Harmful algal blooms (HABs) are thought to be increasing in coastal waters worldwide. Anthropogenic nutrient enrichment has been proposed as a principal causative factor of this increase through elevated inorganic and/or organic nutrient concentrations and modified nutrient ratios. We assess: 1) the level of understanding of the link between the amount, form and ratio of anthropogenic nutrients and HABs; 2) the evidence for a link between anthropogenically generated HABs and negative impacts on human health; and 3) the economic implications of anthropogenic nutrient/HAB interactions. We demonstrate that an anthropogenic nutrient-HAB link is far from universal, and where it has been demonstrated, it is most frequently associated with high biomass rather than low biomass (biotoxin producing) HABs. While organic nutrients have been shown to support the growth of a range of HAB species, insufficient evidence exists to clearly establish if these nutrients specifically promote the growth of harmful species in preference to benign ones, or if/how they influence toxicity of harmful species. We conclude that the role of anthropogenic nutrients in promoting HABs is site-specific, with hydrodynamic processes often determining whether blooms occur. We also find a lack of evidence of widespread significant adverse health impacts from anthropogenic nutrient-generated HABs, although this may be partly due to a lack of human/animal health and HAB monitoring. Detailed economic evaluation and cost/benefit analysis of the impact of anthropogenically generated HABs, or nutrient reduction schemes to alleviate them, is also frequently lacking.