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

Full Report

5. Immediate actions for a healthy, sustainable ocean and a healthy human future

The previous sections of this Blue Paper have shown that the health and wellbeing of humanity, as well as the state of the global economy, are linked inextricably to the health of the ocean. We find that a healthy ocean benefits human health and wellbeing in many ways:

The ocean sustains all life on Earth by providing 50 percent of the oxygen produced on Earth each year and 80 percent of all the oxygen ever created (Grégoire et al. 2023).
The ocean is critical to the fight against climate change (Hoegh-Guldberg et al. 2023; Villasante et al. 2023). It absorbs 25 percent of all CO2 emissions and more than 90 percent of excess atmospheric heat, slowing global warming (Hoegh-Guldberg et al. 2023).
The ocean is a source of new medicines and biotechnologies, from essential pain medicines, to cancer drugs, to plastic alternatives (Antunes et al. 2023; Bouley et al. 2023).
For more than 3 billion people, nearly 40 percent of the world’s population, the ocean is an essential source of food and livelihood (Golden et al. 2021b; FAO 2022; Tigchelaar et al. 2022).
The ocean economy is estimated to generate $1.5 trillion to $2.5 trillion annually and to provide formal employment for more than 30 million people (OECD 2016), with millions more informally employed in artisanal and small-scale fisheries.
Interactions with the ocean and with other blue spaces enhance the physical health and mental wellbeing of humans from infancy to old age (White et al. 2020).

The ocean’s great benefits for humanity are threatened by climate change, worsening pollution and loss of biodiversity. All these threats are driven by the relentless quest for short-term economic gain (primarily by the Global North and by multinational corporations) without concern for the consequences for biodiversity, equity, health, human dignity or sustainability (Whitmee et al. 2015; Abbasi et al. 2023).

We must act now to address this global ocean and human health emergency. Building cross-national, cross-sectoral partnerships, engaging and involving marginalised communities, and sustaining a global structure of laws, treaties, organisations and regulations that protect the environment and prioritise human health and wellbeing will be essential.

Past successes in environmental remediation and health protection, such as the global removal of lead from petrol, the Montreal Protocol ban restricting aerosol products containing chlorofluorocarbons and hydrochlorofluorocarbons, improvements in ambient air quality in a growing number of nations, and the Paris Climate Agreement, show that positive change is possible and attainable. And because LMICs are disproportionately impacted, 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.

Reducing pressures on the ocean

The evidence presented in previous sections of this Blue Paper documents that the health of the ocean is increasingly under threat. These threats are largely of human origin and have been worsening rapidly over the past 50 years. Moreover, evidence is mounting that environmental damage to the coasts, seas and ocean inevitably harms human health and wellbeing. It damages the global economy. And it exacerbates poverty and social injustice. Humans cannot thrive when the ocean is sick (Fleming et al. 2023).

The negative consequences for human health and wellbeing of damaging the ocean are many. Coastal flooding and violent storms destroy coastal communities and result in disease, injury and death. The collapse of fisheries results in malnutrition, starvation, migration and even war. Mercury pollution results in brain injury in infants exposed before birth via maternal consumption of contaminated fish. Plastic pollution, including in the form of lost or discarded fishing gear, entangles whales and turtles, kills seabirds, results in microplastic pollution of food chains and accumulates on beaches and in mangroves. Evidence is building that chronic exposure to microplastics impairs health and increases risk for noncommunicable diseases (Landrigan et al. 2023).

All these negative impacts fall with disproportionate severity on poor, minority, Indigenous and marginalised communities and on countries in the Global South (Landrigan et al. 2023). They are exacerbated by climate change, uncontrolled economic growth, perverse economic incentives and inequality in land and ocean resource ownership (Whitmee et al. 2015; Ma et al. 2021; Callahan and Mankin 2022).

There are multiple gaps in our knowledge of the ocean and in the current understanding of the harms to human health and wellbeing that result from damages to the ocean. Even less is known about the interactions among these harms to the ocean and their possible synergistic impacts on human health.

But we do know with a high degree of certainty that great damage has already been done to the ocean, that human activity is the main cause of this damage and that in the absence of urgent intervention, this damage will only grow worse. We know, in short, that our current use of the ocean is not sustainable.

Recognising and mapping the many harms done to the ocean is, however, only one part of the story of humanity’s interaction with the ocean.

On the positive side, this Blue Paper emphasises that the ocean offers myriad, still largely undiscovered benefits for human health and wellbeing, as well as enormous opportunities for sustainably and equitably strengthening the global economy. Properly and equitably accessed, these benefits could address many of the challenges that surround us today and could sustain humanity in the centuries to come.

The key to realising these benefits will be to harness our intelligence and creativity, curb our appetite for short-term gain, rebalance our relationship with nature and with each other, and take individual and collective evidence-based action to protect and restore the health of the ocean for the good of all humanity (Kelly et al. 2023).

The achievement of these goals will require building cross-sectoral and cross-national partnerships based on mutual respect and creating and honouring a global network of laws, treaties, regulations and organisations that truly involve marginalised communities and whose goal is to promote health, wellbeing, equity and social justice for the good of all humanity and the ocean.

Synthesis of actions and opportunities

The actions highlighted in Sections 1-4, if begun immediately and fully implemented, will ensure that humanity enjoys sustainable and equitable ocean-based opportunities now and for many generations to come. These benefits will advance medicine and biotechnology; food security; and physical, mental and social wellbeing. They can help resolve the injustices caused by economic, social and other inequalities.

The health sector can lead the way as industry leaders across diverse sectors and suppliers, placing nature and ocean at the centre of all strategies through understanding and monitoring its own environmental footprint, helping recovery from decades of mistreatment, re-examining equitable connections to our coasts and ensuring that initiatives benefit both humans and all our natural environments.

In addition, we support the call of the 18 heads of state who comprise the High Level Panel for a Sustainable Ocean Economy (Ocean Panel 2020):

We have a collective opportunity and responsibility to protect and restore the health of our ocean, and build a sustainable ocean economy that can provide food, empower coastal communities, power our cities, transport our people and goods, and provide innovative solutions to global challenges.

The ocean and human health actions presented below can begin immediately and build on those outlined in the Transformations Agenda under the five pillars of health, equity, knowledge, wealth and finance (Ocean Panel 2020) (see Table 1 and Figure 6).

ACTIONS OF OVERARCHING IMPORTANCE

Three key actions of overarching importance must begin immediately and will enhance and sustain the specific actions recommended in the preceding sections of this Blue Paper:

Protect, restore and manage biodiversity: The great potential for marine medicines and biotechnology and marine food sources depends on collaboratively and effectively protecting and managing marine biodiversity. To this end, the world’s nations need to ratify and implement — with genuine commitment to effective management for biodiversity protection, equity and human wellbeing goals — the Convention on Biological Diversity (CBD) Global Biodiversity Framework, the WTO Fisheries Subsidies Agreement and the Agreement under the UN Convention on the Law of the Sea on the Conservation and Sustainable Use of Marine Biological Diversity of Areas beyond National Jurisdiction (BBNJ), in collaboration with local resource users. These are global actions of overarching importance that can and will protect and restore the ocean, improve human health and wellbeing, and reduce stressors on ocean ecosystems. The resourced, equitable and intentional implementation of MPAs and OECMs is a no-regret solution with clear co-benefits for both ocean and human health.
Combat climate change and eliminate pollution: The health of coastal populations depends on slowing climate change to prevent extreme weather events and limit sea level rise, and limiting to the greatest degree possible all pollution from reaching the ocean to conserve healthy marine food sources, with particular focus on reducing emissions from fossil fuels to net zero by 2050 and eliminating plastic pollution. Uphold the commitments of countries to the Paris Agreement, the COP 28 outcomes and the UN Global Plastics Treaty, currently in negotiation. To protect human health and wellbeing, the UN Global Plastics Treaty must impose strict safety requirements on the more than 10,000 synthetic chemicals added to plastics, a mandatory cap on global plastic production and mechanisms to curb the manufacture of single-use plastics. The EU Zero Pollution vision is a cross-cutting objective contributing to the UN 2030 Agenda for Sustainable Development and complementing its 2050 climate-neutrality goal. It steers the European Union towards the 2050 vision of a ‘Healthy Planet for All’ by setting key 2030 targets to speed up pollution reduction. Its main objective is to include pollution prevention in all relevant EU policies. Other countries should follow suit.
Improve measurement and support equity: Integrate linked ocean health and human health indicators as well as metrics of natural and human capital for ongoing monitoring, prevention and evaluation programmes and make these data widely available. Incorporate the evidence and linked indicators of both ocean and human health into all policies and decision-making around ocean-human interactions. We need to simultaneously deploy indicators of both human and ocean health to establish baselines and to track changes in both ocean and human health as actions and interventions (including those outlined below) are rolled out with an overall vision of always improving sustainability and equity. Through continued measurement, effectiveness can be assessed, unintended consequences detected, policies improved and course corrections made towards long-term prevention and equity. To be useful, these monitoring data and appropriate expertise must be shared widely and made available and accessible.

The following symbols are used to cross-reference to the thematic topic, as explored in the sections of this Blue Paper.

Medicine and biotechnology

Building and sustaining food security

Enhancing physical health, mental health and societal wellbeing

Growing the economy and improving health by addressing inequity

Ocean and human health actions

Governments must take action to effectively conserve and manage biodiversity, encourage increased investment support for sustainable and ethical marine biotechnology start-ups with benefit sharing, and support responsible transdisciplinary research. This must be co-designed and implemented with the participation of local communities and other potentially impacted stakeholders.

All industries including (and especially) healthcare must minimise their ocean footprint, helping restore what has been lost and including good ocean stewardship in sustainability strategies. Polluters should pay, instead of profiting from the destruction of ocean and other ecosystems. Systematic incentive structures are needed for industries to invest in long-term sustainable practices. The goal must be to create the inclusive, accessible, clean, productive and resilient ocean called for in the UN Ocean Decade (UN 2021), an ocean that equitably and sustainably benefits the health and wellbeing of all global citizens now and in future generations.

Collaboration between the healthcare and supplier industries (and other sectors) with improved education and communication can lead to changes in procurement frameworks, minimising ocean impacts from product manufacture, use, disposal and marine logistics (see Case study 11). As an example, seaweed-derived home-compostable bioplastics can be utilised for community healthcare products, reducing the need for fossil fuel-derived single-use plastics.

Researchers and public health organisations must scan the horizon for emerging climate-associated disease threats such as antimicrobial-resistant water- and vector-borne diseases in the ocean which not only produce disease in individuals and communities but collectively strain healthcare systems, making it more difficult for them to reduce their climate and pollution footprint.

Ocean equity actions

Ensure genuine engagement of coastal communities, small-scale fishers and Indigenous Peoples in local marine planning, recognising traditional territories and/or incorporating OECMs. The resilience of coastal communities is part of the resilience assessment of any coastal area.

Uphold the marine tenure of local communities and Indigenous Peoples to help support stewardship of the ocean and the security of food, livelihoods and a way of life. This needs to be made explicit when new governance structures are introduced.

Create new institutional structures to facilitate multi-actor, cross-sectoral collaborations. Responsible business practices that engage and co-create with coastal communities, creating inclusive governance in planning and decision-making processes, are essential. However, we need to go further to bridge the organisational and community divides and address the challenges of the full socioeconomic and ecological system, and enable human and ocean health.

Ocean knowledge actions

Enhance ocean skills and knowledge by investing in DNA libraries containing the genetic blueprints of marine life in the ocean. The rich genetic biodiversity of marine species is threatened by habitat destruction, over-exploitation, land-based development and pollution, climate change, de-oxygenation and ocean acidification. We can better appreciate, manage and sustainably utilise the species in the ocean if this resource is jointly owned by governments to support ethical investment and public-private partnerships to develop ocean-sourced medicines, and a variety of new products using the DNA blueprints.

Develop and share technologies and management approaches to produce sustainable, nutrition-sensitive marine food. The ocean provides valuable food and nutrition security to many people. Seafood is generally a good source of dietary micronutrients (e.g. omega-3) that can be increased sustainably and equitably. However, we must address growing inequalities in seafood distribution and consumption.

Share scientific data and expertise through collaborations and partnerships between global institutions and coastal communities to sustainably and equitably manage marine food production already impacted by a combination of climate change, overfishing, pollution and globalisation. For example, small-scale fishers (including women) should be supported who have knowledge useful for the sustainable management of extractive marine food such as seaweeds and molluscs.

Foster pro-ocean policies that will ensure pro-environmental behaviour through knowledge-sharing, ocean literacy and citizenship, increasing sustainable and high-quality blue space access, and appealing to personal and societal values. This is particularly important for the healthcare sector: significantly undervalued, the ocean provides many benefits to human health and wellbeing.

Ocean wealth actions

Identify management processes and ocean products that should be developed as socially relevant, economically sustainable and environmentally friendly so that the ocean can continue to produce sustainably for future generations. The ocean holds enormous, still undiscovered, potential for new medicines, new materials and new products.

End overfishing, reduce seafood loss and waste and stop illegal seafood harvesting, including by ratifying and implementing the Agreement on Port State Measures. Seafood plays an essential role in the diet of the world’s populations, providing proteins and micronutrients.But these resources must not be diverted (as they currently are through mostly legal means) to the benefit of the richest countries.

Support sustainable mollusc and seaweed cultivation and harvest. The development of food technologies with a low carbon footprint should be encouraged. In addition to its potential as food, seaweed has many other potential sustainable uses, such as animal feed, fertilisers, bio-plastics and bio-fuels.

Upscale existing, and develop new, blue care prescription programmes. The cost to society of chronic diseases (cardiovascular, mental health, etc.) has been demonstrated, as has the contribution to health and wellbeing of access to marine and other blue space areas (a process known as the ‘Blue Health Effect’). Make the ocean sustainably and equitably accessible for targeted intervention programmes to reduce health-related and other costs.

Ocean finance actions

Deliver blue health economy investment pathways that align with Sustainable Ocean Plans for 100 percent of the ocean. These would facilitate access to effective healthcare, blue foods and clean water for all coastal and island communities, and increase opportunities to engage in marine research and product development around the globe. Knowledge and management of marine ecosystems is underfunded, and the opportunities for returns are often not fully appreciated, yet the world economy depends on a healthy blue planet.

Reform global finance and trade to provide more equitable access to marine resources. Build on recent multilateral successes (e.g. the new UN High Seas Treaty and the WTO agreement) to phase out selected fisheries subsidies. To this end, redirect finance to support investment in technologies that support sustainable production practices and efforts to meet global climate targets; slow the removal of nutritious aquatic foods from nations with a high prevalence of nutrient deficiencies; and ensure that trade works for low-income nations, through debt relief and aligning trade with domestic food security policy. These efforts could target other subsidies that lead to overfishing and overcapacity but remain in place.

Link the health and ocean finance institutional efforts with a focus on ocean-positive actions and blue infrastructure investments that use nature-based solutions to deliver equitable returns to human and ocean health. By integrating ocean wellbeing solutions systemically into public health and social care, we can reduce costs and improve outcomes.

This requires key reforms of the global trade and finance system, integrating inclusive and ethical accounting for both nature and human wellbeing. Public-private partnerships and insurance solutions can serve to deliver further support and introduce price signals. Using these formats will help to re-allocate risk and encourage private sector engagement alongside public funders.

FIGURE 6. Opportunities for action to support both ocean health and human health and wellbeing in a changing planetary environment

TABLE 1. Summary of key recommended actions to promote human and ocean health

Conclusion

We must act now to address the growing challenges of the climate and health crisis. It is essential to begin to implement these Blue Paper actions immediately in order to prevent more damage, realise the benefits of these actions, and protect both ocean and human health into the future.

Most of these actions are already represented in current and ongoing global policy efforts relevant to protecting and sustaining both ocean and human health. Therefore, it is important to uphold and implement the many existing relevant policy actions (e.g. 30×30 with integration of OECMs; the International Covenant on Economic, Social and Cultural Rights; responsible business and innovation) mentioned throughout this Blue Paper.

In addition to the ongoing work of the Ocean Panel, new policy actions towards ocean and human health are also emerging. For example, in the recent Vigo Declaration (2023), members of the European marine science community have pledged to work together to ensure ocean sustainability; the Villars Framework (2023) redirects finance towards investment in technologies that support sustainable fisheries production practices and efforts designed to meet global climate targets (Cheung et al. 2023); and ongoing international efforts by the United Nations and many others seek to support and produce a legally binding global plastics treaty (UNEP 2021). The resolutions from the UN Human Rights Council in 2021 (A/HRC/RES/48/13) and the UN General Assembly in 2022 (A/RES/76/300) recognise that a clean, healthy and sustainable environment is a human right, giving legal value to the environment; these resolutions also help protect individuals and communities from environmental risks to their health and livelihoods (UNGA 2021). The historic examples of the Montreal Protocol, the Stockholm Convention and the Minamata Convention show us that positive change is attainable, and that humanity can come together to thrive and to preserve planetary health.

Going forward, coastal communities, the healthcare sector, government, academia, business and finance need to join and support these global cooperative efforts for ocean and human health (U.S. Ocean Policy Committee 2023). In the face of uncertainty about strategies for managing ocean resources, governments and international organisations should be guided towards a vision of universal ocean citizenship and planetary stewardship (Kelly et al. 2023) and apply the precautionary principle to prevent future harm (Spalding 2016). Only then can we provide truly transdisciplinary, science-based policy advice and action in all levels of governance, with sustainability, equity and inclusion at the core of all their actions, to ensure that the best decisions are made for both the ocean and people, with no one left behind.

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