The ocean and human health

Writing team: Michael Moore (coordinating author), Lorraine Backer, Maria Bebianno (lead member),Elisa Berdalet, Timothy Bouley, Alistair Boxall, Donovan Campbell (co-lead member), Lora Fleming,William Gaze, William Gerwick, Awadhesh Jha, Hanna Joerss, Jae Ryoung Oh, Francesco Regoli, Aldo Viarengo and Zhiyong Xie.

Key points

• The health of the ocean and of the human population are inextricably linked within a highly complex network that is global as well as regional.
• Benefits include seafood, medicines from marine organisms and the well-being opportunities of populations living near the sea.
• Harmful effects arise from exposures to algal toxins, pathogens, combustion-derived and synthetic chemicals, microparticles and nanoparticles (particularly plastics), coupled with climate change, biodiversity loss and ecosystem degradation due to excess nutrients (nitrogen and phosphorous), diffuse waste and contaminant mixtures, as well as natural threats.
• Despite various international agreements, marine biodiversity continues to decline, and several ecosystems, such as the Atlantic cod fishery, the Black Sea fishery, and the northern Benguela upwelling system, have declined.
• Identifying a single causative factor for many adverse health effects is overly simplistic: a holistic interdisciplinary approach to ocean and human Health is required to focus on the integrated impact of pollutants and environmental factors, including temperature, salinity, hypoxia and acidification.

1. Introduction

For millenniums, humans have lived in close proximity to the sea, and the populations of the global coastal zone (within 100 km from the coast) is currently 38% of the human population Ref 52. This trend reflects the range of benefits coastal living offers, including access to marine resources, opportunities to trade by sea and a sense of well-being that many coastal dwellers derive. However, the trend has already resulted in severe damage to marine ecosystems worldwide as humanity has not interacted sustainably with the oceans; and the more benefits acquired, the greater the damage, in turn threatening future benefits Ref 59 Ref 58 Ref 172. The Black Sea fishery has not yet experienced a total, irreversible collapse, but the combined impacts of long-term overfishing, recent environmental disasters and persistent unsustainable practices, such as ships' ballast water releases, and the report on The State of Mediterranean and Black Sea Fisheries indicates that excessive exploitation has diminished in the region, particularly for key species subject to multilateral management plans. All are recovering, although not necessarily at the previous level. However, 73% of commercial species are still overfished and under fishing pressure, which, while lower than in the past, is still double what is considered sustainable (see Sharma and others (eds.), 2025, for information on specific stocks. Unfortunately, numerous international agreements have failed to prevent the progressive introduction of alien species Ref 59.

Human health and well-being are intrinsically linked with marine ecosystem integrity, depending on the global ocean for food, oxygen, water and climate regulation Ref 87. Human health linkages were first promulgated in the Intergovernmental Oceanographic Commission of the United Nations Educational, Scientific and Cultural Organization (UNESCO- (IOC) Health of the Oceans component of the multi-agency Global Ocean Observing System in the 1990s. The second World Ocean Assessment highlighted the complex network of interactions with ocean and human health, and figure I shows these linkages in much greater detail. Many of these health-related interactions are beneficial, while others can be detrimental Ref 134.

Figure I A tangled net: selected interactions between human health and activities in the marine and coastal environment

Linkages between human health and well-being (see subsect. 5B, chaps. 3 and 4) and the ocean have been known for a long time. New information and understanding by environmental scientists and epidemiologists reinforce the importance of these linkages (Planetary Health Alliance; United Nations Right to Healthy Environment; Convention on Biological Diversity, Biodiversity and Health). Linkages include benefits such as seafood as a source of protein and micronutrients: at least 3.3 billion people obtain approximately 20% of their dietary protein from this resource Ref 83. Additional health-related benefits are derived from medicines from marine organisms and opportunities to enhance well-being by living near the sea Ref 85 Ref 162.

Conversely, negative linkages include adverse impacts on health from exposure to natural and/or anthropogenically sourced events such as: exposure to biotoxins from harmful algal blooms (see sect. 4, subchap. 4H); microbial pathogens from sewage and agricultural run-off, agricultural pesticides, offensive odours and pathogens from the presence of animal carcasses/abattoirs, pathogens from hospital waste; chemical/particle pollutants, including nanoplastics and microplastics (see sect. 4, chap. 6); and radiological contamination (see figure II).

Figure II Routes of human uptake of harmful biogenic toxins, pathogens, particles and chemicals

This chapter contains an assessment of the benefits and adverse impacts from selected ocean-human interactions that are generally global and regional in scope; and emerging health-related issues and problems of future concern are also identified (see tables 1 and 2). Major health challenges discussed below include: antimicrobial resistance (AMR), toxic chemical and pharmaceutical contaminants, nanoparticles and microparticles and environmental radiation, all within the context of climate change, biodiversity loss and environmental degradation, such as habitat loss and coastal zone destruction.

Socioeconomic decline is associated with marine ecosystem degradation and gives rise to, or exacerbates, pre-existing human physical and mental health issues (see subsect. 5B, chaps. 1 and 3). Concerns about pollutant mixtures and their potential interactions are also discussed, as harmful contaminants are rarely found in isolation. Lastly, key knowledge and capacity-building gaps are identified, as well as possible actions to effectively monitor and/or measure the risks and benefits of the links between the health of the ocean and that of the human population (see figure I). 'The ocean's degradation is affecting the enjoyment of human rights, including the rights to health and a clean, healthy and sustainable environment. (see report of the Special Rapporteur on the human right to a clean, healthy and sustainable environment, Astrid Puentes Riaño (A/HRC/58/59)).

2. General aspects of the relationship between the ocean and human health

Human health and well-being depend upon the health of the global ocean. The ocean provides food and livelihoods, such as fishing, transport and leisure, for more than 3 billion people (40% of the world's population) and is a source of cultural, spiritual and artistic expression (Fleming and others, 2023, chap. 1, with permission; figure III).

Figure III The Global Challenges Research Fund (UKRI - GCRF) Blue Communities Project examined the "health" of the environment and the people living in and around marine protected areas (MPAs) in four South-East Asian Countries

Source: https://www.plymouth.ac.uk/research/institutes/marine-institute/our-research/blue-communities, with permission from Lora Fleming.

3. Assessment of health benefits (table 1)

Health of coastal communities relative to inland communities

The Global Burden of Disease study found that the relative burden of disease has already shifted from infectious to noncommunicable diseases (NCDs), such s cardiovascular diseases, diabetes and depression, in many countries. It is in the prevention of NCDs that living near the ocean may offer important human health benefits Ref 85.

Relatively poorer coastal communities may benefit most from interactions with the ocean (Garrett and others, 2019), and people living nearer the coast report better overall health Ref 70 Ref 96. The benefits of residing near a coast can be seen globally Ref 158 and are enhanced during times of stress, such as the COVID-19 pandemic (Pouso and others, 2021; subsect. 5B, chap. 4). Nevertheless, there are challenges associated with coastal living, as noted in a recent report by the Chief Medical Officer of the United Kingdom (2021),even in a relatively high- income country such as the United Kingdom. Challenges include rapid and human-generated environmental change, social and environmental inequalities, poor investment in infrastructure and a lack of a long-term vision.

Research is beginning to show that communities near marine protected areas (MPAs) and other areas designated as "protected" experience diverse human health and well-being benefits, including decreased overall national mortality and improved child health, as well as positive ecosystem impacts Ref 156 Ref 114 Ref 182. It is clear that collaborative, equitable and effective management of these areas with ongoing involvement and economic improvement of local communities is essential to creating and sustaining these ocean and human health benefits Ref 23 Ref 104 Ref 204.

Pharmaceuticals from the sea

Marine-derived pharmaceuticals are currently valued at $4.1 billion and are anticipated to reach $9.1 billion by 2033 (Fact.MR, 2023). As at 2024, there were some 56 marine natural product-inspired pharmaceuticals in use or in human clinical trials (Antunes and others, 2023). For example, one of the fastest growing classes of anticancer agent, an antibody-drug conjugate (ADC), immunologically directs a toxin to selectively kill cancer cells. The toxic component was inspired by dolastatin 10, a natural product of a marine cyanobacterium Ref 220.

The health of functional marine ecosystems is in danger, and numerous marine species are rapidly disappearing, some of which we do not even get to know Ref 57. What unique adaptations do these species possess, and how could they benefit human health? This is a loss of unknowable yet presumably vast impact and consequence.

There is an urgent need to characterize, catalogue and use the DNA genetic blueprints of at least representative marine life.

Marine biotechnology

"Biotechnology", broadly defined, encompasses the exploration and application of biological processes for innovation across medicine, agriculture, manufacturing and any other sector that involves living systems. "Marine biotechnology" refers to those innovations derived from, or applied to, the ocean.

For thousands of years, humans have used marine resources for land-based biologic needs Ref 62, long before "biotechnology" became an established term. Medicines, foods and food supplements, topical ointments, colours and dyes - each are examples of innovative adaptation of local marine resources and are precursors to the advanced technologies that have emerged over the past century.

Building on traditional knowledge, anatomists and physiologists have used marine species to achieve greater understanding of basic biomedical processes. Biochemists extracted and isolated compounds for use in modern medicine and cosmetics. Molecular biologists and geneticists developed marine-based laboratory tests, applied enzymes for gene sequencing and are building reference libraries which hold untold biomedical value. Aquaculturists and conservationists are increasingly adopting sophisticated biotechnological techniques to optimize the feeding, reproduction and health of farmed species and wild marine life.

The explosive growth of synthetic biology, artificial intelligence and data science and new genetic tools means that the potential for new biotechnological adaptation of marine resources has never been greater, underscoring the continued importance of protecting and preserving a healthy ocean Ref 35.

Seafood security - sea fisheries and aquaculture

The role that oceans play as a source of healthy food is widely recognized. Foods from the ocean are considered among the healthiest foods, providing a wide range of essential nutrients, some even difficult to find in natural forms in other foods. Seafood provides high-quality proteins, omega-3 fatty acids (n-3 polyunsaturated fatty acids (PUFAs)) and other nutrients, such as iodine and other trace elements and vitamins (Liu and Ralston, 2021; The Role of Seafood in Child Growth and Development, National Academies; sect. 4, subchap. 4D; subsect. 5A, subchaps. 1A-1D). The conclusion from the recent Joint FAO/WHO Expert Consultation on the Risks and Benefits of Fish Consumption is very clear. Consumption of aquatic foods is highly beneficial for people at all ages, even when considering potential hazards.

Blue gym and mental and physical well-being

There is growing research evidence that interacting recreationally with unpolluted blue spaces (including the coasts and seas) can have beneficial effects on human physical health and mental well-being, such as anti-depression effects (Britton and others, 2020; Depledge and Bird, 2009; Fleming and others, 2024;White and others, 2021).

Coastal residents are more likely than inland dwellers to meet recommended levels of physical activity through recreational exercise Ref 191, reducing the risk of many NCDs. After correcting for income and other factors, longitudinal studies demonstrate that moving to the coast is associated with sustained improvements in mental health Ref 254. Because of these and other factors, such as generally lower levels of air pollution, several comparative studies across multiple countries indicate that many people living nearer the coast report better overall health and well-being Ref 96.

4. Assessment of adverse health impacts (table 2)

Harmful effects of exposure to contaminated seawater, marine aerosols and contaminated seafood

Despite health benefits, many microbial, chemical and particle pollutants and toxins can contaminate seafood. These include marine biotoxins, chemicals produced by certain marine organisms, that cause adverse health effects such as gastrointestinal and neurological symptoms and therefore pose unique food safety concerns Ref 118 Ref 168. According to the World Health Organization (WHO), food-borne illnesses are responsible for approximately 600 million cases and 420,000 deaths each year.

New marine biotoxins and other pollutants are continually being identified, and global demand for seafood continues to grow. Thus, oversight and quality control of seafood should be a priority to prevent future contamination and ensure safe, nutritious and high-quality seafood for consumers (FAO, 2020; subsect. 5A, subchap. 1E).

Harmful biological agents (table 2)

Harmful algal blooms, respiratory distress and toxicity

The term harmful algal blooms refers to a wide range of natural events that occur in aquatic systems that have negative impacts on humans, animals and/or ecosystems (table 2; figure III; GlobalHAB, 2017; Gobler and others, 2017; sect. 4, subchap. 4H and chap. 6 .; subsect. 5B, chap. 1). Some harmful algal blooms, through their production of natural toxins, cause massive mortalities of wild and cultured animals Ref 98. Although these toxic compounds can target certain organisms, they can also be transferred through food webs by non-affected vectors and induce adverse health effects in other animals and humans Ref 28 Ref 29 Ref 136 Ref 268.

Major efforts in interdisciplinary research and monitoring of cells and toxic compounds have targeted those harmful algal blooms with demonstrated human health impacts Ref 110. There were 11,000 hospital admissions and 4,000 emergency department visits in 2012 related to harmful algal blooms in Florida Ref 144, likely only the "tip of the iceberg" because of misdiagnosis and underreporting. However, in the past 40 years, progress in understanding HAB species- specific dynamics, bloom prediction and effective regulations have been successful in preventing seafood poisonings and mitigating illnesses associated with dermal contact from contaminated water or from inhalation of aerosolized toxins (see sect. 4, subchap. 4H and chap. 6).

Figure IV Harmful Algal Blooms (HABs)

Paralytic shellfish toxins (PST) were dominant in East and West Coast America, South America, South- East and North-East Asia; diarrhetic shellfish toxins (DST) in the Mediterranean and Europe; and ciguatera in the Indian Ocean and the tropical Pacific, Australia and New Zealand and Central America and the Caribbean. Currently, adequate monitoring or regulatory tools are in place for diarrhetic shellfish toxins, paralytic shellfish toxins and amnesic shellfish toxins (AST).However, this is not true for fish- killing harmful algal blooms (Trainer and others, 2020) or for ciguatera toxins for which there are no simple or reliable toxin detection tools Ref 47.

Allergies, food sensitivities and poisonings from consumption of seafood

Seafood can be contaminated by naturally occurring or anthropogenic chemicals and toxins, including agents that cause poisonings, allergic reactions and food sensitivities. This part of the chapter (see table 2) focuses on natural toxins, such as saxitoxin and ciguatoxin (Backer and others, 2005) and chemicals that may naturally occur and/or be anthropogenic, such as mercury Ref 229. These chemical agents are responsible for both acute poisonings and exacerbation of chronic illnesses. Landrigan and others (2020) published an extensive review of human health and ocean pollutants, including adverse health impacts from exposure to industrial discharges, pharmaceutical wastes, pesticides, persistent organic pollutants (POPs), mercury and microplastics and nanoplastics.

Allergic reactions may occur after eating seafood, such as shrimp Ref 210 or fish that has been improperly handled (American Academy of Allergy, Asthma and Immunology, 2024). Food protein-induced enterocolitis syndrome in adulthood can be triggered by consuming seafood, particularly in the presence of other gastrointestinal pathologies such as irritable bowel syndrome symptoms Ref 106. These immune-mediated reactions typically occur shortly after consuming seafood.

Seafoods may also induce or exacerbate chronic health conditions. Non-immune-mediated reactions are known as "food sensitivity" or "intolerance" and comprise a delayed response involving the digestive system Ref 177 Ref 14.

Microbial infections and parasitic infestations from consumption of seafood and seawater exposure (mainly from human sewage and agricultural run-off)

Marine environments including recreational waters are polluted by human, animal and industrial waste containing diverse microorganisms including viruses, bacteria and single-celled and multicellular parasites. A systematic review of self-reported symptoms of recreational coastal water users in OECD countries indicated that marine recreational water users are approximately twice as likely to report symptoms of illness as non-marine water users Ref 140. The relationship is strengthened in many low- and middle-income countries, where untreated sewage may be discharged to the ocean and elevated temperatures from climate change favour survival and growth of indigenous marine pathogens such as Vibrio bacteria Ref 22.

A comprehensive literature review on viruses and bacteria in seafood contained reports of 371,962 cases, 18,723 hospitalizations and 445 deaths associated with 19,554 outbreaks in the United States from 2001 to 2021 recorded by the United States National Outbreak Reporting System (see figure V). More than 450 pathogenic viruses have been detected in sewage and in sewage-contaminated seawater (see figure V; Tisza and others, 2023). Norovirus is an important cause of recreational waterborne gastrointestinal llness Ref 128 owing to high loads in wastewater combined with a very low infective dose.

Figure V Human pathogenic enteric viruses in seawater and seafood.

Source: Prepared by the writing team.

Infection risks associated with seafood consumption vary by type of organism and mode of preparation prior to consumption. Bivalve molluscs are of particular concern as they filter large volumes of water and concentrate viral and bacterial pathogens as well as waterborne parasites Ref 165. A study of retail mussels in Canada showed between 1.6% and 5.2%, 3.4% and 10.4% and 0% and 3.3% of packages of fresh mussels and oysters polymerase chain reaction (PCR) positive for Giardia, Cryptosporidium and Toxoplasma, respectively. Bivalves such as oysters and clams are often consumed raw, increasing the likelihood of pathogen transmission and human infection.

Finfish are the primary source of parasitic worms (see figure VI), and infection is associated with eating raw or undercooked fish Ref 214. Larval stages of tapeworms and Anisakid nematodes infect humans from contaminated raw, pickled, smoked or undercooked fish and cause gastrointestinal pathologies and allergic reactions Ref 19.

Figure VI Harmful parasitic worms in seafood, such as sushi and raw or under-cooked fish, and symptoms of infection

Antimicrobial resistance

Antimicrobial resistance (AMR) is the ability of microorganisms to withstand drugs used to treat infections. AMR refers to antiviral, antibacterial (or antibiotic) and, specifically, antifungal resistance, and antiparasitic drug resistance. Antibiotic-resistant bacterial infections are a growing pandemic, with 1.27 million deaths directly attributable to antibiotic resistant infections and 4.95 million deaths associated with these globally in 2019. Antibiotic resistance is often considered to be a clinical phenomenon; however, antibiotic resistance genes frequently acquired by bacteria through horizontal gene transfer are predominantly of environmental origin (Wright, 2007).

Many antibiotic drugs are natural products produced by environmental bacteria and fungi. However, less understood is that bacteria have evolved resistance mechanisms in deep evolutionary history, and these are now emerging in human pathogens relevant to global pandemics.

Antibiotic resistance has long been found in soil bacteria. When marine environments were screened for resistance using functional metagenomics, antibiotic resistance genes were found at all sites, with only 28% identified as known resistance genes. There was a high diversity of previously uncharacterized genes, demonstrating the scale of the marine environment as a reservoir of novel resistance genes Ref 117, with the potential risk of spreading to seafood and humans. For example, bacteria such as Aeromonas species are opportunistic human pathogens of aquatic (including marine) origin and are the origin of clinical important resistance genes that have subsequently spread to other human pathogens at a global scale Ref 66.

A subset of these bacterial pathogens (and accompanying non-pathogenic commensal bacteria) is resistant to antibiotics. For example, Leonard and others (2015) estimated that 6 million exposure events to a clinically important resistant type of the bacterium occurred (i.e. E. coli alone) in United Kingdom bathing waters. Further work illustrated an association between frequent coastal water exposure and gastrointestinal occupation of the same clinically important resistant E. coli Ref 140. In addition to being a reservoir of antibiotic resistance and facilitating environmental transmission to humans, the coastal environment may be impacted by pharmaceutical and antibiotic pollution that can select for antibiotic resistance, even at the very low concentrations present.

Figure VII Pathways for antifungal chemicals entering the marine environment and anti-fungal resistance

A recent study of more than 2,000 metagenomic DNA samples sequenced from marine environments revealed that more than 50% of distinct gene clusters were fungal Ref 39 Ref 130 Ref 206. In estuarine and coastal environments, antifungal residues from human and animal usage and crop applications may be at sufficient concentrations to select for resistance. However, an understanding of minimal selective concentrations of antifungals required to drive the evolution of resistance is just emerging Ref 224. There are also health concerns around antifungal-resistant fungal pathogens in wastewater inputs in coastal waters with the presence of Aspergillus and Fusarium isolates resistant to antifungals Ref 17.

Harmful non-biological pollutants (table 2)

Toxicity from chemical, particle and radiological contaminants

Non-biological pollutants in seafood can represent a serious health risk Ref 228. Although industrial production of potentially toxic chemicals is estimated to be more than 350,000 substances,only a minimal number of these have been identified and quantified in the environmental matrices by national environmental agencies. Seafood animals accumulate chemicals from seawater, sediments and/or diet with different outcomes according to tissues and species. Specific classes of chemicals, such as POPs and mercury, represent a higher risk for human consumption (Al-Sulaiti and others, 2022; see specific subparts below).

Environmental pollutants can be classified according to the biological mechanisms leading to chronic rather than acute health conditions (Mezzelani and Regoli, 2022). Exposure over time to endocrine disruptors in seawater, sediments, aerosols and seafood can alter hormonal balance in both animals and people. Other chemicals can interact with several cellular receptors to alter biological pathways, including those of lipid metabolism with obesogenic effects. Carcinogenic substances can damage DNA following heir biotransformation or through oxidative mechanisms with increased production of reactive oxygen species.

Particles such as microplastics and nanoplastics have been increasingly reported in all species of marine food webs and in human tissues Ref 246 Ref 230. Toxicological potential of microparticles and nanoparticles is inversely related to size, below 20 um down to nanoscale, alterations of immune system, inflammation, decreased growth rate and energy imbalance have been reported (Nardi and others, 2024). nRadioactive contaminants in seafood might potentially affect human health because of the intrinsic long-term risk potential of radiation to cause mutations and an increased risk of cancer (Smith and others, 2023). 

Metals

Many metals and metalloids can impact the health of both aquatic organisms and humans: therefore, maximum permissible concentrations in fish and shellfish exist for mercury (Hg), arsenic (As; metalloid), cadmium (Cd) and lead (Pb) Ref 67 Ref 203.

The main ocean-related toxicity of mercury derives from its bacterial methylation to MeHg, rapidly accumulated and biomagnified, and accounting for up to 100% of total mercury in seafood. MeHg is neurotoxic for the developing nervous system, and dietary guidelines have been provided for a safe level of fish consumption by pregnant women (US-EPA and FDA, 2024). Long-term exposure to cadmium (Cd) results in renal dysfunction, osteoporosis and some cancers in humans Ref 211. Humans can be exposed to arsenic through the consumption of fish contaminated with arsenic. However, non-toxic organic species of arsenic are believed to be the dominant form of arsenic in fish and shellfish, although other organic metabolites produced by gut microbes may be more toxic Ref 43.

Petrochemicals and combustion products

Petrochemical and combustion products such as polycyclic aromatic hydrocarbons (PAHs) are ubiquitous substances in the marine environment Ref 115 Ref 134 Ref 170 Ref 223. Contamination problems are due to human activities such as petroleum extraction, transport, shipping, chemical transformation and their use (International Energy Agency (IEA), 2018; Rovira and others, 2021; UNEP/RAMOGE, 1999; subsect. 5A, subchap. 3B).

Petrochemical and PAH combustion product contamination may be used to evaluate risk for human health from exposure to petrochemicals and combustion processes Ref 149 Ref 154 Ref 170 Ref 181. However, the risk related to these products should be considered as a component of the general evaluation of human health risk due to the mixture of contaminants present in a particular marine environment, along with other factors such as climate change (see information on pollutant interactions below).

Persistent organic pollutants

POPs are hazardous chemicals that threaten human health and ecosystems: for example, polychlorinated biphenyls (Ritter and others, 1995; Stockholm Convention - pops.int). POPs remain intact for a long time, are widely distributed throughout the environment, bioaccumulate and biomagnify in living organisms through the food chain and are toxic to both humans and wildlife (see sect. 4, chap. 6). Furthermore, as a result of releases to the environment over the past several decades due to human activities, POPs are now widely distributed over large regions. This extensive contamination of both the environment and living organisms includes many foodstuffs, resulting in sustained exposure of many species (including humans) for periods of time that span generations, leading to both acute and chronic health effects.

Neurotoxic pesticides and agrochemicals

Wastewater and land runoff of the most common insecticides, herbicides, fungicides and rodenticides represent a significant environmental and health threat because the same molecular targets attacked in

pests are also present in other species, including diverse marine life and humans Ref 207. Neurotoxic effects in humans are supported by their detection in brains of patients affected by Alzheimer's and Parkinson's diseases Ref 195. Acaracides, such as rotenone and pyridaben, can cause human neurological disorders, including the possible pathogenesis of Parkinson's disease.

Pharmaceuticals and endocrine disruptors

More than 2,000 active pharmaceutical ingredients (APIs) are approved for use around the globe. APIs can be released to the environment during their production, patient and veterinary use and their ultimate disposal.

Monitoring of APIs in the marine environment has been carried out in North America, Asia, Africa, Europe, Latin America and Antarctica (UBA, 2024). Substances detected in seawater and estuarine waters included compounds from analgesic, antibiotic, antidepressant, anti-inflammatory, beta blocker, oestrogen, and lipid-lowering agent classes (UBA, 2024). Concentrations in water are typically in the low ng/L range or below (UBA, 2024; Leonard and others, 2020; see also the information on neurotoxic pesticides and agrochemicals above).

Monitoring of fish and shellfish demonstrates that many of these APIs are taken up by these organisms and potentially enter the food chain; therefore human exposure is possible Ref 157. Assessments have estimated the toxicological risks of seafood contamination to human health; these indicate that, in some instances, concentrations of APIs are at levels that might cause harm to humans Ref 80.

Consequently, there are increasing health risks from endocrine disruptors by being exposed to concentrated emerging chemicals through the consumption of contaminated seafood Ref 9 Ref 134.

Contaminants of emergent concern

Emerging contaminants in marine environments, such as detergents, personal care products (PCPs), perfluoroalkyl and polyfluoroalkyl substances (PFAS - "forever chemicals") (see figure VIII), and plastic additives, pose significant threats to marine organisms and human health Ref 50 Ref 108. PCPs (including triclosan, UV blockers, parabens and oxybenzone) are commonly found in sunscreens, shampoos and lotions Ref 42 Ref 196 Ref 247 Ref 264.

Flame retardants and plastic additives are widespread in the ocean and can cause reproductive and gender abnormalities in marine life owing to their endocrine-disrupting properties (Cocchetti and others, 2022; Liu and others, 2023; Xie and others, 2022 ).

Figure VIII Effects of perfluoroalkyl and polyfluoroalkyl substances (PFAS) on human health

PFAS are ubiquitous in coastal waters and are bioaccumulated in the human seafood chain Ref 222. Exposure to all pollutants is particularly concerning for Indigenous and other coastal communities with high seafood diets: they face significant health risks, including immune suppression as identified by the European Food Safety Authority Ref 32 Ref 46 Ref 88.

Microparticles and nanoparticles (including plastics) and from road run-off

Nanotechnology is generating increasing amounts of nanomaterials that enter the marine environment Ref 105. Other nanomaterials and micromaterials are generated by various combustion and frictional processes: of particular concern are what are known as "hidden plastics" Ref 163. These nanoplastics and microplastics are produced by frictional and partial combustion of vehicle tyres. Tyres are approximately 25% plastic and tyre dust contributes to particulate air polluion and road run-off draining into marine environments and comprises approximately 28% of all nanoplastic and microplastic pollution Ref 163 Ref 184 Ref 219.

Figure IX Tyres contain approximately 25% plastic, and frictional heating and breakdown into tyre dust from road contact generates toxic and carcinogenic polycyclic aromatic hydrocarbons and nanoplastic particles

Source: Adapted from Sieber and others, 2022; Aatmeeyata, 2010; Mayer and others, 2024.

Evidence for harmful human health effects of these particles, as well as other various nanoparticles, is growing rapidly, with ingested and inhaled particles finding their way into most human organ systems, as well as emerging evidence for endocrine-disrupting effects (see figure X; Leso and others, 2023; Wang and others, 2023; Yee and others, 2021). Routes of particle uptake include consumption of seafood and inhalation/ingestion of nanoparticles in marine aerosols (i.e. sea spray) Ref 132 Ref 153 Ref 194 Ref 143.

Figure X Potential harmful effects of ingested and inhaled microplastics and nanoplastics

Microplastics and nanoplastics serve as transport vectors for many chemical additives and adsorbed chemicals in the ocean which are persistent, bioaccumulative, mobile and toxic to the marine fish and other organisms Ref 10 Ref 12. Consequently, microplastics and nanoplastics, chemical additives and adsorbed chemicals, such as polycyclic aromatic hydrocarbons, can lead to potential adverse health effects in marine organisms and humans Ref 1 Ref 164.

A new issue of health concern is the presence of microfibres and nanofibres of glass in edible filter- feeding molluscs from degradation of fibreglass hulls of boats, including derelict boats Ref 48.

Environmental radiation

Along with other contaminants, the seas and global ocean are the ultimate recipient of anthropogenic radionuclides. For example, 5.9 x 10¹⁸ becquerel (Bq) of tritium, is discharged in quantities much larger than any other radionuclide Ref 82 Ref 161. 90% of this radionuclide is present in the oceans, compared with 9% and 1% in continental waters and atmosphere, respectively. In this context, the Pacific Ocean currently contains 500,000 TBq of natural and 2,500,000 TBq of anthropogenic tritium, the latter mostly from past atmospheric nuclear weapon testing (Smith and others, 2023).

IAEA concluded in its Comprehensive Report of July 2023 that the discharge of ALPS treated water into the sea from Fukushima Daiichi Nuclear Power Station is consistent with relevant international safety standards and that the discharge will have a negligible radiological impact on people and the environment Ref 5. There are however many unresolved issues in relation to potential short- and long-term impact related to controlled release of radioactive water following the Fukushima Daiichi nuclear accident Ref 81.It is therefore necessary to continue to monitor whether the discharge is being managed as originally planned.

According to the United Nations Scientific Committee on the Effects of Atomic Radiation, DNA is the most important target for the action of ionising radiations. Damage to DNA, if not repaired, is the ultimate cause of many cancers and is associated with many other harmful health impacts. Exposure to radionuclides through different routes, such as consumption of seafood, inhalation or skin penetration, therefore, poses health risks Ref 161. To protect human health, biokinetic models have been developed for specific radionuclides, within specific organs. Data from biokinetic models are then used to calculate absorbed radiation doses and potential biological effects for each target organ (Paquet and others, 2017). It is being emphasized that, in order to minimize the presence of hazardous wastes, Sustainable Development Goals 12 and environmentally sound technologies, Goal 17 should be redefined to include radioactive wastes Ref 259 Ref 258.

Pollutant interactions

It is now well established that biological effects of environmental contaminants are due to their cumulative actions Ref 34 Ref 129. The toxic effects of contaminants present in a mixture may be additive, and even in some cases antagonistic Ref 89 Ref 175; however, synergistic effects of toxic chemicals are also well demonstrated Ref 6 Ref 95 Ref 159 Ref 176. Obviously, there is a clear need to estimate risk for human health from marine pollution, taking into account all available chemical data in terms of contaminant concentrations in waters, sediments, aerosol and seafood. It is important to evaluate the biological effects of contaminants on seafood organisms exposed to all bioavailable contaminants Ref 53 Ref 243 to gain a more complete overview of toxicity and risk.

5. Key remaining knowledge and capacity-building gaps

There clearly remain many unknowns in the field of human health-marine environmental interactions (see figure I). However, there is considerable evidence for research progress and a better understanding of the many and often interconnected areas of interest to scientists and regulators (see figure XI).

Figure XI Key remaining knowledge and capacity gaps that are essential to address for effective ocean regulation and management

Continuing emphasis should be placed on the following key problem areas and issues of emerging concern given the socioeconomic importance of environmental interactions with human health:

• Current lack of an effective international interdisciplinary panel or forum that includes: environmental epidemiologists; public health, biomedical and environmental scientists; clinicians, environmental psychologists, lawyers and economists; marine ecologists and oceanographers; and environmental regulators and managers;

• The High Level Panel for a Sustainable Ocean Economy (https://oceanpanel.org) has produced a number of reports on various aspects related to human health but only one specific report;

• Important to start linking human health and well-being indicators with ocean "health" indicators, and exploring long-term impacts (risks and benefits) of changing ocean health on human health; and recommended in the Ocean Panel ocean and human health (OHH) report (https://oceanpanel.org/publication/ocean-human-health/) as one of three major recommendations;

• Recognition that actions intended to ameliorate risk from particular factors may have unintended adverse consequences for ecosystems and human health;

• The evidence indicates that pollution is causing serious health issues, so why are many national authorities not taking action to protect people ?;

• Promotion of sustainable and equitable use of decreasing marine resources as a result of increasing population and demand;

• Recognition of the benefits of increasing interdisciplinary research efforts into oceans and human health;

• Suggest effective monitoring and quantitative assessment (where possible) of risks and benefits of interlinked human and ocean health;

• Try to ensure that data are truly available and transparent for use by communities and others;

• Increase sustainable and equitable efforts to identify potential marine pharmaceuticals and other natural products;

• Try to ensure that seafood monitoring programmes are effective and up to date for biotoxins, pollutant chemicals and micromaterials and nanomaterials;

• Suggest increasing efforts to reduce the impact of antimicrobial and antifungal resistance in relation to seafood and aquatic systems;

• Aim to end microbial, chemical (including pharmaceuticals) and particulate pollution of the oceans;

• Suggest support for a global ban on the production of single-use plastic and promote effective plastic waste management;

• Recognize that unpredictable emergent future health challenges will occur;

• Recognize that climate change will result in the geographical redistribution of human pathogens; and that enhanced storm-related disturbance of coastal sediments, and erosion of nearshore landfill sites, will release chemical pollutants and other types of waste;

• Recognize the importance of serendipity in scientific discovery, such as the production of "dark" oxygen from sea-floor metal-rich nodules Ref 227; the possible role of algaltoxins in inhaled/ingested sea spray aerosols having a beneficial health effect Ref 242; and the role of environmental endocrine disrupters in gender dysphoria Ref 49;

• Recognize the benefits of developing an integrated modelling capacity for predicting environmental impacts on human health Ref 7 Ref 173;

• Suggest extending regional and international marine pollution control programmes to all countries.

6. Conclusions and vision

The global ocean provides humans with many benefits, including the production of healthy seafood. The marine environment can also be the source of potential health benefits by providing novel pharmaceuticals and related natural products derived from marine organisms, as well as contributing to disease prevention and treatments through encouraging physical activity and enhancing psychological well-being (see table 1).

The complexity of ocean-human interactions is increasing, with mixed exposures from contaminated environments to harmful algal toxins, pathogenic bacteria and viruses, anthropogenic (man-made) chemicals (including microplastics and nanoplastics), as well as other types of pollution. Untangling the relative contributions and interactions of these stressors is challenging, particularly when coupled with climate change, biodiversity loss and ecosystem degradation of the global ocean Ref 7.

Figure XII Schematic diagram illustrating the multiple drivers underlying the various processes contributing to the interactions between marine ecosystems and human health

It is crucial that all of these stressors be considered in depth globally to understand the complexity of interactions between the ocean and human health (see figures I, II and XII). At its core, there must be a well-thought-out and clearly articulated vision of what would be an acceptable relationship between humans and the oceans in the future. This means accepting and embracing that the current and future state of the global ocean will in large part determine current and future sustainability and the health and well- being of all humans on Earth.

The attainment of such a vision requires an appropriate international interdisciplinary forum or panel. However, a one-off report on ocean and human health from the High Level Panel for a Sustainable Ocean Economy (Ocean Panel) could provide the example for a potential way forward (https://oceanpanel.org/publication/ocean-human-health/).

Such a panel/forum could prioritize:

1. The failure of numerous international agreements to prevent progressive loss of marine biodiversity and collapse of several marine ecosystems with implications for human health, and explore strategies to reverse this situation;

2. Effective protection of coastal communities from natural threats, including flooding and tsunamis/hurricanes;

3. Knowledge of interactions between natural and anthropogenic stressors that impact ocean and human health;

4. Most issues are associated with both benefits and threats - it often depends on the context as to whether we sacrifice a benefit to remove a threat or accept a threat to gain a benefit: who then decides and on what basis?;

5. Awareness of health professionals and documentation of environmentally related illnesses;

6. Exploring potential unique medicines and other natural marine products, while ensuring sustainable use and protection of marine life and habitats Ref 189;

7. Developing an integrated modelling capacity for predicting environmental impacts on human health Ref 7 Ref 173.

Acknowledgements

The authors wish to thank Professor Ralf Ebinghaus (Germany, a member of the Pool of Experts for the third World Ocean Assessment) and Professor Michael Depledge (United Kingdom) for their insightful and very helpful comments during the preparation of this chapter.

Table 1 Selected direct and indirect risks, benefits and opportunities for human health and well-being from interactions with the ocean (Fleming and others, in press)

Table 2 Selected adverse human health impacts from ocean interactions

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