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Conservation of Wetlands and Other Coastal Ecosystems: a Commentary on their Value to Protect Biodiversity, Reduce Disaster Impacts, and Promote Human Health and Well-Being

Conservation of Wetlands and Other Coastal Ecosystems: a Commentary on their Value to Protect... There is substantial, growing literature that details positive human health effects, psychological and physiological, of exposure to Bnature,^ including Bgreen^ and Bblue space,^ with evidence suggesting that diversity of species or environments may have specific positive human health benefits. These health benefits are important ecosystem services provided by healthy ecosystems. In this paper, we discuss several critical ecosystem services provided by wetlands including disaster risk reduction, with an emphasis on benefits to human health and well-being. Impacts to human health via damage to ecosystem services from disasters have rarely been considered in disaster planning or mitigation, nor have the health benefits been part of the framework for planning urban greenspaces and land-use. Coastal wetlands can be part of Bnatural and nature-based^ solutions, minimizing the impacts of disasters by buffering coastal communities from storms and erosion and absorbing flood waters. In addition, mental and physical health benefits of experiencing healthy wetlands could offset some stress and disease encounters related to disasters. Thus, coastal wetlands should be part of a strategy for reducing the risk posed by disasters and facilitating recovery. We conclude with recommendations for research priorities and specific inclusion of wetlands in coastal community planning for disaster response and recovery. . . . Keywords Green & blue space Natural and nature-based infrastructure Disaster planning, response and recovery Urban planning and land-use Human health Introduction health benefits to people of all ages, gender, ethnicities, and socio-economic status (e.g., see Jiang et al. 2014; Sandifer It is now well established that exposure to Bgreen^ spaces of et al. 2015; Jiang et al. 2016; White et al. 2016; Cox et al. many kinds (e.g., parks and protected areas that are more 2017; Frumkin et al. 2017; Van den Berg 2017; White et al. natural and biodiverse) and that include water or coasts 2017). There are several theories about how nature experi- (Bblue^) provides a broad suite of mental, physical, and social ences produce health benefits, such as encouraging physical activity (Bauman et al. 1999; Depledge and Bird 2009; Barton and Pretty 2010), promoting attention restoration (Kaplan 1995) and reducing stress and anxiety (Ulrich et al. 1991). * Ariana E. Sutton-Grier However, much work remains to be done to identify and un- ariana.suttongrier@gmail.com derstand mechanisms of action, causality, dose-response char- acteristics, and other factors (Sandifer et al. 2015;Frumkin The MD/DC Chapter of The Nature Conservancy, 425 Barlow Rd, et al. 2017). Nonetheless, available information is sufficiently Bethesda, MD 20814, USA robust that a growing number of medical practitioners is al- Earth System Science Interdisciplinary Center, University of ready prescribing nature exposure (green space, parks, coasts) Maryland, College Park, MD, USA for certain patients (Poulsen et al. 2015; Wessel 2017;Zarr College of Charleston, Center for Coastal Environmental and Human et al. 2017), although this trend is still in relative infancy Health, Hollings Marine Laboratory, 331 Fort Johnson Road, (Haubenhofer et al. 2010; Van den Berg 2017). Charleston, SC 29412, USA 1296 Wetlands (2019) 39:1295–1302 Linking Nature Exposure, Ecosystem Services, According to the Valencia Declaration (Delegates of The Biodiversity, and Human Health World Conference on Marine Biodiversity 2008), BMarine biodiversity underpins the functioning of marine ecosystems Because most, if not all, ecosystem services are important to and their provision of services - without biodiversity there human health and well-being (MEA 2005), Sandifer and would be no ecosystem services.^ Wetlands, especially tidal Sutton-Grier (2014) characterized human health as the marshes and mangroves, are widely considered to be the most, Bcumulative or ultimate^ ecosystem service (see also or at least among the most, valuable of our ecosystems in Frumkin et al. 2017). Healthy ecosystems provide high quality terms of contributions of ecosystem services (Costanza et al. ecosystem services while stressed ecosystems produce de- 2014;Mitsch etal. 2015), and their biodiversity provides an graded services that may cause negative psychological and essential foundation for the sustained production and delivery physical health effects (Sandifer and Sutton-Grier 2014; of ecosystem services. However, the loss of native biodiver- Sandifer et al. 2015). With the exception of hydraulic head, sity along our coasts already has resulted in both diminished mechanical filtration, and a few others, most ecosystem ser- ecosystem capacity to provide ecosystem services and in- vices are, to one degree or another, supported by biodiversity creased health threats to humans from harmful microbes, ex- (Palumbi et al. 2009). Biodiversity-supported ecosystem ser- treme weather, chemical contaminants, etc. (Worm et al. vices that support human well-being can be lumped into a 2006). Although our knowledge of how marine biodiversity variety of categories for ease of consideration, such as im- and ecosystem services are causally linked remains poorly proved psychological health; enhanced physiological condi- developed (Ricketts et al. 2016), we know that functional tion; decreases in some inflammatory-based illnesses and oth- diversity is especially important (Diaz et al. 2006) and we er non-infectious diseases; decreased transmission of certain have sufficient understanding to support the conservation of infectious diseases; aesthetic, cultural, recreational, socio- biodiversity as an essential element in sustaining critical eco- economic and spiritual benefits; and tangible materials such system services (Palumbi et al. 2009). as food, fiber, and medicines (Sandifer et al. 2015). In addi- Biodiversity also may play complex roles in the occurrence tion, exposure to rich microbial biodiversity in managed eco- and transmission of disease. Based on an extensive review of systems, such as traditional farms and in more rural areas, also the literature, Sandifer et al. (2015) posited that global biodi- has been found to support human immune functioning with versity losses may be contributing to increasing prevalence of several examples of children growing up on farms having a variety of inflammatory-based diseases, such as allergies, lower incidences of conditions such as asthma (Debarry asthma, some cardiovascular disease, irritable bowel disease, et al. 2007; Ege et al. 2011; Ruokolainen et al. 2017c). From type 2 diabetes, some obesity, and others. They presented this and other evidence we infer that exposure to biodiversity findings from a number of studies that linked development of healthy human gut and skin microbiota to exposure, espe- in both more natural as well as some managed ecosystems, such as traditional farms, can support human immune function cially during childhood, to environments with diverse micro- and a reduction in disease burden. biota, and in turn linked healthy human microbiota to better immune function and less inflammatory disease (Lynch et al. 2014; Ruokolainen et al. 2015). More recent studies, such as Wetland Ecosystem Services and Biodiversity those by Ruokolainen et al. (2017a, b) provide added support Are Important for Human Health for what has been termed the Bbiodiversity^ or Bhygiene^ hypothesis. As Ruokolainen et al. (2017b) stated, BContact The biodiversity in coastal and marine ecosystems, including with beneficial bacteria, particularly early in life, seems to be marshes, mangrove forests, and seagrass meadows (Fig. 1), instrumental to the normal development of immune response.^ is important for providing ecosystem services humans desire In Australia, Liddicoat et al. (2018) found that good respirato- from coastal ecosystems such as fish nursery habitat, water ry health correlated with landscape biodiversity and suggested purification, flood risk reduction, climate modulation, nutri- possible beneficial immunomodulatory effects from ent cycling and others (MEA 2005;Mitsch etal. 2015). In environmental microbiota in diverse areas as a potential addition to these better-known services, coastal wetlands al- mechanism. Wetlands and coasts were included in areas of so produce a broad range of cultural ecosystem services high biodiversity they recommended should be investigated which are often ignored or poorly accounted for in ecolog- further. Lasher et al. (2009) studied the bacterial communities ical analyses. Rodrigues et al. (2017) summarized available in anaerobic marsh soils of Sapelo Island, GA, and found that literature and recorded the following cultural ecosystem ser- overall bacterial diversity was similar to that of terrestrial soils vices from salt marshes, mangroves and seagrass meadows: but with a unique composition. Interestingly, the marsh bacte- recreation and leisure; aesthetic; spiritual; cultural heritage rial community contained representatives of Firmicutes and and identity; educational; inspirational; sense of place; so- Bacteriodetes, two of the bacterial groups to which exposure cial; scientific; and existence. was negatively associated with allergic reactions in young 1297 Wetlands (2019) 39:1295–1302 A variety of studies have examined the role of local biodi- versityontransmissionofinfectious diseases that affect humans, generally through effects of species and habitat di- versity on the abundance, behavior, or condition of hosts, vectors, or parasites. Some studies have shown a positive ef- fect of biodiversity in reducing disease transmission (e.g., see Young et al. 2014), but overall the evidence is equivocal and may depend on the disease and also the scale at which the relationship is examined. Because there was no clear, generally applicable answer as to whether biodiversity may positively or negatively affect human risk of acquiring infectious disease, Sandifer et al. (2015) suggested that dis- eases and circumstances should be considered on a more or less case by case basis but recommended continued applica- tion of a precautionary approach and strengthening of biodi- versity conservation for human well-being benefits. More re- cently, Ostfeld and Keesing (2017) found strong evidence for an infectious disease protection function of high biodiversity. Potential roles of coastal wetlands and wetland biodiversity in reducing human disease burdens of both infectious and non- infectious etiology deserve additional study. For wetlands specifically, there is limited but growing evi- dence that they do help prevent disease transmission, although this function has not been linked specifically to biodiversity but more to wetland presence and area. For example, De Jesus Crespo et al. (2018) (in this issue) found a relationship between the occurrence of dengue and the presence of wetlands in neighborhoods in San Juan Bay Estuary (SJBE), Puerto Rico. Dengue occurrence was lower in neighborhoods with higher wetland cover even after controlling for population density and other socio-economic aspects. Similarly, Skaff and Cheruvelil (2016) reported that incidence of West Nile Virus in humans was lower in US counties with higher average wetland size compared to those with lower wetland size, but apparent wet- land effects were also related to the dominant species of mos- quito vector and drought status. Lamb et al. (2017) determined that when seagrasses were present there was a 50% reduction in bacterial pathogens capable of causing disease in humans and marine organisms. Corals adjacent to seagrasses showed two- fold reductions in disease levels compared to corals at sites without adjacent seagrasses. The researchers designed this study following field work in coral reefs in Indonesia after Fig. 1 Coastal wetland ecosystems that provide many important which everyone who went in the water got amoebic dysentery ecosystem services include: (a) Coastal salt marshes, such as this one in (Bittel 2017). This ledtheresearcherstoreturntothe sitetotake Waquoit Bay National Estuarine Research Reserve, Massachusetts, USA; water samples where they determined that levels of (b) mangroves, such as these in from Sian Ka’an Biological Preserve in Mexico; and (c) seagrass meadows. Photos: (a & b) A. Sutton-Grier and Enterrococus, a bacteria that can cause vomiting, nausea, and (c) Commission for Environmental Cooperation (CEC) diarrhea, in some areas were much higher than recommended levels but were far lower in the seagrass meadows (Bittel 2017). children (Lynch et al. 2014). Thus, while evidence is yet frag- There may be many more direct, positive health benefits of mentary, there is ample reason to develop and test hypotheses exposure to coastal wetlands that have not yet been discovered. that wetland biodiversity, and more specifically wetland micro- This is a field of research with a great deal of potential. bial biodiversity, may provide health protective benefits for There is also new evidence that suggests that exposure to humans, both from infectious and inflammatory-based diseases. coastal, river, lake and other freshwater ecosystems (termed 1298 Wetlands (2019) 39:1295–1302 Bblue^ space) as well as greenspace, has important mental and is growing scientific evidence that wetlands and other coastal physical health and well-being benefits for humans (Nichols ecosystems can play significant roles in storm, flood and ero- 2014). This research into the health benefits of water exposure sion risk reduction for coastal communities (Tanaka et al. has several descriptors including BBlueHealth^ (Grellier et al. 2007; Gedan et al. 2011; Shepard et al. 2011; Arkema et al. 2017), the BBlue Gym^ (Depledge and Bird 2009; White et al. 2013; Bouma et al. 2014; Ferrario et al. 2014;Möller et al. 2010, 2016), and simply Bblue space^. Water features typical- 2014; Narayan et al. 2016) and conservation of biodiversity ly attract a lot of people and promote physical activity such as (Scholte et al. 2016). Coastal ecosystems, particularly man- running or walking along the shore of a lake or along a beach groves, salt marsh and coral reefs, help reduce wave heights, (Volker et al. 2016). In addition, water is an important part of capture water and sediment, and assist in shoreline stabiliza- restorative experiences and helps people feel a stronger con- tion, reducing the level of flooding and damages, thereby de- nection with a place (Volker et al. 2016), ocean views provide livering important protection for vulnerable coastal communi- people with greater peace of mind (Peng et al. 2016), and ties (Sutton-Grier et al. 2015 and references therein). These those who live nearer the coast tend to be healthier (Wheeler risk reduction benefits have substantial economic value for et al. 2012), all of which suggest that there are many health coastal communities. For example, Narayan et al. (2017)de- benefits of coastal environments, including benefits for psy- termined that coastal wetlands avoided $625 million in direct chological well-being. However, more research on the mech- flood damages during Hurricane Sandy. anisms by which water exposure has these beneficial health Perhaps of equal importance is a role that wetlands and outcomes is greatly needed, as well as more consistent ways to other natural coastal ecosystems may play in providing di- measure the long-term health benefits of Bblue^ contacts rect mental and physical health benefits to those impacted by (Gascon et al. 2015). Despite the limitations in data, however, disasters. People are often stressed for weeks to months or several studies provide evidence for measurable health bene- longer post-disaster because their livelihoods have been fits, particularly for mental health, of water exposure including upended and they are concerned about how disasters will coastal environments. impact their families, neighborhoods, incomes, and future economic prospects (e.g., see Sandifer et al. 2017 and references therein). Although, to our knowledge, there has Potential to Leverage Health Benefits been relatively little research into the potentially significant of Wetlands in Disaster Planning, Response, roles that green and blue space can play in disaster recovery, and Recovery there is evidence to suggest that contact with nature might be an effective way to reduce health problems, including Disasters affecting coastal areas typically include major storms, stress, post-disaster. For example, exposure to natural and such as hurricanes, extreme precipitation events that result in biodiverse areas reduces both mental and physical stress wide-spread flooding, droughts, post-earthquake tsunamis, as symptoms, supports attention restoration, and improves cog- well as man-made or exacerbated technological and natural nition (Sandifer et al. 2015). Thus, it may be possible to help disasters such as the 2010 Deepwater Horizon oil spill in the alleviate mental and physical stress after a disaster by pro- Gulf of Mexico and recent wildfires in California. These events viding opportunities for at-risk individuals to experience in- are very damaging to coastal communities and can have long- creased exposure to healthy natural and biodiverse environ- term impacts on communities, economies and human health ments, including saltmarshes and other wetlands (e.g., and well-being, including mental and physical health and stress Poulsen et al. 2015; Wessel 2017;Zarret al. 2017 and the levels (IOM (Institute of Medicine) 2007;Palinkas 2012; National Park Service’s Park Rx program [www. Parkrx.org] Leaning and Guha-Sapir 2013; Adkins 2015; Shultz et al. about prescriptions for nature contact). Coastal and other 2015;Laffonet al. 2016;Sandiferetal. 2017). During 2017 environments that provide opportunities for wildlife alone, the US experienced 16 separate weather and climate- viewing have been identified as having some health associated disasters, including hurricanes, severe storms, a promoting effects (de Bell et al. 2017; White et al. 2017), freeze, drought, and wildfires, each of which caused damages especially where Bcharismatic^ fauna such as birds, butter- in excess of $1 billion with a total cost of over $300B, the flies, and flowering plants (e.g., Fuller et al. 2007; McGinlay highest annual total on record (NOAA 2017). Better means et al. 2017; White et al. 2017) can be viewed. Also, a variety of preparing for, coping with, and recovering from such trau- of nature-assisted therapies have been and are being tried to matic but all too frequently occurring Bextreme events^ is a treat post-traumatic stress disorders and other stress-related significant need here and elsewhere around the world. mental illness (e.g., Poulsen et al. 2015; Pálsdóttir et al. One approach to improve the protection and resiliency of 2018). Salt marshes, mangroves, and freshwater wetlands coastal communities is use of natural or Bgreen^ infrastructure can provide wonderful and peaceful opportunities for resto- or combinations of natural and built (Bgreen^ + Bgray^)infra- ration and reflection and also regular opportunities for en- structure (Sutton-Grier et al. 2015, 2018). In this regard, there counters with birds and other interesting wildlife. 1299 Wetlands (2019) 39:1295–1302 To be clear, we are not suggesting that disaster man- would likely increase the visibility of these wetland func- agers, and in particular first responders, should change tions among the public, with consequent increases in pub- their focus from providing immediate help and care for lic support for conservation and restoration of wetlands people who are struggling to find safety, food, shelter, and their biodiversity. Raising awareness could lead to and medical care. But for longer-term recovery from ma- additional partners helping to fund and support coastal jor storms or oil spills, which often takes months to protection and restoration projects for coastal resilience. years, it could be useful for disaster response efforts to incorporate access to healthy coastal ecosystems to sup- port mental restoration and reduce anxiety and stress Conclusions among disaster victims. And in the pre-disaster planning phase, it would be useful to consider the roles that There is potential to improve the resilience of coastal com- healthy coastal wetlands and other ecosystems play in munities to major disasters by incorporating into disaster promoting community resilience and human health. planning and response efforts more natural landscapes and These benefits are often overlooked or given little atten- protecting, restoring, and creating green and blue spaces. It tion in disaster planning and response. We hope that this should go without saying that this investment in natural Commentary will reach a broad audience, including ex- infrastructure should be in conjunction with building and perts in disaster response as well as scientists, so that maintaining other critical infrastructure such as roads and more people will consider the multiple benefits coastal bridges. Since the funding for natural infrastructure projects wetlands provide and routinely incorporate them in ef- such as wetland restoration often comes from different forts to increase coastal community resilience. sources than the funding for other critical infrastructure, One way that coastal communities might include wetlands these do not have to be in competition but instead could and other coastal ecosystems in resilience and disaster plan- work together to increase the resilience of coastal communi- ning activities could be via appending a Bnature-based ties and ecosystems. Using this approach, coastal communi- solutions^ section to emergency preparedness plans. Such an ties can both reduce the impacts of disasters and help people addendum could encompass contributions coastal wetlands recover from the stress and some other health impacts asso- and their functions can make to disaster preparation, response, ciated with catastrophes. and recovery including but not limited to: (1) storm protection, It is also important to note that, despite a significant ac- wave attenuation, and sediment control; (2) trapping, filtra- cumulation of evidence on disaster reduction and health ben- tion, and sequestration for carbon, nutrients, a variety of pol- efits of green, blue and biodiverse spaces, there are still lutants, and infectious disease-causing microorganisms); (3) many more questions remaining for which we need addition- water capture, management, supply, flow and flood control; al research and evidence-based answers. This makes it chal- and (4) trauma recovery and alleviation of stress and anxiety lenging to help communities and cities incorporate more for people affected by a specific disaster. Incorporating coastal green and blue spaces into their design and growth because wetland functions broadly into coastal planning could occur at we do not know yet exactly which characteristics of green the national and state levels but might be most effective at and blue spaces elicit human health benefits (Flies et al. county and municipal levels where both disaster impacts and 2017). Some of these research needs we have highlighted response effects are greatest. already (Sandifer et al. 2015), and there have also been other The roles of natural and restored wetlands in support of efforts to specify research priorities (Flies et al. 2017; human health and well-being could also be incorporated Frumkin et al. 2017). Frumkin et al. (2017) laid out seven into ongoing coastal resilience and restoration activities of domains of nature-health research that need further attention, the US Army Corps of Engineers (USACE). USACE does including better understanding of the psychological and a substantial amount of wetland restoration work and is physiological mechanisms by which nature improves human starting to include more natural and nature-based (NNBF) health, determining how best to measure Bnature contact^ features in their coastal resilience projects (Bridges et al. and doses, identifying which elements of nature exposure 2015). In addition, USACE is leading an effort to develop matter, and incorporating roles of human diversity and equity additional guidance for when and how to use NNBF fea- issues with regard to access to nature. We agree with their tures; this guidance includes the ecosystem services pro- recommendations and suggest that in addition, these research vided by NNBF and we suggest it should include a dis- domains should be expanded to include blue spaces, partic- cussion of health benefits as well. ularly coastal environments and their wetlands. Further, pub- Another important reason for highlighting the myriad licizing their importance for human health promotion and roles of natural and restored coastal wetlands to protection disaster impact reduction could help generate strong, addi- of human life and property in emergency plans and by tional public support for biodiversity and wetland conserva- emergency management officials is that such inclusion tion and restoration activities. Based on observations here, 1300 Wetlands (2019) 39:1295–1302 our previous research, and the comprehensive lists in with more natural areas daily; (2) how we can plan and recon- Frumkin et al. (2017), some of the research questions or figure developed coastal areas to better capitalize on the nat- topics we think are most important to tackle include: ural storm impact reduction characteristics of coastal wetlands and other ecosystems while simultaneously leveraging those 1. How do coastal wetlands and their biodiversity support ecosystems to provide people with restorative experiences to ecosystem services that promote human health and well- help reduce anxiety, depression, and assist them in recovering being and what are the mechanisms by which this health from disasters more quickly; and (3) how we can design and enhancement occurs? conduct ecosystem restoration and protection projects in ways 2. Do greenspace prescriptions provide quantifiable health that best conserve biodiversity and provide a diversity of rec- benefits for people, especially children? reational nature exposure experiences for people. Focusing on 3. How does biodiversity produce psychological and phys- research to answer some of the most pressing questions, such iological human health benefits? What physiological and as those noted above, will equip scientists, urban planners, and psychological mechanisms are involved and how do policy makers with critical information to enable society to they operate to produce positive health effects? build more sustainable and resilient cities and communities 4. Is it feasible to use biodiversity metrics as proxies and maintain and protect healthy ecosystems. to identify and quantify certain health effects of Acknowledgements Thank you to Brent Murray for organizing a special nature exposure? session at the Society for Wetland Scientists meeting in 2017 which led to 5. Can we measure the potential immunomodulatory ef- this special feature. A. Sutton-Grier was partially supported by the fects of differing levels and kinds of environmental mi- National Oceanic and Atmospheric Administration (NOAA) Grant crobiota, in particular those associated with wetlands? NA14NES4320003 (Cooperative Institute for Climate and Satellites – CICS) at the University of Maryland/ESSIC. 6. What characteristics of Bblue spaces^ (water) are associ- ated with health benefits and how might these benefits occur? How may biodiversity of coastal and freshwater Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http:// wetlands support the production and delivery of health creativecommons.org/licenses/by/4.0/), which permits unrestricted use, benefits? 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Proceedings of the National Academy of Sciences GeoHealth 1:1–20 of the United States of America 111:7036–7041 Scholte SSK, Todorova M, van Teeffelen AJA, Verburg PH (2016) Public Zarr R, Cottrell L, Merrill C (2017) Park Prescription (DC Park Rx): A support for wetland restoration: what is the link with ecosystem New Strategy to Combat Chronic Disease in Children. Journal of service values? Wetlands 36:467–481 Physical Activity & Health 14:1–2 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png "Wetlands" Springer Journals

Conservation of Wetlands and Other Coastal Ecosystems: a Commentary on their Value to Protect Biodiversity, Reduce Disaster Impacts, and Promote Human Health and Well-Being

"Wetlands" , Volume 39 (6) – Dec 11, 2019

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Springer Journals
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Copyright © The Author(s) 2018
ISSN
0277-5212
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1943-6246
DOI
10.1007/s13157-018-1039-0
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Abstract

There is substantial, growing literature that details positive human health effects, psychological and physiological, of exposure to Bnature,^ including Bgreen^ and Bblue space,^ with evidence suggesting that diversity of species or environments may have specific positive human health benefits. These health benefits are important ecosystem services provided by healthy ecosystems. In this paper, we discuss several critical ecosystem services provided by wetlands including disaster risk reduction, with an emphasis on benefits to human health and well-being. Impacts to human health via damage to ecosystem services from disasters have rarely been considered in disaster planning or mitigation, nor have the health benefits been part of the framework for planning urban greenspaces and land-use. Coastal wetlands can be part of Bnatural and nature-based^ solutions, minimizing the impacts of disasters by buffering coastal communities from storms and erosion and absorbing flood waters. In addition, mental and physical health benefits of experiencing healthy wetlands could offset some stress and disease encounters related to disasters. Thus, coastal wetlands should be part of a strategy for reducing the risk posed by disasters and facilitating recovery. We conclude with recommendations for research priorities and specific inclusion of wetlands in coastal community planning for disaster response and recovery. . . . Keywords Green & blue space Natural and nature-based infrastructure Disaster planning, response and recovery Urban planning and land-use Human health Introduction health benefits to people of all ages, gender, ethnicities, and socio-economic status (e.g., see Jiang et al. 2014; Sandifer It is now well established that exposure to Bgreen^ spaces of et al. 2015; Jiang et al. 2016; White et al. 2016; Cox et al. many kinds (e.g., parks and protected areas that are more 2017; Frumkin et al. 2017; Van den Berg 2017; White et al. natural and biodiverse) and that include water or coasts 2017). There are several theories about how nature experi- (Bblue^) provides a broad suite of mental, physical, and social ences produce health benefits, such as encouraging physical activity (Bauman et al. 1999; Depledge and Bird 2009; Barton and Pretty 2010), promoting attention restoration (Kaplan 1995) and reducing stress and anxiety (Ulrich et al. 1991). * Ariana E. Sutton-Grier However, much work remains to be done to identify and un- ariana.suttongrier@gmail.com derstand mechanisms of action, causality, dose-response char- acteristics, and other factors (Sandifer et al. 2015;Frumkin The MD/DC Chapter of The Nature Conservancy, 425 Barlow Rd, et al. 2017). Nonetheless, available information is sufficiently Bethesda, MD 20814, USA robust that a growing number of medical practitioners is al- Earth System Science Interdisciplinary Center, University of ready prescribing nature exposure (green space, parks, coasts) Maryland, College Park, MD, USA for certain patients (Poulsen et al. 2015; Wessel 2017;Zarr College of Charleston, Center for Coastal Environmental and Human et al. 2017), although this trend is still in relative infancy Health, Hollings Marine Laboratory, 331 Fort Johnson Road, (Haubenhofer et al. 2010; Van den Berg 2017). Charleston, SC 29412, USA 1296 Wetlands (2019) 39:1295–1302 Linking Nature Exposure, Ecosystem Services, According to the Valencia Declaration (Delegates of The Biodiversity, and Human Health World Conference on Marine Biodiversity 2008), BMarine biodiversity underpins the functioning of marine ecosystems Because most, if not all, ecosystem services are important to and their provision of services - without biodiversity there human health and well-being (MEA 2005), Sandifer and would be no ecosystem services.^ Wetlands, especially tidal Sutton-Grier (2014) characterized human health as the marshes and mangroves, are widely considered to be the most, Bcumulative or ultimate^ ecosystem service (see also or at least among the most, valuable of our ecosystems in Frumkin et al. 2017). Healthy ecosystems provide high quality terms of contributions of ecosystem services (Costanza et al. ecosystem services while stressed ecosystems produce de- 2014;Mitsch etal. 2015), and their biodiversity provides an graded services that may cause negative psychological and essential foundation for the sustained production and delivery physical health effects (Sandifer and Sutton-Grier 2014; of ecosystem services. However, the loss of native biodiver- Sandifer et al. 2015). With the exception of hydraulic head, sity along our coasts already has resulted in both diminished mechanical filtration, and a few others, most ecosystem ser- ecosystem capacity to provide ecosystem services and in- vices are, to one degree or another, supported by biodiversity creased health threats to humans from harmful microbes, ex- (Palumbi et al. 2009). Biodiversity-supported ecosystem ser- treme weather, chemical contaminants, etc. (Worm et al. vices that support human well-being can be lumped into a 2006). Although our knowledge of how marine biodiversity variety of categories for ease of consideration, such as im- and ecosystem services are causally linked remains poorly proved psychological health; enhanced physiological condi- developed (Ricketts et al. 2016), we know that functional tion; decreases in some inflammatory-based illnesses and oth- diversity is especially important (Diaz et al. 2006) and we er non-infectious diseases; decreased transmission of certain have sufficient understanding to support the conservation of infectious diseases; aesthetic, cultural, recreational, socio- biodiversity as an essential element in sustaining critical eco- economic and spiritual benefits; and tangible materials such system services (Palumbi et al. 2009). as food, fiber, and medicines (Sandifer et al. 2015). In addi- Biodiversity also may play complex roles in the occurrence tion, exposure to rich microbial biodiversity in managed eco- and transmission of disease. Based on an extensive review of systems, such as traditional farms and in more rural areas, also the literature, Sandifer et al. (2015) posited that global biodi- has been found to support human immune functioning with versity losses may be contributing to increasing prevalence of several examples of children growing up on farms having a variety of inflammatory-based diseases, such as allergies, lower incidences of conditions such as asthma (Debarry asthma, some cardiovascular disease, irritable bowel disease, et al. 2007; Ege et al. 2011; Ruokolainen et al. 2017c). From type 2 diabetes, some obesity, and others. They presented this and other evidence we infer that exposure to biodiversity findings from a number of studies that linked development of healthy human gut and skin microbiota to exposure, espe- in both more natural as well as some managed ecosystems, such as traditional farms, can support human immune function cially during childhood, to environments with diverse micro- and a reduction in disease burden. biota, and in turn linked healthy human microbiota to better immune function and less inflammatory disease (Lynch et al. 2014; Ruokolainen et al. 2015). More recent studies, such as Wetland Ecosystem Services and Biodiversity those by Ruokolainen et al. (2017a, b) provide added support Are Important for Human Health for what has been termed the Bbiodiversity^ or Bhygiene^ hypothesis. As Ruokolainen et al. (2017b) stated, BContact The biodiversity in coastal and marine ecosystems, including with beneficial bacteria, particularly early in life, seems to be marshes, mangrove forests, and seagrass meadows (Fig. 1), instrumental to the normal development of immune response.^ is important for providing ecosystem services humans desire In Australia, Liddicoat et al. (2018) found that good respirato- from coastal ecosystems such as fish nursery habitat, water ry health correlated with landscape biodiversity and suggested purification, flood risk reduction, climate modulation, nutri- possible beneficial immunomodulatory effects from ent cycling and others (MEA 2005;Mitsch etal. 2015). In environmental microbiota in diverse areas as a potential addition to these better-known services, coastal wetlands al- mechanism. Wetlands and coasts were included in areas of so produce a broad range of cultural ecosystem services high biodiversity they recommended should be investigated which are often ignored or poorly accounted for in ecolog- further. Lasher et al. (2009) studied the bacterial communities ical analyses. Rodrigues et al. (2017) summarized available in anaerobic marsh soils of Sapelo Island, GA, and found that literature and recorded the following cultural ecosystem ser- overall bacterial diversity was similar to that of terrestrial soils vices from salt marshes, mangroves and seagrass meadows: but with a unique composition. Interestingly, the marsh bacte- recreation and leisure; aesthetic; spiritual; cultural heritage rial community contained representatives of Firmicutes and and identity; educational; inspirational; sense of place; so- Bacteriodetes, two of the bacterial groups to which exposure cial; scientific; and existence. was negatively associated with allergic reactions in young 1297 Wetlands (2019) 39:1295–1302 A variety of studies have examined the role of local biodi- versityontransmissionofinfectious diseases that affect humans, generally through effects of species and habitat di- versity on the abundance, behavior, or condition of hosts, vectors, or parasites. Some studies have shown a positive ef- fect of biodiversity in reducing disease transmission (e.g., see Young et al. 2014), but overall the evidence is equivocal and may depend on the disease and also the scale at which the relationship is examined. Because there was no clear, generally applicable answer as to whether biodiversity may positively or negatively affect human risk of acquiring infectious disease, Sandifer et al. (2015) suggested that dis- eases and circumstances should be considered on a more or less case by case basis but recommended continued applica- tion of a precautionary approach and strengthening of biodi- versity conservation for human well-being benefits. More re- cently, Ostfeld and Keesing (2017) found strong evidence for an infectious disease protection function of high biodiversity. Potential roles of coastal wetlands and wetland biodiversity in reducing human disease burdens of both infectious and non- infectious etiology deserve additional study. For wetlands specifically, there is limited but growing evi- dence that they do help prevent disease transmission, although this function has not been linked specifically to biodiversity but more to wetland presence and area. For example, De Jesus Crespo et al. (2018) (in this issue) found a relationship between the occurrence of dengue and the presence of wetlands in neighborhoods in San Juan Bay Estuary (SJBE), Puerto Rico. Dengue occurrence was lower in neighborhoods with higher wetland cover even after controlling for population density and other socio-economic aspects. Similarly, Skaff and Cheruvelil (2016) reported that incidence of West Nile Virus in humans was lower in US counties with higher average wetland size compared to those with lower wetland size, but apparent wet- land effects were also related to the dominant species of mos- quito vector and drought status. Lamb et al. (2017) determined that when seagrasses were present there was a 50% reduction in bacterial pathogens capable of causing disease in humans and marine organisms. Corals adjacent to seagrasses showed two- fold reductions in disease levels compared to corals at sites without adjacent seagrasses. The researchers designed this study following field work in coral reefs in Indonesia after Fig. 1 Coastal wetland ecosystems that provide many important which everyone who went in the water got amoebic dysentery ecosystem services include: (a) Coastal salt marshes, such as this one in (Bittel 2017). This ledtheresearcherstoreturntothe sitetotake Waquoit Bay National Estuarine Research Reserve, Massachusetts, USA; water samples where they determined that levels of (b) mangroves, such as these in from Sian Ka’an Biological Preserve in Mexico; and (c) seagrass meadows. Photos: (a & b) A. Sutton-Grier and Enterrococus, a bacteria that can cause vomiting, nausea, and (c) Commission for Environmental Cooperation (CEC) diarrhea, in some areas were much higher than recommended levels but were far lower in the seagrass meadows (Bittel 2017). children (Lynch et al. 2014). Thus, while evidence is yet frag- There may be many more direct, positive health benefits of mentary, there is ample reason to develop and test hypotheses exposure to coastal wetlands that have not yet been discovered. that wetland biodiversity, and more specifically wetland micro- This is a field of research with a great deal of potential. bial biodiversity, may provide health protective benefits for There is also new evidence that suggests that exposure to humans, both from infectious and inflammatory-based diseases. coastal, river, lake and other freshwater ecosystems (termed 1298 Wetlands (2019) 39:1295–1302 Bblue^ space) as well as greenspace, has important mental and is growing scientific evidence that wetlands and other coastal physical health and well-being benefits for humans (Nichols ecosystems can play significant roles in storm, flood and ero- 2014). This research into the health benefits of water exposure sion risk reduction for coastal communities (Tanaka et al. has several descriptors including BBlueHealth^ (Grellier et al. 2007; Gedan et al. 2011; Shepard et al. 2011; Arkema et al. 2017), the BBlue Gym^ (Depledge and Bird 2009; White et al. 2013; Bouma et al. 2014; Ferrario et al. 2014;Möller et al. 2010, 2016), and simply Bblue space^. Water features typical- 2014; Narayan et al. 2016) and conservation of biodiversity ly attract a lot of people and promote physical activity such as (Scholte et al. 2016). Coastal ecosystems, particularly man- running or walking along the shore of a lake or along a beach groves, salt marsh and coral reefs, help reduce wave heights, (Volker et al. 2016). In addition, water is an important part of capture water and sediment, and assist in shoreline stabiliza- restorative experiences and helps people feel a stronger con- tion, reducing the level of flooding and damages, thereby de- nection with a place (Volker et al. 2016), ocean views provide livering important protection for vulnerable coastal communi- people with greater peace of mind (Peng et al. 2016), and ties (Sutton-Grier et al. 2015 and references therein). These those who live nearer the coast tend to be healthier (Wheeler risk reduction benefits have substantial economic value for et al. 2012), all of which suggest that there are many health coastal communities. For example, Narayan et al. (2017)de- benefits of coastal environments, including benefits for psy- termined that coastal wetlands avoided $625 million in direct chological well-being. However, more research on the mech- flood damages during Hurricane Sandy. anisms by which water exposure has these beneficial health Perhaps of equal importance is a role that wetlands and outcomes is greatly needed, as well as more consistent ways to other natural coastal ecosystems may play in providing di- measure the long-term health benefits of Bblue^ contacts rect mental and physical health benefits to those impacted by (Gascon et al. 2015). Despite the limitations in data, however, disasters. People are often stressed for weeks to months or several studies provide evidence for measurable health bene- longer post-disaster because their livelihoods have been fits, particularly for mental health, of water exposure including upended and they are concerned about how disasters will coastal environments. impact their families, neighborhoods, incomes, and future economic prospects (e.g., see Sandifer et al. 2017 and references therein). Although, to our knowledge, there has Potential to Leverage Health Benefits been relatively little research into the potentially significant of Wetlands in Disaster Planning, Response, roles that green and blue space can play in disaster recovery, and Recovery there is evidence to suggest that contact with nature might be an effective way to reduce health problems, including Disasters affecting coastal areas typically include major storms, stress, post-disaster. For example, exposure to natural and such as hurricanes, extreme precipitation events that result in biodiverse areas reduces both mental and physical stress wide-spread flooding, droughts, post-earthquake tsunamis, as symptoms, supports attention restoration, and improves cog- well as man-made or exacerbated technological and natural nition (Sandifer et al. 2015). Thus, it may be possible to help disasters such as the 2010 Deepwater Horizon oil spill in the alleviate mental and physical stress after a disaster by pro- Gulf of Mexico and recent wildfires in California. These events viding opportunities for at-risk individuals to experience in- are very damaging to coastal communities and can have long- creased exposure to healthy natural and biodiverse environ- term impacts on communities, economies and human health ments, including saltmarshes and other wetlands (e.g., and well-being, including mental and physical health and stress Poulsen et al. 2015; Wessel 2017;Zarret al. 2017 and the levels (IOM (Institute of Medicine) 2007;Palinkas 2012; National Park Service’s Park Rx program [www. Parkrx.org] Leaning and Guha-Sapir 2013; Adkins 2015; Shultz et al. about prescriptions for nature contact). Coastal and other 2015;Laffonet al. 2016;Sandiferetal. 2017). During 2017 environments that provide opportunities for wildlife alone, the US experienced 16 separate weather and climate- viewing have been identified as having some health associated disasters, including hurricanes, severe storms, a promoting effects (de Bell et al. 2017; White et al. 2017), freeze, drought, and wildfires, each of which caused damages especially where Bcharismatic^ fauna such as birds, butter- in excess of $1 billion with a total cost of over $300B, the flies, and flowering plants (e.g., Fuller et al. 2007; McGinlay highest annual total on record (NOAA 2017). Better means et al. 2017; White et al. 2017) can be viewed. Also, a variety of preparing for, coping with, and recovering from such trau- of nature-assisted therapies have been and are being tried to matic but all too frequently occurring Bextreme events^ is a treat post-traumatic stress disorders and other stress-related significant need here and elsewhere around the world. mental illness (e.g., Poulsen et al. 2015; Pálsdóttir et al. One approach to improve the protection and resiliency of 2018). Salt marshes, mangroves, and freshwater wetlands coastal communities is use of natural or Bgreen^ infrastructure can provide wonderful and peaceful opportunities for resto- or combinations of natural and built (Bgreen^ + Bgray^)infra- ration and reflection and also regular opportunities for en- structure (Sutton-Grier et al. 2015, 2018). In this regard, there counters with birds and other interesting wildlife. 1299 Wetlands (2019) 39:1295–1302 To be clear, we are not suggesting that disaster man- would likely increase the visibility of these wetland func- agers, and in particular first responders, should change tions among the public, with consequent increases in pub- their focus from providing immediate help and care for lic support for conservation and restoration of wetlands people who are struggling to find safety, food, shelter, and their biodiversity. Raising awareness could lead to and medical care. But for longer-term recovery from ma- additional partners helping to fund and support coastal jor storms or oil spills, which often takes months to protection and restoration projects for coastal resilience. years, it could be useful for disaster response efforts to incorporate access to healthy coastal ecosystems to sup- port mental restoration and reduce anxiety and stress Conclusions among disaster victims. And in the pre-disaster planning phase, it would be useful to consider the roles that There is potential to improve the resilience of coastal com- healthy coastal wetlands and other ecosystems play in munities to major disasters by incorporating into disaster promoting community resilience and human health. planning and response efforts more natural landscapes and These benefits are often overlooked or given little atten- protecting, restoring, and creating green and blue spaces. It tion in disaster planning and response. We hope that this should go without saying that this investment in natural Commentary will reach a broad audience, including ex- infrastructure should be in conjunction with building and perts in disaster response as well as scientists, so that maintaining other critical infrastructure such as roads and more people will consider the multiple benefits coastal bridges. Since the funding for natural infrastructure projects wetlands provide and routinely incorporate them in ef- such as wetland restoration often comes from different forts to increase coastal community resilience. sources than the funding for other critical infrastructure, One way that coastal communities might include wetlands these do not have to be in competition but instead could and other coastal ecosystems in resilience and disaster plan- work together to increase the resilience of coastal communi- ning activities could be via appending a Bnature-based ties and ecosystems. Using this approach, coastal communi- solutions^ section to emergency preparedness plans. Such an ties can both reduce the impacts of disasters and help people addendum could encompass contributions coastal wetlands recover from the stress and some other health impacts asso- and their functions can make to disaster preparation, response, ciated with catastrophes. and recovery including but not limited to: (1) storm protection, It is also important to note that, despite a significant ac- wave attenuation, and sediment control; (2) trapping, filtra- cumulation of evidence on disaster reduction and health ben- tion, and sequestration for carbon, nutrients, a variety of pol- efits of green, blue and biodiverse spaces, there are still lutants, and infectious disease-causing microorganisms); (3) many more questions remaining for which we need addition- water capture, management, supply, flow and flood control; al research and evidence-based answers. This makes it chal- and (4) trauma recovery and alleviation of stress and anxiety lenging to help communities and cities incorporate more for people affected by a specific disaster. Incorporating coastal green and blue spaces into their design and growth because wetland functions broadly into coastal planning could occur at we do not know yet exactly which characteristics of green the national and state levels but might be most effective at and blue spaces elicit human health benefits (Flies et al. county and municipal levels where both disaster impacts and 2017). Some of these research needs we have highlighted response effects are greatest. already (Sandifer et al. 2015), and there have also been other The roles of natural and restored wetlands in support of efforts to specify research priorities (Flies et al. 2017; human health and well-being could also be incorporated Frumkin et al. 2017). Frumkin et al. (2017) laid out seven into ongoing coastal resilience and restoration activities of domains of nature-health research that need further attention, the US Army Corps of Engineers (USACE). USACE does including better understanding of the psychological and a substantial amount of wetland restoration work and is physiological mechanisms by which nature improves human starting to include more natural and nature-based (NNBF) health, determining how best to measure Bnature contact^ features in their coastal resilience projects (Bridges et al. and doses, identifying which elements of nature exposure 2015). In addition, USACE is leading an effort to develop matter, and incorporating roles of human diversity and equity additional guidance for when and how to use NNBF fea- issues with regard to access to nature. We agree with their tures; this guidance includes the ecosystem services pro- recommendations and suggest that in addition, these research vided by NNBF and we suggest it should include a dis- domains should be expanded to include blue spaces, partic- cussion of health benefits as well. ularly coastal environments and their wetlands. Further, pub- Another important reason for highlighting the myriad licizing their importance for human health promotion and roles of natural and restored coastal wetlands to protection disaster impact reduction could help generate strong, addi- of human life and property in emergency plans and by tional public support for biodiversity and wetland conserva- emergency management officials is that such inclusion tion and restoration activities. Based on observations here, 1300 Wetlands (2019) 39:1295–1302 our previous research, and the comprehensive lists in with more natural areas daily; (2) how we can plan and recon- Frumkin et al. (2017), some of the research questions or figure developed coastal areas to better capitalize on the nat- topics we think are most important to tackle include: ural storm impact reduction characteristics of coastal wetlands and other ecosystems while simultaneously leveraging those 1. How do coastal wetlands and their biodiversity support ecosystems to provide people with restorative experiences to ecosystem services that promote human health and well- help reduce anxiety, depression, and assist them in recovering being and what are the mechanisms by which this health from disasters more quickly; and (3) how we can design and enhancement occurs? conduct ecosystem restoration and protection projects in ways 2. Do greenspace prescriptions provide quantifiable health that best conserve biodiversity and provide a diversity of rec- benefits for people, especially children? reational nature exposure experiences for people. Focusing on 3. How does biodiversity produce psychological and phys- research to answer some of the most pressing questions, such iological human health benefits? What physiological and as those noted above, will equip scientists, urban planners, and psychological mechanisms are involved and how do policy makers with critical information to enable society to they operate to produce positive health effects? build more sustainable and resilient cities and communities 4. Is it feasible to use biodiversity metrics as proxies and maintain and protect healthy ecosystems. to identify and quantify certain health effects of Acknowledgements Thank you to Brent Murray for organizing a special nature exposure? session at the Society for Wetland Scientists meeting in 2017 which led to 5. Can we measure the potential immunomodulatory ef- this special feature. A. Sutton-Grier was partially supported by the fects of differing levels and kinds of environmental mi- National Oceanic and Atmospheric Administration (NOAA) Grant crobiota, in particular those associated with wetlands? NA14NES4320003 (Cooperative Institute for Climate and Satellites – CICS) at the University of Maryland/ESSIC. 6. What characteristics of Bblue spaces^ (water) are associ- ated with health benefits and how might these benefits occur? How may biodiversity of coastal and freshwater Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http:// wetlands support the production and delivery of health creativecommons.org/licenses/by/4.0/), which permits unrestricted use, benefits? 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