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2014). Declines in carbonate saturation state make it more difficult for marine organisms to form shells and skeletons, can lead to their dissolution, and may increase natural mortality or decrease somatic growth and egg viability (Cattano et al. 2018). Regionally, acidification is expected to increase most rapidly in polar areas, with carbonate ion concentrations projected to fall below aragonite saturation levels in the Arctic Ocean beginning in 2048, and in the Southern Ocean in around 2067 (Bopp et al. 2013; Ciais et al. 2013). It should be noted that nitrogen and phosphorus run-off into the ocean from agriculture and industrial sources can lead to locally enhanced ocean acidification (Billé et al. 2013).


Trends in ocean resources Protecting ocean resources (SDG target 14.4) is critical, as oceans are sources of food and nutrition for billions of people, especially in income-poor coastal zones where significant shares of nutrition and income derive from fisheries. In addition to being a direct source of human food, fish also contribute indirectly to human nutrition when used as fishmeal in aquaculture and livestock feed. Historically, fish demand per capita has risen significantly from 6kg/yr in 1950 to 20.3kg/yr in 2016 (FAO 2018), with other estimates spanning the range 18.8-21.4kg/yr in 2011 (Troell et al. 2014; Béné et al. 2015). At the same time, there has been a trend towards farmed fish. Since 2014, humans have consumed more farmed fish than wild fish (FAO 2016). Projections from FAO suggest that demand for fish will continue to grow in the future (FAO 2018). However, studies indicate that a sustainable increase in wild fish catch will be difficult under current fishing strategies (Garcia, Rice and Charles 2016; FAO 2018). One important concern is that projections of marine primary productivity, which supports all marine fisheries, and ultimately all marine life, suggest a decline to 2100 under an RCP 8.5 scenario (Bopp et al. 2013; Fu, Randerson and Moore 2016), although considerable uncertainties remain (Laufkötter et al. 2015). No projections of the ‘proportion of fish stocks within biologically sustainable levels’ – the official SDG indicator – are available in the literature. As a proxy, projections of global fisheries under an unchanged climate and current management scenario, suggest that, the proportion of fish stocks at or below a target biomass that can undergo recovery would increase from 53 per cent today to 88 per cent in 2050 (Costello et al. 2016). However, a wide range of improved management measures already in place. In most countries that are funding science and management adequately (Melnychuk et al. 2017), significantly improve the prospects for sustainability (Costello et al. 2016). Catch potential is projected to decline by an average of 7.7 per cent by 2050, while revenue might decline by 10.4 per cent over the same period (Lam et al. 2016).


21.3.6 Human health


In 2012, 23 per cent of deaths globally were due to modifiable environmental factors– “those reasonably amenable to management or change given current knowledge and technology, resources, and social acceptability,” (Prüss-Üstün et al. 2016) – with a greater portion occurring in vulnerable populations (children and the elderly) and developing countries (Prüss-Üstün et al. 2016). The environment affects human health within households (e.g. through unsafe water, sanitation and hygiene, and indoor air pollution), in communities (e.g. outdoor air pollution), and on a global scale (e.g. climate change) (Smith and Ezzati 2005; Hughes et al. 2011).


The proportion of the population with access to safe water, sanitation, and hygiene facilities, as well as clean cooking facilities has been increasing significantly reducing health impacts related to communicable diseases. These trends are projected to continue to 2050 (see Sections 21.3.3 and 21.3.4). For example, global Disability Adjusted Life Years (DALYs), the number of years lost to poor health or early death related to household air pollution due to use of solid fuels, decreased from 9.2 per cent of total DALYs in 1990 to 6.8 per cent in 2016 (Institute for Health Metrics and Evaluation 2016), and is projected to further decline to under 3 per cent by 2024 (Kuhn et al. 2016). Hughes et al. (2011) also project significant decreases in mortality from communicable diseases, largely related to strong economic development. However, many people are projected to live without proper access to improved drinking water and sanitation and clean cooking facilities by 2030, and the levels of improvement across these risk factors vary widely by region. Furthermore, health risks associated with outdoor air pollution and climate change have been increasing (WHO 2014; Forouzanfar et al. 2015; Cohen et al. 2017). The impact from ambient particulate matter pollution will continue to contribute to millions of premature deaths annually in the coming decades (see Section 21.3.3). Likewise, climate change is projected to have substantial negative health impacts in the coming decades, among them heat exposure, coastal flooding, diarrhoea, malaria and undernutrition (Hughes et al. 2011; WHO 2014).


Environmental risk factors at household level have been declining since 1990, while risk factors at community and global level have been increasing. Global health risks have been shifting away from environmental risks and towards behavioural risks (e.g. smoking, childhood undernutrition, and alcohol use) and metabolic risks (e.g. high blood pressure, and high body mass index) (WHO 2009; Forouzanfar et al. 2015). This shift in risk factors is part of a larger epidemiological transition, which has occurred globally over the past two centuries – mortality rates have been decreasing and shifting towards risks that affect people later in life (Murray et al. 2015).


Trends in child mortality Under-five mortality is generally seen as a good indicator of quality of life (see Section 20.4.1). Global child mortality (SDG target 3.2) declined dramatically from 91 deaths per thousand live births in 1990 to 43 per thousand live births in 2015, one of the most successful achievements of the Millennium Development Goal period (You et al. 2015). Yet more than 5 million children died in 2016 before reaching their fifth birthday, and 26 per cent of these deaths were due to environmental factors within our control (Prüss-Üstün et al. 2016). The five leading environmental risk factors (in order of health impact) are: household air pollution, unsafe drinking water, ambient particulate matter, unsafe sanitation, and insufficient handwashing (WHO 2009; Forouzanfar et al. 2015). Furthermore, malnutrition, including fetal growth restriction, child stunting and wasting, micronutrient deficiencies and suboptimal breastfeeding are important health risk factors, related to about 45 per cent of child deaths in 2011 (Black et al. 2013). In 1990, these five leading environmental factors accounted for nearly 2.8 million deaths in children under five (30 per cent of total under-five deaths), which decreased to just over 800,000 deaths in 2016 (24 per cent of total under-5 deaths). Currently, 79 countries have under-five mortality rates higher than the SDG target of 25 per 1,000 live births –


Future Developments Without Targeted Policies 501


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