In 2014, France became the first country in the world to launch a national strategy on endocrine disruptors (SNPE), with the aim of reducing environmental and human exposure to these substances. The adoption of SNPE 2 in 2019 confirms France’s commitment to the issue of endocrine disruptors and its determination to strengthen the work already underway. An integral part of the fourth National Health and Environment Plan (PNSE 4) and overseen by the ministries responsible for the environment and health, it shapes the government’s vision and action regarding endocrine disruptors.

A national monitoring and analysis approach

Santé publique France is leading three types of initiatives under SNPE 2 and PNSE 4:

1. Epidemiological surveillance of health indicators aimed at describing health effects with a proven or suspected link to endocrine disruptors.

2. Monitoring of population exposure levels as part of the national biomonitoring program, including the measurement of biomarkers of exposure to substances suspected of causing endocrine disruption, which have been identified as priorities.

3. Tailored prevention measures to help reduce exposure, particularly for at-risk populations (the first 1,000 days).

Epidemiological surveillance of the health effects of endocrine disruptors

Since 2015, Santé publique France has been conducting epidemiological surveillance of certain reproductive health indicators. Collaboration with the international Hurgent network in 2016 enabled the prioritization of key indicators for reproductive health and the selection of a set of indicators to be monitored as a priority.

As a result, several health indicators are already being monitored using existing health databases:

• the four indicators of testicular dysgenesis syndrome (cryptorchidism, hypospadias, sperm quality, and testicular cancer);

• idiopathic central precocious puberty;

• endometriosis;

• uterine fibroids.

The links between exposure to endocrine disruptors and health effects are still a matter of debate, and the level of evidence is constantly evolving. This is why Santé publique France wishes to adapt its surveillance of endocrine disruptors by incorporating new scientific knowledge on the health effects of EDs (neurological damage, metabolic disorders, skin disorders, etc.): a study on the prioritization of health effects for Santé publique France’s endocrine disruptor surveillance program (PEPS’PE). A major consultation with experts and stakeholders was launched in this context in November 2021.

Estimating the effects of EDs on human health is made very difficult due to numerous uncertainties regarding their mechanisms of action, the wide variety of substances involved and exposure pathways, and critical windows of exposure. Applying the exposome concept to surveillance requires combining all available data and various methodological approaches. Methods for assessing the environmental burden and the cost of diseases allow for the combined use of incidence data, biomonitoring data, and epidemiological relationships to estimate attributable cases for (pollutant)/disease risk factor pairs and translate them into economic costs. The integration of these different methodologies and tools into a comprehensive approach offers promising avenues for ultimately identifying effective prevention strategies and actions in a context of uncertainty and knowledge gaps.

• For more information: PEPS'PE study

Monitoring of population exposure through the National Biomonitoring Program

Regarding exposure in the French population, the National Biomonitoring Program aims to address the following priority public health issues:

• Describing population exposure levels to establish national reference values

• Monitoring exposure levels over time at the national level (through repeated surveys).

It helps guide public policy by enabling the monitoring and evaluation of the effectiveness or impact of exposure reduction strategies.
The perinatal component of the National Biomonitoring Program involves the analysis of biomarkers for mothers included in the Elfe cohort in 2011.

The environmental component of the National Nutrition and Health Study (ENNS) made it possible, for the first time in France, to measure the biological concentrations of several environmental pollutants—some of which are endocrine disruptors—in a representative sample of the population.

The Esteban Study (Study on Health, Environment, Biomonitoring, Physical Activity, and Nutrition) made it possible, for the first time in France, to measure the biological concentrations of several environmental pollutants—some of which are endocrine disruptors—in a representative sample of the child population (ages 6–17), to measure new substances compared to ENNS, and to track changes in exposure to substances previously measured in ENNS among adults.

Tailored prevention to help reduce exposure

In the context of perinatal health, the health promotion approach led by Santé publique France aims to foster the creation of environments conducive to the health of children and the adults they will become, to meet their fundamental needs for healthy growth. Our initiative, which focuses on the first 1,000 days of life, also enables a significant commitment to reducing social health inequalities.

To this end, several key areas are being developed: identifying and supporting the implementation of evidence-based interventions in the field designed to enable parents—who are particularly in need, especially when they face psychosocial vulnerabilities—to mobilize their resources and parenting skills. Furthermore, providing them with access to reliable information during this period can empower them to take actions that benefit their health. To this end, on September 15, 2021, Santé publique France launched a website for parents and expectant parents: https://www.1000-premiers-jours.fr. This site is designed to meet the need for information regarding scientific knowledge about the first 1,000 days.

On this site, the physical and chemical environment is addressed through two sections: pages explaining the risks of exposure to certain factors (harmful chemicals, endocrine disruptors, etc.), and a “practical tool” enabling future parents to take daily actions to minimize chemical exposure, given the risks associated with exposure of mothers and expectant mothers to endocrine disruptors during pregnancy.

• For more information: https://www.1000-premiers-jours.fr