effects of pollution on human health essay

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How air pollution is destroying our health

WHO data show that almost all of the global population (99%) breathe air that exceeds WHO  guideline limits  and contains high levels of  pollutants , with low- and middle-income countries (LMIC) suffering from the highest exposures.

Ambient (outdoor) air pollution in both cities and rural areas is causing fine particulate matter which results in strokes, heart diseases, lung cancer, and acute and chronic respiratory diseases.  

Additionally, around 2.6 billion people are exposed to dangerous levels of household air pollution from using polluting open fires or simple stoves for cooking fuelled by kerosene, biomass (wood, animal dung and crop waste) and coal.

First Global Conference on Air Pollution and Health

To rally the world towards major commitments to fight this problem, WHO and partners convened the first  Global Conference on Air Pollution and Health  in Geneva on 29 October – 1 November 2018. The conference raised awareness of this growing public health challenge and shared information and tools on the health risks of air pollution and its interventions.

This conference showcased some of WHO’s work on air pollution, including the findings of its Global Platform on Air Quality and Health. This platform, whose diverse membership includes researchers, civil society, UN agencies and other partner institutions, reviewed the data on air quality and health. For example, the platform worked on techniques to more accurately attribute air pollution coming from different sources of pollution. Ongoing work includes improving estimates of air quality by combining the data from various air quality monitoring networks, atmospheric modelling and satellite remote sensing.

Health impacts of air pollution

There are two main types of air pollution: ambient air pollution (outdoor pollution) and household air pollution (indoor air pollution). Ambient air pollution is a major environmental health problem affecting everyone in low-, middle-, and high-income countries as its source – combustion of fossil fuel – is ubiquitous. Household air pollution is mainly caused by the use of solid fuels (such as wood, crop wastes, charcoal, coal and dung) and kerosene in open fires and inefficient stoves. Most of these people are poor and live in low- and middle-income countries.

Exposure to smoke from cooking fires causes 3.2 million premature deaths each year, mostly in low- and middle-income countries, where polluting fuels and technologies are used every day, particularly at home for cooking, heating and lighting. Women and children, who tend to spend more time indoors, are affected the most. LMIC also suffer the greatest from exposure ambient air pollution with 3.68 million premature deaths each year, which is almost 8 times the mortality rates in high income countries (0.47 million).

The main pollutants are:

-  particulate matter, a mix of solid and liquid droplets, with larger particles (PM 10 ) arising from pollen, sea spray and wind-blown dust from erosion, agricultural spaces, roadways and mining operations, while finer particles (PM2.5) can be derived from primary sources (for example combustion of fuels in power generation facilities, industries or vehicles) and secondary sources (for example chemical reactions between gases)

-  nitrogen dioxide (NO 2 ), a gas from combustion of fuels in processes such as those used for furnaces, gas stoves, transportation, industry and power generation;

-  sulfur dioxide, another gas mainly from the combustion of fossil fuels for domestic heating, industries and power generation; and

-  ozone at ground level, caused by a chemical reaction of gases, such as NO 2 , in the presence of sunlight. The pollutant that is most commonly monitored by regulatory frameworks and for which a lot of evidence of adverse health impact is available is particulate matter followed by nitrogen dioxide.

Ambient (outdoor) air pollution

Household air pollution

How air pollution affects our body

Particles with a diameter of 10 microns or less (≤ PM 10 ) can penetrate and lodge deep inside the lungs, causing irritation, inflammation and damaging the lining of the respiratory tract. Smaller, more health-damaging particles with a diameter of 2.5 microns or less (≤ PM 2.5 – 60 of them make up the width of a human hair) can penetrate the lung barrier and enter the blood system, affecting all major organs of the body. These pollutants increase the risk of heart and respiratory diseases, as well as lung cancer and strokes.

Ozone is a major factor in causing asthma (or making it worse), and nitrogen dioxide and sulfur dioxide can also cause asthma, bronchial symptoms, lung inflammation and reduced lung function. In 2021 WHO updated the Global Air Quality Guidelines, which recommend the maximum safe level for PM 2.5 annual average concentration of 5 μg/m 3  or less. The guidelines provide evidence of the damage air pollution inflicts on human health, at even lower concentrations than previously understood. The updated guidelines provide recommendations on air quality guideline levels as well as interim targets for six key air pollutants. They also offer qualitative statements on good practices for the management of certain types of particulate matter (PM), for example, black carbon/elemental carbon, ultrafine particles, and particles originating from sand and dust storms, for which there is insufficient quantitative evidence to derive AQG levels.

Air pollution has a disastrous effect on children; there were more than 5 million deaths of children under the age of 5 years. More than 27% of those deaths – 1.7 million – were attributable to environmental factors, with air pollution foremost among them. Globally, lower respiratory infections are the second leading cause of death for children under 5 years. Every year, 442 000 children (as of 2022) younger than 5 years die prematurely from breathing polluted air. Evidence suggests that air pollution could also harm children before they are born (reduced birth weight) through their mothers' exposure. There is emerging evidence linking air pollution exposure to cancer, neurodevelopmental and metabolic diseases in children.

As well as affecting our health, pollutants in the air are also causing long-term environmental damage by driving climate change, itself a major threat to health and well-being. 

Already in 2018, the UN Intergovernmental Panel on Climate Change warned that coal-fired electricity must end by 2050 if we are to limit global warming rises to 1.5 °C. If not, we may see a major climate crisis in just 20 years.

Affordable strategies exist to reduce emissions from energy, transport, waste management, housing and industrial sectors. These interventions often carry other benefits like reduced traffic and noise, increased physical activity and better land use – all of which contribute to improving health and well-being. WHO also supports cities with the data, tools and capacity to select, implement and track clean and healthy policies at the city level. Better air quality will benefit all of us, everywhere.

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Essay on Pollution for Students and Children

500+ words essay on pollution.

Pollution is a term which even kids are aware of these days. It has become so common that almost everyone acknowledges the fact that pollution is rising continuously. The term ‘pollution’ means the manifestation of any unsolicited foreign substance in something. When we talk about pollution on earth, we refer to the contamination that is happening of the natural resources by various pollutants . All this is mainly caused by human activities which harm the environment in ways more than one. Therefore, an urgent need has arisen to tackle this issue straightaway. That is to say, pollution is damaging our earth severely and we need to realize its effects and prevent this damage. In this essay on pollution, we will see what are the effects of pollution and how to reduce it.

Effects of Pollution

Pollution affects the quality of life more than one can imagine. It works in mysterious ways, sometimes which cannot be seen by the naked eye. However, it is very much present in the environment. For instance, you might not be able to see the natural gases present in the air, but they are still there. Similarly, the pollutants which are messing up the air and increasing the levels of carbon dioxide is very dangerous for humans. Increased level of carbon dioxide will lead to global warming .

Further, the water is polluted in the name of industrial development, religious practices and more will cause a shortage of drinking water. Without water, human life is not possible. Moreover, the way waste is dumped on the land eventually ends up in the soil and turns toxic. If land pollution keeps on happening at this rate, we won’t have fertile soil to grow our crops on. Therefore, serious measures must be taken to reduce pollution to the core.

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Types of Pollution

• Air Pollution
• Water Pollution
• Soil Pollution

How to Reduce Pollution?

After learning the harmful effects of pollution, one must get on the task of preventing or reducing pollution as soon as possible. To reduce air pollution, people should take public transport or carpool to reduce vehicular smoke. While it may be hard, avoiding firecrackers at festivals and celebrations can also cut down on air and noise pollution. Above all, we must adopt the habit of recycling. All the used plastic ends up in the oceans and land, which pollutes them.

So, remember to not dispose of them off after use, rather reuse them as long as you can. We must also encourage everyone to plant more trees which will absorb the harmful gases and make the air cleaner. When talking on a bigger level, the government must limit the usage of fertilizers to maintain the soil’s fertility. In addition, industries must be banned from dumping their waste into oceans and rivers, causing water pollution.

To sum it up, all types of pollution is hazardous and comes with grave consequences. Everyone must take a step towards change ranging from individuals to the industries. As tackling this problem calls for a joint effort, so we must join hands now. Moreover, the innocent lives of animals are being lost because of such human activities. So, all of us must take a stand and become a voice for the unheard in order to make this earth pollution-free.

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FAQs on Pollution

Q.1 What are the effects of pollution?

A.1 Pollution essentially affects the quality of human life. It degrades almost everything from the water we drink to the air we breathe. It damages the natural resources needed for a healthy life.

Q.2 How can one reduce pollution?

A.2 We must take individual steps to reduce pollution. People should decompose their waster mindfully, they should plant more trees. Further, one must always recycle what they can and make the earth greener.

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Effects of Air Pollution on Health

Air pollution refers to the presence of substances in the air at concentrations that affect human health or the environment. Clean air is important for clean health, and air pollution threatens health in many ways. Every individual has a fundamental right to access free and unlimited clean air. The human lung acts as an interface between the body and the environment. On average, an individual takes in about 10 million breaths annually.

In the process, there is a high possibility of toxic substances reaching the lungs and other organs where they can cause harmful effects. Therefore, there is a need for an appropriate policy response to minimize levels of air pollutants such as particulate matter, nitrogen dioxide, ozone, carbon monoxide, and others (Koenig 165). Reduction in air pollution will bring considerable health benefits to humans. Adequate understanding of these effects is a significant step towards establishing successful policies to minimize these risks. This paper discusses the main effects of air pollution on health, the main air pollutants, and the policies necessary to reduce the levels of air pollution.

Exposure to air pollution causes several health problems, starting from modest changes in the respiratory tract and the affected pulmonary function, moving to restricted performance, emergency rooms visits and hospital admissions, and to deaths (Saldiva 220). Air pollution has adverse effects not only on the respiratory system but affects the cardiovascular system as well. This is true from both acute and chronic exposures to air pollutants.

The most adverse effects of air pollution in terms of the overall health problems include reduction in life expectancy of average populations, related to long-term exposures to high levels of air pollution with particulate matter. It is necessary to understand adequately the nature and magnitude of the effects of air pollutants on health. Air pollutants constitute an important overall component of both outdoor and indoor air and are known to cause health effects, essentially with individuals with pre-existing illnesses.

Air pollution poses a considerable threat to health causing morbidity and reduced life expectancy. The effects of air pollution on human health can be short term or long term. Both short term and long term effects can cause varying degrees of damage to human health. Short term and long term effects may include minor irritations and death respectively (Bauer 1093). Toxic air particles have short term effects such as; immediate irritation to the eyes or throat and in the long term causes death due to respiratory failure or heart attacks (Bauer 1092).

Population subgroups are affected differently by air pollution risks. Variations in terms of sensitivity exposure occur due to nutrition issues, state of general health, and genetic predisposition. Vulnerable groups under high risk include infants and young children, the elderly, pregnant mothers and their unborn fetuses, individuals suffering from other diseases, malnourished, and others (Koenig 165). It is necessary to identify these vulnerable groups because they are the first to be affected as the levels of air pollution increase. Generally, only a minority of the total population is affected by high levels of exposure. Therefore, any excess to mortality due to a pollutant is likely to be restricted to a small group of the population (Bauer 1094).

The Main Air Pollutants

The main constituents of air pollution include a highly variable, complex mixture of different substances, such as smog, that is, photochemical oxidants, carbon monoxide, nitrogen oxides, sulfur oxides, and particulates (Koenig 165). There are many different components in the troposphere that can cause potential effects on human health and the general environment. This paper focuses on pollutants such as particulate matter, ozone, and nitrogen dioxide.

First, long-term exposure to high levels of pollution with particulate matter causes a significant reduction in the life expectancy of the average population (Douglas 6). Important health effects associated with particulate matter in the short term exposure include respiratory problems, increase in mortality, inflammatory reactions in the lungs, increase in hospital admissions, and adverse effects on the cardiovascular system (Dominici et al., 10). The health effects associated with long-term exposure of particulate matter include; reduction in lung function in children and adults, reduced lung function development, reduction in life expectancy due to mainly cardiopulmonary deaths and lung cancer, and others (Koenig 139).

Particulates absorb various chemicals and increase their penetration and longevity in the lungs. They also condense water and vapor and augment the effects of gaseous pollutants like sulphur oxides. The main particulates of concern include; lead, asbestos, mercury, and other major metals. Effects of lead include; anemia, gastrointestinal cramping, and impaired neural functioning (Koenig 128). Asbestos affects pulmonary lesions and mesothelial tissue damages. Asbestos is also associated linked to pulmonary cancer. Lead poisoning on the other hand may affect retardation and possibly hyperactivity in children (Koenig 129).

Second, the ozone is the main toxic element of the oxidants. All photochemical oxidants are manufactured by processes of photosynthesis involving the emissions of hydrocarbon and nitrogen oxides from internal combustion (Evans 107). Health effects associated with short-term exposure to the ozone include; increase in mortality, an increase in hospital admissions, inflammatory reactions to the lungs, an increase in medication usage, adverse effects on pulmonary function, and others. Health effects associated with long term exposure include reduction in lung function (Koenig 139).

Third, the Combustion of fossils is the major source of ambient sulphur oxides. Exposure to ambient sulfur oxides irritates upper respiratory passage in humans, reducing mucus clearance, and reducing pulmonary functioning (Evans 106). Studies on greater exposures cause nasal lesions, bronchitis, pneumonia, and severe pulmonary disorder. Nitrogen oxides are ubiquitous in the air and produced by fossil fuel combustion in motor vehicles and electrical power production. It causes reduced pulmonary functioning, reduced immunity to fight diseases, diminished weight gain, and bronchial inflammation (Evans 107).

The health effects caused by nitrogen dioxide in the short term exposure include; increase in mortality, an increase in hospital admissions, an increase in airwaves allergic inflammation reactions, and effects in pulmonary functions, specifically in asthmatics. Health effects related to long term exposure include increased probability of respiratory symptoms.

Carbon monoxide is caused by incomplete combustion primarily emitted from motor vehicles or cigarette smoking. It causes headaches, nausea, and dizziness associated with deprivation of oxygen. Greater exposure to carbon monoxide can result to result to cortical cellular structure, altered heartbeat, vascular diseases, impaired liver functioning, and fetal growth retardation (Evans 106). Exposure to carbon monoxide is also associated with low birth weight, increased prenatal deaths, increased distress in patients, cardiovascular ailments, and possible infection of cardiovascular disease (Evans 107).

In sum exposure to air pollution specifically, particulate matter, and ozone pose a significant risk to human health. Recent evidence suggests, however, that ozone levels lower than those experienced during episodes of “summer smog” may have considerable effects on human health (Koenig 44).

Policies Necessary to Reduce Air Pollution Levels and Human exposure

The causes and sources of air pollution are more complex and intricate. Therefore the matrix of strategies to reduce air pollution demands broad policy combinations. This necessitates the need to implement appropriate policy strategies to reduce air pollution at all levels and mitigate its adverse effects on human health. These measures include national policy and regulatory framework; local monitoring of air pollution; public information and health warnings; land use planning; transport policy; and energy policy.

First, the national air pollution standards need to be developed to assist local air pollution management. The national government must offer expertise and guidance not available locally. They can also assist local authorities with the fiscal, legal, and institutional mandate for taking action on air pollution locally. Second, local air pollution monitoring must be put in place to identify the changes in pollution concentrations.

The monitoring mechanism must support the overall air pollution management strategy. Three, use public information systems to warn people of severe air pollution consequences, offer control measures, and in the long run increase public awareness of air pollution problems. Fourth, establish education and awareness programs to help people take measures to avoid exposure. Fifth, there is a need to reduce sulfur and organic toxic elements from relevant petroleum products and encouragement of increased use of locally applicable renewable energy to reduce emissions.

In summary, air pollution affects human health. The quality of air affects our health, interpersonal behavior, mood, attitudes, outdoor activities, outdoor activities, and others. Most research on air pollution effects on health tend to concentrate more on physical outcomes such as mortality or diseases. I would suggest the need to look at air quality in terms of policy strategies that may be linked to air quality such as discomfort, irritability, depression, and anxiety.

There is a need to document the adverse effects of different air pollutants on human health, and this should include diseases and the estimated reduction in life expectancy as a result of toxic air. All evidence of increased mortality in highly polluted areas needs to be documented. Relevant authorities must implement regulations by authorities to minimize emissions of toxic air substances. In essence, there is a need for accurate information on the effects of air pollution on health as a basis for establishing effective strategies to minimize these effects.

Works Cited

Brauer, Michael. “Air Pollution from Traffic and Development of Respiratory.” American Journal of Respiratory and Critical Care Medicine, 166 (2002): 1092-1098. Web.

Dominici, Francesca, Peng Roger, Bell Michel, Pham Luu, and Zeger Scot. Particulate Air Pollution and Hospital Admission for Cardiovascular and Respiratory Diseases. The Journal of the American Medical Association , 295 (2006): 10-21.

Douglas, James, and Waller Ryan. Air Pollution and Respiratory Infection in Children. British Medical Association, 20 (1966):1-8.

Evans, Gary. Environmental Stress. Cambridge: Cambridge University Press, 1984.

Koenig, Jane. Health Effects of Ambient Air Pollution. New York: Springer, 2000.

Saldiva, Lichtenfel, and Paiva Barone. Between Air Pollution and Mortality Due to Respiratory Diseases. Environmental Research Journal, 65 (1994): 218-225.

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REVIEW article

Environmental and health impacts of air pollution: a review.

• 1 Delphis S.A., Kifisia, Greece
• 2 Laboratory of Hygiene and Environmental Protection, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
• 3 Centre Hospitalier Universitaire Vaudois (CHUV), Service de Médicine Interne, Lausanne, Switzerland
• 4 School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom

One of our era's greatest scourges is air pollution, on account not only of its impact on climate change but also its impact on public and individual health due to increasing morbidity and mortality. There are many pollutants that are major factors in disease in humans. Among them, Particulate Matter (PM), particles of variable but very small diameter, penetrate the respiratory system via inhalation, causing respiratory and cardiovascular diseases, reproductive and central nervous system dysfunctions, and cancer. Despite the fact that ozone in the stratosphere plays a protective role against ultraviolet irradiation, it is harmful when in high concentration at ground level, also affecting the respiratory and cardiovascular system. Furthermore, nitrogen oxide, sulfur dioxide, Volatile Organic Compounds (VOCs), dioxins, and polycyclic aromatic hydrocarbons (PAHs) are all considered air pollutants that are harmful to humans. Carbon monoxide can even provoke direct poisoning when breathed in at high levels. Heavy metals such as lead, when absorbed into the human body, can lead to direct poisoning or chronic intoxication, depending on exposure. Diseases occurring from the aforementioned substances include principally respiratory problems such as Chronic Obstructive Pulmonary Disease (COPD), asthma, bronchiolitis, and also lung cancer, cardiovascular events, central nervous system dysfunctions, and cutaneous diseases. Last but not least, climate change resulting from environmental pollution affects the geographical distribution of many infectious diseases, as do natural disasters. The only way to tackle this problem is through public awareness coupled with a multidisciplinary approach by scientific experts; national and international organizations must address the emergence of this threat and propose sustainable solutions.

Approach to the Problem

The interactions between humans and their physical surroundings have been extensively studied, as multiple human activities influence the environment. The environment is a coupling of the biotic (living organisms and microorganisms) and the abiotic (hydrosphere, lithosphere, and atmosphere).

Pollution is defined as the introduction into the environment of substances harmful to humans and other living organisms. Pollutants are harmful solids, liquids, or gases produced in higher than usual concentrations that reduce the quality of our environment.

Human activities have an adverse effect on the environment by polluting the water we drink, the air we breathe, and the soil in which plants grow. Although the industrial revolution was a great success in terms of technology, society, and the provision of multiple services, it also introduced the production of huge quantities of pollutants emitted into the air that are harmful to human health. Without any doubt, the global environmental pollution is considered an international public health issue with multiple facets. Social, economic, and legislative concerns and lifestyle habits are related to this major problem. Clearly, urbanization and industrialization are reaching unprecedented and upsetting proportions worldwide in our era. Anthropogenic air pollution is one of the biggest public health hazards worldwide, given that it accounts for about 9 million deaths per year ( 1 ).

Without a doubt, all of the aforementioned are closely associated with climate change, and in the event of danger, the consequences can be severe for mankind ( 2 ). Climate changes and the effects of global planetary warming seriously affect multiple ecosystems, causing problems such as food safety issues, ice and iceberg melting, animal extinction, and damage to plants ( 3 , 4 ).

Air pollution has various health effects. The health of susceptible and sensitive individuals can be impacted even on low air pollution days. Short-term exposure to air pollutants is closely related to COPD (Chronic Obstructive Pulmonary Disease), cough, shortness of breath, wheezing, asthma, respiratory disease, and high rates of hospitalization (a measurement of morbidity).

The long-term effects associated with air pollution are chronic asthma, pulmonary insufficiency, cardiovascular diseases, and cardiovascular mortality. According to a Swedish cohort study, diabetes seems to be induced after long-term air pollution exposure ( 5 ). Moreover, air pollution seems to have various malign health effects in early human life, such as respiratory, cardiovascular, mental, and perinatal disorders ( 3 ), leading to infant mortality or chronic disease in adult age ( 6 ).

National reports have mentioned the increased risk of morbidity and mortality ( 1 ). These studies were conducted in many places around the world and show a correlation between daily ranges of particulate matter (PM) concentration and daily mortality. Climate shifts and global planetary warming ( 3 ) could aggravate the situation. Besides, increased hospitalization (an index of morbidity) has been registered among the elderly and susceptible individuals for specific reasons. Fine and ultrafine particulate matter seems to be associated with more serious illnesses ( 6 ), as it can invade the deepest parts of the airways and more easily reach the bloodstream.

Air pollution mainly affects those living in large urban areas, where road emissions contribute the most to the degradation of air quality. There is also a danger of industrial accidents, where the spread of a toxic fog can be fatal to the populations of the surrounding areas. The dispersion of pollutants is determined by many parameters, most notably atmospheric stability and wind ( 6 ).

In developing countries ( 7 ), the problem is more serious due to overpopulation and uncontrolled urbanization along with the development of industrialization. This leads to poor air quality, especially in countries with social disparities and a lack of information on sustainable management of the environment. The use of fuels such as wood fuel or solid fuel for domestic needs due to low incomes exposes people to bad-quality, polluted air at home. It is of note that three billion people around the world are using the above sources of energy for their daily heating and cooking needs ( 8 ). In developing countries, the women of the household seem to carry the highest risk for disease development due to their longer duration exposure to the indoor air pollution ( 8 , 9 ). Due to its fast industrial development and overpopulation, China is one of the Asian countries confronting serious air pollution problems ( 10 , 11 ). The lung cancer mortality observed in China is associated with fine particles ( 12 ). As stated already, long-term exposure is associated with deleterious effects on the cardiovascular system ( 3 , 5 ). However, it is interesting to note that cardiovascular diseases have mostly been observed in developed and high-income countries rather than in the developing low-income countries exposed highly to air pollution ( 13 ). Extreme air pollution is recorded in India, where the air quality reaches hazardous levels. New Delhi is one of the more polluted cities in India. Flights in and out of New Delhi International Airport are often canceled due to the reduced visibility associated with air pollution. Pollution is occurring both in urban and rural areas in India due to the fast industrialization, urbanization, and rise in use of motorcycle transportation. Nevertheless, biomass combustion associated with heating and cooking needs and practices is a major source of household air pollution in India and in Nepal ( 14 , 15 ). There is spatial heterogeneity in India, as areas with diverse climatological conditions and population and education levels generate different indoor air qualities, with higher PM 2.5 observed in North Indian states (557–601 μg/m 3 ) compared to the Southern States (183–214 μg/m 3 ) ( 16 , 17 ). The cold climate of the North Indian areas may be the main reason for this, as longer periods at home and more heating are necessary compared to in the tropical climate of Southern India. Household air pollution in India is associated with major health effects, especially in women and young children, who stay indoors for longer periods. Chronic obstructive respiratory disease (CORD) and lung cancer are mostly observed in women, while acute lower respiratory disease is seen in young children under 5 years of age ( 18 ).

Accumulation of air pollution, especially sulfur dioxide and smoke, reaching 1,500 mg/m3, resulted in an increase in the number of deaths (4,000 deaths) in December 1952 in London and in 1963 in New York City (400 deaths) ( 19 ). An association of pollution with mortality was reported on the basis of monitoring of outdoor pollution in six US metropolitan cities ( 20 ). In every case, it seems that mortality was closely related to the levels of fine, inhalable, and sulfate particles more than with the levels of total particulate pollution, aerosol acidity, sulfur dioxide, or nitrogen dioxide ( 20 ).

Furthermore, extremely high levels of pollution are reported in Mexico City and Rio de Janeiro, followed by Milan, Ankara, Melbourne, Tokyo, and Moscow ( 19 ).

Based on the magnitude of the public health impact, it is certain that different kinds of interventions should be taken into account. Success and effectiveness in controlling air pollution, specifically at the local level, have been reported. Adequate technological means are applied considering the source and the nature of the emission as well as its impact on health and the environment. The importance of point sources and non-point sources of air pollution control is reported by Schwela and Köth-Jahr ( 21 ). Without a doubt, a detailed emission inventory must record all sources in a given area. Beyond considering the above sources and their nature, topography and meteorology should also be considered, as stated previously. Assessment of the control policies and methods is often extrapolated from the local to the regional and then to the global scale. Air pollution may be dispersed and transported from one region to another area located far away. Air pollution management means the reduction to acceptable levels or possible elimination of air pollutants whose presence in the air affects our health or the environmental ecosystem. Private and governmental entities and authorities implement actions to ensure the air quality ( 22 ). Air quality standards and guidelines were adopted for the different pollutants by the WHO and EPA as a tool for the management of air quality ( 1 , 23 ). These standards have to be compared to the emissions inventory standards by causal analysis and dispersion modeling in order to reveal the problematic areas ( 24 ). Inventories are generally based on a combination of direct measurements and emissions modeling ( 24 ).

As an example, we state here the control measures at the source through the use of catalytic converters in cars. These are devices that turn the pollutants and toxic gases produced from combustion engines into less-toxic pollutants by catalysis through redox reactions ( 25 ). In Greece, the use of private cars was restricted by tracking their license plates in order to reduce traffic congestion during rush hour ( 25 ).

Concerning industrial emissions, collectors and closed systems can keep the air pollution to the minimal standards imposed by legislation ( 26 ).

Current strategies to improve air quality require an estimation of the economic value of the benefits gained from proposed programs. These proposed programs by public authorities, and directives are issued with guidelines to be respected.

In Europe, air quality limit values AQLVs (Air Quality Limit Values) are issued for setting off planning claims ( 27 ). In the USA, the NAAQS (National Ambient Air Quality Standards) establish the national air quality limit values ( 27 ). While both standards and directives are based on different mechanisms, significant success has been achieved in the reduction of overall emissions and associated health and environmental effects ( 27 ). The European Directive identifies geographical areas of risk exposure as monitoring/assessment zones to record the emission sources and levels of air pollution ( 27 ), whereas the USA establishes global geographical air quality criteria according to the severity of their air quality problem and records all sources of the pollutants and their precursors ( 27 ).

In this vein, funds have been financing, directly or indirectly, projects related to air quality along with the technical infrastructure to maintain good air quality. These plans focus on an inventory of databases from air quality environmental planning awareness campaigns. Moreover, pollution measures of air emissions may be taken for vehicles, machines, and industries in urban areas.

Technological innovation can only be successful if it is able to meet the needs of society. In this sense, technology must reflect the decision-making practices and procedures of those involved in risk assessment and evaluation and act as a facilitator in providing information and assessments to enable decision makers to make the best decisions possible. Summarizing the aforementioned in order to design an effective air quality control strategy, several aspects must be considered: environmental factors and ambient air quality conditions, engineering factors and air pollutant characteristics, and finally, economic operating costs for technological improvement and administrative and legal costs. Considering the economic factor, competitiveness through neoliberal concepts is offering a solution to environmental problems ( 22 ).

The development of environmental governance, along with technological progress, has initiated the deployment of a dialogue. Environmental politics has created objections and points of opposition between different political parties, scientists, media, and governmental and non-governmental organizations ( 22 ). Radical environmental activism actions and movements have been created ( 22 ). The rise of the new information and communication technologies (ICTs) are many times examined as to whether and in which way they have influenced means of communication and social movements such as activism ( 28 ). Since the 1990s, the term “digital activism” has been used increasingly and in many different disciplines ( 29 ). Nowadays, multiple digital technologies can be used to produce a digital activism outcome on environmental issues. More specifically, devices with online capabilities such as computers or mobile phones are being used as a way to pursue change in political and social affairs ( 30 ).

In the present paper, we focus on the sources of environmental pollution in relation to public health and propose some solutions and interventions that may be of interest to environmental legislators and decision makers.

Sources of Exposure

It is known that the majority of environmental pollutants are emitted through large-scale human activities such as the use of industrial machinery, power-producing stations, combustion engines, and cars. Because these activities are performed at such a large scale, they are by far the major contributors to air pollution, with cars estimated to be responsible for approximately 80% of today's pollution ( 31 ). Some other human activities are also influencing our environment to a lesser extent, such as field cultivation techniques, gas stations, fuel tanks heaters, and cleaning procedures ( 32 ), as well as several natural sources, such as volcanic and soil eruptions and forest fires.

The classification of air pollutants is based mainly on the sources producing pollution. Therefore, it is worth mentioning the four main sources, following the classification system: Major sources, Area sources, Mobile sources, and Natural sources.

Major sources include the emission of pollutants from power stations, refineries, and petrochemicals, the chemical and fertilizer industries, metallurgical and other industrial plants, and, finally, municipal incineration.

Indoor area sources include domestic cleaning activities, dry cleaners, printing shops, and petrol stations.

Mobile sources include automobiles, cars, railways, airways, and other types of vehicles.

Finally, natural sources include, as stated previously, physical disasters ( 33 ) such as forest fire, volcanic erosion, dust storms, and agricultural burning.

However, many classification systems have been proposed. Another type of classification is a grouping according to the recipient of the pollution, as follows:

Air pollution is determined as the presence of pollutants in the air in large quantities for long periods. Air pollutants are dispersed particles, hydrocarbons, CO, CO 2 , NO, NO 2 , SO 3 , etc.

Water pollution is organic and inorganic charge and biological charge ( 10 ) at high levels that affect the water quality ( 34 , 35 ).

Soil pollution occurs through the release of chemicals or the disposal of wastes, such as heavy metals, hydrocarbons, and pesticides.

Air pollution can influence the quality of soil and water bodies by polluting precipitation, falling into water and soil environments ( 34 , 36 ). Notably, the chemistry of the soil can be amended due to acid precipitation by affecting plants, cultures, and water quality ( 37 ). Moreover, movement of heavy metals is favored by soil acidity, and metals are so then moving into the watery environment. It is known that heavy metals such as aluminum are noxious to wildlife and fishes. Soil quality seems to be of importance, as soils with low calcium carbonate levels are at increased jeopardy from acid rain. Over and above rain, snow and particulate matter drip into watery ' bodies ( 36 , 38 ).

Lastly, pollution is classified following type of origin:

Radioactive and nuclear pollution , releasing radioactive and nuclear pollutants into water, air, and soil during nuclear explosions and accidents, from nuclear weapons, and through handling or disposal of radioactive sewage.

Radioactive materials can contaminate surface water bodies and, being noxious to the environment, plants, animals, and humans. It is known that several radioactive substances such as radium and uranium concentrate in the bones and can cause cancers ( 38 , 39 ).

Noise pollution is produced by machines, vehicles, traffic noises, and musical installations that are harmful to our hearing.

The World Health Organization introduced the term DALYs. The DALYs for a disease or health condition is defined as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the Years Lost due to Disability (YLD) for people living with the health condition or its consequences ( 39 ). In Europe, air pollution is the main cause of disability-adjusted life years lost (DALYs), followed by noise pollution. The potential relationships of noise and air pollution with health have been studied ( 40 ). The study found that DALYs related to noise were more important than those related to air pollution, as the effects of environmental noise on cardiovascular disease were independent of air pollution ( 40 ). Environmental noise should be counted as an independent public health risk ( 40 ).

Environmental pollution occurs when changes in the physical, chemical, or biological constituents of the environment (air masses, temperature, climate, etc.) are produced.

Pollutants harm our environment either by increasing levels above normal or by introducing harmful toxic substances. Primary pollutants are directly produced from the above sources, and secondary pollutants are emitted as by-products of the primary ones. Pollutants can be biodegradable or non-biodegradable and of natural origin or anthropogenic, as stated previously. Moreover, their origin can be a unique source (point-source) or dispersed sources.

Pollutants have differences in physical and chemical properties, explaining the discrepancy in their capacity for producing toxic effects. As an example, we state here that aerosol compounds ( 41 – 43 ) have a greater toxicity than gaseous compounds due to their tiny size (solid or liquid) in the atmosphere; they have a greater penetration capacity. Gaseous compounds are eliminated more easily by our respiratory system ( 41 ). These particles are able to damage lungs and can even enter the bloodstream ( 41 ), leading to the premature deaths of millions of people yearly. Moreover, the aerosol acidity ([H+]) seems to considerably enhance the production of secondary organic aerosols (SOA), but this last aspect is not supported by other scientific teams ( 38 ).

Climate and Pollution

Air pollution and climate change are closely related. Climate is the other side of the same coin that reduces the quality of our Earth ( 44 ). Pollutants such as black carbon, methane, tropospheric ozone, and aerosols affect the amount of incoming sunlight. As a result, the temperature of the Earth is increasing, resulting in the melting of ice, icebergs, and glaciers.

In this vein, climatic changes will affect the incidence and prevalence of both residual and imported infections in Europe. Climate and weather affect the duration, timing, and intensity of outbreaks strongly and change the map of infectious diseases in the globe ( 45 ). Mosquito-transmitted parasitic or viral diseases are extremely climate-sensitive, as warming firstly shortens the pathogen incubation period and secondly shifts the geographic map of the vector. Similarly, water-warming following climate changes leads to a high incidence of waterborne infections. Recently, in Europe, eradicated diseases seem to be emerging due to the migration of population, for example, cholera, poliomyelitis, tick-borne encephalitis, and malaria ( 46 ).

The spread of epidemics is associated with natural climate disasters and storms, which seem to occur more frequently nowadays ( 47 ). Malnutrition and disequilibration of the immune system are also associated with the emerging infections affecting public health ( 48 ).

The Chikungunya virus “took the airplane” from the Indian Ocean to Europe, as outbreaks of the disease were registered in Italy ( 49 ) as well as autochthonous cases in France ( 50 ).

An increase in cryptosporidiosis in the United Kingdom and in the Czech Republic seems to have occurred following flooding ( 36 , 51 ).

As stated previously, aerosols compounds are tiny in size and considerably affect the climate. They are able to dissipate sunlight (the albedo phenomenon) by dispersing a quarter of the sun's rays back to space and have cooled the global temperature over the last 30 years ( 52 ).

Air Pollutants

The World Health Organization (WHO) reports on six major air pollutants, namely particle pollution, ground-level ozone, carbon monoxide, sulfur oxides, nitrogen oxides, and lead. Air pollution can have a disastrous effect on all components of the environment, including groundwater, soil, and air. Additionally, it poses a serious threat to living organisms. In this vein, our interest is mainly to focus on these pollutants, as they are related to more extensive and severe problems in human health and environmental impact. Acid rain, global warming, the greenhouse effect, and climate changes have an important ecological impact on air pollution ( 53 ).

Particulate Matter (PM) and Health

Studies have shown a relationship between particulate matter (PM) and adverse health effects, focusing on either short-term (acute) or long-term (chronic) PM exposure.

Particulate matter (PM) is usually formed in the atmosphere as a result of chemical reactions between the different pollutants. The penetration of particles is closely dependent on their size ( 53 ). Particulate Matter (PM) was defined as a term for particles by the United States Environmental Protection Agency ( 54 ). Particulate matter (PM) pollution includes particles with diameters of 10 micrometers (μm) or smaller, called PM 10 , and extremely fine particles with diameters that are generally 2.5 micrometers (μm) and smaller.

Particulate matter contains tiny liquid or solid droplets that can be inhaled and cause serious health effects ( 55 ). Particles <10 μm in diameter (PM 10 ) after inhalation can invade the lungs and even reach the bloodstream. Fine particles, PM 2.5 , pose a greater risk to health ( 6 , 56 ) ( Table 1 ).

Table 1 . Penetrability according to particle size.

Multiple epidemiological studies have been performed on the health effects of PM. A positive relation was shown between both short-term and long-term exposures of PM 2.5 and acute nasopharyngitis ( 56 ). In addition, long-term exposure to PM for years was found to be related to cardiovascular diseases and infant mortality.

Those studies depend on PM 2.5 monitors and are restricted in terms of study area or city area due to a lack of spatially resolved daily PM 2.5 concentration data and, in this way, are not representative of the entire population. Following a recent epidemiological study by the Department of Environmental Health at Harvard School of Public Health (Boston, MA) ( 57 ), it was reported that, as PM 2.5 concentrations vary spatially, an exposure error (Berkson error) seems to be produced, and the relative magnitudes of the short- and long-term effects are not yet completely elucidated. The team developed a PM 2.5 exposure model based on remote sensing data for assessing short- and long-term human exposures ( 57 ). This model permits spatial resolution in short-term effects plus the assessment of long-term effects in the whole population.

Moreover, respiratory diseases and affection of the immune system are registered as long-term chronic effects ( 58 ). It is worth noting that people with asthma, pneumonia, diabetes, and respiratory and cardiovascular diseases are especially susceptible and vulnerable to the effects of PM. PM 2.5 , followed by PM 10 , are strongly associated with diverse respiratory system diseases ( 59 ), as their size permits them to pierce interior spaces ( 60 ). The particles produce toxic effects according to their chemical and physical properties. The components of PM 10 and PM 2.5 can be organic (polycyclic aromatic hydrocarbons, dioxins, benzene, 1-3 butadiene) or inorganic (carbon, chlorides, nitrates, sulfates, metals) in nature ( 55 ).

Particulate Matter (PM) is divided into four main categories according to type and size ( 61 ) ( Table 2 ).

Table 2 . Types and sizes of particulate Matter (PM).

Gas contaminants include PM in aerial masses.

Particulate contaminants include contaminants such as smog, soot, tobacco smoke, oil smoke, fly ash, and cement dust.

Biological Contaminants are microorganisms (bacteria, viruses, fungi, mold, and bacterial spores), cat allergens, house dust and allergens, and pollen.

Types of Dust include suspended atmospheric dust, settling dust, and heavy dust.

Finally, another fact is that the half-lives of PM 10 and PM 2.5 particles in the atmosphere is extended due to their tiny dimensions; this permits their long-lasting suspension in the atmosphere and even their transfer and spread to distant destinations where people and the environment may be exposed to the same magnitude of pollution ( 53 ). They are able to change the nutrient balance in watery ecosystems, damage forests and crops, and acidify water bodies.

As stated, PM 2.5 , due to their tiny size, are causing more serious health effects. These aforementioned fine particles are the main cause of the “haze” formation in different metropolitan areas ( 12 , 13 , 61 ).

Ozone Impact in the Atmosphere

Ozone (O 3 ) is a gas formed from oxygen under high voltage electric discharge ( 62 ). It is a strong oxidant, 52% stronger than chlorine. It arises in the stratosphere, but it could also arise following chain reactions of photochemical smog in the troposphere ( 63 ).

Ozone can travel to distant areas from its initial source, moving with air masses ( 64 ). It is surprising that ozone levels over cities are low in contrast to the increased amounts occuring in urban areas, which could become harmful for cultures, forests, and vegetation ( 65 ) as it is reducing carbon assimilation ( 66 ). Ozone reduces growth and yield ( 47 , 48 ) and affects the plant microflora due to its antimicrobial capacity ( 67 , 68 ). In this regard, ozone acts upon other natural ecosystems, with microflora ( 69 , 70 ) and animal species changing their species composition ( 71 ). Ozone increases DNA damage in epidermal keratinocytes and leads to impaired cellular function ( 72 ).

Ground-level ozone (GLO) is generated through a chemical reaction between oxides of nitrogen and VOCs emitted from natural sources and/or following anthropogenic activities.

Ozone uptake usually occurs by inhalation. Ozone affects the upper layers of the skin and the tear ducts ( 73 ). A study of short-term exposure of mice to high levels of ozone showed malondialdehyde formation in the upper skin (epidermis) but also depletion in vitamins C and E. It is likely that ozone levels are not interfering with the skin barrier function and integrity to predispose to skin disease ( 74 ).

Due to the low water-solubility of ozone, inhaled ozone has the capacity to penetrate deeply into the lungs ( 75 ).

Toxic effects induced by ozone are registered in urban areas all over the world, causing biochemical, morphologic, functional, and immunological disorders ( 76 ).

The European project (APHEA2) focuses on the acute effects of ambient ozone concentrations on mortality ( 77 ). Daily ozone concentrations compared to the daily number of deaths were reported from different European cities for a 3-year period. During the warm period of the year, an observed increase in ozone concentration was associated with an increase in the daily number of deaths (0.33%), in the number of respiratory deaths (1.13%), and in the number of cardiovascular deaths (0.45%). No effect was observed during wintertime.

Carbon Monoxide (CO)

Carbon monoxide is produced by fossil fuel when combustion is incomplete. The symptoms of poisoning due to inhaling carbon monoxide include headache, dizziness, weakness, nausea, vomiting, and, finally, loss of consciousness.

The affinity of carbon monoxide to hemoglobin is much greater than that of oxygen. In this vein, serious poisoning may occur in people exposed to high levels of carbon monoxide for a long period of time. Due to the loss of oxygen as a result of the competitive binding of carbon monoxide, hypoxia, ischemia, and cardiovascular disease are observed.

Carbon monoxide affects the greenhouses gases that are tightly connected to global warming and climate. This should lead to an increase in soil and water temperatures, and extreme weather conditions or storms may occur ( 68 ).

However, in laboratory and field experiments, it has been seen to produce increased plant growth ( 78 ).

Nitrogen Oxide (NO 2 )

Nitrogen oxide is a traffic-related pollutant, as it is emitted from automobile motor engines ( 79 , 80 ). It is an irritant of the respiratory system as it penetrates deep in the lung, inducing respiratory diseases, coughing, wheezing, dyspnea, bronchospasm, and even pulmonary edema when inhaled at high levels. It seems that concentrations over 0.2 ppm produce these adverse effects in humans, while concentrations higher than 2.0 ppm affect T-lymphocytes, particularly the CD8+ cells and NK cells that produce our immune response ( 81 ).It is reported that long-term exposure to high levels of nitrogen dioxide can be responsible for chronic lung disease. Long-term exposure to NO 2 can impair the sense of smell ( 81 ).

However, systems other than respiratory ones can be involved, as symptoms such as eye, throat, and nose irritation have been registered ( 81 ).

High levels of nitrogen dioxide are deleterious to crops and vegetation, as they have been observed to reduce crop yield and plant growth efficiency. Moreover, NO 2 can reduce visibility and discolor fabrics ( 81 ).

Sulfur Dioxide (SO 2 )

Sulfur dioxide is a harmful gas that is emitted mainly from fossil fuel consumption or industrial activities. The annual standard for SO 2 is 0.03 ppm ( 82 ). It affects human, animal, and plant life. Susceptible people as those with lung disease, old people, and children, who present a higher risk of damage. The major health problems associated with sulfur dioxide emissions in industrialized areas are respiratory irritation, bronchitis, mucus production, and bronchospasm, as it is a sensory irritant and penetrates deep into the lung converted into bisulfite and interacting with sensory receptors, causing bronchoconstriction. Moreover, skin redness, damage to the eyes (lacrimation and corneal opacity) and mucous membranes, and worsening of pre-existing cardiovascular disease have been observed ( 81 ).

Environmental adverse effects, such as acidification of soil and acid rain, seem to be associated with sulfur dioxide emissions ( 83 ).

Lead is a heavy metal used in different industrial plants and emitted from some petrol motor engines, batteries, radiators, waste incinerators, and waste waters ( 84 ).

Moreover, major sources of lead pollution in the air are metals, ore, and piston-engine aircraft. Lead poisoning is a threat to public health due to its deleterious effects upon humans, animals, and the environment, especially in the developing countries.

Exposure to lead can occur through inhalation, ingestion, and dermal absorption. Trans- placental transport of lead was also reported, as lead passes through the placenta unencumbered ( 85 ). The younger the fetus is, the more harmful the toxic effects. Lead toxicity affects the fetal nervous system; edema or swelling of the brain is observed ( 86 ). Lead, when inhaled, accumulates in the blood, soft tissue, liver, lung, bones, and cardiovascular, nervous, and reproductive systems. Moreover, loss of concentration and memory, as well as muscle and joint pain, were observed in adults ( 85 , 86 ).

Children and newborns ( 87 ) are extremely susceptible even to minimal doses of lead, as it is a neurotoxicant and causes learning disabilities, impairment of memory, hyperactivity, and even mental retardation.

Elevated amounts of lead in the environment are harmful to plants and crop growth. Neurological effects are observed in vertebrates and animals in association with high lead levels ( 88 ).

Polycyclic Aromatic Hydrocarbons(PAHs)

The distribution of PAHs is ubiquitous in the environment, as the atmosphere is the most important means of their dispersal. They are found in coal and in tar sediments. Moreover, they are generated through incomplete combustion of organic matter as in the cases of forest fires, incineration, and engines ( 89 ). PAH compounds, such as benzopyrene, acenaphthylene, anthracene, and fluoranthene are recognized as toxic, mutagenic, and carcinogenic substances. They are an important risk factor for lung cancer ( 89 ).

Volatile Organic Compounds(VOCs)

Volatile organic compounds (VOCs), such as toluene, benzene, ethylbenzene, and xylene ( 90 ), have been found to be associated with cancer in humans ( 91 ). The use of new products and materials has actually resulted in increased concentrations of VOCs. VOCs pollute indoor air ( 90 ) and may have adverse effects on human health ( 91 ). Short-term and long-term adverse effects on human health are observed. VOCs are responsible for indoor air smells. Short-term exposure is found to cause irritation of eyes, nose, throat, and mucosal membranes, while those of long duration exposure include toxic reactions ( 92 ). Predictable assessment of the toxic effects of complex VOC mixtures is difficult to estimate, as these pollutants can have synergic, antagonistic, or indifferent effects ( 91 , 93 ).

Dioxins originate from industrial processes but also come from natural processes, such as forest fires and volcanic eruptions. They accumulate in foods such as meat and dairy products, fish and shellfish, and especially in the fatty tissue of animals ( 94 ).

Short-period exhibition to high dioxin concentrations may result in dark spots and lesions on the skin ( 94 ). Long-term exposure to dioxins can cause developmental problems, impairment of the immune, endocrine and nervous systems, reproductive infertility, and cancer ( 94 ).

Without any doubt, fossil fuel consumption is responsible for a sizeable part of air contamination. This contamination may be anthropogenic, as in agricultural and industrial processes or transportation, while contamination from natural sources is also possible. Interestingly, it is of note that the air quality standards established through the European Air Quality Directive are somewhat looser than the WHO guidelines, which are stricter ( 95 ).

Effect of Air Pollution on Health

The most common air pollutants are ground-level ozone and Particulates Matter (PM). Air pollution is distinguished into two main types:

Outdoor pollution is the ambient air pollution.

Indoor pollution is the pollution generated by household combustion of fuels.

People exposed to high concentrations of air pollutants experience disease symptoms and states of greater and lesser seriousness. These effects are grouped into short- and long-term effects affecting health.

Susceptible populations that need to be aware of health protection measures include old people, children, and people with diabetes and predisposing heart or lung disease, especially asthma.

As extensively stated previously, according to a recent epidemiological study from Harvard School of Public Health, the relative magnitudes of the short- and long-term effects have not been completely clarified ( 57 ) due to the different epidemiological methodologies and to the exposure errors. New models are proposed for assessing short- and long-term human exposure data more successfully ( 57 ). Thus, in the present section, we report the more common short- and long-term health effects but also general concerns for both types of effects, as these effects are often dependent on environmental conditions, dose, and individual susceptibility.

Short-term effects are temporary and range from simple discomfort, such as irritation of the eyes, nose, skin, throat, wheezing, coughing and chest tightness, and breathing difficulties, to more serious states, such as asthma, pneumonia, bronchitis, and lung and heart problems. Short-term exposure to air pollution can also cause headaches, nausea, and dizziness.

These problems can be aggravated by extended long-term exposure to the pollutants, which is harmful to the neurological, reproductive, and respiratory systems and causes cancer and even, rarely, deaths.

The long-term effects are chronic, lasting for years or the whole life and can even lead to death. Furthermore, the toxicity of several air pollutants may also induce a variety of cancers in the long term ( 96 ).

As stated already, respiratory disorders are closely associated with the inhalation of air pollutants. These pollutants will invade through the airways and will accumulate at the cells. Damage to target cells should be related to the pollutant component involved and its source and dose. Health effects are also closely dependent on country, area, season, and time. An extended exposure duration to the pollutant should incline to long-term health effects in relation also to the above factors.

Particulate Matter (PMs), dust, benzene, and O 3 cause serious damage to the respiratory system ( 97 ). Moreover, there is a supplementary risk in case of existing respiratory disease such as asthma ( 98 ). Long-term effects are more frequent in people with a predisposing disease state. When the trachea is contaminated by pollutants, voice alterations may be remarked after acute exposure. Chronic obstructive pulmonary disease (COPD) may be induced following air pollution, increasing morbidity and mortality ( 99 ). Long-term effects from traffic, industrial air pollution, and combustion of fuels are the major factors for COPD risk ( 99 ).

Multiple cardiovascular effects have been observed after exposure to air pollutants ( 100 ). Changes occurred in blood cells after long-term exposure may affect cardiac functionality. Coronary arteriosclerosis was reported following long-term exposure to traffic emissions ( 101 ), while short-term exposure is related to hypertension, stroke, myocardial infracts, and heart insufficiency. Ventricle hypertrophy is reported to occur in humans after long-time exposure to nitrogen oxide (NO 2 ) ( 102 , 103 ).

Neurological effects have been observed in adults and children after extended-term exposure to air pollutants.

Psychological complications, autism, retinopathy, fetal growth, and low birth weight seem to be related to long-term air pollution ( 83 ). The etiologic agent of the neurodegenerative diseases (Alzheimer's and Parkinson's) is not yet known, although it is believed that extended exposure to air pollution seems to be a factor. Specifically, pesticides and metals are cited as etiological factors, together with diet. The mechanisms in the development of neurodegenerative disease include oxidative stress, protein aggregation, inflammation, and mitochondrial impairment in neurons ( 104 ) ( Figure 1 ).

Figure 1 . Impact of air pollutants on the brain.

Brain inflammation was observed in dogs living in a highly polluted area in Mexico for a long period ( 105 ). In human adults, markers of systemic inflammation (IL-6 and fibrinogen) were found to be increased as an immediate response to PNC on the IL-6 level, possibly leading to the production of acute-phase proteins ( 106 ). The progression of atherosclerosis and oxidative stress seem to be the mechanisms involved in the neurological disturbances caused by long-term air pollution. Inflammation comes secondary to the oxidative stress and seems to be involved in the impairment of developmental maturation, affecting multiple organs ( 105 , 107 ). Similarly, other factors seem to be involved in the developmental maturation, which define the vulnerability to long-term air pollution. These include birthweight, maternal smoking, genetic background and socioeconomic environment, as well as education level.

However, diet, starting from breast-feeding, is another determinant factor. Diet is the main source of antioxidants, which play a key role in our protection against air pollutants ( 108 ). Antioxidants are free radical scavengers and limit the interaction of free radicals in the brain ( 108 ). Similarly, genetic background may result in a differential susceptibility toward the oxidative stress pathway ( 60 ). For example, antioxidant supplementation with vitamins C and E appears to modulate the effect of ozone in asthmatic children homozygous for the GSTM1 null allele ( 61 ). Inflammatory cytokines released in the periphery (e.g., respiratory epithelia) upregulate the innate immune Toll-like receptor 2. Such activation and the subsequent events leading to neurodegeneration have recently been observed in lung lavage in mice exposed to ambient Los Angeles (CA, USA) particulate matter ( 61 ). In children, neurodevelopmental morbidities were observed after lead exposure. These children developed aggressive and delinquent behavior, reduced intelligence, learning difficulties, and hyperactivity ( 109 ). No level of lead exposure seems to be “safe,” and the scientific community has asked the Centers for Disease Control and Prevention (CDC) to reduce the current screening guideline of 10 μg/dl ( 109 ).

It is important to state that impact on the immune system, causing dysfunction and neuroinflammation ( 104 ), is related to poor air quality. Yet, increases in serum levels of immunoglobulins (IgA, IgM) and the complement component C3 are observed ( 106 ). Another issue is that antigen presentation is affected by air pollutants, as there is an upregulation of costimulatory molecules such as CD80 and CD86 on macrophages ( 110 ).

As is known, skin is our shield against ultraviolet radiation (UVR) and other pollutants, as it is the most exterior layer of our body. Traffic-related pollutants, such as PAHs, VOCs, oxides, and PM, may cause pigmented spots on our skin ( 111 ). On the one hand, as already stated, when pollutants penetrate through the skin or are inhaled, damage to the organs is observed, as some of these pollutants are mutagenic and carcinogenic, and, specifically, they affect the liver and lung. On the other hand, air pollutants (and those in the troposphere) reduce the adverse effects of ultraviolet radiation UVR in polluted urban areas ( 111 ). Air pollutants absorbed by the human skin may contribute to skin aging, psoriasis, acne, urticaria, eczema, and atopic dermatitis ( 111 ), usually caused by exposure to oxides and photochemical smoke ( 111 ). Exposure to PM and cigarette smoking act as skin-aging agents, causing spots, dyschromia, and wrinkles. Lastly, pollutants have been associated with skin cancer ( 111 ).

Higher morbidity is reported to fetuses and children when exposed to the above dangers. Impairment in fetal growth, low birth weight, and autism have been reported ( 112 ).

Another exterior organ that may be affected is the eye. Contamination usually comes from suspended pollutants and may result in asymptomatic eye outcomes, irritation ( 112 ), retinopathy, or dry eye syndrome ( 113 , 114 ).

Environmental Impact of Air Pollution

Air pollution is harming not only human health but also the environment ( 115 ) in which we live. The most important environmental effects are as follows.

Acid rain is wet (rain, fog, snow) or dry (particulates and gas) precipitation containing toxic amounts of nitric and sulfuric acids. They are able to acidify the water and soil environments, damage trees and plantations, and even damage buildings and outdoor sculptures, constructions, and statues.

Haze is produced when fine particles are dispersed in the air and reduce the transparency of the atmosphere. It is caused by gas emissions in the air coming from industrial facilities, power plants, automobiles, and trucks.

Ozone , as discussed previously, occurs both at ground level and in the upper level (stratosphere) of the Earth's atmosphere. Stratospheric ozone is protecting us from the Sun's harmful ultraviolet (UV) rays. In contrast, ground-level ozone is harmful to human health and is a pollutant. Unfortunately, stratospheric ozone is gradually damaged by ozone-depleting substances (i.e., chemicals, pesticides, and aerosols). If this protecting stratospheric ozone layer is thinned, then UV radiation can reach our Earth, with harmful effects for human life (skin cancer) ( 116 ) and crops ( 117 ). In plants, ozone penetrates through the stomata, inducing them to close, which blocks CO 2 transfer and induces a reduction in photosynthesis ( 118 ).

Global climate change is an important issue that concerns mankind. As is known, the “greenhouse effect” keeps the Earth's temperature stable. Unhappily, anthropogenic activities have destroyed this protecting temperature effect by producing large amounts of greenhouse gases, and global warming is mounting, with harmful effects on human health, animals, forests, wildlife, agriculture, and the water environment. A report states that global warming is adding to the health risks of poor people ( 119 ).

People living in poorly constructed buildings in warm-climate countries are at high risk for heat-related health problems as temperatures mount ( 119 ).

Wildlife is burdened by toxic pollutants coming from the air, soil, or the water ecosystem and, in this way, animals can develop health problems when exposed to high levels of pollutants. Reproductive failure and birth effects have been reported.

Eutrophication is occurring when elevated concentrations of nutrients (especially nitrogen) stimulate the blooming of aquatic algae, which can cause a disequilibration in the diversity of fish and their deaths.

Without a doubt, there is a critical concentration of pollution that an ecosystem can tolerate without being destroyed, which is associated with the ecosystem's capacity to neutralize acidity. The Canada Acid Rain Program established this load at 20 kg/ha/yr ( 120 ).

Hence, air pollution has deleterious effects on both soil and water ( 121 ). Concerning PM as an air pollutant, its impact on crop yield and food productivity has been reported. Its impact on watery bodies is associated with the survival of living organisms and fishes and their productivity potential ( 121 ).

An impairment in photosynthetic rhythm and metabolism is observed in plants exposed to the effects of ozone ( 121 ).

Sulfur and nitrogen oxides are involved in the formation of acid rain and are harmful to plants and marine organisms.

Last but not least, as mentioned above, the toxicity associated with lead and other metals is the main threat to our ecosystems (air, water, and soil) and living creatures ( 121 ).

In 2018, during the first WHO Global Conference on Air Pollution and Health, the WHO's General Director, Dr. Tedros Adhanom Ghebreyesus, called air pollution a “silent public health emergency” and “the new tobacco” ( 122 ).

Undoubtedly, children are particularly vulnerable to air pollution, especially during their development. Air pollution has adverse effects on our lives in many different respects.

Diseases associated with air pollution have not only an important economic impact but also a societal impact due to absences from productive work and school.

Despite the difficulty of eradicating the problem of anthropogenic environmental pollution, a successful solution could be envisaged as a tight collaboration of authorities, bodies, and doctors to regularize the situation. Governments should spread sufficient information and educate people and should involve professionals in these issues so as to control the emergence of the problem successfully.

Technologies to reduce air pollution at the source must be established and should be used in all industries and power plants. The Kyoto Protocol of 1997 set as a major target the reduction of GHG emissions to below 5% by 2012 ( 123 ). This was followed by the Copenhagen summit, 2009 ( 124 ), and then the Durban summit of 2011 ( 125 ), where it was decided to keep to the same line of action. The Kyoto protocol and the subsequent ones were ratified by many countries. Among the pioneers who adopted this important protocol for the world's environmental and climate “health” was China ( 3 ). As is known, China is a fast-developing economy and its GDP (Gross Domestic Product) is expected to be very high by 2050, which is defined as the year of dissolution of the protocol for the decrease in gas emissions.

A more recent international agreement of crucial importance for climate change is the Paris Agreement of 2015, issued by the UNFCCC (United Nations Climate Change Committee). This latest agreement was ratified by a plethora of UN (United Nations) countries as well as the countries of the European Union ( 126 ). In this vein, parties should promote actions and measures to enhance numerous aspects around the subject. Boosting education, training, public awareness, and public participation are some of the relevant actions for maximizing the opportunities to achieve the targets and goals on the crucial matter of climate change and environmental pollution ( 126 ). Without any doubt, technological improvements makes our world easier and it seems difficult to reduce the harmful impact caused by gas emissions, we could limit its use by seeking reliable approaches.

Synopsizing, a global prevention policy should be designed in order to combat anthropogenic air pollution as a complement to the correct handling of the adverse health effects associated with air pollution. Sustainable development practices should be applied, together with information coming from research in order to handle the problem effectively.

At this point, international cooperation in terms of research, development, administration policy, monitoring, and politics is vital for effective pollution control. Legislation concerning air pollution must be aligned and updated, and policy makers should propose the design of a powerful tool of environmental and health protection. As a result, the main proposal of this essay is that we should focus on fostering local structures to promote experience and practice and extrapolate these to the international level through developing effective policies for sustainable management of ecosystems.

Author Contributions

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

Conflict of Interest

IM is employed by the company Delphis S.A.

The remaining authors declare that the present review paper was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Keywords: air pollution, environment, health, public health, gas emission, policy

Citation: Manisalidis I, Stavropoulou E, Stavropoulos A and Bezirtzoglou E (2020) Environmental and Health Impacts of Air Pollution: A Review. Front. Public Health 8:14. doi: 10.3389/fpubh.2020.00014

Received: 17 October 2019; Accepted: 17 January 2020; Published: 20 February 2020.

Reviewed by:

Copyright © 2020 Manisalidis, Stavropoulou, Stavropoulos and Bezirtzoglou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Ioannis Manisalidis, giannismanisal@gmail.com ; Elisavet Stavropoulou, elisabeth.stavropoulou@gmail.com

† These authors have contributed equally to this work

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Essay on Effects Of Water Pollution On Human Health

Students are often asked to write an essay on Effects Of Water Pollution On Human Health in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Effects Of Water Pollution On Human Health

Introduction.

Water is a basic need for all living beings. When it gets polluted, it can harm our health. Water pollution happens when harmful substances like chemicals, waste, or bacteria mix with water.

Water-Borne Diseases

Dirty water can carry diseases. When we drink this water, we can get sick. Some common water-borne diseases are cholera, typhoid, and dysentery. These can cause stomach pain, fever, and diarrhea.

Chemical Effects

Sometimes, water gets polluted with chemicals. These chemicals can cause serious health problems. For example, lead can harm our brain and kidneys. Mercury can affect our nervous system.

Impact on Children

Children are more at risk from polluted water. They can get sick easily and it can affect their growth. It is important to give clean water to children to keep them healthy.

250 Words Essay on Effects Of Water Pollution On Human Health

Water is a basic need for all living beings. But when it gets dirty, it can cause many health problems. This is called water pollution.

Causes of Water Pollution

Water pollution happens when harmful substances like chemicals, waste, and harmful microorganisms get into water bodies. This can happen due to many reasons like throwing trash into rivers, oil spills, and chemicals from factories.

Effects on Human Health

Dirty water can cause many health problems. Drinking or using polluted water can lead to diseases like cholera, typhoid, and dysentery. These diseases can make people very sick and can even cause death.

Long-Term Effects

Long-term exposure to polluted water can lead to serious health issues. It can cause problems in the stomach, liver, and kidneys. It can also lead to skin problems and can harm the nervous system.

To stay healthy, it is important to prevent water pollution. We can do this by not throwing trash into water bodies and by treating waste before it enters the water. We should also avoid using harmful chemicals that can pollute water.

500 Words Essay on Effects Of Water Pollution On Human Health

Water is a basic need for all living beings. We use water in almost everything we do, from drinking and cooking to bathing and cleaning. But what happens when the water we depend on becomes polluted? Water pollution is a serious problem that can have harmful effects on our health. This essay will look at some of the ways water pollution can affect human health.

What is Water Pollution?

Water pollution happens when harmful substances like chemicals, waste, or bacteria get into water sources. This can happen in many ways, such as factories dumping waste into rivers, or people throwing trash into the ocean. When these pollutants get into the water, they can make it unsafe for us to use.

Drinking Polluted Water

Using polluted water.

Even if we don’t drink polluted water, we can still be affected by it. For instance, if we use polluted water to wash our food or to take a bath, we can still get sick. This is because the harmful substances in the water can get into our bodies through our skin or through the food we eat. Some of the diseases we can get from using polluted water include skin rashes, eye infections, and stomach problems.

Long-Term Effects of Water Pollution

Water pollution does not only cause immediate health problems. It can also have long-term effects on our health. Some pollutants found in water, like heavy metals or certain chemicals, can build up in our bodies over time. This can lead to serious health problems in the future, such as cancer or damage to our nervous system.

To conclude, the health effects of water pollution are a major concern that needs immediate attention. We must work together to prevent water pollution and ensure access to clean and safe water for all.

Word Count: 500

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Human Impacts on the Environment

Humans impact the physical environment in many ways: overpopulation, pollution, burning fossil fuels, and deforestation. Changes like these have triggered climate change, soil erosion, poor air quality, and undrinkable water. These negative impacts can affect human behavior and can prompt mass migrations or battles over clean water.

Help your students understand the impact humans have on the physical environment with these classroom resources.

Earth Science, Geology, Geography, Physical Geography

Air Pollution and Its Impact on Human Health

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment
• Common health problems associated with air pollution
• Vulnerability of children to pollutants
• Needs assessment process and the role of Health educator

Common Health Problems Associated with Air Pollution

Indoor and outdoor air pollution causes several common health problems which according to the New Jersey Department of Environmental Protection (2009) are grouped according to the major pollutants. To begin with, carbon monoxide compromises the heart activities hence lethargy and fatigue. It also causes nausea, dizziness, and headaches and in large amounts may even lead to death. Nitrogen dioxide causes nasal and throat irritation and increases the risk of developing respiratory infections.

Ozone causes irritation of the respiratory system leading to coughs, chest and throat pains. Particulates cause damage to respiratory tract tissues especially lung tissue leading to lung diseases. Sulfur dioxide is known to make worse existing lung diseases such as bronchitis, asthma, pneumonia, and tuberculosis. Lead on the other hand causes damage to the brain and the nervous system with children being most susceptible (New Jersey Department of Environmental Protection, 2009; California Air Resources Board 2007a). From these, it is evident that air pollution has adverse common effects on the respiratory system and to some extent other body parts.

Vulnerability of Children to Pollutants

The most common health problems in children associated with air pollution occur in the respiratory system. This is due to the fact that children’s respiratory system is not fully developed therefore immature. This means that the structures are weak and are prone to damage at the slightest exposure to air pollutants.

The children’s health study by the California Air Resources Board reported that children are more vulnerable to effects of air pollutants as they are exposed to more air pollution than adults as they have higher respiratory rates and are normally outdoors (California Air Resources Board 2007b). Other factors may include the underdeveloped immune system in children that is not able to effectively and efficiently fight off the effects of air pollution on the body and large surface area to volume ratio that exposes a large surface area to air pollution.

Needs Assessment Process and the Role of Health Educator

Community needs assessment is a systematic process in which the health educator, the nurse, and other health care professionals together with the members of the community determine the health problems & needs of the community & develop plans of action, and implement those plans. In this case, the needs assessment process will be in relation to air pollution. The first step is exploration which involves mapping out the community with the purpose of obtaining baseline information that helps plan for the rest of the assessment process.

The second is step is planning for assessment exercise where by the necessary resources are put into place and objective designed, in this case, it will be; to assess health impacts of air pollution and how to combat these effects. The third step is recruitment and training of assistants, fourth step is pretesting and reworking of the tool as it helps to detect faults and shortcomings after which corrections are made. The fifth step is execution of the assessment which basically involves actually going to the community and engaging the community into discussions and giving them the assessment tools so that they can feel it with relevant information.

The sixth step is a critical analysis of the findings and recommendations. The collected data is analyzed and then findings and recommendations are drawn. One of fundamental recommendations that will be made is to initiate Health Education and Promotion to combat the effects of air pollution. Health education/promotion empowers an individual with the much needed and relevant information that can be of great assistance in management of his/her health and other related issues.

The health education and promotion will involve sources of air pollutants, their effects on human health, management, and prevention measures. The health educator, the nurse, and other stakeholders can carry out this activity with the help of the local health professionals working within the community and even train some community members who will be educating their colleagues; this creates a sense of belonging and ownership among the community members in that they will participate in the health education/promotion activities as their own. This empowers the community and the information stays with them even years after the time of carrying out the assessment.

The final step is evaluation and just as in nursing process, evaluations help in checking if the assessment was a success and whether there has been any positive impact, and if interventions put in place had desired results. Evaluation also helps in knowing if the set goals and objectives were met, determining success or failure of the problem and to put corrective measure into place (Zerwekh, 112; Holloway, & Wheeler, 76; Grol 361). The health educator works hand in hand with the community health nurse and other health professionals in the above process whereby he/she acts the overall supervisor.

Air pollution has adverse effects on health and majorly affects the respiratory system with children being most vulnerable due to their underdeveloped respiratory system. Health educators are charged with the overall responsibility of overseeing planning, implementation, and evaluation of education programs in the community. They also function as consultants to the other healthcare professionals involved in health education and promotion.

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• Acute Asthma: Home and Community-Based Care For Patients
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• Lung Cancer Disease and Prevention Methods
• Drugs Affecting the Respiratory System: Bronchodilators
• Asthma Is a Chronic Inflammatory Disorder
• Asthma: Leading Chronic Illness Among Children in the US
• Acute Respiratory Distress Syndrome
• Pharmacotherapy for Respiratory Disorders
• Chicago (A-D)
• Chicago (N-B)

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National Institute of Environmental Health Sciences

Your environment. your health., human health impacts of climate change.

Climate change impacts human health in both direct and indirect ways 1 , 2 . Extreme heat waves, rising sea level, changes in precipitation resulting in flooding and droughts, and intense hurricanes can directly cause injury, illness, and even death 3 . The effects of climate change can also indirectly affect health through alterations to the environment. For example, worsening air pollution levels can have negative impacts on respiratory and cardiovascular conditions 4 . Changes in temperature and rainfall can alter the survival, distribution, and behavior of insects and other species that can lead to changes in infectious diseases 5 . Increases in precipitation, storm surge, and sea temperature can lead to more water-related illnesses 6 . Climate change can also affect food safety, exposing people to contaminated foods that can result in foodborne illnesses 7 . In addition, climate change can affect mental health and well-being 8 , 9 .

Exposure to climate-related hazards can include biological, chemical, or physical stressors and can differ in time, locations, populations, and severity. These are referred to as exposure pathways. These threats can occur simultaneously, resulting in compounding health impacts. Climate change threats may also accumulate over time, leading to longer-term changes in resilience and health.

Climate change can affect human health by changing the severity, duration, or frequency of health problems and by creating unprecedented or unanticipated health problems or health threats in places or populations where they have not previously occurred 10 . While everyone is exposed to climate-related health threats, not everyone experiences the same harms. Individuals may experience greater risk from climate-related health effects because: they have greater exposure to climate-related hazards; they are more sensitive to the effects of climate stressors; their own present state of health and wellbeing; or they do not have sufficient capacity or resources to cope or remove themselves from harm 11 . An effective public health response to mitigate the risks of climate change is essential to preventing injuries and illnesses and enhancing overall public health preparedness.

NIEHS supports research that can be used to make decisions that can help reduce the threats of climate change. In the 2016 report by the U.S. Global Change Research Program,  The Impacts of Climate Change on Human Health: A Scientific Assessment , the Interagency Working Group on Climate Change and Health describes seven different types of health threats that help outline the major research areas. These include the following:

• Foodborne Illness and Nutrition
• Health Impacts of Air Quality
• Health Impacts of Extreme Weather Events
• Mental Health and Well-being
• People Who Are Vulnerable to Climate Change
• Temperature-Related Death and Illness
• Vector-borne Diseases
• Water-related Illnesses

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• Cissé, G., R. McLeman, H. Adams, P. Aldunce, K. Bowen, D. Campbell-Lendrum, S. Clayton, K.L. Ebi, J. Hess, C. Huang, Q. Liu, G. McGregor, J. Semenza, and M.C. Tirado, 2022: Health, Wellbeing, and the Changing Structure of Communities. In: Climate Change 2022: Impacts, Adaptation, and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press. In Press. [ Full Text Cissé, G., R. McLeman, H. Adams, P. Aldunce, K. Bowen, D. Campbell-Lendrum, S. Clayton, K.L. Ebi, J. Hess, C. Huang, Q. Liu, G. McGregor, J. Semenza, and M.C. Tirado, 2022: Health, Wellbeing, and the Changing Structure of Communities. In: Climate Change 2022: Impacts, Adaptation, and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press. In Press. ]
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• Balbus J, Crimmins A, Gamble JL, Easterling DR, Kunkel KE, Saha S, Sarofim MC. 2016. Chapter 1: Introduction: Climate Change and Human Health. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. U.S. Global Change Research Program, Washington, DC, 25–42 . [ Abstract Balbus J, Crimmins A, Gamble JL, Easterling DR, Kunkel KE, Saha S, Sarofim MC. 2016. Chapter 1: Introduction: Climate Change and Human Health. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. U.S. Global Change Research Program, Washington, DC, 25–42. ] [ Full Text Balbus J, Crimmins A, Gamble JL, Easterling DR, Kunkel KE, Saha S, Sarofim MC. 2016. Chapter 1: Introduction: Climate Change and Human Health. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. U.S. Global Change Research Program, Washington, DC, 25–42. ]
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• Ebi K.L, Balbus JM, Luber G, Bole A, Crimmins A, Glass G, Saha S, Shimamoto MM, Trtanj J, and White-Newsome JL. 2018: Human Health. In Impacts, Risks, and Adaptation in the United States: Fourth National Climate Assessment, Volume II [Reidmiller, D.R., C.W. Avery, D.R. Easterling, K.E. Kunkel, K.L.M. Lewis, T.K. Maycock, and B.C. Stewart (eds.)]. U.S. Global Change Research Program, Washington, DC, USA, pp. 539–571. doi: 10.7930/NCA4. 2018. CH14. [ Full Text Ebi K.L, Balbus JM, Luber G, Bole A, Crimmins A, Glass G, Saha S, Shimamoto MM, Trtanj J, and White-Newsome JL. 2018: Human Health. In Impacts, Risks, and Adaptation in the United States: Fourth National Climate Assessment, Volume II [Reidmiller, D.R., C.W. Avery, D.R. Easterling, K.E. Kunkel, K.L.M. Lewis, T.K. Maycock, and B.C. Stewart (eds.)]. U.S. Global Change Research Program, Washington, DC, USA, pp. 539–571. doi: 10.7930/NCA4. 2018. CH14. ]
• IPCC, 2022: Climate Change 2022: Impacts, Adaptation, and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press. In Press. [ Full Text IPCC, 2022: Climate Change 2022: Impacts, Adaptation, and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press. In Press. ]
• IPCC, 2021: Climate Change 2021: The Physical Science Basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [Masson-Delmotte, V., P. Zhai, A. Pirani, S.L. Connors, C. Péan, S. Berger, N. Caud, Y. Chen, L. Goldfarb, M.I. Gomis, M. Huang, K. Leitzell, E. Lonnoy, J.B.R. Matthews, T.K. Maycock, T. Waterfield, O. Yelekçi, R. Yu, and B. Zhou (eds.)]. Cambridge University Press. In Press. [ Full Text IPCC, 2021: Climate Change 2021: The Physical Science Basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [Masson-Delmotte, V., P. Zhai, A. Pirani, S.L. Connors, C. Péan, S. Berger, N. Caud, Y. Chen, L. Goldfarb, M.I. Gomis, M. Huang, K. Leitzell, E. Lonnoy, J.B.R. Matthews, T.K. Maycock, T. Waterfield, O. Yelekçi, R. Yu, and B. Zhou (eds.)]. Cambridge University Press. In Press. ]
• Hunter, Paul R. Climate change and waterborne and vector‐borne disease. Journal of Applied Microbiology 94 (2003): 37-46. [ Full Text Hunter, Paul R. Climate change and waterborne and vector‐borne disease. Journal of Applied Microbiology 94 (2003): 37-46. ]
• Lake, Iain R., et al. A re-evaluation of the impact of temperature and climate change on foodborne illness. Epidemiology & Infection 137.11 (2009): 1538-1547. [ Full Text Lake, Iain R., et al. A re-evaluation of the impact of temperature and climate change on foodborne illness. Epidemiology & Infection 137.11 (2009): 1538-1547. ]
• Cissé, G., R. McLeman, H. Adams, P. Aldunce, K. Bowen, D. Campbell-Lendrum, S. Clayton, K.L. Ebi, J. Hess, C. Huang, Q. Liu, G. McGregor, J. Semenza, and M.C. Tirado, 2022: Health, Wellbeing, and the Changing Structure of Communities. In: Climate Change 2022: Impacts, Adaptation, and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press. In Press. [ Full Text Cissé, G., R. McLeman, H. Adams, P. Aldunce, K. Bowen, D. Campbell-Lendrum, S. Clayton, K.L. Ebi, J. Hess, C. Huang, Q. Liu, G. McGregor, J. Semenza, and M.C. Tirado, 2022: Health, Wellbeing, and the Changing Structure of Communities. In: Climate Change 2022: Impacts, Adaptation, and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press. In Press. ]
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• Ann Glob Health
• v.86(1); 2020

Human Health and Ocean Pollution

Philip j. landrigan.

1 Boston College, US

John J. Stegeman

2 Woods Hole Center for Oceans and Human Health, Woods Hole Oceanographic Institution, US

Lora E. Fleming

3 European Centre for Environment and Human Health, GB

4 University of Exeter Medical School, GB

Denis Allemand

5 Centre Scientifique de Monaco, MC

Donald M. Anderson

Lorraine c. backer.

6 Centers for Disease Control and Prevention, US

Françoise Brucker-Davis

7 Université Côte d’Azur, FR

8 Centre Hospitalier Universitaire de Nice, Inserm, C3M, FR

Nicolas Chevalier

Lilian corra.

9 International Society of Doctors for the Environment (ISDE), CH

10 Health and Environment of the Global Alliance on Health and Pollution (GAHP), AR

Dorota Czerucka

Marie-yasmine dechraoui bottein.

11 Intergovernmental Oceanographic Commission of UNESCO, FR

12 IOC Science and Communication Centre on Harmful Algae, University of Copenhagen, DK

13 Ecotoxicologie et développement durable expertise ECODD, Valbonne, FR

Barbara Demeneix

14 Centre National de la Recherche Scientifique, FR

15 Muséum National d’Histoire Naturelle, Paris, FR

Michael Depledge

Dimitri d. deheyn.

16 Scripps Institution of Oceanography, University of California San Diego, US

Charles J. Dorman

17 Trinity College Dublin, IE

Patrick Fénichel

Samantha fisher, françoise gaill, françois galgani.

18 Institut Français de Recherche pour l’Exploitation des Mers, FR

William H. Gaze

19 University of Exeter, GB

Laura Giuliano

20 CIESM The Mediterranean Science Commission, MC

Philippe Grandjean

21 Harvard University T.H. Chan School of Public Health, US

Mark E. Hahn

Amro hamdoun.

22 University of California at San Diego, US

Philipp Hess

Bret judson, amalia laborde.

23 Universidad de la República, UY

Jacqueline McGlade

24 Institute for Global Prosperity, University College London, GB

25 Strathmore University Business School, Nairobi, KE

Adetoun Mustapha

26 Nigerian Institute for Medical Research, Lagos, NG

27 Imperial College London, GB

Maria Neira

28 World Health Organization, CH

Rachel T. Noble

29 University of North Carolina at Chapel Hill, US

Maria Luiza Pedrotti

30 Sorbonne Université, FR

Christopher Reddy

31 Department of Marine Chemistry and Geochemistry, Woods Hole Oceanographic Institution, US

Joacim Rocklöv

32 Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, SE

Ursula M. Scharler

33 University of KwaZulu-Natal, ZA

Hariharan Shanmugam

Gabriella taghian, jeroen a.j.m. van de water, luigi vezzulli.

34 University of Genoa, IT

Pál Weihe

35 University of the Faroe Islands and Department of Occupational Medicine and Public Health, FO

Ariana Zeka

36 Brunel University London, GB

Hervé Raps

37 WHO Collaborating Centre for Health and Sustainable Development, MC

Patrick Rampal

Associated data, background:.

Pollution – unwanted waste released to air, water, and land by human activity – is the largest environmental cause of disease in the world today. It is responsible for an estimated nine million premature deaths per year, enormous economic losses, erosion of human capital, and degradation of ecosystems. Ocean pollution is an important, but insufficiently recognized and inadequately controlled component of global pollution. It poses serious threats to human health and well-being. The nature and magnitude of these impacts are only beginning to be understood.

(1) Broadly examine the known and potential impacts of ocean pollution on human health. (2) Inform policy makers, government leaders, international organizations, civil society, and the global public of these threats. (3) Propose priorities for interventions to control and prevent pollution of the seas and safeguard human health.

Topic-focused reviews that examine the effects of ocean pollution on human health, identify gaps in knowledge, project future trends, and offer evidence-based guidance for effective intervention.

Environmental Findings:

Pollution of the oceans is widespread, worsening, and in most countries poorly controlled. It is a complex mixture of toxic metals, plastics, manufactured chemicals, petroleum, urban and industrial wastes, pesticides, fertilizers, pharmaceutical chemicals, agricultural runoff, and sewage. More than 80% arises from land-based sources. It reaches the oceans through rivers, runoff, atmospheric deposition and direct discharges. It is often heaviest near the coasts and most highly concentrated along the coasts of low- and middle-income countries. Plastic is a rapidly increasing and highly visible component of ocean pollution, and an estimated 10 million metric tons of plastic waste enter the seas each year. Mercury is the metal pollutant of greatest concern in the oceans; it is released from two main sources – coal combustion and small-scale gold mining. Global spread of industrialized agriculture with increasing use of chemical fertilizer leads to extension of Harmful Algal Blooms (HABs) to previously unaffected regions. Chemical pollutants are ubiquitous and contaminate seas and marine organisms from the high Arctic to the abyssal depths.

Ecosystem Findings:

Ocean pollution has multiple negative impacts on marine ecosystems, and these impacts are exacerbated by global climate change. Petroleum-based pollutants reduce photosynthesis in marine microorganisms that generate oxygen. Increasing absorption of carbon dioxide into the seas causes ocean acidification, which destroys coral reefs, impairs shellfish development, dissolves calcium-containing microorganisms at the base of the marine food web, and increases the toxicity of some pollutants. Plastic pollution threatens marine mammals, fish, and seabirds and accumulates in large mid-ocean gyres. It breaks down into microplastic and nanoplastic particles containing multiple manufactured chemicals that can enter the tissues of marine organisms, including species consumed by humans. Industrial releases, runoff, and sewage increase frequency and severity of HABs, bacterial pollution, and anti-microbial resistance. Pollution and sea surface warming are triggering poleward migration of dangerous pathogens such as the Vibrio species. Industrial discharges, pharmaceutical wastes, pesticides, and sewage contribute to global declines in fish stocks.

Human Health Findings:

Methylmercury and PCBs are the ocean pollutants whose human health effects are best understood. Exposures of infants in utero to these pollutants through maternal consumption of contaminated seafood can damage developing brains, reduce IQ and increase children’s risks for autism, ADHD and learning disorders. Adult exposures to methylmercury increase risks for cardiovascular disease and dementia. Manufactured chemicals – phthalates, bisphenol A, flame retardants, and perfluorinated chemicals, many of them released into the seas from plastic waste – can disrupt endocrine signaling, reduce male fertility, damage the nervous system, and increase risk of cancer. HABs produce potent toxins that accumulate in fish and shellfish. When ingested, these toxins can cause severe neurological impairment and rapid death. HAB toxins can also become airborne and cause respiratory disease. Pathogenic marine bacteria cause gastrointestinal diseases and deep wound infections. With climate change and increasing pollution, risk is high that Vibrio infections, including cholera, will increase in frequency and extend to new areas. All of the health impacts of ocean pollution fall disproportionately on vulnerable populations in the Global South – environmental injustice on a planetary scale.

Conclusions:

Ocean pollution is a global problem. It arises from multiple sources and crosses national boundaries. It is the consequence of reckless, shortsighted, and unsustainable exploitation of the earth’s resources. It endangers marine ecosystems. It impedes the production of atmospheric oxygen. Its threats to human health are great and growing, but still incompletely understood. Its economic costs are only beginning to be counted.

Ocean pollution can be prevented. Like all forms of pollution, ocean pollution can be controlled by deploying data-driven strategies based on law, policy, technology, and enforcement that target priority pollution sources. Many countries have used these tools to control air and water pollution and are now applying them to ocean pollution. Successes achieved to date demonstrate that broader control is feasible. Heavily polluted harbors have been cleaned, estuaries rejuvenated, and coral reefs restored.

Prevention of ocean pollution creates many benefits. It boosts economies, increases tourism, helps restore fisheries, and improves human health and well-being. It advances the Sustainable Development Goals (SDG). These benefits will last for centuries.

Recommendations:

World leaders who recognize the gravity of ocean pollution, acknowledge its growing dangers, engage civil society and the global public, and take bold, evidence-based action to stop pollution at source will be critical to preventing ocean pollution and safeguarding human health.

Prevention of pollution from land-based sources is key. Eliminating coal combustion and banning all uses of mercury will reduce mercury pollution. Bans on single-use plastic and better management of plastic waste reduce plastic pollution. Bans on persistent organic pollutants (POPs) have reduced pollution by PCBs and DDT. Control of industrial discharges, treatment of sewage, and reduced applications of fertilizers have mitigated coastal pollution and are reducing frequency of HABs. National, regional and international marine pollution control programs that are adequately funded and backed by strong enforcement have been shown to be effective. Robust monitoring is essential to track progress.

Further interventions that hold great promise include wide-scale transition to renewable fuels; transition to a circular economy that creates little waste and focuses on equity rather than on endless growth; embracing the principles of green chemistry; and building scientific capacity in all countries.

Designation of Marine Protected Areas (MPAs) will safeguard critical ecosystems, protect vulnerable fish stocks, and enhance human health and well-being. Creation of MPAs is an important manifestation of national and international commitment to protecting the health of the seas.

Introduction

The oceans are vast. They cover more than 70% of the earth’s surface, hold 97% of the world’s water, host some of the planet’s most diverse ecosystems, and support economies in countries around the world [ 1 , 2 ]. Microscopic organisms in the seas are a major source of atmospheric oxygen [ 3 , 4 , 5 , 6 ]. By absorbing more than 90% of the excess heat released into the earth’s environment and nearly one-third of carbon dioxide emissions, the oceans slow planetary warming and stabilize the global climate [ 7 ].

The oceans are essential to human health and well-being [ 8 , 9 , 10 , 11 , 12 , 13 ]. They provide food to billions, livelihoods for millions and are the source of multiple essential medicines [ 14 ]. They have traditional cultural value and are a source of joy, beauty, peace, and recreation [ 15 , 16 ]. The oceans are particularly important to the health and well-being of people in small island nations [ 17 ], the high Arctic, and coastal communities, especially those in the Global South [ 1 ]. The very survival of these vulnerable populations depends on the health of the seas [ 10 , 12 ].

Despite their vast size, the oceans are under threat, and human activity is the main source of the threat [ 1 , 2 ]. Climate change and other environmental disruptions of human origin have caused sea surface temperatures to rise, glaciers to melt, and harmful algal species and pathogenic bacteria to migrate into waters that were previously uncontaminated. Rising seas and increasingly violent coastal storms endanger the 600 million people worldwide who live within 10 m of sea level [ 1 ]. Rising concentrations of atmospheric CO 2 have caused acidification of the oceans, which in turn destroys coral reefs, impairs development of oysters and other shellfish, and dissolves calcium-containing microorganisms at the base of the food web [ 1 , 18 , 19 ]. The oceans are losing oxygen [ 1 ]. Fish stocks are declining [ 20 , 21 , 22 ]. Dredging, mechanized trawling, oil exploration, and planned deep undersea metal mining threaten the seabeds [ 23 ].

Pollution – unwanted, often hazardous waste material released into the environment by human activity – is one of the existential challenges of the present age [ 24 ]. Like climate change, biodiversity loss, and depletion of the world’s fresh water supply, pollution endangers the stability of the earth’s support systems and threatens the continuing survival of human societies [ 8 ].

Pollution is also a great and growing threat to human health. It is the largest environmental cause of disease in the world today, responsible for an estimated 9 million premature deaths per year [ 24 ]. It causes enormous economic losses, undermines national trajectories of economic development, and impedes attainment of the Sustainable Development Goals (SDGs) [ 22 ].

Pollution has until recently been overlooked in international development planning and largely neglected in the global health agenda [ 25 ]. For too long, pollution has been regarded as the unavoidable price of economic progress [ 25 ], a view that arose out of the experience of the 19th and 20th centuries when combustion of fossil fuels – coal in particular – was the engine of economic growth and pollution was seen as unavoidable. Today, however, the claim that pollution is inevitable and that pollution control costs jobs and stifles economies is no longer tenable. It has been disproven by the experience of the many countries that have more than doubled their GDPs in the past half century while greatly reducing pollution [ 24 , 25 , 26 ]. It has become irrelevant with the increasing availability of low-cost, renewable sources of energy and advances in green chemistry.

Ocean pollution is a critically important but underrecognized component of global pollution [ 26 , 27 ]. It has multiple direct and indirect impacts on human health [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. The nature and magnitude of these effects are only beginning to be understood.

The purpose of this review is to examine the impacts of ocean pollution on human health and well-being, identify gaps in knowledge, project future trends, and offer scientifically based guidance for effective interventions. Information presented in this review will guide attainment of the Sustainable Development Goals (SDGs), in particular, SDG 14, which calls for prevention and significant reduction of all marine pollution, and SDG 3, which calls for improvement of human health and well-being.

The ultimate aim of this report is to increase awareness of ocean pollution among policy makers, elected leaders, civil society and the public and to catalyze global action to monitor, control, and prevent pollution of the seas.

By focusing our analysis on human impacts, we underscore the fact that pollution of the oceans poses a clear and present danger to human health. It is causing disease, disability, and premature death in countries around the world today.

On the positive side, pollution of the oceans is not inevitable. It is a problem of human origin, and the successes in pollution control that have been achieved in many countries show that it can be controlled and prevented.

World leaders who recognize the great magnitude of ocean pollution, acknowledge its grave dangers to human health, engage civil society and the global public, and take bold, evidence-based action will be key to stop ocean pollution at its source and safeguarding human health.

This report consists of a series of topic-focused reviews that critically examine current knowledge of each ocean pollutant – its sources, magnitude, geographic extent, populations at greatest risk, and its known and potential effects on human health. We examine the strength of the evidence linking pollutants to health effects [ 29 ].

To the extent possible, we consider health effects not only of individual pollutants, but also of the complex mixtures of chemical pollutants and biological contaminants found in the seas today. We examine interactions and synergies among pollution, climate change and ocean acidification. Because the effects of pollution are disproportionately concentrated in low-income countries in the Global South, small island nations, and indigenous populations in the far north [ 12 ], we specifically examine ocean pollution’s impacts on these vulnerable populations. Finally, we consider the prospects for prevention and control of ocean pollution and present case studies of success in pollution control.

The Current State of Ocean Pollution

Pollution of the oceans is widespread, it is worsening, and its geographic extent is expanding [ 26 , 27 , 30 ]. Ocean pollution is a complex and ever-changing mixture of chemicals and biological materials that includes plastic waste, petroleum-based pollutants, toxic metals, manufactured chemicals, pharmaceuticals, pesticides, and a noxious stew of nitrogen, phosphorus, fertilizer, and sewage (Figure ​ (Figure1 1 ).

Ocean Pollution – A Complex Mixture.

Some ocean pollutants are “legacy” pollutants, materials deposited in the seas decades ago, while others are new. The relative concentrations of pollutants vary in different regions of the oceans and at different seasons of the year. Plastic pollution is the most visible component of ocean pollution. It is growing rapidly, but it is only the obvious tip of a much larger problem.

Land-based sources account for approximately 80% of ocean pollution, while discharges from marine shipping, offshore industrial operations, and waste disposal at sea account for the remaining 20% [ 26 ]. Pollution is most severe along coastlines and in bays, harbors, and estuaries where wastewater discharges, industrial releases, agricultural runoff, and riverine pollution cause massive in-shore contamination. Some of the world’s worst ocean pollution is seen along the coasts of rapidly developing countries in the Global South [ 26 ].

The European Environment Agency (EEA) reports that pollution by toxic metals, industrial chemicals and plastic wastes is at problem levels in 96% of the Baltic Sea, in 91% of the Black Sea, in 87% of the Mediterranean Sea, and in 75% of the North-East Atlantic Ocean [ 27 ]. Pollution by plastic waste has become a global threat [ 31 ].

The drivers of ocean pollution are rapid industrialization; continuing increases in the manufacture and release into the environment of chemicals and plastics; expansion of chemically intensive agriculture; massive releases of liquid and solid waste into rivers, harbors, and estuaries; and insufficient re-use and recycling of feedstock materials [ 16 , 32 ]. Specific sources of ocean pollution are:

• Coal combustion and gold-mining are the two main sources of marine mercury pollution [ 33 ].
• Exponential growth in chemical production coupled with inadequate controls on chemical releases are the main drivers of pollution of the oceans by manufactured chemicals [ 34 ].
• Marine pollution by plastic waste reflects massive global growth in plastic production, which now exceeds 420 million tons per year [ 35 ].
• Uncontrolled economic development and rapid population growth along the world’s coasts has led to pollution of in-shore waters by industrial releases, agricultural runoff and sewage [ 36 , 37 , 38 , 39 ]. Many populated coastal areas are now covered by buildings and impervious surfaces, which increases runoff. This runoff as well as discharges of wastewater and storm water, much of it inadequately treated, further increases pollution. The consequences are increasing abundance of pathogenic bacteria, viruses, and parasites [ 40 ], eutrophication, and increased frequency and severity of harmful algal blooms (HABs) – “red tides”, “brown tides”, and “green tides” – some of which produce potent disease-causing toxins.

Despite the great magnitude of ocean pollution and growing recognition of its effects on human and ecosystem health, great gaps remain in knowledge about pollution sources, levels of pollution in many areas of the seas, the sizes of high-risk populations, the extent of human exposure, and the magnitude of health effects. Because of these gaps, the impacts of ocean pollution on human health and well-being are underestimated, and it is not yet possible to fully quantify the contribution of ocean pollution to the global burden of disease [ 41 ].

Climate Change, Global Warming, Ocean Acidification, and Pollution

Since the 1970s, the oceans have warmed steadily in concert with global climate change [ 42 ]. They have taken up more than 90% of the excess heat released into the climate system [ 1 ]. Mean sea surface temperature is rising by 0.13°C per decade [ 43 ]. The frequency of marine heatwaves has more than doubled [ 1 ].

Further impacts of climate change on the oceans are increases in the intensity and frequency of extreme weather events such as heat waves, heavy rainstorms, and major hurricanes, and changes in large-scale planetary phenomena such as El Niño events [ 44 ] and the Indian Ocean Dipole [ 1 , 45 , 46 ].

Ocean acidification is another consequence of climate change. The oceans absorb nearly one-third of the carbon dioxide (CO 2 ) emitted into the atmosphere, and the amount of CO 2 absorbed by the seas has increased in recent decades as CO 2 emissions of human origin have increased. Ocean acidification is the result [ 7 ]. Since the late 1980s, the surface pH of the open ocean has declined by about 0.1 pH units relative to preindustrial time (i.e., a 26% increase in acidity [hydrogen ion concentration]), and the rate of increase is 0.017–0.027 pH units per decade [ 1 ].

Ocean acidification threatens the integrity of coral reefs. It impairs the development of oysters and other commercially important shellfish, thus impacting commercial fisheries. It endangers the survival of calcium-containing microorganisms at the base of the marine food web [ 1 , 47 ]. Ocean acidification may also increase the toxicity of certain heavy metals and organic pollutants [ 1 , 48 ].

Global warming liberates legacy pollutants from ice and permafrost, alters the geographic distribution of chemical pollutants in the oceans, and increases exposures of previously unexposed populations. All of these effects have potential to magnify the ocean pollution’s impacts on human health [ 49 ].

Rising sea surface temperatures and increasing ocean pollution result in greater abundance and expanded geographic ranges of naturally occurring marine pathogens, such as Vibrio species, among them Vibrio cholerae , the causative agent of cholera [ 50 , 51 ] (Figure ​ (Figure2). 2 ). The likely consequences will be increases in the frequency of Vibrio- associated illnesses and spread of these infections to new, previously unaffected areas. Risk is especially high in low-income countries where coastal development is intense and sanitation systems are dysfunctional due to civil unrest, conflict, sea level rise, coastal over-development, and natural disasters [ 52 ].

Areas considered suitable for Vibrio cholerae [ 50 ].

Source : Escobar et al., (2015) ( https://doi.org/10.1016/j.actatropica.2015.05.028 ) CC BY 4.0.

In a similar manner, climate change, sea surface warming, and ocean pollution appear to be increasing the frequency, severity, and global geographic extent of harmful algal blooms (HABs) [ 53 , 54 ]. Some dangerous algal species are moving poleward in response to the warming of coastal waters [ 54 , 55 ], changes in ocean stratification, alteration of currents, changes in nutrient upwelling, and changes in land runoff and micronutrient availability [ 56 , 57 ]. The likely consequences will be the occurrence of HABs in previously unaffected areas and exposures of previously unexposed populations in the circumpolar regions to HAB toxins.

Impacts of Ocean Pollution on Human Health

Chemical pollutants, toxic metal pollutants.

Releases of toxic metals to the environment began millennia ago with the inception of mining and smelting. These releases have increased since the beginning of the Industrial Revolution and risen especially in the past two centuries [ 58 , 59 , 60 ].

Mercury is the metal pollutant in the oceans of greatest concern for human health [ 34 ]. Over the past 500 years, human activities have increased total environmental mercury loading by about 450% above natural background. About 70% of the mercury circulating in the environment today consists of mercury emitted from human sources in the past, termed legacy mercury [ 61 ] (Figure ​ (Figure3). 3 ). The presence of large quantities of legacy mercury in the global environment and the potential for climate change to remobilize this mercury complicate projections of future exposures and health impacts.

Total global mercury releases and relevant historical factors, 1510–2010.

Source : Street et al., (2019) ( https://doi.org/10.1088/1748-9326/ab281f ) CC BY 3.0.

Current Sources of Mercury Pollution

An estimated 2,220 tons of mercury are currently emitted to the environment each year as the direct result of human activity. These emissions account for about 30% of current mercury emissions. Another 60% of current mercury emissions result from environmental recycling of anthropogenic mercury previously deposited in soils and water. The remaining 10% comes from natural sources such as volcanoes.

Combustion of coal and artisanal/small-scale gold-mining (ASGM) are the two principal human sources of current mercury emissions. All coal contains mercury and when coal is burned, mercury is released into the atmosphere where it can travel for long distances until ultimately it precipitates into rivers, and lakes and the oceans.

In ASGM, mercury is used to form an amalgam to separate gold from rock. The amalgam is heated to boil off the mercury leaving the gold behind. ASGM operations release mercury to the environment through vaporization and through runoff of spilled mercury into waterways [ 34 ]. Metal mining and oil and gas exploration can be additional sources of mercury release. In rivers, lakes and the oceans, the metallic, inorganic mercury released to the environment from these sources is converted by marine microorganisms into methylmercury, an organic form of mercury that is a potent neurotoxicant.

The largest fraction of global mercury emissions – about 49% – originate today in East and South-East Asia. Coal combustion and industrial releases are the major sources there. South America accounts for 18% of global mercury emissions and Sub-Saharan Africa for 16%. In both of these regions, ASGM is the major source of mercury releases.

Methylmercury is a persistent pollutant in the marine environment. It bioconcentrates as it moves up the food web, so that top predator species such as tuna, striped bass and bluefish as well as marine mammals can accumulate concentrations of methylmercury in their tissues that are 10 million or more times greater than those in surrounding waters [ 34 ].

Mercury levels vary substantially in different regions of the ocean. This variation is seen in a recent survey of methylmercury concentrations in yellowfin tuna, in which levels differed by 26-fold around the world. Highest levels were found in tuna from the North Pacific Ocean (Figure ​ (Figure4), 4 ), and these high concentrations reflect mercury releases from coal-fired power plants and steel mills in Asia that are carried northeastward across the Pacific on the prevailing winds [ 62 , 63 ].

Geographic differences in methylmercury concentrations of yellowfin tuna ( Thunnus albacares ).

Source : Reprinted from Nicklish et al., Mercury levels of yellowfin tuna ( Thunnus albacares ) are associated with capture location. Environmental Pollution 2017: 87–93, doi.org/10.1016/j.envpol.2017.05.070 with permission from Elsevier.

Human exposure to methylmercury occurs primarily through consumption of contaminated fish and marine mammals [ 34 , 64 ] Populations in the circumpolar region are heavily exposed to mercury in their diets – principally in the form of methylmercury – as a consequence of their traditional consumption of a diet rich in fish and marine mammals. Most of the mercury to which these populations are exposed originates from sources far away.

Neurobehavioral Toxicity of Methylmercury

The brain is the organ in the human body most vulnerable to methylmercury. This vulnerability is greatest during periods of rapid brain growth – the nine months of pregnancy and the first years of postnatal life [ 65 ].

There appears to be no safe level of methylmercury exposure in early human development.

Prospective epidemiological cohort studies undertaken in the Faroe Islands demonstrate that children exposed to methylmercury in utero exhibit decreased motor function, shortened attention span, reduced verbal abilities, diminished memory and reductions in other mental functions. Follow-up of these children to age 22 years indicates that these deficits persist and appear to be permanent [ 66 ].

A similar study conducted in Nunavik of child development at age 11 years showed that methylmercury exposure in early life is associated with slowed processing of visual information, decreased IQ, diminished comprehension and perceptual reasoning, impaired memory, shortened attention span, and increased risk of attention deficit/hyperactivity disorder (ADHD) [ 67 , 68 ]. Other prospective studies have also reported neurobehavioral deficits in children with elevated prenatal exposure to methylmercury [ 69 ].

Mercury exposure later in childhood and also in adolescence can also cause damage because the human brain continues to develop throughout this time [ 70 ]. Genetic factors may increase vulnerability to methylmercury in some individuals [ 71 ].

Accelerated Loss of Neurocognitive Function in Adults Exposed to Methylmercury

Recent studies have shown that adult exposures to methylmercury can also have negative effects on brain function [ 72 ]. Thus, in a cross-sectional study of 129 men and women living in six villages on the Cuiaba River in Brazil, elevations in hair mercury concentrations were associated with reductions in motor speed, manual dexterity, and concentration [ 73 ]. Some aspects of verbal learning and memory were also impaired. The magnitude of these effects increased with increasing concentrations of mercury in hair. The brain functions disrupted in adults by methylmercury – attention span, fine-motor function, and verbal memory – are similar to those previously reported in children with prenatal exposures but appear to occur at substantially higher levels of exposure.

Cardiovascular Effects of Methylmercury Pollution

Elevated concentrations of methylmercury in blood and tissue samples are associated with increased risk for acute coronary events, coronary heart disease, and cardiovascular disease [ 74 ]. The US National Research Council concluded in 2000 that methylmercury accumulation in the heart leads to blood pressure alterations and abnormal cardiac function [ 75 ].

Subsequent research has strengthened these findings. An expert panel convened by the US Environmental Protection Agency in 2011 concluded that methylmercury is directly linked to acute myocardial infarction and to increases in cardiovascular risk factors such as oxidative stress, atherosclerosis, decreased heart rate variability, and to a certain degree, hypertension [ 76 ]. Likewise, a 2017 systematic review found that methylmercury enhances production of free radicals resulting in a long-lasting range of effects on cardiac parasympathetic activity that increase risk for hypertension, myocardial infarction, and death [ 77 ]. Further research has confirmed these findings [ 78 , 79 ].

The Contribution of Marine Mercury Pollution to the Global Burden of Disease

Efforts have begun to estimate the contribution of mercury pollution of the oceans to the global burden of disease (GBD). A recent estimate finds that between 317,000 and 637,000 babies are born in the United States each year with losses of cognitive function that are the consequence of prenatal exposures to methylmercury resulting from consumption of mercury-contaminated fish by their mothers during pregnancy. These losses range in magnitude from 0.2 to 5.13 IQ points depending on the severity of exposure. These authors found additionally that population-wide downward shifts in IQ caused by widespread exposure to methylmercury are associated with excess cases of mental retardation (IQ below 70), amounting to 3.2% (range: 0.2–5.4%) of all cases of mental retardation in the United States [ 80 ].

Impacts of Ocean Acidification on Metals Toxicity

The alterations of carbonate chemistry in the seas – i.e. decrease in pH, decrease in [CO 3 2– ] and increase in [HCO 3 – ]) – that are the consequences of increasing CO 2 absorption induce changes in the speciation of metals that alter their solubility and bioavailability and therefore their toxicity [ 48 , 81 ].

For example, by 2100, the projected pH of the oceans will be approximately 7.7, resulting in a 115% increase in the mean free ionic form of copper (Cu 2+ ) in certain estuaries [ 82 ]. Consequently, the biotoxicity of copper to invertebrates [ 83 ] and to plankton photosynthesis and productivity will be enhanced. At the same time, however, ocean acidification will increase the concentration of dissolved iron, which could partially alleviate the inhibitory effect of copper on photosynthesis [ 84 ]. Ocean acidification appears in some instances to mitigate [ 85 ] or even reduce [ 86 ] the toxicity of mercury. As metals may play a role in the biodegradation of organic pollutants, changes in metal speciation could slow these processes and therefore potentiate the toxicity of some organic pollutants [ 87 ].

Prevention of Mercury Pollution

Evidence has shown that two actions will be key to preventing further addition of mercury to the oceans. These are a cessation of coal combustion and reduction of mercury use in artisanal and small-scale gold mining (ASGM). Cessation of coal combustion will not only slow the pace of climate change and reduce particulate air pollution, but will also greatly reduce atmospheric emissions of mercury and thus reduce additional deposition of mercury into the oceans. ASGM is a major source of mercury pollution of the oceans in the Global South. Actions underway under the aegis of the Minamata Convention are seeking to identify and control major sources of mercury pollution from ASGM [ 34 ].

Plastic Pollution of the Oceans

Plastic waste represents approximately 80% of all marine litter [ 88 ]. An estimated 10 million metric tons of plastics – range of estimate, 4.8 to 12.7 million – are released to the oceans each year [ 89 ]. The total amount of plastic waste circulating in the world’s oceans is projected to be 150 million tons by 2025 [ 89 , 90 ]. Marine plastic waste ranges in size from floating barrels, plastic bottles and plastic sheets down to sub-microscopic particles and fibers.

Recent increases in marine plastic pollution reflect massive growth in plastic production (Figure ​ (Figure5), 5 ), which now exceeds 420 million tons per year. Much of this plastic goes into consumer products, and over 40% is used in products that are discarded within one year of purchase – often after only a single use [ 91 ]. The consequence is massive global accumulation of plastic waste [ 92 ].

Cumulative Plastic Production since 1960. Calculated as the sum of annual global polymer resin, synthetic fiber, and plastic additive production. Most of this plastic still exists.

Source : Our World in Data ( https://ourworldindata.org/plastic-pollution ), CC BY 4.0).

Plastics are produced by the polymerization of highly reactive and often toxic chemical monomers, 98% of them derived from fossil fuels. They are designed to be stable, durable and resistant to degradation [ 93 ]. Because of these properties, discarded plastic that reaches the marine environment can persist for decades and travel long distances. Plastic waste is now ubiquitous in surface waters, on the coasts, in estuaries, on the high seas, and even in the deepest and most remote parts of the ocean [ 94 , 95 , 96 , 97 , 98 , 99 , 100 ].

Sources of Plastic Pollution

The United Nations Joint Group of Experts on the Scientific Aspects of Marine Pollution (GESAMP) [ 101 ] estimates that land-based sources account for up to 80% of the world’s marine pollution with 60–95% of this waste comprised plastic debris.

Rivers are a major source of plastic waste in the oceans, and riverine input is estimated to be between 1.15 and 2.41 metric tons per year, corresponding to between 9 and 50% of all plastic transported to the oceans. Rivers draining densely populated, rapidly developing coastal regions with weak waste collection systems are particularly important sources [ 102 ], and it is estimated that between 88–95% of marine plastic comes from only 10 rivers [ 103 ]. Largest inputs, accounting for approximately 86% of the plastic waste entering the marine environment, are from the coasts of Asia, mainly China [ 89 , 104 ]. Additional sources include aquaculture, fishing and shipping [ 27 ].

Plastic wastes are gathered by oceanic currents and collect in five large, mid-ocean gyres located in the North Pacific, South Pacific, North Atlantic, South Atlantic, and Indian Oceans. The North Pacific gyre is a relatively stationary area twice the size of France that has waste from across the North Pacific Ocean, including material from the coastal waters of North America and from Japan.

Marine Pollution by Plastic Microparticles

Weathering, mechanical abrasion, and photodegradation break plastic waste in the oceans down into smaller particles termed microplastics (<5 mm in diameter) and still smaller particles termed nanoplastics (<1μm in diameter; defined as <100 nm by some authors) [ 105 , 106 , 107 ]. The size distribution of ocean microplastics is highly skewed, with increasing numbers of particles at smaller particle sizes [ 108 , 109 ]. Microplastic particles can sink downward through the water column and accumulate on the ocean floor. In contrast to microplastics, which have been measured widely in the marine environment (e.g., Text Box 1 ) and in marine organisms, concentrations of nanoplastics are poorly defined [ 110 , 111 , 112 , 113 , 114 , 115 ].

TEXT BOX 1: Microplastic contamination in Massachusetts beaches and blue mussels, Mytilus edulis .

Background. Microplastic particles have been increasing in prevalence in the oceans since the late 1900s and are found today on beaches across the world [ 101 , 182 ]. The majority are produced through weathering and fragmentation of larger macroplastics. Toxic and endocrine disrupting chemicals such as phthalates and bisphenol A may be incorporated into plastics during manufacture, and microplastics can also absorb toxic chemicals from seawater. Because of their small size, microplastics are easily absorbed by microscopic marine organisms and thus can enter the food chain where they bioconcentrate [ 101 ]. Current studies are examining the possible effects of microplastics on ecosystem dynamics and also on the health of humans who consume fish and shellfish.

Goal. The two goals of this study were to examine (1) the physical characteristics, spatial distribution and abundance of microplastics on Massachusetts beaches, and (2) the characteristics of microplastics in wild blue mussels harvested in Massachusetts.

Methods. Six Massachusetts beaches were targeted – beaches in and around Boston (high urban density) and in more remote areas (Provincetown, Cape Cod, low population density). Sediment samples were collected from representative beaches and microplastics were prepared by density separation [ 183 ]. Blue mussel ( Mytilus edulis ) samples were collected from Provincetown. Samples were prepared following tissue digestion with concentrated KOH [ 184 ]. All samples were visualized by standard light microscopy and select samples were further analyzed by Raman spectroscopy.

Findings. Microplastics were found in all beach samples examined and in most mussels screened. Microplastics in select blue mussel samples showed Raman spectra similar in appearance to those associated with polycarbonate plastics.

Conclusion. This study demonstrates that microplastics are ubiquitous on Massachusetts beaches and that they can enter the human food chain through consumption of blue mussels.

Further studies. Future studies are targeting additional beaches (including freshwater beaches) and examining species higher on the food chain (crustaceans and fish). Laboratory-based weathering studies are underway to examine the processes involved in microplastic generation. Studies in Drosophila melanogaster are examining the effects of off-the-shelf and laboratory-generated microplastic exposure via feeding on behavior, phenotype and gene expression.

Microplastics are also manufactured. They are produced in the form of microplastic beads – polystyrene spheres 0.5 to 500 μm in diameter. These beads are used in industrial processes such as 3D printing. They also have multiple applications in human and veterinary medical products to enhance drug delivery to tissues, and in cosmetics such as toothpaste, abrasive scrubbers and sunscreen. Manufactured microplastic beads are released to the environment from these products. They enter the oceans by way of urban runoff, sewage discharge, and direct wash-off of cosmetics and sunscreens from the skin of swimmers and surfers.

Microplastics degrade in the marine environment at varying rates depending on the core material and weathering conditions. Some petroleum-based plastics can take hundreds of years to degrade, although under some circumstances photochemical degradation can be significant [ 97 , 116 , 117 ].

Microplastic particles contain substantial quantities of toxic chemicals. Toxic chemical additives are incorporated into plastics during their manufacture to convey specific properties such as flexibility, UV protection, water repellence, or color [ 118 , 119 , 120 , 121 , 122 ]. These additives can comprise as much as 60% of the total weight of plastic products. They include plasticizers such as phthalates, brominated flame retardants, antioxidants, UV stabilizers, and pigments [ 106 , 123 ]. Due to their large surface-to-volume ratio, microplastic particles can also adsorb toxic chemical pollutants from the marine environment – polycyclic aromatic hydrocarbons (PAHs), PCBs, DDT, and toxic metals [ 106 ].

Some plastic additives such as synthetic dyes, are classified as mutagens and carcinogens [ 124 , 125 , 126 ]. Others such as bisphenol A and phthalates are endocrine disruptors – chemicals that can mimic, block, or alter the actions of normal hormones. Perfluorinated additives, widely used in plastic to make them water-repellent, are deleterious to human reproduction. Still other plastic additives can reduce male fertility and damage the developing human brain [ 127 , 128 ]. Also of concern are residual unreacted monomers and toxic chemical catalysts that may be trapped in plastic during its manufacture.

Chemical additives and adsorbed chemicals can leach out of microplastic and nanoplastic particles. They can enter the tissues of marine organisms that ingest these particles, including species consumed by humans as seafood. Concentrations of some chemical additives have been found to be orders of magnitude higher in microplastic particles than in surrounding seawater [ 129 ].

Marine Pollution by Plastic Microfibers and Tire-Wear Particles

Microfibers and tire-wear particles are distinct sub-categories of microplastics. Microfibers originate mainly from the clothing and textile industries [ 130 , 131 , 132 ]. Tire-wear particles are formed by the abrasion of car and truck tires. These materials reach surface waters and ultimately the oceans through runoff from roadways [ 133 , 134 , 135 ].

Plastic microfibers are distributed globally in both water and air [ 129 , 136 , 137 , 138 ]. They have become ubiquitous in all ecosystems. They are found in seafood [ 139 , 140 ]. Humans can be exposed to microfibers through consumption of contaminated fish or shellfish. Inhalation of airborne microfibers may represent an even greater source of human exposure [ 141 , 142 ].

Effects of Plastic Pollution on Marine Species

Elucidation of the toxicological impacts of microplastics, including microfibers, is challenging because of their heterogeneity and great complexity [ 106 ]. Microplastics span a wide range of sizes and shapes, they are comprised of various polymer materials, and as noted above they contain myriad chemical additives, the identity of which may be proprietary and therefore not generally known. Once in the marine environment, plastics undergo weathering and adsorb additional contaminants, further enhancing their complexity. Finally, marine species exhibit a range of sensitivity to microplastics [ 143 ]. All of these factors complicate assessments of toxicity and health hazard [ 144 , 145 ].

Although there is evidence for transfer of additives and adsorbed chemicals from plastics to organisms, the relative contribution of plastics to total chemical exposure by all pathways is thought in most situations to be minor [ 146 , 147 , 148 , 149 , 150 , 151 , 152 ]. Likewise, although some additives and sorbed contaminants are able to bioaccumulate and biomagnify in aquatic food webs, there is not yet strong evidence that plastic particles themselves are able to undergo biomagnification [ 153 ].

Microplastics have potential to harm living organisms through several mechanisms:

Physical toxicity . Macroscopic plastic wastes, such as bottle caps, small bottles, and food packaging, can be ingested by fish, seabirds, and marine mammals that mistake them for food. Undigested plastic accumulates in these animals’ gastrointestinal tracts where it can cause obstruction that leads to malnutrition, reproductive impairment and death [ 129 , 154 , 155 , 156 , 157 , 158 , 159 , 160 ]. Marine species can also be harmed and killed by becoming entangled in abandoned fishing gear, plastic nets and plastic rings that are caught on reefs or drifting in the water column. An estimated 5.7% of all fishing nets, 8.6% of all traps, and 29% of all lines are lost each year [ 161 , 162 ]. Plastic pollution is a threat to coral reefs [ 163 ]. Large plastic debris such as plastic bags and sheeting can smother coral colonies by preventing light from reaching the phototrophic organisms that build reefs and can also cause physical damage. Particle effects. Microplastics can harm living organisms by virtue of their ability to damage cells, injure tissues, and cause inflammation [ 164 ]. While microplastics cannot easily pass through cell membranes, nanoplastic particles can cross the gut lining and accumulate in tissues [ 165 , 166 , 167 ] where they may have the potential to cause deleterious effects [ 168 ]. Leachates containing tire-wear particles have been associated with storm water-associated mortality in salmon [ 169 ]. Chemical Toxicity. The toxic chemical additives and the sorbed pollutants in and on microplastics and nanoplastics can leach from plastic particles and enter the tissues of marine organisms [ 123 , 170 , 171 , 172 ]. Although plastic particles may not be a major source of chemical exposure [ 146 , 147 , 148 , 149 , 150 , 151 , 152 ], there is evidence that in some instances they can be significant contributors to chemical body burden [ 173 ].

The challenges associated with assessing the impacts of microplastics on marine organisms are evident in the divergent results of studies reported to date. A recent meta-analysis and review of published research on the effects of microplastics and macroplastics found similar numbers of positive and negative results [ 174 ]. A major conclusion from this and other reviews is that most of the experimental work to date has been done using concentrations of microplastics that are not environmentally relevant [ 144 , 174 , 175 ]. Future research should be conducted under more environmentally relevant conditions [ 174 ].

Microplastics as Vectors for Microbial Pathogens

An additional hazard of microplastic particles and fibers in the marine environment is that they can transport and shelter hazardous microorganisms, including vectors for human disease [ 176 ]. Pathogenic bacteria have been detected on sub-surface microplastics comprised of polyethylene fibers, in plastic-containing sea surface films, and in polypropylene fragments sampled in a coastal area of the Baltic Sea [ 177 ]. Similarly, E. coli and other potentially pathogenic species have been found on plastics in coastal waters [ 178 ] and on public beaches [ 179 ]. Algal species involved in HABs [ 180 ] and ciliates implicated in coral diseases [ 181 ] have also been found attached to marine microplastics.

These findings suggest that harmful microbes and algae that colonize plastics in the marine environment may use microplastic particles to expand their geographical range (‘hitch-hiking’). Adhesion to marine plastic may also enable pathogens to increase their anti-microbial resistance thus facilitating their spread to new areas where they may cause disease and death in previously unexposed populations [ 177 ].

Human Exposure to Plastic Pollution in the Oceans

Consumption of contaminated fish and shellfish is a major route of human exposure to marine microplastics and their chemical contaminants [ 140 , 184 , 185 ]. Microplastic and nanoplastic particles are ingested by filter-feeders such as oysters and mussels that are then consumed by humans. Microplastic particles are found also in finfish that have consumed smaller organisms below them in the food web whose tissues are contaminated by microplastics and nanoplastics [ 123 ]. Greatest risks of human exposure are associated with consumption of small fish such as sardines that are eaten whole, including the gut [ 186 ]. The risk of microplastic ingestion may be especially great in fishing communities and in indigenous populations who rely heavily on seafood and marine mammals for their diet.

A recent study based on assessment of commonly consumed food items estimates that an average person consumes between 74,000 and 121,000 microplastic particles per year [ 161 ]. Particle consumption varies by age, sex and diet. Microplastic particles have been detected in human stool samples with about 20 particles detected per 10g of stool, indicating that these particles can reach the human gut [ 187 ]. Ingestion of contaminated drinking water and inhalation of airborne microplastic fibers are additional sources of human exposure, and inhalation may be an especially important source [ 138 , 141 ].

Human Health Effects of Plastic Pollution in the Oceans

The risks that marine microplastics may pose to human health are not yet well understood and uncertainty about their potential hazard is high [ 125 , 186 , 188 , 189 ]. A recent review by SAPEA, an arm of the European Academies of Science, concluded that at present there is “no evidence of widespread risk to human health” of marine plastic pollution [ 124 ]. This report goes on to state, however, that as disposal of plastic waste into the oceans continues to increase and more knowledge becomes available, the assessment could change [ 125 , 126 , 128 ].

Protection of human health against the potential hazards of marine plastic requires a precautionary approach. While current knowledge of health hazards is incomplete, there is sufficient information to justify urgent action to prevent the continuing discharge of plastic waste into the oceans [ 190 , 191 ].

Pollution of the Oceans by Manufactured Chemicals

More than 140,000 new chemicals have been invented and manufactured in the past 75 years. These synthetic chemicals are largely produced from fossil fuels – coal, oil, and increasingly, gas. Some are used in the manufacture of plastics. Others are incorporated into millions of consumer goods and industrial products ranging from foods and food packaging to clothing, building materials, motor fuels, cleaning compounds, pesticides, cosmetics, toys, and baby bottles [ 37 ].

Global chemical manufacture is increasing by about 3.5% per year and is on track to double by 2045 (Figure ​ (Figure6). 6 ). More than 60% of current chemical production is in low- and middle-income countries [ 192 ], where health and environmental protections are often scant and waste disposal not well controlled.

Global Chemical Production and Capacity Index (%) 1987–2020.

Source : The pH Report, American Chemistry Council.

Manufactured chemicals have become widely disseminated in the environment and are found today in the most remote reaches of the planet [ 193 ]. Humans are exposed to these chemicals. In national surveys conducted across the United States by the Centers for Disease Control and Prevention, measurable quantities of more than 200 manufactured chemicals are routinely detected in human tissues [ 194 ].

The majority of manufactured chemicals have never been tested for safety or toxicity. Their potential to damage ecosystems or harm human health is therefore not known. In most countries, manufactured chemicals are allowed to enter markets with little scrutiny. Some are found belatedly – sometimes only after years or even decades of use – to have caused damage to planetary support systems ( Text Box 2 ), or injury to health. Examples include DDT, asbestos, tetraethyl lead, and the chlorofluorocarbons. Even less is known about the possible combined effects of exposures to mixtures of manufactured chemicals [ 1 , 2 , 34 , 195 ].

The thousands of manufactured chemicals that pollute the world’s oceans are variously classified by source (e.g. industrial), chemical structure (e.g. polycyclic aromatic hydrocarbons [PAHs]), intended use (e.g. pesticides; flame-retardants; pharmaceuticals), and environmental and biological properties (e.g., persistent, bioaccumulative), and by mode of toxicity (e.g., endocrine disruptors) [ 196 ]. Many are “legacy” pollutants, deposited in the seas over decades, while others are newly recognized.

Major Classes of Marine Chemical Pollutants

PCBs are mixtures of related chemicals that are resistant to extreme temperature and pressure. In the past, PCBs were used widely in electrical capacitors and transformers, in hydraulic fluids, as heat transfer fluids, lubricants, and as plasticizers. Although production has been banned since the 1970s and 1980s, massive quantities are still present in electrical generators and capacitors and still larger amounts persist in the environment as legacy pollutants. PBBs and PBDEs have been used as flame retardants.

Dioxins, including the highly toxic 2,3,7,8-tetrachlorodibenzo- p -dioxin (TCDD), and furans are by-products formed in the synthesis of chlorinated industrial chemicals and formed also in the incineration of PCBs, polyvinyl plastics, and other manufactured chemicals containing halogens.

Although the HAHs of greatest concern are manufactured chemicals, the marine environment is also a rich source of naturally occurring HAHs, including hydroxylated PBDEs, halogenated bipyrroles, and halogenated indoles [ 200 ].

• Perfluoroalkyl substances (PFAS): This group contains hundreds of related compounds, all containing fluorine atoms on a carbon backbone. They are used in manufacture of a wide range of products, including non-stick cookware, stain-repellant carpets and furniture, water-repellent clothing, and firefighting foam. PFAS chemicals are highly persistent in the environment. They have caused extensive contamination of surface waters and groundwater, especially near airports and military bases where large quantities were used in firefighting foams. PFAS compounds have entered the oceans in substantial quantities and like other persistent chemicals have been incorporated into the marine food chain.
• Organophosphorus flame retardants (OPFRs): As the persistence and toxicity of first-generation flame retardants such as PBBs and then PBDEs became known, manufacturers turned to OPFRs, which have now also come to be contaminants in marine ecosystems.
• Polynuclear aromatic hydrocarbons (PAHs): These are multi-ring compounds that occur naturally in petroleum and oil products and also are generated as soot during incomplete combustion of organic material. Alkylated PAHs are common in petroleum.
• Pesticides: The term ‘pesticides’ encompasses insecticides, fungicides, and herbicides. These are a large and diverse group of manufactured chemicals designed to be toxic to target organisms (“pests”). Common classes of insecticides are organochlorines (e.g., DDT, and its metabolite DDE), organophosphates, carbamates, and pyrethroids. Herbicides include phenoxyacetic acids (2,4-D and 2,4,5-T), atrazine, and glyphosate.
• Organometals: Alkylated tin products, especially phenyltin compounds, were commonly used as antifouling agents added to marine paints used on the hulls of ships to prevent growth of barnacles.

Spatial and Temporal Distribution of Marine Chemical Pollutants

The oceans are the ultimate sink for chemical pollutants, and persistent pollutants that enter the seas from land-based sources will stay in the oceans for years and even centuries [ 201 ].

Concentrations of contaminants vary in different parts of the oceans. Therefore, tracking the levels, fate and geographic distribution of chemical pollutants is a fundamental prerequisite to predicting patterns of exposure, evaluating health effects, and designing evidence-based strategies for pollution control and disease prevention.

With the exception of crude oil, almost all of the chemical contaminants considered in this report originate on land and are transported to the ocean through atmospheric transport, river deposition, runoff, and direct discharges to the seas. In the oceans, pollutant concentrations are influenced by proximity to source, global transport patterns, and marine ecology. Highest concentrations tend to occur near population centers, industrial areas, and centers of industrialized agriculture such as concentrated animal feeding operation (CAFOs). Large-scale changes in ocean temperature and circulation induced by global climate change appear to be important drivers of pollutant distribution [ 202 ].

Atmospheric transport is a major factor governing the movement of certain manufactured chemicals from land-based sources to the sea [ 203 ]. For example, several classes of persistent organohalogen compounds, such as PCBs and fluorinated compounds volatilize at equatorial and temporal latitudes, move poleward in the atmosphere, and then precipitate to land and in water in the cool air of the polar regions, a phenomenon termed “atmospheric distillation” [ 204 , 205 ]. The consequences are high concentrations of persistent pollutants in marine microorganisms in the circumpolar regions as well as in top predator fish species and marine mammals. Indigenous peoples in the far north who rely heavily on marine species for food are therefore placed at high risk of exposure to POPs.

Direct dumping of industrial wastes into the sea is another source of pollution by toxic chemicals. For example, an estimated 336,000–504,000 barrels of acid sludge waste generated in the production of DDT have been dumped into the Southern California Bight [ 206 ]. The disposal process was sloppy and the contents of the barrels readily leaked leading to localized contamination. Once they are in the seas, chemical wastes can be further mobilized through natural or human-caused disturbances. For example, PCBs [ 207 ] in the Southern California Bight [ 206 ] have been mobilized by dredging of contaminated sediments from San Diego Bay.

Leaching from plastic waste is another route by which toxic chemical pollutants can enter the seas. As was described in the preceding section of this report, a wide range of toxic chemicals can leach out of the 10 million tons of plastic waste deposited in the oceans each year. These manufactured chemicals can enter the marine food chain, thus potentially resulting in ecosystem effects and human exposure.

Global efforts to reduce or eliminate pollution have resulted in some successes in control of ocean pollution, for example in reductions in PCBs and mercury in the seas surrounding Europe (EEA) [ 27 , 208 ]. In general, however, halogenated organic compounds, such as those governed by the Stockholm Convention, are highly resistant to degradation in the marine environment, and these persistent legacy pollutants remain widespread in marine environments.

Human Exposure to Marine Chemical Pollutants

An estimated 1–3 billion people depend on seafood as their principal source of dietary protein. Thus, contaminated seafood is the major route of human exposure to marine pollutants. The chemical pollutants most often identified in seafood are methylmercury, PCBs, dioxins, brominated flame retardants, perfluorinated substances, and pesticides.

Factors that influence concentrations of chemical pollutants in fish include geographic origin, fish age, fish size, and species. Geographic origin is a highly important determinant of pollutant load [ 209 , 210 , 211 ] and often outweighs the influence of other factors (Figure ​ (Figure7). 7 ). Thus, fish that live and are caught near cities and major points of pollutant discharge typically contain highly elevated concentrations of POPs and other chemicals [ 193 ].

Impact of geographic variation on risk-based fish consumption advisories. Ranges of risk-based consumption limits for 11 sites, calculated in meals per month and based on multiple contaminant exposure with cancerogenic health endpoints, including total PCBs (n = 209), toxaphene and dieldrin. The red hollow spheres to the left of each box plot display the individual fish values. Letters in parenthesis represent subgroups of the sample population with means that were significantly different from each other using Tukey’s post hoc analysis. The U.S. Food and Drug Administration (FDA) and American Heart Association (AHA) recommended minimum monthly fish consumption levels and the U.S. Environmental Protection Agency (EPA) threshold for unrestricted (>16) fish meals per month are shown as dashed lines. Note: GOM, Gulf of Mexico, IO, Indian Ocean; NCS, North China Sea; NEAO, Northeast Atlantic Ocean; NEPO, Northeast Pacific Ocean; NPO, Northern Pacific Ocean; NWAO, Northwest Atlantic Ocean; NWPO, Northwest Pacific Ocean; SCS, South China Sea; SEPO, Southeast Pacific Ocean; SWPO, Southwest Pacific Ocean.

Source : Nicklisch et al. (2017), https://doi.org/10.1289/EHP518 .

Predator fish species at the top of the food web generally accumulate higher concentrations of chemical pollutants than fish at lower trophic levels. Therefore, fish consumption advisories typically focus on limiting consumption of predator species. However, given the vast scale of the oceans and wide geographic variation in pollutant concentrations, it is perhaps not surprising that that these advisories do not always adequately protect consumers. For instance, one survey found that sardines, a species relatively low on the marine food web, can have higher concentrations of PCBs than cod or salmon [ 212 ].

Human Health Consequences of Marine Chemical Pollutants

Toxic chemical pollutants in the oceans have been shown capable of causing a wide range of diseases in humans. Toxicological and epidemiological studies document that toxic metals, POPs, dioxins [ 213 ], plastics chemicals, and pesticides can cause cardiovascular effects, developmental and neurobehavioral disorders, metabolic disease, endocrine disruption, and cancer (detailed references are provided in the following paragraphs). Effects in humans and laboratory animals are generally similar. Independent, systematic reviews undertaken by the US National Academy of Medicine and the International Agency for Research on Cancer confirm and validate these findings [ 214 , 215 ].

Appendix Table ​ Table1 1 in the Supplementary Appendix to this report summarizes the known links between exposures to toxic chemicals in the oceans and a range of human health outcomes. Key associations are the following:

Major Oil Spills [ 299 ].

• Cardiovascular disease. Multiple toxicological and epidemiologic studies indicate that PCBs, dioxins, PBDEs, OPs, OCs, PAHs and petroleum pollutants, can increase cardiovascular risk factors, including hypertension and atherosclerosis [ 216 , 217 , 218 , 219 ], and increase prevalence of cardiovascular disease, stroke, and heart failure. Powerful prospective cohort studies, such as the Nurses’ Health Study II and the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study [ 220 ] provide compelling evidence that POPs exposures in humans are associated with a broad range of cardiovascular conditions.

The first well-described example of the unique susceptibility of infants and children to toxic chemicals in the environment was in the Minamata disaster in post-war Japan. In Minamata, prenatal exposures of human infants in utero to high concentrations of methylmercury in contaminated fish consumed by their mothers during pregnancy caused profound neurological impairment. The mothers, by contrast, sustained little or no physical toxicity [ 227 ].

Manufactured chemicals now recognized to be developmental toxicants include:

• PCBs and dioxins, which have been linked to neurological, behavioral, and metabolic effects [ 228 , 229 ] and also to reduced fetal growth and low birth weight [ 230 ].
• PBDEs, which have been linked to cognitive impairment in children [ 231 ].
• Phthalates, which are linked to reduced birth weight [ 232 ], behavioral abnormalities resembling attention deficit/hyperactivity disorder (ADHD), reproductive abnormalities in baby boys and decreased male fertility [ 233 , 234 ].
• Bisphenol A, which is linked to behavioral disturbances in childhood [ 235 ].
• Organophosphate compounds, which are associated with reduced head circumference at birth (a measure of delayed brain development), developmental delays, cognitive impairments, and autism spectrum disorder (ASD) [ 236 , 237 , 238 ].
• Perfluorinated compounds, such as PFOA and PFOS, which have been linked to decreased fetal growth [ 239 , 240 ], decreased birth weight, reduced head circumference in newborn infants and increased risk of ADHD [ 241 ]. Exposures to PFAS compounds are associated additionally with hepatic toxicity, increases in serum lipid levels, increased risk of thyroid disease, suppression of immune function [ 242 ], and decreased fertility [ 239 , 240 , 243 ].
• p, p’- DDE, the principal metabolite of the insecticide, DDT, which affects birth weight [ 232 ].
• Organotin compounds, used extensively in anti-fouling marine paints, have been linked to neurotoxicity, hepatotoxicity, and renal toxicity as well as to ecosystem harm [ 244 ].

Analysis of NHANES data suggests that PBDE exposure in early life is a major contributor to the burden of intellectual disability in children, resulting in loss of 162 million IQ points and more than 738,000 cases of intellectual disability [ 249 ] in the United States each year.

Prenatal and adult exposures to PCBs are linked to a series of adverse neurodevelopmental outcomes related to cognition – IQ loss and deficits in language, memory and learning – as well as to problems in attention, behavior, executive function, and social behavior. Early-life exposures to PCBs have been associated also with increased risk for attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) [ 215 ].

The consequences of developmental neurotoxicity in early life appear to persist across childhood and adolescence and even into adult life [ 250 ]. Thus, the association between prenatal PBDE exposure and attention problems persists at least to age seven years [ 251 ]. Likewise, early exposures to PCB 153, DDE, β-HCH, and PFOS are associated with hyperactivity up to at least age 13 years [ 241 , 252 ]. Postnatal exposures may also contribute to these effects and post-natal exposure to PCBs are linked to deficits in fine motor function in Inuit children at age 11 years [ 253 ].

Many POPs are EDCs. Because they are environmentally persistent, these chemicals can continue cause damage to living organisms for years or even decades after their release to the environment [ 255 ]. Two examples are DDE, the stable metabolite of DDT and PCBs. Both DDT and PCBs have been banned for several decades, but both are still identified in most human blood, milk, and adipose tissues as well as in top predator fish species and marine mammals.

• Immune toxicity: Halogenated aromatic hydrocarbons, in particular dioxin and dioxin-like compounds have long been known to have harmful effects on the immune system in animals and humans, especially in the embryonic/developing stages [ 256 , 257 , 258 ]. Evidence suggests that these effects may persist into adolescence and adult life [ 259 ]. Some of the less highly persistent PAHs may also have immune effects [ 260 ]. Recent evidence indicates that PBDEs and PFAS also have negative effects on human immune function [ 261 , 262 ]. Thus, deficient vaccine antibody responses at age five years were associated with PFAS exposures prenatally and during early infancy [ 242 ]. Susceptibility to infectious diseases may also be increased.
• Increased Risks of Metabolic Syndrome and Diabetes: Consistent associations have been reported between several POPs and increased risk for diabetes and the metabolic disorder [ 263 ]. Altered lipid metabolism is another outcome linked to several POPs. A review of health effects linked to PFAS exposure identified dyslipidemia as the strongest metabolic outcome [ 262 ]. PCBs have been identified as possibly diabetogenic in the Nurses’ Health Study II [ 264 ]. A study in young adults examined changes in metabolism over a 23-year follow-up from exposure [ 265 ]. The findings suggest that PCBs and OCPs effects on glucose homeostasis may worsen after decades of exposure to background environmental levels.
• Carcinogenesis: Numerous toxicological and epidemiological studies have established that many PAHs are carcinogenic, and these studies have also elucidated many of the underlying biochemical mechanisms [ 266 , 267 ]. PAHs are proven human carcinogens and are linked to multiple human cancers, including lung cancer, skin cancer, and bladder cancer [ 268 ]. Rodent bioassays conducted by the US National Toxicology Program (NTP) have concluded that PCBs and dioxins are carcinogenic. Occupational and military exposures to these compounds are linked to increased incidence rates of lymphatic cancers, especially Non-Hodgkin’s Lymphoma (NHL), and also to diabetes [ 269 ]. Meta-analysis of results from the Yusho and Yu-Cheng cohorts report elevated lung, liver, and all cancers 30 to 40 years after prenatal poisoning by PCBs, chlorinated dioxins, and furans [ 270 ].
• Mortality: Studies in the PIVUS cohort suggest that mortality due to CVD is associated with higher body burdens of POPs [ 220 ]. In the US NHANES survey, some organochlorine pesticides have been found to be associated with increased all-cause mortality and others with increased non-cancer, non-cardiovascular mortality [ 271 ]. Higher concentrations of POPs in plasma are associated with decreased survival of patients with amyotrophic lateral sclerosis (ALS) [ 272 ]. Kim et al. found that an interaction between POPs concentrations and total body fat mass affected risk of mortality from chronic diseases [ 273 ]. Massive exposures in early life to PCBs, dioxins, and furans in the Yusho and Yu-Cheng episodes in Japan and Taiwan have been linked to increased risk of mortality from chronic diseases [ 273 ] and to elevated all-cause mortality [ 234 , 270 ].

Ocean Pollution by Pharmaceuticals and Personal Care Products (PPCPs)

More than 10,000 chemicals are used in the manufacture of pharmaceuticals and personal care products (PPCPs). These products include therapeutic drugs with both medical and veterinary applications, cosmetics, and cleaning products. They are a subset of the manufactured chemicals discussed in the preceding section. Like pesticides, pharmaceuticals are specifically designed to have biological effects, and thus even low-dose exposures can affect living organisms, including humans.

With increasing manufacture and use of pharmaceuticals by a growing global population, pharmaceutical wastes have entered ecosystems in increasing quantities. Pharmaceutical and cosmetic manufacturing plants, hospitals, nursing homes, confined animal feeding operations (CAFOs), and aquaculture can all release PPCPs into wastewater systems, rivers, and eventually the oceans. Environmentally persistent pharmaceutical pollutants (EPPPs) have been recognized as a “new and emerging issue” under the United Nations’ Strategic Approach to the International Management of Chemicals (SAICM) since 2015.

Therapeutic drugs commonly found in measurable quantities in urban wastewater and coastal waters include ibuprofen and other painkillers, anti-depressants, steroids, caffeine, estrogens and other hormone-containing products, anti-epileptics, cancer drugs, antimicrobials such as triclosan, and antibiotics [ 274 , 275 , 276 , 277 ]. Many pharmaceutical and cosmetic products in current use contain manufactured plastic nanoparticles [ 278 ].

Some PPCPs have potential to accumulate in fish and shellfish species consumed by humans and thus have potential to affect human health [ 279 ]. Concern is growing that pharmaceutical chemicals and their metabolites can damage marine species through a range of toxicological mechanisms, including endocrine disruption and neurotoxicity. A recent case study suggests that the widely used sunscreen chemical, oxybenzone (benzophenone-3) may have toxic effects on the larval forms of several coral species [ 280 ]. The study reports that these effects include transformation of coral larvae from a motile state to a deformed, sessile condition; increased coral bleaching; leading to deformed skeleton formation; and DNA lesions.

Hazards of Combined Exposures to Multiple Chemical Pollutants

Manufactured chemicals are rarely present in the environment in isolation, but instead are found in complex mixtures. This complicates assessment of health impacts, because toxicological tests most often are conducted on one chemical at a time, thus potentially missing additive, antagonistic, or synergistic actions that could result from simultaneous exposures to mixtures of POPs and other manufactured chemicals that occur together in the oceans as “chemical cocktails” [ 281 , 282 ]. Future public health studies should pay additional attention to complex mixtures and cumulative risk assessment. The possibility of interaction among multiple POPs raises the question as to whether any one chemical that shows an association with disease is really acting a “proxy” for the combined effect of all the chemicals [ 283 , 284 ].

Consideration of the susceptibility of exposed populations is also important. The safe limit for exposure at sensitive life stages of development, in utero or in nursing infants, will be lower than for adults. And in the adult population, underlying disease may modify risk. Finally, “safe” levels for one pollutant may not pertain to the combined risk from simultaneous exposure to the many pollutants to which a person may be exposed.

Balancing Risks and Benefits of Exposure to Chemical Pollutants in the Oceans

Because of widespread pollution of the oceans by toxic metals and POPs and contamination by HAB toxins (discussed in the next section of this report), it is necessary to balance the risks of chemical pollutants in seafood against the benefits derived from nutrients unique to fish and shellfish. Thus, the benefits of essential fatty acids (EPA and DHA) in farmed and wild fish must be balanced against the risks for adverse health outcomes from chemical contaminants in those same fish [ 285 , 286 ].

To assess whether the beneficial effects of omega-3 fatty acids in seafood may mitigate the adverse effects of methylmercury on brain development, IQ was measured in 282 school-age Inuit children in Arctic Québec whose umbilical cord blood samples had been analysed for mercury and DHA [ 287 , 288 ]. The investigators found that prenatal mercury exposure was associated with lower IQ after adjustment for potential confounding variables. Incorporation of DHA into the model significantly strengthened the association with mercury, supporting the hypothesis that the beneficial effects of DHA intake can at least partially offset the harmful effects of mercury [ 65 ].

Similarly, some studies have noted that the beneficial effect of fish consumption on the cardiovascular system appears to be reduced by co-exposure to PCBs [ 289 ]. The risk differential between wild and farmed salmon is a prime example of these concerns. While the abundance of omega-3 as well as omega-6 fatty acids differ between wild and farmed fish, both contain high levels of these beneficial compounds. However, farmed fish tend to have higher levels of PCBs and other contaminants than wild fish, and contaminant burdens differ between fish farmed in different parts of world. Determining risk of those contaminants depends in part on which outcome is considered, and whether the risk is from one or many chemicals.

Studies comparing relative risk of cancer and other health outcomes associated with dioxin-like compounds in salmon concluded that consumption of farmed salmon would need to be limited to many fewer meals per month than for wild salmon, to reduce cancer risk to a level near the WHO “tolerable daily intake” for dioxin-like compounds [ 290 , 291 ].

A review examining the health risks and benefits of seafood consumption and the impact of fish consumption on sustainability of fish stocks concluded that “few, if any, fish consumption patterns optimize all domains”, but called for development of “comprehensive advice … to describe the multiple impacts of fish consumption” [ 292 ]. Several groups have disseminated such guidance [ 293 , 294 , 295 ].

Chemical Pollutants in the Oceans and the Global Burden of Disease

Despite extensive knowledge of the toxicology of many ocean pollutants, the contribution of chemical pollutants in the marine environment to the global burden of disease (GBD) is, with the exception of mercury [ 296 , 297 ], largely unknown. A major impediment to developing these estimates is that detailed, population-level studies of human exposures to ocean pollutants have not been conducted, although it is unarguable that fish and other seafood are a major source of human exposure. Moreover, POPs and other toxic chemicals that are found in terrestrial meat sources can in fact originate in the oceans, because fish meal, containing POPs, is often used in animal feeds [ 298 ].

Crude oil and petroleum products are complex mixtures of light and heavy hydrocarbons, toxic metals, and other chemicals. Polycyclic aromatic hydrocarbons (PAHs) are a particularly hazardous component. When oil spills and leaks release these toxic chemicals into the marine environment, they can bioaccumulate in the food web; kill fish, birds and marine mammals; destroy commercial fisheries, aquaculture operations, and shellfish beds; release toxic volatile toxic chemicals such as benzene to the atmosphere; and foul shorelines.

Oil spills range in magnitude and visibility from massive releases such as the Deepwater Horizon disaster in the Gulf of Mexico or the Amoco Cadiz Oil Spill off the coast of France down to chronic, slow leaks from pipelines and aging tankers. Petroleum in the marine environment can be either fresh or highly weathered, meaning that it has undergone a variety of chemical and photochemical processes that change its composition and toxicity.

Oil spills have occurred with increasing frequency in recent years as the result of growing global demand for petroleum. These spills have resulted in direct release of millions of tons of crude oil and other petroleum products into the oceans (Table ​ (Table1, 1 , Figure ​ Figure8 8 ).

Major Oil Spills, 1967–2010. From: World Ocean Review 3, maribus gGmbH, Hamburg 2015.

Source : Bücker et al. 2014 [ 314 ]. See also ITOPF 2019 [ 315 ].

Ecosystem effects of oil spills include disruption of food sources, destruction of fragile habitats such as estuaries and coral reefs, and fouling of beaches [ 300 ]. Marine and coastal wildlife, including birds and mammals, can be exposed to petroleum-based pollutants through ingestion, absorption, and inhalation. Ingestion of these materials can lead to digestive problems, ulcers, and bleeding; kidney and liver damage; reproductive failure; and anemia. Inhalation can lead to lung problems [ 301 ] that appear to persist long after initial exposures [ 302 ]. Effects on immune systems of fish predispose them to infections [ 303 ]. PAHs contained in oil spills have been shown to cause DNA damage in marine species and have been associated with hepatic, pulmonary and cardiac lesions in Arctic seals [ 304 , 305 , 306 , 307 ].

Human health and well-being also can be seriously affected by oil spills. Heaviest exposures and the most severe health consequences occur among occupationally exposed populations such as oil industry workers and workers involved in cleanup efforts. Cohort studies suggest that respiratory effects may persist for 2+ years post spill in some responders [ 308 ]. DNA damage has been documented in cleanup workers [ 309 , 310 ]. Community residents can be exposed through consumption of contaminated seafood and inhalation of volatile petrochemicals. Some studies have suggested little long-term health risk for consumption of fish or shellfish after the Deep Water Horizon spill. However, assessments of the possible health hazards of abundant alkylated PAHs have not been included in such studies [ 311 ].

In addition to their effects on physical health, major oil spills, like other disasters, can have serious impacts on mental health. Populations in areas with lower income are often at heightened vulnerability to such effects [ 312 ]. There is need for cohort studies on resilience to disasters as well as on chemical stressors [ 312 , 313 ].

Biological Contamination of the Oceans

Many toxin-producing algae, pathogenic bacteria, viruses, fungi, and protozoa are native to marine and estuarine environments. Other species can be introduced to the oceans as the result of human activity.

Marine Algae and Harmful Algal Blooms (HABs)

Algae, microscopic and macroscopic, are the foundation of the aquatic food web. They are the invaluable primary producers of fixed carbon, a vital nutrient that supports aquatic ecosystems, and of oxygen. Free-living planktonic algal species dominate the world’s oceans, and a small number of species account for the great majority of the global algal biomass. In coastal and estuarine systems, cyanobacteria, as well as dinoflagellates, diatoms, and cryptophytes emerge seasonally and are vital components of these ecosystems. Floating tropical beds of brown macroalgae (e.g., Sargassum ) serve as habitats and nurseries for many marine species. They also sequester CO 2 and thus mitigate global warming and ocean acidification [ 316 , 317 ].

Marine microalgae are of great importance to human health and well-being not only because they support the marine food web upon which all commercial fisheries depend, but also because they provide food for aquaculture, produce a range of pharmaceutical compounds [ 14 ], and are potentially a source of renewable biofuels [ 318 ].

On the negative side, some algal species are noxious [ 319 ] and produce powerful toxins have potential to cause great harm [ 320 ]. When high densities of these species accumulate in an area of the ocean, they can form harmful algal blooms (HABs) – described as “red tides”, “green tides”, or “brown tides”. In these blooms, the great masses of algae that have accumulated in an area of the sea exhaust inorganic nutrients in the water column allowing bacteria move in and decompose the senescing organic material. The consequences are reduced dissolved oxygen in the ocean, dead zones, fish kills, and a broad range of adverse ecological impacts [ 321 , 322 , 323 ] (Figure ​ (Figure9 9 ).

Frequency of Bottom-Water Hypoxia (‘Dead Zones’), Gulf of Mexico, 1985–2014.

Source : Rabalais et al., 2019, CC BY 4.0 [ 327 ].

HABs directly harm human health by producing toxins, potent natural compounds that can cause disease and death, most commonly through consumption of contaminated seafood [ 32 , 323 , 324 , 325 , 326 ].

Causes and Drivers of HAB Events

HABs are not a new phenomenon and some occur naturally. However, the frequency and magnitude of HAB events appears to be increasing [ 328 ]. These increases have been linked to three factors:

• Increasing pollution of the oceans, and especially of coastal waters by nitrogen and phosphorus which leads to eutrophication. Sources of nitrogen include agricultural runoff, septic tank leachate and effluent from municipal deep injection wells [ 329 , 330 , 331 ];
• Sea surface warming; and
• Ocean acidification.

Increases in frequency and severity of HAB events have been linked to increasing coastal pollution in the Seto Inland Sea of Japan in the mid-1970s [ 332 ] and in the northwestern Black Sea in the 1970s and 1980s [ 333 ]. Both of these situations have subsequently been remediated, and case studies describing these and other successful remediation efforts are presented in the section of this report on Successes in Prevention and Control of Ocean Pollution [ 334 ].

A current example of the effect of increasing coastal pollution on HAB frequency is seen at the mouth of the Changjiang River in China, where nitrate concentrations have increased four-fold in the past 40 years and phosphate concentrations have increased by 30%. The main drivers are increases in population size and agricultural production. Significant increases in algal biomass and a change in the composition of the phytoplankton community have resulted. The frequency of local HABs has increased dramatically [ 335 ].

Climate Change and HABs

Increases in the frequency and severity of HABs have been linked to changing weather patterns such as major warming events, increased runoff, and changes in ocean currents (Figure ​ (Figure10). 10 ). Examples include recent Alexandrium blooms in the northeastern United States [ 336 ] and massive blooms of Pseudonitzschia on the US west coast associated with a mesoscale warm-water anomaly termed “the blob” [ 337 ]. These events presage projected future climate scenarios [ 54 , 338 , 339 ].

Geographical Distribution of Paralytic Shellfish Poisoning (PSP) Events, 1970 and 2017.

Source : US National Office for HABs, Woods Hole, MA.

Sea surface warming leads to range extensions of HAB species and to the appearance of algal toxins in previously unaffected areas [ 53 , 55 , 340 , 341 , 342 , 342 ]. An example is seen in the recent, first ever detection of HAB toxins in Arctic waters [ 343 ]. The movement of harmful algae into the Arctic coupled with northern indigenous peoples’ lack of experience with HAB toxins put these populations at high risk of exposure and disease. This risk is compounded by lack of knowledge about uptake of HAB toxins by species such as whales, walruses, seals, and seabirds used by northern indigenous people as food sources.

Another example of climate-driven change in HAB range that has already occurred is poleward extension in the geographic ranges of the benthic dinoflagellates responsible for ciguatera poisoning into warm-temperate habitats, for example from the Caribbean Sea northward into the Gulf of Mexico [ 55 , 342 , 344 ]. This range extension appears to be associated with warming sea surface temperatures and higher storm frequencies, and destruction of coral reefs [ 345 , 346 , 347 , 348 , 349 ]. It is reflected in increased numbers of calls about ciguatera poisoning to poison control centers in the United States.

An impact on HAB biology that appears to reflect synergy between global climate change and ocean acidification is the observation that HAB toxins can become more potent at higher temperatures or under more acidic conditions [ 350 , 351 ]. This change may reflect temperature-induced shifts in the relative abundance of dinoflagellate species [ 340 , 352 , 353 ].

Pathways of Human Exposure to HAB Toxins

Consumption of fish and shellfish that have ingested toxic algae is a major route of human exposure to HAB toxins. Filter-feeding shellfish such as oysters and mussels pose an especially high risk because these species ingest toxic algae and then accumulate algal toxins to high concentrations that can cause acute disease and sudden death in shellfish eaters. The poisoning syndromes caused by HABs in shellfish include paralytic, neurotoxic, amnesic, diarrhetic, and other gastrointestinal poisoning [ 354 , 355 ]. Consumption of finfish and shellfish containing ciguatera toxin may also result in ciguatera poisoning.

Human exposure to HAB toxins can also occur through skin or respiratory contact via swimming or visiting beaches during algal blooms. People have reported skin rashes, respiratory irritation such as sneezing, and a burning or itching in the nose or throat while swimming, visiting, or working at the beach during Karenia brevis red tide events [ 356 , 357 ]. People with asthma appear to be at particular risk [ 358 ]. Karenia brevis blooms are associated additionally with increases in emergency room admissions for respiratory, gastrointestinal, and neurologic illnesses [ 359 , 360 , 361 ]. There is evidence that people experience adverse effects also during Sargassum blooms [ 362 ] and from exposures to algal-derived palytoxins [ 363 ].

Macroalgal blooms, can harm human health by causing massive accumulations of algae in bays and on beaches. When these piles of algae decompose, they can release foul-smelling and hazardous gases, including hydrogen sulfide, methyl mercaptans, and dimethyl sulfide [ 364 ]. Coastal populations exposed to decomposing algal mats have reported eye and respiratory tract irritation.

Syndromes Associated with HAB Toxins

HABs cause a variety of human diseases, some of them extremely serious ( Text Box 3 ). HAB-related illnesses are for the most part acute, and acute reference doses (ARfD) have been derived to protect the public against these acute exposure events (See Appendix Table 2 in the Supplementary Appendix). Little research has been done to evaluate chronic illness after either acute or chronic exposures to HAB toxins, and information on long-term health effects is still insufficient to allow determination of tolerable long-term daily intakes (EFSA opinions or FAO/WHO/IOC ad hoc expert consultation).

TEXT BOX 2: Chemical Pollution of the Oceans and Reduced Generation of Oxygen .

A novel mechanism by which petrochemical pollutants in the oceans may endanger human and ecosystem health is through reducing production of oxygen [ 197 ]. Beneficial marine microorganisms such as cyanobacteria of the genus Prochlorococcus are major producers of oxygen. Through photosynthesis, the billions of these organisms in the earth’s oceans remove CO 2 from the atmosphere and convert it to oxygen.

Recent experimental findings from the Atlantic, Pacific, and Indian Oceans have found that mixtures of POPs and aromatic hydrocarbons in seawater at concentrations only two times above usual background levels can reduce expression of photosynthetic genes in Prochlorococcus and thus impede oxygen generation [ 6 , 198 ]. The photosynthetic toxicity of pollutant mixtures exceeds that of single chemicals by as much as three orders of magnitude [ 5 ].

TEXT BOX 3: A Primer on Poisonings by HAB Toxins.

Consumption of contaminated seafood is the major route of human exposure to HAB toxins. Many thousands of poisoning episodes occur worldwide each year.

Paralytic Shellfish Poisoning (PSP) is caused by saxitoxins (STX), potent neurotoxins that act on voltage-gated sodium channels as well on other nervous system receptors [ 366 , 367 ]. PSP typically begins with tingling sensations or numbness of face, neck, fingers, and toes. These symptoms progress within 30 minutes to weakness, limb incoordination, and respiratory difficulty. In severe cases, respiratory paralysis, cardiovascular shock, and death may ensue. There is no antidote to PSP, and the only available treatment consists of artificial respiration by ventilator [ 368 , 369 ] and removal of non-absorbed toxins from the gut with activated charcoal. STX is listed as a Schedule 1 chemical intoxicant by the Organization for the Prohibition of Chemical Weapons (OPCW) [ 370 ]. The lethal oral dose is 1–4 mg [ 371 ].

Amnesic shellfish poisoning (ASP) is caused by domoic acid (DA) , a potent toxin produced by planktonic diatoms that targets glutamate receptors in the central nervous system [ 372 , 373 ]. After initial gastrointestinal symptoms, affected persons develop confusion, lethargy, disorientation, and short-term memory loss. Severe cases evolve to coma. Deaths have occurred [ 368 , 369 ]. A persistent toxicity syndrome has been defined consisting of episodic seizures and permanent loss of spatial memory [ 374 ].

Diarrhetic shellfish poisoning (DSP) is associated with exposures to okadaic acid and dinophysis toxins. The syndrome presents with diarrhea, nausea, vomiting and abdominal pain. Symptoms may be confused with infectious intestinal diseases. No lethal cases have been reported [ 368 , 369 ].

The azaspiracid group of HAB toxins also results in diarrhetic symptoms. Its mechanism of action is not yet known, but recent evidence suggests that mitochondrial dehydrogenase may be a major target of this toxin group [ 375 ].

The yessotoxins are a group of lipophilic HAB toxins. Although never associated with human illness, they are controlled in seafood based on an acute reference dose established through oral administration of yessotxins in toxicological studies in experimental animals.

Neurotoxic shellfish poisoning (NSP) is caused by brevetoxins (BTX), neurotoxins that target voltage-gated sodium channels and cause depolarization of neuronal, muscular and cardiac cells [ 376 ]. NSP produces a mixture of gastrointestinal and neurologic symptoms – nausea, vomiting, diarrhea, and abdominal cramps as well as paresthesia, paralysis, convulsions, and coma [ 377 ]. Symptoms begin within 30 minutes to three hours following consumption of contaminated seafood.

Ciguatera Fish Poisoning (CFP) is caused by consumption of fish and shellfish that have accumulated ciguatoxins (CTX) in their tissues [ 378 , 379 , 380 ]. CTXs are neurotoxins that target voltage-gated sodium channels. They are produced by benthic dinoflagellate plankton of the genera Gambierdiscus and Fukuyoa that live on coral surfaces and also by bottom-dwelling algae.

CFP is associated with higher sea surface temperatures and the El Nino Southern Oscillation. In the United States, the number of CFP-related calls to poison control centers appears to correlate with warmer sea surface temperatures and higher storm frequencies.

CFP is estimated to affect 50,000 to 200,000 people per year. It is the most commonly reported of the HAB-associated illnesses globally. It an important health problem in the Caribbean and Pacific regions and more recently has been reported in the Mediterranean.

Symptoms of CFP include gastrointestinal distress that may occur before or simultaneously with peripheral neurological symptoms, neuropsychiatric, and cardiovascular symptoms [ 381 ]. Symptoms generally appear within 12 hours after eating contaminated seafood [ 382 , 383 ]. Although rarely fatal, CFP symptoms have been reported to persist in about 20% of cases, lasting days, months or even years, with worsening symptoms of anxiety or depression [ 381 , 384 ].

Clupeotoxism is a form of HAB-related human poisoning caused by consumption of contaminated fish and crustaceans contaminated by palytoxin (PTX) [ 385 ]. Exposure can also occur through handling zoanthid corals in either private homes or aquarium shops [ 386 ]. Symptoms include gastrointestinal, neurological, and cardiovascular symptoms, as well as weakness, cough, and muscle pain.

Children may be more likely than adults to be affected by HAB toxins due to a combination of greater exposure, riskier behaviors, and sensitive developmental stage. Children also consume more food per unit body weight than do adults and thus may receive higher relative doses [ 365 ].

Prevention of HABs

The frequency and severity of some HAB events can be controlled by reducing releases of nitrogen, phosphorus, animal wastes, and human sewage into coastal waters. (See Text Boxes 9–13 ). Additional actions that can be taken to mitigate HABs are the following:

• Increase freshwater flows and tidal exchanges in coastal waters to increase flushing, prevent stagnation, and enhance the composition of coastal phytoplankton communities. In some instances, this will require modifying built structures such as breakwaters, jetties, and dams that impede flow of fresh and salt water [ 387 ] (See Text Box 4 ).
• Restrict activities that might result in the accidental transfer of harmful algal species into environments where they do not naturally occur (e.g., ballast water discharge) [ 388 , 389 ].

TEXT BOX 4: Reduced Water Flow and Increased Frequency of HABs.

An example of an area where changes in freshwater flow may be affecting HAB incidence is in the Bohai Sea of China. The Bohai is one of several regions in China where the number of HABs has increased in recent years. Due to droughts and water diversions for drinking water and agriculture, several of the rivers that used to flow freely into the Bohai are now dry for many days every year. This reduces the dilution of pollution loads in nearshore waters and also reduces stratification.

Dams are another factor that can increase frequency of HABs by altering fresh water flow into the ocean. Dams decrease turbidity and the availability of silicate to downstream waters due to sediment trapping within impounded waters. A decrease in the amount of silicate reaching coastal waters, concurrent with increases in water transparency can lead to shifts in the nutrient ratios that regulate phytoplankton community composition [ 390 ]. An increase in HAB frequency has been observed downstream of the massive Three Gorges Dam in China, and this increase is linked to a decrease in sedimentation and turbidity [ 391 ].

Prevention of HAB Poisoning

Routine monitoring for HAB toxins in shellfish is key to the prevention of human illness caused by these toxins. Monitoring programs are typically embedded within comprehensive shellfish safety programs. Details are presented in the Monitoring of Ocean Pollution section of this report.

Another strategy for mitigating the impact of HAB toxins on human health is to process harvested shellfish in such a way as to reduce toxicity to an acceptable level. An example is the removal of scallop viscera and marketing of only the adductor muscle, which generally contains little or no HAB toxins [ 389 ].

Economic and Social Consequences of HAB Poisoning

HABs have multiple negative economic and social effects. In the US, it is conservatively estimated that the average annual cost of marine HABs is USD $95million [ 392 ]. Health impacts are responsible for the largest component of these economic loses [ 331 ]. Economic losses attributable to HABs are estimated to $850 million (USD) annually in Europe and over $1 billion (USD) in Asia [ 392 ]. The costs of individual catastrophic HAB events can be overwhelming. Mexico, for example, spent $17 million in 2018 to remove 500,000 tons of Sargassum from its Caribbean beaches and declared a state of emergency. Another large HAB resulted in the largest fish farm mortality ever recorded and a loss of USD $800 million [ 339 ]. Increased frequency of respiratory ailments, aerosolized toxins, noxious gas, dead fish, proliferation of biting sand fleas from decaying piles of macroalgae, and discolored waters drive tourists away from beaches, change recreational habits, and thus reduce income from tourism in coastal communities [ 393 , 394 , 395 , 396 ].

Ocean Bacteria, Viruses, and Protozoa

Bacteria are abundant in the oceans. Every cubic centimeter of seawater contains, on average, one million microbial cells and the global ocean harbor an estimated 4–6 × 10 30 microbial cells [ 397 ]. Although the majority of bacteria in the oceans are harmless to humans, some are pathogenic. Naturally occurring marine pathogens of great significance for human health include Vibrio cholerae, Vibrio vulnificus, Vibrio parahaemolyticus , and Mycobacterium marinum .

With climate change, sea surface warming, and worsening marine pollution, the geographic ranges of naturally occurring marine pathogens as well as of microorganisms introduced to the oceans from land-based sources are expanding. Harmful bacteria are moving into estuaries, bays, and regions of the oceans they did not previously inhabit and moving poleward into cold, previously uncontaminated waters [ 22 ].

Microbial infections are contributing to degradation of fragile marine environments such as coral reefs [ 398 , 399 ]. They contribute to shellfish mortality in both wild and farmed areas, thereby affecting economies [ 400 , 401 ]. Widening geographic ranges of human diseases caused by marine microorganisms and the appearance of disease in previously unaffected populations are additional consequences [ 402 ].

Marine Vibrio Species and Human Disease

Marine bacteria of the genus Vibrio are particularly important causes of disease and death [ 403 ]. Vibrio cholerae , the causative agent of cholera, is the species of greatest concern. Vibrio species exhibit strong seasonality, and warmer water temperatures result in increased concentrations in estuarine and coastal waters [ 50 , 51 , 404 , 405 , 406 , 407 , 408 ]. Further warming of coastal waters caused by climate change is likely to further increase abundance of Vibrio bacteria and expand their geographic range [ 409 ]. These changes will likely result in increased frequency of Vibrio infections in coming decades and possibly to appearance of Vibrio infections in previously unaffected areas [ 52 ]. There is some indication that after extreme weather events such as hurricanes, droughts, and tropical storms shifts occur in the composition of Vibrio species and that these shifts are driven by discharges of sewage and inorganic nutrients into coastal waters [ 410 ].

Vibrio parahaemolyticus and Vibrio vulnificus are two additional Vibrio species that pose grave risks to human health [ 412 , 413 ]. These organisms are now appearing for the first time in previously cold waters at northern latitudes with major peaks occurring during warm summers (Figure ​ (Figure11) 11 ) [ 411 ]. This trend is particularly well documented for the Baltic Sea, where the annual incidence of Vibrio infections is reported to almost double for every one-degree increase in sea surface temperature (Figure ​ (Figure12) 12 ) [ 402 , 414 ]. Similar trends have been reported in the United States where incidence of infections by Vibrio species has increased by 115% in the past decade, especially along the Gulf, Northeast, and Pacific Northwest coasts [ 50 , 414 , 415 ].

Trends in conditions favorable to Vibrio outbreaks in selected world regions [ 411 ].

Source : Reprinted from Watts et al. The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come. Lancet 392: 2479–2514, 2018, with permission from Elsevier.

Sea surface temperature and relative risk of clinically notified cases of Vibrio infection, Sweden, 2006–2014 [ 416 ].

Source : Semenza et al. (2017), https://doi.org/10.1289/EHP2198 .

Vibrio vulnificus can enter the human body either through ingestion of contaminated seafood or through open wounds [ 417 ]. When V. vulnificus , known colloquially as ‘flesh-eating bacteria’, enters an open wound it can cause severe infections such as necrotizing fasciitis ( Text Box 5 ).

TEXT BOX 5: Case Studies of Vibrio Wound Infection.

Vibrio wound infections are generally rare, even though the bacteria are quite common in brackish, mesohaline estuarine systems [ 424 ]. Unfortunately, these infections can be very severe resulting in some cases in amputation of infected limbs and loss of life. The great majority occur in males, especially in men over 40 years of age, presumably reflecting occupational and recreational activities [ 425 , 426 ].

Case study . In 2011, a report was presented of three elderly men in New Caledonia who developed severe gastrointestinal illness after consumption of raw oysters during a period of particularly heavy rainfall, and regional flooding. V. vulnificus was confirmed as the causative agent through PCR amplification of the hemolysin gene.

Case study . In 2005, 18 cases of confirmed wound infections with V. vulnificus and V. parahaemolyticus were observed following Hurricane Katrina. Five of the patients died [ 427 ].

Case study . Next-generation sequencing (NGS) was used to diagnose V. vulnificus infection in a 55-year old man who was admitted to a hospital in Wenzhou, China hospital with severe wound infection. The man had been selecting fish at the market at 6:00 AM and developed a skin infection on his hand. The infection progressed rapidly, and the patient was admitted to hospital 11 hours later. Even though blister fluids, and wound and blood samples returned negative results by bacterial culture, tissue analyses using NGS were able to confirm Vibrio infection and guide treatment. After two weeks of hospitalization, the man was released.

These cases and other published literature on the emergence of pathogenic forms of Vibrio following flooding and tropical events indicate the need for improved warning systems in anticipation of the increased frequency of extreme weather events that is expected to accompany climate change [ 428 , 429 , 430 ].

Ingestion of shellfish contaminated by V. vulnificus , especially oysters, causes more than 90% of cases of V. vulnificus gastroenteritis [ 418 , 419 ]. This reflects the fact that filter-feeding shellfish such as oysters, clams, and mussels can concentrate Vibrio by several orders of magnitude over concentrations in seawater [ 412 , 418 ].

Vibrio vulnificus gastroenteritis can progress very rapidly to septicemia – sometimes within 24 hours after ingestion of contaminated seafood [ 418 , 420 ]. Even with aggressive medical treatment, the case-fatality ratio for Vibrio vulnificus septicemia is greater than 50%. Vibrio vulnificus thus has the unlovely distinction of having the highest case-fatality ratio of any foodborne pathogen [ 418 , 420 ]. It is the cause of 95% of seafood-borne deaths in the USA [ 420 ].

Recent data suggest that rising sea surface temperature may expand not only the temporal and spatial distribution of Vibrio species, but also increase the virulence and antimicrobial resistance of some Vibrio strains [ 421 , 422 , 423 ].

Salinity is another factor that affects the abundance of Vibrio species in marine environments. Typically, V. vulnificus and V. parahaemolyticus are not prevalent in waters where salinity exceeds 25 parts per thousand. Recent anecdotal reports from the UK, EU, and Brazil indicate, however, that shifts in the composition of Vibrio communities in estuarine systems and increases in Vibrio infections are now being recorded in waters where salinity is greater than 30 parts per thousand [ 431 ], possibly reflecting an interaction between salinity and sea surface warming. A decade-long study of Vibrio conducted in the Neuse River Estuary in North Carolina, USA, has shown the temperature is not increasing in that system, and that temperature increase cannot therefore explain the significant increase observed in Vibrio concentrations (Figure ​ (Figure13) 13 ) [ 424 ].

Seasonal abundance of Vibrio species, Neuse River Estuary, NC, USA, 2003–2017. (Autoregressive integrated moving average of mean monthly abundance at a mid-water station). Dots are actual measurements. Red line represents model abundance. Blue lines are 95% confidence intervals.

Source : Froelich et al. (2019), https://doi.org/10.1371/journal.pone.0215254 , Creative Commons, license CC BY 4.0.

In some major river basins (i.e., the Amazon, the Ganges, the Brahmaputra, and the Congo), increased incidence of Vibrio infection is reported to coincide with high sea surface temperatures and high discharge events, events that typically are associated with abnormal phytoplankton growth [ 432 ]. In other marine coastal areas, the global abundance of Vibrio has been shown to correlate with chlorophyll, acidity, maximum sea surface temperature, and salinity [ 50 ].

Allochthonous Bacterial Pathogens in Marine Environments

Allochthonous bacteria are microorganisms not native to marine environments that are introduced into coastal waters from land-based sources. Allochthonous pathogens of greatest concern include virulent Enterococcus species, Escherichia coli serotypes (e.g., O157:H7), Campylobacter species, Clostridium species, Shigella species, and Salmonella species [ 433 ].

Pathogenic bacteria can enter coastal waters through sewage effluent, agriculture and storm water runoff and wastewater discharges from ships [ 434 ]. Rivers, especially those near major population centers, are an important source [ 434 ]. Through horizontal gene transfer, allochthonous bacteria can introduce harmful new genetic traits into indigenous marine microorganisms thus increasing their virulence and their capacity for anti-microbial resistance [ 435 ].

Climate change is accelerating the introduction, dispersion, and growth of allochthonous bacteria in coastal waters. For example, rising sea surface temperatures have been shown to increase the abundance of Salmonella species in Hawaiian coastal streams [ 436 ]. Warming may also increase the variability of salinity gradients along coastlines [ 437 ] thus affecting the growth and persistence of fecal-oral pathogens and increasing risk for major outbreaks of diarrheal disease [ 438 ].

Fecal-derived bacteria in marine environments tend to bind to particle surfaces (sediment, sand, plastics) where they form biofilms that enhance their survival. In estuarine environments, for example, the concentration of fecal bacteria is generally one or more orders of magnitude higher in surface sediments (per 100 g dry weight) than in the water column (100 ml). The survival of fecal bacteria in the oceans is thus positively linked to concentrations of pollutants and other suspended matter in the water column [ 439 , 440 , 441 ].

Human Diseases Caused by Allochthonous Bacterial Pathogens

Bacterial pathogens in the marine environment are responsible for a wide range of acute and chronic diseases. These include diarrhea and gastroenteritis, ocular and respiratory infections, hepatitis, and wound infection. Transmission of disease occurs mainly through ingestion of contaminated water and consumption of contaminated seafood [ 433 ].

From 1973 to 2006, 188 outbreaks of seafood-associated infections causing 4,020 illnesses were reported to the Foodborne Disease Outbreak Surveillance System in the United States [ 442 ]. Most of these outbreaks were due to bacterial agents (76.1%), a significant proportion of them linked to pathogens with a human reservoir such as Salmonella and Shigella [ 443 , 444 ] (Table ​ (Table2 2 ).

Optimal Temperature and Salinity Fecal-Oral Pathogens in Sea-Water [ 445 ].

Antimicrobial Resistance in Coastal and Ocean Environments

Antimicrobial resistance (AMR) is likely to have been present for millions or billions of years in marine microbial communities as the result of resistance mechanisms that bacteria have evolved in response to naturally occurring threats [ 446 ].

More recently, however, the prevalence of AMR has been increasing in marine environments, especially in coastal waters. These increases appear to reflect increasing introductions from land-based sources of allochthonous bacteria that carry resistance genes that can be passed to marine bacteria through horizontal gene transfer [ 16 , 447 ]. Such exchanges may account for the acquisition of AMR by indigenous pathogens such as Vibrio .

The development of confined animal feeding operations (CAFOs) to enhance livestock production and increase the profits in the poultry, beef, and swine industries have further promoted the development of AMR bacteria. These facilities are associated with poor waste treatment practices, and the vast quantities of effluent they release into waterways and directly into the ocean are associated with increased genetic encounters across “promiscuous” bacterial species able to transfer resistance genes horizontally.

An increasing body of evidence documents that significant human exposure to AMR bacteria can occur in coastal environments. A study in the UK reports that an estimated 6 million exposures occur per year to cefotaxime-resistant E. coli [ 448 ]. Another study found an increased probability of gut colonization by cefotaxime-resistant E. coli , a known risk factor for infection, in persons such as swimmers and surfers heavily exposed to contaminated recreational waters [ 449 ]. Recent studies of near-bottom waters from the Polish coastal zone reported multiple antibiotics at ng/L concentrations, with enrofloxacin reported at >200 ng/L [ 450 , 451 ].

Marine Viral Pathogens and Human Health

Viruses in coastal and estuarine systems that pose serious threats to human health include the Picornaviridae (enteroviruses, e.g., poliovirus, coxsackievirus, and echovirus), Adenoviridae (adenovirus), Astroviridae (astrovirus), Reoviridae (reovirus, rotavirus) and most significantly the Caliciviridae , a genus that includes norovirus and calicivirus [ 452 ]. Norovirus infections represented 21% of enteric virus infections reported from recreational water exposures across the USA from 2000–2014 [ 453 ]. Noroviruses enter coastal waters through stormwater, flooding, illicit boat discharges, and sewage system leaks and spills (E.g., Text Box 6 ).

TEXT BOX 6: Case Studies of Gastrointestinal Illness among Swimmers and Surfers Caused by Viruses in Polluted Marine Environments.

A recent study of gastrointestinal infections among surfers on the beaches near San Diego, California, USA, found that during rainy weather there was increased abundance of norovirus contamination in storm water runoff along the beaches [ 454 ]. Rates of gastrointestinal illness were increased among surfers during these periods of high contamination [ 455 ].

Other studies of gastrointestinal illness among swimmers during periods of heavy storm water discharge to coastal environments have found strong relationships between disease incidence and proximity to storm water pipes [ 36 , 37 ].

Dramatic improvements have been made in the past decade in diagnostic technologies for direct quantification of viral pathogens in marine environmental samples. These include new molecular approaches such as digital droplet PCR [ 454 ].

Marine Parasites and Human Health

Parasitic infections associated of marine origin are increasing in number and geographic range in response to climate change [ 456 ]. Cryptosporidiosis, giardiasis, and salt water schistosomiasis are the most common of these infections [ 453 , 457 , 458 , 459 ].

Two emerging human parasitic diseases of particular concern in the ocean environment are Anisakiasis (a zoonosis caused by the fish parasitic nematode, Anisakis ) and Diphyllobothriasis (caused by the adult tapeworm, Diphyllobothrium nihonkaiense ) [ 460 ]:

• Thousands of cases of anisakiasis have been reported, primarily from Japan but also from Europe and other parts of the world since the first case was reported in the 1960 [ 461 , 462 ]. An extensive survey carried out in the European anchovy Engraulis encrasicolus showed that rates of infection are as high as 70% among anchovy taken from fishing grounds in the Mediterranean Sea [ 463 ]. Spain is currently considered to have the highest incidence of anisakiasis in Europe [ 464 ].
• Diphyllobothriasis is associated with the consumption of raw Pacific salmon and is the most frequently occurring foodborne parasitic infection in Japan. Diphyllobothrium nihonkaiense , the causative agent, can grow to lengths of up to 10 meters in the human digestive tract and lay millions of eggs that are excreted in feces [ 460 ].

Impacts of Ocean Pollution on Fish Stocks and Fisheries

Increasing pollution of the oceans, climate change and ocean acidification can cause changes in the marine food web and these changes can influence the abundance and geographic distribution of commercially significant fish species that are important human food sources. Species that are intolerant of pollution will decrease in number under the pressure of pollution and climate change, while more pollution-tolerant species will increase ( Text Boxes 7 and 8 ).

TEXT BOX 7: Climate-related collapse of a South African prawn fishery.

A modelling study conducted off the coast of eastern South Africa showed that compromised production of penaeid prawns in the St Lucia estuary, an important nursery area, and eventual collapse of this shallow water fishery was associated with prolonged closure of an inlet [ 479 ].

The problem was that prolonged closure of an inlet to the estuary hindered the movement of post-larval shrimp into the nursery area and also blocked movement of juveniles out of the estuary to the trawling ground. Through feedback loops within the food web, these changes had knock-on effects on other commercially exploited species in the same fishing grounds, even on species that did not directly depend on estuaries, lowering their biomass and potential for commercial exploitation [ 480 ].

Source : CF MacKay, Oceanographic Research Institute, Durban, South Africa.

This case study illustrates that food security for humans can depend on the indirect effects of pollution and climate change that extend over several ecosystem types and are influenced by the geographical distribution of species across their life stages. In countries where subsistence fishers are reliant on fishing in estuaries, the effects on human food security can be devastating.

TEXT BOX 8: Marine Viruses and Declines in Salmon Populations. Interaction with Pollution?

The last three decades have seen large declines in salmon populations in both the Atlantic and Pacific Oceans. Recent studies investigating these declines using in situ hybridization, epidemiological surveys, and sequencing technologies have led to discovery of multiple new viruses. These viruses have been associated with disease among both wild and farmed salmon from different populations [ 495 ].

In these studies, fish were screened against a viral disease detection biomarker panel (VDD) that elucidates a conserved transcriptional pattern indicative of immune response to active RNA viral infection. Individual fish that were strongly VDD positive, but negative for any known salmon virus were subject to metatranscriptomic sequencing. This sequencing revealed viral transcripts belonging to members of the Arenaviridae (Salmon pescarenavirus: SPAV-1and 2), the Reoviridae (Chinook aquareovirus: CAV), and the Nidovirales (Pacific salmon nidovirus: PsNV), three divergent groups of highly pathogenic RNA viruses.

The distributions of the three viruses were markedly different:

• Both SPAV-1 and 2 were relatively widespread along the coast of southwestern British Columbia in ocean-caught Chinook and Sockeye salmon.
• CAV was not detected in any juvenile wild or hatchery Chinook salmon, but was detected in farmed fish on both the west and east coast of Vancouver Island.
• PsNV distribution was strongly associated with salmon-enhancement hatcheries, but was also detected in 18% of aquaculture Chinook and 3% wild Chinook. In hatchery fish, infection by PsNV was primarily localized to gill tissue, a pattern reminiscent of the respiratory disease caused by the related mammalian coronaviruses, such as MERS, SARS or COVID-19.

An unresolved question is whether spread of these viruses to salmon or severity of disease is enhanced by marine pollution.

A principal mechanism through which pollution alters the marine food web and affects fisheries is by causing changes in the abundance and composition of microalgae and other species that are the foundation of the marine food web [ 155 , 298 , 465 , 466 ]. Pollution that enters coastal waters through agricultural runoff and sewage discharges is typically rich in nutrients – nitrogen, phosphorus, and organic chemicals. Increased abundance of these materials results in proliferation of some, but not all species of microalgae. If the proliferating species are not the preferred food source of species above them, the composition of the entire food web can be altered and follow-on adjustments in the relative abundances of grazers and predators can ripple through multiple trophic levels [ 467 ]. If the end result is decreased species diversity, and the productivity of the few pollution-tolerant species that remain can seldom sustain food web, sharp reductions in catches of commercially important fish and food shortages can result.

Estuaries are highly sensitive to marine pollution. Estuaries are also vital nurseries for many commercially important fish species. In South Africa, for instance, 60% of exploited fish species inhabit estuaries as juveniles, and small invertebrates, which are abundant in estuaries, are the juveniles’ main food stock there [ 468 ]. The small invertebrates that populate estuaries are well able to cope with changing conditions of salinity and temperature caused by riverine and marine tidal influences [ 469 ]. However, these organisms can be highly susceptible to pollution, and coastal pollution can reduce invertebrate abundance and remove intolerant species entirely [ 470 , 471 ]. In these circumstances, the food security of the juveniles becomes precarious, and stocks of key fish species can decline. These estuarine effects are particularly important when pollution is widespread.

Short-term, high-impact pollution events can also result in food web alterations and reductions in seafood productivity. The most famous of these events in recent times have been the Deep Water Horizon oil spill in the Gulf of Mexico, and the Fukushima nuclear power plant accident in Japan. Both direct effects to individual species and indirect effects on the food web were apparent in these two events [ 472 ].

Climate change can also affect the health of estuaries and fish stocks. It can exert synergistic effects on marine ecosystems in concert with pollution. Climate change causes changes in rainfall that, in turn, alter runoff to estuaries and nearshore environments. In nutrient-poor areas, nutrients delivered from the land to the oceans via rivers are very important to sustain local food webs and fish production [ 473 , 474 ]. With changes in the global climate, estuaries in arid and semi-arid regions may receive less freshwater runoff, or receive large rainfalls over fewer days or in the wrong season. All of these changes compromise the nursery function of estuaries. These changes can result in increased or decreased salinity, more frequent or less frequent flooding, changes in energy supplies, frequent closures of inlets that hinder migration of marine species in and out of estuaries, and changes in the timing of inlet closure and opening such that they no longer synchronize with fish life stages [ 475 , 476 , 477 , 478 ].

Coastal marine ecosystems in and near cities, especially near rapidly growing megacities in developing countries and those with emerging economies are constantly exposed to pollution and other environmental stressors of human origin [ 481 , 482 ]. Losses and changes of habitat, increasing light and noise levels, and industrial chemical discharges impact fish populations in these areas, modifying their behavior and ultimately reducing the amounts of fish available to feed humans [ 483 , 484 ]. Dredging and coastal pollution increase turbidity, change the light regime in the water column, impact primary production, and affect migration and predator-prey interactions [ 481 ]. Increased foraging activity in artificially lit areas increases predation pressure on one trophic level, and in turn releases predation pressure on the next trophic level [ 485 ]. Noise pollution may affect fish and marine mammal communication, as well as the behavior of invertebrates. Artificial hard structures change habitat that might originally have been comprised of soft sediment. Such changes in habitat provide opportunities for invasive species [ 481 , 481 ]. All such modifications, especially when they are of large scale, cause changes in the food web, resulting in changed productivity patterns that alter ecosystem services to humans. Although human modifications can occasionally enhance habitat and increase fishery production (e.g., around artificial reefs), the negative impacts of human activity far outweigh their positive benefits on a global scale [ 481 ].

Reduced content of dissolved oxygen in seawater – ocean hypoxia – is another consequence of pollution and climate change that has negative impacts on fish stocks [ 486 , 487 ]. Ocean hypoxia is the result of terrestrial runoff that introduces nutrients to the seas, increases frequency of HABs, and leads to eutrophication and the formation of dead zones. Vast releases of organic matter from industry and waste water systems further compound these effects. Hypoxic areas and dead zones are increasing in seas across the globe [ 488 ]. Additional contributory factors are sea surface warming, which reduces oxygen solubility in the oceans and changes stratification patterns that, in turn, may reduce ocean mixing and prevent re-oxygenation [ 489 ]. All of these effects are most pronounced in coastal and continental shelf areas of the oceans – the regions of the seas that produce 90% of commercially exploited fish species [ 490 ].

Ocean acidification, a direct consequence of increasing concentrations of atmospheric CO 2 , is another environmental factor of human origin that can affect fish stocks. By inhibiting the growth of calcified primary producers (calcified phytoplankton such as coccolithophores or foraminifera) or zooplankton (krill, pteropods) at the base of the food web, ocean acidification may alter the food chain production [ 491 , 492 , 493 ].

In addition to decreasing seafood production, ocean acidification may also alter seafood quality. Researchers asked 30 volunteer testers to assess the gustatory quality (appearance, texture, and taste) of shrimp raised at different pH levels [ 494 ]. The test was conducted under the supervision of a chef. Decreased pH significantly reduced appearance and taste scores. Thus shrimp maintained at a pH of 8.0 had a 3.4 times higher likelihood of being scored as the best shrimp on the plate, whereas shrimp maintained at a pH of 7.5 had a 2.6 times higher likelihood of being scored as the least desirable shrimp on the plate, a result that may have socio-economic implications.

Increased bioaccumulation of pollutants in the food web will be a further impact of pollution, ocean acidification, and climate change on fisheries. Concentrations of PCB and MeHg in top predators such as killer whales are projected to increase by 3% to 8% by 2100 under a high-carbon-emission scenario compared to a control scenario [ 496 ]. MeHg accumulation is particularly sensitive to variations in emission scenarios with a trophic amplification factor generally ten times higher than for PCBs.

Most of the world’s fish stocks are already either fully or over-exploited [ 497 ]. Pollution, ocean warming and ocean acidification add to these pressures. The warming of the marine environment during the last two decades has reduced the productivity of marine fisheries worldwide and contributed to a 4.1% decrease of maximum sustainable yield of several fish populations, with some regions showing losses of as much as 15 to 35% [ 498 ] (Figure ​ (Figure14). 14 ). Almost 90% of the large predator fish species have been removed from all seas around the globe leading to the collapse of certain species, such as Newfoundland Cod [ 499 ]. Increasing global demand for fish as a food source has driven rapid increase of aquaculture, which has resulted in high demands on capture of large wild fish used for feeding of farmed fish [ 500 ].

Global changes in maximum fish catch potential.

Source : IPCC.

Reductions in fish stocks have direct impacts on human health by jeopardizing food security in coastal communities in low-resource countries [ 501 ]. Declines in fish catches deprive people of protein, as fish is a highly important source for nearly 20–30% of the human population [ 502 ]. Reduced fish consumption results not only in protein malnutrition, but also in reduced consumption of essential micronutrients, including Vitamin A, iron, Vitamin B12, and omega-3 fatty acids among vulnerable populations [ 502 ]. These impacts fall most heavily on poor countries [ 503 ], but negative impacts are seen also in areas of economically developed nations where shellfish make up a substantial part of the commercial and traditional subsistence fisheries such as Alaska, USA [ 504 ].

Continuing reductions in fish stocks and in the productivity of the oceans may be anticipated in future years due to the combined effects of pollution, sea surface warming, ocean acidification, and other wide-scale ecological impacts. Poleward migration of many commercially important marine species towards higher latitudes is occurring already and will increase further. Ocean acidification and pollution will damage tropical and subtropical coral reefs thus reducing the abundance of reef fish species [ 502 ].

Additional effects on fish stocks could be mediated through changes in major ocean currents. Thus, there is growing concern that climate change could disrupt the highly productive Eastern Boundary Upwelling Systems, such as the Humboldt and Benguela currents in the South Atlantic Ocean that rely on the upwelling of nutrient-rich water to stimulate productivity and produce large fish yields. These changes could jeopardize the security of coastal fishing communities that depend on them for their food and their livelihoods [ 505 ]. These grave dangers justify the proactive policy of designating Marine Protected Areas in critical areas of the seas.

Impacts of Ocean Pollution on Vulnerable Human Populations

Ocean pollution, like all forms of pollution, has disproportionately severe health impacts in low-income and middle-income countries [ 24 ]. It especially affects coastal communities in low-income countries that are dependent on the oceans for their food and livelihood. The effects of pollution and climate change fall especially heavily on these populations because they do not have the resources or the infrastructure to buffer diminished ecosystem services. Thus they are highly vulnerable to the increasingly frequent HAB events and HAB toxin exposures that are the consequences of worsening coastal pollution. Poignant examples are seen in small island nations [ 17 ] and in the countries of the Western Indian Ocean region – Comoros, Mauritius, Mozambique, and Somalia [ 506 ].

Indigenous peoples are another group highly vulnerable to ocean pollution and its health effects. Their heightened vulnerability to ocean pollution reflects the fact that these groups consume up to 15 times more seafood per year as non-indigenous peoples [ 20 , 507 ]. They are also at high risk of exposure to plastic particles, methyl mercury, POPS, and manufactured chemicals that concentrate in marine species.

Populations in the circumpolar regions – indigenous peoples as well as non-indigenous populations such as the people of the Faroe Islands [ 66 ] – are yet another group placed at high risk by worsening ocean pollution. The increasingly heavy atmospheric deposition in northern waters of mercury, PCBs, and other POPs transported poleward on the winds from distant population centers has led to accumulations of hazardous chemicals in the tissues of the predator fish species and marine mammals that are major components of these populations’ diets. This, in turn, has led to increasing toxicity – toxicity that has been well documented through epidemiologic studies [ 67 , 68 , 508 , 509 , 510 ].

Dietary Change. As seafood becomes increasingly scarce and more contaminated by chemical pollutants [ 66 ] and HAB toxins [ 343 ], people in low-income countries, indigenous areas, and the circumpolar regions are forced to turn away from their traditional fish-based diets and to eat more meat and poultry. This dietary change places them at risk of all the health consequences of the “Western” diet – obesity, type 2 diabetes, cardiovascular disease, and cancer. This trend is evident in Alaska native populations and appears to have contributed to the deteriorating health status of these groups [ 511 ].

In high-income countries, consumers’ perception of the safety of seafood has led to a reduction in demand for shellfish, and this change has had severe economic consequences for the shellfish industry [ 512 ]. The lack of diagnostic tools and treatment options for HAB-related illnesses leads to increased psychological stress in fishing communities [ 513 , 514 ].

Ocean Pollution as a Risk factor for Migration. Migration is another consequence of ocean pollution, climate change and declining fish stocks. Study of environmentally induced migration has grown in recent years [ 515 ]. Of particular importance has been emergence of the concept of “environmental refugees” [ 516 ], people who have been forced to leave their homes because of pressures created directly or indirectly by anthropogenic environmental, ecological and climate change [ 517 ]. Migration and conflict are now considered key mechanisms through which climate change and other environmental stressors increase frequency of migration and thus create environmental refugees [ 517 , 518 , 519 , 520 ].

The 2015 Rockefeller- Lancet Commission on Planetary Health has identified migration as a major concern for human health and development and a priority area of research [ 2 ]. Ocean pollution and other ecosystem changes are already triggering environmental migration and will continue to do so over the coming decades [ 497 , 521 , 522 ].

While global ecological trends and climate change impacts have been a priority of the research community, complex implications at local scales are less well understood. Climate-induced triggers for migration include sea level rise, salinization of fresh water supplies, changing patterns of flooding and draughts, pest and alien species invasion, changing weather patterns, and ocean acidification [ 523 ]. These drivers can act concurrently and produce synergistic effects on human health and well-being. In combination with pollution, changes in land use, loss of biodiversity, mismanagement of resources, and collapse of the fisheries on which coastal populations rely for food and economic security [ 2 , 524 , 525 ], are multiple drivers that lead to vulnerability, threatened livelihoods, culture and political instability, and social injustice [ 523 ]. They reduce food and water security and increase risk of starvation [ 8 , 526 , 527 ]. These factors lead also to loss of property, shelter and human life [ 504 , 528 , 529 , 503 , 530 ].

The Critical Importance of Ocean Monitoring

Robust monitoring of ocean pollution is important for protecting human health and safeguarding marine ecosystems. Need for monitoring will become increasingly great as the global climate continues to change, seas continue to warm, extreme weather events become more frequent, and human impacts on coastal, estuarine, and deep-ocean environments continue to grow.

Monitoring provides information on background levels of pollution, tracks trends, maps geographical variation, identifies ‘hot spots’, provides early warning of impending crises, guides interventions against pollution, and evaluates the effectiveness of interventions. Monitoring of chemical and physical processes in the oceans is essential to tracking sea surface warming, ocean acidification, and the consequences of these phenomena on marine ecosystems, including their impacts on the frequency of HABs and the spread of marine pathogens.

The great importance of ocean monitoring in guiding the protection of human and ecosystem health was recognized in a seminal 2002 report that recommended establishing programs to monitor ocean pollution [ 531 ]. That report called for the establishment of multidisciplinary research programs to address the intersection between ocean and human health. Such programs have now been established in the United States and Europe. They provide an essential complement to ocean monitoring.

The Health of the Oceans (HOTO) Module of the Global Ocean Observing Systems (GOOS) is a key international initiative in ocean monitoring [ 532 ]. HOTO employs a range of sampling strategies across a variety of temporal and spatial scales using agreed standards and methodologies to track the effects of anthropogenic activities, ocean pollution in particular, on human health and marine resources. HOTO and other global and regional ocean monitoring systems are generating data showing the impacts of maritime and navigation activities; trends in ocean acidification and coral reef destruction; trends in fish stocks; introductions of invasive species; changes in sea surface temperature; the spread of life-threatening bacteria and harmful algae, and trends in plastic pollution [ 533 , 534 ].

Improved monitoring of all forms of ocean pollution and better documentation of pollution-related patterns of human exposure and disease will improve estimates of the contribution of ocean pollution to the Global Burden of Disease [ 41 ].

Monitoring Toxic Chemicals and Plastics in the Ocean Environment

Monitoring of chemical and plastic pollution in the oceans has been ongoing for decades. One approach has been direct measurement of discharges of pollutants such as waste plastics into the seas from land-based sources, and tabulation of the number and frequency of discharge events such as oil spills. Under the aegis of the Horizon 2020 Initiative for a Cleaner Mediterranean, the European Environment Agency, and UNEP-MAP have defined a set of indicators that will potentially enable an integrated assessment of key land-based sources of pollution in European seas, including solid waste and marine litter.

A key monitoring strategy for toxic chemical pollutants is to measure concentrations of indicator pollutants in seawater or in organisms that are “sentinel species”. Since the 1970s, the U.S., the European Environment Agency, and the International Mussel Watch Program have measured geographic patterns and temporal trends in concentrations of organic chemical and heavy metal pollutants along the coasts, through analysis of residues in bivalve mollusks [ 535 ]. These programs have identified locations where heavy metals, POPs, and pesticides are most highly abundant and have highest potential to contaminate seafood. These programs have documented that pollutant concentrations are highest near urban areas [ 536 ].

Evaluation of molecular biomarkers of exposure to chemical contaminants is an important complement to direct measurement of chemicals [ 531 , 537 ]. Biomarkers have been used to assess exposures and early biological effects of exposures to oil spills, PCBs, dioxins, toxic metals, and endocrine disruptors [ 538 ]. Pollutant levels in broad areas of the open ocean can be inferred by analysis of tissue levels in large ocean species that serve as biological monitors. Thus, measurement of levels of chemical pollutants and of molecular biomarkers of exposure has been done by analysis of skin biopsies of sperm whale [ 536 ]. Studies in tissues of large sharks and finfish (yellowfin tuna) provide similar data [ 210 , 539 ].

Future Directions in Monitoring of Chemical and Plastic Pollution in the Oceans.

• Airborne and satellite sensors hold great promise for advancing the science of chemical and plastic pollution monitoring. There now exist many platforms and sensor technologies with the potential to scan large areas of the oceans continuously and to provide information on a range of conditions in nearly real-time. These sensors can map and track the distribution of pollutants such as oil spills and plastic waste. Plastic monitoring may be a proxy for monitoring POPs and other toxic chemicals associated with plastic. Remote sensors can also detect HABs [ 540 , 541 ].
• To track ocean pollution by mercury and POPs, the Group on Earth Observations (GEO) has developed the Global Observation System for Mercury (GOS4M) and is developing a Global Observation System for Persistent Organic Pollutants (GOS4POPS).
• To store and analyze data on POPs levels in marine biota, the Global Monitoring Plan (GMP) Data Warehouse established under the auspices of the Stockholm convention is a growing resource. It could be expanded and linked to data on POP levels in human milk and serum in high-risk populations such as people in the circumpolar regions.
• Systematic measurement of pollutant levels in mesopelagic or midwater fishes could be a means for assessing the global status of ocean pollution in the future, as a companion to studies of large fish and marine mammals. Midwater fishes live in the seas at intermediate depths, 200–1,000 m below the surface, and are present in all the oceans of the world.
• Passive samplers and sensors are being developed and applied to assess the distribution and concentrations of pollutants in waters around the world, and to detect new pollutant chemicals [ 540 , 541 ].

Monitoring HABs

Several international and European systems currently capture and disseminate information about HAB events, their predisposing factors, and HAB- related illnesses [ 542 , 543 ]. Other initiatives are being coordinated by the Intergovernmental Panel for Harmful Algal Blooms (UNESCO, IPHAB) collaboration. Specific initiatives are summarized in the following, Tables ​ Tables3 3 and ​ and4 4 :

European Ocean Monitoring Programs.

United States Ocean Monitoring Programs.

Monitoring Bacterial, Viral, and Parasitic Pathogens

Serious challenges impede the detection, quantification and prediction of viral, bacterial, and parasitic pathogens in seafood, shellfish, and oceanic waters as well as in aquaculture operations. Although molecular diagnostics and other tools have improved dramatically over the past two decades [ 454 , 551 ], additional advances are required to better detect and quantify pathogens in water, seafood products, aquaculture facilities, and shellfish meats [ 552 ].

The significant relationships observed between pollution concentrations, rising sea surface temperatures, Vibrio infections and HABs have catalyzed the development of modeling efforts. These models incorporate multiple layers of geocoded data and are designed to generate predictive forecasts [ 553 ]. New technologies such molecular and bioinformatics-based diagnostics [ 410 , 425 , 554 ], metabarcoding, “big data” mining and machine learning may be expected to contribute to further development of these efforts [ 40 , 555 , 556 ]. Implementation of real-time PCR-based approaches has already been shown to be a useful tool for diagnosing V. vulnificus wound infections [ 554 ].

A mapping tool developed by the European Centre for Disease Prevention and Control (ECDC) [ 416 ] is now operational and is providing 24-hour updated Vibrio risk data freely available to the community. However, this system has not yet been implemented by all EU Member States. Also, it needs to be further developed to incorporate relevant variables associated to major climatic events that have been proven to have an impact.

Successes in Prevention and Control of Ocean Pollution

A key finding of the 2018 Lancet Commission on Pollution and Health is that much pollution can be controlled and pollution-related disease prevented [ 24 ]. The Commission noted that most high-income countries and an increasing number of middle-income countries have curbed their most flagrant forms of pollution by enacting environmental legislation and developing regulatory policies. These policies are based on science and are backed by strict regulation. They set targets and timetables, they are adequately funded, and they are based on the “polluter-pays principle”. Air and fresh water in these countries are now cleaner, health has improved, and longevity has increased. The Lancet Commission concluded that pollution control is “a winnable battle” [ 24 ].

An additional benefit of pollution control is that it is highly cost-effective. Rather than stifle economic growth and depress job markets, as is often claimed, pollution control has, in fact, been shown to boost economies, increase human capital and create prosperity. It creates these gains by preventing disease and premature death, reducing productivity losses, and preventing environmental degradation. In the United States, air pollution has declined by 70% since passage of the Clean Air Act in 1970, and every $1 (USD) invested in control of air pollution has returned an estimated benefit of $30 (USD) (range of estimate, $4–88 USD) [ 24 ]. Likewise, the removal of lead from gasoline has boosted economies in countries around the world by increasing the intelligence of billions of children who have come of age in relatively lead-free environments and who are thus more intelligent and productive [ 24 ].

The strategies used to control pollution of air and fresh water are beginning to be applied to the prevention and control of ocean pollution. Key to the effectiveness of these efforts has been the recognition that 80% of ocean pollution arises from land-based sources [ 29 ]. Accordingly, successful marine pollution control programs have identified, targeted, and reduced releases from important land-based polluters. They have been guided by multi-scale monitoring that tracks pollutant discharges, measures pollutant levels in the seas and in marine biota, and assesses human exposures and health outcomes. They have been backed by strict enforcement. They have engaged civil society and the public by making their strategies, their data, and their progress reports available on open-source platforms.

These strategies are beginning to make a difference. As is described in the case studies presented below ( Text Boxes 9–13 ), industrial discharges have been reduced in some areas, plastic pollution reduced, agricultural runoff mitigated, and sewage more effectively treated. Coastal contamination has been reduced, levels of toxic chemicals in marine organisms have declined, the frequency and severity of HABs have been reduced, polluted harbors have been cleaned, estuaries have been rejuvenated, shellfish beds [ 557 ] and aquaculture operations [ 558 ] have been protected, fish stocks have rebounded, and coral reefs have been restored. The successes in control of ocean pollution achieved to date demonstrate that broader prevention is possible.

TEXT BOX 9: Control of Plastic Pollution in the Mediterranean.

Plastic pollution is one of the most pervasive and highly visible threats to the health of the oceans today. Once discharged into the natural environment, plastic can take up to 500 years to disappear. The Mediterranean Sea is particularly vulnerable to plastic pollution because of its semi-enclosed geographical location, and the intensity of its maritime transport, fishing, industry, and tourism. With more than 3000 billion microplastic particles estimated to be in its waters, the Mediterranean is the most polluted sea in the world.

In 2015, the Prince Albert II of Monaco Foundation, the Tara Ocean Foundation, Surfrider Foundation Europe, the MAVA Foundation and the IUCN joined forces to launch the Beyond Plastic Med (BeMed) Initiative. BeMed’s objectives are to bring together and support the stakeholders involved in the fight against plastic pollution in the Mediterranean, implement sustainable solutions, encourage the search for new solutions, and mobilize stakeholders and the general public through knowledge and sharing of best practices.

To achieve its objectives, BeMed supports projects every year that aim to reduce plastic pollution at source by minimizing the use of plastic, finding alternatives, improving waste collection systems, raising awareness, collecting data, and helping to implement new regulations. To date, 53 projects in 15 countries have been supported.

In addition to providing financial support to these efforts, BeMed works to build and coordinate the network of active Mediterranean stakeholders by facilitating the sharing of experience and knowledge and by creating links between organizations. Principal Investigators of the projects supported by BeMed are gathered every year for a day of exchange during Monaco Ocean Week. In addition, stakeholders working on similar topics or in the same region are put in contact with one another to foster collaborations, share knowledge, and thus reinforce the effectiveness of their actions. Replication of successful actions is strongly encouraged.

Since early 2020, BeMed has also engaged the private sector in the fight against plastic pollution by forming of a consortium of companies committed to preventing plastic pollution of the Mediterranean. This consortium includes players at every stage in the plastics value chain – producers of plastic raw materials, plastic manufacturers, producers of plastic-containing consumer products, retailers, and waste management companies – in order to draw companies into a common dynamic of pollution reduction on a Mediterranean-wide scale. Activities of this consortium are structured around two working groups: a group promoting dialogue between scientists and industrialists to clarify the key issues, and a group dedicated to implementing pilot projects in the field. An advisory committee of scientific experts ensures the effectiveness and sustainability of the proposed solutions.

TEXT BOX 10: Control of Persistent Organic and Metal Pollutants in European Waters.

The European Environmental Agency [ 27 ] tracks concentrations of eight indicator pollutants in the waters surrounding Europe. These include three metals – mercury, lead, cadmium, and five persistent organic pollutants (POPs) – hexachlorobenzene (HCB), lindane, PCBs, DDT (using DDE as a proxy), and the polycyclic aromatic hydrocarbon (PAH) BAP (benzo[ a ]pyrene).

The first seven of these substances have been banned from use in Europe, and their discharges into the seas have declined, in some cases sharply. Thus mercury concentrations in North Sea blue mussels have fallen, as have PAH and PCB concentrations in monitored areas in the North Atlantic [ 27 , 208 ]. (See Figure)

Concentrations of PCBs in archived herring gull eggs from three locations on the North German coast, 1988–2008 [ 208 ]

Source : Fleidner et al. (2012), https://doi.org/10.1186/2190-4715-24-7 , Creative Commons, license CC BY 2.0.

These trends document the power of bans on hazardous chemicals in reducing chemical pollution of the oceans. However, despite these successes, levels of all eight of these pollutants remain elevated in European waters and are anticipated to remain unacceptably high for many decades to come. Pollutant levels will be especially slow to decline in Arctic waters where cold temperatures slow chemical degradation [ 208 ].

TEXT BOX 11: Successful Control of Harmful Algal Blooms in Japan’s Inland Sea.

A striking example of successful control of HABs through a science-based prevention program is seen in the case of the Seto Inland Sea in Japan.

In the Seto Inland Sea, the number of visible “red tides” (high biomass blooms) increased seven-fold between 1960 and the mid 1970s. This increase paralleled increases in industrial production and in chemical oxygen demand (COD) from domestic and industrial wastes discharged into the sea.

In 1973, Japan instituted the Seto Inland Sea Law to reduce COD loadings to half of the 1974 levels over a three-year period. As a result, the number of red tides began to decrease in 1977, dropping to, and remaining at levels approximately one-third of peak frequency [ 332 , 559 ]. These data demonstrate an increase in phytoplankton abundance due to over-enrichment of coastal waters, followed by a proportional decrease in blooms when that loading was reduced. Importantly, toxic blooms (in this instance, those that caused fish mortalities or other fisheries damage) also decreased after the loadings were reduced.

The legislative or policy changes implemented in the Seto Inland Sea demonstrate that control of sewage and industrial discharges has the potential to prevent some HABs. Nevertheless, there are other important sources of nutrients to coastal waters, and these are more difficult to control, given the increased population pressures and the need to feed a growing world population. In particular, the steady expansion in the use of fertilizers for agricultural production represents a significant and worrisome source of plant nutrients to coastal waters.

TEXT BOX 12: Boston Harbor Restoration: From a “Harbor of Shame” [ 560 ] to a “Great American Jewel” [ 561 ].

Background. Boston Harbor is an estuary of Massachusetts Bay that provides services worth $30–100 billion to society [ 562 ]. Beginning in the nineteenth century, industrialization, urban development, and population growth led to heavy pollution of the harbor [ 560 , 562 ]. The construction of wastewater treatment plants at Deer Island in the 1950s and Nut Island in the 1960s further exacerbated this problem. The amount of wastewater delivered to these plants often exceeded the plants’ capacities, and by the 1980s, they discharged 350 million gallons of untreated wastewater into the harbor daily. The wastewater devastated water quality, marine habitats, and recreational activities [ 562 ]. Boston Harbor became one of the most polluted harbors in the US [ 560 ].

Solution. Local organizations had already begun advocating for a cleaner Boston Harbor when Congress passed the Clean Water Act in 1972 [ 562 ]. This law catalyzed the cleanup of the polluted harbor. The City of Quincy and the Conservation Law Foundation sued the Commonwealth of Massachusetts for failing to comply with the Clean Water Act, and in 1986, a court-ordered cleanup began [ 563 ].

The cleanup strategy consisted of several steps, including [ 563 ]:

• + Improvements to the 1950s-era treatment plant on Deer Island
• + Construction of a new Deer Island Treatment Plant
• + Transfer of Nut Island Treatment Plant flows to Deer Island
• + Creation of a 9.5-mile outfall to discharge treated effluent from Deer Island into Massachusetts Bay
• + Conversion of sludge into fertilizer, rather than discharge
• + Combined Sewer Overflow projects to protect sensitive waters from overflows.

Results. The Boston Harbor cleanup strategy has had many accomplishments. Most notably, sewage waste that had previously undergone little or no treatment before discharge into the Harbor is now subjected to state-of-the-art treatment [ 561 ]. As a result, the harbor has steadily become cleaner, as illustrated by data taken from 70 locations throughout the harbor since 1989 [ 561 ]. The cleanup resulted additionally in elimination of hepatic neoplasia in winter flounder in the harbor, which had previously been highly prevalent [ 564 ].

Conclusion. The cleanup of Boston Harbor was effective, and the Harbor is now known as the “Great American Jewel” [ 561 ]. To continue the work, policymakers are now addressing current threats to the health of the harbor, including sea level rise, habitat destruction, and invasive species [ 560 ].

TEXT BOX 13: Restoration of Coral Reefs in American Samoa.

Background. American Samoa is a US territory consisting of seven islands in the South Pacific [ 565 ]. The territory contains coral reefs that are both diverse and essential: 2,700 marine species depend on the reefs for shelter, and 55,000 people depend on the reefs for sustenance and employment. Over the past several decades, several disturbances have threatened the reefs (Craig et al., 2005). In the latter half of the 20th century, tuna canneries regularly released nutrient-rich wastewater to Samoan coastal waters leading to an increase in coral-eating plankton and a decrease in corals. By the late 1970s, after an outbreak of crown-of-thorn starfish, only 10% of the corals remained. The problem was further exacerbated by the overfishing of parrotfish, which typically protect corals by consuming harmful algae [ 565 ].

Solution. To address the problems confronting the reefs of American Samoa, a suite of solutions was implemented. In 1986, the Fagatele Bay National Marine Sanctuary was created, thereby imposing restrictions on pollution and fishing. Then, in 1991, the government diverted wastewater pipes to combat the increase in coral-eating plankton. In 2000, spearfishing was banned to protect parrotfish [ 565 ].

Results. The reefs of American Samoa have slowly but surely recovered. In the past nine years, the reefs’ coral cover (proportion of the reef’s surface covered in coral) has increased from 25 to 36%. Compared to the Great Barrier Reef’s coral cover of 14%, the American Samoa reefs are faring well [ 565 ].

Conclusion. The reefs of American Samoa are considered to be in “good” condition [ 566 ], but they continue to face ongoing threats, such as pollution, red tides, coastal sedimentation, and ocean acidification [ 565 , 566 , 567 ]. To protect the reefs, these threats should be addressed.

Programs for the control of ocean pollution create multiple benefits. They boost economies, increase tourism, bring back commercial fisheries, and improve human health and well-being. These benefits will last for centuries.

The following Text Boxes ( Text Boxes 9–13 ) present case studies of successes in control of ocean pollution. A central element in each of these examples has been careful documentation of progress against pollution through robust monitoring. Five case studies are presented here and additional studies are presented in the Supplementary Appendix to this report.

Conclusions

Ocean pollution is a global problem. It arises from multiple sources and crosses national boundaries. It is worsening and in most countries poorly controlled. More than 80% arises from land-based sources.

Plastic waste is the most visible component of ocean pollution and has deservedly attracted much attention. It kills seabirds, fish, whales and dolphins. It breaks down into plastic microparticles and nanoparticles and fibers containing myriad toxic and carcinogenic chemicals. These chemical-laden particles are absorbed by fish and shellfish, enter the marine food chain, and can ultimately be consumed by humans. Their dangers to human health are only beginning to be assessed.

Additional components of ocean pollution include mercury released by the combustion of coal and from small-scale gold mining; petroleum discharges from oil spills and pipeline leaks; persistent organic pollutants, such as PCBs and DDT; thousands of manufactured chemicals, many of unknown toxicity; pesticides, nitrogen, and phosphorus from animal waste and agricultural runoff; and sewage discharges containing multiple microbial contaminants. In concert with sea surface warming and ocean acidification, ocean pollution leads to increasing frequency and severity of HABs, destruction of coral reefs, and spread of life-threatening infections.

Pollution of the oceans can be directly ascribed to the “take-make-use-dispose” economic paradigm that Pope Francis has termed, “the throwaway culture” [ 568 ]. This linear, economic paradigm focuses single-mindedly on gross domestic product (GDP) and on endless economic growth [ 569 ]. It views natural resources and human capital as abundant and expendable and gives little heed to the consequences of their reckless exploitation [ 2 , 8 ]. It ignores the precepts of planetary stewardship [ 102 , 568 , 570 ]. It is not sustainable [ 571 ].

Leaders at every level of government - city, regional and national – as well as sustained engagement by the international community and civil society will be key to the control of ocean pollution and the prevention of pollution-related disease.

Eight key conclusions that emerge from this analysis are the following:

• Ocean pollution is a complex mixture of plastic waste, toxic metals, manufactured chemicals, oil spills, urban and industrial wastes, pesticides, fertilizers, pharmaceutical chemicals, agricultural runoff, and sewage. More than 80% arises from land-based sources. Chemical and plastic pollutants have become ubiquitous in the earth’s oceans and contaminate seas and marine organisms from the high Arctic to the abyssal depths.
• Consumption of contaminated seafood is the main route of human exposure to chemical pollutants, HAB toxins, and plastic microparticles and microfibers in the oceans.
• Coal combustion is a major source of marine mercury pollution.
• Artisanal, small-scale gold mining is a second source of mercury pollution.
• Omega-3 fatty acids and other beneficial nutrients unique to seafood can partially mitigate the injuries caused by mercury and POPs. Several groups have disseminated guidance on safe, sustainable seafood consumption [ 293 , 294 , 295 ].
• Manufactured chemical pollutants – phthalates, bisphenol A, flame retardants, organophosphorus compounds, organotin compounds, and perfluorinated chemicals, many of them released into the oceans via plastic waste – are known to have multiple negative effects on human health that include cardiovascular disease, developmental disorders, endocrine disruption, depression of immune function, decreased fertility, and cancer.
• Plastic microbeads and microfibers formed by the breakdown of plastic waste and manufactured as plastic microbeads contain many of the above-listed manufactured chemicals. These chemical-laden microscopic particles appear capable of entering the marine food web and concentrating in species consumed by humans. The burden of disease associated with human exposures to these chemical-laden particles and fibers is not yet known.
• Coastal pollution by industrial discharges, agricultural waste, and human sewage leads to increasing frequency and severity of HABs – “red”, “green”, and “brown tides”. These blooms produce potent natural toxins such as ciguatera toxin and domoic acid that can concentrate to high levels in fish and shellfish. When ingested, these toxins can cause severe neurological disease and rapid death. HAB toxins can also become airborne and trigger asthma and other respiratory diseases.
• Coastal pollution in concert with sea surface warming stimulates overgrowth of dangerous pathogens, most notably Vibrio species. Coastal pollution also increases antimicrobial resistance (AMR) in marine pathogens. With worsening coastal pollution and rising sea surface temperatures, concern is great that diseases caused by marine pathogens could spread into new, previously unaffected areas, especially places in the Global South where infrastructure is poorly developed and public health systems are weak.
• Declines in seafood stocks caused by pollution, ocean warming, ocean acidification and overfishing threaten the health and well-being of the millions of people worldwide who depend on the seas for their food and their livelihood.
• Ocean pollution has multiple harmful effects on marine ecosystems. These effects can have negative impacts on human health. Plastic pollution kills fish, seabirds, whales, and dolphins. Pharmaceutical waste contributes to the destruction of coral reefs. Increasing absorption of carbon dioxide into the oceans causes ocean acidification, destroys coral reefs and dissolves calcium-containing plankton at the base of the marine food web. Petroleum-based pollutants and POPs impede the production of oxygen by beneficial marine microorganisms.
• Ocean pollution is deeply unjust. Ocean pollution and all its negative impacts fall disproportionately on people in small island nations, indigenous communities, coastal communities in the Global South, and fishing communities worldwide. These are populations that create only miniscule amounts of pollution. Most of the pollution to which they are exposed arises from sources far away. This is environmental injustice on a global scale.
• Ocean pollution is inadequately charted. Current knowledge of ocean pollution and its impacts on human health is still at a relatively early stage. Information on the geographic distribution and concentrations of pollutants in the oceans is fragmentary and confined mostly to the seas that border high-income countries. Likewise, information on the sizes of the human populations exposed to ocean pollution and their levels of exposure is scant. Data that could support the development of estimates of the contribution of ocean pollution to the global burden of disease (GBD) are only beginning to be developed.

Prevention is achieved through identifying and quantifying pollution sources and then deploying data-driven control strategies that are based on law, policy, and technology and backed by enforcement. Many countries have used these tools to successfully control air and water pollution, and these programs have proven effective as well as cost-effective. The same strategies are now being applied to prevention and control of ocean pollution. The case studies in successful control of marine pollution presented in this report demonstrate that broader control is feasible.

Prevention of ocean pollution will require recognition by policy-makers and the global public that pollution can indeed be prevented – that it is not the unavoidable price of economic progress. It will require understanding additionally that pollution control creates many benefits. Control of ocean pollution improves the health of the oceans, boosts economies, enhances tourism, restores fish stocks, prevents disease, extends longevity, and enhances well-being. These benefits will last for centuries.

Ultimate and sustainable prevention of chemical pollution of the oceans will be achieved through wide-scale adoption of non-polluting, renewable fuels, transition to a circular economy, and adoption of the principles of green chemistry ( Text Box 15 ).

Other remediation strategies have explored breaking down synthetic microplastic polymers in the oceans through the use of microorganisms [ 576 ]. A number of fungal and bacterial strains possess biodegradation capabilities and have been found capable of breaking down polystyrene, polyester polyurethane, and polyethylene. A specialized bacterium is able, for example, to degrade poly(ethylene terephthalate) (PET) [ 577 ]. Such microorganisms could potentially be applied to sewage discharges in highly localized environments, but scrupulous due diligence will be required prior to their wider deployment to avoid unintended consequences [ 578 ].

Bloom control – actions taken to suppress or destroy HABs – has been proposed, but is challenging and controversial. The science in this area is rudimentary [ 331 ]. Physical removal of algal cells from the water column using clay flocculation is currently the only strategy in routine use. In South Korea a clay called “yellow loess” has been used since 1996 to control HAB blooms that threaten aquaculture [ 579 ]. Likewise the Chinese have used clay to control algal blooms for over 20 years, with wide-scale applications covering up to 100 km 2 [ 580 ].

In sum, it is far more effective and also more cost-effective to prevent the entry of pollutants into the world’s oceans than to try to remove them from the seas after they have become dispersed.

• Most directly, control of ocean pollution will advance SDG 14, which calls on all countries to “prevent and significantly reduce marine pollution of all kinds, in particular from land-based activities, including marine debris and nutrient pollution” by 2025.
• Control of ocean pollution will advance SDG 3, which calls for improvement of human health and well-being;
• SDG1, which calls for an end to poverty;
• SDG2, which calls for an end to hunger;
• SDG 6, which calls for clean water and sanitation;
• SDG 8, which calls for decent work and sustainable economic growth; and
• SDG12, which calls for responsible consumption and production.

Recommendations – The Way Forward

Policy priorities.

• Cessation of coal combustion; and
• Control of inorganic mercury, especially in artisanal and small-scale gold mining (ASGM).

Cessation of coal combustion will not only slow the pace of climate change and reduce particulate air pollution, but will also greatly reduce the atmospheric emissions of mercury, thus reducing deposition of mercury into the oceans. Actions ongoing under the Minamata Convention on Mercury are seeking to identify and control major sources of mercury pollution [ 34 ].

• End Plastic Pollution of the Oceans and Consider a Global Ban on Production of Single-Use Plastic. Marine plastic pollution has become one of three top priorities in global pollution identified by UN Environment [ 581 ]. Many countries have taken regulatory and social actions to control the use and disposal of plastics and reduce plastic waste. These include bans of single-use articles such as plastic bags and straws and bans on the use of cosmetic microbeads. In 2015, the United States banned the manufacture and distribution of cosmetic products containing plastic microbeads. The EU parliament has voted to ban several single-use plastic categories (cutlery, cotton buds, straws and stirrers) by 2021.
• Promote Effective Waste Management. Improvement in collection and management of solid waste is a key strategy for prevention and control of marine plastic pollution. UNESCO reports that seven of the EU Member States plus Norway and Switzerland now recover more than 80% of their used plastics. These countries have adopted integrated waste and resource management strategies to address each waste stream with the best options. Rwanda, Kenya, and some jurisdictions in the United Sates have banned single-use plastic bags. These are model programs and have potential to extend to other countries.
• Reduce Releases of Nitrogen, Phosphorus, Animal Waste, Industrial Discharges and Human Sewage into Coastal Waters. Proper management of coastal pollution can reduce the frequency of HABs, prevent eutrophication, and alleviate the burden of disease associated with HABs and marine pathogens. Monitoring seafood, including farmed fish, for human pathogens is a proven strategy for tracking the efficacy these control efforts and reducing risk of disease. The UNESCO Blueprint for Ocean and Coastal Sustainability includes proposals to green the nutrient economy and achieve these goals [ 578 ].
• Create Marine Protected Areas. Designation of new Marine Protected Areas around the world will safeguard critical ecosystems, protect vulnerable fish stocks, and enhance human health and well-being [586–588]. Creation of Marine Protected Areas is an important manifestation of national and international commitment to protecting the health of the seas.
• Assist countries with the establishment and certification of monitoring programs for chemical pollutants, algal toxins, microplastics, and microbial pathogens in seafood products.
• Build and sustain strong transdisciplinary teams of scientists and strengthen analytical capabilities at the national level to provide countries with capability to respond to new and unexpected marine pollutants.
• Develop new monitoring capabilities using networks of in situ sensors that can detect toxic chemical pollutants, HAB cells and their toxins, microplastics and pathogenic bacteria.
• Support the global efforts of the IOC-UNESCO Intergovernmental Panel on Harmful Algal Blooms (IPHAB) [ 389 ].
• Enhance communication, literacy and outreach efforts so that the risks of human illness and death from ocean pollutants is recognized and understood throughout all levels of society.

TEXT BOX 16: Regional and International Marine Pollution Control Programs.

• The London Convention on the Prevention of Marine Pollution by Dumping of Wastes and Other Matter (1975) and its Protocol (1996)
• The United Nations Convention on the Law of the Sea (1982)
• The OSPAR Convention for the Protection of the Marine Environment of the North-East Atlantic (1992)
• The Bucharest Convention on the Protection of the Black Sea against Pollution (1992)
• The Helsinki Convention on the Protection of the Marine Environment of the Baltic Sea Area (1992) and its Action Plan (2007)
• The Barcelona Convention for the Protection of the Marine Environment and the Coastal Region of the Mediterranean (1995) and its Protocols (2005)
• The Stockholm Convention on Persistent Organic Pollutants (2001)
• The Strategic Action Plan for the Environmental Protection and Rehabilitation of the Black Sea (2009)
• The Minamata Convention on Mercury (2013)
• The United Nations Decade of Ocean Science for Sustainable Development (2021–2030)

TEXT BOX 14: Principles of a Circular Economy

In a circular economy, economic, and social development is decoupled from the consumption of non-renewable resources. The generation of pollution and other forms of waste is minimized and replaced by recycling and reuse [ 2 ]. The focus is on stability and equity rather than endless growth.

The core principles of a circular economy are preservation of natural capital by reducing use of non-renewable resources and ecosystem management; optimization of resource yields by circulating products and materials so that they are shared and their lifecycles extended; and fostering system effectiveness by designing out pollution, greenhouse gas emissions, and toxic materials that damage health [ 2 ].

Evidence of global movement towards a circular economy is seen in policy-related recommendations to control plastic pollution of the oceans that have been proposed by the UN Food and Agriculture Organization (FAO) and the Group of Experts on the Scientific Aspects of Marine Environmental Protection (GESAMP). These bold and visionary strategies call for sweeping change in current, highly wasteful practices of plastic production and consumption and for a global move toward biodegradable, non-persistent polymers [ 572 ]. They provide a model for interventions against other marine pollutants.

TEXT BOX 15: The Promise of Green Chemistry

Green chemistry is “the design of chemical products and processes to reduce and eliminate the use and generation of hazardous compounds” [ 573 ].

Adoption of the principles of green chemistry will require a paradigm shift away from narrow consideration of the properties and economic viability of new molecules and chemical products towards consideration and avoidance of their potential negative impacts on humans, ecosystems, and society. This reorientation will need to take place in every stage in the design and development of new chemicals and new chemical products from their earliest inception.

Green chemistry takes special note of the potential of new chemicals to cause low-dose toxicity through mechanisms such as endocrine disruption and developmental toxicity, and it avoids new products that will persist in the environment or in living organisms. The goal is to create safe, nontoxic materials and technologies and thus prevent future health and environmental catastrophes while building a sustainable chemical economy [ 574 ].

Wide-scale adoption of the principles and practices of green chemistry coupled with broad movement towards a circular economy could reduce pollution of the world’s oceans by manufactured chemicals and plastic waste and end the need to balance the dangers of toxic chemicals in seafood against the clear benefits of seafood for human health.

Research Priorities

The overall goal of the following research recommendations is to increase knowledge of the extent, severity, and human health impacts of ocean pollution. A second goal is to better quantify the contributions of ocean pollution to the global burden of disease (GBD). Findings from the GBD study have become powerful shapers of health and environmental policy and are used by international agencies and national governments to set health and environmental priorities and guide the allocation of resources. It is therefore critically important that accurate information on the disease burden attributable to ocean pollution be accurately and fully captured in the GBD analysis and made available to policy-makers. Specific recommendations are the following:

Monitoring for all of the chemical and biological hazards in the oceans should increase in scope and be coordinated globally. It is possible to monitor for some biological hazards, ocean pH, and temperature in sensors that are part of the Global Ocean Observing system (GOOS) within the UN system. Enhancing this capability and adding sensors for chemical hazards that incorporate new technologies and capabilities is an objective that may be achieved by partnering with programs such as the Partnership for Observation of the Global Ocean (POGO).

• Enhanced sampling of pollutant concentrations in fish, shellfish, and marine mammals. Because consumption of contaminated seafood is the major route by which chemical pollutants in the ocean as well as HAB toxins reach humans, better information is needed on concentrations of key pollutants in seafood. High-quality data are available from high-income countries, but much less information is available from the countries of the Global South.
• Improved tracking of biomarkers that are early indicators of damage caused to human health and marine ecosystems by chemical pollutants.
• Expanded coverage of ocean sampling for marine pathogens. Techniques have been developed for monitoring the global spread of pathogenic bacteria, such as Vibrio species, but these techniques have been deployed to date in only a few areas of the world. Expanded geographic coverage of marine bacterial sampling – especially into areas important for commercial fishing, shellfish harvesting and aquaculture – coupled with real-time information on sea surface temperature will be important for tracking, and predicting the spread of life-threatening bacteria and for mobilizing early responses to new outbreaks of diseases.
• Improved studies of human exposure to ocean pollutants. A major impediment to developing estimates of the GBD attributable to ocean pollutants is lack of detailed, population-level studies of human exposures to marine pollutants. Conducting such studies in a number of countries will elucidate the importance of such factors as geographic variation in background exposure to pollutants, in seafood consumption, in pollutant concentrations in seafood, and in exposures to toxic chemicals via routes other than consumption of contaminated seafood.
• Improved assessments of combined effects of exposures to multiple ocean pollutants. Humans are seldom exposed to pollutants one at a time. Instead, people are typically exposed to complex mixtures of pollutants. The limited available evidence indicates that these combined exposures can produce additive, synergistic, and antagonistic effects.
• Implementation research. Transdisciplinary international cooperative implementation research is needed to identify best practices and feasible, cost-effective solutions to prevention and control of ocean pollution. This research will build upon and codify the findings that have emerged from the case studies in success against ocean pollution presented in this report. Continuing research and development into biodegradable polymers will be an important component of this research [ 572 ].
• Build and sustain strong teams of scientists at the national level to provide each country with capacity to respond to new and unexpected marine pollutants and assess their health impacts.
• Establish lines of communication and collaboration between marine scientists and public health agencies and institutions [ 531 ].
• Support the global efforts of the IOC-UNESCO Intergovernmental Panel on Harmful Algal Blooms (IPHAB), which coordinates actions at a policy level and that relies on the work of institutions in many countries, and contributes to achieve the SDGs.
• Develop new monitoring capabilities using networks of in situ sensors that can detect toxic chemical pollutants, HAB cells and their toxins, microplastics, and pathogenic bacteria.
• Deploy improved analytical capabilities to document health and economic benefits of programs to control and prevent ocean pollution.
• Assist countries with the establishment and certification of monitoring programs for chemical pollutants, algal toxins, microplastics, and pathogenic bacteria in seafood products.
• Strengthen analytical capabilities at the national level.
• Support research and application of technologies for control of marine pollutants.

Additional Files

The additional files for this article can be found as follows:

Supplementary Appendix.

This Supplementary Appendix contains additional references and documentation supporting the information presented in the report, Human Health and Ocean Pollution.

Declaration of Monaco.

This Declaration summarizes the key findings and conclusions of the Monaco Commission on Human Health and Ocean Pollution. It is based on the recognition that all life on Earth depends on the health of the seas. It presents a Call to Action – an urgent message addressed to leaders in all countries and to all citizens of Earth urging us to safeguard human health and preserve our Common Home by acting now to end pollution of the ocean.

Special Acknowledgement

The authors acknowledge the generous assistance of Drs. Jennifer De France and Bruce Allen Gordon of the World Health Organization in reviewing this manuscript.

The authors acknowledge the outstanding illustrations by Dr. Will Stahl-Timmins, Data Graphics Designer.

The following authors contributed to the design and planning of this study:

Philip J. Landrigan, Patrick Rampal, Hervé Raps, Marie-Yasmine Dechraoui Bottein, Françoise Gaill, Laura Giuliano, Amro Hamdoun, Christopher Reddy, Joacim Rocklöv, Luigi Vezzulli, Pál Weihe, Ariana Zeka.

Funding Statement

The Centre Scientifique de Monaco, the Prince Albert II of Monaco Foundation and the Government of the Principality of Monaco John J. Stegeman is supported by U.S. Oceans and Human Health Program (NIH grant P01ES028938 and National Science Foundation grant OCE-1840381). Lora E. Fleming is supported by the European Union’s Horizon 2020 research and innovation programme under grant agreement No 774567 (H2020 SOPHIE Project) and No 666773 (H2020 BlueHealth Project). Plastic toxicity research for Dimitri Deheyn is supported by the BEST Initiative ( https://deheynlab.ucsd.edu/best-2/ ). Barbara Demeneix is supported by grants from the program H2020. Charles J. Dorman is supported by Science Foundation Ireland Investigator Award 13/IA/1875. William H. Gaze is supported by a Natural Environment Research Council Knowledge Exchange Fellowship NE/S006257/1 on the environmental dimension of antimicrobial resistance. Philippe Grandjean is supported by National Institute of Environmental Health Sciences (NIEHS) of the NIH (grant No. ES027706), a Superfund center grant for the Sources, Transport, Exposure and Effects of Perfluoroalkyl Substances (STEEP) Center. Mark E. Hahn is supported by U.S. Oceans and Human Health Program (NIH grant P01ES028938 and National Science Foundation grant OCE-1840381). Amro Hamdoun is supported by NIH and NSF Program on Oceans and Human Health Grants NIH ES030318 and NSF 1840844. Philipp Hess is supported by the IAEA Core Research Project K41014, by the European H2020 program for funding the EMERTOX project (grant number 778069), by the Atlantic Interreg (grant number Alertox-Net EAPA-317-2016) and by EFSA for the project EUROCIGUA (framework partnership agreement GP/EFSA/AFSCO/2015/03). Rachel T. Noble was supported by the US National Science Foundation Accelerating Innovations in Research #1602023 and the NOAA NERRS Science Collaborative. Maria Luiza Pedrotti is supported by Centre National de la Recherche Scientifique (CNRS). Luigi Vezzulli is supported by the following grants: European FP7 Program Grant AQUAVALENS 311846 and European Union’s Horizon 2020 Research and Innovation Program Grant VIVALDI 678589. Pál Weihe is supported by the Danish EPA programme: Danish Cooperation for Environment in the Arctic and by the Faroese Research Council.

Funding Information

Research supported by:

• The Centre Scientifique de Monaco, the Prince Albert II of Monaco Foundation and the Government of the Principality of Monaco
• John J. Stegeman is supported by U.S. Oceans and Human Health Program (NIH grant P01ES028938 and National Science Foundation grant OCE-1840381).
• Lora E. Fleming is supported by the European Union’s Horizon 2020 research and innovation programme under grant agreement No 774567 (H2020 SOPHIE Project) and No 666773 (H2020 BlueHealth Project).
• Plastic toxicity research for Dimitri Deheyn is supported by the BEST Initiative ( https://deheynlab.ucsd.edu/best-2/ ).
• Barbara Demeneix is supported by grants from the program H2020.
• Charles J. Dorman is supported by Science Foundation Ireland Investigator Award 13/IA/1875.
• William H. Gaze is supported by a Natural Environment Research Council Knowledge Exchange Fellowship NE/S006257/1 on the environmental dimension of antimicrobial resistance.
• Philippe Grandjean is supported by National Institute of Environmental Health Sciences (NIEHS) of the NIH (grant No. ES027706), a Superfund center grant for the Sources, Transport, Exposure and Effects of Perfluoroalkyl Substances (STEEP) Center.
• Mark E. Hahn is supported by U.S. Oceans and Human Health Program (NIH grant P01ES028938 and National Science Foundation grant OCE-1840381).
• Amro Hamdoun is supported by NIH and NSF Program on Oceans and Human Health Grants NIH ES030318 and NSF 1840844.
• Philipp Hess is supported by the IAEA Core Research Project K41014, by the European H2020 program for funding the EMERTOX project (grant number 778069), by the Atlantic Interreg (grant number Alertox-Net EAPA-317-2016) and by EFSA for the project EUROCIGUA (framework partnership agreement GP/EFSA/AFSCO/2015/03).
• Rachel T. Noble was supported by the US National Science Foundation Accelerating Innovations in Research #1602023 and the NOAA NERRS Science Collaborative.
• Maria Luiza Pedrotti is supported by Centre National de la Recherche Scientifique (CNRS).
• Luigi Vezzulli is supported by the following grants: European FP7 Program Grant AQUAVALENS 311846 and European Union’s Horizon 2020 Research and Innovation Program Grant VIVALDI 678589.
• Pál Weihe is supported by the Danish EPA programme: Danish Cooperation for Environment in the Arctic and by the Faroese Research Council.

Competing Interests

All authors declare no Conflict of Interest in regard to the work presented in this paper with the following exceptions.

• – Author William H. Gaze declares no conflict of interest although he has received co-funding for PhD studentships from AstraZeneca.
• – Author Philippe Grandjean has provided paid expert assistance in legal cases involving populations exposed to PFAS.
• – Author Barbara Demeneix is an inventor of “Transgenic clawed frog embryos and used as detectors of endocrine disruption in the environment”, a French patent application filed in 2002 (n°FR0206669), that was extended through a PCT application filled in 2003. Applicants: Centre National de la Recherche Scientifique (CNRS) and Muséum National d’Histoire Naturelle (MNHN). Inventors: B. Demeneix and N. Turque. The patent has been extended worldwide: France (2007), Japan (2011), United States (2013), Canada (2013) and Europe (2015). There has been no financial compensation for the patent.

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Crossing the Line: Microplastics Breach the Blood-Brain Barrier

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It’s no secret that plastic has become ubiquitous in our daily lives, from the packaging of our food to the clothes we wear. Recent research has revealed that microplastics, tiny fragments resulting from our plastic-dominated world, are not just contaminating our oceans and soil—they're infiltrating our bodies and crossing the blood-brain barrier, suggesting potential impacts on the nervous system. This discovery opens a new frontier in our understanding of human health risks. 

What are microplastics and why should you care?

Microplastics are tiny plastic particles less than 5mm in size, often invisible to the naked eye. They come from two main sources:

• The breakdown of larger plastic items exposed to environmental factors like sunlight and wave action.
• Manufactured microplastics, such as microbeads used in cosmetics or fibers shed from synthetic clothing.

The blood-brain barrier is a highly selective, semipermeable border of cells that prevents solutes in the circulating blood from non-selectively crossing into the extracellular fluid of the central nervous system. This barrier is a vital defense mechanism that protects our brain from potentially harmful substances.

Recent studies on microplastics and the blood-brain barrier

Studies from 2024 confirm the presence of microplastics in human brain tissue, but they also suggest that the brain may be particularly susceptible to microplastic accumulation compared to other organs.

Research published in September 2024 by Professor Dr. Thais Mauad and Dr. Luis Fernando Amato-Lourenco from the University of Sao Paulo and Freie University Berlin found microplastics in the olfactory bulb of deceased residents in Sao Paulo, Brazil. This study, which examined samples from 15 individuals, identified plastic fibers and particles in 8 out of 15 samples. Their findings include:

• The most common plastic found was polypropylene, which is unsurprising as it is one of the most widely produced plastics globally. 
• Larger nano and microplastics may be able to pass through the blood-brain barrier. Nanoplastics are defined as plastics with dimensions ranging from 1 nm to 1 μm, while microplastics are defined as plastics less than or equal to 5 mm. It was previously assumed that only nanoplastics smaller than 1 micron were able to pass the blood-brain barrier. 
• The olfactory pathway appears to be a potential major entry route for plastic into the brain, implying that breathing in air with higher levels of microplastics such as indoor environments could be a significant source of plastic pollution in the brain.

In addition, a  study published earlier this year by researchers from the Office of the Medical Investigator in Albuquerque, New Mexico, compared microplastic accumulation in kidneys, livers, and brains from autopsy samples collected in 2016 and 2024. Their findings raise concerns, including:

• Brains exhibited higher concentrations of microplastics than liver or kidney samples (9 up to 0.48% by weight).
• All organs showed significant increases in microplastic concentrations from 2016 to 2024, indicating a potential rise in microplastic pollution.
• Polyethylene was the predominant polymer found, with a higher relative proportion in brain samples compared to liver or kidney.

What are the potential health implications?

Researchers have already observed adults with higher concentrations of microplastics in the heart were at higher risk for stroke or heart attack . Thus, the presence of microplastics in the brain raises several concerns. In particular, researchers are working to understand the capacity of such particles to be internalized by cells and alter how our bodies function, potentially leading to disruptions in normal brain function and cellular processes. There is also concern about the interaction of microplastics with organs in children, with the research suggesting that exposure during critical developmental periods could lead to definitive alterations in adult life, potentially affecting cognitive function, behavior, and overall brain health.

 In a related study, Dr. Lukas Kenner found that cancer cells in the gut can  spread at an accelerated rate after contact with microplastics , indicating that the presence of microplastics in the body could potentially exacerbate existing health conditions or contribute to the development of new ones. Furthermore, microplastics may act as a conveyor of additional contamination into the human body as they may also contain chemicals such as per- and polyfluoroalkyl substances, or PFAS, lead, and other chemical compounds embedded within or on the surface of the microplastic.

Who is most at risk?

Due to the ubiquitous nature of microplastics, it is assumed that everyone is potentially at risk. However, certain groups may be more vulnerable:

• Children : Because of their developing organs and systems, children may be particularly susceptible to the effects of microplastics. Their smaller body size also means that a given amount of microplastic exposure represents a proportionally larger dose compared to adults.
• People with occupational exposure : People working in industries that produce, recycle, dispose or handle large amounts of plastic may be at higher risk of inhaling or ingesting microplastics.
• Urban dwellers : Given that indoor environments appear to be a significant source of microplastic exposure to the brain, people living in urban areas with less ventilation and more synthetic materials may face higher exposure levels.
• Individuals with pre-existing conditions : Those with compromised immune systems or existing health issues may be more susceptible to the potential negative effects of microplastic accumulation.
• Underserved communities :  People living in underserved communities and people of color are often  disproportionately burdened by environmental contamination at the household and community level for a myriad of reasons, such as living in closer proximity to particulate pollution. 

What can we do to protect ourselves?

While it's challenging to completely avoid microplastics in our current plastic-dominated world, there are steps we can take to reduce our exposure:

• Minimize use of plastic products, especially single-use items. For example, use a reusable glass or stainless steel water bottle or coffee mug when you’re on the go when possible.
• Choose natural fiber clothing over synthetic materials. Synthetic fabrics like polyester, nylon, and acrylic shed microfibers during washing and wearing.
• Filter drinking water at your household kitchen tap and limit use of plastic water bottles.
• Avoid heating food in plastic containers and using plastic cutting boards.
• Reduce dust in your home. Regular cleaning through vacuuming and dusting along with the use of air purifiers can help reduce indoor microplastic pollution.

The push for policy change

As the evidence of microplastics' impact on human health grows, so does the push for policy changes.

In November 2024, the final round of negotiations for a UN Global Plastics Treaty will take place in South Korea. NGOs and scientists are calling for urgent action, especially with these new findings about microplastics in the brain. The Plastic Health Council, a group of leading scientists dedicated to researching the impact of micro, nano-plastics and chemicals on human health, is arguing for an  alternative   treaty that would reduce the production volumes of plastics, eliminate all but truly essential single-use plastic items, and require testing of all chemicals used in plastics.

There's a growing call for the precautionary principle to be applied to plastic production and use, given the potential harm to human health. The precautionary principle forms the basis of many modern environmental regulations and urges caution with new technologies where there is lack of scientific consensus on the long-term potential for harm from these technologies ( see Principle 15 of the United Nations Rio Declaration on Environment and Development ) .

Need for additional research and proactive measures can occur in tandem

In 2019, the World Health Organization stated that while microplastics are ubiquitous in our environment, there was no evidence to conclude an impact to human health. In 2024, the United States Food and Drug Administration concluded that “Current scientific evidence does not demonstrate that levels of microplastics or nanoplastics detected in foods pose a risk to human health due to lack of harmonization in microplastic research methodology and the many research gaps left to explore.”

While finding microplastics in the human brain is a cause for concern, it also further highlights the need to determine the impacts of these particles to the human body. As research continues individuals can take proactive steps to voluntarily minimize plastic use, stay informed, and support policies that protect our health and environment from the growing threat of microplastic pollution.

RTI is actively working to address the issue of plastic pollution through waste management practices globally. Additionally, work is being done to develop standard reference materials for nanoplastics and testing the human health effects of microplastics within in vitro cell models. 

Related Resources

Harmful effects of plastic pollution on human health, contaminants of concern, impact of plastics lifecycle, webinar: how to characterize and validate ai and in vitro nams for toxicity testing.