Water and health: From environmental pressures to integrated responses.

The water-related exposome is a significant determinant of human health. The disease burden through water results from water-associated communicable and non-communicable diseases and is influenced by water pollution with chemicals, solid waste (mainly plastics), pathogens, insects and other disease vectors. This paper analyses a range of water practitioner-driven health issues, including infectious diseases and chemical intoxication, using the conceptual framework of Drivers, Pressures, State, Impacts, and Responses (DPSIR), complemented with a selective literature review. Pressures in the environment result in changes in the State of the water body: chemical pollution, microbiological contamination and the presence of vectors. These and other health hazards affect the State of human health. The resulting Impacts in an exposed population or affected ecosystem, in turn incite Responses. Pathways from Drivers to Impacts are quite divergent for chemical pollution, microbiological contamination and the spread of antimicrobial resistance, in vectors of disease and for the combined effects of plastics. Potential Responses from the water sector, however, show remarkable similarities. Integrated water management interventions have the potential to address Drivers, Pressures, Impacts, and State of several health issues at the same time. Systematic and integrated planning and management of water resources, with an eye for human health, could contribute to reducing or preventing negative health impacts and enhancing the health benefits.

Diseases of dab (Limanda limanda): Analysis and assessment of data on externally visible diseases, macroscopic liver neoplasms and liver histopathology in the North Sea, Baltic Sea and off Iceland.

In the framework of the ICON project (Integrated Assessment of Contaminant Impacts on the North Sea), common dab (Limanda limanda) from seven offshore sampling areas in the North Sea, Icelandic waters and the western Baltic Sea were examined in 2008 for the presence of externally visible diseases and parasites (EVD), macroscopic liver neoplasms (tumours) (MLN) and histopathological liver lesions (LH). Methodologies applied followed standardised ICES and BEQUALM protocols. The EDV results revealed pronounced spatial variation, with dab from the central and northern North Sea sampling areas showing the highest disease prevalence. MLN were recorded only in North Sea dab from the German Bight, Firth of Forth and Ekofisk at a low prevalence. LH results revealed a dominant prevalence of non-specific, mostly inflammatory, lesions and a low prevalence of early toxicopathic non-neoplastic lesions, tumour pre-stages (foci of cellular alteration) and liver tumours. For the analysis and assessment of spatial variation of EVD, a Fish Disease Index (FDI) was calculated for individual dab, summarising data on the presence/absence of EDV, their severity grades, effects on the host and compensating for effects of length, sex and season. FDI data confirmed that the health status of North Sea dab from the offshore areas Dogger Bank, Ekofisk and Firth of Forth was significantly worse than in dab from the German Bight, Icelandic areas and the western Baltic Sea. An assessment of the disease data following ICES/OSPAR criteria was accomplished by applying established numeric background (BAC) and ecological assessment criteria (EAC) for EDV, MLN and LH. The combined assessment of the three disease categories indicated that health effects classified as unacceptable were rare and mainly affected dab from the North Sea. Based on the findings of the present study, it is recommended to monitor wild fish diseases in the context of assessing the impact of hazardous substances and other stressors on the marine environment. The Fish Disease Index (FDI) is regarded as a strong tool for disease data analysis and assessment, suitable as ecosystem health indicator.

Assessment of contaminant concentrations in sediments, fish and mussels sampled from the North Atlantic and European regional seas within the ICON project.

Understanding the status of contaminants in the marine environment is a requirement of European Union Directives and the Regional Seas Conventions, so that measures to reduce pollution can be identified and their efficacy assessed. The international ICON workshop (Hylland et al., in this issue) was developed in order to test an integrated approach to assessing both contaminant concentrations and their effects. This paper describes and assesses the concentrations of trace metals, polycyclic aromatic hydrocarbons, and polychlorinated biphenyls in sediments, mussels, and fish collected from estuarine, coastal and offshore waters from Iceland to the Mediterranean Sea. For organic contaminants, concentrations progressively increased from Iceland, to the offshore North Sea, to the coastal seas, and were highest in estuaries. Metals had a more complex distribution, reflecting local anthropogenic inputs, natural sources and hydrological conditions. Use of internationally recognised assessment criteria indicated that at no site were concentrations of all contaminants at background and that concentrations of some contaminants were of significant concern in all areas, except the central North Sea.

Towards the review of the European Union Water Framework Directive: Recommendations for more efficient assessment and management of chemical contamination in European surface water resources.

Water is a vital resource for natural ecosystems and human life, and assuring a high quality of water and protecting it from chemical contamination is a major societal goal in the European Union. The Water Framework Directive (WFD) and its daughter directives are the major body of legislation for the protection and sustainable use of European freshwater resources. The practical implementation of the WFD with regard to chemical pollution has faced some challenges. In support of the upcoming WFD review in 2019 the research project SOLUTIONS and the European monitoring network NORMAN has analyzed these challenges, evaluated the state-of-the-art of the science and suggested possible solutions. We give 10 recommendations to improve monitoring and to strengthen comprehensive prioritization, to foster consistent assessment and to support solution-oriented management of surface waters. The integration of effect-based tools, the application of passive sampling for bioaccumulative chemicals and an integrated strategy for prioritization of contaminants, accounting for knowledge gaps, are seen as important approaches to advance monitoring. Including all relevant chemical contaminants in more holistic "chemical status" assessment, using effect-based trigger values to address priority mixtures of chemicals, to better consider historical burdens accumulated in sediments and to use models to fill data gaps are recommended for a consistent assessment of contamination. Solution-oriented management should apply a tiered approach in investigative monitoring to identify toxicity drivers, strengthen consistent legislative frameworks and apply solutions-oriented approaches that explore risk reduction scenarios before and along with risk assessment.

Integrated chemical and biological assessment of contaminant impacts in selected European coastal and offshore marine areas.

This paper reports a full assessment of results from ICON, an international workshop on marine integrated contaminant monitoring, encompassing different matrices (sediment, fish, mussels, gastropods), areas (Iceland, North Sea, Baltic, Wadden Sea, Seine estuary and the western Mediterranean) and endpoints (chemical analyses, biological effects). ICON has demonstrated the use of a framework for integrated contaminant assessment on European coastal and offshore areas. The assessment showed that chemical contamination did not always correspond with biological effects, indicating that both are required. The framework can be used to develop assessments for EU directives. If a 95% target were to be used as a regional indicator of MSFD GES, Iceland and offshore North Sea would achieve the target using the ICON dataset, but inshore North Sea, Baltic and Spanish Mediterranean regions would fail.

Integrated indicator framework and methodology for monitoring and assessment of hazardous substances and their effects in the marine environment.

Many maritime countries in Europe have implemented marine environmental monitoring programmes which include the measurement of chemical contaminants and related biological effects. How best to integrate data obtained in these two types of monitoring into meaningful assessments has been the subject of recent efforts by the International Council for Exploration of the Sea (ICES) Expert Groups. Work within these groups has concentrated on defining a core set of chemical and biological endpoints that can be used across maritime areas, defining confounding factors, supporting parameters and protocols for measurement. The framework comprised markers for concentrations of, exposure to and effects from, contaminants. Most importantly, assessment criteria for biological effect measurements have been set and the framework suggests how these measurements can be used in an integrated manner alongside contaminant measurements in biota, sediments and potentially water. Output from this process resulted in OSPAR Commission (www.ospar.org) guidelines that were adopted in 2012 on a trial basis for a period of 3 years. The developed assessment framework can furthermore provide a suitable approach for the assessment of Good Environmental Status (GES) for Descriptor 8 of the European Union (EU) Marine Strategy Framework Directive (MSFD).

Toxicity profiling: An integrated effect-based tool for site-specific sediment quality assessment.

A toxicity profile is a toxicological "fingerprint" of an environmental sample, obtained by testing its extract in a battery of bioassays. Each represents a different mode of action. The present work explores the applicability of in vitro toxicity profiles as an effect-based tool for sediment quality assessment. For this purpose, a previously published dataset was used, in which sediment extracts from 15 different locations in the Rhine-Meuse estuary were tested in 5 different bioassays. Three useful approaches could be distinguished for applying toxicity profiles in sediment quality assessment. In the first approach, toxicity profiles are translated into hazard profiles, indicating the relative distance to the desired or acceptable sediment quality status for each toxic mode of action. Hazard profiles can be considered as location-specific characteristics; sampling locations with similar hazard profiles can be classified into clusters. This approach seems directly applicable but requires a very careful selection of a reference toxicity profile that is either measured at a reference location or is designated as a desirable or acceptable toxicity profile for that particular location. In the second approach, toxicity profiles are translated into ecological risk profiles indicating for each toxic mode of action the ratio between the actual measured bioassay response and the bioassay response level that is considered safe for environmental health. This approach has a high ecological relevance but is only feasible for a few modes of action for which toxicity data are available at the ecological level of population or higher that allow derivation of ecologically safe bioassay responses for sediment extracts. In the third approach, toxicity profiles and their derived hazard profiles are used to select samples with unusually or unexpectedly high bioassay responses for further in-depth effect-directed analysis (EDA). EDA is a powerful strategy to identify emerging compounds that contribute significantly to the toxic load on the environment. EDA is an expensive and laborious strategy, however, making it currently suitable only for investigative monitoring on a limited scale and not for routine monitoring. Future perspectives in toxicity profiling include expansion of the battery of bioassays with test methods that cover other toxic endpoints or multiple endpoints, are high throughput, and improve the ecological relevance.

An integrated assessment of estrogenic contamination and biological effects in the aquatic environment of The Netherlands.

An extensive study was carried out in the Netherlands on the occurrence of a number of estrogenic compounds in surface water, sediment, biota, wastewater, rainwater and on the associated effects in fish. Compounds investigated included natural and synthetic hormones, phthalates, alkylphenol(ethoxylate)s and bisphenol-A. The results showed that almost all selected (xeno-)estrogens were present at low concentrations in the aquatic environment. Locally, they were found at higher levels. Hormones and nonylphenol(ethoxylate)s were present in concentrations that are reportedly high enough to cause estrogenic effects in fish. Field surveys did not disclose significant estrogenic effects in male flounder (Platichthys flesus) in the open sea and in Dutch estuaries. Minor to moderate estrogenic effects were observed in bream (Abramis brama) in major inland surface waters such as lowland rivers and a harbor area. The prevalence of feminizing effects in male fish is largest in small regional surface waters that are strongly influenced by sources of potential hormone-disrupting compounds. High concentrations of plasma vitellogenin and an increased prevalence of ovotestes occurred in wild male bream in a small river receiving a considerable load of effluent from a large sewage treatment plant. After employing in vitro and in vivo bioassays, both in situ and in the laboratory, we conclude that in this case hormones (especially 17 alpha-ethynylestradiol) and possibly also nonylphenol(ethoxylate)s are primarily responsible for these effects.