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


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.


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.


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.


Evidence synthesis, Participatory approach, Policy relevance, HELCOM region, Ecosystem services, Marine and coastal environment


The Baltic Sea ecosystems supply many benefits to society, termed ecosystem services. These depend upon a healthy marine environment requiring marine and relevant land-based policies integrated with public health policies. Until recently marine environment protection policies have largely focussed on human impacts on the environment and have not taken into account impacts of ecosystems on human health beyond the direct impacts of hazardous substances, such as those present in seafood. Whilst endeavours have been made to integrate human health and well-being into marine policies, interviews with key stakeholders through a participatory process revealed that the linkages were not sufficiently strong to inform policymaking. The existing evidence base urgently needs to be identified and synthesised to support relevant policy updates of the Marine Strategy Framework Directive (MSFD) 2008/56/EC and the Baltic Sea Action Plan (BSAP) (2007) as well as to help direct future research priorities.


The protocol is based on the primary question, “What linkages have been researched between Baltic Sea ecosystems and the positive and negative impacts to human health and wellbeing?” Using systematic mapping, this study will identify and map the state and the geographical distribution of the existing research evidence linking human health and well-being with the Baltic Sea ecosystems. The types of ecosystem services supplied by the Baltic Sea and the associated health and well-being impacts will be categorised and presented in a graphical matrix, illustrating ecosystem service type and the types of health and well-being outcomes. The systematic mapping procedure will result in a narrative report published with a searchable database, which will contain a descriptive summary of the information from all of the eligible studies. The systematic map and database will be displayed on the website of the Finnish Environment Institute (SYKE).