IntroductionProximity and access to water have long been central to human culture and accordingly deliver countless societal benefits. Over 200 million people live on Europe’s coastline, and aquatic environments are the top recreational destination in the region. In terms of public health, interactions with ‘blue space’ (eg, coasts, rivers, lakes) are often considered solely in terms of risk (eg, drowning, microbial pollution). Exposure to blue space can, however, promote health and well-being and prevent disease, although underlying mechanisms are poorly understood.Aims and methodsThe BlueHealth project aims to understand the relationships between exposure to blue space and health and well-being, to map and quantify the public health impacts of changes to both natural blue spaces and associated urban infrastructure in Europe, and to provide evidence-based information to policymakers on how to maximise health benefits associated with interventions in and around aquatic environments. To achieve these aims, an evidence base will be created through systematic reviews, analyses of secondary data sets and analyses of new data collected through a bespoke international survey and a wide range of community-level interventions. We will also explore how to deliver the benefits associated with blue spaces to those without direct access through the use of virtual reality. Scenarios will be developed that allow the evaluation of health impacts in plausible future societal contexts and changing environments. BlueHealth will develop key inputs into policymaking and land/water-use planning towards more salutogenic and sustainable uses of blue space, particularly in urban areas.Ethics and disseminationThroughout the BlueHealth project, ethics review and approval are obtained for all relevant aspects of the study by the local ethics committees prior to any work being initiated and an ethics expert has been appointed to the project advisory board. So far, ethical approval has been obtained for the BlueHealth International Survey and for community-level interventions taking place in Spain, Italy and the UK. Engagement of stakeholders, including the public, involves citizens in many aspects of the project. Results of all individual studies within the BlueHealth project will be published with open access. After full anonymisation and application of any measures necessary to prevent disclosure, data generated in the project will be deposited into open data repositories of the partner institutions, in line with a formal data management plan. Other knowledge and tools developed in the project will be made available via the project website (www.bluehealth2020.eu). Project results will ultimately provide key inputs to planning and policy relating to blue space, further stimulating the integration of environmental and health considerations into decision-making, such that blue infrastructure is developed across Europe with both public health and the environment in mind.

In this article, social-economic, legal and ecological perspectives on effectiveness of water quality governance and their interactions have been studied. Worldwide, authorities are facing the challenge of restoring and preserving aquatic ecosystems in accordance with the United Nations Sustainable Development Goals (SDG 6). Over the last few decades, governance approaches have often been used to realise these ambitions. To date, scholars have identified that it is difficult to relate governance approaches to water quality improvement and have offered several different explanations for this. Combined with a targeted conceptualisation of the perspectives and their interactions, the systematic literature review demonstrates the gap that exists in the current understanding of these interactions and what their effects are on water quality improvement, especially in regard to the identification of ecological issues and their boundary conditions for the legal framework and the development of measures and follow-up. The review also reveals that the scientific debate is focused on the planning rather than implementation phase. A step forward can be made by supplementing existing analytical frameworks by the interactions between the different perspectives, especially those related to problem definition and the development and realisation of measures.

The integrated study of ocean health and human health is an emerging area of increasing global importance. Growing evidences demonstrate that the health of the ocean and the health of humans have always been and will continue to be, inextricably linked. Our actions toward the oceans will significantly influence the future of the whole planet and, in turn, our own health. The current review of these issues arose from a summer school in San Sebastian (Spain), from 5th to 7th June, 2019. An interdisciplinary group of researchers discussed key risks (e.g., microbial pollution, pharmaceuticals, harmful algal blooms, plastic pollution) and benefits (e.g., bathing waters, recreation, tourism) of the seas and global ocean for humanity; and debated the future priorities and potential actions for a joint Oceans and Human Health research and governance programme in Europe. The aim of this review is to contribute to the emerging scientific agenda on ocean health and human health, as well as coordinate efforts with stakeholders, policy makers and the general public. This agenda operates within the larger context of the upcoming United Nations Decade of Ocean Science for Sustainable Development: 2021-2030, which strives to achieve the Sustainable Development Goals (SDG), including healthy (human) lives and well-being (SDG3) and conserving and sustainably using the oceans (SDG14), among others. In addition to summarizing some of the key risks and benefits, therefore, we describe the governance of oceans and health interactions (especially in Europe), and we finish by proposing a list of elements for potential future research priorities on oceans and human health.

Clinically relevant antimicrobial resistant bacteria, genetic resistance elements, and antibiotic residues (so-called AMR) from human and animal waste are abundantly present in environmental samples. This presence could lead to human exposure to AMR. In 2015, the World Health Organization (WHO) developed a Global Action Plan for Antimicrobial Resistance with one of its strategic objectives being to strengthen knowledge through surveillance and research. With respect to a strategic research agenda on water, sanitation and hygiene and AMR, WHO organized a workshop to solicit input by scientists and other stakeholders. The workshop resulted in three main conclusions. The first conclusion was that guidance is needed on how to reduce the spread of AMR to humans via the environment and to introduce effective intervention measures. Second, human exposure to AMR via water and its health impact should be investigated and quantified, in order to compare with other human exposure routes, such as direct transmission or via food consumption. Finally, a uniform and global surveillance strategy that complements existing strategies and includes analytical methods that can be used in low-income countries too, is needed to monitor the magnitude and dissemination of AMR.