Exposure to and potential effects associated with endocrine disruptors pose significant public health challenges. These effects could largely be prevented, particularly for future generations (product substitution, regulation, remediation, recommendations, etc.), and certain targeted measures have already been implemented (ban on BPA in baby bottles, restrictions on the use of phthalates, recommendations for pregnant women).

The complexity of this issue is a source of debate, and media coverage of studies on certain substances has led the public to take up the issue. In this context, the mobilization and collaborative efforts of all stakeholders—including the government, local authorities, economic actors, associations, health and education professionals, scientists, and experts—are essential. That is why Santé publique France, in accordance with its mission to monitor exposure and health effects related to endocrine disruptors, is fully fulfilling its role and launching a broad consultation to survey a panel of participants on two fronts: scientific and societal.

Why was this study conducted, and what is its purpose?

Current monitoring of health effects linked to endocrine disruptors focuses on certain reproductive health indicators prioritized in 2015 based on the weight of evidence, using the HURGENT network of international experts ^[1]. Nevertheless, the scientific literature increasingly reports other effects on human health ^{[2, 3]} (neurodevelopmental disorders, metabolic diseases, thyroid disorders, etc.), and expectations from public authorities and civil society on this subject are growing.

Santé publique France is studying the relevance and feasibility of expanding the monitoring of health indicators related to endocrine disruptors. This is why a prioritization effort was launched with the PEPS’PE project (prioritization of health effects to be monitored within the framework of Santé publique France’s endocrine disruptor monitoring program), with the aim of identifying health indicators that should be prioritized for spatio-temporal monitoring by the agency, and ultimately to have indicators useful for evaluating actions. This monitoring must be conducted on a sufficiently large scale (covering all of France, including the overseas departments and regions).

Study Methodology

The proposed methodology combines available literature data with consultations with experts and stakeholders using the DELPHI consensus method. This work is part of a public health monitoring approach rather than a substance- or exposure-based approach: the aim is to track changes in a health indicator in the general population due to its suspected link to exposure to endocrine disruptors, not to characterize the effect of a specific ED product (or group of products).

Two prioritization criteria will be evaluated:

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

• The value of establishing surveillance for this indicator, taking into account:

  • epidemiological relevance (severity, incidence rate),

  • societal concern.

To inform the agency’s planning, Santé publique France will subsequently analyze the feasibility of monitoring the health effects identified as priorities.

• For more information on the project and the consultation: see the Methodological Report - PEPS'PE Study

Study Procedure

Participants previously selected for this survey will be interviewed using online questionnaires: one questionnaire for the scientific component and another for the societal component.

Participants will be pre-selected for certain health effects, but they will also have the option to choose the topics on which they wish to be surveyed.

Completing a questionnaire takes a maximum of 15 minutes per category of health effects. Responses will be anonymous. In accordance with the Delphi method, several rounds of questionnaires are planned with a response deadline of 3 weeks.

Who will participate in this study?

Several experts and stakeholders involved in the issue of PE have been identified to participate in this study. Two groups of participants were formed to complete each of the two questionnaires.

• Group 1: national and international scientific experts (epidemiologists, toxicologists, academics, etc.) for the scientific component.

• Group 2: stakeholders in the field (SNPE1, SNPE2, the Board of Directors of Santé publique France, etc.) for the societal component, excluding those participating in Group 1 as scientists and excluding central government agencies and state operators.

Please note that participants are selected to complete one or the other questionnaire, but will not be able to complete both questionnaires.

How will the results be presented?

Following this consultation, an initial report will be produced, and a public consultation will be held in 2022. Several follow-up meetings will then be organized to discuss the results and next steps.