Do the Oceans really affect our health and wellbeing?

1. Do the Oceans really affect our health and wellbeing? Professor Michael H. Depledge PhD DSc FRCP Chair of Environment and Human Health

2. The environments in which we live influence our health, wellbeing and longevity. 25% Genes : 75% Environment

3. Context Mountains and Human Health Rivers and Human Health Oceans and Human Health Forests and Human Health Deserts and Human Health Savannah and Human Health

5. Oceans and Human Demographics • 2-3 billion increase in population by 2050 in developing countries of the tropics and subtropics. • Sewage disposal largely into estuaries and coastal waters. • More than half of the world's 7.4 billion population currently live in cities. Up to 60% by 2030. • World’s 33 mega cities each have > 8 million residents). • 21 are coastal/estuarine cities. • 50% of the EU citizens live within 50 km of sea.

6. Why focus on coastal communities? • Seafood is a vital source of protein (half from coastal aquaculture). • Reduction or interruption of this food supply could be catastrophic both economically and with regard to the health and wellbeing of more than 2 billion people.

7. Why focus on coastal communities? • Industrial manufacture is shifting to lower and middle income countries mainly near rivers, estuaries and coasts (with associated pollutant discharges) • Many adverse impacts of climate change are (& will be) felt by coastal and estuarine communities (sea-level rise, storms, altered precipitation and ocean currents, etc.)

8. The Human Connection: Thames Estuary, England

9. A historical perspective…….

10. More….. More people living by the coasts More consumption of goods and energy More transport across our sea. More frequent and intense storms More sea level rise and coastal flooding More invasive species More algal blooms More chemical contaminants More contamination with plastics (macro, micro and nano) More pathogens (potentially antibiotic resistant pathogens) More extensive aquaculture (GMOs?) More coastal and marine tourism (active leisure and cruises) More deep sea mining More exploration for non-renewable energy resources (deep sea fracking) More renewable and non-renewable energy from the sea. More extensive knowledge of ocean geomorphology and biology (including many new species) More detailed knowledge of the ocean-climate system

11. Leading Causes of Death (1900 vs 2010) 1.5 What next? 7.0

12. Why should medical professionals be concerned about the threats posed by seasand oceans to human health?

13. Health impacts in coastal communities • Coastal Flooding: ca. 1560 flood disasters - 1994-2004. • Killed120,000, affected 2 million. • Hurricanes and Typhoons: Mitch, Honduras, Oct 1998. 18,000 deaths. • Katrina, USA, Aug. 2005. 1800 deaths • Haiyan, Philippines, Nov 2008, 5200 deaths • Earthquakes and Tsunamis: 226,000 deaths - 13 countries over 10 yrs. • 150,000 additional deaths due to disease. • Infectious Diseases: >700 million live near coasts - discharge raw • sewage >> 120 million cases GI disease pa. • 50 million cases of respiratory disease pa. • 4 million cases of Hepatitis A, 40,000 deaths pa. • ca. 3–5 million cholera cases;100K –120K cholera • deaths pa.

14. Health impacts in Coastal Communities. • Algal blooms: ca. 60,000 cases of gastroenteritis and respiratory • disease from seafood (containing algal toxins) pa. • Paralytic shellfish poisoning, amnesic shellfish poisoning, Ciguatera. • Drowning: ca. 372,000 people drown pa. • Work-related deaths: 2000-2006, average annual fatality rate in USA - 115 deaths per 100,000 fishermen. 3 times greater than the next most dangerous occupation. > than 25 times that USA national average across all workers. • Recreation in estuarine and coastal areas: > 355,000 people injured annually in recreational boating accidents, 40% of injuries require medical treatment beyond simple first aid. In Europe, 14,000 - 47,000 injuries occur during water sports and boating every year.

15. Chemicals Pollutants in the Sea • Pesticides(DDT, organophosphates, carbamates, etc.) • Fertilizers (phosphates, nitrates) • Industrial chemicals • - Heavy metals and metalloids. • - Organics (PCBs, PAHs, BPA, PFs, Dioxins, BFRs, Plastics). • - Nanomaterials. • Pharmaceuticals(antibiotics, analgesics, cardiovascular • and respiratory drugs, contraceptive pills, chemotherapy agents, etc. • Gases(carbon dioxide, carbon monoxide, methane, etc.) • Particulates

16. Global Chemical Production …………………………………………… …………………………………………… …………………………………………… …………………………………………... …………………………………………… …………………………………………… …………………………………………... …………………………………………... …………………………………………... ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… …………………………………………... …………………………………………... …………………………………………... …………………………………………... …………………………………………... . . …………………………………………... …………………………………………... …………………………………………... …………………………………………... …………………………………………... …………………………………………... …………………………………………... …………………………………………… …………………………………………… …………………………………………… …………………………………………… …………………………………………… …………………………………………… …………………………………………… …………………………………………… …………………………………………… 2016 1940

17. Chemical Pollutants and Contaminants Lang, I.A, Galloway, T.S., Scarlett, A., Henley, W.E., Depledge, M.H., Wallace, R.B. and Melzer, D. (2008). Association of Bisphenol A concentration with medical disorders and laboratory abnormalities in adults. Journal of the American Medical Association, 300(11), 1303-1310. Melzer D, Rice N, Depledge MH, Henley WE, Galloway TS 2010. Association Between Serum Perfluoroctanoic Acid (PFOA) and Thyroid Disease in the NHANES Study. Environ Health Perspect:-. doi:10.1289/ehp.0901584

18. Men Women Millions Dioxin TEQ levels by age: 4 studies Patterson, ORGANOHALOGEN COMPOUNDS – Volume 66 (2004)

20. Benefits of New Technologies Nanotechnology & the Life Straw Plus thousands more! e.g. Sunscreen, fuel additives, antiseptics, medicines, novel electronics, paints, decontaminating of land, water and air, fabrics...

21. Do some nanomaterials pose new threats to coastal ecosystems and human health? How would we know? N.B. San Francisco Bay

22. Pharmaceuticals and the Ageing Demographic

23. Antimicrobial Resistance: An emerging threat in marine environments? • Coastal waters receive sewage discharges and agricultural runoff. • Antimicrobial agents present in increasingly large amounts in coastal waters. • Derived from medical use (~40%) and veterinary Use (~60%) • Low AM concentrations select for resistant strains (bacteria, viruses, fungi) • Are people likely to become contaminated? (Florida studies) • Does this result in AMR infections? Pathogen Pollution

24. . 16 November 2012 Resistance to antibiotics is one of the greatest threats to modern health, experts say. The chief medical officer, Prof Dame Sally Davies, said: "Antibiotics are losing their effectiveness at a rate that is both alarming & irreversible, posing a threat similar to global warming”. Depledge, M.H. Nature, Vol. 478, 6th Oct. 2011. p36

25. May, 2009. c m.depledge@exeter.ac.uk

26. Oh damn! was that today?

27. Climate change, pollution and coastal seas • Climate change alters local environmental conditions including temperature, salinity, oxygen concentrations and pH (acidification). • Climate change influences the bioavailability of environmental pollutants (persistence, toxicity, transformations) • Climate change influences the distribution and lifecycles of organisms – and hence the pollutants that they come into contact with.

28. Integrated impacts of the Oceans on Human Health Modified from Moore, M.N. Depledge, M.H. et al. 2012, Microbial Ecol.

29. Do the treatment of diseases and the pursuit of health require different approaches? HEALTH Healthy Diet Physical Activity Time in NatureLifestyle choices Socio-cultural environment. Avoidance and mitigation of pathogen threats Avoidance of natural & anthropogenic hazards. DISEASE Surgery PharmaceuticalsChemotherapy Radiotherapy Immunotherapy Transplantation Fertility treatment Gene therapy Gene editing etc. Interventions by Public Heath Agencies Done by you Done to you Related to Environmental Quality Environmentally damaging

30. The unexpected value of the Oceans.

31. Addressing the Obesity and Mental Health Epidemics 1 in 4 people Women - 37-57% Men - 51-69% Eurostat 2010

32. What can coastal areas do for you? • Increased energy use (standing, walking, running, etc.). • Mental stimulation (reduced risk of psychiatric disorders, improved sense of wellbeing). • Long term motivation and beneficial habits. • Increased social cohesion. • Something EVERYONE can do.

33. Blue Gym…Blue Health https://www.youtube.com/watch?v=Jq44KhBSgQA Sailing Rockpool rambles Health and Wellbeing from the Environment Coastal walks Kayaking Surfing Swimming Diving

34. Does living by the sea improve your health and wellbeing? B. Wheeler, M. White, W. Stahl-Timmins and M.H. Depledge, 2012 .

35. Oceans, Health and the Economy • Children who live within 500 m of accessible blue/green space are 24 per cent more likely to meet recommended levels of physical activity. • Reducing the sedentary population by just 1 per cent could reduce UK morbidity and mortality rates valued at £1.44 billion

36. Future Challenges…… • How can we assemble a consensus view of how to manage, protect and develop European oceans and human health over the next 20 years? • What should be the role of • European marine and health • experts in identifying • managing emerging threats • and opportunities? • What are the major research • questions that we should address in the • short term (5years) and the longer term • (5-20years)?

37. The Future we want…. • Global population – decreasing after 2050. • Technological advances that can reduce pollution. • Improvements in aquaculture and land use that can deliver more food. • Conservation strategies that can protect and restore marine biodiversity and sustainable estuarine ecosystems. • Greater understanding of marine ecosystems that will provide new insights and reveal new ways to use renewable resources. • Identification of policy co-benefits that improve cost effectiveness of actions. • Recognition that marine environments offer huge opportunities for improving human health and wellbeing in harmony with sustainable ecosystems.

38. John Ruskin 1819 - 1900 “There is no wealth but life” To support environment and health research please contact: m.depledge@exeter.ac.uk