1. International HIA 2011 Conference: In crisis times, healthier ways Marianne Rappolder, André Conrad, Otto Hänninen, Annette Prüss-Üstün, Anne Knol, Matti Jantunen, Olli Leino Odile Mekel, Jurgen Buekers, Paolo Carrer, Thomas Classen, Ivano Iavarone, Rokho Kim Virpi Kollanus, Tek-Ang Lim, Rudi Torfs

2. Environmental Burden of Disease in Europe Participating countries: Belgium Finland The Netherlands France Germany Italy 15 April 2011 2 International HIA 2011 Conference: In crisis times, healthier ways http://en.opasnet.org/w/Ebode

3. Environmental Stressors 15 April 2011 3 International HIA 2011 Conference: In crisis times, healthier ways Outdoor Benzene Ozone Particulate Matter (PM10 und PM2,5) Indoor:Radon in buildings Formaldehyde Second hand smoke Noise:Traffic noise Biomonitoring: Lead Food:Dioxins + dioxin like PCB

4. Overall results DALYs per 1 million people, range of the 6 participating countries 15 April 2011 4 International HIA 2011 Conference: In crisis times, healthier ways Non-discounted values

5. Data and information needed 15 April 2011 5 International HIA 2011 Conference: In crisis times, healthier ways Fraction of the population, affected by the environmental stressor Total Burden of Disease (specific endpoints) Environmental Burden of Disease (specific endpoints) Dose-response of specific environmental stressor Exposure and population data Epidemiology, Toxicology Health data

6. Dioxins - Introduction 15 April 2011 6 International HIA 2011 Conference: In crisis times, healthier ways Dioxin is not a single chemical Dioxins are always found as a mixture of dioxins and furans Only the seventeen 2,3,7,8 congeners have dioxin-like toxicity with different toxic power, concentration is expressed by Toxic EQuivalence (TEQ) Polychlorinated biphenyls (PCBs) with similar structure have dioxin-like toxicity (from 209 PCB congeners 12 PCBs) - are included in TEQ Daily intake estimation included these chemicals

7. Dioxins – exposure Main exposure root is via oral intake: About 90 % to 95 % of dioxin exposure in men is from food, mainly from animal fat Dioxins are bio accumulating - half life is 7 to 19 years, stored in fatty tissue (body burden) Dioxin and PCB contamination in most matrices have been decreased dramatically in the last decades The body burden increase with age, depends on dioxin contamination in food but also on eating habits and fat content of the body 15 April 2011 7 International HIA 2011 Conference: In crisis times, healthier ways

8. Dioxins – daily intake estimation Dioxin levels in food National food monitoring programmes Food baskets or duplication studies Food Consumption Food frequency questionnaire Duplication studies Body burden Humanbiomonitoring and back-calculation Problems Dioxin and PCB contamination varies especially in fish (e.g. Finland 0.2-14 pg/g TEQ), Eating habits differ a lot 15 April 2011 8 International HIA 2011 Conference: In crisis times, healthier ways

9. Daily intake of Dioxins and dl PCBs 15 April 2011 9 Countries Population group Source Sampling year Dioxin intake pg/kg bw/d Belgium adults-fem.18-44 y adults 50-65 y Adults - mean Bilau 2008 Calculated 2002-06 2.09 1.74 1.9 (mean) Finland all Kiviranta et al 2005 2002 1.5 France 30-65 y Fréry et al. 2006 2004 2.3 Germany adultsUBA 20052003 2.0 Italy 13 – 94 y Fattore et al 2006 1997-2003 2.3 Netherlands adultsDe Mul 20082004 1.0 International HIA 2011 Conference: In crisis times, healthier ways

10. Comparison Human milk – daily intake France was not includied in the WHO-Study The daily intake from the Netherlands seemed to be underestimated 15 April 2011 10 International HIA 2011 Conference: In crisis times, healthier ways CountryHuman milk Daily intake factor ng TEQ/kg fat ng TEQ/kg bw/d Milk/ intake Belgium29.51.916 Finland15.31.510 Germany26.22.013 Italy29.02.313 Netherlands29.81.030

11. Exposure - response 15 April 2011 11 International HIA 2011 Conference: In crisis times, healthier ways Unit-risk (UR) approach Cases = f(UR,Exposure) Dioxins (all cancer) UR = 1*10 -3 pro pg/kg/d All cancer cases are lethal Advantage: absolute number, independent from background disease incidence All other effects (immunotoxic, neurotoxic, toxic for reproduction and development, other endocrine disrupting effects were not considered due to lack of dose-response- function and countable endpoints –

12. Health effects 15 April 2011 12 International HIA 2011 Conference: In crisis times, healthier ways Prerequisites of quantifyable endpoints: A validated dose-response function Endpoint in humans measurable Data of burden of disease in humans available Problems: Environmental stressors have effects in animal studies Many different effects - difficult to measure and to quantify in humans Epidemiological data are usually from occupational health from mixtures exposure, or by accident

13. Results of EBoDE 15 April 2011 13 International HIA 2011 Conference: In crisis times, healthier ways Comparison of Countries DALYs per milion people and country for dioxinsand dioxin-like PCBs (undiscounted, un-age-weighted)

14. Uncertainties and limitation 15 April 2011 14 International HIA 2011 Conference: In crisis times, healthier ways Exposure data (daily intake): very high variation Dose-response function: only for endpoint „all cancer“ - all other endpoints not included DALY-calculation includes only mortality (all cancer cases are considered to be lethal in the first year Health effect: non cancer effects not considered, e.g. endocrine disrupting effects difficult to have quantifyable endpoints

15. Conclusion and outlook 15 April 2011 15 International HIA 2011 Conference: In crisis times, healthier ways DALY for dioxins could be overestimated (all cancer lethal) or underestimated (no inclusion of non cancer effects) DALY-calculation is a suitable method for acute effects, specific endpoints, low variation in exposure DALY-method is useful for an initial estimation of the impact of a reduction measure for a chemical At this time: limited priorisation of environmental stressors based on DALY Further developing of EBD-Method is needed to take into account: effects of endocrine disruptors, low dose, mixture exposure Need for better dose responses functions from animal studies

16. Thank you for your attention! Marianne Rappolder marianne.rappolder@uba.de Federal Environment Agency Germany, Berlin Corrensplatz

17. Measures for daily intake 15 April 2011 17 Type of measurementType of use Specific limitations and uncertainties ASurvey (questionnaire) on food consumption Information on food consumption and about the content of dioxins in representative food samples allow modelling of daily intake Results are modelled for an average population - food contamination and eating habits can differ on a large scale BTotal diet studiesThe total diet in a population group over a certain time period and dioxin in this food or representative food samples are measured. Results are only relevant for the investigated groups and not necessarily representative for the whole population, sampling period influence the results. CHumanbiomonitoring Investigation of human milk or blood levels Analyses of samples can show the body burden. Experimental scaling is used to convert observed biomonitoring results (blood) into daily intakes. D-R function is based on daily intake. It had to calculate from body burden. Human milk or blood samples are not widely available. Different fat content of the bodies influences the results. International HIA 2011 Conference: In crisis times, healthier ways