FEATURE SPOTLIGHT : ENVIRONMENTAL HEALTH
Biomonitoring with a Health Equity Lens
By Kelly Chen , MSc , research scientist , California Department of Public Health ; Jessica Nelson , PhD , MPH , epidemiologist and director , Biomonitoring Program , Minnesota Department of Health ; and Jennifer Liebreich , manager , Environmental Health
Biomonitoring measures levels of environmental chemicals or their metabolites in a person ’ s body fluids or tissues and is an important tool that can characterize the disproportionate burden of harmful exposures among certain communities . Public health programs and academic partners can use biomonitoring data to identify contributing risks and associated health impacts , evaluate intervention strategies , and monitor progress in reducing exposures . Combined , these efforts can lead to meaningful strategies to reduce disparities and move towards environmental health equity .
Figure 1 . California ’ s ACE Project has adopted levels of concern ( LOCs ) for arsenic , cadmium , lead and mercury . Participants whose levels exceeded an LOC received personalized follow-up , such as discussions to identify potential sources of their chemical exposures , and advice on ways they might reduce their exposures .
California
Biomonitoring California implemented the Asian / Pacific Islander Community Exposures ( ACE ) Project in 2016 and 2017 as a two-phase biomonitoring study of 200 adults in the San Francisco Bay Area . The ACE Project was conducted in collaboration with two community partners : APA Family Support Services and the Vietnamese Voluntary Foundation . These projects were motivated by prior studies across the United States , which have consistently found higher levels of heavy metals and per- and poly-fluoroalkyl substances ( PFAS ) among Asian / Pacific Islanders ( API ) compared to other race / ethnic groups . 1 , 2 , 3 Community groups in the Bay Area were also interested in local biomonitoring data , as an evidence base to support ongoing efforts to educate constituents about safer fish consumption .
The ACE Project confirmed that Chinese Americans ( ACE 1 ) and Vietnamese Americans ( ACE 2 ) in California had elevated exposures to arsenic , mercury and legacy PFAS ( Figure 1 ). In both phases of ACE , measured levels were even higher than those seen in a national cohort of API participants from National Health and Nutrition Examination Survey ( NHANES ). Biomonitoring California provided personal biomonitoring results to participants , and for those with elevated levels of metals , conducted a follow-up survey to identify potential sources of exposures and provide advice on exposure reduction . The findings from the ACE Project are being used to develop health education materials on topics including arsenic in rice and safer fish consumption choices .
Minnesota
The Minnesota Biomonitoring Program ’ s 2016 – 2018 Minnesota Family Environmental Exposure Tracking ( MN FEET ) study found that participating women from some Minnesota communities had elevated urine mercury exposures as a result of using skin lightening products . MN FEET showed that skin lightening product use may be putting some Hmong , Latina and East African women in danger of mercury exposure . Follow-up work that offered urine mercury testing as part of routine clinical screenings confirmed these results and emphasized the need for more urine mercury biomonitoring , interventions to reduce exposures , and specific cultural community outreach and engagement on the topic .
The use of skin lightening creams has deep roots in colorism and the preference for lighter skin , supporting a $ 10 billion market . However , a common ingredient in these products is mercury , which is dangerous and illegal . Consumers are generally unaware that mercury exists in these products and are therefore unaware of the risks to themselves and their families . Because of this , these risks and negative health consequences fall unequally on communities of color .
APHA
’ s Environmental Health and Equity Collaborative created Achieving Environmental Health Equity : The Need and Opportunities for Public Health Action , a brief providing background , examples , data and actionable steps environmental public health leaders and their organizations can take to move towards health equity . Actions are organized by the 10 Essential Public Health Services and include a poster and summary version .
18 LAB MATTERS Summer 2023
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