Linking the oceans to public health: current efforts and future directions

We review the major linkages between the oceans and public health, focusing on exposures and potential health effects due to anthropogenic and natural factors including: harmful algal blooms, microbes, and chemical pollutants in the oceans; consumption of seafood; and flooding events. We summarize briefly the current state of knowledge about public health effects and their economic consequences; and we discuss priorities for future research.We find that:? There are numerous connections between the oceans, human activities, and human health that result in both positive and negative exposures and health effects (risks and benefits); and the study of these connections comprises a new interdisciplinary area, "oceans and human health."? The state of present knowledge about the linkages between oceans and public health varies. Some risks, such as the acute health effects caused by toxins associated with shellfish poisoning and red tide, are relatively well understood. Other risks, such as those posed by chronic exposure to many anthropogenic chemicals, pathogens, and naturally occurring toxins in coastal waters, are less well quantified. Even where there is a good understanding of the mechanism for health effects, good epidemiological data are often lacking. Solid data on economic and social consequences of these linkages are also lacking in most cases.? The design of management measures to address these risks must take into account the complexities of human response to warnings and other guidance, and the economic tradeoffs among different risks and benefits. Future research in oceans and human health to address public health risks associated with marine pathogens and toxins, and with marine dimensions of global change, should include epidemiological, behavioral, and economic components to ensure that resulting management measures incorporate effective economic and risk/benefit tradeoffs.     

Environmental controls,oceanography and population dynamics of pathogens and harmful algal blooms: connecting sources to human exposure

Coupled physical-biological models are capable of linking the complex interactions between environmental factors and physical hydrodynamics to simulate the growth, toxicity and transport of infectious pathogens and harmful algal blooms (HABs). Such simulations can be used to assess and predict the impact of pathogens and HABs on human health. Given the widespread and increasing reliance of coastal communities on aquatic systems for drinking water, seafood and recreation, such predictions are critical for making informed resource management decisions. Here we identify three challenges to making this connection between pathogens/HABs and human health: predicting concentrations and toxicity; identifying the spatial and temporal scales of population and ecosystem interactions; and applying the understanding of population dynamics of pathogens/HABs to management strategies. We elaborate on the need to meet each of these challenges, describe how modeling approaches can be used and discuss strategies for moving forward in addressing these challenges.     

Daily measures of microbes and human health at a non-point source marine beach

Studies evaluating the relationship between microbes and human health at non-point source beaches are necessary for establishing criteria which would protect public health while minimizing economic burdens. The objective of this study was to evaluate water quality and daily cumulative health effects (gastrointestinal, skin, and respiratory illnesses) for bathers at a non-point source subtropical marine recreational beach in order to better understand the inter-relationships between these factors and hence improve monitoring and pollution prevention techniques. Daily composite samples were collected, during the Oceans and Human Health Beach Exposure Assessment and Characterization Health Epidemiologic Study conducted in Miami (Florida, USA) at a non-point source beach, and analyzed for several pathogens, microbial source tracking markers, indicator microbes, and environmental parameters. Analysis demonstrated that rainfall and tide were more influential, when compared to other environmental factors and source tracking markers, in determining the presence of both indicator microbes and pathogens. Antecedent rainfall and F+ coliphage detection in water should be further assessed to confirm their possible association with skin and gastrointestinal (GI) illness outcomes, respectively. The results of this research illustrate the potential complexity of beach systems characterized by non-point sources, and how more novel and comprehensive approaches are needed to assess beach water quality for the purpose of protecting bather health.     

Future trends in environmental mercury concentrations: implications for prevention strategies

In their new paper, Bellanger and coauthors show substantial economic impacts to the EU from neurocognitive impairment associated with methylmercury (MeHg) exposures. The main source of MeHg exposure is seafood consumption, including many marine species harvested from the global oceans. Fish, birds and other wildlife are also susceptible to the impacts of MeHg and already exceed toxicological thresholds in vulnerable regions like the Arctic. Most future emissions scenarios project a growth or stabilization of anthropogenic mercury releases relative to present-day levels. At these emissions levels, inputs of mercury to ecosystems are expected to increase substantially in the future, in part due to growth in the legacy reservoirs of mercury in oceanic and terrestrial ecosystems. Seawater mercury concentration trajectories in areas such as the North Pacific Ocean that supply large quantities of marine fish to the global seafood market are projected to increase by more than 50% by 2050. Fish mercury levels and subsequent human and biological exposures are likely to also increase because production of MeHg in ocean ecosystems is driven by the supply of available inorganic mercury, among other factors. Analyses that only consider changes in primary anthropogenic emissions are likely to underestimate the severity of future deposition and concentration increases associated with growth in mercury reservoirs in the land and ocean. We therefore recommend that future policy analyses consider the fully coupled interactions among short and long-lived reservoirs of mercury in the atmosphere, ocean, and terrestrial ecosystems. Aggressive anthropogenic emission reductions are needed to reduce MeHg exposures and associated health impacts on humans and wildlife and protect the integrity of one of the last wild-food sources globally. In the near-term, public health advice on safe fish consumption choices such as smaller species, younger fish, and harvests from relatively unpolluted ecosystems is needed to minimize exposure risks.     

Indicators of ocean health and human health: developing a research and monitoring framework

We need to critically assess the present quality of the marine ecosystem, especially the connection between ecosystem change and threats to human health. In this article we review the current state of indicators to link changes in marine organisms with eventual effects to human health, identify research opportunities in the use of indicators of ocean and human health, and discuss how to establish collaborations between national and international governmental and private sector groups. We present a synthesis of the present state of understanding of the connection between ocean health and human health, a discussion of areas where resources are required, and a discussion of critical research needs and a template for future work in this field. To understand fully the interactions between ocean health and human health, programs should be organized around a "models-based" approach focusing on critical themes and attributes of marine environmental and public health risks. Given the extent and complex nature of ocean and human health issues, a program networking across geographic and disciplinary boundaries is essential. The overall goal of this approach would be the early detection of potential marine-based contaminants, the protection of marine ecosystems, the prevention of associated human illness, and by implication, the development of products to enhance human well-being. The tight connection between research and monitoring is essential to develop such an indicator-based effort.     

The interface of public healthcare with the health of the oceans: proliferation of disease, socio-economic impacts and beneficial relationships

Over the past decades, human activities have had a heavy impact on the marine environment, causing alterations in ecological processes. The relationship between the health of the oceans, human activities and public healthcare is already generally accepted, though the mechanisms involved are still under scientific scrutiny. These relationships include a focus on climate change, toxic algal blooms, microbial and chemical contamination in marine waters and bioinvasion by exotic species. Moreover, there is the beneficial effect of the oceans on human health and wellbeing, such as natural products for the human diet, the development of biomedicine, or simply the satisfaction derived from human recreation, sports and other interactions of humans with oceans. The importance of appreciating the link between public healthcare and the health of the oceans is especially important due to the growing number of people living in coastal areas, mainly in tropical and subtropical regions. The backcloth to this is risk-related human activities that pose a danger to marine environmental health and the increase in the vulnerability of humans and biodiversity and socio-environmental iniquity.     

Influence of Humans on Evolution and Mobilization of Environmental Antibiotic Resistome

The clinical failure of antimicrobial drugs that were previously effective in controlling infectious disease is a tragedy of increasing magnitude that gravely affects human health. This resistance by pathogens is often the endpoint of an evolutionary process that began billions of years ago in non–disease-causing microorganisms. This environmental resistome, its mobilization, and the conditions that facilitate its entry into human pathogens are at the heart of the current public health crisis in antibiotic resistance. Understanding the origins, evolution, and mechanisms of transfer of resistance elements is vital to our ability to adequately address this public health issue.     

Future directions of environmental public health research: ATSDR's 2002-2010 agenda for six priority focus areas

Additional research on human exposures to hazardous substances in community settings and resultant adverse health effects is needed to fill an extensive number of information gaps. For example, information is needed to answer specific public health questions about the toxic effects of specific chemicals, who has been exposed, what the health risks might be, and what interventions are effective. The Agency for Toxic Substances and Disease Registry (ATSDR) is the principal federal agency responsible for addressing issues of public health concerning the human health risks associated with hazardous waste sites and unplanned releases of hazardous substances into the environment. Research is a critical component in how effectively the agency can identify persons exposed, determine health risks, and intervene to reduce exposures and adverse health outcomes. ATSDR has recently developed an agenda for public health environmental research for 2002-2010, divided into the following six research focus areas: exposure assessment; chemical mixtures; susceptible populations; community and tribal involvement; evaluation and surveillance of health effects; and health promotion and intervention. This article discusses the agenda's development, the research issues within each of the six focus areas, and preliminary implementation plans.     

Environmental degradation and health risks in Beijing, China

As China's capital city, Beijing is experiencing unprecedented environmental degradation accompanied by complex interactions between urbanization and global environmental change, which places human health at risk on a large spatial and temporal scale. For sustainable development that supports environmental and human health in Beijing and during the upcoming "green" Olympic games in 2008, experts and political leaders must acknowledge the urgent health risks from environmental changes related to urbanization. A range of urban health hazards and associated health risks in Beijing result from a variety of factors including heat islands, air pollution, water crisis, soil pollution, infectious diseases, and urban consumerism; in addition, some hazardous health conditions are associated with inequality in living and working conditions. The authors suggest 2 main areas for policy action and research direction: (1) the need to get full-scale information related to environmental monitoring data and health data (and then to provide new methodological approaches and techniques to implement interventions) and (2) the need for effective cooperation among different sectors.     

Indicators of ocean and human health

The interactions between humans and the ocean are significant, and necessitate more comprehensive study on an international scale. The world's oceans provide great health benefits to humans ranging from food and nutritional resources, to recreational opportunities and new treatments for human disease. However, recently, human health effects from exposure to substances present in the marine ecosystem such as synthetic organic chemicals (e.g., chlorobiphenyls, chlorinated dioxins and some industrial solvents), polycyclic aromatic hydrocarbons (PAHs), metals (both introduced and anthropogenic), marine toxins, and pathogens have been recorded and are of great concern. This paper reviews our state of knowledge of the interactions between oceans and human health and proposes indicators and a research strategy to investigate and monitor these relationships more closely. Four approaches to gathering information on indicators included here are: biomarkers; cellular pathology; physiological and behavioural responses; and changes in populations. All hold the potential to enhance our understanding of marine environmental quality and far-reaching effects on human health. Monitoring systems that include the rapid assessment of contaminants in the ecosystem and subsequent risk to human populations, with appropriate internationally distributed data bases, need to be developed and validated. Such tools would provide early detection of potential environmental threats, and enhance the ability to prevent human illness.     

Public, animal, and environmental health implications of aquaculture.

Aquaculture is important to the United States and the world''s fishery system. Both import and export markets for aquaculture products will expand and increase as research begins to remove physiologic and other animal husbandry barriers. Overfishing of wild stock will necessitate supplementation and replenishment through aquaculture. The aquaculture industry must have a better understanding of the impact of the "shrouded" public and animal health issues: technology ignorance, abuse, and neglect. Cross-pollination and cross-training of public health and aquaculture personnel in the effect of public health, animal health, and environmental health on aquaculture are also needed. Future aquaculture development programs require an integrated Gestalt public health approach to ensure that aquaculture does not cause unacceptable risks to public or environmental health and negate the potential economic and nutritional benefits of aquaculture.     

Animal sentinels for environmental and public health

Studies of the effects of environmental exposures on domestic and wild animals can corroborate or inform epidemiologic studies in humans. Animals may be sensitive indicators of environmental hazards and provide an early warning system for public health intervention, as exemplified by the iconic canary in the coal mine. This article illustrates the application of animal sentinel research to elucidate the effects of exposure to traditional and emerging contaminants on human health. Focusing on environmental issues at the forefront of current public health research, the article describes exposures to community air pollution, environmental tobacco smoke, and pesticides and associations with cancer, reproductive outcomes, and infectious diseases. Finally, it covers the role of marine mammals in monitoring the health of the oceans and humans.     

Impacts of waste from concentrated animal feeding operations on water quality

Waste from agricultural livestock operations has been a long-standing concern with respect to contamination of water resources, particularly in terms of nutrient pollution. However, the recent growth of concentrated animal feeding operations (CAFOs) presents a greater risk to water quality because of both the increased volume of waste and to contaminants that may be present (e.g., antibiotics and other veterinary drugs) that may have both environmental and public health importance. Based on available data, generally accepted livestock waste management practices do not adequately or effectively protect water resources from contamination with excessive nutrients, microbial pathogens, and pharmaceuticals present in the waste. Impacts on surface water sources and wildlife have been documented in many agricultural areas in the United States. Potential impacts on human and environmental health from long-term inadvertent exposure to water contaminated with pharmaceuticals and other compounds are a growing public concern. This work-group, which is part of the Conference on Environmental Health Impacts of Concentrated Animal Feeding Operations: Anticipating Hazards--Searching for Solutions, identified needs for rigorous ecosystem monitoring in the vicinity of CAFOs and for improved characterization of major toxicants affecting the environment and human health. Last, there is a need to promote and enforce best practices to minimize inputs of nutrients and toxicants from CAFOs into freshwater and marine ecosystems.     

秦皇岛近海域海产品中铅、镉、汞和无机砷污染状况及食用风险评价

目的 研究秦皇岛近海域海产品重金属铅（Pb）、镉（Cd）、汞（Hg）以及无机砷污染现状,评价其食用健康风险。方法 2018年4 - 5月采集本市所产的海产鱼类、软体类和甲壳类共3类50份,采用电感耦合等离子体质谱仪（ICP - MS）,高效液相色谱 - 电感耦合等离子体质谱仪（HPLC - ICP - MS）进行分析测定,并采用国家标准限量法、单因子污染指数法、内梅罗污染指数法以及食用健康风险指标对检测结果进行评价。结果 被调查的海产品中Pb、Cd 、Hg和无机砷含量高低排序为软体类＞甲壳类＞海水鱼类,其总体合格率为96%;不同污染物在海产品中产生的健康风险大小为Cd＞无机砷＞Hg＞Pb;不同类别海产品污染程度和食用健康风险大小为软体类＞甲壳类＞海水鱼类。结论 秦皇岛近海域海产品中Cd和无机砷处于轻度污染水平;健康风险模型结果表明秦皇岛近海域海产品食用健康风险处于可接受范围之内,尚未出现明显的污染安全问题,但软体类海产品中Cd和无机砷残留状况值得进一步关注。     

Ranking the contributions of commercial fish and shellfish varieties to mercury exposure in the United States: Implications for risk communication

Fish and shellfish have important nutritional benefits, and US per capita seafood consumption has increased substantially since 2002. Recent research has reinforced concerns about adverse effects of methylmercury exposure, suggesting that methylmercury doses associated with typical US rates of fish consumption may pose measurable risks, with no threshold. These converging trends create a need to improve risk communication about fish consumption and mercury. The analysis performed here identifies the relative importance of different fish and shellfish as sources of mercury in the US seafood supply and proposes improved consumer advice, so that the public can benefit from fish consumption while minimizing mercury exposure. I have quantified contributions to total mercury in the US seafood supply by 51 different varieties of fish and shellfish, then ranked and sorted the 51 varieties in terms of relative impact. Except for swordfish, most fish with the highest mercury levels are relatively minor contributors to total inputs. Tuna (canned light, canned albacore and fresh/frozen varieties) accounts for 37.4 percent of total mercury inputs, while two-thirds of the seafood supply and nine of the 11 most heavily consumed fish and shellfish are low or very low in mercury. Substantial improvement in risk communication about mercury in fish and seafood is needed; in particular, several population subsets need better guidance to base their seafood choices more explicitly on mercury content. I have sorted the 51 seafood varieties into six categories based on mercury levels, as a framework for improving risk communication in this regard.     

First report of Cryptosporidium spp. oocysts in oysters (Crassostrea rhizophorae) and cockles (Tivela mactroides) in Brazil

The consumption of oysters and cockles, which are usually eaten raw or lightly-cooked, can cause outbreaks of human diseases, especially if these shellfish are harvested from polluted areas. In Brazil data about the occurrence of pathogens, like hepatitis A virus, in shellfish have been reported but research on natural contamination for pathogenic protozoa is still non-existent. Cryptosporidium oocyst contamination of oysters (Crassostrea rhizophorae) and cockles (Tivela mactroides) was evaluated during two different periods in a coastal area from S?o Paulo, Brazil. From June to November 2005, and from July to December 2006, 180 mollusks were harvested for tissue examination. The gills and gastrointestinal tract (n = 36 pools) were carefully extracted from the animals and homogenized in a tissue homogenizer by adding surfactant Tween 80 (0.1%). Immunofluorescence assays were performed and Cryptosporidium oocysts were detected in 50.0% of gill pools of cockles and 10.0% of gill pools of oysters. In order to evaluate seawater quality in shellfish growing areas, total levels of thermotolerant coliforms, Escherichia coli and enterococci were determined. This is the first time that Cryptosporidium oocysts were found in shellfish from the coastal region of Brazil, and to the best of our knowledge it is also the first report in Latin America and the case might be of public health importance, reflecting the extension of the contamination on seafood, requiring a need for quality control standards.     

A framework for the integration of ecosystem and human health in public policy: two case studies with infectious agents

Despite that a significant body of published literature exists in the complex area of interconnection among the environment, ecosystems, and human activity, relatively little attention has been paid to the integration and analysis of ecological and human health data in the form of a conceptual model. Human and ecological health protection generally have been treated as separate domains of policy, with significant differences in both the analytic methods used to characterize risks and the policies developed for risk reduction. Understanding the relationships among population growth, development, natural resource use, the environment, human health, and ecosystems is an important area of both scientific inquiry and environmental policy. The present paper focuses on the development of a conceptual model for understanding disease causation, particularly infectious disease, and the implications of such a model for public policy. The conceptual model incorporates ecological and human health risk assessment information applied to case studies of two infectious diseases. This article takes an initial step toward formalizing the conceptual model so that research and assessment procedures can be developed.     

Sedentary behavior: Understanding and influencing adults' prolonged sitting time

Too much sitting is now understood to be a health risk that is additional to, and distinct from, too little exercise. There is a rapidly-accumulating evidence on relationships of prolonged sedentary time and patterns of sedentary time with cardio-metabolic risk biomarkers and health outcomes. There is, however, the need to gather dose–response evidence and develop a broader understanding of the set of mechanisms linking sedentary behavior to health outcomes. In addition to the further understanding of the associated health risks, there is a new health-behavior, and epidemiological and experimental research agenda to be pursued, which include measurement studies; understanding the relevant determinants—particularly environmental determinants of sedentary behavior; and, developing effective interventions. A broad-based body of evidence is needed to inform the research-translation agenda—identifying and developing the future public health initiatives, environmental and policy changes and clinical guidelines that may be required.     

Ethics, practice, and research in public health

Ethical issues that can arise in distinguishing public health research from practice are highlighted in 2 case studies--an investigation of a tuberculosis outbreak in a prison and an evaluation of a program for improving HIV prevention services.Regardless of whether such public health investigations represent research or practice, we see a need for ethics oversight procedures that reflect actual risks and enable timely responses to crises.Such oversight should accommodate the perspectives of persons and communities affected by public health threats and by governmental responses to those threats; it should further recognize that public health ethics is a distinct field combining bioethics, political philosophy, human rights, and law.     

Sedentary behavior: Understanding and influencing adults' prolonged sitting time

Too much sitting is now understood to be a health risk that is additional to, and distinct from, too little exercise. There is a rapidly-accumulating evidence on relationships of prolonged sedentary time and patterns of sedentary time with cardio-metabolic risk biomarkers and health outcomes. There is, however, the need to gather dose–response evidence and develop a broader understanding of the set of mechanisms linking sedentary behavior to health outcomes. In addition to the further understanding of the associated health risks, there is a new health-behavior, and epidemiological and experimental research agenda to be pursued, which include measurement studies; understanding the relevant determinants—particularly environmental determinants of sedentary behavior; and, developing effective interventions. A broad-based body of evidence is needed to inform the research-translation agenda—identifying and developing the future public health initiatives, environmental and policy changes and clinical guidelines that may be required.