.4 W arning signals from the m arine e nvironm ent - clinical-typ e tests on sentinel
o rg a n is m s.......................................................................................................................................................... 73
3.5
Epidem iological m odelling o f the health o f coastal hum an c o m m u n itie s ................................. 74
3.6 Knowledge m anagem ent, co m m un icatio n and m axim izing the science policy
in te r fa c e ............................................................................................................................................................ 76
the w ritin g process and in presenting the messages o f the paper at meetings and conferences in Europe and beyond. As
always, I thank the EMB Secretariat for its coordination and support o f the entire e ffo rt from concept to delivery. A t the
4 A European Research S tra te g y fo r Oceans and H um an H e a lth ................................................................ 85
tim e o f publication, there are a num ber o f follow -up activities in the pipeline to promote the key messages o f the paper.
I hope th a t this marks ju s t the beginning o f a process to embed the human health im plications o f our interaction w ith
R efe re n ce s.................................................................................................................................................................... 92
the seas and oceans in the scientific and m aritim e policy agendas. In the context o f rapidly changing seas and growing
coastal populations, this represents an im p o rta n t societal challenge.
Kostas Nittis
Chair, European Marine Board
ANNEX 1. A ffilia tio n s of c o n trib u tin g au th ors
112
LINKIN G OCEANS A N D H U M A N HEALTH
Executiue s u m m a ry
Executive Sum m ary
The marine environm ent contributes significantly to human health through the
EXECUTIVE SUMMARY BOX 1.
provision and quality of the air th a t we breathe, the food we eat, the water we drink
Recommended strategic research
and in offering health-enhancing economic and recreational opportunities. A t the
targets of a proposed European
same tim e, the marine environm ent is under pressure from human activities such
Oceans and Human Health
as transport, industrial processes, agricultural and waste management practices.
Research Programme
1.
Innovative m onitoring and surveillance techniques w hich allow
much greater provision o f relevant and accurate datasets (e.g.
remote observation systems fo r coastal and marine ecosystems,
detection o f chemical / material pollutants, biogenic and microbial
toxins and human pathogens, and improved testing for seafood and
Evaluation and management o f the resultant impacts, on both marine ecosystems
w ater safety).
themselves, and on human health, have largely been undertaken as separate activi­
ties, under the auspices o f different disciplines w ith no obvious interaction. Hence,
2.
Improved understanding o f the physical, chemical and biological
many of our perceptions o f the relationships between the marine environm ent and
processes involved in the transport and transmission o f toxic
human health are lim ited and still relatively unexplored, leaving critical knowledge
chemicals and pathogenic organisms through the marine
gaps fo r those seeking to develop effective policies for the sustainable use o f ma­
environm ent to humans.
rine resources and environmental and human health protection.
3.
Improved understanding of the direct and indirect causal relationships
To address the considerable knowledge gaps th a t exist, research in Oceans and Hu­
between degradation o f the marine environm ent and the incidence
man Health (OHH) m ust be directed at elucidating key environmental processes,
o f human disease.
and providing a predictive capability fo r both biotic and abiotic environmental in­
fluences on human health and well-being. This can only be achieved through the
4.
Improved environmental models to determ ine the patterns and
m obilization o f interdisciplinary competencies around Europe and ensuring th a t
extent o f natural dispersion o f sewage, agricultural effluents and
the necessary scientific and technical capabilities are available.
industrial waste.
The main high-level recommendation o f this Position Paper is th a t a consolidated
5.
Expert systems to link existing models w ith our experience and
European Oceans and Human Health Research Programme should be developed
knowledge o f the connectivity between the marine environment
and supported to ensure the scale o f investm ent and collaboration necessary to ad­
and human health.
dress the major challenges o f understanding and dealing w ith the immense com­
plexity o f the relationship between the marine environm ent and human health.
6.
The establishm ent and im plem entation o f such a programme w ill ultim ately allow
Appropriate indicators in support o f sustainable development
where environm ental, social and economic measures are linked.
us to:
improve our understanding o f the potential public health benefits from ma­
7.
Methods and mechanisms which demonstrate the value
rine and coastal ecosystems;
(economic, cultural, aesthetic, etc.) to human w ell-being o f marine
reduce the burden o f human disease linked w ith marine environmental
environments from coastal seas to global oceans.
causes; and
anticipate
new threats to
public health
before they become serious.
The complex and causal interconnections between marine environm ent and hu­
man health requires a systems approach addressing all levels o f organization from
genes to ecosystems. Such an integrated systems approach m ust draw on the skills
To successfully realize the objectives o f a large interdisciplinary European research
and expertise o f many scientific disciplines as well as the social and economic sci­
programme on Oceans and Human Health, it w ill be necessary to support a range
ences.
o f enabling actions and capacities (see Executive Summary Box 2).
In this position paper, the European Marine Board W orking Group on Oceans and
Much has already been done to address the research targets summarised in Execu­
Human Health (WG OHH) has identified a number o f key research targets to build
tive Summary Box 1, both at the scientific and policy level. Hence, when develop­
the necessary OHH research capability in Europe (see Executive Summary Box 1).
ing the European research capability in OHH, there is a need to build on, support
These targets should therefore constitute the main objectives o f the proposed
and com plem ent past and current efforts and existing policy and regulatory fram e­
European Oceans and Human Health Programme.
works th a t share the same research targets.
This w ill require consideration o f the long and diverse set o f policies and regula­
tions relevant for OHH in a more integrated way than hitherto achieved. One of
the firs t steps should, therefore, be a thorough analysis o f the various policies and
legal instrum ents which have a bearing on the complex relationship between our
marine environm ent and human health, to identify weaknesses, gaps and overlaps,
and consider mechanisms to strengthen th e ir interactions to improve effectiveness.
Such an analysis should provide the basis fo r identifying how a coordinated Euro­
pean research e ffo rt in Oceans and Human Health w ould support the refinem ent
4
5
LINKIN G OCEANS A N D H U M A N HEALTH
Executiue s u m m a ry
and im plem entation o f the current EU policies, including, but not restricted to, the
Marine Strategy Framework Directive.
EXECUTIVE SUMMARY BOX 2.
Provide adequate support fo r interdisciplinary research and training
Enabling actions and capacities required
o f young investigators to build capacity and improve our knowledge
to maximize the efficiency and impact
From an EU perspective, a key policy fram ew ork fo r developing a coordinated and
of an Oceans and Human Health
science-based approach to the link between oceans and human health is the M a­
Research Programme
base on the relationship between the marine environment and
human health. A particular focus should be on developing modelling
capacities (e.g. to design early w arning systems) and linking experts
rine Strategy Framework Directive (MSFD). Key European programmes which have
in fields as diverse as oceanography, marine ecology, ecotoxicology,
the capacity to support an Oceans and Human Health initiative include Horizon
epidemiology and public health. Where relevant and possible,
2020, the EU’s next programme fo r research and technology development (2014-
collaborative links should be developed w ith the private sector, for
2020), and the relevant European Joint Programming Initiatives. However, national
example by establishing co-funded PhDs and research fellowships;
research programmes should also provide support for the rapid development o f
and capacities in the area o f Oceans and Human Health.
Increase knowledge management and the capacity to conduct
expert horizon scanning fo r emerging problems, benefits and
A European Oceans and Human Health Programme should also encourage interna­
technologies in relation to the marine environm ent which may
tional collaboration (e.g. w ith the NIH/NSF and NOAA programmes in the USA) as
im pact on human health and well-being;
this w ill facilitate synergies and added value.
Build bridges between relevant stakeholders, fo r example by
Securing human health by reducing the burden o f disease and im p ro vin g th e qual­
involving stakeholders early on during project form ulation, allow ing
ity o f the global environm ent are tw o grand challenges which top the policy agenda
fo r the co-evolution and jo in t construction o f knowledge;
o f governments w orldw ide. Nevertheless, recognition o f the importance o f the ma­
rine environm ent fo r human health and w ell-being is currently lim ited. Moreover,
Develop specific interdisciplinary Oceans and Human Health networking
the research com m unity required to address Oceans and Human Health challenges
actions to overcome the fragmented research capability in Europe;
in Europe remains very fragm ented and this lack o f coordination results in a failure
to adequately support evidence-based policy making in the areas o f marine m an­
Stim ulate creative th in kin g and develop opportunities to explore
agement and public health. Failure to effectively address this situation w ill impact
alternatives to standard risk assessment procedures;
adversely on efforts to alleviate poverty, to sustain the availability o f environmental
goods and services, and to improve health and social and economic stability.
•
Improve communication
One of t he ways in which the m arine
environm ent contributes to hum an
a)
w ith in the scientific com m unity to support the
development o f a European Oceans and Human
health is through the food we eat.
Health research com m unity;
©Parc M arin de la Côte Bleue
b)
between research com m unity and public authorities
w ith competency fo r environmental protection, food
safety and human health; and
c)
to raise public awareness regardingthe complex
relationship between oceans and human health.
This includes supporting activities to promote Ocean
Literacy w hich entails public outreach to improve the
understanding o f the importance o f the oceans and,
more specifically, the risks and benefits o f human
interactions w ith the marine environm ent (e.g.
through citizen science-public participation, beach
watches, etc.).
6
7
Introduction and policy context
1.1
Background and rationale
For m illennia humans have been dependent on seas and oceans as a source o f food
and a means o f expansion. However, the oceans and coastal seas are like a doubleedged sword when it comes to interactions w ith human health. Natural events such
as hurricanes, severe storms and tsunam is can have devastating impacts on coastal
populations, w hile pollution o f the seas by pathogens and toxic waste can cause ill­
ness and death. An estimated 250 m illion cases o f gastroenteritis occur w orldw ide
each year as a result o f bathing in contam inated water, and 50,000-100,000 people1
Introduction and
policy context
die annually from infectious hepatitis. In term s o f productivity (lost w orking days),
the overall global burden o f human disease caused by sewage pollution o f coastal
waters has been estimated at 4 m illion lost person-years annually.
On the positive side, the oceans provide humans w ith many benefits including food
for around a th ird o f the global population, the air th a t we breathe and our climate
system which enables habitation o f much o f the planet. The marine environm ent
can also be the source o f potential health benefits through the provision o f healthy
food, novel pharmaceuticals and related products derived from marine organisms,
as well as through a contribution to general well-being from a close association
w ith the coastal environm ent (i.e. recreational and psychological benefits, or the
“ Blue Gym” effect) (W hite etal., 2010; Depledge & Bird, 2009; Fleming etal., 2006).
Environmental change and human health
Changes in the marine environm ent have direct and indirect impacts on human
health and well-being, but in many cases we are not aware o f how actions in one
place affect other parts o f the ecosystem. Factors th a t may have a negative in flu ­
ence on ecosystem function and ecological integrity, fo r instance, w ill not necessar­
ily be linked to adverse effects on human health or well-being (Figure 1.1; Moore
et al., 2011, 2013). Environmental changes are often regarded as unavoidable or as
the unforeseen consequences o f economic and cultural changes. However, there is
much th a t we can do through policy interventions to manage human impacts on
the marine environm ent and this has been dealt w ith in depth by the MAES Work­
ing Group2 which has proposed a conceptual fram ew ork th a t responds to EU policy
questions regarding ecosystem assessment and services. In this paper, we argue
th a t fu rth e r research on the complex relationship between the oceans and human
health, and on the capacity to protect public health through holistic m aritim e poli­
cies and management actions, is essential to manage the challenges we face result­
ing from humans interacting w ith the marine environment.
1 UNEP Our P lanet 14(4) on Water,
S a n ita tio n , People
h ttp ://w w w .o u rp la n e t.c o m /im g v e rs n /1 4 4 /
vandew eerd.htm l
1 M apping and A ssessm ent o f E cosystem s and
th e ir Services: An a n a ly tic a l fra m e w o rk fo r
ecosystem assessm ents under A c tio n 5 o f
th e EU B io d iv e rs ity S trategy to 2 0 2 0
Discussion paper
h ttp ://b io d iv e rs ity .e u ro p a .e u /
ec o sy stem -a sse ssm en ts/a b o u t-1 /
a n -a n a ly tic a l-fra m e w o rk -fo r-e c o s y s te m a s s e s s m e n ts -u n d e r-a c tio n -5 -o f-th e -e u /
download
9
LINKIN G OCEANS A N D H U M A N HEALTH
Societal issues G
political decision making
In tro d u c tio n and policy c o n te x t
INTERCONNECTIONS IN MARINE
ENVIRONMENT & HEALTH
often found in the vicinity o f large estuaries and river deltas and often depend on
the fishing industry fo r food, em ploym ent and w ealth generation. The rapid grow th
in coastal populations, often accompanied by extensive urban and industrial devel­
opment, means th a t coastal and shelf sea areas are the most impacted and hence
the most vulnerable zones o f the ocean (Figure 1.2; Cassar, 2001; McGlade, 2001;
Moore & Csizer, 2001; Population Reports, 2000).
Coastal waters receive a m u ltitude o f human and zoonotic pathogens and biogenic
and chemical waste inputs originating from industrial, domestic and agricultural
land-based sources, all o f w hich are d ifficu lt to estimate quantitatively (Windom,
Environmental
Socio-economic
factors
1992). A complex m ix o f other toxic chemical pollutants is also introduced through
shipping activities, offshore oil and gas extraction, and atmospheric inputs o f air­
borne particles o f industrial origin (Roose et al., Marine Board Position Paper 16,
2011; Bowen & Depledge, 2006). To fu rth e r complicate this already complex pic­
ture, coastal zones include the most diverse and productive ecosystems in our
oceans. Previous economic studies have placed a higher value on coastal zones (US$
Natural
Events
12.6 trillio n /ye a r fo r coastal zones out o f a global total o f US$ 33.3 trillion/year)
Poverty disease
than any other com partm ent o f our environm ent (Costanza etal., 1997).
There is evidence o f a significant increase in marine environmental disturbance ow ­
ing to both natural and anthropogenic pressures (Bowen & Depledge, 2006) and it
is often the combination of, or interaction between, natural and human pressures
which increases the potential for human health impacts. Im portant stressors in­
clude: domestic sewage and agricultural faecal waste runoff; sea-level rise; ocean
acidification; chemical contam inants including medical and veterinary pharmaceu­
ticals; radionuclides; natural biogenic toxins (e.g. from harm ful algal and cyano­
FIGURE 1.1.
A sum m ary of the interco nn ectivity o f the
bacteria! blooms - HABs); sound and light pollution; climate change and extreme
key processes o f public health relevance
weather; increased UV-radiation; n utrie nt enhancement or deprivation; hypoxia;
in the m arine environm ent (adapted from
habitat disturbance (e.g. from commercial fishing activity); and microbial run-off
(Figures 1.1 and 1.2; Fleming et al., 2006; Todd, 2006; Maso & Graces, 2006; Orr et
Moore e ta l., 2011)
(HABs: Harm ful Algal Blooms)
In the new Anthropocene3 age, the influence o f humans on the global environm ent
al., 2005; McGlade, 2001; Moore & Csizer, 2001). In fact, environmental disturbance
is arguably greater than th a t o f any other species, and so are the effects o f environ­
w ill frequently comprise various combinations o f such stresses (Di Giulio & Ben-
mental change on human health and well-being. Human im pact on our environ­
m ent is shaped by our social actions, governance, economic forces, international
Marine Ecosystem Change: a multiple driver problem
trade, land use and industrial and urban development (Roodman, 1998; Torres &
Monteiro, 2002). Societal factors responsible fo r the deterioration o f the health o f
marine ecosystems include: econom icfailure lea d in g to reduced efforts in manage­
<
f>
m
/
the m ultiple drivers underlying the
E
o
m ent and protection; inadequate governance including non-enforcement o f exist­
DÛ
ing environmental protection laws; haphazard industrialization and urbanization
ui
o
—I
P athogens
various processes contributing to the
HUMAN
HEALTH
V irus
interaction s between m arine ecosystems
HAB Toxins
resulting in ru n -o ff o f polluted wastewater and contam ination o f land, rivers and
and hum an health (Allen, 2011)
B acteria
coastal waters; poor public education and understanding o f the problems; and the
W e ll-b e in g
strongly sectoral structure o f governm ent policies and in stitutions which generally
presents a barrier to integrated solutions (Bryant et al., 1995; Burke et al., 2000;
FIGURE 1.2.
Schem atic diagram illu s tra tin g
r( G E S )
Wastewater
[Phytoplankton]
Mee, 1992; United Nations Environment Programme, 1991). High density human
occupation o f the coastal zone often lies at the heart o f these problems (Figure 1.1;
P ro te in
P athogens
P o llu ta n ts
HAB Toxins
Zooplankton
United Nations Population Division, 1999; World Bank, 1995).
3 The te rm A nthropo cene is an in fo rm a l
10
te rm coined by th e Nobel P rize-w in ning
Historically, research and regulatory concern has concentrated on the im pact o f hu­
a tm o sp h e ric c h e m is t Paul C rutzen to reflect
man activities on the marine environment, particularly through anthropogenic pol­
th a t th e influe nce o f hum an behaviour on the
lution and the over-exploitation o f resources. A significant proportion o f the human
Earth s y s te m in recent cen turies has been
population lives in close proxim ity to the coastal zone (up to 70%, depending on
so s ig n ific a n t th a t i t can be considered to
the definition o f “coastal zone”, in this case w ith in 200km o f the coast) and coastal
c o n s titu te a new geological epoch.
population densities are increasing globally. High-density human settlem ents are
Nutrient supply/
Eutrophication
Temperature
Pollutants
Acidification
S hellfish
Fish
Fishing & ^
Aquaculture
Log (Size)
11
LINKIN G OCEANS A N D H U M A N HEALTH
In tro d u c tio n and policy c o n te x t
INFORMATION BOX 1.1.
chronic exposure to environmental stress (including chemical pollutants or other
Ecosystem services (environmental, economic, cultural, etc.) as a
Key areas at risk from human
anthropogenic factors) w ill seldom result in rapid and catastrophic change (Bowen
result o f human and environmental pressures and impacts;
and natural pressures central to
& Depledge, 2006; Moore et al., 2004; Orr et al., 2005). Rather, the im pact w ill be
the interaction between marine
gradual, subtle, and frequently d ifficu lt to disentangle from the process and effects
Q uality of life, including the economic, social and health
environmental health and human
of natural environmental change (Figure 1.3). This latter problem has been a major
im plications o f deteriorating marine environments;
health
stum bling block in assessing environmental im pact since such investigations be­
gan in the 1960s.
Habitats and environmental resources (e.g. salt marshes, coral
The Ecosystem Approach is considered one o f the most im po rtant principles o f sus­
reefs, large estuaries and deltas), which are under pressure from
tainable environmental resource management, which is the management o f the
unprecedented land use and urbanisation at a tim e o f sea level rise
interaction and im pact o f human societies on the environment. Environmental
and coastal erosion;
resource management aims to ensure th a t ecosystem services are protected and
Coastal biodiversity of land and aquatic animals and plants;
Environmental quality (e.g. due to contam ination w ith chemical and
endocrine disrupting properties);
Aesthetics (e.g. oil and litte r on beaches).
\
.1
\
\
\
I
WEEK
S E AS O N
Aquaculture
Microbial bathing waters
Pollution Dispersion
Contaminants
Pathogens
Fisheries Advice
Benthic Health/
productivity
Primary Production
À
Aquaculture
Pollution fates
Contaminants
Pathogens
tio n may be an im p o rta n t contributing factor leading to reduced well-being and
a poor quality o f life, which is itself associated w ith an increased risk o f disease.
// r
//
M O N TH
son, 2002). In term s o f tangible consequences, insidious environmental degrada­
</)
Inform ation Box 1.1 provides a summary o f some o f the key areas at the interface
-
YEAR S TO D E CAD ES
Good Environmental
Status
Habitats
Acidification
Biodiversity
between marine environmental health and human health.
In order to develop a strategy fo r dealing w ith the potential problems, we need to
consider how we can forecast and reduce risks. To date, public health policy and m an­
agement actions have m ostly relied on a simple univariate action-reaction model
or, at most, multi-level relations but always w ith a clear directionality (Westra etal.,
2008, Bowen & Depledge, 2006; Fleming et al., 2006; Torres & Monteiro, 2002). For
example, fo llo w in g identification o f an algal toxin in seafood, action w ill be taken
to ensure th a t consumption o f the seafood ceases until the threat has passed. Eco­
logical interactions are, in fact, much more complex, and models o f ecological and
health interconnectivity require a much greater degree o f sophistication (see Figure
1.1; Allen, 2011; Moore et al., 2011; Morris et al., 2006). This complexity underlines
S e asons
•C
O
Years
y
TO DAY
Nowcast & real-time
HABs
Eutrophication
Microbial bathing waters
Visibility/turbidity
Forecast lead tim e
FIGURE 1.3. Schem atic diagram
illu s tra tin g the tim escales of forecast
p ertin ent to m arine ecosystems and
hum an health (Allen, 2011)
the need to adopt systems-level approaches when addressing the relationships be­
tween the marine environm ent and public health (see also Chapter 4).
Assessment and management of environmental change
F o re c a s t
U n c e rta in ty
D ecades
maintained fo r equitable use by future human generations, and also to m aintain
ecosystem integrity in its own right by taking into consideration ethical, economic,
The assessment o f impacts o f environmental disturbances on ecosystems and or­
and ecological variables (Pahl-Wostl, 2007; Morris et al., 2006). Environmental re­
ganisms (including humans) requires an understanding o f stress effects th ro ugh ­
source management tries to identify the factors th a t have a stake in the conflicts
out the hierarchy o f biological organization, from the molecular and cellular to the
th a t may arise between meeting societal needs and protecting environmental re­
organism and population levels, as well as the com m unity and ecosystem levels
sources.The ecosystem approach provides a sound management fram ew ork w ith in
(Di Giulio & Benson, 2002; Moore et al., 2004). In the past, damage to the environ­
which efforts to reduce the risks to human health posed by marine environmental
m ent has largely been identified retrospectively, in response to acute events such
degradation can and should be progressed, and has been at the heart o f some im ­
as major disasters (e.g. industrial accidents like Seveso and Bhopal; and oil spills
portant EU policy instrum ents listed below.
such as the Amoco Cadiz, Exxon Valdez and G ulf War, and chemical pollution of
the Great Lakes) (Moore & Csizer, 2001; Moore et al., 2004). Generally, these have
been measured in term s o f human health impacts and visible changes resulting
from the loss o f particular populations or comm unities. However, long-term and
12
13
LINKIN G OCEANS A N D H U M A N HEALTH
In tro d u c tio n and policy c o n te x t
1.2
Scientific challenges and research questions
As a starting point, the OHH W orking Group compiled a list o f key scientific chal­
1.3
Policy context
Oceans and human health research not only covers a wide range o f scientific do­
lenges fo r consideration in this Position Paper and ultim ately in a coordinated
mains, but also touches upon many different policy areas. A complex set o f EU Poli­
Oceansand Human Health Research Programme. These challenges were translated
cies and regulations relevant in this context are currently in place. Some are entirely
in research w hich are questions listed in Inform ation Box 1.2 below and fu rth e r
oriented towards the marine and coastal environm ent w hile some are not specifi­
discussed in more detail in the fo llo w in g chapters together w ith the related policy
cally focused on seas and oceans but are partly or indirectly relevant.
drivers.
At the core o f these policies is the EU Integrated M aritim e Policy (IMP), adopted in
2007, which aims to stim ulate the development and m anagement o f sea-related
activities in an integrated and sustainable manner. The IMP was initiated recogniz­
INFORMATION BOX 1.2.
1.
ing the need for an integrated ecosystem-based approach to reduce environmental
Can we demonstrate
and nanoparticles and
Key research questions for consideration
pressures, and constitutes an im portant stepforw ard in developing a more coherent
associations between
conventional chemical
in an Oceans and Human Health
approach to managing m aritim e activities across a range o f sectors and policy ar­
ecosystem health and human
pollution, including complex
Research Programme
eas. It provides a powerful fram ew ork w hich is in line w ith the integrated approach
health?
mixtures?
necessary to better understand and manage the intricate relationship between
the oceans and people’s health. The IMP provides an overarching m aritim e policy
2.
3.
W hat are the risks from radio­
fram ew ork w ith in w hich fu rth e r more focused policy instrum ents are supported.
im pact on health and
How does climate change
9.
nuclides, including direct risks
These include the Marine Strategy Framework Directive (2008), the European Strat­
w h a t are the public health
and food safety and security
egy for Marine and M aritim e Research (2008), Marine Knowledge 2020 (2012)4, the
consequences?
as a result o f the expansion o f
Proposed Directive on a Framework fo r M aritim e Spatial Planning and Integrated
the nuclear energy industry?
Coastal Zone Management (2012)5and the EU Blue Growth Strategy (2012)6.
How do adverse natural events
(such as earthquakes, volcanic
10. Are there common pathways
The environmental pillar o f the IMP, the Marine Strategy Framework Directive
eruptions, flooding, tsunam i,
fo r transport and uptake of
(MSFD), offers a suitable operational policy fram ew ork for developing a coordinat­
severe storms) im pact on
pathogens and chem ical/
ed and science-based approach to elucidate and better manage the relationship
public health?
particle pollutants?
between oceans and human health. The MSFD came into force in June 2008 and
recognizes th a t the seas and oceans are complex but entirely interconnected envi­
4.
How does eutrophication from
11. W hat are the impacts of
food safety and food quality
w hole ecosystem ratherthan on individual parts o f the ecosystem or restricted only
im pact on seafood security
(nutritional components)?
to the location o fth a t activity. The MSFD is designed prim arily to address the declin­
ing environmental health status o f European marine waters and sets an ambitious
and safety?
12. Can problems w ith food
5.
ronments, and th a t activities such as fisheries or dredging w ill have impacts on the
land-based nutrient in flu x
target o f “ Good Environmental Status” o f European marine waters by 2020. Good
How do harm ful algal blooms
security (over-exploitation,
Environmental Status (or GES) w ill be measured according to eleven descriptors o f
(HABs) and other biogenic
environmental degradation
“ health”, against which appropriate indicators and targets m ust be developed for
4 M arine Knowledge:
toxins cause direct-contact
and biodiversity loss;
specific marine regions identified in the Directive. W hile all o f these targets have
h ttp ://e c .e u ro p a .e u /m a ritim e a ffa irs /p o lic y /
to xicity and im pair seafood
reduction in adaptive capacity
relevance to human health, the health and well-being o f coastal populations is not
ma rin e_ kn o w ledge_2020/i ndex_en.htm
safety and other impacts on
through loss o f genetic
directly addressed by m ost o f them (save fo r the threats to human health posed by
human health?
diversity) be effectively
contam inated seafood).
5 M arine S patial Planning and ICZM:
managed to prevent loss
6.
o f biological resources
The regional sea conventions such as OSPAR and HELCOM have also played, and
LexUriServ/LexUriServ.
routes and public health
(fisheries)?
w ill continue to play, an im portant role in term s o f m onitoring and protecting the
do?uri=COM:2013:0133:FIN:EN:PDF
consequences o f pathogens
(helminths, protozoans,
bacterial, rickettsial and viral)?
7.
13. Does proxim ity to the seas and
protection o f human health, a number o f Directives are applied across the EU for
6 Blue Growth:
coasts have health benefits? -
particular stressors. For example, the Bathing Water Quality Directive7 focuses on
h ttp ://e c .e u ro p a .e u /m a ritim e a ffa irs /
the so called “ Blue Gym” effect
w ater quality in the context o f pathogens w hile the Shellfish Directive8 focuses on
poli c y /b lu e _ g ro w th /i ndex_en.htm
the quality o f the shellfish grow th conditions in EU coastal waters.
14. Can environm ental, social and
7 EU B athing W ater Q uality:
environm ent and public
economic interactions (quality
In relation to reducing pressures from overfishing, a landmark agreement between
h ttp ://e c .e u ro p a .e u /e n v iro n m e n t/w a te r/
health?
o f governance, pressures from
the Council o f Ministers and European Parliament was reached in 2013 on the re­
w a te r-b a th in g /in d e x _ e n .h tm l
coastal zone overpopulation
form o f the Common Fisheries Policy (CFP) which represents another m ajor policy
Are there risks from
and sustaining critical coastal
development. The overarching aim o f the reformed policy is to end overfishing and
3 Shellfish D irective:
contam ination o f seawater
ecosystems) be predicted?
make fishing sustainable. A key element o f the policy entails the banning o f dis­
h ttp ://e u r-le x .e u ro p a .e u /L e x U riS e rv /
and seafood by micro-
14
European marine environm ent at the level o f the European Sea Basins. In term s o f
Are there negative impacts
o f aquaculture on the
8.
h ttp ://e u r-le x.e u ro p a .e u /
W hat are the transmission
cards to bring fish stocks above sustainable levels. The new policy enters into force
LexUriServ.do?uri=O J:L:2006:376:0014:002
on 01 January 2014 w ith a progressive im plem entation o f the new rules.
0:EN:PDF
15
LINKIN G OCEANS A N D H U M A N HEALTH
In tro d u c tio n and policy c o n te x t
Other complementary policy efforts and legislation not specifically focused on the
national solutions if the marine environm ent is to remain ecologically functional
marine environm ent include the EU W ater Framework Directive (WFD) and other
and economically sustainable (Figure 1.1; Bowen & Depledge, 2006; Fleming et al.,
freshwater legislation, the Habitats and Birds Directives, legislation to lim it n u tri­
2006; Todd, 2006; Moore & Csizer, 2001).
ent and waste w ater pollution inflows into EU coastal waters such as the Nitrates
Directive9 and the Urban Waste Water Directive10, the EC Regulation on chemicals
These challenges have been recognized fo r many years in the USA. A symposium
and th e ir safe use (REACH legislation)11 which entered into force on 1 June 2007
held in 1999 at the Bermuda Institute for Ocean Science entitled, “The Interaction
and the Stockholm Convention on Persistent Organic Pollutants (UNEP - POPs). In
between Healthy Oceans and Human Health,” led to a later funding programme
fact, given environmental degradation and human health are inextricably linked, all
developed as a collaboration between the US National Institute o f Environmen­
environmental policy and legislation is relevant to some extent and w ill need to be
tal Health Sciences (NIEHS) and the National Science Foundation (NSF). This pro­
taken into account when considering policy options to improve the sustainability o f
gramme supported the establishm ent o f four Oceans and Human Health research
human-sea interactions. This also encompasses w ider policies and strategies in the
centres at the universities o f Hawaii, Washington and M iam i and the Woods Hole
area o f Climate Change and Biodiversity (e.g. the EU Climate and Energy package
Oceanographic Institute. In addition, the US National Oceanic and Atmospheric Ad­
and the EU 2020 Biodiversity Strategy).
m inistration (NOAA) funded three o f its own centres in Washington State, South
Carolina and the Great Lakes (Depledge e ta l, 2013).
Further policy priorities in the EU in the general area o f environm ent and health pol­
icy have also been articulated w ith in the EU Action Plan on Environment and Health
Europe on the other hand has failed to develop any form o f dedicated or coherent
(Hester and Harrison, 2011), w hich covered the period between 2000 and 2010.
Oceans and Human Health Research collaboration, instead dealing w ith specific is­
Priorities w ith relevance to the marine environm ent include better understand­
sues in a compartmentalized way through individual projects supported by gener­
ing o f the links between environmental quality and human health (particularly for
alized funding programmes (e.g. environm ent and human health). Over the years,
vulnerable groups such as children), the development o f tools to better character­
the Member Organizations from the European Marine Board have recognized th a t
ize causal links (e.g. environmental health indicators, biom onitoring approaches)
Europe m ust urgently address the many challenges faced by a large and growing
and the need for integrated m onitoring approaches fo r the environm ent (including
coastal dw elling population, in m aintaining and improving th e ir safety, health and
food), to allow the determ ination o f relevant human exposure. Endocrine disrup­
well-being. In order to provide strategic advice on the key scientific priorities which
tio n is a specific area where more inform ation is needed, as are the effects o f chem i­
should form the basis o f a coordinated collaborative research e ffo rt on Oceans and
cal m ixtures in the environm ent (Howard, 1997; Kortenkamp & Altenberger, 1998).
Human Health in Europe, the Board therefore decided in 2010 to convene an expert
W orking Group on this topic. The tasks o f the Working Group were to:
M ost o f the above m entioned policies and regulations are addressed individually
where appropriate th ro u g h o u t this position paper. However, as much as there is a
H ighlight the critical importance o f the marine environm ent for health and
need for integration o f the oceans and human health science, there is a need to fu r­
welfare o f European citizens;
ther consider and address policy developments in an integrated way. Unfortunately,
Identify societal, environmental and biomedical challenges linking human
the list o f relevant regulations and policies is as long as it is diverse and has not
health w ith the marine environm ent and marine processes;
previously been considered in a holistic way.
Review research and existing initiatives w orldw ide to provide a global over­
view;
One o f the firs t steps ahead w ould therefore be to perform a thorough analysis o f
Encourage grow th, development and facilitation o f interdisciplinary, systems
the various policies and legal instrum ents which have a bearing on the complex
approach to Oceans and Human Health research and training to address real-
relationship between our marine environm ent and human health, to identify weak­
w orld problems, not ju s t in Europe but globally;
nesses, gaps and overlaps, and consider mechanisms to strengthen th e ir interac­
Identify strategic areas in Europe fo r Oceans and Human Health and marine
tions to improve effectiveness.
ecosystems and improve European competiveness in this field;
Provide recommendations to guide European research and training in the me­
dium -term (2020);
Develop recommendations to foster the process o f policy form ulation through
improved Knowledge Transfer (KT) and Knowledge Exchange (KE) in order to
9 See EU N ilra le s D irective overview page:
h ttp ://e c .e u ro p a .e u /e n u iro n m e n t/w a te r/
w a te r-n itra te s /i ndex_en.htm l
1.4
Towards a European Research Programme
on Oceans and Hum an Health
w a te r-u rb a n w a s te /i ndex_en.htm l
Summarize the findings o f the Working Group in a European Marine Board Po­
sition Paper targeted in the firs t instance at those people w ho determine and
set the research agenda, including research funding organizations, programme
10 The Urban W astew a ter Directiue:
h ttp ://e c .e u ro p a .e u /e n u iro n m e n t/w a te r/
facilitate decision-making in marine environm ent and health;
It is clear th a t there is a complex but im portant relationship between the marine
managers and science policy advisors/developers both at the national and Eu­
environm ent and human health w hich raises many questions and challenges both
ropean level.
fo r scientists and for policy makers. Moreover, policy makers w ill rely on scientific re­
16
11 The REACEI Directiue:
search and advice to develop a deeper knowledge and understanding o f the cause-
h ttp ://e c .e u ro p a .e u /e n te rp ris e /s e c to rs /
and-effect relationships between marine environmental health and public health
A key message o f this paper is th a t Oceans and Human Health research requires
strategic prioritization and resource mobilization at both the European and na­
c h e m ic a ls /re a c h /i ndex_en.htm
in order to fram e appropriate and effective policy responses. This is not a national
tional level. Key European programmes w hich have the capacity to support a
or even a regional problem, but is in fact a major global issue th a t w ill require trans­
major Oceans and Human Health initiative include Horizon 2020, the EU’s next
17
LINKIN G OCEANS A N D H U M A N HEALTH
In tro d u c tio n and policy c o n te x t
programme fo r research and technology development (2014-2020), and the Joint
Programming Initiative on Healthy and Productive Seas and Oceans (JPI Oceans).
INFORMATION BOX 1.3.
The complex but Im portant relationship between the marine
environm ent and human health has long been recognized as a priority
area fo r research in the USA. Several science programmes from the mid-
A brief history of Oceans and Human
Health (OHH) Programmes and related
activities in the United States
2007- 2008 making awards specifically targeted to the interdisciplinary
education and training o f doctoral and post-doctoral scholars in OHH, as
part o f a long-term strategy to build a new cadre o f OHH scientists.
1970s up to the 1990s focusing on issues such as seafood safety, harm ful
algal blooms (HABs), toxicology and the use o f aquatic organisms in
The year 2008 also saw publication o f the firs t OHH textbook fo r use in
health-related research paved the way fo r OHH research to be recognized
new academic courses in OHH, and the first Gordon Research Conference
as a metadiscipline in the USA. In the late 1990s through the mid-2000s,
(GRC) and Graduate Research Seminar (GRS) devoted exclusively to the
a spate o f activities and publications fu rth e r catalysed the creation of
new OHH metadiscipline. These conferences have continued at regular
them atic OHH programmes in the USA.
2-year intervals since, w ith the latest held in the summer o f 2012,
indicating strong com m unity recognition o f OHH as an im portan t area
The 1999 publication o f the National Research Council’s report, “From
o f scientific inquiry and discovery. The next OHH GRC/GRS is being
Monsoons to Microbes: Understanding the Ocean’s Role in Human Health "
planned for the summer o f 2014 and plans are already developing fo r an
can be considered as a key stepping stone in the advancement o f an
OHH GRC to be held in Europe in 2016.
OHH research capacity. Concerns in the research and public health
com m unities summarized in this report and the 2004 final report o f the
Following more than a year o f intensive interagency work, on 19 July,
US Commission on Ocean Policy, resulted in establishm ent or enhanced
2010, President Obama issued Executive Order 13547 to establish a
development o f Oceans and Human Health (OHH) programmes in the
"National Policy fo r the Stewardship o f the Ocean, Our Coasts and the
USA. Other NRC reports and a number o f high level workshops provided
Great Lakes”, also referred to as the National Ocean Policy (NOP). The
additional m om entum . For example, in December 2001, the National
NOP references several OHH issues, such as HABs, pathogens, chemical
Science Foundation (NSF) and National Institute o f Environmental Health
contaminants, and disease, and uses the term "hum an health” 17 times.
Sciences (NIEHS) sponsored a com m unity workshop follow ed by a jo in t
The firs t paragraph o f the NOP states th a t "America’s stewardship
request fo r proposals for the creation o f academic centres o f excellence
o f the ocean, our coasts, and the Great Lakes is intrinsically linked to
in OHH. Shortly thereafter, the US Congress appropriated fu n d in g to
environmental sustainability, human health and well-being, national
the National Oceanic and Atmospheric Adm inistration (NOAA) for
prosperity, adaptation to climate and other environmental changes,
establishm ent o f its Ocean and Human Health Initiative (OHHI).
social justice, international diplomacy, and national and homeland
As a result o f the in itia l efforts by NSF, NIEHS, NOAA, and others, in 2004
firm ly embodied in the ocean policy o f the US.
security.” Hence, linkages between oceans and human health are now
the USA developed a national network o f seven com petitively-funded
OHH centres o f excellence in academia and government. At the same
The te x t in this inform ation box is largely based on Sandifer et al. (2013).
tim e, the US Commission on Ocean Policy (USCOP), in its final report,
For additional inform ation please consult:
called fo r the development o f national research programmes in this
arena. This prompted the US Congress to pass the Oceans and Human
the website o f NOAA’s Oceans and Human Health Initiative at
Health Act (OHHA), w ith the stated aim to "...improve understanding
http://oceansandhum anhealth.noaa.gov/
o f the role o f the oceans in human health.” Subsequently, NOAA fu lly
developed its OHHI and began concentrating on its three prim ary goals:
the website o f Woods Hole Oceanographic Institution (WHOI) on
jo in t Centers fo r Oceans and Human Health (COHH) at
(1) development o f early w arning systems to forecast threats and predict
http://w w w .w hoi.edu/science/cohh/
long-term risks to human health th roughout US coastal and Great Lakes
waters;
relevant pages o f the National Institute o f Environmental Health
Sciences (NIEHS) at http://w w w .niehs.nih.gov/research/supported/
(2) investigation o f health benefits from the sea; and
dert/program s/oceans/index.cfm
(3) development o f a robust OHH com m unity w orking across disciplines
and institution s to improve public health.
To stim ulate the development o f this interdisciplinary OHH research
comm unity, NOAA inaugurated its OHH Trameeship Programme in
18
19
LINKIN G OCEANS A N D H U M A N HEALTH
I n t r o d u c t i o n a nd p ol ic y c o n t e s t
1.5
A bout this Position Paper
This Position Paper is not intended to be a comprehensive review o f public health
FIGURE 1.5.
concerns connected to the marine environm ent which has already been covered
This position paper is aim ed at
in more detail by other sources and authors (Bowen & Depledge, 2006; Fleming et
id e n tify in g critical scientific and
at, 2006; Roth & Rosenthal, 2006; Todd, 2006; McGlade, 2001). Rather, it is aimed
policy challenges associated w ith the
at identifying critical scientific and policy challenges associated w ith the intercon­
interconnection between the m arine
nection between the marine environm ent and public health. The fo llo w in g chap­
environm ent and public health.
ters w ill add detail to the questions outlined in Inform ation Box 1.3, identifying
some o f the key societal challenges and related research questions. W hile much o f
the discourse concerning the relationship between oceans and human health has
tra d itio n a lly revolved around the risks and negative impacts o f marine pollution,
disease associated w ith marine-borne pathogens and harm ful algal blooms, this
paper also addresses some o f the positive health benefits afforded to humans by
the marine environment, including the “ Blue Gym” effect (see Section 2.6). Chapter
2, therefore, provides an overview both o f the emerging health benefits and oppor­
tunities o f the oceans as well as the health hazards and risks they entail. Chapter
3 focuses on w h a t can and should be done to address the public health challenges
presented by the seas and oceans and includes an analysis o f some o f the tools
FIGURE 1.4.
and approaches th a t may help to meet the societal and scientific targets. Finally,
Man and Sea are inextricably bound
Chapter 4 summarizes the recommendations o f the W orking Group w hich should
(Credit: lo s e f Stuefer / NWO)
form the basis o f a fu tu re research programme on Oceans and Fluman Health.
21
The lin k between th e oceans and h u m a n health:
hazards, risks, ben efits and o p p o rtu n itie s fro m th e sea
2.1
Climate change, natural events and
human health
Although the scientific validity o f global climate change has been increasingly ac­
cepted w ith in the international scientific com m unity fo r several decades, other
audiences (ranging from policy makers to the general public) have been less con­
vinced. Moreover, there has been a relative lack o f research into, and inform ation
about, the human health impacts o f climate change. Over the past decade, there
The link between the
oceans and human health:
hazards, risks, benefits and
opportunities from the sea
has been increasing attention paid to this issue, focusing on both direct and in­
direct health impacts and th e ir consequences (McMichael, 2011; IWGCCH, 2010;
Haines, 2009; Epstein, 2005; Haines, 2004; Bunyavanich, 2003).
It is now clear th a t the oceans are inextricably intertw ined w ith both global climate
change and its impacts on human health and well-being (Kite-Powell, 2008; Flem­
ing, 2006a; Fleming, 2006b). Human populations are both m ovingto, and growing
in, ocean, estuarine and coastal areas globally, particularly in developing nations.
Consequently, there is an increased reliance on, and use of, these coastal resources,
ranging from fishing and aquaculture activities to desalination for drinking water
and recreational use o f beaches and inshore waters. Therefore, not only are these
coastal areas highly exploited, but there are increasing numbers o f people depend­
ing on the coasts fo r th e ir living place, food, and livelihood. This creates highly
vulnerable populations in light o f projected sea-level rises, tem perature extremes,
ocean acidification, and other potential effects o f climate change.
The most obvious im pact o f global climate change on human health is from ex­
trem e weather events such as cyclones which, as a result o f climate change, appear
to be increasing in both incidence and intensity and w ith variable predictability.
W hile frequently attracting disproportionate media attention, such events can still
cause significant ecological damage and im pact severely on human health in af­
fected locations (UNISDR12; Population Reports, 2000).
Recently, Hurricane Katrina (August 2005), the Burmese cyclone (May 2008) and
Hurricane Sandy (October 2012) have demonstrated th a t coastal populations, par­
ticularly o f socially deprived groups in both developing and developed nations, are
highly vulnerable to the m orbidity and m o rtality associated w ith extreme coastal
events.The 2004 Indian Ocean tsunam i killed more than 230,000 people in 14 coun­
tries.The health impacts o f such m ajor events can be acute (e.g. traum a, drowning,
starvation, water-borne and vector-borne diseases) and are often follow ed by more
chronic issues such as mental illness, m aln utrition and population m igration, which
can last fo r years (Berry et al., 2010). Improvements in m odelling capabilities cou­
pled w ith remote-sensing should help to provide better early-warning capacity in
the future.
Sea-level rise, another major im pact o f global climate change, is also likely to
im pact in significant and complex ways on the health and w ell-being o f coastal
populations, particularly those in low-lying coastal zones. A t the most basic, physi­
cal level, the extent o f sea-level rise predicted by the Intergovernmental Panel on
Climate Change (IPCC, 2013) w ill cause substantial disruption o f coastal infrastruc­
ture, ranging from ports to sewage trea tm ent plants to housing. At the same tim e,
sea-level rise and ocean acidification are expected to im pact on coastal fisheries
ow ing to direct and indirect destruction o f habitats and nursery grounds, leading
to decreased nutritional and occupational opportunities in coastal comm unities. As
12 U nited N ation s In te rn a tio n a l S trategy fo r
sea levels rise, the freshwater supplies o f many coastal com m unities w ill become
D isaster R eduction (UNISDR)
contam inated w ith saltw ater, rendering them unusable or only usable w ith expen-
iwiwiw.unisdr.org
23
LINKIN G OCEANS A N D H U M A N HEALTH
The lin k between th e oceans and h u m a n health:
hazards, risks, ben efits and o p p o rtu n itie s fro m th e sea
sive desalination procedures. Some indirect health impacts may also arise through
the release o f toxic waste and human pathogens from inundation o f coastal land­
fill sites, agricultural land, and disturbance o f estuarine sediments (Population Re­
ports, 2000; Zhou etal., 1998,1999).
Another key climate change impact concerns th a t of rising water temperatures in
the marine environment. Rising water temperatures are already having a significant
impact on the marine environment which w ill ultim ately have implications for hu­
man health. Changes in the distribution o ffis h stocks w ill have direct impacts on
coastal fisheries and hence human livelihoods and diet. Harmful algal blooms (HAB)
are also projected to increase in frequency and intensity, in part due to the increasing
S f/ n
temperatures (caused by climate change), and in part due to the increased microbial
FIGURE 2.1.
pollution from coastal populations and the resulting nutrient load. This w ill lead to
Satellite pictures of the coast of Bandah
acute and chronic illness in humans and other organisms associated w ith exposure
Aceh before (top) and a fte r the tsu n am i
to seafood, water and marine aerosol contaminated w ith the potent natural HAB
struck (b o tto m ) on 26 December 2004
toxins and microbial pathogens, leading to additional threats to the nutrition and
(O digiglobe)
occupations o f coastal communities (Moore, 2008). Further discussion o f the human
health implications o f HABs is included in section 2.4.
Figure 2.2.
Spatial distrib ution o f sea surface
tem p e ra tu re trend o v e rth e past 25 years
(1 9 8 7 -2 0 1 1 )fo rth e European seas as
calculated from th e FIADISST1 dataset.
(Credit: In stitu to Nazionale de Geofísica e
Vulcanologia (INGV)).
Mean annual sea surface
temperature trend in
European seas, l9 fl? " 2 0 ll
°C per year
EU
o. oa
0.06
0 .0 4
0.02
0
-Û .Û 2
- 0.04
24
25
LINKIN G OCEANS A N D H U M A N HEALTH
The lin k between th e oceans and h u m a n health:
hazards, risks, ben efits and o p p o rtu n itie s fro m th e sea
2.2
M arine chemical polution
Thus, increasing w ater tem peratures caused by climate change may have negative
Marine coastal environments are characterized by the presence o f different p ollut­
im plications fo r marine organisms and human health, but may also have some
ants originating from terrestrial, atmospheric and marine sources (Islam & Tanaka,
“ positive” effects. There is grow ing evidence, fo r example, th a t increasing tem pera­
2004). Human-produced chemical inputs to coastal waters include industrial, do­
tures may reduce the to xicity o f organic pollutants such as pesticides, pharmaceu­
mestic and agricultural nutrients, pesticides, road run-off, personal care products,
ticals and arom atic hydrocarbons, in tu rn reducing th e ir environmental impacts
disinfectants, pharmaceuticals and novel chemicals. It is clear th a t m onitoring and
(Lartigues & Grarrigues, 1995; Kitts et al., 1992). W ith increasing w ater tem pera­
controlling chemical pollution in marine ecosystems is a critical issue fo r sustain­
tures, numerous organicxenobiotic chemicals may be more rapidly “aged” by oxida­
able environmental management, particularly in light o f the EU Marine Strategy
tion in the environm ent or in living organisms. However, the resulting degradation
Framework Directive (Directive 2008/56/EC). To date, the m onitoring o f European
products may represent an additional problem at the environmental level. In some
seas has been based prim arily on the measurement o f chemical concentrations in
cases, they may become less toxic (reduced bioavailability, higher excretion level
water, sediments and biota (Roose et al., 2011). However, in practical terms, com­
from the organisms), but may also represent compounds capable o f interacting
plete screening o f chemical contam ination is not possible. There are about 100,000
w ith genetic material at a nuclear level. This interaction may lead to DNA strand
chemicals produced fo r sale in Europe, o f w hich about 30,000 have a production
breaks and to the form ation o f micronuclei due to chromosomal damage (i.e. the
volume o f higher than one tonne per year and have been on the market fo r more
chemicals may be transform ed into substances able to stim ulate / participate in tu ­
than 20 years (Roose et al., 2011). The list o f substances classified by the American
mour genesis). In addition to this, tem perature increases may also render some in ­
Chemical Society as toxic includes more than 282,000 compounds (CAS, 2011). Yet,
organic chemicals and non-degradable organic contam inants more toxic (Gomiero
the number o f chemicals norm ally analyzed during characterization campaigns is
et al., 2012; Negri et al., in press). This complex antagonism between the positive
around 100-120 compounds.
and negative effects o f increasing w ater tem peratures requires significant fu rth e r
research, not least to assist in the generation o f more accurate predictions on the
500
fu tu re consequences o f climate change in the marine environm ent and the im plica­
TABLE 2.1.
Direct Connections
The potential impacts of climate change
Weather-Related M orb id ity & M o rta lity
connections to the oceans.
on human health and their potential
Mental Health and Stress-Related Disorders
Projected growth index
tions fo r human health.
400
I
I Global chem ical production
I
I Global population
300
300
100
Waterborne Diseases
Foodborne Diseases & N utrition
2000
2005
Z010
2015
2020
2025
2030
2035
2040
2045
2050
Year
Indirect Connections
FIGURE 2.3
Global chem ical production is projected
to grow a t a rate o f 3% per year, rapidly
outpacing the global population growth.
On th is tra je c to ry , chem ical production
w ill double by 2024, indexed to 2000.
(From W ilson and Schw arzm an, 2009)
Heat-Related M orbidity & M o rta lity
Vectorborne & Zoonotic Diseases
Asthma, Respiratory Allergies, & Airway Diseases
Neurological Diseases & Disorders
The reliability o f the chemical approach in the assessment o f marine ecosystem
quality is also questionable because m onitoring o f chemical concentrations alone
provides little inform ation on the ecosystem effects o f chemical pollution (Roose
et al., 2011). Furthermore, toxicity resulting from interactions among chemicals
Unclear Connections
in a pollutan t m ixture (e.g. additive, antagonistic, synergistic, etc.) is only partially
estimable from analytical data (Jonker et al., 2005). Chemicals entering seawater
Cancer
and accum ulating in the sedimentary com partm ent undergo different chemical-
Cardiovascular Disease & Stroke
et al. 2006, Pempkowiak et al., 1999). Moreover, sediments are a key m atrix to as­
physical processes able to alter th e ir molecular structure and th e ir to xicity (Jonker
sess the impacts o f contam ination in marine coastal environments. In fact, many
Human Developmental & Reproductive Effects
26
pollutants can be sequestered in the sedimentary m atrix as a result o f environmen27
LINKIN G OCEANS A N D H U M A N HEALTH
tai processes driven by different factors (i.e. pH, redox potential, oxygen concentra­
Complex issues are involved in evaluating environmental risk, such as the effects
tion, tem perature, etc.), by form ing insoluble or poorly soluble compounds, or by
of the physico-chemical environm ent on the spéciation and uptake o f pollutant
adsorbing onto suspended particles (Chapman & Anderson, 2005). The levels o f
chemicals and inherent inter-individual and inter-species differences in vulner­
pollutants in marine sediments can be considerably higher than those detected
ability to to xicity (Moore et al., 2004). Effectively linking the im pact o f pollutants
in the w ater column, where contam inant concentrations are often near analytical
through the various hierarchical levels o f biological organization to ecosystem and
detection lim its (Zoumis et al., 2001). However, the resuspension o f sedimentary
human health requires a pragmatic integrated approach based on existing inform a­
particles due to the mechanical action o f waves and currents as well as human
tion th a t either links or correlates processes o f pollutant uptake, detoxification and
activities such as sediment dredging can lead to the mobilization o f pollutants ac­
pathology w ith each other and w ith higher level effects (Moore etal., 2011).
cumulated in sediments towards the w ater column, w ith consequent impacts on
biota (Eggleton & Thomas, 2004).
Generic quantitative models may provide a partial solution to the problem o f pre­
The real ecosystem im pact o f chemical pollution can only be properly determined
through the development and im plem entation o f computational models. Such
dicting the dynamics and risk o f adverse impacts o f chemical po llu tant stressors
by coupling exposure (i.e. chemical concentrations) and effects (i.e. ecotoxicological
models could be used to simulate po llu tant pathways in the human food chain, and
tests), allow ing increased reliability in the determ ination o f risks due to contam ina­
could be adapted to investigate environmental transport o f human pathogens and
tion (Lyons etal., 2010; Chapman, 2007). Although some studies exist, there is still a
th e ir viability, and the interactions between pollutants and microbial populations
significant, but scientifically challenging, lack o f understanding o f the interactions
th a t may lea dto increased biogenictoxin production.The kinetics and dynamics o f
between various environmental stressors and th e ir ecological consequences. A
harm ful carcinogenic and toxic chemicals in fish and shellfish species th a t are har­
major challenge in im pact and risk assessment as part o f environmental manage­
vested fo r human consumption could also be characterized and modelled, as could
m ent is to link harm ful effects o f pollution (includingtoxicchem icals) in individual
pathological reactions (molecular to tissue level) to known pollutants and poten­
sentinel animals to th e ir ecological consequences (Moore et al., 2004). Part o f the
tia lly hazardous novel particles, chemicals and radionuclides.The systems approach
FIGURE 2.4.
solution may lie w ith the use o f diagnostic, clinical-type, laboratory-based ecotoxi­
is essential if we are to effectively interpret reductionist chemical and biological
Mussels are often used to measure
cological tests or biomarkers (e.g. Rapid Assessment o f Marine Pollution, RAMP; De­
data in a m eaningful holistic context for prediction o f risk to consumers o f seafood
the biological effects of pollution in
pledge, 2000), utilizing sentinel animals as integrators o f pollution, coupled w ith
and recreational users o f the marine environment. This step is necessary to ensure
the m arine environm ent. The IMW
direct immunochemical tests for contaminants. These rapid and cost-effective
th a t the social and economic im plications o f reductionist chemical and biological
(In te rn atio n a l Mussel W atch ) for example,
ecotoxicological tools can provide inform ation on the health-status o f individuals
data are understood, and to encourage the application o f these data in an environ­
a ctu ally started in 1991-1992, but data
and populations based on relatively small samples o f individuals. In the context
mental management context.
were already available since 1965 from
o f health o f the environment, biomarkers are also being used to link processes of
e arlier program m es. Left: mussels in
molecular and cellular damage through to higher levels (i.e. prognostic capability),
This approach w ill allow us to explore the use o f measures o f environm entally
m onitoring cage (© Karen Rappé / Inram ).
where they can result in pathology w ith reduced physiological performance and
induced pathological deterioration in flesh quality or “ health status” o f seafood,
Right: m arine blue mussel. M ytilu s edulis,
reproductive success.
particularly filter-feeders (bivalves) and bottom -dw elling fish, due to pollutants or
showing some of the inn er anatom y
pathogens, as predictors o f riskto human health. A methodological co-evolutionary
(© R ainer Zenz)
“synthesis through m odelling” approach w ill facilitate targeted experimental de­
sign and field sampling, as well as the effective integration o f m ultiple environ­
mental datasets and th e ir subsequent interpretation. This synthesis is viewed as a
crucial step towards the development o f explanatory frameworks for prediction of
outbreaks o f human pathogen-related diseases, potential for low-level chronic ex­
posure to biogenic and anthropogenic chemical contaminants, as well as environ­
mental im pact on animal health status as a surrogate measure for human health
risk. Therefore, the novel use o f biogeochemical and molecular measurements o f
pollutan t kinetics and dynamics, high-throughput molecular methods fo r tracking
pathogens and determ ining th e ir viability, and new probes fo r molecular, cellular
and tissue pathological reactions to environmental stressors, coupled w ith sim ula­
tion modelling, is proposed as a practical step in the development o f a pre-operational toolbox. The overall goal should be to provide a toolbox th a t w ill facilitate
an environmental m anagement regime th a t maintains both food security and ap­
propriate public health m anagement for human use o f the marine environment.
As m entioned above, sediment m anagement is a key issue in marine coastal policy
due to the large am ount o f material collected during maintenance dredging from
harbours, estuaries and channels. The development o f an objective fram ew ork to
correctly support decision-making in planning the re-use or remediation o f collect­
ed materials, allows fo r a clear im provem ent in environmental management in the
ligh t o f sustainability as requested in the fram ew ork o f MSFD (Directive 2 0 0 8 /5 6 /
28
LINKIN G OCEANS A N D H U M A N HEALTH
EC). The role o f such decision support systems is to objectively integrate chem i­
exposed, the so-called ‘Critical Group’ or ‘Representative Group’. Increased exposure
cal and ecotoxicological data into numerical indices useful in supporting decision­
may occur through the consumption o f contam inated seafood and occupancy of
makers in managing contam inated marine coastal sediments and, eventually, in
intertidal areas e.g. house boat dw elling or bait digging. These pathways may be
p la n nin g th e necessary remediation activities.
additive and are usually assessed by the use o f site-specific habit surveys (Leonard,
Chemical contam inants remain high on the agenda o f environmental threats due
W ith o u t doubt, the most significant sources o f radionuclides entering the sea from
to emerging po llu tan t issues such as changes in environmental burdens and ef­
authorised discharges occur from reprocessing plants e.g. Sellafield (UK) and La
fects o f contam inants w ith climate change, and better-known substances w ith
Hague (France). Smaller contributions are made from nuclear power stations, hos­
2012 ).
"new ” mechanisms o f action (endocrine disruption, reproductive and developmen­
pitals, defence facilities, and have resulted from nuclear bomb testing during 1950s
tal toxicity). The next steps necessary for a correct application o f approaches in the
and 1960s and the Chernobyl accident in 1986. In addition, the public may be also
m onitoring, study and management o f contam ination in marine and coastal areas
exposed to naturally occurring radionuclides.
entail the definition o f a set o f bioassays13 (or bioassay battery) to be applied in
marine coastal studies as well as the definition o f common Environmental Quality
The EU has encouraged decreases in discharges from nuclear sites and national gov­
Standards fo r the most diffuse pollutants th ro u g h o u t Europe.
ernments have made com m itm ents towards progressive reduction o f human expo­
sure to ionising radiation arising from radioactive discharges. On the basis o f these
INFORMATION BOX 2.1.
com m itm ents, a representative member o f a critical group o f the general public
To guarantee a complete and reliable determ ination o f the biological
Criteria for the selection of appropriate
should not be exposed to more than 0.02 millisieverts (mSv) per year from liquid
effects induced by pollutants, the selection o f a set o f bioassays (or
components of bioassays for reliable
radioactive discharges to the marine environm ent made from 2020 onwards. How­
bioassay battery) should take in to account the fo llo w in g criteria:
determination of the biological effects
ever, the way th a t the public is protected depends on the knowledge available and
induced by pollutants
the interpretation o f such inform ation. Over the years many studies have assessed
Acute and chronictests should be balanced,theform er being useful
the significance o f such pathways and there is a need to continue such work. Future
to gain a rapid understanding o f the sediment hazard to the biota
studies should include sufficient focus on (i) programme design; (ii) sampling and
and the latter, being more sensitive, are also able to underline cases
in situ measurement; (iii) laboratory analysis; (iv) description o f the pathways to
where long-term effects are present;
humans; (v) radiation dosimetry; and (vi) calculational and presentational error.
The selection o f model organisms should consider the composition
Developing a clearer understanding o f the pathways o f radioactive contam ination
o f the com m unity under study and, in particular, the food-web in
from the marine environ m ent to humans should form a key component of a coordi­
the area e.g. grazing food web in the w ater column and detritus
nated European research effort on oceans and human health.
food web in the sedimentary com partm ent; the effects o f pollutants
on developing embryos should also be evaluated;
The ecotoxicological battery should include some sub-lethal
biomarkers capable o f describing the stress syndrome evolution
2.3
M aterial pollution, including marine litter
in the model organisms and objectively assessing the biological
and nanoparticles
vulnerability of the system: this offers an insight in to the potential
risk to biota;
Marine Litter
The use o f particular core biomarkers, such as genotoxicity
Marine litter, w hich consists o f persistent, manufactured or processed solid m ate­
biomarkers, endocrine disruption parameters, im m u n o to xicity and
rial discarded, disposed o f or abandoned in the marine environm ent (Galgani et
bioaccum ulation o f pollutants in marine organisms fo r human
al., 2010), has been considered to represent an increasing pollution problem since
consumption, is a key recommendation to link environmental risk
the end o f the 1960s. However, only in the last tw o decades has it been recognised
w ith human health hazard.
th a t marine litter, most o f w hich is plastic residues, represents a m ajor problem
for marine ecosystems, especially in coastal areas (Carpenter et al., 1972). Global
production o f plastics (synthetic organic polymers) has risen in the past 30 years
Radionuclides
and this has coincided w ith a proportional increase in the levels o f plastics pollution
observed in all components o f the marine environment. In benthic sediments the
13 Bioassay, c o m m o n ly used as s h o rlh a n d
30
There are many ways in which the public may be exposed to human-generated and
presence o f plastic particles can affect gas exchanges between the w ater column
fo r biological assay, is a ly p e o f sc ie n tific
naturally occurring radioactivity. W ithin the EU there are numerous nuclear fa cili­
and interstitial w ater in the sediments which can reduce the oxygen concentration
exp erim e nt ty p ic a lly conducted to measure
ties w hich produce waste. Such facilities include power stations, hospitals, defence
and affect ecosystem fu nctioning (Goldberg, 1994).
th e e ffe c ts o f a substance on a liv in g
manufacturers and reprocessing plants. Disposal o f the waste from those opera­
organism . B ioassays are essential in the
tions into the environm ent may be made under licence and results from m onitoring
Recent reports demonstrate th a t at least 267 marine species are adversely affect­
developm ent o f new drugs and in m o n ito rin g
such discharges have been assessed (e.g. European Commission 2002, 2010). The
ed by plastic contam ination. Ingestion o f plastics by marine organisms is known
e n v iro n m e n ta l p o llu ta n ts .
EC has embraced the concept o f protecting those people w ho are potentially most
to affect th e ir physiology. As far back as 1997, Laist (1997) identified th a t floating
LINKIN G OCEANS A N D H U M A N HEALTH
Th e l in k betauten t h e o ce a n s an d h u m a n h e a lth
h az a rd s , risks, b e n e f it s a nd o p p o r t u n i t i e s f r o m t h e seu
macroplastics (> 5nm) affect 86% o f all sea tu rtle species, 44% o f all seabird spe­
cies, and 43% o f all marine mam mal species. Experimental and field studies have
In recent years it has been found th a t in the marine environm ent (in the surface and
demonstrated th a t plastics ingestion may reduce food consumption in seabirds,
the w ater column as well as in the sediments even o f deep sea environments) plas­
thus reducing fa t deposition and consequently th e ir fitness and reproductive ef­
tics are increasingly present as “ microplastics,” also called “ plastic dust,” i.e. plastic
fo rt (Gramentz, 1988; Moser & Lee, 1992). Physical entanglem ent in plastic debris
fragm ents o f a diam eter less than 5mm (Secchi & Zarzur, 1999; Spear et al., 1995).
can also cause death in marine animals (Schrey & Vauk, 1987; Connors & Smith,
Microplastics are accumulated in marine organisms including invertebrates such
1982). W hile we have some insight on the impacts o f plastics pollution on various
as polychaetes, crustaceans and molluscs (Coleman & Wehle, 1984). It has been
species o ffis h , birds (Figure 2.5), and mammals (Azzarello & Van-Vleet, 1987), little
demonstrated th a t mussels exposed to microplastics (< lm m ) accumulate particles
is known about the possible effects on invertebrates and microorganisms (Ryan,
in the gut and th a t during the detoxification period, the particles move to the cir­
1987).
culatory system fo r approxim ately three days but persist in the haemolymph for
more than 48 days (Browne etal., 2008). In a recent investigation by the University
o f Ghent, mussels retrieved from the North Sea contained about one particle of
FIGURE 2.5.
m icroplastic per gramme o f tissue. Particles can enter the human blood circulation
Plastics ending up in the coastal and
and can even be transferred through the placenta after consumption o f mussels
m arine environm ent are com m only
w ith microplastic contam inants (Claessens etal., 2013, in press).
ingested by birds, som etim es leading to
FIGURE 2.6.
Scanning electron microscope (SEM)
im ag e of a m icroplastic particle recovered
death of the anim als (top: seagulls may
from deep-sea sedim ents in the A tlantic
ingest plastic from th e ir environm ent -
Ocean (scalebar represents 100pm ; credit:
Credit: Neil Collier
bottom : A decaying
Colin R. Janssen)
sea bird carcass w ith plastic debris in its
stom ach - Credit: Chris Jordan)
32
33
LINKIN G OCEANS A N D H U M A N HEALTH
The lin k between th e oceans and h u m a n health:
hazards, risks, ben efits and o p p o rtu n itie s fro m th e sea
Because o f th e ir surface physical-chemical characteristics, plastics are able to ab­
sorb organic lipophilicxenobiotic compounds. W ith th e ir higher surface-to-volume
ratio, microplastics provide a medium fo r the transfer and accumulation o f persis­
te n t organic pollutants (POPs) such as Polychlorinated Biphenyls (PCBs) and Polycyclic Arom atic Hydrocarbons (PAHs) in the tissues o f marine organisms w ith po­
tential consequences fo r both environmental and human health (the latter in the
case o f ingestion o f contam inated seafood) (Ryan etal., 1988). Data have also been
reported on the role o f plastics in assisting invasion o f alien species (Irish & Norse,
1996).
Nanoparticles
The to xicity o f a new class o f emerging contam inants called nanoparticles, i.e. par­
ticles w ith a size ranging from ln m to lOOnm in at least one dimension, is based
not only on th e ir chemical composition but on th e ir physical characteristics of
shape and size (SCENIHR, 2005, Joner et al., 2007, Moore M.N., 2006). Nanoparticles
(both inorganic and organic) have been shown to be toxic fo r animals (Novack et
al., 2007), plants (Daohui et al., 2007) and microbes (Novack et al., 2007; Jingyuan,
2007; Handy R.D. et al., 2008). Usually nanoparticles are assumed in the anim als’
cells by phagocytosis. In the cytoplasm they may alter the functions o f different
organelles, thus affecting the cell physiology (Heilaan et al., 2008). This may re­
duce the survival a nd/or the reproduction rate o f the organisms (Singh etal., 2010).
Effects at nuclear level have been also well established (Reeves, et al., 2007). The
level o f nanoparticle-induced stress in the different organisms may greatly vary for
different types o f nanoparticles depending on th e ir composition, dimension and
shape. For inorganic nanoparticles, often the inorganic ions released in the external
medium or in the cytosol o f the cells contribute to th e ir to xicity (BystrzejewskaPiotrowska et al., 2009; SCENIHR, 2005).
Nanoparticles may reach the marine environm ent both through direct release into
coastal waters or as an in p u t from riverine and estuarine inflows. They may also be
transported in the air and enter the marine system through the air-sea interface
(Handy R.D. et al., 2008). Due to extensive industrial use, nanoparticle contam ina­
tion is now widespread in the marine environm ent and th e ir number o f particle
types has rapidly increased from few er than 10 a decade ago to more than 1200
today. It is increasingly clear th a t nanoparticles represent an im portant problem in
term s o f biological effects at the ecosystem level and on human health.
34
On the basis o f chemical composition they are categorized as organic nanoparti­
The detection o f inorganic nanoparticles in environmental matrices and in w ild
Figure 2.7.
cles, such as C90 carbon nanotubes (CNT), and inorganic nanoparticles containing
organisms could be achieved using methods such as Inductively Coupled Plasma
T ransm ission electron M icroscopy (TEM)
cations, such as Ag, Cu, andTi (Joner e tal., 2007). However, the number o f particles
Mass Spectrometry (ICP-MS) w hich is used to identify m etal/com pound concen­
(a, b, and c) im ages o f prepared
characterized by an inorganic core and an organic envelope has rapidly increased in
trations. However, the levels o f different metals cannot solely be attributed to na­
m esoporous silica n a n op a rticle s w ith mean
recent years.
noparticle contam ination (Novack et al., 2007). The detection and quantification
o u te r dia m e te r: (a) 20nm , (b) 45nm ; and
of carbon-based nanoparticles in marine organisms may be even more difficult.
(c) 8 0nm . SEM (d) im a ge corresponding to
Various methods have been used to identify and characterize nanoparticle con­
Fullerene14 nanoparticles may be extracted from environmental matrices using or­
(b). The in s e ts are a high m a g n ific a tio n o f
tam ination in the marine environm ent and in marine organisms. In purified prep­
ganic solvents and then analysed by fractionation using High-Performance Liquid
m esoporous silica p a rtic le (© N a n d iya n to )
arations, the location and the shape o f nanoparticles may be determined using
Chromatography (HPLC) coupled w ith a UV detector (Fortner et al., 2005) or elec­
techniques such as Transmission Electron Microscopy (TEM) or Scanning Electron
trospray Time-of-Flight Mass Spectrometry (TOF MS) (Kozlovski et al., 2004). CNT
Microscopy (SEM) (Rose, 2007). In the presence o f nanoparticles which have an in ­
may be detected w ith UV-vis spectrometry (Jiang etal., 2003) and more recently by
organic core, Energy-dispersive X-ray spectroscopy (EDX) may allow fo r the iden­
RAMAN spectroscopy (Xue et al., 2012). However, w hile the above methods detect
tifica tio n o f the elemental composition. A tom ic Force Microscopy (AFM) has been
nanoparticles in the tissues o f different organisms and prove the presence o f these
also used in the analysis o f nanoparticle sizes and shape and th e ir surface charge
contaminants, they do not a llo w fo r quantification o f the am ount o f nanoparticles
14 Composed e n tire ly o f carbon, in th e fo rm o f
measured as Zeta potential (Rose, 2007).
accumulated in the organisms.
a hollow sphere, ellipsoid or tube.
35
LINKIN G OCEANS A N D H U M A N HEALTH
2.4
Finally, research has identified th a t organic nanoparticles, w ith th e ir lipophilic na­
Biological hazards to human health
Phytoplankton
ture, usually represent a sink o f organic pollutants such as Arom atic Polycyclic Hy­
drocarbons, Polychlorinated biphenyls (PCBs) and dioxins (Pulskamp e ta l., 2006).
Phytoplankton is an intricate component o f marine ecosystem com plexity and it
On the other hand, inorganic nanoparticles tend to release th e ir metal content
is widely recognised th a t phytoplanktonic organisms provide ecosystem services,
(Pokhrel etal., 2009) into the environm ent and in the tissue o f an organism (Soenen
both in a positive sense (e.g. oxygen generation, carbon dioxide sequestration, fish
et al., 2010). Taking this into account, the best way to study the biological risk o f
and shellfish productivity) and in a negative sense (harm ful and toxic algae) (M il­
contam inants is to associate chemical data w ith studies o f the biological effects o f
lenium Ecosystem Report, 2005a to d). To date, few models have been developed
the to ta l am ount o f contam inants bioavailable to the organisms.
which can predict the occurrence o f any particular algal species. Anderson (2005)
goes so far as to describe this as one o f the major challenges o f the 21st century.
The intrinsic difficulties o f m odelling marine ecosystem com plexity are most likely
exacerbated by global change and, in particular, prolonged intensive fishing activi­
ties (top-down disturbance o f marine ecosystems) and climate change (bottom -up
FIGURE 2.8.
ecosystem disturbance through changes in tem perature, pH and turbidity).
N a n o p article s in th e scale o f th in g s
(designed by th e O ffice o f Basic Energy
Sciences (BES) fo r th e U.S. D e p a rtm e n t
From a human health perspective, phytoplankton organisms can be harm ful in
o f Energy)
tw o ways either (i) through the production o f potent biotoxins; or (ii) through the
production o f massive blooms which result in oxygen depletion leading to mass
m ortality o f marine life (e.g. Karenia mikim otoi, Gentien et al., 2007). To date, o f
the 5000 known algal species, more than 300 have been listed as being toxic or
The Scale of Things - Nanometers and More
^Things Natural
harm ful (IOC, 2012). Natural toxins produced by microalgae exhibit a wide range
o f mechanisms and modes o f action th a t affect human health through direct w a­
Things Manmade
K H m ,—
1 cm
10 mm
H ead o f a p in
1 -2 m m
ter ingestion/contact, aerosolized transport, and/or the consumption o f a marine
organism which has concentrated the toxins. Recently, the chemistry and to xicity
____
The Challenge
A nt
~ 5 mm
10'3m
t
I
Red b lo o d c e lls
(~ 7 -8 um )
phenomena, although some can cause prolonged sub/chronic disease (e.g. ciguat­
era) (Backer 2003, 2005, 2010; Fleming 2011; Friedman 2008; Okamoto 2005; W at­
kins 2008). In the case o f tetrodotoxin (TTX) at least, the origin o f the toxin is not
fu lly understood, w ith reports highlighting the bacterial origin o f the toxin th a t is
accumulated in vertebrates and invertebrates (Wang et al., 2008).
0.01 mm
10 pm
P o lle n g ra in
R ed b lo o d c e lls
10 6my
f
The m ajority o f human diseases associated w ith HAB toxins appear to be acute
0.1 mm
100 pm
2
i»
O
o 10 '5m
1.
o
H u m a n h a ir
~ 6 0 -12 0 jjm w id e
are neurotoxins, although some can cause skin and liver damage, and even cancer.
M ic ro E le c tro M e c h a n ic a l
(M E M S ) d e v ic e s
10-10 0 p m w id e
i
10'4m
1,000 n a n o m e te rs
^ = 1 m ic ro m e te r (um )
1I
10-®m
10 nm d ia m e te r
The evolution and efficiency o f phytoplankton and toxin m onitoring systems in
Europe have been reviewed by Hess (2011) as a function o f legislative changes.
Z o n e p la te x - r a y “ le n s ”
O u te r rin g s p a c in g ~ 3 5 n m
The most common HAB toxins are regulated and monitored in European countries
Fabricate and combine
nanoscale building
blocks to make
useful devices e.g., a
photo synthetic reaction
center with integral
semiconductor storage
0.1 pm
100 nm
O
0.01pm
10 nm
S e lf-a s s e m b le d ,
N a tu re in s p ire d s t ru c tu re
M a n y 10s o f nm
DN A
~ 2 -1 /2 n m d ia m e te r
36
A to m s o f s ilic o n
s p a c in g 0 ,0 7 8 n m
I
which have already substantially decreased the risk o f illness arising from the con­
sum ption o f shellfish, including illnesses such as PSP (Paralytic Shellfish Poison­
ing), ASP (Amnesic Shellfish Poisoning) and DSP (Diarrhoeic Shellfish Poisoning)
(EU, 2004, 2005 and 2010). Other toxins such as cyclic imines (including spirolides,
gymnodimines, pinnatoxins and pteriatoxins) and palytoxins are being studied but
th e ir to xicity and prevalence is not known and no regulatory lim its have been es­
N a n o tu b e e le c tr o d e
ATP s y n th a s e
(both acute poisoning and mechanistic considerations) o f algal toxins have been
systematically reviewed (Rossini and Hess, 2010). Many o f the known algal toxins
1,000,000 n a n o m e te rs
= 1 m illim e te r (m m )
tablished in Europe or anywhere in the world. Chronic to xicity data is needed in
order to allow the establishm ent o f Tolerable Daily Intake (TDI). N o ta b ly, the Euro­
10-9 m
C a rb o n
b u c k y b a ll
- 1 nm
d ia m e te r
1 n a n o m e te r (nm )
C a rb o n n a n o tu b e
~ 1,3 nm d ia m e te r
10 10m —
0.1 nm
Q u a n tu m c o rra l o f 48 iro n a to m s o n c o p p e r
s u rfa c e p o s itio n e d o n e a t a tim e w ith a n S T M t ip
C o rra l d ia m te r 14 nm
Office o f Basic Energy Sciences
Office o f Science, U.S. DOE
Version 05-26-05, pmd
pean Food Safety A u thority has produced a series o f risk assessments which outline
current knowledge on the risks posed by regulated marine biotoxins (EFSA 2008
and b, 2009a to f) and the lack o f knowledge in the area o f emerging toxins (EFSA
2009g and 2010a to d).
LINKIN G OCEANS A N D H U M A N HEALTH
Th e l in k b e t w e e n t h e o ce a n s an d h u m a n h e a lth
h az a rd s , risks, b e n e f it s a nd o p p o r t u n i t i e s f r o m t h e seu
Red Tide Microalgae
¡síselas.
W E S T P A C ;iO C /U N E S C O
Ver 1-5 2552-4.15
< n y d ( u f LJ k u y o @ m a l I . e e t . u - t O k y O .S C -j|
ed. by Yasuwo Fukuyolufukuywgim&H.eci.tMoJfyo.sc-jp}
A: Useful, mostly harmless
B; Potentially harmful fay oxygen depletion C: Harmful, responsible tor fish mass mortality
FIGURE 2.9.
Red Tide M icroalgae (A: Useful, mostly
harmless; B: P o ten tially harm ful by
oxygen depletion; C: H arm ful, responsible
fo r fish mass m o rta lity ) © UNESCO/IOC/
WARNING
WESTPAC - Courtesy Dr. Yasuwo Fukuyo
TOXIC
SHELLFISH
(WESTPAC IOC/UNESCO)
m aim a fbqm TWff
FIGURE 2.10.
A ÏÎL À A I E UNSAFE TÛ
EAT DUE TO F A ÍA L T O T
S èiÖ JJrE H TO W N
D O N O T EAT CLAM S
OTSTEH5. MUSSELS OU
SCALLOPS
Public notice w arning in Florida, USA,
Trichodesmium Skeletonem a Chaetoceros so có te (Al Thgtasiosska w j/a lB I Eucam pia -zodiacus (A)
thiebautii (B) eofisiurtr(B)
_
_ _____________
against the consum ption o f shellfish from
areas where biotoxin c on tam ination is
present (Credit: Lora Fleming, European
Centre for Environm ent and Human
H ealth, University o f Exeter, UK).
Prorocentrum Prorocentrum
stgmoides(A)
micans (B)
Dinophysis caudata {B}
Noctiluca scintillans <B)
There is also an increase on the num ber o f reports on emerging marine toxins such
as tetrodotoxin (TTX), ciguatera (CTX) and ovatoxin and palytoxin analogues (PITX)
in European waters (Ciminiello etal., 2008, Otero etal., 2010, Rodriguez etal., 2008,
2012; Silva et al., 2012). M ost o f these toxins are very toxic if ingested orally and
can reach high levels in vertebrate or invertebrate species th a t enter the human
food chain.
A lthough most o f the marine toxins are neurotoxic, dermal toxicity through direct
contact is also possible. Examples o f such occurrences include dermal intoxication
Ceratium tripos {A) Gymnodinium
Cochlodinium
sanguintium(A) polyknkoidesiC)
Karenia
mfAimüto/tC}
by palytoxin (PITX) due to m anipulation o f corals (Hoffman et al., 2008, Deeds and
Schwartz, 2009). In the Mediterranean there are reports on the intoxication o f hun­
dreds o f people due to the presence o f PITX and ovatoxin-a in the marine aerosol
(Ciminiello et al., 2008). However, there are fe w epidemiological studies or reports
on dermal toxicity ow ing to the fact th a t symptoms can be sim ilar to other w ater­
borne or food-borne intoxications.
Ceratium
Ceratium
furca {A) Jusos (A)
From a human health perspective, a major issue is the lack o f systematic epide­
Lingulodinium
polyedrum {A}
Protoceratium
reticulatum (A)
Gonyaulax
spinifera j B)
Gonyaulax
polygramma { B)
miological surveillance, especially fo r emerging toxins, and thus baseline incidence
rates fo r the HAB-associated human illnesses, both locally and globally. Recent ef­
forts by the US Center for Disease Control (CDC) and other organizations to estab­
lish a coordinated human, animal and environmental health surveillance network
known as HABISS15 may improve this situation in the future. In Europe, the estab­
lished m onitoring programmes fo r HAB toxins screen for the major toxins but may
miss emerging ones. In addition, detection methods for the HAB toxins either in the
H etero cap sa
Peridinium
triquetra {&)
quinquecorne I A)
Heterosigm a
akashiw o <©}
environment, or more im portantly in humans, are either lacking completely (par­
ticularly human biomarkers), or are expensive and not widely available. Therefore,
although HABs appear to be increasing w orldw ide, it cannot be easily determined
w hether HAB-associated human illnesses are increasing or not. Nonetheless, m a­
rine toxins have been responsible fo r more than 25% o f all non-compliances in
shellfish detected by the EU Food and Veterinary Office’s “ Rapid A lert System” over
the period from 2006 to 2010. This represented a to ta l o f 71 cases o f food com­
Alexandrium affine l[A)
38
S crip p s ie lla
H e te ro c a p s a ^ ) Fibrocapsa
Chattonella antiqua (C)
troch o id ea (A) c irc u la ris q u a m a ja p o n ic a 1C)
plaints and violations o f EU-levels (Hess, 2011). Hence, epidemiological studies to -
15 See
gether w ith broader m onitoring programmes are urgently needed.
default.htm
http://www.cdc.gov/nceh/hsb/hab/
39
LINKIN G OCEANS A N D H U M A N HEALTH
The lin k between th e oceans and h u m a n health:
hazards, risks, ben efits and o p p o rtu n itie s fro m th e sea
INFORMATION BOX 2.2.
Gram-negative bacterium Vibrio
parahaemolyticus as an example of an
important bacterial pathogen causing
gastroenteritis associated w ith the
consumption of seafood
The Gram-negative bacterium V. parahaemolyticus is a common
inhabitant o f tem perate and w arm estuarine European waters. Globally,
V. parahaemolyticus is an im po rtant cause o f bacterial gastroenteritis
associated w ith the consumption o f seafood. An established and
common route o f transmission includes the consumption o f raw bivalve
shellfish species, such as oysters and clams, or via w ound exposure to
seawater containing these bacteria.
The presence o f V. parahaemolyticus in the marine environment is
closely related to water temperature, w ith strains readily isolated when
environmental temperatures exceed 15°C. Recent studies suggest that the
number o f V. parahaemolyticus infections are increasing in Europe
(Baker-Austin etal., 2010). However, few if any systematic or long-term
ecological data exists on the temporal and spatial dynamics o f these
bacteria in the environment (Baker-Austin et al., 2010 and references
therein). Interestingly, because of the salinity tolerances of V. parahaemolyticus,
which grows particularly well in lower salinity seawater (e.g. <30 ppt NaCI),
few large-scale food borne outbreaks have been reported in high salinity yet
temperate areas, such as the Mediterranean Sea.
FIGURE 2.11.
The m onitoring, management and prevention o f both HABs and th e ir possible hu­
Several recent studies have identified highly pathogenic ‘pandemic
Toxic Harm ful Algal Blooms (HABs) like
man health effects are hampered by the lack o f a broader HAB surveillance and
complex’ V. parahaemolyticus strains in European seafood produce w ith
red tides can make people sick, cause
improved detection methods (Backer 2008; Hess and Nicolau 2010; Kite-Powell
associated clinical infections (Martinez-Urtaza et al., 2005; Ottaviani et
death in m arine life and con tam inate
2008). W hile recent legislative changes in Europe have resulted in more effective
al., 2010). Because Europe contains many of the fastest w arm ing coastal
seafood w ith considerable risks for
detection o f a range o f known lipophilic toxins harm ful to shellfish consumers (EU,
environments anywhere on Earth, there is growing concern regarding
hum an health (credit: Ocean Cham pions)
2011), the absence o f biological screening w ill result in reduced protection o ffis h
the spreading o f these bacteria as w ell as the associated clinical risk.
and shellfish consumers against emerging toxins. Therefore, novel approaches are
required to increase our capacity to:
Detect phytoplankton com m unity changes in real tim e;
per gastrointestinal illness (Gl) was $36.58 w hile it was $77.76 per acute respiratory
Detect to xicity o f algal comm unities, preferably using non-m am m alian m inia­
disease, $37.86 per ear ailment, and $27.31 per eye ailm ent (2001 values in Orange
turized bioassays a n d / or functional assays;
County, California). The authors then estimated the cumulative public health bur­
Detect emerging compounds amongst algal metabolomes (dereplication o f
den from the excess illnesses associated w ith coastal w ater pollution to be $3.3
natural products).
m illion pe ryearfro m ju s t tw o recreational beaches on the Californian coast. Finally,
Given et al. (2006) used epidemiological dose-response models to predict the risk
Marine-borne Pathogens
of gastrointestinal illness at 28 beaches spanning 160km o f coastline in Los Ange­
Humans may be exposed to marine microbial pollution (e.g. bacteria, viruses, and
excess cases o f gastrointestinal illnesses occurred at these beaches each year, corre­
parasites) in many different ways. The routes o f exposure include the consumption
sponding to an annual economic loss o f $21m to $ 51m dollars (atyear 2000 values).
les and Orange County (California). They estimated between 627,800 to 1,479,200
o f contam inated seafood and direct and indirect exposure to contam inated sea­
water (e.g. skin, eye, respiratory, and oral contact) (Fleming, 2006). In the US, o f the
Better control o f human pathogens requires an understanding o f th e ir transport
estimated 76 m illion foodborne illnesses occurring annually (resulting in 325,000
and ecology in the environment. Transfer o f pathogens via faecal waste from
hospitalizations and 5,000 deaths w ith health-related costs up to $152 billion), sea­
farmed animals into waterways and, hence, into the marine environm ent is a po­
food is implicated in 10-19% o f these illnesses (Butt, 2004; Tibbetts, 2004; Iwamo-
te ntia lly im portant hazard, particularly w ith the current trends fo r intensification
to, 2010; Scharff, 2010). When a causative agent can be identified, viruses account
of livestock farm ing, which can result in vastly greater am ounts o f waste entering
for around half o f these illnesses, although m ost hospitalizations and deaths are
the aquatic environm ent (Boxall et al., 2009; Feldhusen, 2000; World Bank, 1995).
prim arily associated w ith bacteria (particularly in susceptible subpopulations).
Furthermore, irrigation and fertilization o f crops w ith contam inated w ater or or­
ganic waste is a potential means o f contam inating foodstuffs and waterways w ith
Based on risk assessments from the World Health Organization (WHO) and aca­
enteric viruses, and studies have demonstrated th a t viruses can be transferred to
demic research sources, Shuval (2003) estimated th a t globally there are in excess
the surfaces o f plants and vegetables, and persist there fo r several days, follow ing
o f 120 m illion cases o f gastrointestinal disease and 50 m illion cases o f more se­
the application o f sewage sludge or effluent (Defra, 2004; Rzezutka & Cook, 2004;
vere respiratory diseases caused by sw im m ing and bathing in wastewater-polluted
World Bank, 1995).
coastal waters each year. D w ight et al. (2005) estimated th a t the economic burden
40
41
LINKIN G OCEANS A N D H U M A N HEALTH
Many human pathogens have reservoirs in the environm ent or are transm itted be­
Given th a t viruses w hich grow in the gut (such as those causing gastroenteritis)
tween humans by animal vectors or through animal interm ediate hosts (Boxall et
generally produce vast numbers o f progeny in faeces, faecal pollution is the main
al., 2009; Fleming et al., 2006; Todd, 2006). It is highly im portant, therefore, to try
source o f risk to human health. Human faecal pollution in the marine environm ent
to anticipate new emerging diseases, a problem th a t is likely to become acute w ith
arises from municipal sewerage discharges and point sources such as septic tanks,
global climate change, and increasing globalization w ith its concom itant rapid
boats, emergency and storm w ater discharges. However, close contact between
transfer o f people and products th ro u g h o u t the world.
humans, fo r example during sw im m ing, may also be a risk factor. Awareness o f
the role o f the sea in the transmission cycle o f human pathogenic viruses relies
on find ing evidence for an epidemiological linkage between exposure to the sea
(in some form ) and a recognizable illness. Thus for illnesses w ith a long incubation
INFORMATION BOX 2.3.
period (e.g. Hepatitis), or which cause clinical symptoms in only a small percentage
Seafood and seawater safety is directly linked to the quality of w ater
Estimates of seawater and seafood
o f those infected (e.g. many o f the enteroviruses), or w hich cause chronic infec­
in the European coastal zone. Infectious agents in coastal waters and
related illness and economic cost
tions, the potential role o f the sea as a transmission route may be impossible to
seafood th a t can cause diarrhoea result in significant amounts o f illness
verify. Consequently, o f the many different viruses known to be transm itted by the
each year in Europe. It has been estimated th a t approxim ately 20% o f
faecal-oral route, in only tw o (Norovirus and Hepatitis Avirus) has a marine route of
the western European population is affected by diarrhoeic disease each
exposure been unequivocally identified as a significant pathway.
year from all causes, which w ill have a significant economic im pact in
term s o f treatm ent costs and loss o f w ork-tim e (van Pelt e t al., 2003;
Easily the most well documented vector fo r marine-borne viruses is transmission
Roberts e t al., 2003). Based on these studies, the estimated costs of
by filter-feeding bivalve molluscs. Bivalve molluscs grown in faecally contaminated
treatm ent care and employm ent costs is approxim ately €80 billion (van
waters concentrate human viruses in th e ir digestive tract during normal feeding
Pelt etal., 2003; Roberts eta l., 2003). W hile an, as yet unquantified,
processes. Their consumption w hole (including the digestive tract) and either raw
proportion o f th is diarrhoeic illness w ill be due to water-borne agents
(e.g. oysters) or lightly cooked (eg mussels and clams) combine to accentuate the
and contam inated seafood, comprehensive integrated estimates o f
risk. The literature contains abundant case reports o f outbreaks associated w ith bi­
economic im pact are not directly available fo r the EU countries. This
valve molluscs caused by both Norovirus and Hepatitis A virus (Lees, 2000). Such
inform ation can only be partially gleaned w ith considerable d ifficu lty
outbreaks continue to occur on a regular basis both in the UK and w orldw ide and
from a range o f national and international sources, including from the
can be high profile (Smith et al., 2011). The World Health Organization identified
Food and Agriculture Organization (FAO),the European Environment
Norovirus and Hepatitis A virus as the viruses o f prim ary concern w ith regard to
Agency (EEA) and the European Food Safety A u th o rity (EFSA) (Cato, 1998;
seafood consumption (Anon, 2009).
http://w w w .eea.europa.eu/publications/eea_report_2008_4jppl49160CC2008_ch5-10_Human Health.pdf; EFSA, 2010).
The second main route o f exposure to enteric viruses is through sw im m ing in pol­
This deficit in clear inform ation represents a significant gap in our
tions, it has proven difficult to unequivocally link a causative pathogen w ith the vari­
knowledge concerning the health-related economic im pact o f w a te r­
ous (often minor) ailments reported by swimmers (Priiss, 1998). Given the symptoms
luted seawater. However, in this case, despite extensive epidemiological investiga­
borne infectious diseases in the EU. Consequently, the production of
reported and the ubiquitous nature of Norovirus, this virus is likely to be responsible
effective estimates o f seawater and seafood related disease should be an
for at least some o f the illnesses described. However, this h a s y e tto be confirmed.
im porta nt driver fo r any fu tu re EU-focused effort in Oceans and Human
Health as argued in this position paper.
Norovirus is the leading cause o f gastroenteritis in the UK and probably world-wide.
These viruses possess all the attributes o f an ideal infectious agent being highly
contagious, rapidly and prol itica Ily shed, constantly evolving, evoking only lim ited
im m unity, and being only moderately virulen t (Haii et al., 2012). Recent extensive
studies suggest they are the leading cause o f gastroenteritis in the UK, causing
Viruses
some 3 m illion cases annually (Tam et al., 2011), and are also probably the lead­
The sea can provide a vehicle for transmission o f pathogenic viruses to humans.
for example in ward closure, have been estimated to cost the UK National Health
The viruses most adept at survival in the marine environm ent are those adapted
Service £115 m illion per year (Lopman et al., 2004). Although person-to-person is
ing cause o f foodborne disease (Scallan et al., 2011). Hospital outbreaks, resulting
to transmission by the faecal-oral route. These include a large and diverse group
undoubtedly the main route o f transmission, the contribution o f the marine path­
o f viruses causing human gastroenteritis and other viruses, such as poliovirus or
way (e.g. via bivalve molluscs) may be significant in introducing strains to previously
Hepatitis A virus, w hich although having a grow th phase in the human gut, pro­
unexposed susceptible populations (through w orld-w ide trade) and in the emer­
duce th e ir main clinical symptoms elsewhere. Unlike bacterial and protozoal path­
gence o f new recom binant variants follow in g a mixed infection, a common feature
ogens, the viruses which are recognized to be potentially transm itted via seawater
o f seafood related illness (Symes et al., 2007).
are generally human in origin.T husthe role o f the sea is in recycling human viruses
backto humans. Faecally-orally transm itted zoonotic viruses (for example hepatitis
42
Compared to other enteric viruses, Hepatitis A virus has an extended incubation
Evi ru s) have the potential fo r transmission via the marine pathway but this has not
period o f about 4 weeks and causes a serious debilitating disease progressing from
yet been conclusively demonstrated.
a non-specific illness w ith fever, headache, nausea and malaise, to vom iting, diar-
LINKIN G OCEANS A N D H U M A N HEALTH
The lin k between th e oceans and h u m a n health:
hazards, risks, ben efits and o p p o rtu n itie s fro m th e sea
FIGURE 2.12.
Transm ission Electron M icrograph
*
*
*
# b
i t
* * * * * *
|L « ” *
*
ñ
4 *'
É»A* * á
* * * 4
(TEM) o f u ltrastru ctu ral morphologic
application o f these methods to surveys o f commercial bivalve mollusc production
com ponents displayed by norovirus
has uncovered alarm ingly high levels o f Norovirus contam ination in several EU
virions, or virus particles. Noroviruses
countries (EFSA, 2012). Similar surveillance has not yet been conducted for bathing
belong to the genus Norovirus, and
waters. These studies suggest th a t Norovirus contam ination is a regular occurrence
the fa m ily C aliciviridae. They are a
in bivalve molluscs in Europe (and probably world-wide). Hence, the introduction of
group of related, single-stranded RNA,
legislation controlling virus contam ination, depending on the standards set, could
nonenveloped viruses th a t cause acute
potentially have a devastating im pact on current commercial production w ith in the
g astro enteritis in hum ans. (Credit: US
EU. By contrast available evidence suggests th a t Hepatitis A virus contam ination
Center fo r Disease Control (CD C )/ Charles
o f bivalve molluscs produced w ith in the EU is currently a rare event. Since hepati­
D. Hum phrey)
tis A virus is no longer endemic in m ost EU countries, this reflects the low level of
infection in the general population. In this case, a standard based on absence of
virus would be appropriate and w ould protect the population against introductions
through consumption o f seafood.
In general, most o f Europe’s coastal areas are affected to some degree by human
activity and pollution. High human population densities, combined w ith other
land uses such as farm ing, result in significant faecal loadings in coastal waters.
rhoea, abdominal pain and jaundice. Hepatitis A is self-lim iting and rarely causes
Although m ajor infrastructure investments have been made, driven by the need
death but patients may be incapacitated for several months. Outbreaks associated
to address failures o f bacterial indicator standards (both in shellfish and bathing
w ith bivalve molluscs are well documented and still occur w ith in the EU from tim e
waters), growing evidence suggests th a t tackling viral contam ination may be even
to tim e, both through im ported shellfish (Pinto e tal., 2009) and through consump­
more problematic and costly in the long-term. Considering the economic cost and
tion o f products grown in EU waters (Guillois-Bécel et al., 2009). However, w ith
im pact o f such measures to the European area, it seems crucial to have a better
the introduction o f vaccines and im proving hygiene standards, Hepatitis A virus is
understanding o f the nature and behaviour o f viral contam ination.
largely now non-endemic w ith in EU member states.
The public health risks associated w ith eating contam inated seafood and bathing
INFORMATION BOX 2.4.
in polluted waters have been identified fo r many years. Hence, w orld-wide, these
Research priorities to better inform the
Research in the fo llo w in g areas w ould inform development o f European
risks are controlled through food or environmental legislation. In the European Un­
development of European policies for
policies fo r control and m itigation measures o f viral pathogens and thus
ion, Regulation 854/2004 (Anon, 2004) specifies the controls required for produc­
control and mitigation measures of
tion and placing on the market o f live bivalve molluscs and Directive 2006/7/EC
viral pathogens
potentially significantly contribute to im proving public health:
sets out the quality required for bathing waters (Anon, 2006). A key component of
Development o f standardized methods for detection o f Norovirus
such legislation is the setting o f w ater or seafood quality standards along w ith a
in bathing and marine waters w ith the potential for adoption into
requirement for m onitoring to ensure compliance w ith these standards. In the case
m onitoring programmes;
o f faecal pollution, standards are based on the long-established bacterial faecal
indicator concept (e.g. E. coli or intestinal enterococci).
D eterm ination o f the relationship between test results based on
quantitative PCR and human health consequences;
Both Norovirus and Hepatitis A virus have been demonstrated to be robust persistent
viruses surviving long periods in the environment. For example in a recent human
Investigation o f the epidemiological contribution o f Norovirus to
volunteer study, Norovirus in groundwater was demonstrated to survive for more
bathing w ater and food borne illness;
than 61 days (Seitz et al., 2011). Hepatitis A virus has been demonstrated to survive
in seawaters for several weeks (Bosch, 1995). These characteristics are in contrast to
Establishment o f baseline contam ination rates fo r Norovirus in
the bacterial faecal indicator organism specified in food and environment legislation
designated EU shellfish and bathing waters;
which generally persistfor a few days at most in the marine environment (Vasconce­
los and Swarmz, 1976). Thus in many viral illness outbreaks caused by consumption
Investigation o f the effectiveness o f sewage treatm ent processes for
of bivalve molluscs, the responsible seafood batches are found to be in full compli­
Norovirus removal and the fate, behaviour, persistence and reservoirs
ance w ith the faecal indicator legislative standards (Lees, 2000).
o f Norovirus follow ing its release into the marine environment;
The recognized lim itations o f the faecal indictor approach for controlling virus risks
Testing the effectiveness o f food treatm ent and/or processing
has led to manyyears o f research into methods fo r direct detection o f viruses in en­
methods (e.g. depuration) th a t can control enteric viral hazard;
vironm ental samples. For seafood this is now well advanced w ith standard m eth­
ods based on quantitative PCR, suitable for use in EU food legislation, now available
Determination o f how best to incorporate virus testing into legislative
(Lees etal., 2010). Similarly, methods for detection o f viruses in w ater samples have
control programmes (eg sampling strategies and focus, etc.).
been developed, although not yet standardized to the same extent. Unfortunately,
44
45
LINKIN G OCEANS A N D H U M A N HEALTH
2.5
Products from th e Sea
The Complex Relationship between seafood production, consumption and human
health
It is evident th a t a continued dependence on the ocean to ensure food security
depends on healthy aquatic ecosystems. Today, one o f the biggest single threats
to the marine ecosystems, including biodiversity, is overfishing. The proportion o f
Hunger was an increasing problem even before the present food and economic cri­
marine fish stocks overexploited, depleted or currently recovering from overfishing
ses and remains among the most devastating problems in the world. Estimates from
increased from 10% in 1974 to 32% in 2008. Du ring the same period, the proportion
the Food and Agriculture Organization (FAO) suggest th a t 1.02 billion people w orld­
estimated to be underexploited or modestly exploited declined from 40% to 15% in
wide were undernourished in 2009, a higher number than at any tim e since 1970
2008 (FAO, 2010). It is clear th a t global fisheries are at, or close to, th e ir m axim um
(FAO, 2009). Seafood, supplied by both capture fisheries and aquaculture, is a crucial
sustainable production levels, w ith no room fo r fu rth e r expansion. Moreover, global
component in the goal o f achieving global food security. Fish accounted for 15.7% of
climate change and changes in ocean tem perature and currents are expected to
the global population’s intake o f animal protein in 2007 and 6.1% o f all protein con­
affect the productivity o f fisheries by altering both the geographical distribution
sumed (FAO, 2009,2010). In some low-income,food-deficient countries (FIFDCs),fish
as well as the total am ount o f available fish. Foss o f biodiversity may reduce the
proteins are absolutely essential to food security as they comprise a significant share
adaptive capacity o f commercial fish species to cope w ith increasing temperatures
o f a low-level of animal protein consumption. Moreover, seafood provides micro­
resultingfrom climate change.
nutrients, minerals and essential fa tty adds which, if they are available from other
sources at all, are most likely too expensive for widespread consumption.
Despite these challenges, the FAO estimates th a t seafood production needs to in­
On a global basis, em ploym ent in fisheries has been increasing since 1980, and in
tion. Put another way, we need to increase production o f seafood by approximately
crease by 8-10% annually to meet the requirements of a rapidly rising global popula­
2008 some 44.9 m illion people were directly engaged in fisheries or aquaculture
27 m illion tonnes by 2050 in order to maintain the present per capita consumption,
production. Including the secondary sectors, fisheries and aquaculture support the
when the forecasted rise in the global population is taken into account. W ith fish­
livelihood o f 8% (circa 540 m illion) o f the global population (FAO, 2010). Thus, these
eries production already stretched to the lim it, farmed fish are an increasingly im ­
industries contribute significantly to food security, both in term s o f directly provid­
portant source o f seafood, accounting for more than 50% o f w orld seafood produc­
ing food, as well as serving as crucial sources o f income and livelihood for hundreds
tion in 2012, and steadily increasing. The grow th in global, per capita production
o f m illions o f people.
of farmed fish has increased from 0.7kg in 1970 to 7.8kg in 2008. Thus, forecasted
fu ture increases in per capita consumption o ffis h w ill depend on aquaculture.
FIGURE 2.13.
Capture fisheries provide a critical supply
Increasing aquaculture production itse lf may have consequences fo r the health of
o f anim al protein w orldw ide and are an
the marine environm ent and consequently fo r human health. For example, the tra ­
im p o rta n t source o f em ploym ent. Top:
ditional use offish-derived raw materials in aquaculture, such as fish meal and fish
North Sea tra w le r (© Clicks/istock);
oil, is not sustainable in the long-term. An increase in production volumes, there­
bottom : Seafood on sale in Milan, Italy (©
fore, w ill depend on the development and use o f alternative feed ingredients (Tacon
le a n -lo s e p h Renucci/istock)
et al., 2006). However, replacing marine feed ingredients w ith agricultural alterna­
tives w ill alter the composition o f the final seafood product both n u tritionally and
in term s o f possible contam ination, and may have profound consequences fo r the
health effects o f seafood. This may be viewed as an opportunity as there is a strong
potential fo r using aquaculture to produce tailored farm ed fish products targeted
at consumer groups w ith particular nutritional needs (functional foods). Essential
nutrients, such as vitam ins and minerals, can be increased and contam inants kept
low in farmed fish using specially designed aquaculture feeds.
According to the World Health Organization (WHO, 2008), non-communicable dis­
eases, comm only referred to as lifestyle diseases, including cardiovascular diseases,
cancer, osteoporosis, chronic respiratory diseases and diabetes, currently cause 60%
of all deaths. Today, obesity is a leading and preventable cause o f death and is con­
sidered as one o f the m ost serious public health problems o f the 21st century. Of
note, the number o f total deaths from lifestyle diseases is projected to increase by
a fu rth e r 17% over the next 10 years (Figure 2.14). It is o f great importance to note
th a t up to 80% o f the cases o f heart disease and type 2 diabetes can be prevented
by reducing risk factors. Together w ith physical inactivity and smoking, diet is an
im porta nt risk factor w hich can be improved to reduce the risk o f developing life­
style diseases. Dietary changes m ight thus be an im portant factor in curbing the
global burden o f non-communicable diseases.
46
LINKIN G OCEANS A N D H U M A N HEALTH
P rojected in cid en ce of n o n -co m m u n icab le d iseases
It is evident th a t seafood represents an im portant part o f a healthy diet. So far,
the m ajority o f w ork on the beneficial health effects o ffis h consumption focuses
on fish oil, and various health benefits are thereby attributed to marine oils rich in
80
omega-3 fa tty acids (Figure 2.15). The importance o f marine oils in the prevention
o f cardiovascular diseases is well documented and recognized, and seafood, obvi­
ously, is the only dietary source o f such oils.
70
D e a th
In addition to marine oils, other dietary benefits o f seafood should be taken into
D is e a s e
account. First and forem ost it should be recognized th a t seafood is an excellent
protein source, as marine proteins contain all essential amino acids, as well as hav­
60
ing high biological values. Secondly, seafood is a good nutritional source o f several
key m icronutrients, such as vitam ins D and B12, and minerals including selenium
and iodine. Vitam in D and iodine are good examples o f marine nutrients deserving
50
fu rth e r research. Through its stim ulation o f calcium absorption and bone form a­
tion, vitam in D has tradition ally been recognized as an im p ortant factor fo r proper
bone health and prevention o f osteoporosis. More recently, reduced vitam in D sta­
40
tus has also been associated w ith mental disorders, insulin resistance and obesity
in humans. Floweverthe mechanisms involved are not clear and fu rth e r investiga­
i World Health
' Organization
tion is warranted.
Whereas the vitam in D concentration is highest in the fille t o f oily fish and in fish
2020
1999
liver, the highest levels o f iodine are in the fille t o f lean fish. Iodine is an im portant
constituent o f the thyroid hormones which play a basic role in regulating the basal
metabolic rate in humans. According to the WFIO, iodine deficiency is the w o rld ’s
FIGURE 2.14.
W orld Health O rganization (W HO )
most prevalent, preventable, cause o f brain damage and mental retardation. In ad­
projection of trends in life s ty le diseases
dition to iodizing table salt, an increased knowledge o f the im pact o f consuming
lean fish may contribute to reducing this global health problem.
Like any food item, seafood also has the potential to cause diseases by acting as a
FIGURE 2.15.
The recognized im p ortan ce of m arine oils
m atrix fo r viral, bacterial and parasitic pathogens. Although such agents to a large
in hum an health
extent originate from pollution, some occur naturally in the aquatic environment.
The health im plications o f (Harmful Algal Blooms (FIABs), in particular, have been
The role of om ega-3 fatty acids, proteins and
m icronutrients from seafood on human health
discussed in section 2.4 o f this report.
Another m atter of concern which has arisen during the last decades is the presence
o f toxic contam inants including heavy metals and persistent organic pollutants
(POPs) in seafood. The Stockholm Convention, a global treaty designed to protect
Brain:
- Im portant for brain
developm ent
- Improve mental health
H eart:
- Reduce risk of
cardiovascular disease
- Reduce risk of stroke
- Improve circulation
Joints:
- Relieve sym ptons
caused by rheum atoid
arthritis
48
Eyes:
- Im portant for vision
developm ent
human health and the environm ent from POPs, in itially included twelve groups of
compounds fo r priority action. Plowever in 2009 this list was expanded to tw entyone groups, now including brominated flam e retardants, fluorinated compounds
and endosulfan, which was included under the Convention in 2011. Limited infor­
mation is available regarding the to xicity o f these compounds to humans and it
Bones:
- Protection against
osteoporosis
is not possible to establish tolerable intakes o f these contam inants by consumers
w ith o u t fu rth e r research.
From the above it is clear th a t human consumption o f seafood is a double-edged
sword when it comes to human health. N utritional benefits and contam ination
risks o f eating seafood have been dealt w ith separately above but there is an in­
Pancreas:
- Protection against
type II diabetes
creasing awareness th a t future challenges in risk assessment include the interac­
tion o f contam inants and nutrients (Figure 2.16). This is especially im portant for
food chain risk assessment where contam inants are responsible fo r altering n u tri­
ent matrices, which w ill affect the toxic outcome. Nutrients (e.g.tocopherols, flavonoids and fa tty acids) are known to interact and even protect against contam inant
LINKIN G OCEANS A N D H U M A N HEALTH
The lin k between th e oceans and h u m a n health:
hazards, risks, ben efits and o p p o rtu n itie s fro m th e sea
(e.g. polycyclic arom atic hydrocarbons and pesticides) toxicity. Thus, pathway iden­
w ith Anisakid worm s in Northern Europe was a significant problem
tifica tio n is essential to assess how nutrients interact w ith contaminants.
prior to the 1970’s but w ith the introduction o f flash freezing o f herring
and other hosts o f the larval w orm s (e.g., cod and salmon) the problem
Dietary guidance to pregnant women, for example, is an im portant issue in this
was greatly reduced (Huss eta!., 2004). More recently Anisakiasis and
context. M ost international public guidelines advise pregnant women to increase
associated gastro-allergic reactions has become more prevalent in
th e ir intake o f seafood and oily fish in particular due to its high levels o f benefi­
Southern Europe and is an issue o f seafood hygiene and safety (Mattiucci
cial nutrients, as there is ample evidence o f detrim ental effects linked to m ater­
etal., 2013; Valero etal., 2006).
nal nutritional deficits during gestation. However, the opposite holds true in some
countries such as Sweden, where the high levels o f mercury16 in fish have resulted
These types o f infections are not ju s t a European problem as they
in recommendations fo r pregnant women to reduce th e ir consumption o f fish. In
occur w orldw ide. Consequently, w ith increasing globalisation and the
lig h t o f the rich source o f nutrients in seafood, the potential am eliorating effect o f
frequent sourcing o f seafood products from many regions o f the world,
dietary nutrients on the toxic response to environmental contam inants needs to be
there needs to be an enhanced awareness o f the potential fo r human
fu rth e r evaluated.
parasitic infection or accidental introduction o f alien parasitic organisms
into European ecosystems. Furthermore, physicians may fail to correctly
diagnose the symptoms o f these infections as the y are often not trained
to associate the symptoms w ith seafood-borne parasites.
Balancing the risks and benefits of eating seafood
Most o f these parasitic infections can be avoided or minim ised if
FIGURE 2.16.
appropriate food hygiene measures are implem ented as outlined by
Positive and negative aspects o f d ietary
Huss eta/. (2004).
seafood
Dioxins
Focus on the impacts of aquaculture on human health
Mercury
Marine oils
Vitamin A and D
Aquaculture has been one o f the w orld’s fastest-growing food producing sectors in
Iodine
recent decades. Global o utput has increased from less than 1 m illion tonnes in 1950,
Selenium
to 52.5 m illion tonnes in 2008 (FAO, 2010). Aquaculture is also an increasingly impor­
ta n t source o f nutrients for the global population and serves as an im portant provider
of employment and income in LIFDCs in particular. Of note, developed countries pro­
duced only 3.92 million tonnes, accounting for 7.5% o f global aquaculture produc­
tion in terms o f quantity, although this accounted for 14.6% o f production value. In
the European Union, aquaculture contributes approximately 20% of the total EU fish
production, yet represents only 2% o f global aquaculture production. Nevertheless,
Europe has a number o f key strengths in aquaculture as there is a strongfocus in the
sector on technology, research and training o f highly skilled employees. In addition,
the environmental quality standards in Europe are rigorous to ensure th a t aquacul­
ture products are both healthy for the consumer and environmentally sustainable.
INFORMATION BOX 2.5.
There are many different techniques used to farm a broad array o f fish, shellfish
Human consumption o f raw, marinated or undercooked fish and
Parasitic Infections from consumption of
(predom inantly molluscs and crustaceans) and more recently algae, but tw o fu n ­
shellfish can result in parasitic infections, which may result in severe
seafood
damental factors dictate the environmental im pact o f any aquaculture operation,
symptoms or even death. The parasites o f most concern are nematode
namely w ater processing and feeding regime. By economic necessity, most inland
worm s (e.g., Anisakis species), tapeworm s (e.g., Diphyllobothrium
facilities use a flow -through system where w ater is diverted from surface waters
species) in the flesh o f a range edible finfish, and protozoan parasites,
(lakes, rivers) or underground reservoirs. For farmed species held in natural water
16 M ercury in fish (and o lh e r food) is
such as Cryptosporidium species and Giardia duodenalis assemblages
bodies, restrictions generally reflect site selection because w ater quality is depend­
considered and im p o rta n t risk fo r hum an
A and B, o f w hich the spores and cysts respectively can accumulate in
ent on natural w ater flows in and around the farm. In term s o f the impacts o f aqua­
health. Therefore, th e European Food Safety
filte r feeding mussels, clams and oysters (Gómez-Couso e t al., 2004;
culture on the marine environment, effluents from rearing ponds and the im pact of
A u th o rity (EFSA) establish Tolerable Weekly
Huss e t al., 2004; Lucy e t al., 2008). These types o f parasites can all cause
cage farm ing are the m ost relevant.
severe gastro-intestinal infections ranging from asym ptom atic or mild
50
Intakes (TWIs) in 2012 in te nded to p ro te c t
consum ers fro m adverse health e ffe c ts posed
gastric or bowel discom fort to diarrhoea or dysentery; and some can
Even if aquaculture is a valuable contributor to food security issues, the sector faces
cause fatalities, such as Giardia and Cryptosporidium. Human infection
increasing conflicts w ith other users o f the marine environment. It is well known
m ercury fou nd in fo o d — m e th y lm e rc u ry and
th a t intensive aquaculture operations may lead to water pollution as accumulation
in o rg a n ic m ercury.
by th e possible presence o f th e m ain fo rm s o f
51
LINKIN G OCEANS A N D H U M A N HEALTH
The lin k between th e oceans and h u m a n health:
hazards, risks, ben efits and o p p o rtu n itie s fro m th e sea
o ffis h faeces and feed waste below sea cages, fo r example, can lead to oxygen de­
farmed fish. Secondly, the presence o f antim icrobial drug residues in food products
pletion and contribute to harm ful algal blooms. In order to expand aquaculture in
represents a potential health hazard, and may lead to development o f allergies,
European coastal waters, a strong emphasis m ust be placed on the development of
toxic effects and changes in the colonization patterns o f hum an-gut flora (WHO,
farm ingtechniques w hich have a reduced environmental impact.
1999). The use o f antibiotics does not only relate to aquaculture, as it is an integral
For cage culture o ffis h , escape o f the farmed animals is a continuous threat, both
authorizes veterinary medicines and establishes M axim um Residue Limits (MRLs).
fo r the farm ing business and the surrounding environment. Escapees can have det­
The MRL is the m axim um concentration o f residue accepted by the European Union
rim ental impacts on the genetic integrity o f w ild populations o f the same species.
in a food product obtained from an animal th a t has received a veterinary medicine.
Interbreeding between escaped and farmed fish may thus affect genetic diversity,
The assessment o f the safety o f residues is carried out by the by the Committee for
leading to reduced disease resistance and adaptability. At its most serious extent,
Medicinal Products for Veterinary Use (CVMP).There has been considerable e ffo rt in
part o f all intensive animal husbandry. In Europe, the European Medicines Agency
the decline or elim ination o f a native species through com petition or predation by
Europe to reduce the use o f veterinary medicines in farmed fish, prim arily through
farmed organisms can occur, resulting in changes in biodiversity and ecosystem
the development o f vaccines to restrict prophylactic use.
functioning. Moreover, escapees from farms represent a danger for transmission
o f trans-boundary aquatic animal diseases. EU FP7 project, Prevent Escape17 has fo ­
cused entirely on reducing the threats and impacts o f farmed fish escapes but it is
clear th a t fu rth e r efforts both to lim it escapes from fish farms as well as research
on the im pact o f the escapes on w ild stocks are warranted.
INFORMATION BOX 2.6.
Oceans and Allergies
Negative health affects after consumption o f seafood include true
A lthough escapees may have harm ful genetic and ecological effects on biodiversity,
food allergy (including Type I IgE-mediated hypersensitivity), as well
fish culture can also be used to re-stock populations through the release o f cultured
as food intolerance (i.e. non-im m unologic hypersensitivity) (Fleming
larvae or juveniles into the w ild to strengthen natural populations (“ stock enhance­
2001, Lopata 2010, Hajeb 2012). The development o f allergy is complex,
m e n t” ). However, exploring the possibilities o f genetic conservation o f endangered
influenced by genetic, environmental, and demographic factors and
stocks warrants fu rth e r attention.
potentially by gene-environment interactions; nevertheless, shellfish
FIGURE 2.17.
and fish allergies are in general more common in adults than children,
Finfish aquaculture farm on Frioul island
A critical concern for public health surrounds the intensive use o f antimicrobial
near Marseille, France (© Ekaterina
agents to combat and tre a t infections in farm ed fish. Such concern is prim arily
Finnish children are allergic to fish and the prevalence o ffis h allergy is
Krasnikova / istockphoto)
linked to a possible transfer o f antim icrobial resistant bacteria to consumers of
close to 1/1000 in the general Norwegian population (Zinn 1997). The
except in Asia (Ben-Shoshan, 2012). An estimated 3% o f three-year old
approximate prevalence o f shellfish allergy is estimated at 0.5-2.5% of
the general population across several countries, depending on degree
o f consumption (Woo, 2011). Symptoms range from acute cutaneous
disorders (such as hives) to gastrointestinal complaints to respiratory
symptoms and anaphylaxis, even death (Woo, 2011). Although most
seafood-associated allergies occur after consumption, shellfish protein in
particular is a potent allergen w ith symptoms occurring after inhalation
or skin contact. The reported prevalence o f occupational asthma in
shellfish-processing workers is 2-36% (Jeebhay, 2001).
Allergic reactions, ranging from hives to anaphylaxis, have been reported
after the consumption o f seafood contam inated w ith parasites (Fleming
2001). Acute and chronic in te rm itte n t allergic reactions occur after
the consumption o ffis h w ith Anisakidae parasites, even when the
parasitized fish has been cooked (Moreno Ancillo 1997). Scombroid fish
poisoning can appearto be a severe allergic reaction, but it is actually
due to the histamines elaborated by bacteria in im properly stored fish.
Although not purely allergic reactions, contact w ith a number o f marine
organisms (e.g. some jellyfish) can be associated w ith skin rashes
and hives (Perkins 2004); in some cases, these can progress to fatal
anaphylaxis via the involvement o f the im m une system (Tibbals 2011).
Other marine exposures can appear to be allergic. Skin reactions are
seen w ith excessive exposure to UV light (i.e. sun burn); skin infections
w ith bacteria, fungus, and even parasites (e.g.Toxicara canis) can also be
17 www.preventescape.eu
52
acquired at the beach (Plano 2013).
55
LINKIN G OCEANS A N D H U M A N HEALTH
Th e l in k b e t w e e n t h e o ce a n s an d h u m a n h e a lth
h az a rd s , risks, b e n e f it s a nd o p p o r t u n i t i e s f r o m t h e seu
It is w o rth noting th a t m ost modern food scandals have started w ith contam ina­
A significant proportion o f feed for farmed fish still relies on both fishmeal and fish
tion o f an animal feed (EU, 2000). Contaminants found in feed can be transferred
oil as essential components. Although the major source o f fishmeal is pelagic fish
to fish and thus affect seafood safety. As farmed fish in the future w ill constitute
species and by-catch not norm ally consumed by humans, the sustainability o f the
an increasing proportion o f the overall fish consumption, there is an ongoing effo rt
sector is increasingly tenuous.This raises concerns both from an ecological perspec­
to change the composition o f aquaculture feeds in order to rely less on marine fish
tive and from consumer demand, particularly in the w o rld ’s richer economies, th a t
feed ingredients such as fish meal and fish oil. Vegetable ingredients, including ge­
fish are safe to eat and are derived from sustainable sources. Due to the pressure
netically modified plants, animal by-products, and even algae may constitute alter­
on w ild fish stocks, and hence the lim ited availability and variable prices o f fish­
native protein and lipid sources fo r fish feed. Replacing fish oil in aquaculture feed
meal and fish oil for the rapidly growing global aquaculture industry, there has been
w ith alternative lipid ingredients w ill alter both n u trie n t and contam inant com­
a focus on the development o f aquafeeds th a t rely less on fishmeal and fish oil
position, and may have profound consequences for the health effects o f seafood.
(Torstensen et al., 2008). Data from The European Commission’s 6th Framework In­
Novel feed ingredients w ill introduce new challenges for food safety, for example in
tegrated Project AQUAMAX18 show th a t the use o f plant oils and meals reduces lev­
the control and regulation o f pesticides, mycotoxins and medicine residues.
els o f known persistent organic pollutants in A tlantic salmon, but also introduces
There is a continuous need fo r analytical methods and safety evaluation o f emerg­
al., 2010). Furthermore, the use o f novel sustainable plant feed ingredients in aqua­
ing risks in seafood. This includes studying the transfer o f undesirable compounds
feeds w ill potentially affect fish health and fille t composition. As both the nutrient
to the edible product th a t may affect consumer health. Other undesirable compo­
and contam inant status o f the fish is affected by the use o f plant-based feed ingre­
nents in the feed produce such as additives from fish feed and feed raw m ateri­
dients, it m ig ht be expected th a t consumer benefits o ffis h consumption are also
als are also an im p o rta n t area requiring fu rth e r research. An understanding o f the
altered. Aquaculture has great potential fo r food production and the alleviation o f
ways in which these substances are transferred from feed to fille ts and th e ir effects
poverty, particularly fo r people living in coastal areas. A balance between food secu­
other contam inants not previously associated w ith salmon farm ing (Berntssen et
on farm animal and consumer health is vital to ensure seafood safety. Furthermore,
rity, public health and the environmental costs o f production should be addressed
toxicological evaluations o f undesirable compounds have tra d itio n a lly focused on
through an interdisciplinary approach.
one compound at the tim e. However, food contains an abundance o f compounds,
w ith both positive and negative im plications fo r human health. Risk-benefit assess­
Global environmental change is another issue which w ill need to be addressed
ments are necessary to enable an integrated evaluation o f the positive and nega­
in order to ensure long-term sustainability o f the aquaculture sector. Farmed fish
tive compounds present in seafood (EFSA, 2010).
held in sea cages have lim ited possibilities to migrate from environmental changes,
and environmental effects do directly affect the fish performance. Future effects
o f global w arm ing at local level may increase incidences o f elevated tem perature
and hypoxic conditions. In a recent experiment, Hevr0y et al. (2012) studied tw o
groups o f large salmon (about 2 kg average w eight) after they had spent 56 days
in seawater. One group lived in w ater at 19 °C, the other at 14 °C. The salmon were
also fed diets w ith different fa t content. It turned out th a t the fish at 19 °C, which
ate little, also took up very little fat, drawing instead on th e ir own reserves o f fat,
particularly polyunsaturated marine omega-3 fa tty acids. High tem peratures can
thus have im plications not only for grow th, but can also lead to changes in product
quality and how the feed resources are used. The direct effects o f tem perature or
hypoxia is possible to predict w ith focused experimental design. But there is an­
other aspect o f climate change th a t w ould be d ifficu lt to see today, and th a t is the
combined factors o f ocean acidification and rainfall. How w ould this com bination
affect w ild or farmed fish; and w h a t w ould the fu tu re seafood problems look like?
FIGURE 2.18.
This w ill require fu rth e r research effort.
Left: Fish feeding a t a Norw egian fish farm
(Credit: Research Council of Norway / M arine
Microbial Contamination and Eutrophication
Harvest); Above: feeds used in aquaculture
(picture from w w w .clextral.com ). The
An area th a t is w orthy o f more focused attention w ith regards to nutrients and
feed used in aquaculture influences the
human health effects, is the increasing im pact o f microbial contam ination as a nu­
health and com position of the farm ed
trie n t inp ut associated w ith increased HAB incidence, environmental degradation,
fish, and hence the n u tritio n al value and
and the potential fo r human health effects from both the microbial pathogens and
potential health risks fo r consumers. W ith
HABs. There is controversial evidence o f increasing marine HAB occurrences and a
an increasing proportion o f fish protein
documented increasing incidence o f cyanobacteria! blooms in freshwater bodies
provided by aquaculture, there is an
w orldw ide associated w ith nutrient contam ination, and these have been associ­
ongoing effo rt to change the com position
ated w ith increased reports o f deaths and illness o f domestic and other animals.
of aquaculture feeds in order to rely less on
However, dem onstrating a parallel increased incidence o f human health events is
13 h ttp ://e c .e u ro p a .e u /re s e a rc h /b io s o c ie ty /
more d ifficu lt (Stewart, 2011; Zaias, 2010).
in c o /p ro je c ts /0 0 6 _ e n .h tm l
m arine fish feed ingredients such as fish
meal and fish oil.
54
55
LINKIN G OCEANS A N D H U M A N HEALTH
The lin k between th e oceans and h u m a n health:
hazards, risks, ben efits and o p p o rtu n itie s fro m th e sea
w ater cyanobacteria. They may accumulate saxitoxins (Lassus et al., 1989), m icro­
cystins (Amorim and Vasconcelos, 1999), cylindrospermopsin (Saker et al., 2004) or
anatoxin-a (Osswald etal., 2008), w ith o u t any obvious harm to the mussel, but ex­
posing humans w ho eat contam inated mussels to these toxins. Moreover, o f these
contaminants, only saxitoxins are subject to any form o f m onitoring anywhere.
There is recent evidence th a t BMAA may enter the food chain in the Baltic Sea, w ith
the highest levels in the brain and muscle o f bottom dw elling fishes (Jonasson etal.,
2010). O f all these toxins, the microcystins may be the most problem atic due to the
fact th a t they in h ib it protein phosphatases 1 and 2a (Mackintosh et al., 1990) and
consequently are potent tu m o u r promoters.
Mechanisms for tracing freshwater toxins and th e ir producer organisms in coastal
environments w ill be needed in order to assess the risks fo r human and environ­
mental health o f land-based processes. Bioavailability, biodégradation and biomag­
nification o f these toxins need to be investigated, especially in microcystins, BMAA
and cylindrospermopsin, ow ing to th e ir ubiquity, resistance and toxicity. In marine
coastal waters, phytoplankton and phytobenthos analysis should be extended to
freshwater species whenever signs o f freshwater eutrophication are clear. Early
w arning molecular methods such as qPCR may be used because they detect re­
duced numbers o f cells and toxin producing genotypes (M artins and Vasconcelos,
2011 ).
Pharmaceuticals from the Sea
Natural products from the environment, including the oceans, have been used by
FIGURE 2.20.
humans for thousands o f years to treat and prevent illness, and as a source o f n u tri­
Left: A colony of the m arine tun icate
tion. W ith issues o f increasing antibiotic resistance o f human pathogens and the
Ecteinascidia tu rb in a ta (le ft) which
need fo r new cancer chemotherapy and AIDS drugs over the past 2-3 decades, in a
is the source of the anticancer agent
process also known as “ bioprospecting,” researchers have started to actively seek
tra b e c tid in , com m ercially available as
new pharmaceuticals and other compounds from the vast biodiversity o f organ­
Yondelis® (© Pharm aM ar, S. A.). Right:
FIGURE 2.19.
The loads o f n u trie n t inputs into aquatic systems, due to the overuse o f fertilizers,
isms found in the oceans (Galeano, 2011; Hughes, 2010; Jones 2009; Skropeta,
Structures of a n titu m o r and an tiviral
Algal bloom a t the Swedish coast in
pesticides and treated and untreated wastewaters, can cause freshwater eutrophi­
2008; Gerwick, 2008; Fenical, 2006; Marine Board, 2010). For example, more than
drugs created on the basis o f m arine
the Baltic Sea resulting from excessive
cation which can, in turn, affect coastal waters. Moreover, the im pact of land-based
50% o f the current anticancer drugs are natural products or derived from a natural
natural products, including Trabectidin
n u trie n t loads entering the m arine
influx o f nutrients and toxins on coastal eutrophication is neither well-known nor
origin, many o f these originally from marine organisms (M udit, 2011). Some ma-
(from Stonik, 2009).
environm ent which m ay result in oxygen
understood. Nevertheless, it is also im p o rta n t to consider th a t freshwater toxin-
depletion and fish m o rta lity . (Credit:
producing organisms may have a significant im pact in estuarine and coastal sys­
istockphoto / Mikael Eriksson)
tem s b y tra n s fe rrin g to x in s to marine systems th a t are usuallyfound only in freshwaters.
Although m ost marine national m onitoring programs deal w ith the m ost common
toxins and th e ir producers, they do not include toxins o f strictly freshwater origin
such as microcystins, cylindrospermopsin oranatoxin-a and its analogues. Recently,
the occurrence o f the neurotoxic amino acid ß-N-methylamino-L-alanine (BMAA)
produced by marine and estuarine cyanobacteria has been highlighted due to the
1RsH SprogoiükiH
2(t»CMi
hrpiftdH'M
3 W J ir ib ê r f l, A u * A
4 C y i # # b f w , A r i- C
potential im plication on human neurodegenerative diseases (Cianea et al., 2012;
Banack etal., 2007; Baptista etal., 2011). These toxins o f fresh w ater origin can have
a direct negative im pact on public health if they occur in drinking or recreational
waters, but in coastal waters they may also accumulate in seafood.
Among the seafood animals, bivalve molluscs probably cause the greatest human
health problems due to th e ir unselective feeding habits. In estuaries and coastal
waters near eutrophic rivers they may feed on freshwater cyanobacteria responsib le fo rth e production o f a variety o f toxins. Mussels are very tolerant to toxicfresh56
57
LINKIN G OCEANS A N D H U M A N HEALTH
The lin k between th e oceans and h u m a n health:
hazards, risks, ben efits and o p p o rtu n itie s fro m th e sea
2.6
Social and behavioural aspects:
people and th e sea
riñe organisms are known to produce secondary metabolites w ith pharmaceutical
Managing and m itigating the effects o f human activities on the structure and fu n c­
potential (Fleming, 2006). Globally, the marine pharmaceutical pipeline consists o f
tion o f coastal and freshwater ecosystems in a whole ecosystem context is emerg­
three US FDA-approved drugs, one EU-registered drug and thirteen natural prod­
ing as a unifying them e for environmental protection, resource management and
ucts at various stages o f clinical testing (Mayer, 2010). The technical and economi­
integrated environmental m anagement (Allen, 2011; Moore et al., 2011). The over­
cal potential o f using the marine biota fo r its therapeutic benefits is considerable,
all problem is, how can we develop effective procedures fo r environmental m an­
but w ill require inputs from many areas o f clinical, pharmaceutical and marine sci­
agement, im pact assessment, and risk evaluation, which take account o f human
ence if this potential is to be exploited in the future.
health, economic and other societal issues?
Marine organisms are genetically highly diverse and have adapted to extreme en­
Effective coastal and estuarine m anagement has the prerequisite o f a sound fo u n ­
vironm ents ranging from deep sea vents to coral reefs (Thornberg 2010, Skropeta
dation o f scientific research and understanding o f environmental processes. M ore­
2008, Gerwick 2008, Fenical 2006). These qualities make them ideal as sources of
over, programmes fo r environm entally sustainable m anagement o f coastal areas
novel approaches to terrestrial problems. For example, marine sponges are sessile,
m ust engender a move away from the traditional sector by sector management
but they have developed a wide range o f bioactive products to protect themselves
practices towards a cross-sectoral approach. This requires collaboration between
from predators; some o f these compounds (e.g. discodermalide) can in h ib it cancer
environmental managers (i.e. in national and international environmental protec­
cell grow th at m inute concentrations. The marine snail, Conus magus, has devel­
tion agencies) and research centres w ith the strategic capability to understand
oped a powerful neurotoxin as a defense mechanism which has been licensed as
processes o f change and the im pact o f human activities upon the natural environ­
Ziconotide for intractable neuropathic pain. Marine bacteria and other organisms
ment. In addition, it is im portant th a t the various governments, regional organiza­
are being explored fo r novel antibiotic compounds to address the increasing re­
tions (e.g. EU) and global UN organizations (e.g. the Global Environment Facility or
sistance o f human pathogens to most currently available antibiotics. A very recent
GEF, the United Nations Development Programme UNDP, the United Nations Envi­
discovery is the ability o f peptides from a marine algae and protozoan to induce an
ronm ent Programme or UNEP, IOC-UNESCO - Inter-Governmental Oceanographic
FIGURE 2 .2 1 .
im m une reaction to FIIV (Su et al., 2013). Finally, the marine environm ent is also a
Commission, United Nations Educational, Scientific and Cultural Organization;
S u r f e r a i B a rc e lo n a beach In S p ain . V a rio u s
source o f other bioactive compounds ranging from natural antifouling substances
IM O - International M aritim e Organization; W M O -W o rld Meteorological Organi­
h u m a n a c tiv itie s c o n v e rg e on t h e seas
to cosmetics, as well as im portant sources o f nu tritio n and possible fu tu re biofuels
zation; WFIO - World Flealth Organization; & UNIDO - United Nations Industrial
an d c o a s tlin e such as t o u r is m , re c re a tio n
Development Organization), which have interests in Intergrated Coastal Zone M an­
a n d m a r it im e in d u s try . (© is to c k p h o to /
agement (ICZM) and marine spatial planning, harmonize th e ir activities in o rderto
C a ra c te rd e s ig n )
(e.g. algae) (Camps, 2011; Gerwick, 2008; Fleming, 2006b).
Marine organisms can serve as sentinel species fo r human health, and as potential
models o f human disease (Walsh, 2008; Bossart, 2006; Fleming, 2006b; Grosell,
2006). For example, the Aplysia or “sea hare” is an organism w ith a very simple and
well understood nervous system. These organisms have been used to explore the
function o f the developing and mature human nervous system, resulting in the
awarding o f the 2000 Nobel Prize in Physiology or Medicine to Dr Eric Kandel. In
recent years, marine mammals such as dolphins and sea lions have demonstrated
severe health effects ranging from infections and neurologic illness to cancer due
to th e ir exposure through the food chain and the ocean waters to mixtures o f an­
thropogenic pollution ranging from antibiotic resistant bacteria to harm ful algal
bloom toxins to persistent organic pollutants. These animals serve as a w arning or
sentinel o f both the harm to the oceans from humans, and the consequent poten­
tial harm to human health.
W hile there is clearly significant potential in marine biodiscovery, there are lim ita ­
tions to this harvesting of natural products and organ isms from the w o rld ’s oceans.
As w ith many issues related to oceans and human health, it is clear th a t anthropo­
genic im pact upon the oceans, both coastal and deep sea, can have significant and
wide ranging consequences. In particular, the threat from microbial and chemi­
cal pollution, general environmental overuse and degradation, and global climate
change threaten the diversity o f marine life (Rogowska, 2010; Pandey, 2009; Flem­
ing, 2006b). This loss w ill have direct impacts on our ability to explore and discover
new compounds and organisms w ith direct and indirect benefits on human health
and wellbeing.
The strategic development and research priorities for European marine biotechnol­
ogy are set out in the 2010 European Marine Board position paper, “Marine Bio­
technology: A New Vision and Strategy for Europe” (Marine Board, 2010).
58
affect synergies in this global activity.
LINKIN G OCEANS A N D H U M A N HEALTH
Th e l in k b e t w e e n t h e o ce a n s an d h u m a n h e a lth
h az a rd s , risks, b e n e f it s a nd o p p o r t u n i t i e s f r o m t h e seu
It is also considered crucial th a t research programmes address broader socio-eco­
FIGURE 2.22.
nomic issues involving people-orientated environmental health-related problems,
The Blue Gym is an innovative project
such as human population pressure. Unfortunately, there is still a relative dearth o f
origin atin g in Cornwall (UK) utilizing
substantial epidemiological data th a t w ould perm it a comprehensive understand­
the coastal environm ent as a resource
ing o f possible causal links between human and ecosystem health (see M illennium
to prom ote health and wellbeing
Ecosystem Assessment19, 2005, and World Health Organization20). We m ust w o rk to -
by increasing physical a c tiv ity ,
wards a better understanding o f how we interact w ith our environm ent and w hat
reducing stress, and building stronger
the consequences w ill be fo r sustainability o f environmental goods and services,
com m unities (top: fa m ily w alk on beach
and ultimately, fo r human health. This goal requires th a t we have the necessary
a t sunset © Bruno Misseeuw;
m ultidisciplinary capacity capable o f resolving problems th a t are intrinsically inter­
bottom : jo g g er on the beach - courtesy
facial in character. By effectively identifying and interconnecting the interdiscipli­
Ocean Champions)
nary elements we w ill see the emergence o f new ways o f solving problems in what,
at present, are seemingly unrelated areas o f environm ent and human health.
Finally, given the state o f the oceans and th e ir undeniable im pact on human
health, more research is needed on the best methods fo r changing human behav­
iour towards the environm ent on both the individual and societal level, particularly
towards the oceans (WWF 2011, World Bank 2010). There are myriads o f theories
and examples o f tryin g to move humans towards more responsible behaviour in
relation to the natural environment. These have ranged fo r the pure comm unica­
tion o f knowledge to the use o f short-term financial or social status gains to envi­
ronmental regulations and punitive laws, each w ith variable degrees o f success.
The developing m ovem ent in “Ocean Literacy” in Europe has potential to provide a
more coordinated approach to im proving peoples’ knowledge and appreciation of
the oceans and the benefits they provide to human wellbeing.
The Blue Gym effect
There are currently global epidemics o f obesity and depression th a t have arisen as
we adopt more sedentary lifestyles, disconnected from nature and living in increas­
ingly urban environments. Recent statistics show th a t 85% o f the UK population
live in cities, and recent UK Departm ent o f Health statistics indicate th a t adults
now spend only 20% o f th e ir tim e outdoors (Lawton, 2011), w hile for children,
th a t value is an alarm ing 9%. Research indicates th a t re-engaging people w ith the
natural environm ent encourages greater physical activity (Thompson Coon, 2011),
improves mental health (van den Berg, 2010), reduces disease prevalence (Maas
et al., 2009), and increases life expectancy (Mitchell, 2008). However, this research
has focused mainly on “green space” (woodlands, parks, countryside) and very little
is known about the potential public health benefits o f marine and other aquatic
“ blue space” environments (Depledge, 2011).
Marine environm ent and health has predom inately been framed from the point o f
view o f risks to health (e.g. chemicals, pathogens and other stressors). Literature in
the field is dom inated by studies identifying hazards, and assessing and manag­
ing risks. Marine products th a t promote health (including pharmaceutical develop­
ment) provide an alternative avenue for research, but this is usually considered as a
separate field o f study. Far less research has been undertaken into the potential for
marine and other aquatic environments to directly prom ote health and wellbeing
(Volker and Kistemann, 2011).
19 w w w .m ille n n iu m a sse ssm e n t.o rg /
60
en/index.aspx
The notion th a t the sea could have therapeutic properties, referred to as Thalasso­
90 w w w .w h o .in t/to p ic s /e n u iro n m e n ta l_
therapy (from the Greek fo r sea, Charlier, 2009), was already recognised in ancient
h e a lth /e n /
tim es (Jackson, 1990). Indeed by the late 18th Century an influential English doc61
LINKIN G OCEANS A N D H U M A N HEALTH
The lin k between th e oceans and h u m a n health:
hazards, risks, ben efits and o p p o rtu n itie s fro m th e sea
to r (Russell, 1760) published a collection otease studies claim ing Thalassotherapy
could cure a variety of ailments leading to the establishm ent o f several coastal hos­
pitals, such asThe Royal Margate Seabathing Infirm ary in 1791. Although “spa” and
coastal treatm ents o f various kinds remained widespread in Europe for the next
150years (Fortescue Fox, 1938) th e ir popularity declined after the 1940s in part due
to the development o f antibiotics. However, faced w ith the complex health prob­
lems o f modern populations and the decreasing effectiveness o f various kinds o f
pharmaceutical treatm ents, there is a resurging interest in the health prom oting
potential o f the coast through such projects as the “ Blue Gym”.
The Blue Gym21 is an innovative project originating in Cornwall (UK), but now
spreading w orldw ide, utilizing the coastal environm ent as a resource to promote
health and w ellbeing by increasing physical activity, reducing stress, and building
stronger com m unities (Depledge, 2009). The Blue Gym programme is designed to
c
1,4 1
o
ro
1 ,2 -
3
a
o
a
£ JO
<o a
'■= co
55
0
around coastal and other aquatic environments. The hypothesis is th a t this may
-a G)
CO
0,6
-
0,4 -
i s
instance, analysis o f the English Census data (w ith approximately 40m illion adults)
CO
■O
o f 12,000 adults in England found th a t the same individuals were happiest and
-
a> c
found th a t people w ho lived w ith in walking distance o f the coast were healthier
than those w ho lived inland (Wheeler, 2012). Moreover, analysis o f an 18 year study
0,8
o
prom ote health and w ellbeing by re-engaging people w ith outdoor activities in and
marine and other natural environments. Early results are highly encouraging. For
-
G) a)
£ P
encourage people to both improve th e ir own health, and to value and conserve the
1
w
c
CO
0,2 -
+■<
CO
healthiest in years when they lived near the coast (White, Alcock et al., 2013).
a>
In the laboratory, people rate marine and other aquatic scenes as more psychologi­
<
G)
>50 km (ref)
cally “ restorative” than urban or green spaces, and are w illin g to pay more for homes
20-50 km
5-20 km
1-5 km
<1 km
and hotel rooms w ith aquatic views (White, 2010). Field studies find th a t visits to
the coast elicit greater feelings o f calmness and revitalisation compared to visits
Home distance to the coast (n = 48 million adults)
to urban parks and open countryside (White, Pahl et al., 2013, Barton, 2010). These
beneficial effects are consistent across weather conditions (White, Cracknell et al.,
2013), and appear to extend to sub-aquatic environments (Cracknell, 2013). Blue
FIGURE 2.23.
Gym interventions engaging disadvantaged youth from coastal com m unities w ith
English census data on relationship
th e ir local environm ent are also starting to show not ju s t psychological benefits,
between coastal proxim ity and stated
b ut a greater awareness o f the marine environm ent and the importance o f protect­
health status (adapted fro m W heeler e t
ing it (W hite etal., 2012). However, all o f these results are from theU K , a n islandna-
a l , 2012)
tion w ith strong cultural connections w ith the sea. Although we see no reason why
the effects m ight not also exist th ro u g h o u t Europe’s many coastal nations there is
much w ork still to be done to explore how widespread and generalizable the effects
are and the potential im plications fo r coastal ecosystems and infrastructures if the
coast were to be promoted fo r its health-enhancing properties.
21 w w w .bluegym .org.uk
62
63
Addressing th e pub lic h ea lth challenges
presented by th e seas and oceans
3.1
Interdisciplinary systems approach
incorporating environm ental, biomedical, socio­
economic and epidemiological methods
Development o f an integrated interdisciplinary framework
3
Ecosystems th a t encompass all modern human activity have been profoundly
modified or completely altered to both the detrim ent and the benefit o f human
health and society. Therefore, society m ust weigh the benefits against the risks as­
sociated w ith development and progress and make sometimes d ifficu lt but neces­
sary choices (International Risk Governance Council, 2010). However, the negative
effects have not always been im m ediately obvious, given the difficulties inherent
Addressing the public
health challenge
presented by tne seas
and oceans *
in “future -proo fing ”. In many cases, the direct and indirect impacts on human and
ecological health associated w ith urbanization have been subtle, and we were slow
to recognize these stresses. Because we did not understand human-ecological in­
teractions, we could not calculate appropriate risk-benefit ratios. Thus, an integrat­
ed explanatory fram ew ork fo r adverse changes in w hole systems, from the physical
en viron m entto marine biodiversity to human health and ecosystems is required.
Whereas considerable progress has been made to address the more obvious prob­
lems, there is concern th a t the increasing effects o f urbanization, poorly regulated
industrial development and habitat destruction on human and ecological health
may go undetected until more sensitive sectors o f society or ecological indicators
are adversely affected. Thus, in this chapter, a case is made fo r the identification,
quantification, and application o f biological indicators o f ecological integrity, as
well a sto de term inethe sim ilarities and differences in responses o f various aquatic
ecosystems to stress. Our objectives in this respect are tw o-fold:
1.
Identify appropriate diagnostic and prognostic markers o f health o f the envi­
ronm ent th a t m ight be used as sensitive indicators o f the stresses th a t result
in biological or ecological damage;
2.
Reconcile various prognostic marker responses w ith ecological consequences
th a t have a human-health relevance.
Integrated modelling tools required for effective health management and
prediction
As already stated, a systems-based approach w ill be essential. This requires the
development o f a hierarchy o f interacting and overlapping computational models,
integrating those elements essential for effectively predicting ecological health
risks. Achievement o f this goal w ill require the integration o f functional ecological
expertise w ith th a t o f environmental physics, chemistry, toxicology and epidem iol­
ogy. Such an interdisciplinary approach can provide insights into the relationship
between ecological and human health. As a sub-objective, it w ill also be necessary
to derive new strategies fo r improving risk evaluation, as well as countering the
new pollution problems th a t w ill arise though the expansion in the quantity and
variation o f chemical and material pollution ente rin g th e marine environment.
In the past decade, genomic and proteomic technologies have spectacularly ex­
panded the m ethodology and explanatory capability of the biological sciences. One
o f the next m ajor challenges w ill be to provide a mechanistic explanatory and pre­
dictive fram ew ork for the integrated expression o f emergent function in w hole sys­
tem s such as cells, organs, animals and even ecosystems. System function emerges
through the interactions among the components o f the system in question (e.g.
cellular proteins, cells, tissues, individual organisms, populations and assemblages
or communities) and the integrative emergent properties or “ biocom plexity” o f
the system are “com puted” by these interactions. Consequently, the system can be
viewed as a biological computer. Therefore, if we w a nt to explain complex physi65
LINKIN G OCEANS A N D H U M A N HEALTH
Addressing th e pub lic h ea lth challenges
presented by th e seas and oceans
ological or ecological functions, as well as various pathologies and diseases induced
ing complex environmental inform ation th a t is currently lacking (International Risk
by environmental stressors (including pathogens and pollutants), then we m ust fo l­
Governance Council, 2010). A practical solution to this problem lies in a “ w hole sys­
low nature’s computational example and develop a predictive simulative capacity
tem s” approach to the development of early-warning strategies fo r assessing risk to
th a t exhibits emergent behaviours alongside our existing experimental m ethodol­
aquatic ecosystem function and health, which effectively integrate physical, chemi­
ogy-
cal and biological processes. To achieve this, we need an innovative approach and
This new m ethodology of biological systems m odelling for human health is heavily
tress sign ais” and evaluation o f “ecosystem health status” in novel ways. Integration
reliant on cell-based physiological and pathological sim ulation. These types o f sim­
of this complex inform ation can be achieved using whole system-based sim ulation
ulation provide an essential complement to experim entation and w ill increasingly
modelling; this w ill also facilitate the targeting o f current “ knowledge gaps” and
play a central role in the investigation o f normal function, responses to environ­
how to fill them .
can use existing environmental data and diagnostic tools fo r the detection o f “dis­
mental signals (eco-physiomics), environmental toxicology and disease processes.
Novel modelling tools are needed th a t w ill allow physiologists, epidemiologists,
Consequently, a hierarchy o f overlapping computational models w ill be needed,
epizootiologists and environmental toxicologists to search fo r possible pathologi­
each capable o f interacting w ith the others (Allen & Moore, 2004; Allen, 2011;
cal targets for environmental stressors in a rapid and rational manner. This search
Moore etal., 2011). Development o f these models w ill need to be hypothesis-driven
w ill be carried out in models o f physiologically normal systems, as well as disease
and w ill, o f necessity, integrate physical and chemical processes w ith ecosystem
models, in order to facilitate prediction o f relevant environmentally-related end­
function using a systems biology approach. The aim here w ill be the development
points and synergies.
of an affordable pre-operational predictive toolbox to aid decision-making in a systems-based holistic way fo r advising environmental policy form ulation. Achieve­
The need for an integrated approach in the development o f effective environmen­
tal and public health policies on a regional and global scale
m ent o f this aim w ill require an interdisciplinary evaluation o f the existing physical
and chemical parameters, diagnostic and prognostic biomarkers o f health status,
and indices o f biodiversity and ecosystem integrity currently used as indicators o f
W hile it is recognised th a t healthy ecosystems provide basic goods and services to
biological and ecological damage. This process w ill also include an assessment o f
humans and other organisms, some o f these are so basic (for example, air and w a­
the ecological resilience o f critical habitats, like river basins and coastal zones.
te r quality) th a t they are taken for granted when ecosystems are healthy. However,
when the buffering capacity o f aquatic ecosystems is exceeded, as in many highly
industrialised areas, there is frequent evidence o f compromised human health, par­
ticularly in the developing world (e.g. Bangladesh arsenic problem and water-borne
diseases). It is probably a reasonable assumption th a t such phenomena have im ­
pacted other organisms as well.
FIGURE 3.1.
Ecosystems th a t encompass all modern
Unfortunately, the necessary epidemiological data for pollutant im pact on sentinel
human activity have been profoundly
animals th a t should perm it a comprehensive understanding o f possible causal links
modified or completely altered to both the
between ecosystem integrity and human health, are often lim ited or fragmentary,
detrim ent and the benefit of human health
both spatially and temporally. Consequently, alternative interdisciplinary approach­
and society. Therefore, society must weigh
es w ill be required to identify such links, but interdisciplinary th in kin g m ust indeed
the benefits ag ain stth e risks associated
extend beyond the boundaries o f individual scientific disciplines. Unless this can
w ith development and progress.
be effectively applied, disciplinary boundaries become impermeable to intellectual
synergy and hinder the enlightenm ent we fin d only at the interfaces between dis­
ciplines.
Improving our understanding o f the linkages between ecological integrity, environ­
mental services and human health, w ill be necessary as we strive to achieve an ac­
ceptable standard o f living fo r many more people, w hile at the same tim e ensuring
th a t the ecological pillars which support our society and industries are protected
and remain sustainable. We m ust successfully integrate social and natural systems
on a local scale, w hile understanding the larger scale ram ifications and conse­
quences o f decisions on a local, national and trans-national scale. Our knowledge
o f the biosphere and our connections w ith it m ust be adequate to inform policy and
decision-making.
Harmful impacts o f pollutants on ecological integrity are complex, often subtle,
and may go undetected until a major problem arises. However, effective risk evalu­
ation and forecasting o f im pact requires a capability fo r interpreting and integrat­
66
67
LINKIN G OCEANS A N D H U M A N HEALTH
Addressing th e pub lic h ea lth challenges
presented by th e seas and oceans
3.2
Improved tests for detecting pathogens in
seaw ater and seafood
The marine environm ent contains m illions o f different types o f microorganism th a t
USA Environment Protection Agency (EPA) recently discussed the use o f qPCR tests
are both naturally occurring and foreign; and a number o f these microbial agents
for enterococcus in surface waters, as part o f th e ir recommended recreational w a­
have been linked to human diseases (Thompson et al., 2006). Until recently, the
ter quality criteria (RWQC), w hich is designed to protect human health in inland
identification o f pathogens - including bacteria and viruses found in seawater and
and coastal waters (EPA 2012). The EPA has subsequently developed and validated
seafood - was a lengthy and labour-intensive process th a t frequently provided in­
qPCR as a rapid analytical technique fo r the detection o f enterococci, and provided
sufficient inform ation to either identify pathogens o f interest o r to define precise
inform ation on its use and application (EPA Method 1611). Although there is cur­
relationships between particular strains. Such lim itations are particularly problem­
rently no direct regulatory requirem ent fo r its use, this methodology is particularly
atic from the standpoint o f many clinical, diagnostic and regulatory sectors, where
promising as it may provide near ‘real tim e ’ data fo r state-level m anagement o f
it is often necessary to identify and categorise pathogens quickly, reliably, and
faecal m onitoring in a variety o f site specific areas, such as beaches th a t regularly
cheaply, and often across a range o f different matrices, such as seawater, seafood
exceed regulatory w ater quality thresholds for Enterococcus. Another area where
produce, clinical samples etc. Several new and improved approaches have circum­
regulatory need has driven the evolution o f new pathogen testing approaches is
vented many o f these problems and form the basis o f a new generation o f m eth­
seafood safety. For the firs t tim e, a range o f fit-for-purpose and robust molecular
ods in this field. These approaches can be broadly classified into identification and
testing platforms are now available fo r m ajor seafood pathogens, such as human
typing-based techniques, essentially based on the level o f biological identification
Noroviruses (NoV), and hepatitis (Lees, 2010). These methods, utilising qPCR now
required (e.g. genus, species, strain etc.).
offer quantification o f enteric viruses in a range o f shellfish matrices (among other
food commodities), which w ill have major ram ifications in food safety and interna­
Among molecular methods, the polymerase chain reaction (PCR) has been used ex­
tional food regulatory sectors.
tensively now for alm ost three decades as a means to identify pathogens o f inter­
est. PCR remains the mainstay o f molecular methodologies fo r identifying and ty p ­
It is frequently necessary to identify not ju s t a bacterium or virus present in a par­
ing bacterial and viral pathogens in m ost clinical, regulatory, diagnostic and food
ticular m atrix, or implicated in a foodborne outbreak, but to provide more detailed
safety sectors. Essentially all clinically-relevant pathogens in seawater and seafood,
inform ation regarding the pathogen in question. A key development th a t is rapidly
including m ajor bacterial groups (E. coli, Enterococcus, Vibrio spp. Salmonella spp.
expanding the ability to type, analyse and track pathogens has been the advent of
etc) and viruses (Norovirus, Hepatitis A and E, Enteroviruses, Sappoviruses, Polio vi­
cheap and accessible high thro u g h p u t sequencing approaches coupled to sim pli­
ruses etc), have established and well characterised PCR te st assays published in the
fied downstream bioinform atics platforms (Köser et al., 2012). These approaches
peer reviewed literature. The last decade has seen the evolution o f real-time PCR,
can either be used in a targeted fashion, e.g. to identify and type strains directly
which when linked to appropriate sample processing and nucleic acid extraction
from pure culture, or as part o f a metagenome approach where particular matrices
Im provem ents in the rate o f DNA
approaches has facilitated the accurate, reliable and quantitative identification o f
are fu lly sequenced, and pathogens o f interest are mined in silico for bioinform atic
sequencing over the past 30 years and
these pathogen groups in both seawater and seafood matrices. Again, the m ajority
identification and characterization purposes (Belda-Ferre etal., 2011). This marked
in to the fu tu re (From Stratton et al., 2009,
o f marine-borne human pathogens (bacterial and viral) have established and well
evolution in sequencing-used as a practical tool in epidemiological investigations-
N ature 458:719-724)
FIGURE B.2.
characterised real-time PCR methods available for such purposes.
It is w o rth noting th a t molecular approaches are essentially the only reliable m eth­
odology to identify slow-growing or non-cultivable pathogens, such as human
noroviruses. A pathogen detection method term ed loop-mediated isothermal am­
plification (LAMP) was developed by Notom i etal. (2000). LAMP, which is carried out
Single
molecule?
1 , 0 0 0 , 000,000
in a single tube, allows the rapid am plification o f DNA w ith high specificity under
isothermal (single tem perature) conditions using a novel enzymatic reaction. LAMP
100 , 000,000
Massively parallel
sequencing
has several advantages as a pathogen detection tool over other current and exist­
ing methods. Firstly, LAMP uses several specific targets, increasing the specificity
o f the reaction compared to other molecular approaches (Nagamine eta l., 2002).
The enzymatic reaction is catalysed at 60-65°C, so the use o f a PCR machine is not
=
o
required. Detection is achieved using simple UV light; Bright fluorescence indicates
a positive reaction, negating the need fo r cumbersome and complex visualisation
ai
E
>.
w
"D
al. 2008), genotype I and II Norovirus (Fukuda et al., 2006), Vibrio vulnificus (Han
ai
these tests is th a t they can be used as portable devices, potentially allow ing the
user to sample pathogens directly in the field.
A driving force behind the emergence o f many molecular techniques is a regula­
to ry need to provide rapid inform ation to a range o f different stakeholders in a
tim e ly manner. The assessment o f w ater quality provides one good example. The
1 , 000,000
100,000
Q.
cn
a)
<n
w
.Q
o
f
Microwell
pyrosequencing
Capilary sequencing
Q.
LAMP to detect im p o rta n t seafood pathogens such as Vibrio cholerae (Yamazaki et
et al. 2008) and Vibrio parahaemolyticus (Chen and Ge, 2010). A key advantage o f
Short-read
sequencers
D
(0
techniques required fo r other tests. A w ealth o f reports have successfully used
68
10 , 000,000
10,000
Gel-based systems
1,000
100
Second-generation
capillary sequencer
Automated
slab gel
Manual
slab gel
First-generation
capillary
10
— I---1980
1985
1--------------- 1---1990
1995
2000
— I—
2005
1
2010
1
Future
Year
69
LINKIN G OCEANS A N D H U M A N HEALTH
A d d re s s in g t h e p ub lic h e a lt h ch al le n g es
p re se n te d by t h e seas an d oc ea ns
3.3
was demonstrated by the rapid identification and tracking o f the Escherichia coli
Improved tests and protocols for harm ful
nanoparticles and chemical pollutants in seafood
O104:H4 strains responsible for serious foodborne outbreaks in Europe in 2011
(Grad etal., 2012; M ellm ann etal., 2011) as well asthe recent analysis regardingthe
In the past decades research has clarified how organisms reorganise th e ir physi­
origin and global spread o f pandemic V. cholerae pathotypes (Mutreja et al., 2011).
ological processes to adapt to th e ir environm ent in the presence o f different types
o f stressors. Particular attention has been paid to the more im po rtant molecular
Several molecular approaches underpinned by the development o f whole genome
and cellular responses to the more diffuse classes o f organic xenobiotic pollutants.
sequencing (WGS) as well as high-throughput typing methods, form the basis o f
More recently, a set o f biological parameters (biomarkers), able to indicate the re­
a new generation o f experiments th a t can be used to generate testable hypoth­
sponse to particular classes o f chemicals (biomarkers o f exposure) or the overall
eses regarding the routes o f pathogen emergence, dissemination and evolution in
toxic effects o f the pollutants accumulated in the organism (biomarker o f stress),
the marine environment. Of these, the m ost applicable approaches involve high-
have been identified. This has been achieved largely in the fram ew ork o f the Pro­
th ro u g h p u t sequencing coupled to single nucleotide polymorphism (SNP) identi­
gramme fo r the Assessment and Control o f Pollution in the Mediterranean Region
fication and phylogenetic determ ination o f pathogenic strains. A major advantage
(MED POL), the Oslo and Paris Conventions for the protection o f the marine environ­
o f th is approach is the ability to sequence hundreds o f microbial genomes and
m ent o f the North-East A tlantic (OSPAR), and International Council fo rth e Explora­
compare them , rapidly and easily, using free open access software. In essence, this
tion o f the Sea (ICES). A selection o f the biomarkers that, in different organisms
approach can be used to determine the geographical structure w ith in particular
may be suitable to indicate a response to certain classes o f chemicals, is today used
pathogen lineage(s), the possible source as well as routes o f geographical transm is­
in different international biom onitoring programmes to determ ine the biological
sion o f a particular pathogen and im p o rta n t clinical inform ation such as carriage
sub-lethal effects o f toxic chemicals or th e ir mixtures. Therefore a starting point to
o f antibiotic resistance or new or novel virulence attributes. Such inform ation w ill
determine the health status o f organisms th a t represent the usual “ seafood” may
have profound ram ifications fo r infectious diseases, as well as microbial ecology.
be the use o f the biomarkers to understand, through some low-cost analysis, if the
organisms reaching consumers are contam inated by toxic chemicals.
In summary, molecular methods have revolutionized our capacity to detect, iden­
tify and quantify pathogens in seawater and seafood. They offer huge potential to
An example may better clarify this approach. Fish th a t are contam inated by or­
address emerging and well recognised problems in this field. However, currently
ganic arom atic xenobiotics should show, in empathie cells, high levels o f cellular
the uptake o f such methods into a risk m anagement and regulatory fram ew ork
m ixed-function oxygenase (MFO) activity. If the chemicals are genotoxic (capable of
to improve human health protection is fairly lim ited. A significant research need,
damaging the genetic inform ation w ith in a cell, potentially leading to mutations),
therefore, is for applied field studies dem onstrating how these methods can be best
it should be possible to point out DNA damage in the cells and increased micronu­
applied in a real w orld risk m anagement context. The US EPA have made an im ­
clei frequency. In the bile it should be possible to find fluorescent pigments w ith
portant contribution in this regard w ith molecular methods fo r faecal enterococci
typical spectrofluorim etric spectra. In fish exposed to xenoestrogens, it should be
determ ination. By contrast, the EU has made little progress towards evaluation o f
possible to detect an abnormal presence o f vitellogenin in the plasma o f male fish.
molecular methods fo r risk management in, for example, bathing waters. The best
A decrease in acetylcholinesterase activity w ill indicate th a t the organism was ex­
example o f progress towards molecular methods fo r pathogens is in the field o f
posed to pesticides. However, in the case o f heavy metals, it is now clear th a t in fish,
Norovirus contam ination o f bivalve molluscs. Similar studies fo r other pathogens
m etallothionein (a protein, the concentration o f which increases in an organism
and matrices is now required.
exposed to heavy metal) may increase also in response to organic chemicals able
to induce oxidative stress. However, both the toxic effects o f metals and o f organic
xenobiotics are clearly indicated by elevated levels o f organic stress markers or by
FIGURE 3.3.
the presence o f oxidative stress or by the genotoxic effects o f the pollutants.
New pathogen testin g approaches for
seafood w ill have m ajo r ram ifications
In this example, the health status o f the fish is evaluated by the use o f 4-5 simple
in food safety and in te rn a tio n a l food
biomarkers to analyse the liver and blood o f the fish, together w ith a simple histo­
regulatory sectors.
logical analysis o f the organ. This may indicate w hether the to ta l accumulation o f
© Parc M arin de la Côte Bleue
pollutants in the organism represents a riskto human health.Therefore, animals in
which the response to specific classes o f chemicals is known and in which toxic, ge­
notoxic, and hormonal markers are not elevated over control level should represent
safe food fo r the consumers.
More recently toxicogenomics, proteomics and metabolomics have started to give
a more in-depth comprehension o f the biological responses to the toxic effects o f
many different chemicals. However DNA microarrays, a classical tool in toxicog­
enomics, have been developed and used only on a certain number o ffis h and m ol­
lusc species. A generalized use o f these methods to evaluate the effects o f bioavailable contam inants on “ seafood” is not yet established.
70
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Addressing th e pub lic h ea lth challenges
presented by th e seas and oceans
3.4
W arning signals from th e marine
environm ent: clinical-type tests on
FIGURE B.4.
sentinel organisms
Histological analysis is often used to
look for cellular responses to organic
xenobiotic pollutants. Credit:
Veronica French
Harmful biological effects indices o f environmental im pact should be considered
as potential early indicators o f adverse interactions w ith human health. These indi­
ces can include molecular and cellular biomarkers fo r pathology, as well as higher
level patho-physiological effects, w hich are determined either by biom onitoring or
laboratory-based toxicological testing. A broad approach to the complex problem
o f assessing the “ health o f ecosystems” w ill facilitate the validation and fu rth e r
the essential new development o f robust and rapid tools for assessment th a t w ill
provide indicators fo r public health risk (Bowen & Depledge, 2006; Brander, 2007;
Depledge etal., 1993; Ferson & Long, 1996; Galloway, 2006; Jha et al., 2000; Moore
et al., 2004; Owen et al., 2008; Rice, 2003). Future efforts should focus on an inte­
grated approach to the validation o f biomarkers th a t are prognostic fo r ecological
endpoints and th a t also have im plications for human health, such as food safe­
ty (Bowen & Depledge, 2006; Depledge et al., 1993; Galloway, 2006; Todd, 2006;
Moore et al., 2004; Owen et al., 2008). As w ith bioavailability and uptake, expo­
sure to pollutant m ixtures m ust also be considered w ith the possibility o f complex
synergistic interactions resulting in emergent and novel toxicities and pathologies
(Howard, 1997; Kortenkamp & Altenburger, 1998; Warne & Hawker, 1995).
Coastal marine ecosystems are sensitive to exposure to toxic contaminants. Pol­
lutants either individually, or in com bination, may have sub-lethal effects at the
The use o f qRT-PCR allows the precise detection o f the change in the am ount of
cellular, organ and individual level, (e.g. causing changes in genetic, behavioural
specific mRNA. This approach is simpler and o f lower cost than the use o f a DNA
and reproductive activity). Particular species have been identified as indicators o f
microarray, but its general use as a method for the detection and quantification
this sensitivity, including the edible mussel, periwinkles, crabs and several species
o f specific mRNA in different organisms belonging to different phyla has yet to be
of fish (Altieri et al., 2007; Bayne et al., 1988; Stebbing et al., 1992). Biomarker re­
proven. However, as mentioned above, the mRNAs to be investigated should be
sponses fo r such sub-lethal effects include a variety of measures o f specific molecu­
those coding fo r highly-conserved proteins such as benzo(a)pyrene hydroxylase,
lar, cellular and physiological reactions o f these species to contam inant exposure.
m etallothionein, antioxidant enzymes, oxidative damage markers, heat shock pro­
A biomarker reaction is generally indicative o f either contam inant exposure or poor
teins and proteins involved in DNA repair.
health. The challenge is to integrate individual biomarker reactions into a set o f
tools and indices capable o f detecting and m o n ito rin g th e degradation in health o f
The use o f proteomics is at a starting point; although very promising, this technol­
a particular organism.
ogy does not seem ready, today, fo r a large application in the evaluation o f “ sea­
food” quality. In fact, proteomic analyses are expensive (reagents and equipm ent)
Cellular and molecular biomarkers in fish and molluscs, coupled w ith histopathol-
and tim e-consum ing. The quantification o f protein changes in the sample analysed
ogy provide a pow erful set o f “ health status-related” assessment tools (Allen &
by 2D electrophoreses needs 5-10 replicating experiments and the use o f isotopic
Moore, 2004). Adverse molecular and cellular functional reactions, are often good
labelling is also currently very expensive. In addition, a Maldi TOF approach is usu­
indicators o f cell injury and animal health status. In a situation where exposure to
ally not sufficient to identify the protein from an organism whose DNA is not fu lly
environmental stressors is likely to be sustained, biomarkers can be used to predict
sequenced. The protein identification needs the “ novo“ amino acid sequencing, re­
th a t fu rth e r pathological changes w ill occur. Biomarkers for functional lysosomal
quiring instrum ents such as an MSMS/TOF or TOF TOF which are expensive and
and autophagic perturbations also appear to have potential as a measure o f dam ­
complex to operate.
age to ecological health (Moore et al., 2006).
The data concerning metabolomics analysis seems to represent a possible future
Environmental Prognostics has previously been proposed as a branch o f systems bi­
application in the field o f food quality. However the use o f equipm ent such as the
ology th a t is specific to the reactions o f organisms to both natural and anthropro-
NMR 500 trip le quadrupole or TOF-TOF is highly expensive and, as fo r proteomics
genic stress (Allen & Moore, 2004). Although biologists have been reducing life to its
and genomics, the analysis o f the results is complex. Therefore, system toxicology
constituent parts for over 50 years, the new challenge is to reassemble these data
represents an area o f secure development in the field o f ecotoxicology and prob­
to determine how complex systems, from subcellular processes to organisms, work.
ably, in the coming years, w ill contribute considerably to the development o f food
Systems biology attem pts to reconstruct biological systems by developing and evolv­
q u a lity / toxicology analysis w ith the development o f low-cost tools fo r simple and
ing series o f overlapping conceptual, numerical and statistical models (Hunter, 2003),
fast utilisation, capable o f describing m ajor characteristics o f seafood in term s o f
a process involvingthe interaction o f experiment and simulation in an ongoing itera­
both quality and security.
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presented by th e seas and oceans
tive process. Cell-based simulation models have also been successfully developed for
There has been some epidemiologic work looking at the effects o f specific chemical
molluscan hepatopancreas or liver analogue (McVeigh etal., 2006).
pollutants (e.g. methyl mercury and persistent organic pollutants in fish), microbial
pollution (particularly o f recreational marine waters), specific HAB exposures (e.g.
The use o f coupled empirical measurements o f biomarker reactions and modelling
brevetoxins and ciguatera fish poisoning), and coastal disasters (Fleming, 2006).
is proposed as a practical approach to the development o f an operational toolbox
However, there has been no epidemiologic research evaluating this rich m ixture of
fo r predicting the health o f the environm ent and this has been manifested in the
exposures th a t coastal populations experience. Furthermore, even in developed na­
form o f a decision support or “expert system” th a t can be used to categorise harm ­
tions, there are very limited surveillance mechanisms in place to m onitor possible
fu l environmental impact. This decision support system can be used to categorise
changes in exposures and health in coastal populations. In addition, although inte­
environmental risk in populations o f sentinel animals (Dagnino et al., 2007).
grated ocean observing systems are being established globally to m onitor oceano­
graphic events using satellite, ship, and buoy technology, there has been relatively
The current evolving ecosystem approach to marine environmental management
little communication between the oceanographic and public health (including epi­
requires th a t the cumulative effects o f all conceivably relevant im pacting human
demiologic) communities to explore possible interactions and collaborations o f sepa­
activities are considered. Work by Defra in the UK has shown that, although per­
rate observing systems around coastal populations beyond specific examples o f early
form ance indicators play an im portant and essential role in environmental protec­
warning systems for tsunamis and hurricanes (Kite-Powell, 2008). Therefore, as the
tion, these indicators do not allow us to say w ith confidence that, for example, the
w orld’s coastal areas are increasingly impacted by human populations, it w ill be dif­
coastal seas are in a healthy state. Consequently, Defra have identified the require­
fic u lt to evaluate the impact this w ill have on the health and wellbeing o f coastal
m ent fo r a fu rth e r category o f indicators th a t can dem onstrate th a t ecosystems are
populations as well as coastal ecosystems.
healthy (Altieri e tal., 2007). These are known as indicators o f state (Defra, 2005).
FIGURE B.5.
3.5
Epidemiological modelling o f th e health o f
coastal human comm unities
Increasing num bers of people w orldw ide
have moved to live, w ork and play along
coastal areas around the world's oceans.
Increasing numbers o f people w orldw ide have moved to live, w ork and play along
coastal areas around the w o rld ’s oceans. As discussed previously, coastal living is
associated w ith both risks (e.g. natural events and extreme weather, sea level rise
w ith climate change, microbial and chemical pollution, and HABs) and benefits (eg.
access to jobs and commerce, to food supplies, and to the natural environment) for
these human populations (Dewailly, 2002; Fleming, 2006; Knap e tal., 2002).
The epidemiology (i.e. the study o f the risks and health effects) o f coastal human
com m unities is in its infancy (Backer & Fleming, 2008; Kite-Powell et al., 2008). In
developed countries, there are good data about the numbers and types o f people
living in coastal comm unities. Flowever, there has been very little exploration o f the
short- and long-term exposures, health effects, and other consequences o f living
near the oceans fo r these coastal comm unities. In developing nations, there are lit­
tle to no data on even the demographics (i.e. population numbers and characteris­
tics) o f th e ir rapidly expanding coastal populations. Flence, in these countries, there
are not even established baselines to m onitor change in the exposures and health
o f expanding coastal populations.
Furthermore, only lim ited research has been done to identify those vulnerable popu­
lations at particular risk, either due to th e ir innate vulnerabilities (e.g. the extremes
o f age, socio-economic factors, or underlying ill health), or th e ir residence in higherrisk environments (e.g. coastal communities), or a combination o f vulnerabilities.
W ith increasing impacts o f climate change and other oceans and human health
challenges, these populations m ust be identified as being particularly vulnerable
w orldw ide, and targeted for adaptation and m itigation interventions (Backer etal.,
2008). Flowever, w hile more could be done to consider w h a t populations may be
most vulnerable, even more im portant is the lack o f surveillance and epidemiology
research concerningthese vulnerable populations.
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Addressing th e pub lic h ea lth challenges
presented by th e seas and oceans
3.6
Knowledge m anagem ent, comm unication
and m axim izing th e science policy interface
There is a broad consensus that, as a society in Europe, we m ust change unsustain­
able domestic and industrial practices th a t may have been acceptable in the past
but w ill not be acceptable in the fu tu re (see ICS-UNIDO22). These changes w ill oc­
casionally be dram atic and at other tim es w ill be slow and less overt. Changes w ill
occur in the choices th a t we make as individuals, in the technologies and solutions
to problems th a t we demand from industry and government, and in the role th a t
communities, in the broadest sense, play in decision-making.
Rapid economicand population grow th are p u ttin g increasing pressures on natural
resources, and human activities are causing unprecedented environmental chang­
es. A t the same tim e, science is responding to these challenges and knowledge o f
the interactions between natural environm ent and human health is continually
growing. W ith the development o f new technologies, we are entering an exciting
and unprecedented era o f biomedical and environmental science. Scientific know l­
edge can make an im p o rta n t contribution to the economy and im proving people’s
wellbeing. However, if this knowledge remains largely inaccessible or unavailable it
w ill not be used fo r the benefit o f society. The effective management, comm unica­
tio n and targeted translation o f knowledge w ill, therefore, be critical to ensure th a t
able grounds fo r concern th a t human activities may bring about hazards to human
FIGURE 3.6.
scientific advances are used to address im portant and emerging societal challenges.
health, harm living resources and marine ecosystems, damage amenities or inter­
The EU Bathing W aters Directive
fere w ith other legitim ate uses o f the sea, even when there is no conclusive evi­
requires M em ber States to m onitor
dence o f a causal relationship. A lack o f fu ll scientific evidence m ust not postpone
popular bathing places fo rin d ic a to rs
Engaging w ith policy formulators and public health decision makers
action to protect the marine environment. The principle anticipates th a t delaying
o f m icrobiological pollution and other
The last 50 years has witnessed the steady grow th o f risk-based regulation as a
action would, in the longer term , prove more costly to society and nature and would
substances
key policy strategy fo r protecting the marine environment. Arguably, it was Rachel
compromise the needs o f fu tu re generations.”
Carson’s book Silent Spring in 1963 th a t propelled appreciation o f the widespread
impacts o f chemical pollution into the public consciousness, catalysing President
The second feature is best illustrated by perhaps the most im porta nt piece o f envi­
FIGURE 3.7.
Richard Nixon to establish the US Environmental Protection Agency nearly a decade
ronmental regulation covering the aquatic and near-shore environm ent to emerge
Rapid economic and population growth
later. Since the 1960s and 1970s an increasing am ount o f legislation has been de­
in recent decades, the EU Water Framework Directive (WFD - 2000/60/EC; EU Water
puts increasing pressures on natural
veloped in the environm ent and health arena. Some o f this has been specifically de­
Framework Directive, 2000). The WFD is underpinned by an integrated risk assess­
resources.
signed fo r protection o f the marine environm ent (e.g. OSPARfor the North Sea) and
m ent and m anagement approach, whereby there is consideration o f both chemical
various Directives applied across the EU fo r particular stressors (e.g. the Bathing
and ecological status in defining w ater quality, w ith ‘ecological status’ incorporat­
Water Directive fo r w ater quality in the context o f pathogens). Other pieces o f leg­
ing biological, physico-chemical and hydro-morphological elements (Vincent et al.,
islation are not particularly focused on the marine environm ent but are still highly
2002). Water bodies (including rivers, lakes, estuaries, coastal waters and ground­
relevant (e.g. the REACH legislation and the Stockholm Convention on Persistent
waters) are periodically assessed and assigned to a classification system th a t
Organic Pollutants, UNEP - POPs).
grades th e ir deviation (high, good, moderate, poor and bad) from a comparable site
REACH illustrates one o f tw o features o f policy and regulatory development over
2002). Programmes o f measures (e.g. risk management) are put in place to facili­
the last fe w decades. Regulation has taken an increasingly precautionary approach
tate meeting the WFD’s overarching environmental objective fo r all w ater bodies
and indeed, in the EU, policy is underpinned by an explicit com m itm ent to the pre­
to achieve “good ecological status” by 2015. This illustrates a move towards more
having no or very m inor disturbance from human activity (Environment Agency,
cautionary principle (European Community, Lisbon Treaty, A rt. 191) and enacted
holistic, integrated risk assessment and risk management approaches, in which
through mechanisms such as ‘data before m arket’ legislation enshrined in REACH
ecological goals and assessment methods play a more prom inent or even a central
and other Directives (e.g. those covering pharmaceutical products). The precau­
role. This integrated approach recognises the complex m ultifactorial nature o f en­
tionary principle is both defined and applied in different ways (Wiener & Rogers,
vironm ental risks and the need to apportion these to specific pressures such as d if­
2002). A comm only cited version is th a t defined w ith in the UN Rio 1992 Declara­
fuse agricultural pollution and point source discharges from industrial complexes
tio n : ‘where there are threats o f serious or irreversible damage, lack of fu ll scientific
or sewage treatm ent works.
certainty shall not be used as a reason for postponing cost-effective measures to
prevent environmental degradation’.
W ithin the coastal zone, this integrated approach has been expanded fu rth e r
through the concept o f Integrated Coastal Zone Management (ICZM), supporting
22 www.UNIDO.org
76
The precautionary principle has been broadened under the ecosystem approach o f
regional transboundary-level programmes for inter-governmental bodies (Brander,
the OSPAR Commission to encompass all human activities: “ By virtue o f the pre-
2007; McGlade, 2001; Moore & Csizer, 2001). This essentially “ systems approach”
cautionary principle, preventive measures are to be taken when there are reason-
assesses the changing states o f coastal ecosystems using science-based inform a77
LINKIN G OCEANS A N D H U M A N HEALTH
Addressing th e pub lic h ea lth challenges
presented by th e seas and oceans
tion, linked to socio-economic benefits for countries sharing or bordering on large
marine environm ent is given special consideration w ith in the Action Plan, but it is
estuaries and deltas. The methods can be used in an integrated interdisciplinary
possible to identify key priorities as these relate to the marine environments th a t
way in order to address the consequences o f ecosystem change and the ensuing
are covered by it.These priorities include better understanding o f the links between
im plications fo r sustainable use and development o f food resources, as well as the
environmental quality and human health (particularly for vulnerable groups such
needs o f industry and the im pact on human health.
as the young children and the very old), the development o f tools to better charac­
terize causal links (e.g. environmental health indicators, biom onitoring approaches)
and the need fo r integrated m onitoring approaches for the environm ent (including
food), to a Ilow the determ ination o f relevant human exposure. Endocrine disruption
and the effects o f chemical mixtures in the environm ent are specific areas where
more inform ation is needed (Howard, 1997; Kortenkamp & Altenberger, 1998).
Recently, a survey conducted by one o f the authors as part o f the EU Environment
and Health ERANET (a European Research Area Network o f environmental agen­
cies, research funders and Government departments across Europe) confirmed
th a t these remain priorities at an EU level (see Inform ation Box 3.1), in addition to
other priorities such as better understanding o f the risks o f emerging technologies
(such as nanotechnology), improved understanding o f the health impacts and con­
sequences o f climate change, and risk management o f priority (toxic) substances
such as mercury, PAHs, benzene, chlorinated solvents and Carcinogenic, M utagenic
and Reprotoxic (CMR) substances (Hylland, 2006; Jha etal., 2004; Kurelec, 1993).
In March 2010, the Fifth M inisterial Conference on Environment and Health, which
convened under the auspices o f the World Health Organisation in Parma, Italy, iden­
tifie d similar environm ent and health challenges for current societies around the
world (see Inform ation Box 3.1).
INFORMATION BOX 3.1.
Major environment and health policy
FIGURE 3.8.
ICZM holistically assesses the changing states o f coastal ecosystems based on in­
challenges of our times as identified by
Point source discharges from sewage
form ation obtained from five operational modules: (i) Ecosystem productivity; (ii)
European and international fora
tre a tm e n t works are incorporated into
Fish and fisheries (sustainability & seafood safety); (iii) Pollution and health (both
the in te g ra te d risk assessm ent and
ecosystem & human); (iv) Socioeconomic conditions (poverty alleviation and public
m an agem en t approach o f the EU W a ter
health im provem ent through development, education & investment); and (v) Gov­
Fram ew ork Directive. Credit:
ernance protocols.These modules link science-based inform ation to socioeconomic
Veronica French
Common policy priorities in the Environment and Health
area across the EU identified by the EnvHealth ERANET*
Key environment and health challenges identified by the
Fifth Ministerial Conference on Environment and Health
(Parma, Italy, March 2010)
benefits for countries sharing coastlines or bordering on large estuaries and deltas.
The methods can be used in an integrated interdisciplinary way in order to address
Climate change: health impacts, health consequences;
Health and environmental impacts o f climate change;
Environment and health risks o f (emerging)
technologies: nanotechnology, environmental
technologies, electromagnetic fields;
Health risks to children and other vulnerable groups
posed by poor environmental, w orking and living
conditions (especially the lack o f w ater and sanitation);
Socioeconomic and gender inequalities in the human
environm ent and health;
1995; Cassar, 2001).
Tools and techniques: health im pact assessment,
biom onitoring, socio-econom ic approaches, cost benefit (e.g. health damage evaluation);
The development of such approaches and tools to support management decisions con­
Indoor air pollution: cardiovascular health,
aeroallergens, particulates;
the consequences o f ecosystem change and the ensuing implications fo r sustain­
able exploitation and development o f food resources, as well as the needs o f in­
dustry and the im pact on human health. It is essential in the use o f these methods
to always strive to address the needs and welfare issues o f regional populations,
as well as the requirements o f industry, fisheries and agriculture for sustainable
economic development (European Commission Coastal Policy, ICZM23; World Bank,
cerning the marine environment has been an important policy priority over the last
50 years and w ill continue to be im portant in the future (e.g. current areas o f interest
include the development and use o f health impact assessment, health damage valua­
tion, human biomonitoring and cost-benefrts methodologies as supporting tools).
Vulnerable or susceptible groups, environmental health
inequalities: children, prenatal, social unevenness,
environmental justice;
Endocrine disruption.
Burden o f non-communicable diseases, in particular
to the extent th a t it can be reduced through adequate
policies in areas such as urban development, transport,
food safety and n u tritio n, and living and w orking
environments;
Persistent, endocrine-disrupting and bio-accumulating
harm ful chemicals and (nano)particles.
Further policy priorities in the EU in the general area o f environm ent and health
78
23 h ttp ://e c .e u ro p a .e u /e n v iro n m e n t/ic z m /
policy have been articulated w ith in the EU Action Plan on Environment and Health
p d f/e v a lu a tio n _ ic z m _ re p o rt.p d f
(Hester and Harrison, 2011), w hich covered the period between 2000 and 2010.The
*www.era-envhealth.eu, adapted from Moore et al. (2011)
79
LINKIN G OCEANS A N D H U M A N HEALTH
Addressing th e pub lic h ea lth challenges
presented by th e seas and oceans
These policy priorities are very complementary and in some cases sim ilar to the sci­
entific challenges identified in Chapter 1, although from a policy perspective priori­
ties remain predom inantly focused w ith in a risk assessment and risk management
framework, w ith little consideration o f some issues such as the marine environ­
m ent as a health-prom oting resource.
Engaging w ith the public
As noted above, a m ajor challenge is to change the behavior o f human populations
affected by oceans and human health around th e ir health and the health o f the
oceans. One way is to increase th e ir involvement in oceans and human health re­
search as “citizen scientists.” Examples o f citizen science initiatives include the Jellywatch programme24, designed to collect inform ation on the distribution o f jellyfish
species in the Mediterranean Sea and supported in ten countries. Other examples
include beach clean ups, marine mammal stranding networks and bird sightings.
Another key requirement w ill be the improved com m unication w ith the general
public o f the close links between the oceans and human health. “ Ocean literacy” is
a term th a t has been coined to describe the capacity o f people to:
understand the essential principles and fundam ental concepts about the fu n c­
tio n in g o f the ocean;
communicate about the ocean in a m eaningful way; and
make informed and responsible decisions regarding the ocean and its resources25.
Ocean Literacy can be explored and promoted at all ages through the form al school
curriculum and beyond. One example is a high school student and teacher targeted
curriculum called AMBIENT26 which explores various science and literacy skills re­
lated to the environm ent and human health using a HAB-related foodborne illness
as a case study27. The establishm ent o f the European Marine Science Educators’ As­
sociation28 in 2012 represents a major step forward in the development o f Ocean
Literacy in Europe. Since then, tw o European conferences on Ocean Literacy have
been held, the firs t in Bruges, Belgium in October 2012 and the second in Plymouth,
UK in September 2013. Thanks to these efforts, the European Commission is begin­
FIGURE B.9.
ning to recognize the key role o f ocean literacy in supporting its broader goals o f a
One w ay to raise aw areness of the
th rivin g blue economy and good environmental status o f European seas.
lin k between hum an health and the
health of the oceans is to increase the
Targeted research around the knowledge and decision making of human com m uni­
general public's involvem ent in oceans
ties affected by oceans and human health issues is also needed. For example, Kuhar
and hum an health research as "citizen
et al. (2009) and Nierenberg et al. (2009) investigated the public perception and
scientists." An example is the recording
consequent reactions to Florida red tides among persons living and visiting coastal
of m arine m am m al sightings and
areas regularly affected by the FIABs. The results indicated th a t coastal residents
strandings. Credit: Neil Collier
and tourists may not have been effectively inform ed about Florida red tides and
th e ir impacts because o f inconsistent public outreach. Preferred inform ation sourc­
24 w w w .focu s.it/m edu se
es included internet (80% o f tourists and 53% o f residents) as well as a local science
45 h ttp ://w w w .c o s e e .n e t/a b o u t/
organization (66%), w hile to ll free numbers were rarely (14%) used by tourists.
o c e a n lite ra c y /
46 h ttp ://y y y .rs m a s .m ia m i.e d u /g ro u p s /
80
This type o f evaluative research has led to targeted outreach and education which
n ie h s /a m b ie n t
has evolved from basic p rint material (flyers and posters) to an interactive website,
47 h ttp ://y y y .rs m a s .m ia m i.e d u /g ro u p s /
to the use o f video and social netw orking technologies, such as Facebook and Tw it­
n ie h s /a m b ie n t/te a c h e r/fo o d /T fo o d .h tm l
te r (Nierenbergetal., 2011, Figure 3.10 and Figure 3.12). In addition, there has been
43 http ://w w w .e m s e a .e u
an increase in the use o f various sources and methods o f inform ation delivery on
49 h ttp ://c o o lg a te .m o te .o rg /
oceans and human health issues. To take another example from the US, the Beach
b each con dition s/; tel: 1-941-BEACHES
Conditions Reporting System29 is a network which has been set up to collect and
LINKIN G OCEANS A N D H U M A N HEALTH
Addressing th e pub lic h ea lth challenges
presented by th e seas and oceans
report real tim e data from life guards and beach managers on a range o f beachrelated issues (including respiratory irritation and dead fish from HABs, and oil from
oil spil Is) to the p u b licthro u g h o u t the G ulf o f Mexico. The inform ation is accessible
through phone or internet (Kirkpatrick 2009, Nierenberg et al. Fleming et al., 2011
Figure 3.11).
FIGURE 3.10.
Y o u r l y m p f M i iA n u v b e r c lj i c - J ct> I I n r i i J a R « d l i d v
The Florida Poison Inform ation Center has created and form ally evaluated a 24/7
c Kk Il Ifod lld t c o n d i t i o n * i »d u*r cutiuiuui u-*id.
( k ita i, ü ttlo w * thu u M m s le y»u Fed twUïT.
to ll free num ber on aquatic toxins w hich allows the caller to access inform ation on
"Ui Kfir jíL Cu * hrjlth p n f r u t a n i l i m t i n i c , bull f m ,
«II the Himhíj «HI llde ¡Hrjll hllacllitr.
a range o f aquatic toxin issues including Florida red tide in English and Spanish, as
I-8SS-232-S635
t r i i ik f í f r>'ji ihi i Ílíd Tidlí
well as to speak directly w ith a trained Florida Poison Inform ation Specialist (Flem­
ing, 2007). M onitoring inform ation for the Florida red tide organism has become
more available through the Florida Fish and W ildlife Commission30, and through
Florida Red Tide Beach Signage (Courtesy
Florida Dept o f Health, START, Mote
M arine, U niversity o f M iam i Oceans 8
Hum an Health Center, Florida Poison
Info rm ation Center, and Ms W endy
Stephan MPH)
the NOAA G ulf o f Mexico PIAB Bulletin31 (Stum pf et al., 2009) (Figure 3.12). Finally,
“grassroots” com m unity groups (e.g. Solutions to Avoid Red Tide [START32]) health
S O 'C O O L
M iïT E
HUINI UlAailfiTl
i
m h
educators, public health managers, and researchers have developed targeted ma­
terials to educate various groups about exposure to and health effects from Florida
red tide toxins, including: coastal residents and tourists, healthcare providers, and
beach managers.
Horizon scanning for emerging hazards, risks and benefits
It w ill become increasingly im p o rta n t to develop a perm anent surveillance for
FIGURE 3.11.
emerging problems affecting human health related to the coastal and oceanic
Beach Conditions Reporting of the Gulf of
environment. M any o f these are readily apparent and can be predicted w ith vary­
Mexico Beach by Mote M arine Laboratory
ing degrees o f confidence as outlined in this paper. However, as has been the case
and Collaborators ( h ttp ://c o o lg a te .m o te .
w ith many health problems, these can emerge from unexpected quarters and over­
org/beachconditions).
w helm unsuspecting public health organizations.
NOAA HAß Bulletins
Forecast
D e ta ile d A n a ly s is
FIGURE 3.12.
N atio n al Oceanographic and Atmospheric
Infrared S atellit«
A d m in istration (NOAA) Harm ful Algal
Im a g e r y (C h la ro p h y i)
Bloom (HAB) Bulletin
W ind Speed Graph
( h ttp ://tid esan d cu rren ts.n o aa.g o v/h ab /
bulletins.htm l)
30 h ttp ://re s e a rc h .m y fw c .c o m /fe a tu re s /
vie w _article.asp?id= 9670
31 h ttp ://tid e s a n d c u rre n ts .n o a a .g o u /h a b /
b u lle tin s .h tm l
33 h ttp ://w w w .s ta rt1 .c o m
82
83
The marine environm ent contributes significantly to public health and w ell-being
through the provision and quality o f air we breathe, the food we eat, the w ater we
drink and in offering health-enhancing economic and recreational opportunities.
At the same tim e, the marine environm ent is threatened by human activities such
as transport, industrial processes, agricultural and waste m anagement practices.
Although we remain dependent upon marine ecosystems, humans have altered,
and w ill continue to alter, the marine environment. Evaluation and management
of the resultant impacts, on both marine ecosystems themselves, and on human
health, have largely been undertaken as separate activities, under the auspices o f
different disciplines w ith no obvious interaction. Hence, many o f our perceptions o f
the relationships between the marine environm ent and human health are lim ited
and still relatively unexplored, leaving critical knowledge gaps fo r those seeking to
develop effective policies fo r sustainable use o f marine resources and environm en­
tal and human health protection.
Research in Oceans and Human Health m ust be directed at elucidating key environ­
mental processes, and providing a predictive capability fo r both biotic and abiotic
environmental influences on human disease and well-being. The way forward re­
quires the mobilization o f interdisciplinary competencies around Europe and en­
suring th a t the necessary scientific and technical capabilities are available. The key
recommendation o f this position paper is th a t a coordinated European programme
o f research in the area o f Oceans and Human Health should be developed and sup­
ported to ensure the scale o f investm ent and collaboration necessary to address
the m ajor challenges o f understanding and dealing w ith the immense com plexity
of marine environm ent and human health interactions. The support for, and estab­
lishm ent of, such a programme w ill ultim ately allow us to:
better understand the potential health benefits from marine and coastal eco­
systems;
reduce the burden o f human disease linked w ith marine environmental caus­
es; and
anticipate new threats to public health before they become serious.
A European Oceans and Human Health programme could also provide a platform
for collaboration w ith other Oceans and Human Health initiatives (e.g. NIH/NSF
and NOAA programmes in the USA) which w ill facilitate synergies and added val­
ue. This is an opportunity fo r the EU to build on existing and developing research
platform s and opportunities fo r the benefit o f not only EU citizens, but the global
coastal com m unity (particularly in developing nations).
Key Elements of an Oceans and Human Health Research Programme
If society is to have a practical capability to forecast how changes in the marine and
other environments im pact on linkages between natural systems, social systems
and human health, we m ust develop a better understanding o f the fun ctioning o f
the biosphere and our connections w ith it (Allen, 2011). The complex and causal
interconnections between marine environm ent and human health requires a sys­
tem s approach addressing all levels o f organization from genes to ecosystems. Such
an integrated systems approach m ust be interdisciplinary drawing on the skills and
expertise o f many scientific disciplines as well as the social and economic sciences
(see Figure 4.1).
LINKIN G OCEANS A N D H U M A N HEALTH
A European Research S tra te g y fo r Oceans
and H u m a n H ealth
W hile such predictive capability m ust remain a major long-term scientific goal, the
All placed in the context of clim ate change
Active and passive
waste managem ent
drivers and transport
Land use
ch ange
Natural sources
I
Pollutants & pathogens
incl. nanoparticles, radio­
nuclides, bacteria, viruses,
nutrients & mixtures
U rbanisation
/
land-ocean
interface
FIGURE 4.1.
scope o f an Oceans and Human Health Programme should have an initial focus on
Schem atic diagram of a systems
exploratory research (e.g., “ proof-of-concept” ) and on building the interdisciplinary
approach to m arine environm ent and
com m unity required for the longer-term task. A particular emphasis in an Oceans
hum an health illu s tra tin g the interfaces
and Human Health programme m ust be to brin g th e research com m unity together
between the land and the ocean and
w ith policy makers and decision makers in order to foster the process o f policy fo r­
between the natural environm ent and
m ulation through improved knowledge transfer and exchange.
medical and social sciences (Allen, 2011)
A significant aspect of an OH H Programme should be the inclusion o f broader socio­
Effects on m arine
ecosystem services
Environm ental Algal toxins
status —
(HABs)
uptake, pathways and
impacts
Food
Q uality
economic issues addressing people-oriented, environmental health-related prob­
lems. Particular emphasis needs to be placed on the integration o f public health
w ith in an ecosystem-based approach to management, as described in Chapter 1.
‘Blue gym ’
Aquaculture
Fisheries
Unfortunately, there remains a relative dearth o f substantial epidemiological and
public health data th a t w ould perm it a comprehensive understanding o f possible
environm enthuman interface
causal links between human and ecosystem health (see M illennium Ecosystem
Assessment, 200533 and the World Health Organization34). However, by effectively
Human Health
S o cio lo g y
identifying and interconnecting the interdisciplinary elements, we are beginning to
W ellbeing
Econom ics
see the emergence o f new ways o f solving problems in w h at are, at present, areas
Human dim ension
societal consequences
and policy responses
o f research th a t have tradition ally had little connection w ith one another (Di Giulio
R egulatory fram ew ork including EU D irectives
& Benson, 2002).
Effective com m unication o f risk and risk assessment is an area th a t is still challeng­
ing. We need to conduct m onitoring more effectively and improve risk com m uni­
Living systems are strongly interdependent, often in ways th a t continue to surprise
cation practices, especially in relation to epidem iologic data. Questions arise as to
us, and environmental impacts - by both natural events and man-made interven­
w hether we need alternatives to standard risk assessment; w hether current risk
tions - are a fact o f life. Among these impacts are harm ful environmental pollutants
assessment approaches and existing legislation are sufficient; and w hether more
and potentially pathogenic organisms to which people are exposed through a vari­
efficient approaches are available o rto be developed?
ety o f complex transport and exposure pathways, e.g. through air (including marine
aerosols), sediment, w ater and from chemical and microbiological residues in food.
More effective public health outcomes may be delivered through the creation o f sci­
Many o f these issues relate to complex problems such as the environmental biol­
ence o u tp u t th a t can be beneficial to public health through knowledge exchange.
ogy and geochemistry of estuarine and marine sediments, and how these influence
Other new actions such as adding a component o f environmental m onitoring to
the transport, accessibility and bioavailability o f chemical pollutants and infectivity
existing Public Health observatories and creating public awareness should also be
o f pathogens. The dispersion o f harm ful particles in the oceans is another area of
explored and expanded. For example, in the USA there are initiatives making use of
major concern, including how environmental factors may govern th e ir to xicity to
public/tourists in coastal areasto increase observation capacity via the distribution
marine organisms and human consumers o f seafood. How exposed populations
o f hand microscopes and reporting on smartphones, o f beach conditions including
respond to these stressors in both the short and long-term w ill depend on both the
HABs and oil spills. The Eye on Earth in itiative 35, including a ‘w atch’ on EU bathing
degree o f exposure and on individual factors (such as socio-economic and n u tri­
w ater quality and a forthcom ing ‘w atch’ application on marine litte r represent good
tional status, age, genes, gender and behavioural aspects) th a t influence avoidance
examples o f initiatives th a t raise awareness through involvement in observation
or risk-accepting attitudes.
activities.
Developing the capa city to predict and m inim ise impacts o f potential risks (and their
Improved integration, communication and training w ill be essential in order to cre­
harm ful consequences fo r biological resources, ecosystems and human health) is a
ate a European Oceans and Human Health research community. This w ill be com­
daunting task fo r legislators and regulators. Evaluating environmental risk requires
plemented by the provision o f a best practice guide for public health authorities.
dealing w ith complex issues such as the effects o f the physico-chemical interac­
This guide w ould complement the RASFF (Rapid Alert System on Food and Feed) and
tions on the spéciation and uptake o f po llu tan t chemicals; inherent inter-individual
inform in order to guide local decision makers.
and inter-species differences in vulnerability to toxicity; the emergent to xicity o f
complex chemical m ixtures; and knowledge o f reservoirs o f microbial pathogens as
Strategic research priorities and enabling actions
well as factors governing infectious via b ility (Allen, 2011; Moore et al., 2011). It is,
86
33 ururur.m illennium assessm ent.org /e n /
index.aspx
therefore, not surprising th a t these are areas o f grow ing public and governm ent in­
Taking into account all relevant environmental com partm ents in the coastal zone,
34 h ttp ://u ru ru r.u rh o .in t/to p ics/
terest, which are reflected in various national and international priorities; fo r exam­
the Oceans and Human Health W orking Group has identified a number o f key re­
e n v iro n m e n ta l_ h e a lth /e n /
ple, in the NSF/NIH Oceans and Human Health Programme (USA), the EU, the World
search targets to build the necessary Oceans and Human Health research capability
33 http://ururur.eea.europa.eu/about-us/
Health Organisation (M illennium Ecosystem Assessment, 2005), and International
in Europe (see Inform ation Box 4.1). These targets should therefore constitute the
u rh a t/in fo rm a tio n -s h a rin g -1 /e y e -o n -e a rth
Year o f Planet Earth 2006 (Earth and Health theme).
main objectives o f the envisaged European Oceans and Human Health Programme.
87
LINKIN G OCEANS A N D H U M A N HEALTH
1.
A European Research S tra te g y fo r Oceans
and H u m a n H ealth
INFORMATION BOX 4.1.
has already been done to address these targets, both at the scientific and policy
Innovative m onitoring and surveillance techniques in place which
Recommended strategic research
level, although often from a topical or sectoral perspective, respectively. For exam­
allow a much greater provision o f relevant and accurate data (e.g.
targets of an envisaged European
ple, the indicators m entioned in research target 6 (see Inform ation Box 4.1) exist to
remote observation systems fo r coastal and marine ecosystems,
Oceans and Human Health Research
a certain extent or are being developed under the MSFD. M ethods to demonstrate
detection o f chemical and material pollutants, biogenic and
Programme
value m entioned in research target 7 (see Inform ation Box 4.1) also exist to a cer­
microbial toxins and human pathogens, and improved te s tin g fo r
tain extent or are being developed in the context o f the im plem entation o f Target
seafood and w ater safety.
2/Action 5 o f the EU 2020 Biodiversity Strategy, and/or by Member States carrying
out MSFD initial assessments. Hence, when developing the European research ca­
2.
Improved understanding o f the physical, chemical and biological
pability in OHH, there is a need to build on, support and complement past and cur­
processes involved in the transport and transmission o f toxic
rent efforts and existing frameworks th a t share the same research targets.
chemicals and pathogenic organisms through the marine
environm ent to humans.
3.
Improved understanding o f the direct and indirect causal
relationships between degradation o f the marine environm ent and
the incidence o f diseases and adverse and beneficial effects on the
w ell-being o f the human population.
4.
INFORMATION BOX 4.2.
Cross-cutting enabling actions and
Provide adequate support fo r interdisciplinary research and training
capacities required to maximize the
o f young investigators to build capacity and improve our knowledge
Improved environmental models to determ ine the extent o f natural
efficiency and impact of a European
base on the marine environm ent and human health which is
dispersion o f sewage, agricultural effluents and industrial waste.
Oceans and Human Health research
currently fragm ented both in Europe and globally. A particular
programme
5.
focus should be on developing m odelling capacities (e.g. to design
Expert systems to link existing models w ith our experience and
early w arning systems) and linking experts in fields as diverse
knowledge o f the connectivity between the marine environment
as oceanography, marine ecology, ecotoxicology, epidemiology
and human health
and public health. Where relevant and possible, collaborative
Appropriate indicators to show the effectiveness o f moving
establishing co-funded PhDs and Research Fellowships;
links should be developed w ith the private sector, fo r example by
6.
towards sustainable development where environmental, social and
economic measures are linked.
Increase knowledge management and horizon scanningfor
emerging problems, benefits and technologies in relation to the marine
7.
Methods and mechanisms which demonstrate the value
environment which may impact on human health and well-being;
(economic, cultural, aesthetic etc.) to human w ell-being o f marine
environments at local, regional and global scale.
Build bridges between relevant stakeholders, fo r example by
involving stakeholders at the outset o f project form ulation;
Develop specific netw orking actions to overcome the fragm ented
To successfully realise the objectives o f a large interdisciplinary European research
research capability in Europe;
e ffo rt on Oceans and Human Health, it w ill be necessary to develop and/or improve
a range o f research support functions and capacities. Capacity-building is consid­
Stimulate creative thinking and develop opportunities to explore
ered to be crucial in order to increase European competence in this area and is ur­
alternatives to standard risk assessment procedures;
gently required to overcome the fragm ented nature o f current research effort in
Europe. Initial investments at European level should aim to fast-track the develop­
Improve comm unication between research com m unity and
m ent o f these structural elements, w hich w ill be crucial to the long-term capac­
authorities in charge o f environmental protection, food safety and
ity o f Europe to support a m ajor research programme linking marine environment
human health;
and human health. Key areas fo r attention w ill include research infrastructures
(including observation and m onitoring platforms), building o f interdisciplinary net­
Improve comm unication to, and participation by, the w ider public
w orking and partnerships, improved tra in in g programmes (PhDs and early stage
to raise public awareness about the complex relationship between
researchers), knowledge m anagement protocols and science-policy interfaces to
oceans and human health. This includes supporting activities to
ensure rapid uptake o f policy-relevant knowledge.
promote Ocean Literacy w hich entails outreach to the public to
improve the understanding o f the im portance o f the oceans and,
Implementation of a European Oceans and Human Health Research Programme
more specifically, about risks and benefits o f human interactions
w ith the marine environm ent (e.g. through citizen science-public
Considering the research targets to build the Oceans and Human Health research
participation, beach watches, etc.).
capability in Europe (Inform ation Box 4.1), it is im portant to recognize th a t much
89
LINKIN G OCEANS A N D H U M A N HEALTH
A European Research S tra te g y fo r Oceans
and H u m a n H ealth
In spite o f progress in the last decades, there remains an im p o rta n t need to con­
sider and address the long and diverse set o f policies and regulations relevant for
OHH in a more integrated way than hith e rto achieved. One o f the firs t steps should
therefore be to perform a thorough analysis o f the various policies and legislations
which have a bearing on the complex relationship between our marine environ­
m ent and human health, to identify weaknesses, gaps and overlaps, and consider
mechanisms to strengthen th e ir interactions to improve effectiveness.
When im plem enting the OHH Research Programme, it w ill be essential to move
towards a joined-up flexible research effort; not ju s t m ulti-disciplinary, but a tru ly
integrated and interdisciplinary e ffo rt th a t links to policy considerations and risk
management in a whole ecosystem context. A dedicated programme w ill therefore
require a holistic and interdisciplinary approach and m ust be o f sufficient scale to
allow a coordinated, m ulti-national collaboration. Particular emphasis should be
put on ecosystems as providers o f environmental goods and services and th e ir sus­
ta in a b ility as well as identifying the potential threats to these goods and services.
W hile it is necessary to increase our understanding o f fundam ental processes and
complex interactions, Oceans and Human Health research should put consider­
able focus on fin d in g tangible solutions (including capacity building) for known
and emerging problems, and supporting current and fu tu re policy requirements. To
ensure effective knowledge exchange between researchers, policy form ulators and
other stakeholders (e.g. NGOs and industry), an effective knowledge management
system w ill be essential.
From an EU perspective, a key policy fram ew ork fo r developing a coordinated and
science-based approach to the link between oceans and human health is the M a­
rine Strategy Framework Directive37. The recommendations o f this paper w ill also
have relevance to the m anagement o f catchments, groundwater, estuarine and
coastal marine environments under the EU W ater Framework Directive38, as well as
the developing EU Coastal Zone Policy. Key European programmes w hich have the
capacity to support an Oceans and Human Health initiative include Horizon 2020,
the EU’s next programme fo r research and technology development (2014-2020),
and the newly emerging European Joint Programming Initiatives. However, nation­
al research programmes should also provide support fo r the rapid development o f
research programmes and capacities in the area o f Oceans and Human Health.
A European Oceans and Human Health Programme should also encourage inter­
national collaboration w ith other Oceans and Human Health initiatives (e.g. N IH /
NSF and NOAA programmes in the USA) as this w ill facilitate synergies and added
value. This is an opportunity for the EU to build on existing and developing research
platform s and opportunities fo r the benefit not only o f EU citizens, but a global
coastal-dwelling com m unity (particularly in developing nations).
The research com m unity required to address Oceans and Human Health challenges
in Europe is currently very fragm ented and recognition by policy makers o f some
o f the problems is probably lim ited. Nevertheless, relevant policy issues fo r gov­
ernments w orldw ide include the reduction o f the burden o f disease (including the
37 See h ttp ://e c .e u ro p a .e u /e n u iro n m e n t/
early detection o f emerging pathogens) and im proving the quality o f the global
w a te r/m a rin e /d i re c tive_en.htm
environment. Failure to effectively address these issues w ill im pact adversely on
33 See h ttp ://e c .e u ro p a .e u /e n u iro n m e n t/
efforts to alleviate poverty, sustain the availability o f environmental goods and ser­
w a te r/w a te r-fra m e w o rk /
vices, and improve health and social and economic stability.
C re d it: Neil C o llie r
90
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