Marine pollution threatens food security and ecological integrity in China’s coastal and near-shore regions(CCNR), yet quantitative evidence linking pollutant pathways to health outcomes remains limited. This study presents original empirical analysis of marine pollution impacts across major Chinese coastal provinces (Shandong, Jiangsu, Zhejiang, Fujian, Guangdong, and Hainan) using a One Health framework. We conducted systematic data collection between 2022 and 2024, including: (i) seafood contaminant measurements (n = 847 samples; heavy metals via ICP-MS, microplastics via FTIR spectroscopy) from artisanal fishing sites and aquaculture facilities; (ii) 312 structured household surveys measuring food security indicators; (iii) spatial analysis of pollution entry points using satellite imagery and port authority records; and (iv) comparative policy assessment across all six nations using semi-structured interviews with 48 government officials and environmental managers.Results demonstrate that microplastics (detected in 73 % of samples, mean 4.2 particles/g) and heavy metals (lead: 0.34 mg/kg; mercury: 0.18 mg/kg; both exceeding WHO limits in hotspot areas) constitute primary contamination vectors, with significant inter-island variation (p < 0.001). Port proximity emerged as the strongest predictor of contamination (OR=3.8, 95 % CI: 2.1–6.9), followed by inadequate wastewater infrastructure (OR=2.4). Food-borne disease incidence correlates positively with contamination levels (r = 0.67, p < 0.01), with aquaculture and artisanal fisheries jointly explaining 64 % of community-level exposure variance. Integrated multi-trophic aquaculture (IMTA) systems achieved 45–67 % nutrient load reductions while maintaining 89 % of baseline yields. Gear-marking initiatives reduced abandoned fishing gear by 52 % across pilot sites. Veterinary-monitored AMR surveillance in aquaculture reduced antibiotic resistance prevalence by 38 % over 18 months.Cost-effectiveness analysis reveals that bundled interventions—combining wastewater upgrades (USD 2.3 M per island), IMTA conversion pilots (USD 450 K), gear-marking programs (USD 120 K), and AMR surveillance systems (USD 85 K annually)—offer economically viable pathways to simultaneously improve food safety, protect coastal ecosystems, and enhance community resilience in China's coastel and near-shore regions contexts.
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