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Rose Marie Martinez and Erin Rus sch, Rapporte eurs Round dtable on Env vironmental Health Science Research and Medicin H es, h, ne Board on Population He ealth and Pub Health Pr blic ractice

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This activity was supported by contracts between the National Academy of Sciences and the National Institute of Environmental Health Sciences (HHSN26300033), The Kresge Foundation, Colgate-Palmolive Company, ExxonMobil Foundation, and Royal Dutch Shell. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity. This summary is based on the proceedings of a workshop that was sponsored by the Roundtable on Environmental Health Sciences, Research, and Medicine. It is prepared in the form of a workshop summary by and in the name of the rapporteurs as an individually authored document. International Standard Book Number-13: 978-0-309-29468-3 International Standard Book Number-10: 0-309-29468-1 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2014 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2014. Understanding the connections between coastal waters and ocean ecosystem services and human health: Workshop summary. Washington, DC: The National Academies Press.

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The National Acade emy of Scienc is a privat nonprofit, self-perpetuati ces te, ing society of distinguish scholars en y hed ngaged in scien ntific and engin neering researc ch, dedicat to the furth ted herance of scie ence and technnology and to their use for t the general welfare. Upo the authority of the charte granted to it by the Congre l on y er ess in 1863, the Academ has a man my ndate that req quires it to ad dvise the fedeeral governnment on scie entific and tecchnical matter Dr. Ralph J. Cicerone is rs. h preside of the Natio Academy of Sciences. ent onal The National Acade emy of Engin neering was e established in 1964, under t the charter of the Natio r onal Academy of Sciences, as a parallel organization of outstannding engineers It is autonom s. mous in its adm ministration and in the selecti d ion of its members, sharin with the Na m ng ational Academ of Sciences the responsibil my lity for advvising the feder government The National Academy of Engineering al ral t. l lso sponsors engineering programs aim at meetin national ne g med ng eeds, encourag ges educati and researc and recogn ion ch, nizes the super achieveme rior ents of enginee ers. Dr. C. D. Mote, Jr., is president of the National Ac D s t cademy of Eng gineering. The Institute of Med dicine was estaablished in 197 by the Natio 70 onal Academy of Science to secure th services of eminent memb es he bers of approp priate professio ons in the examination of policy matter pertaining to the health of the public. T e rs o f The Institut acts under th responsibilit given to the National Acad te he ty demy of Scienc ces by its congressional charter to be an adviser to the federal gover c c n e rnment and, up pon its own initiative, to identify issues of medical car research, an education. D n i re, nd Dr. Harvey V. Fineberg is president of the Institute of Medicine. y t f The Na ational Resea arch Council was organized by the Natio w d onal Academy of Science in 1916 to associate the broad commun of science and technolo es b nity e ogy with th Academy’s purposes of fu he urthering knowwledge and adv vising the fede eral governnment. Function ning in accordance with gene policies determined by t eral the Academ the Counc has become the principal operating age my, cil e l ency of both tthe National Academy of Sciences an the Nationa Academy of Engineering in o nd al f providin services to the government the public, an the scientific and engineeri ng t t, nd c ing commu unities. The Coouncil is admi inistered jointl by both Ac ly cademies and t the Institut of Medicine Dr. Ralph J. Cicerone and Dr. C. D. Mo Jr., are ch te e. d ote, hair and vic chair, respec ce ctively, of the National Resea N arch Council. w www.national l-academies.o org .

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PLANNING COMMITTEE FOR THE WORKSHOP ON UNDERSTANDING THE CONNECTIONS BETWEEN COASTAL WATERS AND OCEAN ECOSYSTEM SERVICES AND HUMAN HEALTH1 JAY LEMERY, University of Colorado, Denver, CO PAUL SANDIFER, National Oceanic and Atmospheric Administration, Charleston, SC CARL SHAPIRO, U.S. Geological Survey, Reston, VA JOHN SPENGLER, Harvard University, Boston, MA HAROLD ZENICK, U.S. Environmental Protection Agency, Washington, DC 1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. v

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ROUNDTABLE ON ENVIRONMENTAL HEALTH SCIENCES, RESEARCH, AND MEDICINE1 FRANK LOY (Chair), Washington, DC LYNN R. GOLDMAN (Vice Chair), George Washington University, Washington, DC HENRY A. ANDERSON, Wisconsin Division of Public Health, Madison JOHN M. BALBUS, National Institute of Environmental Health Sciences, Bethesda, MD JAMES K. BARTRAM, University of North Carolina, Chapel Hill LINDA S. BIRNBAUM, National Institute of Environmental Health Sciences, Research Triangle Park, NC LUZ CLAUDIO, Mount Sinai School of Medicine, New York, NY DENNIS J. DEVLIN, ExxonMobil Corporation, Irving, TX RICHARD A. FENSKE, University of Washington, Seattle ALISTAIR FRASER, Royal Dutch Shell, The Hague, The Netherlands LUIZ A. GALVÃO, Pan American Health Organization, Washington, DC BERNARD D. GOLDSTEIN, University of Pittsburgh, PA RICHARD J. JACKSON, University of California, Los Angeles SUZETTE M. KIMBALL, U.S. Geological Survey, Reston, VA JAY LEMERY, University of Colorado, Denver ANDREW MAGUIRE, Environmental Defense Fund, Washington, DC LINDA A. MCCAULEY, Emory University, Atlanta, GA AL MCGARTLAND, U.S. Environmental Protection Agency, Washington, DC DAVID M. MICHAELS, Occupational Safety and Health Administration, Washington, DC CANICE NOLAN, European Commission, Brussels, Belgium MARTIN A. PHILBERT, University of Michigan, Ann Arbor CHRISTOPHER J. PORTIER, Centers for Disease Control and Prevention, Atlanta, GA PAUL SANDIFER, National Oceanic and Atmospheric Administration, Charleston, SC 1 Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. vii

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JOHN D. SPENGLER, Harvard School of Public Health, Boston, MA LOUIS W. SULLIVAN, Morehouse School of Medicine, Atlanta, GA ANNE M. SWEENEY, Texas A&M University, College Station G. DAVID TILMAN, University of Minnesota, St. Paul PATRICIA VERDUIN, Colgate-Palmolive Company, Piscataway, NJ NSEDU OBOT WITHERSPOON, Children’s Environmental Health Network, Washington, DC HAROLD ZENICK, U.S. Environmental Protection Agency, Research Triangle Park, NC IOM Staff CHRISTINE COUSSENS, Study Director (until August 2013) ERIN RUSCH, Associate Program Officer ANDRÉS GAVIRIA, Research Associate HOPE HARE, Administrative Assistant ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice viii

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Reviewers This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary: Samantha Joye, University of Georgia Kimberley Thigpen-Tart, National Institute of Environmental Health Sciences Juli Trtanj, National Oceanic and Atmospheric Administration Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Richard B. Johnston, University of Colorado School of Medicine. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteurs and the institution. ix

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Contents 1 INTRODUCTION 1 Aims of the Workshop, 1 Structure of the Summary, 3 References, 4 2 CONCEPTUAL ISSUES 5 Understanding Ecosystem Services, 5 Integration of Environmental Health and Marine Ecosystem Services, 13 Discussion, 19 References, 21 3 STRESSORS IMPACTING COASTAL AND OCEAN ECOSYSTEM SERVICES AND HUMAN HEALTH 23 Relationships Among Stressors, Ecosystem Services, and Human Health, 23 Framework for Assessing Marine Ecosystem Services and Human Health, 32 A U.S. Geological Survey Perspective on Stressors Impacting Coastal and Ocean Systems, 36 Discussion, 41 References, 42 4 SEAFOOD SUPPLIES AND FOOD SECURITY 45 Fish, Fisheries, and Food Security, 45 Putting the World on a Fork, 50 Aquaculture: Ensuring a Future Seafood Supply for a Healthy Population and Environment, 56 New Opportunities for Resource Management: Life-Cycle Analysis, Sustainability, and Co-Benefits, 64 Discussion, 69 References, 72 5 OPPORTUNITIES FOR MEDICINES 75 Current and Emerging Opportunities and Challenges for Pharmaceuticals from the Sea, 75 References, 81 xi

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xii CONTENTS 6 COASTAL CHANGE AND HUMAN HEALTH 83 The Role of Coastal Ecosystems in Protecting Gulf Coast Communities, 83 Discussion, 86 References, 87 7 ENSURING BENEFITS OF RECREATIONAL WATERS THROUGH MONITORING 89 Use of Indicator Organisms to Assess Public Health Benefits and Risks Associated with Recreational Use of Natural Waters, 89 Discussion, 95 References, 96 8 NEW APPROACHES TO PROTECT ECOSYSTEM SERVICES AND HUMAN HEALTH 97 Framing of Management of Ecosystem Services, 97 Protecting Water Quality: Tampa Bay, Florida, 100 Optimizing Ecosystem Services in the Face of Global Increases in Human Consumption and Population Growth, 108 Discussion, 113 References, 115 9 CLOSING OBSERVATIONS 117 APPENDIXES A WORKSHOP AGENDA 119 B SPEAKER BIOGRAPHICAL SKETCHES 125