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9 Closing Observations Paul A. Sandifer, Ph.D. Chief Science Advisor, National Ocean Service, National Oceanic and Atmospheric Administration In closing, Paul Sandifer reminded the participants that this workshop began with an exploration of ocean ecosystem services, as well as how one begins to measure both ecosystem services and their connections to human health. He noted that the impacts of a variety of stressors were considered and there appears to be much more known about stressors’ impacts on the environment and much less understood about the resulting health outcomes for humans. Both direct and indirect connections to human health are evident but measuring health outcomes remains more difficult. Sandifer reminded the participants that during the workshop, great examples of site-specific issues were presented for Puget Sound, the Great Lakes, the Gulf of Mexico, and the Aral Sea. The talks highlighted challenges like storm protection and ecosystem restoration, as well as the potential for aquaculture, sustainable fisheries, and advances in other areas to contribute to improved global food security. Presentations effectively made connections among oceans, coast, land, land use, populations, and in some cases health. But again, he said, the metrics for human health impacts from diminished coastal ecosystem services are largely lacking. This should be a prime area for further exploration. Sandifer noted that ecosystem services are the benefits to humans provided by ecosystems. He appreciated that this workshop looked at coastal ecosystem services in the specific context of how they support and affect human health and well-being, and considered how changes in ecosystems and related services can affect many benefits to humans that are taken for granted. Changes in ecosystems can have substantial effects on health and well-being, including mental health issues associated with job security or recreation or specific disease processes related to 117

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118 ECOSYSTEM SERVICES AND HUMAN HEALTH environmental exposures. Overall, this workshop made connections to a wide range of environmental health sciences topics and set the stage for further thinking about the nexus of ecosystem services and health, not only for this Roundtable but also with regard to the application of long- term research and investments in the environmental sciences.