How can a healthy ocean improve human health and enhance wellbeing on a rapidly changing planet?

These goals can be achieved by incorporating measures of natural and human capital as well as formal assessments of impacts on human health and wellbeing in addition to metrics of short-term gain, such as GDP, into assessments of the benefits of ocean development (Fenichel et al. 2020). Bringing the frameworks of the precautionary principle and environmental justice into such evaluations has the potential to transform traditional approaches to often siloed environmental, equity and health policies. And because LMICs are disproportionately impacted by climate change and ocean pollution (including ocean plastic pollution), increasing the scope and impact of ocean policies to mitigate climate change and prevent ocean pollution has the potential to improve the environment and human health and deliver a more equitable ocean environment.

This section examines the complex interlinkages between ocean and human health and the ocean economy. It analyses the opportunities and actions available to deliver a socially inclusive, sustainable ocean economy that generates wealth for all and sustains a healthy ocean that benefits human health today and for future generations. Two case studies, one from the Global North and one from the Global South, are used to demonstrate that policies grounded in pro-environmental behavioural change and social innovation can ensure the equitable distribution of both the social and economic benefits of a healthy ocean. 

Key risks and opportunities for human health

Globally, coastal communities in countries at every level of income are experiencing the most severe negative economic, environmental and health impacts of unrestrained human-induced changes to marine and coastal ecosystems, such as uncontrolled coastal development and coastal pollution (Ehsan et al. 2022). Many of these communities report high levels of poor health and wellbeing (Depledge et al. 2017; UK Chief Medical Officer 2021).

These impacts are most obvious in LMICs, where people rely directly on intact ecosystems for their daily sustenance and livelihood (Ehsan et al. 2022). But they are seen also in high-income countries, where economic pressures, environmental degradation and climate-driven change have resulted in economic precarity in low-income coastal communities (Acheson and Acheson 2020).

Economic inequality is both a key determinant and an outcome of negative changes to ocean ecosystems and of their knock-on effects on human health and wellbeing (Bambra 2011; Berthe and Elie 2015) (Figure 5). Inequality is typically the consequence of long-standing inadequate and/or negligent institutional practices, such as exclusionary ownership of land or fishing rights, race-based discrimination, gender-based exclusion and economic and taxation policies that favour the few at the expense of the many.

The health and wellbeing of coastal communities can be enhanced, inequity reduced, and fisheries and other marine resources restored through policies and programmes that take an inclusive approach to improving human and ocean health. Such policies have been shown to have positive impacts on ocean ecosystems, livelihoods (both ones related and not related to the ocean), as well as other employment and financial opportunities in coastal communities. Such policies also improve access to key services, including health services (Gollan and Barclay 2020; Rasheed 2020; Das 2023).

One promising area for improving the health and wellbeing of coastal communities is through ‘social innovation’, a process whereby relevant actors and institutions join in self-organising, community-driven networks to develop new and improved ways of collaborative action. The core objective of social innovation is to deliver bottom-up individual and community behavioural change across multiple actors (Merz et al. 2023).

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A positive example of such intervention is seen in the case of small-scale fisheries in LMICs, where a focus on an equitable ocean and human health has been linked to increased ocean health, improved nutritional outcomes and food security, stabilisation of local economies and better physical and mental wellbeing outcomes across all age groups (Béné et al. 2010). An example of a ‘bottom up’ approach by small-scale fishers in the Global South to preserve an ocean fishery, reduce economic insecurity and improve human health and wellbeing is seen in Case study 9, while Case study 10 presents an example of cooperative, community-led action in a high-income country to protect an endangered fishery and marine habitat.

However, a continuing challenge to such ‘bottom up’ approaches is that they often do not result in changes to the prevailing systems and power structures that impede equitable development. Political and economic power, regulation, enforcement, resources and ongoing commitment are all issues to be considered in efforts to bring community-led approaches to regional and national scales.

Such interventions have the potential to particularly benefit communities living in and around MPAs and other protected areas in the Global South. Burgeoning research in these communities demonstrates diverse human health and wellbeing benefits, including decreased overall mortality and improved child health, as well as positive ecosystem impacts (Rasheed 2020; Madarcos et al. 2021; Haque et al. 2023; Nowakowski et al. 2023). To unlock the opportunities that a socially inclusive, sustainable ocean development agenda can deliver, bold policies and actions are needed in ocean protection, fishery management and international trade regulations (Nash et al. 2022).

CASE STUDY 9. Bangladeshi fishers’ collective action to create inclusive growth for ocean and human health

The hilsa shad (Tenualosa ilisha (Hamilton 1822)) constitutes Bangladesh’s single-most important fishery, contributing about 12 percent of total production and about 1 percent of the country’s GDP; and employing an estimated 50,000 people, predominantly artisanal fishers (Islam et al. 2018).

A structural problem in the hilsa industry is that access to fishing equipment and to lucrative urban markets is largely in the control of middlemen. These fish brokers secure their hold on the industry by extending investment capital to fishers at high interest rates, thus locking fishers into poverty, jeopardising their economic security and threatening their health and wellbeing.

The hilsa fishers’ precarious existence is further endangered by increasing numbers of climate change–driven tropical depressions and cyclones in the Bay of Bengal. These events jeopardise fishers’ incomes as well as their lives. Each year, dozens of fishers are killed or go missing at sea, and fishers report insufficient life-saving equipment. These problems were exacerbated in 2019, when an existing 65-day fishing ban for industrial fishing was extended to small-scale fishing boats without any discussion with the artisanal fishers (Islam et al. 2021).

FISHERS’ ACTION 

Fishers in several villages along the southern coast of Bangladesh have begun to form rural self-developing societies and cooperatives that extend financial support and equipment to their members. These groups have the potential to protect community interests, enhance communal and individual health and wellbeing, and promote ocean stewardship.

Fishing cooperative members typically contribute to a common fund, which entitles them to a variety of material and non-material benefits, including access to low-interest loans and fishing gear. Membership in cooperatives also enhances fishers’ political position and strengthens their bargaining power when negotiating with fish brokers and government agencies.

RESULTS

Within rural fishing communities that have formed cooperatives, reports show that increased social cohesion and collective action is emerging as a basis for future adaptation strategies, and that positive social support within the group benefits mental health. Further benefits of these cooperatives are particularly relevant to physical health; for example, awarding collateral-free loans supports food and nutritional security during seasonal fishery closures, and medical treatment during illness. Building alternative skills and self-help infrastructure development in rural communities could also support better market access, enhance fishery income and generate support for poverty-alleviation programmes (Islam et al. 2021). The challenge remains of how to support such initiatives in the face of powerful and competing interests that are able to deliver, and profit from, economies of scale.

Limitations to current knowledge requiring additional research

Ocean economy initiatives have often failed to advance socially inclusive ocean and human health because of lack of concern for factors beyond economic development, and the lack of the tools and knowledge needed to ensure equity and justice from ocean-based activities. To confront these problems and to inform policy and develop interventions, more information is needed in the following areas:

• The complex and reinforcing interconnections between ocean health, human health, and economic and social processes.
• Relationships between ocean and human health and social equity and justice outcomes in both LMICs and high-income countries.
• The scale at which policies can most effectively drive a more inclusive ocean and human health agenda.
• The capacity of ocean sectors, including and beyond small-scale fisheries, to advance an inclusive ocean and human health agenda at a community level.

Measuring progress in all the above areas will require the development, deployment and field-testing of new, holistic economic indicators of the ocean economy that move beyond a sole focus on productivity, such as GDP, and account for the natural, social and human capital provided by a healthy ocean (Fenichel et al. 2020).

Behaviour change across all sectors of society is required to meet the UN Sustainable Development Goals and mitigate the impact of climate change on the ocean and human health in an inclusive manner (Merz et al. 2023). The recent multilateral successes in sustainable and collaborative fishery management discussed in detail in Section 2 offer models. These include the new UN High Seas Treaty and the WTO (2022) agreement to phase out selected fishery subsidies and favour equity (Stokstad 2023).

CASE STUDY 10. Lyme Bay Fisheries and Conservation Reserve 

Lyme Bay Fisheries and Conservation Reserve, located in southwest England, is one of the largest marine protected areas in England, with 206 square kilometres of seabed protected from dredging and trawling (Rees et al. 2010) (Figure CS-10.1). It is a marine biodiversity hotspot supporting unusual species such as the pink sea fan (Eunicella verrucosa (Pallas 1766)) and ross coral (Pentapora fascialis (Pallas 1766)). It is also important socially and economically (Singer and Jones 2021).

Although the scallop and demersal trawl fishers lost access to valuable fishing grounds, static gear and diving fishers have been able to continue their activities without conflict, and a closed conservation area has led to recovered seabed and coral gardens (Rees et al. 2010). Scallop populations have recovered and the number of new entrants to the scallop diving industry has increased, as has whelk fishing effort (Singer and Jones 2021), all contributing to increased human wellbeing.

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The governance approach to the reserve has been a combination of voluntary bottom-up and statutory top-down measures. Voluntary agreements were made, and broke down, several times prior to the statutory closure (Rees et al. 2010).

Key positive actions that emerged from this effort have included collaborative learning through a joint working group of scientists, regulators, nongovernmental organisations and the private sector; peer enforcement due to dialogue between regulators and fishers to promote recognition of regulations and restrictions; and efforts to increase social capital, building trust through the working group and increased transparency from regulators (Singer and Jones 2021). 

Actions and opportunities

Develop and deploy indicators to measure progress in both ocean and human health. Assessment of the efficacy of new governance structures will require the development, deployment and refinement of new economic indicators. These indicators will need to move beyond a sole focus on measuring productivity, such as gross domestic product, because productivity metrics fail to capture the natural capital provided by a healthy ocean, while also hiding how the ocean’s benefits are derived and to whom they accrue (Fenichel et al. 2020). The development and use of new, more holistic indicators that account for both natural and human capital and for the equitable and sustainable distribution of wealth from the ocean offer a key opportunity to highlight the need for, and the returns from, an inclusive ocean economy agenda centred on ocean and human health (Kumar et al. 2019).

Reform global finance and trade. Strict regulation of industries that destroy marine resources; removal of government subsidies for industries that destroy marine resources such as distant-water fishing, seabed mining and fossil fuel extraction, and incentivisation of industries that advance sustainability are actions that will protect human health and wellbeing and advance social justice. Such actions could build on recent multilateral successes, such as the new UN High Seas Treaty and the WTO agreement on fisheries to ensure that trade works for low-income nations.

Advance behavioural change policies to foster pro-environmental behaviour for ocean and human health. Behavioural change across all sectors of society, supported by international treaties and enforced through national and local regulations, is of great importance.

For example, in the health sector, pharmaceuticals are crucial for improving healthcare but often end up in the ocean, resulting in growing threats to ocean and human health such as antimicrobial resistance; particularly in LMICs where labour is cheap, environmental laws less stringent, and many pharmaceuticals are made. An example of an early-stage intervention to combat the impact of pharmaceuticals in the ocean is Scotland’s first blue-green prescribing programme to protect the ocean from pharmaceutical pollution by using nature-based health interventions or ‘blue prescriptions’ (see Case study 8 for an example) for people with mental health conditions in addition to prescribing less environmentally harmful medications (Janković 2023). Recognising the global extent of this problem, WHO (2015) has developed a Global Action Plan on Antimicrobial Resistance.

Another example in the health sector is the ongoing work between the UK NHS with its suppliers and shippers towards a more sustainable approach to international shipping, discussed in Case study 11.

Catalyse actions to create cross-sectoral linkages and partnerships, encourage co-creation and bridge organisational divides. Confronting current environmental and societal challenges in ocean and human health requires new institutional structures that facilitate multi-actor, cross-sectoral collaborations that emerge directly from the environmental, economic and health needs of communities. Actions arising from social innovation-based processes offer an important pathway to address issues of equity while simultaneously improving human and ocean health at the community level.

An example of a good practice is outlined in Case study 9, which highlights the capacity for communities in southern coastal Bangladesh to develop locally sustaining, inclusive actions for ocean and human health that also can further encourage multi-sector collaborations across local, regional and national scales.

CASE STUDY 11. Decarbonising healthcare’s maritime logistics

The National Health Service (NHS) in England serves a population of 56 million people and is supported by 80,000 global suppliers. It has committed to reaching net zero carbon emissions for all the emissions it controls, including in its supply chain, by 2045. Transportation of healthcare goods from manufacturer to use is part of the product’s lifecycle; and 80 percent of NHS goods arrive via maritime routes.

THE MARITIME CHALLENGE

The global healthcare system depends on fast, reliable, smooth and affordable maritime shipping to deliver more than 80 percent of the goods needed to maintain human health and wellbeing. However, the emissions from maritime shipping activities for the healthcare and other sectors pose a threat to planetary health and hence human health. The healthcare system’s workload is fuelled by the planetary harm it causes.

Although container shipping is the most economical and sustainable global mass transportation, there are still environmental impacts, with direct and indirect human health implications. These impacts include emissions (1 billion tonnes of CO2 per year) at sea and in ports, transfer of invasive species, underwater radiated noise, damage to marine protected areas, wastewater and other marine pollution, and marine mammal collisions. NHS England’s global supply chain emissions represent 62 percent of its overall greenhouse gas footprint. Decarbonisation of the maritime shipping sector is essential to achieve the NHS net zero goals.

Shipping is included in NHS England’s (n.d.) Evergreen Sustainable Supplier Assessment, which sets a clear standard for sustainable maritime logistics. Suppliers can become signatories of the Aspen Institute’s Cargo Owners for Zero Emission Vessels ambition statement (coZEV n.d.), a collective aim from cargo owners to only use zero emission shipping services by 2040, and subsequently become members of the Zero Emission Maritime Buyers Alliance (ZEMBA). ZEMBA is a buyers’ group within the maritime sector that aims to accelerate commercial deployment of zero emission shipping, enable economies of scale and help cargo owners to maximise emissions reduction beyond what any one freight buyer could accomplish alone.

Many of NHS England’s suppliers deliver goods to industries beyond healthcare. Therefore, these changes for the healthcare sector can be amplified across multiple sectors, accelerating positive change, and be taken up by the national health services in all countries globally.