Keywords: power and agency, human development, human health, well-being, sense of place, food system

Over 40% of the global population and most of the world’s megacities are located in coastal areas (Neumann et al. 2015; Seto 2011), with migration towards urban coastal areas expected to continue beyond 2030 (Merkens et al. 2016; Steffen et al. 2015). The co-location of human population centres at the interface between land and sea has far-reaching effects on the health of our oceans and the health of society (Figure 1; Box 1). Human health is dependent on the ocean because many coastal communities depend on the marine environment for food, shelter, livelihoods, spiritual wellbeing, medicines and other resources (Fleming et al. 2019; Malve 2016). Proximity to coastal areas has also been associated with better quality of life, and enhanced mental health and well-being (Britton et al. 2018; Garrett et al. 2019), due to reductions in stress, improved air quality, relaxation and physically active lifestyles, increased social interactions, and spiritual connection to the ocean (Fleming et al. 2019). At the same time, coastal communities also face ocean-associated risks and are vulnerable to natural disasters such as storm surges (Arkema et al. 2013; Neumann et al. 2015). These desirable and undesirable interactions between society and the oceans affect human health; for example, ocean animals and plants provide essential nutrition for humanity, while oceanic plankton supports oxygen production into our atmosphere. Just as the oceans influence human health, society impacts ocean health, through coastal development, pollution, and industry-driven ecosystem degradation (Halpern et al. 2017). In contrast, close cultural connection with the oceans, can result in significant stewardship and support for the protection or restoration of ocean ecosystems (Ainsworth et al. 2019; Beatley 2014). These links can lead to reinforcing feedbacks that perpetuate desirable or undesirable outcomes. For example, where communities or individuals are unable to meet their basic physiological needs, such as safe, nutritious food, their capacity to engage with higher-level needs such as environmental stewardship is undermined (Maslow 1943). As a result, loss of access to seafood due to ocean degradation may lead to a reduction in stewardship behaviour that leads to further environmental damage.

To address pressing sustainability issues at the intersection of ocean and society, there is a need to promote desirable and minimise undesirable interactions and feedbacks. However, intensifying and diversifying global anthropogenic developments make this a considerable challenge. Firstly human population growth increases society’s pressure on the oceans, for example through rising demand for seafood (Blanchard et al. 2017) and industrialisation of the ocean (Golden et al. 2017). Secondly, large-scale anthropogenically driven environmental change impacts ocean and human health. For example, via adverse impacts on marine productivity (Singh et al. 2019), the increased prevalence of non-communicable diseases such as malnutrition (both under nutrition, e.g. stunting, and poor nutrition, e.g. obesity), and communicable disease such as cholera, (Jutla et al. 2017; Swinburn et al. 2019). Thirdly, there are major geographic inequalities in health outcomes. For example, seafood is a disproportionately a more important protein and micronutrient source in many low-income countries compared to wealthier nations (Golden et al. 2016; Hicks et al. 2019). However, it is also anticipated these same low-income countries will suffer disproportionally from climate change impacts such as the geographic redistribution of their primary seafood resources (Cheung et al. 2010; Lotze et al. 2019; Pecl et al. 2017) and rising sea-levels (Dolan and Walker 2006; Mergler et al. 2007). There are also geographic disparities in ocean health: climate-induced marine species range expansions and extinctions will likely have a greater impact on tropical regions, while invasive species will alter marine communities in polar and Southern seas (Cheung et al. 2009; Pecl et al. 2017). Countries derive different levels of benefit from marine resource extraction, with associated consequences for ocean health. For example, nations that have oil and gas reserves and exploit these resources receive significant revenues. However, they also place disproportionately more environmental pressure on associated marine ecosystem and contribute more to climate change than countries with lesser or no oil and gas reserves (Nixon 2011).

Exploring potential pathways towards a future that supports both ocean and human health is critical to improve society’s capacity to achieve the Sustainable Development Goals (SDGs). In this paper, we identify two scenarios for 2030. The first is Business-as-Usual (BAU), which we title ‘Command & (Out of) Control ’, and which focuses on the anticipated future based on our current trajectory. This BAU scenario assumes a lack of understanding of current or prospective desirable and undesirable feedbacks between ocean and human health has the potential to lead to detrimental decision-making (‘Command’). The result is an ‘out of control’ trajectory of undesirable human and ocean health connections. The second is a more sustainable scenario, which we call ‘Living & Connecting ’, which emphasises the development of desirable interactions between ocean and human health in line with meeting the SDGs. We then explore a potential pathway to achieve the ‘Living & Connecting’ scenario, highlighting key actions to move towards this future. There are two aspects to the future scenarios that should be noted here. Firstly, the futures described below are representative of the authors worldviews and experiences predominately within western cultures, and as such are primarily representative of futures in these contexts. In doing so, we note that these scenarios would differ based on different perspectives (in particular, those from the global south), and thus the interpretation of the pathways presented should be considered within this context. Secondly, in the process of writing these scenarios the COVID-19 pandemic presented the world with new challenges and imposed some major changes to economies and socioecological systems. The business as usual scenario assumes a return to the trajectory underway at the time immediately before COVID-19. We note that current disruptions to the global ocean, environment and society because of COVID-19 may indeed present a platform for change and an opportunity to ‘reset’ trajectories in the coming decade (as discussed in Pecl et al. in prep.).The sustainable future presented here is one option for such a shift.

Under this scenario, looking back from 2030 we can see that GDP has continued along an upward trend, though the disparities in growth within and among countries persist. The blue economy, in particular, is booming, having doubled in value to $3 trillion since 2020. Traditional sectors such as fisheries, shipping, and resource extraction contributed to this growth, but industries that have emerged in recent decades, such as geoengineering, offshore aquaculture, renewable energy and the mining of deep-water, previously unexplored mineral resources continue to add increasing value to the sector (Wan et al. 2018).

An increasing trend in seafood consumption continues to support the health of a burgeoning middle class globally. International coastal tourism continues to expand, along with associated service industries providing revenue and alternate livelihoods for destination communities (Fatanti and Suyadnya 2015; Kim et al. 2017; Liu et al. 2018). Health and wellbeing improve for the select demographic who can afford to take part in these tourism and recreational opportunities and incorporate more seafood into their diet. The result of these trends is that SDG 8 (Decent Work & Economic Growth) and 9 (Industry, Innovation & Infrastructure) were met in many countries. Furthermore, overall poverty has continued to decline (World Bank 2019), and although Sub-Saharan Africa has not attained the growth of other regions, many nations in other regions of the world meet SDG 1 (No Poverty) ahead of the 2030 target (Sachs et al. 2018).

Examples of local and regional policies and consequent management strategies that account for the inextricable links between oceans and humans, such as the Marine Framework Strategy Directive, Integrated Maritime Policy and the Marine Spatial Planning Directive within the EU are now well established (Costa and Caldeira 2018). These frameworks recognise the positive impacts that global oceans have on human health and wellbeing (McMeel et al. 2019), for example, Article 1.2 of the Marine Framework Strategy Directive “prevent and reduce inputs in the marine environment, with a view to phasing out pollution as defined in Article 3(8), so as to ensure that there are no significant impacts on or risks to marine biodiversity, marine ecosystems, human health or legitimate uses of the sea.” (European Commission 2008). This progress and an increased understanding of the links between land, coastal and ocean uses regulated by these policies, has led to positive outcomes for both ocean health and human health. Unfortunately, instances of well-resourced, large-scale, integrated management are not yet widespread, and decision-making around the blue economy, human health and the marine environment are often siloed (Alexander and Haward 2019; Hoegh-Guldberg et al. 2019; Stephenson et al. 2019). As a result, environmental degradation has continued virtually unabated leading to few targets of SDGs 13 (Climate Action), 14 (Life Below Water) or 15 (Life on Land) being met by 2030.

Continued negative trends in environmental conditions, together with rising inequality and vulnerability to food insecurity and disease, contribute to worsening health outcomes for populations with lower socio-economic status (Pickett and Wilkinson 2015; Raworth 2012). Deleterious interactions between ocean and human health that have occurred more frequently since 2020 include, for example, the increasing intensity of natural disasters such as hurricanes (Knutson et al. 2013), which in addition to their direct impacts (e.g. destruction of coastal infrastructure) also negatively impact individual mental and psychological well-being by precipitating anxiety, depression, grief and trauma (Doherty and Clayton 2011). Natural disasters also have a significant impact on shipping, disrupt supply chains, affect food security, and impede access to medicines and other resources on which human health relies (Manners-Bell 2017; McDonald 2018).

Changes in the composition and functioning of estuarine and nearshore ecosystems due to coastal development and climate change, are contributing to long-term declines in coastal marine fisheries (Halpern et al. 2008; Lotze et al. 2019; Vitousek et al. 1997). The prevalence of harmful algal blooms and heavy metals is increasingly affecting the safety of seafood consumption (Cottrell et al. 2019; Fuentes-Gandara et al. 2018; Purcell et al. 2007; Sellner and Rensel 2018; Zhang and Gui 2015). These impacts are significantly reducing gains towards reaching SDG 2 (Zero Hunger). Furthermore, uneven distribution of access to resources, and unequal power among nations and between social classes is exacerbating inequality (SDG 10). Inequality is not only experienced in terms of income and livelihoods; the development of ocean literacy, mental health and stewardship are also negatively affected. For example, a loss of access to marine environments, due to the privatisation of coastlines, physically and emotionally disconnects some people from the oceans (Bennett et al. 2015; Bennett et al. 2018b). These events are leading to poor health outcomes (SDG 3) and in turn are exacerbating environmental degradation (SDG 14 and 15)(Kite-Powell et al. 2008; Pittman et al. 2019; White et al. 2016).

In this scenario, efforts have been made to assess human progress and well-being on a number of dimensions using well-being indicators that complement GDP (e.g. Au and Karacaoglu 2018). As such, human welfare and wellbeing have increased in most places since the start of the UN Decade of Ocean Science, while environmental degradation has slowed.

Local communities are progressively showing increased engagement, and building more sustainable relationships, with the marine environment (Foley and Kistemann 2015; White et al. 2016). Greater participation in activities including marine citizen science and community forums is enhancing individual and community-level environmental literacy (Kelly et al. in press). Engagement is also facilitated in novel ways through the arts. Visual and performing arts play a major role in creating awareness but importantly, benefiting mental and physical human health (e.g. Dirksen 2019; Trihanondo and Endriawan 2019). There is also enhanced knowledge exchange among scientists, community members, policy-makers and marine resource managers (Fernández Otero et al. 2019; Forrester et al. 2017; Kelly et al. 2019; Smith et al. 2019). Furthermore, ‘attachment’ to the oceans arising from engagement activities is reducing environmentally-damaging behaviour among people (van Putten et al. 2018b; Walker and Moscardo 2016). Engagement and the associated increase in literacy is driving a renewed eagerness to support environmental initiatives and positively impacts outcomes of SDG 13 (Climate Action), 14 (Life Below Water) and 15 (Life on Land) (Dean et al. 2019). These changes are having the additional benefit of fostering a greater sense of community (Ainsworth et al. 2019), helping to reduce social challenges such as loneliness and improving mental health outcomes (SDG 3), particularly in western nations (Downward et al. 2017; Rayon-Viña et al. 2019; Wyles et al. 2016).

Slowing environmental degradation is reliant, in part, on the speed and deliberate actions by which we are moving towards a circular economy. The circular economy is key to ocean health because circular process in manufacturing and industrial processes reduce extraction of resources and negative impacts on the marine environment, particularly around eco-engineering, renewable energy and offshore aquaculture (Box 2; Ellen MacArthur Foundation 2019; Falk et al. 2019). A healthy ocean is supported through strong transdisciplinary research and development teams who lead a structured and careful expansion of industry into offshore areas. These careful expansion are facilitated through for instance, the production of multi-use platforms which provide renewable energy, aquaculture, marine bio-resources and biotechnologies, maritime transport and related services, in the same marine space (Marine South East Ltd 2018; Novaglio et al. in review). These changes in ocean health have knock-on benefits for human health via a number of avenues, from improved food safety to aesthetic benefits of a healthy marine environment. Furthermore, participation in the development of circular industry practices and the use of resultant products may help individuals to internalise the value and importance of ocean health, and have it contribute to their own self-identity. This, in turn, has the potential to shape attitudes and behaviours consistent with ocean protection and enhancement.

Positive interactions between ocean and human health have strengthened since 2020; emerging innovations are reducing pollutants entering the oceans, minimising food waste, and have increased access to basic human needs such as adequate nutrition and energy (Circulate Capital LLC 2019; Willett et al. 2019; World Economic Forum 2017). There has also been an increase in the consumption of nutritionally rich seafood by previously food-insecure populations (Farmery et al. in review), reducing levels of micronutrient deficiencies and associated health conditions such as stunting and wasting (Hicks et al. 2019; Ruel et al. 2018). The result of these trends is widespread attainment of a range of SDGs e.g. SDG 1 (No Poverty), SDG 2 (Zero Hunger) and SDG 9 (Industry, Innovation & Infrastructure).

Sustainable expansion of the blue economy is facilitated by integrated management across sectors. In the integrated management approach, the focus is a ‘One Health’ framework, which explicitly on both human and ocean health, and takes account of the feedbacks between them (Stephenson et al. 2019; Wilcox et al. 2019). For example, an online platform to facilitate sharing of information on harmful algal blooms among both environmental and public health agencies (Centre for Disease Control’s One Health Harmful Algal Bloom System - https://www.cdc.gov/habs/ohhabs.html).

An enduring connection between human and ocean health is also ensured by a strong commitment to precautionary approaches to development and explicit consideration of social, economic and environmental trade-offs in natural resource use decision-making (Singh et al. 2017). Furthermore, standardized environmental impact assessments provide more information, which allows for integrated decision-making and cumulative impact assessment across sectors. For example, careful design and placement of new industrial developments (e.g. multi-trophic aquaculture and offshore industries) limits environmental impacts and reduces transportation costs, while maximising the positive influence of these developments on human health and well-being (SDG 3). As a result, there have been significant gains made towards meeting goals and targets focused primarily on the biosphere e.g. SDG 13 (Climate Action), 14 (Life Below Water) and 15 (Life on Land), which were, prior to 2021, showing little progress and were of low priority for many decision-makers (Cutter et al. 2014; GSS 2017).

In this scenario, environmental change still disproportionately affects people of low socio-economic status (Pickett and Wilkinson 2015; Raworth 2012), and inequality remains unacceptably high. However, increases in inequality have slowed since 2020 and have declined appreciably in some locations (SDG 10). The harmful interactions between ocean and human health that have strengthened since 2020 are largely of natural origin (but linked to climate change). For example, the increasing intensity of natural disasters such as hurricanes (Knutson et al. 2013) has a significant impact on human mental and physical health in affected regions. These events disrupt supply chains, affect food security, shipping, psychological safety and access to medicines and other resources on which human health has become dependent (Manners-Bell 2017; McDonald 2018). However, the increasing intensity of natural disasters and volatility in world markets for food and pharmaceutical products is being met by a greater focus on building resilience within communities, particularly among the disadvantaged and food insecure (BlueHealth 2019; Moreno et al. 2019; Sadri et al. 2018). Thus, these communities have an improved capacity to cope with adverse events while addressing concomitant human health issues, positively impacting attainment of SDG 3 (Good Health & Well-being) and SDG 11 (Sustainable Cities & Communities) (e.g. Vogel et al. 2016).

Here we have described two different futures for 2030 with respect to the interactions between human and ocean health, informed by our collective worldviews, perspectives and experiences. These futures are based on 5 key drivers of change that will influence where we end up at the close of the UN Decade of Ocean Science.

The first driver of change incorporates three aspects that influence whether people can, and will, change their individual behaviours. Ourworld view (1) relates to how people perceive the world and value their own health and that of the oceans. Our world view and values directly shape attitudes which guide our individual decision-making and behaviours, and are crucial in determining future outcomes (Goldberg et al. 2018). The context in which decisions are made (2) will indirectly influence behaviour change and determine future outcomes. For example, within a policy context, political agendas, politics and public support (among other things) influence the outcomes. At a practical level, the types of policies and initiatives put in place (3) are also driven by politics, and they will influence how behaviour change is guided to achieve the desired outcomes. All three factors are important as they affect individual and collective behaviours and influence how feedbacks between ocean and society manifest (Klöckner 2013).

In the ‘Living & Connecting’ scenario, the strong feedbacks between human health and environmental health are universally understood. For example, the close links between biodiversity loss, poverty and health is clear (UNEP 2015; UNEP 2019). In addition, there is a stronger focus on the development and implementation of health and environmental initiatives that target behaviour change at the community level. These schemes build community cohesion and social capital, for example, through engagement in beach clean-ups and citizen science projects. The result is policy design, development and implementation that is focused on encouraging community behaviour change that incentivises ocean stewardship, builds community resilience, and focuses on changing social norms to support pro-environmental behaviours (Cinner 2018; Faulkner et al. 2018).

In contrast, in the ‘Command & (Out of) Control’ scenario, although the interactions between human and ocean health are well recognised in environmental, health, and sustainability disciplines, public understanding of these interactions remains limited. Furthermore, policy focusing on health and environmental issues employ a mixture of approaches and are implemented at different scales. For example, in some areas there is a focus on behaviour change initiatives that target the community. However, such efforts are still not well co-ordinated or linked, leading to piecemeal and inconsistent implementation (Bravo et al. 2009; Nelms et al. 2017) which undermine the potential for meaningful gains in this domain. In other areas, individuals are the focus of behaviour change initiatives. These latter approaches are based on behaviour change theories (e.g. the theory of planned behaviour) that place responsibility for change at the level of the individual as opposed to the collective, and assume personal self-efficacy can change behaviours and outcomes (Nutbeam et al. 2010). However, outcomes of such individual level campaigns do not reliably result in long-term behaviour change at a population level, as it emphasises individualist rather than communal ideals, and in many instances stigmatises individuals who have not changed their behaviour leading to their marginalisation (Albarracín et al. 2005; Davis et al. 2015; Michie and Johnston 2012). Furthermore, these approaches do not develop community cohesion or build social capital, such that the resilience of communities to cope with change in the oceans may be low (Magis 2010; Wilson 2013).

The second driver that we consider impacting future ocean and human health outcomes focusses on the capacity to create change and the capability to enact change. These apply at an individual and collective level, and can influence policy at the local, national, regional and international scale. We focus specifically on two dimensions; power and agency. Agency refers to the means and ways in which individuals can act (relying upon themselves only), or collective agency(when groups of people act for their collective selves). Powerrefers to the ways in which an individual or group of individuals can act to influence others (Haugaard 2012). Power and agency are important as they determine who can drive change, and consequently influences whether negative or positive human and ocean health outcomes emerge.

In ‘Living & Connecting’, the decentralisation of power in governance enables community level behaviour change initiatives (Cvitanovic et al. 2017). Community level initiatives increase community and social capital and provide individuals with the capacity and tools to affect environmental change and shape their own health outcomes (Ko et al. 2018). For example, marine planning and development employs strategies to empower stakeholders, and discussions are facilitated for communities to collectively debate their futures (Clarke and Flannery 2019). Simultaneously, decentralisation of power may redistribute power away from private corporations to other groups in the community.

Industry increasingly supports the view that poor social and environmental management poses a significant business risk, which incentivises environmental stewardship (Franks et al. 2014; Olson 2009). These instances create a positive feedback loop, further empowering individuals and communities (Cvitanovic and Hobday 2018). For Indigenous people and communities, agency is supported by improved negotiating power with parties involved in resource use activities on (or adjacent to) the land or sea to which they are culturally connected. Favourable changes in power relations and distribution enable the transmission of Indigenous and local knowledge, and the ability of Indigenous peoples and communities to manage biodiversity (Gilberthorpe and Hilson 2016; Mustonen and Kontkanen 2019).

In ‘Command & (Out of) Control’, a few global corporations influence local to global scale governance. These corporations dominate markets, and exercise significant control over developments in science and technology as well as political agendas (Blasiak et al. 2018; Folke et al. 2019). This unbalanced power situation negatively impacts the equitable distribution of resources and opportunities, with unfavourable ecological impacts and human health outcomes (Hanna 2019; Suarez-Villa 2012). The increasing use of Social Licence to Operate (SLO) is an indication that trust in (and legitimacy of) the formal regulation of natural resource management continues to erode (van Putten et al. 2018a). Even though trust in the formal regulatory system may be eroded, there are instances (typically at local scales) where communities successfully influence government and industry decision-making processes and affect industry actions (Harvey and Bice 2014; van Putten et al. 2018a).

In ‘Command & (Out of) Control’, large inequities in the capacity to manage ocean and human health emerge among nations (Ottersen et al. 2014), due to imbalances in agency and power. Small island nations and low-income countries have very little economic or political power and are unable to redirect the impacts of pollution and climate change to the (often wealthier) nations who are predominantly responsible (Akpan and Bassey 2017). Similarly, low-income nations and disadvantaged communities lose access to marine resources due to the international expansion of the ‘Blue Economy’ (Cohen et al. 2019). For example, industry demands for access and use of Indigenous land or sea (or areas important to Indigenous people) for resource extraction, commodity production, mining, transport, and energy infrastructure can seriously challenge the rights, health and wellbeing of Indigenous peoples (Bozigar et al. 2016; Parlee 2015; Trigger et al. 2014). Dispossession and disempowerment impacts traditional management, the transmission of Indigenous and local knowledge, and the ability of Indigenous peoples and communities to manage biodiversity (Gilberthorpe and Hilson 2016), with negative outcomes for both ocean and human health at the local and global level.

Economic development, and industrial and urbanisation patterns and trends comprise this third driver of human and ocean health interactions. Human and industry development influences people’s access to basic needs such as employment, energy and health care, which in turn mediate their interactions with the ocean.

In ‘Living & Connecting’, significant efforts are made to assess human progress and well-being on a number of different and contextually relevant dimensions that do not replace, but instead complement, GDP growth data (e.g. Au and Karacaoglu 2018). Reporting on multiple indicators and dimensions of growth creates a positive feedback loop, because it forces decision-makers to develop and implement policy initiatives that take account of and integrate a broader suite of interrelated considerations. This de-emphasises the focus on GDP growth and re-focusses on accounting for non-renewable resource depletion, irreversible biodiversity losses, and intergenerational equity. In combination with shifts in the drivers described in previous sections, innovation and provision of a range of marine resources such as marine-derived medicines and energy, support a circular economy and a transparent approach to manufacturing and service provision.

In ‘Command & (Out of) Control’, assessment of progress is largely limited to existing trajectories of GDP (Raworth 2017) and the focus is to optimise processes and revenues. This leads to disproportionate benefits for large private corporations and the wealthy, but reduces the resilience of the industry and communities to future change (Cox 2016; Gibbs 2009), with likely negative environmental and human health impacts. For example, through the loss of jobs and livelihoods and subsequent negative impacts on mental well-being.

The fourth driver that we consider impacting human and ocean health is directly related to terrestrial, aquaculture, and wild fisheries food production systems, and associated supply chains. The structure of food production systems affects all dimensions of food security (production, availability, stability and utilisation) and directly impacts human health (e.g. micronutrient deficiencies, malnutrition, obesity and chronic disease and inequalities in health status disproportionately affecting the poor). Ocean resource use and extraction directly affects the health and resilience of marine environments. Critically, because there are pervasive links between food production on land and at sea, this driver is not just focused on marine-based food systems but encompasses all food systems, crossing the land-sea boundary (Cottrell et al. 2018; Halpern et al. 2019). A further inhibitor towards achieving a sustainable relationship between human and ocean health in the BAU scenario is that when populations are systematically disadvantaged and can’t meet their basic physiological needs including food, their capacity to engage with higher-level needs such as environmental stewardship is undermined. Consistent with the hierarchy of motivation proposed by Maslow (1943), in this scenario it is hard to enact behaviours to mitigate long-term risks to food supply chains and ocean health (behaviours incorporated in the self-actualisation step of the hierarchy), if in the short-term there is not enough food on a day-to-day basis, or if the only affordable food is that which compromises sustainability goals (behaviours associated with meeting basic physiological needs).

In ‘Living & Connecting’, there is a shift to nutritionally-sensitive food policy and explicit recognition of the trade-offs and synergies between environmental and nutritional objectives (Farmery et al. in review; Hicks et al. 2019). For example, management interventions such as multi-use marine protected areas are being designed and implemented to successfully achieve both conservation and equitable food outcomes (Aswani and Furusawa 2007). There are concerted efforts to disseminate the lessons learnt from successful marine policy and management (e.g. Cinner et al. 2016; Cvitanovic and Hobday 2018). Decision-makers globally benefit from evidence-based information and more support for management decisions from society at large. Moves towards a circular economy are also positively influencing the sustainability of the global food system, for example, via reduced food wastage (Parfitt et al. 2010) and redirection of waste back into food production (Mo et al. 2018).

In ‘Command & (Out of) Control’, the emphasis remains on increasing production in individual sectors, with considerably less focus on integrated management across sectors and ‘circular’ management within the food system. Sectoral management without integration creates conflicts between different sectors vying for ocean space and increases the prevalence of unanticipated shocks in the food system. Volatility in food availability in certain regions has significant negative consequences for moderately to severely food insecure parts of the world (Cottrell et al. 2019; FAO 2019).

The fifth driver of change in human and ocean health is people’s personal and cultural connection to the oceans. Connections to the ocean can occur, for example, via tourism, recreation, or an individual’s sense of place (van Putten et al. 2018b). It is critical to consider connections to the ocean because they impact all dimensions of human health (Beute and de Kort 2014; Biedenweg et al. 2017; Frumkin et al. 2017; Marselle et al. 2019). Human connections to the ocean also impact individual and collective environmental stewardship behaviours (Chambers et al. 2019). Stewardship actions emerge as a result of the diversity of worldviews, beliefs and values that individuals and communities hold in relation to the ocean (Masterson et al. 2019).

In ‘Living & Connecting’, actions and activities that build a sense of connection to the oceans are strongly valued by society. Furthermore, environmental stewardship behaviour is viewed as an integral component of a healthy individual (Moewaka Barnes and McCreanor 2019). For example, there is an increase in social prescribing (non-medical interventions and services designed to improve health behaviour) of ‘blue activities’ focused on exercise and conservation initiatives in aquatic environments, leading to improved health and connection to oceans across a range of demographics (Britton et al. 2018; Gibbons et al. 2017). Similarly, the role of visual and performing arts to create a connection is widely recognised and supported by government and the community (Fryer 2017). These diverse activities help individuals develop a sense of awe regarding the natural world, leading to an increase in prosocial behaviour and collective action to support ocean stewardship (Piff et al. 2015). This connection, combined with a widespread understanding of the feedbacks between ocean health and human health, drives a positive feedback loop (Figure 2).

In ‘Command & (Out of) Control’, people are less connected to the ocean. People are inhibited from creating or maintaining connections because access to the oceans may be limited through existing governance arrangements (Bennett et al. 2018a), such as privatisation of coastlines (Skladany et al. 2007) or designation of marine protected areas (Mascia et al. 2010). Importantly, the lack of connection to the oceans has significant implications for how society views the ocean as a driver of human health (Masterson et al. 2019): society places more importance on optimising the quantity and/or quality of resources gained from marine systems rather than exhibiting stewardship behaviour towards the oceans (Folke et al. 2011; Holling and Meffe 1996). Their interactions with the marine environment are often resource intensive. For example, there is a rise in high-end (but environmentally insensitive) tourism that caters to a burgeoning middle class, and that does not engender a connection to the ocean. The COVID-19 experience may add additional (yet unknown) challenges for a tourism industry that will need to completely rebuild.

Significant and transformational change will be needed to move the five drivers that mediate the interactions between human and ocean health away from the Business-as-Usual, ‘Command & (Out of) Control’ trajectory towards the more sustainable world of ‘Living & Connecting’. We propose three foundations of change (bold text ) which are fundamental precursors to achieving sustainable changes at the individual, community, and policy level. The first foundation concerns marine citizenship , defined as “the rights and responsibilities of an individual towards the marine environment” (p. 839 McKinley and Fletcher 2012). Marine citizenship arises from marine education, a sense of personal responsibility for the health of the marine environment, and a feeling of connection to the oceans (McKinley and Fletcher 2010). A core principle of this foundation to change is engagement for capacity building (Ika and Donnelly 2017; Selin et al. 2016). Building of capacity will be required across scales for the second foundation of change: a more equitable distribution of power. A more equitable distribution of power will mean that the capacity to act (and the feeling of empowerment) is likely to be present in a greater proportion of the population (Sinharoy and Caruso 2019). With a more equitable distribution of power people will tend to participate more in decision making processes, and in a more meaningful way (Boyd 2002; Lockwood 2010; Tonelli et al. 2018), with the resultant positive impacts at both the individual and societal level encouraging ongoing participation in this way. Finally, the third foundation: greater and more equitable access to resources and opportunities , will contribute to a greater sense of agency among currently disadvantaged individuals and communities. Equitable access to resources goes hand in hand with the equitable distribution of power. Both power and resource distribution must be guided by strong foundations in the governance approach to provide certainty and build trust (Lockwood 2010; Ratner et al. 2013).

We identified 80 actions (Extended Data 1) that are critical to ensure these three foundations of change are achieved, and subsequently built upon by individual, community, and policy initiatives that move us towards our desirable ‘Living & Connecting’ scenario. To gain oversight and bring clarity to the types of actions we have identified, we categorise them into different groups, called ‘strategies’. These strategies should be implemented successively over the UN Decade of Ocean Science (2021-2030). Some of the actions within each strategy can be implemented immediately (in the short-term) while others may require some lead time or are dependent on other actions to precede them to take effect. In some cases, ‘investment’ in an action has a longer-term pay-off time (i.e. the money invested now will not return a positive benefit for some time), whereas others have immediate perceivable impacts and returns. More generally, an adaptive and reflexive approach should be taken when implementing the actions as some feedback (i.e. synergies) and timing issues are likely to arise. To gain insight into the actions (across time and also in relation to the actors who will be responsible for undertaking the actions) we provide a summary below (see Extended Data 1 for a full list of actions).