The Roses Ocean and Human Health Chair: A New Way to Engage the Public in Oceans and Human Health Challenges

Involving and engaging stakeholders is crucial for studying and managing the complex interactions between marine ecosystems and human health and wellbeing. The Oceans and Human Health Chair was founded in the town of Roses (Catalonia, Spain, NW Mediterranean) in 2018, the fruit of a regional partnership between various stakeholders, and for the purpose of leading the way to better health and wellbeing through ocean research and conservation. The Chair is located in an area of the Mediterranean with a notable fishing, tourist, and seafaring tradition and is close to a marine reserve, providing the opportunity to observe diverse environmental conditions and coastal and maritime activities. The Chair is a case study demonstrating that local, collaborative, transdisciplinary, trans-sector, and bottom-up approaches offer tremendous opportunities for engaging coastal communities to help support long-lasting solutions that benefit everyone, and especially those living by the sea or making their living from the goods and services provided by the sea. Furthermore, the Chair has successfully integrated most of its experts in oceans and human health from the most prestigious institutions in Catalonia. The Chair focuses on three main topics identified by local stakeholders: Fish and Health; Leisure, Health, and Wellbeing; and Medicines from the Sea. Led by stakeholder engagement, the Chair can serve as a novel approach within the oceans and human health field of study to tackle a variety of environmental and public health challenges related to both communicable and non-communicable diseases, within the context of sociocultural issues. Drawing on the example provided by the Chair, four principles are established to encourage improved participatory processes in the oceans and human health field: bottom-up, “think local”, transdisciplinary and trans-sectorial, and “balance the many voices”.

In collaboration with the Institute of Marine Sciences (ICM-CSIC), the D.G Fisheries of the Government of Catalonia, the Fisheries Local Action Group (FLAG) Costa Brava, the Catalan Institute of Oncology, local professional fisheries. associations, fishmongers, fish restaurants, and fish processing plants Goal: to evaluate the health risks in seafood (parasites and heavy metals)

Social studies with health repercussions
Research study on the social determinants of health, including equitable access to marine resources among people from different ethnic groups In collaboration with the Social Anthropology Dept. of the Autonomous Barcelona University, the Fisheries Local Action Group (FLAG) Costa Brava, local professional fisheries associations, and fishmongers Goal: to integrate the sociocultural issues in the OHH field Table S2. International and local/regional cornerstone strategies endorsed by the Chair, together with a short description of each.

Level Cornerstone strategy Description References
International One Health and Planetary Health approaches Two worldwide strategies for expanding interdisciplinary collaborations and communications in all aspects of health care for humans, animals, and the environment to safeguard the health of the environment and humans. Lerner et al., 2017Hill-Cawthorne, 2019 Precautionary principle A worldwide strategy initially designed for approaching issues of potential environmental risks when extensive scientific knowledge on the matter is lacking, but can also be extended into public health Kriebel et al., 2001Sand, 2000 Sustainable Development Goals of the UN's 2030 Agenda for Sustainable Development.
A worldwide strategy, the goals of which include the conservation of the seas and oceans, the sustainable use of the marine resources, the promotion of a healthy life, the preservation of people's wellbeing, and the reduction of inequalities. In particular SGD no. 14: Conservation and sustainable use of the oceans, seas, and marine resources.  Kim et al., 2009Trainer et al., 2015Dallinger et al., 1987 Current and emerging health risks of seafood consumption leading to acute or chronic health diseases such as nervous system diseases, allergies, gastrointestinal diseases, reproductive system Berdalet et al., 2016;González et al., 2018; Microplastics Toxins in seafood (e.g. shellfish) from Harmful Algal Bloom (HABs) species (certain dinoflagellates and cyanobacteria).

Pathogenic organisms (vectors):
Bacteria, virus and parasites Smith et al., 2018Johnson et al., 2013 diseases, immune diseases, and chronic inflammation (which increases the risk of cancer). González et al., 2019;Prata et al., 2020;Trabalón et al., 2017;Vilavert et al., 2017 Air, water and noise pollution from maritime recreational activities Maritime cruising Leisure motor boating Perić et al., Maragkogianni et al., 2015Rako et al., 2013 Air and water pollution from leisure boats and cruise ships (e.g., bad air quality on the decks of cruise ships and in the vicinity of ports and berths) may affect both users' health and that of other citizens (e.g., swimmers, local residents, etc) Quality reduction or loss of blue spaces where citizens can practice healthy outdoor activities. Specific health risks for certain sea users (e.g., swimmers and surfers) posed by exposure to toxic algae (e.g., Ostreopsis) and antibiotic resistant strains of bacteria (e.g., E. coli). Borja et al., 2020;Vila et al., 2016 Impacts of global change on vulnerable marine species with bioactive potential

Loss of biodiversity / Risk of extinction Mass mortalities of certain taxa
Oxygen limitation and acidification Declining populations Casoli et al., 2017;Peters, 2019;Verdura et al., 2019 Loss of the opportunities that the bioactive potential of these species represent for discovering new medicines (e.g., antiviral, antifungal, antibacterial, and particularly antitumoral) within the framework of marine biotechnology.

Carreño and Lloret, 2019
Marine protected areas (MPAs) as a management tool for preserving the marine ecosystems and promoting better health and wellbeing.
Protection of fish stocks. Protection of blue spaces. Protection of species with bioactive potential. Protection of biodiversity.  Table S4. List of major human health issues and associated goals within the framework of OHH proposed by the Chair's stakeholders. Key references used are shown.

Health issue Goal Key references
Sociocultural and economic factors related to health (health inequalities).
Consider the equal and fair access to safe, nutritious, and sustainable seafood by different collectives and ethnic groups. Consider the salutogenic effects of leisure activities and coastal proximity among socioeconomically deprived communities since these effects could be stronger among these populations. Leppo et al., 2013;Miller et al., 2012 Community health promotion and engagement.
Improve health and wellbeing outcomes by promoting a healthy, active life on the coast or in the sea through the design of "Blue Prescriptions" (similar to the so-called "Green Prescriptions"), as part of patients' health management in primary care centers. Embrace the "asset approach" and the "salutogenic model", which value the capacity, skills, knowledge, connections, and potential in a community (with particular emphasis in empowering women in community health) Improvement and Development Agency (Great Britain), 2010; Lindström et al., 2005 Blue Spaces as a tool for the improvement of the individual and collective wellbeing of particular vulnerable and at-risk populations.
Propose blue spaces as sites where vulnerable and at-risk populations such as migrants and refugee communities, patients recovering from clinical treatments, and the elderly can carry out healthy activities Departament de Salut, Generalitat de Catalunya, 2014; Gascon et al., 2017;Vert et al., 2019 Historic wisdom: traditional diet and therapies.
Rediscover the importance of maritime leisure activities to prevent and/or restore health by learning from history regarding the use of the coast and the seas.
Rediscover the importance of seafood as a component part of the so-called "Mediterranean diet", including the promotion of exploited, sustainable species that have fallen into disuse and that may contribute to a balanced diet Better understand of the evolution of coastal communities towards medicalization in the 20th century. Mentella et al., 2019;Schwingshackl et al., 2017 Blue zones Understand why people live longer (areas with a high percentage of centenarians) and enjoy a better quality of life (so-called Blue Zones) in certain areas and communities located on the coast. Buettner et al., 2016 Prevention of non-communicable diseases (NCDs) Promote seafood in the diet and/or physical activity on the coast and at sea to help prevent diseases such as cardiovascular diseases, cancer, and mental disorders. https://www.seafish.org/promotingseafood