Exposure to and effects potentially linked to endocrine disruptors pose real public health concerns. Furthermore, the effects potentially attributed to EDs could largely be prevented, particularly for future generations (through product substitution, regulations, remediation, recommendations, etc.), and certain ad hoc measures have already been implemented (such as the ban on BPA in baby bottles, restrictions on the use of phthalates, and recommendations for pregnant women).

The complexity of this issue is a source of debate. But beyond the mobilization of the scientific community, media coverage of studies on certain substances has led the public to legitimately take up the issue. In this context, the mobilization and collaborative efforts of all stakeholders—including government, communities, economic actors, associations, health and education professionals, scientists, and experts—are essential.

Santé publique France, as part of its mission to monitor exposures and health effects related to EDs, is launching a broad consultation to gather input from 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 related to EDs currently underway focuses on certain reproductive health indicators, which were selected and prioritized in 2015 by the Institute for Public Health Surveillance (now Santé publique France) based on the weight of evidence, with the assistance of the HURGENT network of international experts ^[1]. Nevertheless, the current scientific literature review reports an increasing number of other effects on human health ^[2,3] (neurodevelopmental disorders, metabolic diseases, thyroid disorders, etc.), and the expectations of public authorities and civil society regarding the Agency on this subject are growing.

Today, Santé publique France is studying the relevance and feasibility of expanding the monitoring of health indicators related to EDs. This is why prioritization work has been initiated: the PEPS’PE project (Prioritization of Effects for the Endocrine Disruptor Monitoring Program of Santé publique France), with the aim of identifying health indicators that should be prioritized for spatio-temporal monitoring by the agency, and ultimately to have available indicators useful for evaluating actions. These monitoring efforts should be conducted on a sufficiently large scale (covering all of France, including the overseas departments and regions).

Methodology

Santé publique France has developed a complementary method combining data from the available literature and a broad consultation of experts and stakeholders on the topic using the DELPHI consensus method. This work is part of a health monitoring approach rather than a substance- or exposure-specific approach: the aim is to monitor changes in a health indicator in the general population due to its suspected link with exposure to EDs, not to characterize the effect of an ED product (or a group of products) on health.

Two prioritization criteria will be evaluated:

• The body of evidence regarding the association between the health effect and exposure to EDs,

• The value of establishing monitoring of this indicator. This will take into account:

  • the epidemiological significance (severity, incidence rate),

  • and societal concern.

Santé publique France will then analyze the feasibility of establishing monitoring of the health effects identified as priorities at the conclusion of the consultation.

• For more information on the project and the consultation: PEPS’PE study - Methodological Report

Conduct of the study

The participants previously selected for this survey will be interviewed via online questionnaires: one for the scientific component and the other for the societal component.

Participants will be pre-selected for certain health effects, but they will also have the opportunity to choose the topics 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 eating disorders with a view to inviting them to participate in this study. Two groups of participants were formed to answer each of the two questionnaires.

• Group 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 2: French stakeholders in the field (SNPE1 and SNPE2, the agency’s board of directors, etc.) who will be interviewed on the societal aspects.

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.

Presentation of results

A preliminary report will be prepared based on this consultation and taking into account the findings of the monitoring feasibility study; a public consultation will then be conducted in 2022. Several presentations will subsequently be organized to discuss the results and the follow-up actions to be taken.