A co-ordinated approach

04 March 2009

Dr Ludwine Casteleyn, Chair of the European Group on Human Biomonitoring, assesses the role of human biomonitoring in environmental health

Human Biomonitoring (HBM) measures chemicals or their effects in the human body. Blood or urine in most cases, but also other bodily fluids or tissues such as breast milk, saliva, faeces, hair, nails, teeth, breath and sweat, are used to assess exposure, how much of the substance or its metabolites are in the body, and whether this causes an (adverse) health effect.

HBM has proven its added value in occupational health as part of a preventive approach, combined with workplace monitoring and hygienic measures. Nowadays HBM is increasingly used in environmental health for hypothesis testing studies, surveillance studies¹ and awareness raising activities², often alongside other more classical methods such as environmental monitoring and modelling, and with health and lifestyle questionnaires.

Scientists, policy-makers, and stakeholders recognise HBM's relevance. It may act as an important trigger for action at personal and policy level by making pollution and its effects a personal matter.³ Even the act of measuring itself is an important message. Governmental bodies that organise HBM programmes emphasise their concern for the health impact of the environment and their readiness to take up their responsibility.

HBM is not yet at its full potential. Much research work is ongoing to increase the utility and interpretation of data. As for environmental monitoring, information from HBM studies needs expert interpretation and clarification.⁴ Good communication and transparency at all stages of a study or programme, to participants, the general public and to policy-makers, is a key prerequisite in HBM, to secure its real added value. As HBM involves taking samples in humans, it requires due consideration of the ethical issues.

Within Europe a broad consensus exists on the need for more harmonised approaches allowing a better use of the HBM data obtained.⁵ Accurate, comparable information on the prevalence of exposure to environmental agents and on the related public health impact is not yet available for the whole of Europe. Such information is needed to evaluate country specific data, to assess spatial and time trends, to identify and characterise vulnerable populations and to help policy-makers understand what is needed to reduce morbidity and mortality. If repeated over time, HBM may give an indication to the extent policy measures have proven to be successful and serve as a benchmark for specific research studies.

The EU Environment and Health Action Plan⁶ proposes to test out the feasibility of a co-ordinated approach. A recent EU conference under the auspices of the French Presidency⁷ aimed to define necessary conditions and infrastructure to develop harmonised programmes at national and European level based on different countries' experiences. Scientists, government institutions and authorities, non-governmental organisations (NGOs) and industry experts in the field currently join efforts to secure funding and to implement a pilot project together with the Commission. For the post-pilot project phase, the Commission is exploring the possibility of embedding future HBM activities in a framework such as the EU Health Examination Survey⁸ and it will ensure that HBM is linked to the existing regulatory frameworks such as REACH⁹ and the Stockholm Convention.¹⁰

1 See eg. GerES: German Environmental Survey www.umweltbundesamt.de/gesundheit-e/survey/index.htm
2 See eg. WWF Chemical trespass: a toxic legacy www.wwf.org.uk/filelibrary/pdf/chem4.pdf
3 Stokstad E (2004) Pollution gets personal, Science: 304:1892-93
4 See http://www.invs.sante.fr/publication/2008/biosurveillanceS4_Tuomo_karjalainen.pdf
5 Strong political commitments were expressed at several levels: by the EU Commission, the European Economic and Social Committee, the Council,
the EU Parliament, the WHO Madrid Conference 2008 http://www.eu-humanbiomonitoring.org/sub/back/polcom.htm/
6 http://ec.europa.eu/environment/health/index_en.htm
7 www.invs.fr/surveillance/biosurveillance/default.htm A-C Viso, L Casteleyn, P Biot, D Eilstein, Human biomonitoring programmes and activities in the EU, Journal of Epidemiology and Community Health, in press.
8 In development, see EHES: http://ec.europa.eu/health/ph_information/dissemination/reporting/ehss_06_en.htm
9 REACH: Registration Evaluation and Authorisation of Chemicals http://ec.europa.eu/environment/chemicals/reach/reach_intro.htm
10 The Stockholm Convention on Persistent Organic Pollutants http://chm.pops.int