Waking up to Blue Planetary Health: The role of our seas ...

Waking up to Blue Planetary Health: The role of our seas and oceans

Exeter 07/11/18

Mat White (Senior Lecturer in Environmental Psychology)

+ Ian Alcock, Sophie Davison, Sian de Bell, Claire Eatock, Jacqui Eales, Lewis Elliott, Jo Garrett, Ruth Garside,

Caroline Hattam, James Grellier, Timur Jack-Kadioglu, Anne Leonard, Aimee Murray, Sabine Pahl, Rebecca

Shellock, Em Squire, Tim Taylor, Nicole van den Bogerd, Anastacia Voronkova, Nicky Yeo, Lihong Zhang.

Michael Depledge

Ben WheelerKaryn Morrissey

Lora Fleming Connie GuellWill Gaze

Mik VosRebecca Lovell

Overview

1. Marine – seriously?

2. Oceans & Human Health: The threats- Flooding/drowning- Biological threats- Chemical threats

3. Oceans & Human Health: The benefits- Mental, physical and social - Health inequalities- Policy implications

4. A planetary perspective- BlueHealth- SOPHIE (Seas Oceans & Public Health in Europe)- Blue Communities

5. Some closing thoughts

The Ocean – Seriously?

I’ve got enough to worry about on land without worrying about

the ocean

Marine in the Commission on Planetary Health (2015)

Search terms: marine (22); ocean* (44); coast* (23)

14 Anthropocene trends 2 (mainly) marine 1 explored in detail

Why it matters – Part 1It directly affects the health of a lot of people

• 71%: Surface of the earth = Ocean

• 2.9 Billion: People who depend on seafood for ≥20% of annual protein3

• SDG 14: Life Below Water

• 16 million: People protected from flooding by mangroves

• 2.5 billion: Global population live in coastal zones1

• 21/33: Megacities are on the coast

• 8/10: Top EU tourist destinations = coastal2

1. Martínez et al. (2007). The coasts of our world: Ecological, economic & social importance. Ecological Economics, 63(2-3), 254-272.2. https://ec.europa.eu/eurostat/3. Whitmee, et al. (2015). Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary

health. The Lancet, 386(10007), 1973-2028.

https://ec.europa.eu/eurostat/

Why it matters – Part 2:Seas/oceans can help tackle key health issues

• Childhood obesity: Lower at the coast3

• Vitamin D: Levels higher at the coast4

• Physical activity: Higher at the coast2

• Depression/anxiety: Lower at the coast1

1.White et al., (2013). Coastal proximity and health: A fixed effects analysis of longitudinal panel data. Health & Place, 23, 97-103.2.White et al. (2014). Coastal proximity and physical activity. Preventive Medicine, 69, 135-140.3.Wood et al (2016). Exploring the relationship between childhood obesity and proximity to the coast. Health & Place, 40, 126-136.4.Cherrie et al. (2015). Elevated solar irradiance and higher 25(OH)D level in coastal residents. Environment International, 77, 76-84

Overview






Significant focus in US More recent in Europe More recent still in the UK

Oceans and human health

Summary of threats: Foresight report

Human activitiesUrbanisation; Mining; Shipping; Fishing Aquaculture; Marine renewables; Marine biotechnology

Environmental Ecosystem degradation, flooding, storm

surges, water/vector borne diseases, current/wind changes,

earthquakes/tsunamis, invasive species, harmful algal blooms, ocean acidification

PollutionMicrobial, chemical, air (from coastal shipping/industry), pharmaceutical, nutrient (run-off), plastics

Socioeconomic -cultural Demographic change, destruction of traditional (e.g. fishing) communities; shifts in economies and industries; Tourism & 2nd

home ownership; peripherality/remoteness

Health OutcomeDrowningInjuryInfectious diseasesPollutant exposureAMRAcute toxicity, Respiratory/cardiovascularBbirth defectsChronic diseasesMental health Body burdens of toxins

Depledge, Lovell, Wheeler, Morrissey, White, & Fleming (2017). Review of Evidence: Health and well-being of coastal communities. Government Office of Science Foresight ‘Future of the Sea’ Project. London: Author.

Overview






Flooding and storm surges

Tsunamis: 28th Sept 2018 Central Sulawesi (Palu)>2,000 deathsLegacy of public health threats (sanitation)

Not simply ‘acts of god’: Human decisions about1: Cutting mangrovesWhere to build homes/infrastructureMitigation/adaptation strategies

UK: Climate change increased threat of storm surges & floods – associated threats to homes & infrastructure (increased demands on health services).

South west UK – especially vulnerable!!!

Photograph: Antara Foto/Reuters

Photograph: Adek Berry/AFP/Getty Images

Eiser et al. (2012). Risk interpretation and action: A conceptual framework for responses to natural hazards. International Journal of Disaster Risk Reduction, 1, 5-16.Lowe & Gregory (2005). The effects of climate change on storm surges around the United Kingdom.Philosophical Transactions of the Royal Society of London A, 363(1831), 1313-1328.

Drowning: WHO report

http://www.who.int/violence_injury_prevention/publications/drowning_global_report/Final_report_full_web.pdf

Most accidental drownings occur from people who fell into the water while walking/running

More people drown in the bath than either sailing or angling

85% males (mainly young adults); 39% involved alcohol/drugs

Accidental drownings in the UK 2017 (n =255)

At SeaBath (inchot-tubs)

Canal/Aquaduct

Coast/Shore/Beach

Harbour/Dock/Marina/Port Lake Pond

Pool (Swimming) Quarry Reservoir River

Stream/Ditch

Water Container

Grand Total

Angling 7 1 1 1 10Animal rescue 1 1Bath 10 10Climbing/cliff 1 1Commercial 3 1 1 1 1 7Cycling 1 2 3Jumping/diving in 2 1 1 1 5 10Manually powered boats 4 1 1 6Motor vehicle 3 1 3 3 10Motorboating 2 1 1 4 2 10

Person/object in water, 1 2 3 2 6 14Personal water craft 1 1 2Recreational flying 2 2Sailing 1 1 2Sub aqua diver 8 6 1 1 16Swimming 14 3 6 4 1 7 35Walking/running 19 25 14 5 2 32 9 106Waterside/in water play 1 1 1 2 4 9Wind/kitesurfing 1 1Grand Total 14 11 23 68 21 27 2 6 2 4 64 12 1 255

National Water Safety Forum (2017) https://www.nationalwatersafety.org.uk/waid/reports.asp

Overview






Biological threats [Pt 1]

Wade, et al. (2005). Rapidly measured indicators of recreational water quality are predictive of swimming-associated gastrointestinal illness. Environmental Health Perspectives, 114(1), 24-28.

Halliday, E., & Gast, R. J. (2010). Bacteria in beach sands: an emerging challenge in protecting coastal water quality and bather health. Environmental Science & Technology, 45(2), 370-379.

Towan Head Newquay Sept 2nd 2018

https://www.sas.org.uk/news/towan-head-sewage-spill-2nd-september/

EU’s Revised Bathing Water Directive

4 year rolling average (with 15% discounts!!)Excellent, Good, Sufficient,

Poor: E.Coli: >500 cfu/100ml; I.enterococci: >185 cfu/100ml

EC: Escherichia coli, IE: Intestinal enterococci, CFU – colony forming units

Contingent behaviour experiment –14 EU countries – Would seeing this sign influence your choice?

White et al., (in prep). Public reactions to EU standard bathing water signage: A 14 country contingent behaviour experiment.

Drug resistant E.coli (genes)

Beach Bum Survey

Leonard AFC, Zhang L, Balfour AJ, Garside R, Gaze WH (2015). Human recreational exposure to antibiotic resistant bacteria in coastal bathing waters. Environment International, 82, 92-100.

Leonard, et al. (2018). Exposure to and colonisation by antibiotic-resistant E. coli in UK coastal water users: Environmental surveillance, exposure assessment, and epidemiological study (Beach Bum Survey). Environment international, 114, 326-333.


Parasites

https://www.cdc.gov/parasites/hookworm/index.html

Centres for Disease Control and Prevention: Est.- 576-740 million people infected

Harry the Hookworm


Harmful algal blooms

Berdalet, Fleming, et al. (2016). Marine harmful algal blooms, human health and wellbeing: challenges and opportunities in the 21st century. JMBA, 96(1), 61-91.

Toxins (e.g. Brevetoxin)

• Mass fish kills

• Ingested via affected seafood (esp. shellfish)

• Paralytic shellfish poisoning (PSP)

• Inhalation from aerosolization (aggravates asthma etc)

• Increased likely in UK waters due to more prevalent in the UK due to a) warmer waters (+ encouraging more people to be exposed); b) Increased nutrient loads

Moore … & Fleming (2008). Impacts of climate variability and future climate change on harmful algal blooms and human health. In Environmental Health (Vol. 7, No. 2, p. S4).


Overview






Chemical pollutants: e.g. Methylmercury

Sheehan, M. C., Burke, T. A., Navas-Acien, A., Breysse, P. N., McGready, J., & Fox, M. A. (2014). Global methylmercury exposure from seafood consumption and risk of developmental neurotoxicity: a systematic review. Bulletin of the World Health Organization, 92, 254-269F.

Understanding the pathways (human decisions)

Thompson, Moore, Vom Saal, & Swan. (2009). Plastics, the environment and human health: current consensus and future trends.Phil Trans of the Royal Society of London B: Biological Sciences, 364(1526), 2153-2166.

Plastics: Signal value!

Pahl, Wyles, & Thompson, (2017). Channelling passion for the ocean towards plastic pollution. Nature Human Behaviour, 1(10), 697.

Galloway, T. S. (2015). Micro-and nano-plastics and human health. In Marine anthropogenic litter (pp. 343-366). Springer, Cham.

Vijaykumar, S., Jin, Y., & Nowak, G. (2015). Social media and the virality of risk: The risk amplification through media spread (RAMS) model. Journal of Homeland Security and Emergency Management, 12(3), 653-677.

Signal value & the importance of public buy-in

Kasperson, Roger E., Ortwin Renn, Paul Slovic, Halina S. Brown, Jacque Emel, Robert Goble, Jeanne X. Kasperson, and Samuel Ratick. "The social amplification of risk: A conceptual framework." Risk analysis 8, no. 2 (1988): 177-187.

Overview






Policy Goal 1: Valuing the Ocean

“Europe needs a coordinated, interdisciplinary and integrated programme on Oceans and Human Health, understanding and managing the risks and benefits of our interactions with the seas”

Oceans and human health EU: Rome Declaration 2014

The benefits to health and wellbeing

Dr Richard Russell (1687– 1759)

Royal Sea Bathing Hospital (Est.1791)

Dr Fortescue Fox(1934 & 1938 Lancet)

Charlier & Chaineux(2009) Thalassotherapy

National evidence?

Self-reported health & coastal proximity

Wheeler, White, Stahl-Timmins, & Depledge (2012). Does living by the coast improve health and wellbeing?. Health & Place, 18(5), 1198-1201.

Oceans and human health: A paradox?

‘Poor health’ is HIGHER at the coast (Unadjusted model) a

‘Poor health’ is LOWER at the coast (Adjusted model)

a Depledge et al. (2017). Future of the sea: Foresight report b Wheeler, White, Stahl-Timmins & Depledge (2012). Health & Place, 18, 1198-1201; C White, Alcock, Wheeler & Depledge (2013). Health & Place, 23, 97-103

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No paradox: Reflects an older population at the coast a – when we account for this – coastal residents are healthier! b

- Not a selective migration effect – people get healthier when they move to the coast (BHPS data 1991-2008: n = 12,818; Obs = 87,573) c

Overview






The Blue Gym: Our highly multi-method approach

Method Pros (inc.) Cons (inc.) Our studiesSystematic reviews Better overview; Meta-

analyse dataExclusion of important studies; Non-weighting of quality criterion

- Blue health- Attention Restoration- Nature volunteering

Where people live Representative samplesSome longitudinal data

Causality?Multiple confounders

- Census (N = 48 million)- BHPS (N = 12,000 x 18 yrs)

Visitor surveys Big numbers / Multiple environments (controls)Voluntary/chosen

Memory biases, selectioneffects

- MENE (N = 280,000)- Wembury surveys- Surfing / sailing studies

Lab experiments Reduced confounds & selection effects. Increased understanding of underlying processes

Small Ns (convenience samples); non-ecologicale.g. may miss synergistic effects

- Videos/photos/sounds- Attention processes- Delay of gratification- Pain

Field experiments Realistic exposure conditions with some control

Hard to randomise/blind to condition

- Marine Aquarium- Dental surgeries- Walking brochures

Narrative interviews In-depth understand of people’s motives & beliefs

Unrepresentative samples Demand characteristics

- Parent/child interviews- Sailing/surfing programmes

White et al. (2016). The ‘Blue Gym’: What can blue space do for you and what can you do for blue space? JMBA,96, 5-12.White et al. (2016). The health effects of blue exercise in the UK. In J. Barton (Eds), Green Exercise: Linking Nature, Health and Well-BeingWhite et al. (2018). Blue landscapes and public health. In M. van den Bosch & W. Bird (eds). Landscape and Public Health (pp154-159). Oxford: OUP

Coast & health: Main pathways

< Stress

> Exercise

> Environment

> Social

Monitor of Engagement with the Natural Environment

MENE Subset (n = 4,255) asked about experiences in

a) Urban green spaceb) Rural green spacec) Coast

Stress reduction: To what extent did they feel ‘x’ after the visit:1) Relaxed2) Calm3) Refreshed4) Revitalised

Stress reduction in different natural environments

White, Pahl, Ashbullby, Herbert & Depledge (2013). Journal of Environmental Psychology, 35, 40-51

Error bars: 95% CI

- All visits were good but coastal visits were most stress reducing

3.6

3.7

3.8

3.9

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4.1

4.2

4.3

4.4

Urban green (n = 1,816) Rural green (n = 1,884) Coast (n = 555)

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Controlling for Who (Age, gender, SES) & What (activities, duration, who with, distance travelled etc.)

BHPS, Coastal proximity & Health

White, Alcock, Wheeler & Depledge (2013). Health & Place, 23, 97-103

British Household Panel Survey (1991-2008)(N =12,818, Obs = 87,573)

- This isn’t a “healthier” retiree effect

-10-8-6-4-202468

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Error bars: 95% CI


< Stress

> Exercise

> Environment

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Do people who live near the coast exercise more?

MENE n = 183,755 – “How many days a week of ≥ 30mins exercise” (Recommendations: 5 or more)

White, Wheeler, Herbert, Alcock & Depledge (2014). Preventive Medicine, 69, 135-140.

Controlling for area (income etc.) and individual controls (age, gender, dog ownership etc).

Error bars: 95% CI

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0.940.960.98

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Home (LSOA) distance from the coast

Gascón, Zijlema, Vert, White & Nieuwenhuijsen (2017). Blue spaces, human health and well-being: a systematic review. International Journal of Hygiene and Environmental Health, 1207-1221.

Studies: N = 35 (22 good quality)

“The balance of evidence suggested a positive association between greater exposure to outdoor blue spaces and benefits to both mental health and wellbeing and physical activity…

The evidence for … general health, obesity, CVD and related outcomes was less consistent.”

Blue space systematic review


< Stress

> Exercise

> Environment

> Social

Family time? Qualitative interviews 15 families

“I'll just go straight in surfing and I might get out for a bit of lunch and then I might make a sandcastle with my sister… and then I'd go back in again or I'd go rock pooling with my sister” (Boy aged11, Family 11)

“Instead of the adults just sitting somewhere on a bench while the kids do activities they get up and they play Frisbee or cricket and football and sometimes go swimming with them.” (Boy aged 11, Family 6).”

Ashbullby, Pahl, Webley & White (2013). Health & Place, 23,138-147

- The coast encourages families to play together

“There's no sunbathing sort of thing we don't have time for that…it's all kind of up and about and making up games and playing with

sandcastles and things” (Father, Family 2)


< Stress

> Exercise

> Environment

> Social

Solar irradiance (UVR) & Vitamin D are higher at the coast

Cherrie, Wheeler, White, Sarran, & Osborne (2015). Coastal climate is associated with elevated solar irradiance and higher 25(OH)D level in coastal residents. Environment International, 77, 76-84

Low VitD associated with certain auto-immune & cardio-vascular diseases, some cancers & poor mental health.

UVR a source of VitD

(A) Higher UVR near coast

(B) Higher VitD levels among coastal dwellers

(A)

(B)

Overview






The coast may be good for health inequalities

Wheeler, B., White, M.P., Stahl-Timmins, W. & Depledge, M.H. (2012). Does living by the coast improve health and wellbeing? Health & Place, 18, 1198-1201.

Any health benefits from living near the coast are strongest for those in more deprived areas

Beaches are used by all sectors of society

Other natural areas (e.g. woodlands) are dominated by the middle classes Elliott, White, Grellier, Rees, Waters, & Fleming (2018). Recreational visits to inland and coastal waters in England: Who, where, when, what and why. Marine Policy, 97, 305-314

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Beaches (n = 6,256) Woodlands (n = 8,347)

MENE n = 82,322 visits (urban parks most)

Overview






White et al. (2016)

White, Elliott, Taylor, Wheeler, Spencer, Bone, Depledge, & Fleming, (2016). Recreational physical activity in natural environments and implications for health: A population based cross-sectional study in England. Preventive Medicine, 91, 383-388.

Participants: n = 280,790 English population (MENE)

Exposure: Physical activity in nature

Outcomes: % of people who achieve PA recommendations all or in part in nature

£2.03bn - 2.33bn pa (95% CI) Check (walking only)

PA QALYs: £1.59bn

WHO HEAT tool: £1.75bn

English Coast Path (DEFRA’s ‘Living Coast’ project)

“aims to improve public access to, and enjoyment of, the English coastline by creating clear and consistent public rights along the English coast for open-air recreation on foot.”

Overview






Investigate the relationship between

urban blue infrastructure and health and

wellbeing in Europe

3 example OHH projects @ ECEHH

€6,000,000

2016 2020

Bluehealth is funded by the European Union’s Horizon 2020 research and innovation programme, grant agreement No. 666773.

Pan European project to look at blue space & health across EU.

WP1 - Management

WP2 – Large surveys

WP3 – Natural experiments

WP4 – Health care & VR

WP5 – Acupuncture interventions

WP6 – Future scenarios

WP7 –Policy development (WHO)

WP8 – Communication/Dissemination

BlueHealth

N=1,000 nationally (sex, age, region) and seasonally (4 waves) representative

Blue health survey (18 countries)

Blue health survey (14.5k visits)

Blue health survey (14.5k visits)

Learning something about their health and wellbeing living near and/or visiting the coast

Acupuncture Interventions: e.g. Teat’s Hill in Plymouth

High deprivation, mainly social housing, and poorly maintained park/beach area

Any effects on health & wellbeing?2016• Initial discussions•Survey design

2017•Piloting survey•Stakeholder engagement•Data collection and analysis (Stage 1)•Public consultation•Landscape design•Renovation of site

•Renovation of Teat’s Hill

2018•Renovation of site•Data collection and analysis (Stage 2)•Data assessment

2019•Further analyses•Reporting

Shellock, Hattam, Borger & White (in prep). A contingent valuation study of an urban bluespace regeneration project.van den Bogerd, Elliott, White, Bell, Sekhra, Fleming (in prep). Urban blue acupuncture & well-being: A case study from a deprived area of Plymouth, UK.

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10

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Before rennovation (n 309) After rennovation (n 331)Ad

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Well-being (WHO-5)

Adj: Age, gender, income, dog ownership, marital status, household composition, home distance,

Local resident survey



wellbeing in Europe


€6,000,000

2016 2020€2,000,000

2017 2020

Produce a research agenda for oceans and human health for the European context


SOPHIE overview

SOPHIE survey (14 EU countries)

More focused on the trade-offs between marine sector growth, marine environmental protection and human health & wellbeing

Survey currently being tested with international polling company (going

live Feb 2019)



wellbeing in Europe


€6,000,000

2016 2020

€2,000,000

2017 2020

£6,000,000

2018 2022

Produce a research agenda for oceans and human health for the European context

Build capacity for sustainable interactions with marine ecosystems for the benefit of health,

well-being, and livelihoods of coastal

communities in Southeast Asia


Blue Communities: Sustainable Marine Planning

Overview






The Ocean – Seriously!

So spending time by the sea can help tackle some big issues for my patients• Physical activity• Mental health• Social relations• Health inequalities

Not to mention the billions of people whose livelihoods & health depend on the health of the oceans in Asia, Africa, South America, Europe, Australasia etc.

A word of caution ………………….

Marine = 3Ocean* = 3Coast* = 0

2017 Pollution & health report:- Methylmercury discussed but no mention that the main source of human

contact is through eating fish/shellfish

- Ocean acidification barely mentioned despite being a major (CO2) pollution issue

Search words: marine OR ocean OR coast

Marine = 22Ocean* = 44Coast* = 23

2015 (56pp) 2017 (51pp)

?

Take home message

Let’s build on the excellent work of the Rockefeller-Lancet Commission on Planetary Health

But let’s not forget it’s the Blue Planet

And that our own health and wellbeing crucially depends on how we care for the seas and oceans

Waking up to Blue Planetary Health: The role of our seas and oceans

Thanks very much for your attention

Mat White ([email protected])

+ Ian Alcock, Sophie Davison, Sian de Bell, Claire Eatock, Jacqui Eales, Lewis Elliott, Jo Garrett, Ruth Garside,

Madeleine Gustavsson, Caroline Hattam, James Grellier, Timur Jack-Kadioglu, Anne Leonard, Aimee Murray,

Sabine Pahl, Rebecca Shellock, Em Squire, Tim Taylor, Anastacia Voronkova, Nicky Yeo, Lihong Zhang.

Michael Depledge

Ben WheelerKaryn Morrissey

Lora Fleming Connie GuellWill Gaze

Mik VosRebecca Lovell

The environment plays a key role in public health

Health Map, Barton & Grant, 2006

Ecosystem services & human well-being

Walking (with/without a dog) the most frequent activity by far

Direct contact is not that common

Elliott, White, Grellier, Rees, Waters, & Fleming (2018). Recreational visits to inland and coastal waters in England: Who, where, when, what and why. Special Issue in Marine Policy, 97, 305-314

Grellier, White, Albin, Bell, Elliott, Gascón, Gualdi, Mancini, Nieuwenhuijsen, Sarigiannis, Van den Bosch, Wolf, Wuijts, Fleming (2017). BlueHealth: a study programme protocol for mapping and quantifying the potential benefits to public health and well-being from Europe’s blue spaces. BMJ Open, 7(6), e016188.

Blue Health’s Conceptual Framework

Waking up to Blue Planetary Health: The role of our seas ...

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