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1 Introduction AIMS OF THE WORKSHOP Lynn R. Goldman, M.D., M.P.H. Vice Chair, Roundtable on Environmental Health Sciences, Research, and Medicine Dean, George Washington University School of Public Health Lynn Goldman set the stage for the workshop by noting that the Roundtable on Environmental Health Sciences, Research, and Medicine was established in 1998 to allow science and technology leaders in environmental health, health care organizations, top administrators in government agencies, representatives from consumer interest groups, representatives in industry, and academicians to convene and discuss current and emerging environmental health issues. The Roundtable seeks not to reach consensus on any particular issue, but rather to engage in rigorous dialogue and sharing of perspectives to forge new directions and solutions. She noted that the definition of the environment adopted by the Roundtable is a broad one—it includes the natural, built, and social environments and their impact on human health. In conducting its work, the Roundtable considers issues from a life-course perspective (i.e., how the environment affects individuals from birth to death) and a life-cycle perspective (i.e., beginning to the end of a process), and it uses multidisciplinary approaches to assess the impacts of environmental change on human health. She provided examples of workshop topics the Roundtable has considered: urban sprawl and its impact on human health, the role of nanotechnology and environmental health, and, most recently, shale gas extraction and human health. These workshop discussions help to illuminate and build understanding of the complex environmental factors that impact human health and provide information that scientists and decision makers can use to promote healthier environments. 1

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2 ECOSYSTEM SERVICES AND HUMAN HEALTH The Roundtable chose to host a workshop to examine the relationship between ecosystem services and human health, and in doing so is forging a new direction for environmental public health, Goldman said. Ecosystem services are the benefits that people obtain from ecosystems. For example, humans rely on the natural environment (e.g., oceans and coastal waters) for essential human services such as providing food and essential dietary nutrients and purifying drinking water. Humans also rely on the environment for the natural cycles that renew the oxygen in the air, reduce carbon dioxide in the air, and recycle nitrogen, Goldman said. The Millennium Ecosystem Assessment (MEA, 2005) concluded that approximately 60 percent of 24 ecosystem services were being degraded or used unsustainably—this percentage is not likely to be lower today, she stated. She noted that while ecosystem services are interdependent, decision makers manage each of these services independently of each other. She concluded that the result can be devastating. For the coastal areas, where a majority of the global populations are living, the loss of mangroves and barrier islands has resulted in significant loss of human health due to coastal flooding. Droughts in the Midwest have resulted in saltwater intrusion of the Mississippi River. For New Orleans parishes, this change requires moving their drinking water intake pipes farther upstream. Goldman noted that these scenarios will continue as climate change continues to be unabated and the economic costs will be staggering. With growing populations and increasing standards of living globally, additional pressures will be on the world’s oceans and waterways to provide essential services. During the workshop, Goldman noted there is a need to discuss the current and future availability and demand for seafood, which currently shows no sign of subsiding. In fact, the Institute of Medicine’s (IOM’s) report Seafood Choices: Balancing Benefits and Risks (IOM, 2006) highlighted the health benefits of the consumption of seafood that is relatively free of contaminants. Fisheries and fish farms will need to be carefully managed for all people to have access to this vital source of omega-3 fatty acids and protein. Currently, many regions around the United States and around the world are in danger of losing these crucial services, she said. Goldman highlighted one example of health effects in an area that lost ecosystem services. The loss of the Aral Sea, due to the diversion of water for irrigation, has been accompanied by many worsening health indices, including increases in infant mortality in the region, rising from 25 per 1,000 live births in 1950 to 70 to 100 per 1,000 live births in

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INTRODUCTION 3 1996. In comparison, she noted that the U.S. infant mortality rate was approximately 7 per 1,000 in 1996. At the same time, the levels of persistent toxics such as organochlorine pesticides, polychlorinated biphenyls, and dioxins have been found at very high levels in blood and breast milk in the Aral Sea region as a result of the overexploitation of the region for growing cotton and other crops. Whether there is a causal association between the levels of toxics and declining health in the Aral Sea region is debatable; however, it is clear, Goldman noted, that without a new approach to ecosystem services, and especially those provided by our multiple uses of ocean and coastal ecosystems, the health of individuals in the United States could be similarly threatened. This workshop provided an opportunity to discuss coastal waters and ocean ecosystem services in the United States and to understand impacts on human health and elucidate key linkages by discussing three questions: 1. What ecosystem services provided by coastal waterways and oceans are essential for human health and well-being? How can these services be valued and what are the consequences of these services being reduced or not provided? 2. What major stressors, both natural and human induced, can affect the ability of coastal waterways and ocean systems to provide essential services? 3. How can we best consider these impacts in decision making? What are the key factors that affect the resiliency of these systems and how can we enhance their resilience? STRUCTURE OF THE SUMMARY The workshop was organized by an independent planning committee,1 whose role was limited to planning the workshop, in accordance with the procedures of the National Research Council. This summary was prepared by the workshop rapporteurs as a factual summary of what 1 The planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the Institute of Medicine, and they should not be construed as reflecting any group consensus.

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4 ECOSYSTEM SERVICES AND HUMAN HEALTH occurred at the workshop. All views presented in the summary are those of the workshop participants. The summary does not contain any findings or recommendations by the planning committee or the Roundtable. The statement of task of the workshop can be found in Box 1-1. The presentations and discussions that occurred during the workshop are summarized in the subsequent chapters. Chapter 2 provides an overview of the conceptual issues surrounding coastal waters and ocean ecosystem services and environmental health. Chapter 3 covers stressors impacting coastal and ocean ecosystem services and human health. Chapter 4 explores connections between seafood supplies and food availability. Chapter 5 considers opportunities for medicines arising from ecosystem services. Chapter 6 follows with links between coastal change and human health. Chapter 7 examines how the benefits of recreational waters can be maintained through monitoring. Chapter 8 presents new approaches for optimizing sustainable solutions to protect ecosystem services and human health. Chapter 9 provides a brief summation of key points discussed at the workshop. The workshop agenda can be found in Appendix A and the workshop speaker biosketches are included in Appendix B. BOX 1-1 Statement of Task An ad hoc committee will plan and conduct a public workshop on the connection of ecosystem services and human health. The committee will focus on oceans, but may draw from other areas of the natural environment. The workshop will feature invited presentations and discussions to look at the state of the science of the role of oceans in ensuring human health and identify gaps and opportunities for future research. The committee will develop the workshop agenda, select invited speakers and discussants, and moderate the discussions. A workshop summary will be prepared by a designated rapporteur in accordance with National Research Council policies and procedures. REFERENCES IOM (Institute of Medicine). 2006. Seafood choices: Balancing benefits and risks. Washington, DC: The National Academies Press. MEA (Millennium Ecosystem Assessment). 2005. Millennium ecosystem assessment. Synthesis report. Washington, DC: Island Press.