Health-related environmental monitoring

Humans are at the heart of health-related environmental monitoring. The German Environment Agency mainly uses two instruments: the German Environmental Surveys on Health (GerES, formerly environmental survey) and human samples from the German Environmental Specimen Bank.

On behalf of the Federation, the German Environment Agency has been conducting German Environmental Surveys on Health (GerES) since the 1980s at intervals of several years. The surveys are used to acquire and update representative data on the internal exposure of humans to pollutants and pollutant exposure in the living environment. To this end, blood and urine samples are examined and samples of tap water, indoor air and house dust are taken and analysed. The survey also includes a standardised interview with participants about their living environment and exposure‑relevant behaviour.

The findings of the GerES are "population-representative" meaning that the results enable statements to be made about the overall population in the age groups examined.

The fifth cycle of the GerES (GerES V) focussed on exposure in children and adolescents aged 3 to 17 years. As the GerES V was carried out in close cooperation with a health study of the Robert Koch Institute, the specific data it obtained on exposure to chemicals, noise and indoor air pollutants could also be assessed in the context of more general data on the health of the participating individuals. In addition to familiar chemicals such as cadmium, lead and mercury, newer substances like phthalates, triclosan, UV filters, bisphenol A and per- and polyfluoroalkyl substances (PFAS) were also investigated.

Field work for the next German Environmental Survey on Health (GerES VI), focussing on exposure in adults, is being carried out from 2023 to 2024.

The German Environmental Specimen Bank archives frozen human samples (blood and urine). Samples are collected every year from young adults (mostly students) in Münster (since 1984), Halle/Saale (since 1995), Greifswald (since 1996) and Ulm (since 1997). In addition, participants fill out a questionnaire to obtain socio‑demographic information and information on exposure-relevant behaviour and living conditions. Given that new samples have been put into storage every year since the 1980s, statements can be made on changes in public exposure to pollutants over time. Using the stored samples, It is also possible to retroactively identify substances or their metabolites, which were not known or could not be analysed as environmental pollutants at the time of storage.

Human biomonitoring (HBM) plays a key role in the GerES and the German Environmental Specimen Bank. HBM involves the examination of blood and urine for pollutants or their metabolites. Occasionally, breast milk and other body fluids or tissue are also examined. Human biomonitoring provides information on whether chemicals have entered the human body from the environment, and if so which chemicals and in what quantities. This data alone is not sufficient to draw conclusions about the sources of the chemicals.

There are a variety of sources from which chemicals can be absorbed by humans, for example via air, water, food, textiles or personal care products. Some chemicals can accumulate in different organs over time with continued exposure, other substances are quickly excreted. Where people are directly exposed to chemicals, absorption may be limited to individual sources, even if they occur in other media, depending on the extent of exposure and types of chemicals involved.

For that reason, more comprehensive investigations are often needed to identify intake pathways and chemical sources and, if necessary, initiate targeted measures to minimise them.

Not every chemical absorbed adversely impacts human health. Modern analytical methods enable the detection of many chemicals in the human body that do not pose a risk to human health. There are, however, numerous chemicals which we know for certain need to be urgently (further) reduced as they can compromise human health.

The Human Biomonitoring Commission (HBM Commission) of the German Environment Agency is responsible for the health assessment of chemical concentration levels detected in blood and urine. The Commission has derived reference values and human biomonitoring values (HBM values) for a range of chemicals. Reference values are statistically derived and represent the average concentrations of a chemical in the population or a specific population group at a particular point in time. These values are per se of no health relevance. By contrast, HBM values are toxicologically founded and include a health assessment. HBM values are divided into HBM-I and HBM-II values. If the concentration is below the HBM-I value of a chemical, there is no cause for concern according to current knowledge of its properties. If the concentration is above the HBM-II value, adverse health effects are possible. In these cases, action needs to be taken to reduce exposure and, depending on the concentrations in question, biomedical support may need to be provided. If the concentration lies between the two values, an attempt should be made to identify the exposure source in order to reduce substance absorption into the body and prevent adverse health impacts.

Human biomonitoring is an indispensable monitoring tool for initiating and adjusting environmental policy measures and determining whether protection goals are being met. It is the only way to reliably assess whether a ban or restriction of harmful chemicals has reduced public exposure to these chemicals. That is why there is close cooperation with REACH, the European regulatory framework for chemicals policy.

Human biomonitoring also makes it possible to determine whether chemicals have been absorbed by the human body to an unexpectedly high extent and therefore require regulation.

Not all chemicals can be reliably examined in the context of human biomonitoring. That is why, in 2010 the Federal Environment Ministry and the German Chemical Industry Association (VCI) launched a cooperative initiative to further develop human biomonitoring. The aim of this initiative, originally intended for a period of ten years, is to develop ways of testing for chemicals that were not previously measurable. Due to the complexity of the tasks involved, the initiative has been extended until the agreed methods have been completed. The goal is to develop the first methods for the detection of up to 50 chemicals of relevance to the general population which have potential health implications. Among the substances for which such methods have been successfully developed to date are new plasticisers, flame retardants, technical solvents, UV filters and preservatives, all of which are used in consumer products.

The main partners in this project are the German Environment Agency and a panel of experts from the scientific community, public authorities and industry. The panel of experts proposes substances and supports the method developing process. The VCI is responsible for the development of detection methods. All methods are validated and published in scientific journals so that they are available worldwide.

The Federation is responsible for the application of new methods (e.g. using samples from the Environmental Specimen Bank or within the framework of German Environmental Surveys on Health). Once the Human Biomonitoring Commission of the German Environment Agency has established the appropriate HBM values, exposure levels can finally be assessed from a health standpoint. This will provide valuable information for chemicals policy.

With its human biomonitoring activities, Germany plays a pioneering role in Europe. In view of that, the German Environment Agency took on coordination of a major EU research project for the 2016-2022 period: The European Human Biomonitoring Initiative (HBM4EU) was supported by the European Commission with up to 50 million euros. The project coordinated HBM activities in the 30 participating countries, established common standards and developed approaches to make results usable for EU substance policy. The project concluded mid-2022. The work is being continued and expanded on in the framework of a new EU research partnership on chemical safety — PARC (Partnership for the Assessment of Risks from Chemicals), which began in May 2022 and will run for seven years.

The Federal Environment Ministry and the German Environment Agency jointly organised international human biomonitoring conferences in Berlin in 2010, 2016 and 2020 to promote the international exchange of experience and knowledge in the field of health-related environmental monitoring.

Important health-related environmental monitoring activities also take place at international level. For instance, since 2010 the Federal Environment Ministry has been promoting the activities of the Environment and Child Health International Group (ECHIG), which comprises the German Environment Agency and other experts from Germany as well as representatives of birth cohorts from Japan, China, France, Denmark and Norway. The goal of this collaboration is to exchange methods and experiences and harmonise approaches to ensure that the data obtained is as comparable as possible. This will enable findings which would not be possible using isolated data from individual investigations. The World Health Organization (WHO) is part of this initiative through the International Agency for Research on Cancer (IARC).

The Federal Environment Ministry also works together with WHO in the context of the Environment and Health Process (EHP). This WHO Europe process was initiated in 1989 in Frankfurt am Main. At intervals of several years, conferences of environment and health ministers set goals for further improvements in the field of environment and health. Data from health-related environmental monitoring supports this process and helps to set priorities. The most recent, seventh, Ministerial Conference on Environment and Health took place in Budapest from 5 to 7 July 2023. EHP Partnerships were launched as a new tool to implement decisions. The Federal Environment Ministry, supported by the Georgian Health Ministry, took over lead responsibility for a new EHP Partnership on human biomonitoring, which is open to all interested member states of the WHO European region. The focus of the Partnership is the exchange of experience, mutual support in the practical implementation of studies, capacity building, joint development of strategies for anchoring HBM more firmly in legislation, the mobilisation of resources and risk communication. Unlike research-oriented EU cooperation, which is always for a limited time period, the Partnership under the umbrella of WHO should enable the creation of more permanent networks. As of July 2024, 19 member states have joined the Partnership.

WHO Europe is one of the regional organisations of the World Health Organization (WHO). The WHO European region comprises 53 countries, including all EU member states, the countries of the former Soviet Union, Israel and Turkey. A central pillar of this process is the WHO European Centre for Environment and Health (ECEH) in Bonn, which receives significant financial support from the Federal Environment Ministry.