Table 1.

Selected direct and indirect risks, benefits, and opportunities for human health and wellbeing from interactions with the ocean.

BENEFIT/OPPORTUNITY	HEALTHY OCEAN BENEFIT	POTENTIAL HUMAN HEALTH AND WELLBEING BENEFIT	CITATIONS
Climate and weather	The ocean is critical to the fight against climate change.	Prevention of injury, death, and mental health impacts from extreme weather	Villasante et al. 2023 [3]; Falkenberg et al. 2023 [4]
Heat and CO2 sink	The ocean absorbs 25% of all CO2 emissions and more than 90% of excess atmospheric heat.	Prevention of extreme heat, crop loss, starvation	Hoegh-Guldberg et al. 2023 [2]
Oxygen	The ocean sustains all life on earth by providing 50% of the oxygen produced on earth each year and 80% of all the oxygen ever created.	Prevention of crop and other biodiversity loss	Grégoire et al. 2023 [1]
Biodiversity (including marine protected areas [MPAs])	Emerging research with communities living in/around MPAs and other areas designated as protected; diverse human health and wellbeing benefits; and collaborative and effective management with ongoing involvement of local communities is essential toward creating and sustaining these ocean and human health benefits.	Livelihoods, improved nutrition, decreased overall national mortality, and improved child health as well as positive ecosystem impacts	Winther et al. 2020 [5]; Madarcos et al. 2021 [6]; Haque et al. 2023 [7]; Nowakowski et al. 2023 [8]; Ban et al. 2019 [9]; Gollan and Barclay 2020 [10]; Rasheed 2020 [11]
Livelihoods and economics	The ocean is a source of wealth. The ocean economy is estimated to generate US $1.5–2.5 trillion annually and to provide jobs for more than 30 million people.	Seafood as nutrition and prevention of NCDs and mental health impacts	OECD 2016 [12]; Ocean Panel 2020 [13]
Marine Biotechnology (including marine drugs)	Thirty thousand unique molecules and 10% of currently known natural products have been discovered in marine life; 23 approved pharmaceutical agents have been developed from marine molecules, and an additional 33 are in clinical trials. The ocean is a source of new medicines and biotechnologies, from essential pain medicines to plastic alternatives to essential DNA libraries.	Development of treatments for inflammation, immune system disorders, skin pathologies, infectious diseases, NCDs, and cancers Alternatives to plastics and creation of sustainable other biomaterials	Antunes et al. 2023 [14]; Bouley et al. 2023 [15]; CHEMnetBASE 2023 [16]; Pascual Alonso et al. 2023 [17]
Seafood and food security	For more than 3 billion people, nearly 40% of the world’s population, the ocean is an essential source of food and livelihood.	Prevention of starvation, childhood stunting, NCDs	FAO Duke University & WorldFish 2022 [18]; Maycock et al. 2023 [19] Golden, et al. 2021 [17]; Tigchelaar et al. 2022 [20]; Naylor et al. 2021 [21]; Golden et al. 2016 [22]
Blue spaces (including culture)	Interactions with the ocean and with other blue spaces enhance the physical health and mental wellbeing of humans from infancy to old age.	Support culture, physical health, and mental wellbeing	White et al. 2020 [23]; Fleming et al. 2019 [24]
Threat	Unhealthy Ocean Risks	Potential Human Health and Wellbeing Risks	Citations
Heat	As the ocean absorbs more heat, the sea surface temperature rises: increased frequency of extreme weather, polar ice melting, sea level rise, and coastal flooding; migration of fish stocks from dependent communities; increased harmful algal blooms (HABs); and pathogen spread.	Death Injury Infectious diseases Starvation HAB illnesses Mental health NCDs Disrupt cultural integrity	Nash et al. 2017 [25]; Falkenberg et al. 2023 [4]
Acid	Increased atmospheric CO2 is absorbed by the ocean; low pH dissolves coral, shellfish, and calcium-containing microorganisms that sustain the entire marine web, and impacts fisheries.	Starvation Obesity Mental health NCDs Disrupt cultural integrity	Nash et al. 2017 [25]; Falkenberg et al. 2023 [4]
Deoxygenation	Dissolved ocean oxygen decreases as oceans become warmer and more acidic: oceanic ‘dead zones’ impact fisheries.	Starvation Obesity Mental health NCDs Disrupt cultural integrity	Grégoire et al. 2023 [1]; Falkenberg et al. 2020 [26]
Overfishing	Destructive industrial fishing practices, with rising temperatures and pollution, damage ocean ecosystems and biodiversity, and deplete fisheries.	Starvation Obesity Mental health NCDs Disrupt cultural integrity	FAO Duke University & WorldFish 2022 [18]; Maycock et al. 2023 [19]; Golden, et al. 2021 [17]; Tigchelaar et al. 2022 [20]; Naylor et al. 2021 [21]; Golden et al. 2016 [22]
Oil and gas extraction	Fossil fuel extraction and transport release toxic hydrocarbons, increasing climate change; oil spills injure and kill marine organisms, destroy biodiversity, and impact fisheries.	Death Injury Mental health Increased NCDs Disrupt cultural integrity	Nash et al. 2017 [25]; Landrigan et al. 2020 [27]; Lelieveld et al. 2019 [28]
Deep-sea mining	Deep-sea mining may damages the seabed and vulnerable habitats, releases radiation, and impacts fisheries.	Obesity NCDs Cancer Starvation Disrupt cultural integrity	Landrigan et al. 2020; [27] Hamley 2022 [29]; Miller et al. 2021 [30]
Pollution	Eighty percent of pollution arises on land from human activities: plastics, heavy metals, petroleum waste, manufactured chemicals, pesticides, radiation, and nutrients (including sewage); these pollutants damage ecological health and biodiversity, and impact fisheries.	HAB illnesses Neurotoxicity Foetal/developmental toxicity Reproductive toxicity Mental health NCDs Cancer Disrupt cultural integrity	Landrigan et al. 2020 [25]; Landrigan et al. 2023 [27]; Short et al. 2021 [31]
Economics	Profit-driven, ocean-based economic development offers short-term economic gain, with no concern for ocean health, the health and wellbeing of marginalised coastal communities, biodiversity, and marine degradation.	Occupational injury and death Starvation Mental health Disrupt cultural integrity	Germond-Duret et al. 2022; Das 2023 [32,33]