Human biomonitoring (HBM) is a valuable tool used to quantify exposures and effects by measuring levels of chemicals and/or their metabolites in biological matrices such as blood, urine, exhaled breath, breast milk, hair, fingernails and teeth (Sexton and Pirkle, 2004; Angerer J et al., 2006; Choi J et al., 2015). HBM studies are always combined with questionnaires to evaluate exposure risk factors and sources such as food, consumer products and the environment. Additionally, markers of effect can be incorporated to facilitate our understanding of the health impacts of these exposures. The applications of the information gained from HBM are broad and include trend analysis (geographical and temporal) in the exposure or health status of a population, identification of emerging threats, undertaking chemical risk assessment, chemical incident and disaster response, addressing policy needs/development and raising awareness.

Results from HBM studies can contribute to improve public health both directly and indirectly by providing evidence of individuals’ exposure and data to understand the burden of disease and costs associated with chemicals in the environment (Knudsen and Merlo, 2011a, 2011b), thereby galvanising the development and implementation of evidence-based policy. The value of national HBM programmes has been recognised in many countries across the world for decades (Choi et al., 2015). As a result, some countries have developed regional or national standalone HBM programmes (without the inclusion of health surveys or other studies) while others have sought to integrate/combine HBM with existing Health Examination Surveys (HESs)/diet/nutrition surveys or engage in targeted, specific problem oriented HBM studies. A network of European countries has been working since 2003 to progress the development and implementation of national HBM programmes as part of fulfilling the European Environmental Health Initiatives (Commission, 2020). This has culminated in the current European Human Biomonitoring project which started in 2017 and is a collaborative effort involving 30 countries, the European Environment Agency (EEA) and the European Commission (contracting authority) (HBM4EU, 2022). The European Human Biomonitoring Project (known as HBM4EU) is a multinational effort to harmonise procedures across Europe and advance research into the understanding of the health impacts of environmental chemical exposure. One of the aims of HBM4EU was to assist partner countries to develop and/or strengthen their networks of government departments/agencies/ministries, and stakeholders (from herein these groups are referred to as National Hubs (NHs). Each NH nominated a National Hub Contact Point (NHCP) that acted as the link between the project and the national institutions. The National Hubs constitution was not prescribed by HBM4EU as the national activities were not part of the project activities in HBM4EU. Thus, each country developed a NH to suit their requirements and expertise. For instance, NHs could contain all the partners who were taking part in HBM4EU plus others – such as other academic institutes, national funding bodies, government departments and other stakeholders like the industry and NGOs (Fig. 1).

The use of HBM to raise awareness of public health issues, steer policy development and protect population health is evident on a global level. Numerous studies directed to specific chemicals (e.g. lead, polychlorinated biphenyls (PCBs), dioxins) and geographical hotspot investigations (e.g., arsenic in drinking water, cadmium around industrial sources) have applied HBM methods to investigate excess exposures, often leading to targeted policy interventions. Also, in occupational settings, HBM has proven valuable to protect workers’ health in many studies. The value of national HBM programmes is demonstrated by the National Health and Nutrition Examination Survey (NHANES) in the USA where a decline of blood lead level was detected (using HBM) following a ban on lead in gasoline (petrol) and its removal from soldered cans for food (Pirkle et al., 1994). The German Environmental Survey (GerES) and the German Environmental Specimen Bank (ESB) were instrumental in initiating the avoidance of amalgam teeth fillings containing mercury in children (Kolossa-Gehring et al., 2012). Additionally, it contributed to the arguments on restriction of phthalate use in plastics (Göen T et al., 2011). In Belgium, information from the Flemish Environmental and Health Survey (FLEHS) informed the development of policy measures for persistent organic pollutants (POPs); including source-related regulation such as optimising and tightening existing Flemish legislation on open fires (Reynders et al., 2017). Biomonitoring data from the Canadian Health Measures Survey (CHMS) have been used to establish baseline concentrations of chemicals in Canadians; inform public health, regulatory risk assessment and management decisions; and fulfil national and international reporting requirements (Haines DA et al., 2017).

Action 3 of the European Environment and Health Action Plan 2004–2010 required the development of a coherent approach to biomonitoring in Europe (European Commission, 2004). Hence in 2005, the Expert Team to Support Biomonitoring in Europe (ESBIO) project supported the Implementation Group on HBM (IG-HBM) in commencing the preparation of protocols for the selection of study populations and priority chemicals. In 2009, this work was continued by the Consortium to Perform Human Biomonitoring on a European Scale (COPHES, 2009–2012) resulting in the finalisation of the protocols, selection of appropriate biomarkers and recruitment strategy. Demonstration of a study to Coordinate and Perform Human Biomonitoring on a European Scale’, LIFE+, 2010–2012 (DEMOCOPHES), then tested the feasibility of a harmonised HBM approach in Europe, by successfully applying the COPHES approach in 17 European countries (Joas et al., 2012). Den Hond et al. (Den Hond E et al., 2015) provide a summary of these data for the exposure to selected chemicals, such as cadmium and phthalate concentrations in urine which are contained in consumer products and food packaging (Koch and Calafat, 2009), and mercury in hair (Grandjean and Landrigan, 2006) in mother-child pairs in those 17 countries (Wittassek and Angerer J, 2011; Budtz-Jørgensen et al., 2004; Akerstrom et al., 2013).

This work continued with HBM4EU, one of the major objectives being to create a harmonised HBM platform leading to consistent comparable and quality assured data throughout Europe. Another objective of HBM4EU is to use HBM data to support evidence based chemical policy and make this information timely and directly available for policy makers and all partners. Furthermore, the programme aims to ensure the sustainability of HBM and support capacity building through the development of a strong NHs network.

This article will assess national narratives provided by the NHCPs in countries within HBM4EU by highlighting good practice and learning gained from partner countries in the application of HBM for chemical risk assessment, policy issues and raising awareness.