Evidence on the impact of Baltic Sea ecosystems on human health and well-being: a systematic map

Abstract

Background: While the unique marine and coastal environment of the Baltic Sea provides numerous ecosystem services, its ecosystems are under pressure due to the intensification and diversification of anthropogenic uses. This present work constitutes a systematic map of the evidence of the impacts of ecosystem services and disservices on human health and well-being. The aim is to create a better understanding of the threats of unsustainable management or the benefits of sustainable management of the Baltic Sea and the impacts these may have on the health and well-being of human populations and present these findings to policy advisors. The mapping process is described, and the characteristics of the evidence base are presented.

Methods: The applied method has been previously published in a systematic map protocol. Literature searches were carried out in English considering published peer-reviewed literature from traditional scientific journals and scientific reports from the grey literature, using synthesis software. A total of 17 databases were searched. Articles were screened in stages at title and abstract stage, then full-text stage. Geographic limitations were placed on the searches in accordance with research funders call, however, watersheds that had an impact on the Baltic Sea marine and coastal regions were considered. We used the more open PEO format, where population (P) included the human populations within the marine and coastal environment of the Baltic Sea region, exposure (E) related to the Baltic Sea ecosystems services and disservices, and the outcome (O) included all aspects of human health and well-being. After full-text screening articles selected for inclusion were searched for metadata connected to bibliographic information, ecosystem services, health and well-being outcomes and policy relevance.

Review findings: Out of 6456 hits only 460 studies discussed either health or well-being indicators to some extent. Of these, only 67 explicitly mentioned ecosystem services and health and well-being indicators. However, few in this subset engaged with the topic of ecosystem services or disservices and health and well-being in depth. Studies are increasingly relating the two concepts but currently it is mainly studies focussed on cultural ecosystem services that deal with the concept of health and well-being to a greater degree. Studies in the medical literature relating to impacts on health from exposure to the Baltic Sea did not relate their findings to ecosystem services. The database of 67 studies is attached as Additional file 5.

Conclusions: Ecosystem services play an important role in human health and well-being; however, we found few studies that explicitly examine these impacts in detail. Further research is needed to link the health and well-being outcomes from the Baltic Sea to the ecosystem services supplied and therefore to demonstrate the benefits and disservices provided by the Baltic Sea ecosystems to human populations.

Supplementary information: The online version contains supplementary material available at 10.1186/s13750-021-00244-w.

Keywords: Ecosystem services; Evidence synthesis; HELCOM region; Marine and coastal environment; Participatory approach; Policy relevance.

Fig. 1

ROSES flowchart of the screening process. The diagram also depicts at what stage the online tools CADIMA and EPPI-reviewer were used. The final studies (n = 67) were selected based on studies that explicitly mentioned ecosystem services and elaborated on health and well-being to some extent. All excluded articles are included in Additional file 4

Fig. 2

Publication years of the included full-text references (n = 67), situation at the end of March 2020. These were primarily journal articles, but also included some dissertations (see Additional file 6 details on article types)

Fig. 3

Publications by source type (other is defined as articles which were only published in one publication source)

Fig. 4

Study design formats of the included full-text references (n = 67). Some articles were double-coded. Observatory refers to case studies where populations or areas were observed. Review refers to articles that took a selection of papers to examine a topic. Modelling refers to the theoretical development of concepts. Comparative refers to articles with multiple site observations. Mapping refers to either the mapping of ecosystem services or quantifying of a component of an area, for example nitrogen retention of a wetland. Experimental refers to a study where parameters are tested, for example choice experiment

Fig. 5

Articles by country: Research carried out in a single country and labelled according to ISO country codes. Countries include all Baltic Sea Countries: Sweden (SWE), Germany (DEU), Denmark (DNK), Estonia (EST), Finland (FIN), Lithuania (LTU), Latvia (LVA), Poland (POL) and Russian Federation (RUS)

Fig. 6

Spread of articles by country: multiple countries may occur in one article

Fig. 7

Study scale: typology of locally coded research

Fig. 8

The HELCOM sea regions [41] included full-text references (n = 67). Note the codes are not exclusive and therefore one study can refer to more than one HELCOM region

Fig. 9

The mentioned ecosystem service sections in the articles (n = 67). Articles may have more than one ecosystem service mentioned

Fig. 10

Number of different ecosystem services (ES) mentioned in the articles (n = 67). Two articles did not mention any specific ecosystem services

Fig. 11

Health and well-being outcomes identified in the articles (n = 67) according to the definition of health and well-being domains in McKinnon et al. [11]. Articles may have been coded with more than one code

Fig. 12

Topics identified by cluster analysis linking ecosystem services and human well-being in the mapped articles (n = 67). Articles may be coded with more than one code

Fig. 13

The distribution of articles between the ecosystem services of provisioning, regulating and cultural services plus Ecosystem disservices and the indicators for health and well-being. Knowledge clusters are shown in a stronger green with knowledge gaps represented by a pale green colour (see Additional file 8 for interactive map with references created with eppi-mapper software [69])

Fig. 14

Distribution of articles between Provisioning ecosystem services and health and well-being. The first column shows the distribution of articles that specifically mentioned provisioning services and the health and well-being indicators. The four columns together show the distribution of articles by the different provisioning ecosystem services as outlined in Table 3 and health and well-being indicators in Table 1 (see Additional file 9 for interactive map with references created with eppi-mapper software [69])

Fig. 15

Cluster analysis of provisioning ecosystem services. Articles may be coded with more than one code

Fig. 16

Distribution of articles between Regulating Ecosystem Services and Health and Well-being. The first column shows the distribution of articles that covered the various health and well-being indicators and those articles that specifically mentioned regulating ecosystem services. The following columns together show the distribution of articles by the different regulating ecosystem services as outlined in Table 3 and health and well-being indicators in Table 1. (see Additional file 11 for interactive map with references created with eppi-mapper software [69])

Fig. 17

Distribution of articles between Cultural Ecosystem Services and Health and Well-being. The first column shows the distribution of articles that covered the various health and well-being indicators and those articles that specifically mentioned cultural ecosystem services. The following four columns show the distribution of articles by the different cultural ecosystem services as outlined in Table 3 and health and well-being indicators in Table 1 (see Additional file 12 for interactive map with references created with eppi-mapper software [69])

Fig. 18

Number of articles with the descriptors of good environmental status (n = 67)