HumanHuman BiomonitoringBiomonitoring as a tool in as a tool in surveillance of environmental health: surveillance of environmental health:

where are we today in Europe ?where are we today in Europe ?

Ludwine CasteleynLudwine Casteleyn & Birgit Van & Birgit Van TongelenTongelenImplementation Group HBM Implementation Group HBM

CenterCenter for Human Geneticsfor Human GeneticsFederal Public Service Health, Safety of the Food Chain and EnviFederal Public Service Health, Safety of the Food Chain and Environmentronment, Belgium, Belgium

ludwineludwine..casteleyncasteleyn@med.kuleuven.be@med.kuleuven.beludwineludwine..casteleyncasteleyn@health.@health.fgovfgov.be.be

Human Biomonitoring = measuring in Human Biomonitoring = measuring in humans (effect of) exposurehumans (effect of) exposure

air

water soil

food

consumables

Biomarkers of exposureBiomarkers of effectBiomarkers of susceptibility

kg4

Slide 2

kg4 koppeng; 16/09/2002

We are learning We are learning ““how much we may how much we may have in our bodies,have in our bodies,”” but not always but not always ““how comehow come”” or or ““how to respondhow to respond”” to to what we find out. what we find out.

……. the complete potential of this tool . the complete potential of this tool has yet to be realized, inasmuch as the has yet to be realized, inasmuch as the science science needed to understand the needed to understand the implications of implications of biomonitoringbiomonitoring data for data for human health is still in its nascent human health is still in its nascent stages stages

Scientists, policyScientists, policy--makers, and the makers, and the public are just beginning to grasp the public are just beginning to grasp the tremendous tremendous ethical and ethical and communication challengescommunication challenges that the that the biomonitoring biomonitoring data are creatingdata are creating””..

CONSENSUS CONFERENCE

“ Government by the people and for the people.’

Boston University School of Public

Health

December 2006

ec.europa.eu/environment/health/biomonitoring.htmwww.eu-humanbiomonitoring.org

EU Environment and Health Action PlanEU Environment and Health Action PlanACTION 3ACTION 3

Develop a coherent approach to HBM in Develop a coherent approach to HBM in EuropeEurope

Why? (1)Why? (1)Link between Environment and HealthLink between Environment and Health

within thewithin the

chain it is chain it is much closer to much closer to health effects than health effects than environmental monitoringenvironmental monitoring

HBM results HBM results integrate integrate the contribution of the the contribution of the different sources and different sources and routes of exposure routes of exposure

Biomarker of susceptibility

Biomarker of exposure

Internal dose

Biological effective dose

Biomarker of effect

Early response

Altered structure and funcion

Disorder Disease

Exposure Emission Ambient level

air

water soil

food

consumables

Why? (2)Why? (2)Need for a more coordinated HBM Need for a more coordinated HBM

approachapproach

a a more effective use of resourcesmore effective use of resources by shared by shared development of tools and strategies development of tools and strategies

more meaningful results of national surveysmore meaningful results of national surveys

better support for policybetter support for policy

Why? (3)Why? (3)Relevance for policymakersRelevance for policymakers

identification of identification of priorities priorities in exposure reduction strategiesin exposure reduction strategies

providing a providing a warning signalwarning signal

•• urgency of environmental measures urgency of environmental measures •• unknown pollution / pollutantsunknown pollution / pollutants

allowing allowing follow upfollow up of the efficiency of reduction strategiesof the efficiency of reduction strategies

•• including analysis of time trends)including analysis of time trends)

allowing development of allowing development of geographically differentiated geographically differentiated environmental health policy environmental health policy

•• analysis of spatial trendsanalysis of spatial trends

More than classical More than classical environmental environmental measurements it gets measurements it gets pollution personalpollution personal

Testing is a messageTesting is a message

WhyWhy? (4) ? (4) The power of HBMThe power of HBM

differences in differences in environmental exposuresenvironmental exposuresnational environmental health concerns national environmental health concerns analytical capacities analytical capacities political and health priorities political and health priorities cultural differencescultural differencesperceptions of ethics perceptions of ethics

may render a common may render a common biomonitoringbiomonitoring survey carried survey carried out simultaneously in several European countries out simultaneously in several European countries difficult to achieve difficult to achieve

a STEPa STEP--BYBY--STEP approach STEP approach ……

What? (1)What? (1)

What? (2)EU wide pilot project

testing the hypothesis that similar procedures (for e.g.recruitment, sampling, data analysis, quality control, ….) can becarried out in different Member States

→ better comparable results → better support for policy→ more effective use of resources

“FEASIBILITY STUDY””“learning by doing”

•• focus on the focus on the organisational, technical, logistical and organisational, technical, logistical and infrastructuralinfrastructural feasibility feasibility –– capacity building capacity building preliminary reference valuespreliminary reference values of selected biomarkers from of selected biomarkers from all participating Member Statesall participating Member States

HowHow? ? (1) (1) TechnicalTechnical & & politicalpolitical preparationpreparation

Research Research contractscontracts: : protocol protocol proposalproposalImplementationImplementation GroupGroup

preparesprepares recommendationsrecommendations (3) (3) forforMS/MS/ConsultativeConsultative Group Group ensuresensures feedback to and feedback to and fromfrom nationalnationalgovernmentsgovernments

InformalInformal MemberMember StatesStates meetingsmeetingsConsultativeConsultative ForumForumMember States, European bodies, Networks of Regional and Local AMember States, European bodies, Networks of Regional and Local Authorities, uthorities,

EuropeanEuropean--wide Stakeholder wide Stakeholder OrganisationsOrganisations: Civil: Civil Society, NGO, Research, Society, NGO, Research, Industry, International Industry, International OrganisationsOrganisations) )

appropriate biomarkers / substances

availablebudget

Target population

expected outcome forpolicy makers

No consensus onNo consensus on::

the populationthe populationchildren. children. whole population with particular attention to whole population with particular attention to vulnerable groups such as children or elderly people. vulnerable groups such as children or elderly people.

the choice of the substancesthe choice of the substances-- well validated methodologies : biomarkers for lead well validated methodologies : biomarkers for lead --

cadmium cadmium -- methylmercurymethylmercury-- substances for which a great societal concern exists, substances for which a great societal concern exists,

but methodologies less validated: e.g. but methodologies less validated: e.g. phtalatesphtalates ……

National National FundersFunders meeting meeting November 2005November 2005

sufficient analytical experience. sufficient analytical experience. exposure and health relevance exposure and health relevance well knownwell known

Basic scenario: all MS Basic scenario: all MS measuremeasure atat least least 1 1 commoncommon substancesubstance

MethylmercuryMethylmercury, , leadlead, cadmium, , cadmium, cotininecotinine

ExtendedExtended scenario: scenario: additionaladditionalsubstances by substances by atat least 5 MS least 5 MS

PhtalatesPhtalates, , PAHsPAHs, , InorganicInorganic Arsenic, Arsenic, BFR, PFOS BFR, PFOS ……

2007SubstancesSubstances

Target populationTarget populationage group of 6age group of 6--11 years: comparable with data reported 11 years: comparable with data reported by the US CDC by the US CDC ThirdThird National Report on Human National Report on Human Exposure to Environmental ChemicalsExposure to Environmental Chemicals

2222--50 years: accompanying mothers: comparable with 50 years: accompanying mothers: comparable with CDC's female gender and age group "20 years and CDC's female gender and age group "20 years and older".older".

This approach covers two subThis approach covers two sub--populations of priority: populations of priority: a) children before reaching puberty and a) children before reaching puberty and b) women of childbearing age.b) women of childbearing age.

FP7 - Call 22 December 2006 Sub-activity 6.1.2. Environment and HealthArea 6.1.2.2. Integrated approaches for environment and health risk assessment

ENV.2007.1.2.2.1. European network on human Biomonitoring

Funding scheme network of excellence.Community contribution from 4 up to 7 million Euros.Similar contribution from Member States

HowHow??(2) (2) Financial preparation Financial preparation

HIGH EXPECTATIONS HIGH EXPECTATIONS ……....Consultative forum 2005Consultative forum 2005

POLICYPOLICYsupport initiation of policy support initiation of policy evalutionevalution of efficiency of measures (forbidden substances)of efficiency of measures (forbidden substances)tool in REACH tool in REACH ……legal obligations, recommendations (WHO, legal obligations, recommendations (WHO, POPsPOPs))produce point 0 of exposureproduce point 0 of exposureassess respective contribution of sourcesassess respective contribution of sources

CONCERNCONCERN about: about: increased exposureincreased exposureemerging public health problems (e.g. flame retardants) emerging public health problems (e.g. flame retardants) exposure at levels close to those where effects expectedexposure at levels close to those where effects expected

tool for tool for HEALTH EDUCATIONHEALTH EDUCATION

Botsivali Maria, Berglund Marika, Botsivali Maria, Berglund Marika, BloemenBloemen Louis, Louis, BoogaardBoogaard Peter, Canna Michaelidou Peter, Canna Michaelidou Stella, Cerna Milena, De Felip Elena, Stella, Cerna Milena, De Felip Elena, FabianovaFabianova EleonoraEleonora, , FrFrééryry Nadine, Fucic Nadine, Fucic Aleksandra, Hirvonen Ari, Jakubowski Marek, Knudsen Lisbeth, KyrAleksandra, Hirvonen Ari, Jakubowski Marek, Knudsen Lisbeth, Kyrtopoulos topoulos SoteriusSoterius, , Lehners Maryse, Levy Len, Reis Lehners Maryse, Levy Len, Reis FFáátimatima, , ReisnerReisner--OberlehnerOberlehner Martina, Sala Carlo, Martina, Sala Carlo, Schoeters Greet, Seifert Bernd, KolossaSchoeters Greet, Seifert Bernd, Kolossa--Gehring Gehring MariekeMarieke, Sepai Ovnair, Ten Tusscher , Sepai Ovnair, Ten Tusscher Gavin, Van Gavin, Van WijnenWijnen JoopJoop, Veidebaum Toomas, Joas , Veidebaum Toomas, Joas ReinhardReinhard, Van , Van TongelenTongelen Birgit, Birgit, Casteleyn LudwineCasteleyn Ludwine. .

19 EU countries and 21 organisations and institutions19 EU countries and 21 organisations and institutions