Exposures and effects possibly related to endocrine disruptors represent real public health issues. In addition, the effects possibly attributed to EDs could be largely avoidable, in particular for future generations (substitution of products, regulations, remediation, recommendations, etc.), and certain ad hoc measures have already been taken (ban of BPA in baby feeding bottles, limitation of the use of phthalates, recommendations for pregnant women).
The complexity of this theme is a source of debate. But beyond the mobilization of the scientific community, the media coverage of studies on certain substances has led public opinion to legitimately seize up the issue. In this context, the mobilization and synergistic work of all stakeholders, including government, communities, economic actors, associations, health and education professionals, scientists and experts, imposes itself.
Santé publique France, through its mission of monitoring exposures and health effects related to EDs, is launching a broad consultation in order to question a panel of participants on two aspects of this topic : scientific and societal.
Why this study and for what purpose?
The monitoring of health indicators in connection with EDs carried out today concerns certain reproductive health indicators, which were selected and prioritized in 2015 by the Institute for Public Health Surveillance (now Santé publique France) on the basis of the weight of evidence with the help of the HURGENT network of international experts [1]. Nevertheless, the scientific literature review today reports more and more other effects on human health [2,3] (neurological development disorders, metabolic diseases, thyroid disorders, etc.) and the expectations of public authorities and of civil society vis-à-vis the Agency on this subject are increasing.
Today, Santé publique France is studying the relevance and feasibility of expanding the monitoring of health indicators in connection with EDs. This is why prioritization work has been initiated : PEPS’PE project (Prioritization of effects for the endocrine disruptor monitoring program of Santé publique France), with the aim of identifying health indicators which should as a priority be the subject of spatio-temporal monitoring by the agency, and ultimately to have available indicators useful for evaluation of actions. Thes monitorings should be on a sufficiently large scale (entire France with DROM).
Methodology
Santé publique France has developed a complementary method combining data from the available literature and a wide consultation of experts and stakeholders on the topic via the DELPHI consensus method. This work is part of a health monitoring logic and not in an approach by substance or exposure : it is a question of monitoring the evolution of a health indicator in the general population for its suspected link with exposure to EDs, not of characterizing the effect of an ED product (or a group of products) on health.
Two prioritization criteria will be evaluated:
- The body of evidence concerning the association between the health effect and exposure to EDs,
- The interest of setting up monitoring of this indicator. It will take into account:
- the epidemiological interest (severity, incidence rate),
- and societal concern.
Santé publique France will then analyze the feasibility of setting up monitoring of the effects that emerged as priorities at the end of the consultation.
The Delphi method
The objective of the Delphi consensus method is to demonstrate a convergence of opinion. Through a questionnaire, each participant learns about the opinions of others and through this process can review their arguments and positions. Each review remains anonymous and the experts never interact directly. The Delphi method therefore proceeds by iterations. The responses are collected and synthesized then made available to the experts for them to express themselves again. This process is repeated as many times as necessary, until consensus is reached and / or differences of opinion become evident.
What are its advantages?
- Provides decision-making elements in cases where one can not rely on either scientific certainties or regulations,
- Allows remote interrogation of a large number of participants,
- Enables questioning of experts and stakeholders with various skills, backgrounds and areas of expertise,
- Guarantees the anonymity of participants,
- Avoids the effect of "personalities" (notoriety, charisma, leadership, etc.),
- Allows the expression of knowledge that is difficult to access (unpublished for example).
Conduct of the study
The participants previously targeted in this survey will be interviewed by online questionnaires: one for the scientific component, the other for the societal component.
Participants will be pre-identified for certain health effects but they will also have the opportunity to select the themes on which they wish to be interviewed.
Completing a questionnaire takes a maximum of 15 minutes per health effect category. In accordance with the Delphi method, several rounds of questionnaires are planned.
Who will participate in this study?
Santé publique France has identified the experts and stakeholders involved in the issue of EDs with a view to soliciting them to participate in this study. Two groups of participants were formed to answer each of the two questionnaires.
- Group n ° 1: international experts in the scientific field involved in the topic of EDs (epidemiologists, toxicologists, academics, etc.) who will be interviewed on the scientific aspect.
- Group n ° 2: french stakeholders in the field (SNPE1 and SNPE2, agency's board of directors …) who will be questioned on the societal aspect.
It is important to note that participants are selected in advance to participate in one or the other of the questionnaires, but will not be able to answer both questionnaires.
Restitution of results
A first report will be produced on the basis of this consultation and taking into account the monitoring feasibility study stage; then a public consultation will be carried out in 2022. Several presentations will then be organized to discuss the results and the follow-up to be given.
1 Le Moal J, et al., Toward a multi-country monitoring system of reproductive health in the context of endocrine disrupting chemical exposure. European Journal of Public Health, 2016. 26(1): p. 76-83.
2 Programme, U.N.E. and W.H. Organization, State of the Science of Endocrine Disrupting Chemicals. 2012.
3 Kortenkamp A, et al., State of the art assessment of endocrine disruptors. 2012, European Commission.