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Economic benefits of methylmercury exposure control in Europe: monetary value of neurotoxicity prevention.
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MedLine Citation:
PMID:  23289875     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Due to global mercury pollution and the adverse health effects of prenatal exposure to methylmercury (MeHg), an assessment of the economic benefits of prevented developmental neurotoxicity is necessary for any cost-benefit analysis.
METHODS: Distributions of hair-Hg concentrations among women of reproductive age were obtained from the DEMOCOPHES project (1,875 subjects in 17 countries) and literature data (6,820 subjects from 8 countries). The exposures were assumed to comply with log-normal distributions. Neurotoxicity effects were estimated from a linear dose-response function with a slope of 0.465 Intelligence Quotient (IQ) point reduction per μg/g increase in the maternal hair-Hg concentration during pregnancy, assuming no deficits below a hair-Hg limit of 0.58 μg/g thought to be safe. A logarithmic IQ response was used in sensitivity analyses. The estimated IQ benefit cost was based on lifetime income, adjusted for purchasing power parity.
RESULTS: The hair-mercury concentrations were the highest in Southern Europe and lowest in Eastern Europe. The results suggest that, within the EU, more than 1.8 million children are born every year with MeHg exposures above the limit of 0.58 μg/g, and about 200,000 births exceed a higher limit of 2.5 μg/g proposed by the World Health Organization (WHO). The total annual benefits of exposure prevention within the EU were estimated at more than 600,000 IQ points per year, corresponding to a total economic benefit between €8,000 million and €9,000 million per year. About four-fold higher values were obtained when using the logarithmic response function, while adjustment for productivity resulted in slightly lower total benefits. These calculations do not include the less tangible advantages of protecting brain development against neurotoxicity or any other adverse effects.
CONCLUSIONS: These estimates document that efforts to combat mercury pollution and to reduce MeHg exposures will have very substantial economic benefits in Europe, mainly in southern countries. Some data may not be entirely representative, some countries were not covered, and anticipated changes in mercury pollution all suggest a need for extended biomonitoring of human MeHg exposure.
Authors:
Martine Bellanger; Céline Pichery; Dominique Aerts; Marika Berglund; Argelia Castaño; Mája Cejchanová; Pierre Crettaz; Fred Davidson; Marta Esteban; Marc E Fischer; Anca Elena Gurzau; Katarina Halzlova; Andromachi Katsonouri; Lisbeth E Knudsen; Marike Kolossa-Gehring; Gudrun Koppen; Danuta Ligocka; Ana Miklavčič; M Fátima Reis; Peter Rudnai; Janja Snoj Tratnik; Pál Weihe; Esben Budtz-Jørgensen; Philippe Grandjean;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2013-01-07
Journal Detail:
Title:  Environmental health : a global access science source     Volume:  12     ISSN:  1476-069X     ISO Abbreviation:  Environ Health     Publication Date:  2013  
Date Detail:
Created Date:  2013-03-20     Completed Date:  2013-08-30     Revised Date:  2014-02-24    
Medline Journal Info:
Nlm Unique ID:  101147645     Medline TA:  Environ Health     Country:  England    
Other Details:
Languages:  eng     Pagination:  3     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Child
Environmental Exposure / economics*,  prevention & control
Environmental Pollutants / analysis*
Europe
Female
Hair / chemistry*
Humans
Intelligence
Maternal Exposure / economics,  prevention & control
Methylmercury Compounds / analysis*
Neurotoxicity Syndromes / economics*,  metabolism,  prevention & control
Pregnancy
Grant Support
ID/Acronym/Agency:
092731//Wellcome Trust; ES009797/ES/NIEHS NIH HHS; ES012199/ES/NIEHS NIH HHS; G9815508//Medical Research Council
Chemical
Reg. No./Substance:
0/Environmental Pollutants; 0/Methylmercury Compounds
Comments/Corrections
Comment In:
Environ Health. 2013;12:2   [PMID:  23289850 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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Journal ID (nlm-ta): Environ Health
Journal ID (iso-abbrev): Environ Health
ISSN: 1476-069X
Publisher: BioMed Central
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Copyright ©2013 Bellanger et al; licensee BioMed Central Ltd.
open-access:
Received Day: 3 Month: 12 Year: 2012
Accepted Day: 13 Month: 12 Year: 2012
collection publication date: Year: 2013
Electronic publication date: Day: 7 Month: 1 Year: 2013
Volume: 12First Page: 3 Last Page: 3
PubMed Id: 23289875
ID: 3599906
Publisher Id: 1476-069X-12-3
DOI: 10.1186/1476-069X-12-3

Economic benefits of methylmercury exposure control in Europe: Monetary value of neurotoxicity prevention
Martine Bellanger1 Email: martine.bellanger@ehesp.fr
Céline Pichery1 Email: celine.pichery@ehesp.fr
Dominique Aerts2 Email: dominique.aerts@health.fgov.be
Marika Berglund3 Email: Marika.Berglund@ki.se
Argelia Castaño4 Email: castano@isciii.es
Mája Čejchanová5 Email: mcejch@szu.cz
Pierre Crettaz6 Email: pierre.crettaz@bag.admin.ch
Fred Davidson7 Email: fred.davidson@hse.ie
Marta Esteban4 Email: m.esteban@isciii.es
Marc E Fischer8 Email: Marc.Fischer@lns.etat.lu
Anca Elena Gurzau9 Email: ancagurzau@ehc.ro
Katarina Halzlova10 Email: katarina.halzlova@uvzsr.sk
Andromachi Katsonouri11 Email: akatsonouri@sgl.moh.gov.cy
Lisbeth E Knudsen12 Email: liek@sund.ku.dk
Marike Kolossa-Gehring13 Email: marike.kolossa@uba.de
Gudrun Koppen14 Email: gudrun.koppen@vito.be
Danuta Ligocka15 Email: Ligocka@imp.lodz.pl
Ana Miklavčič16 Email: ana.miklavcic@ijs.si
M Fátima Reis17 Email: mfreis@fm.ul.pt
Peter Rudnai18 Email: rudnai.peter@oki.antsz.hu
Janja Snoj Tratnik16 Email: janja.tratnik@ijs.si
Pál Weihe19 Email: Pal@health.fo
Esben Budtz-Jørgensen12 Email: ebj@sund.ku.dk
Philippe Grandjean2021 Email: PGrandjean@health.sdu.dk
1EHESP School of Public Health, Rennes Cedex, France
2FPS Health, Food Chain Safety and Environment, Brussels, Belgium
3Karolinska Institutet, Stockholm, Sweden
4Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
5National Institute of Public Health, Prague, Czech Republic
6EDI, Bundesamt für Gesundheit, Liebefeld, Switzerland
7Health Service Executive South, Cork, Ireland
8Laboratoire National de Santé, Luxembourg, Luxembourg
9Environmental Health Center, Cluj-Napoca, Romania
10Public Health Authority of the Slovak Republic, Bratislava, Slovakia
11Cyprus State General Laboratory, Nicosia, Cyprus
12Department of Public Health, University of Copenhagen, Copenhagen, Denmark
13Umweltbundesamt, Berlin, Germany
14Flemish Institute for Technological Research, Mol, Belgium
15Nofer Institute of Occupational Medicine, Lodz, Poland
16Jožef Stefan Institute, Ljubljana, Slovenia
17Faculdade de Medicina de Lisboa, Lisboa, Portugal
18National Institute of Environmental Health, Budapest, Hungary
19Faroese Hospital System, Tórshavn, Faroe Islands
20Institute of Public Health, University of Southern Denmark, Odense, Denmark
21Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA

Background

Methylmercury (MeHg) is a well-documented neurotoxicant, and prenatal exposures are therefore of particular concern [1,2]. The main sources of exposure are seafood and freshwater fish [3]. Thus, MeHg exposures vary with dietary habits, contamination levels, and species availability. While the distribution of MeHg exposures has been studied in substantial detail in the United States [4], only scattered information is available on MeHg exposures in Europe.

Because the critical effect of MeHg exposure is developmental brain toxicity, exposures among women of reproductive age groups are of primary concern [5,6]. As has previously been determined in regard to lead exposure [7], developmental MeHg exposure is linked to a loss in Intelligence Quotient (IQ), with associated lower school performance and educational attainment, thereby leading to long-term impacts on societal benefits of pollution abatement [8]. These consequences may be expressed in terms of economic impacts, as has been demonstrated in United States [9,10]. However, few economic evaluations have been performed in Europe [8,11,12], primarily because of the lack of exposure data.

Based on harmonised protocols developed in COPHES [13], the DEMOCOPHES project has just completed a multi-country study of hair-mercury concentrations in women of reproductive age groups in 17 European countries. In conjunction with literature data, we now utilise the exposure data to generate estimates of economic impacts of MeHg exposures in Europe.

The economic assessment relies on several assumptions. The hair-Hg concentrations is used as the main exposure indicator in this study, and any blood-based measurements also considered are expressed in terms of hair-mercury using a conversion factor of 250 [14,15]. In regard to the dose-response function (DRF), a linear model is usually the default [14], although it may not necessarily provide the best statistical fit to the data [16]. We therefore used the linear slope as the primary DRF and then conducted a sensitivity analysis using the log function, where each doubling of exposure above the background causes the same deficit of 1.5 IQ points [10].

With regard to background exposures and the possible existence of a threshold, the U.S. EPA’s Reference Dose (RfD) of 0.1 μg/kg body weight/day corresponds to a hair-Hg concentration of about 1 μg/g hair [14]. Updated calculations [17] resulted in an adjusted biological limit about 50% below the recommended level, corresponding to 0.58 μg/g hair. The validity of this lower cut-off point below the RfD is supported by recent studies of developmental neurotoxicity at exposure levels close to the background [18-21]. We assumed that, below the 0.58 μg/g cut-off point, only negligible adverse effects would exist. As additional reference point, we use a tolerable limit proposed by the World Health Organization (WHO), which corresponds to a hair-Hg concentration of approximately 2.5 μg/g [22]. This limit takes into account the possible compensation of MeHg toxicity by beneficial nutrients in seafood [22].


Methods
Exposure information

DEMOCOPHES is a cross-sectional survey of European population exposure to environmental chemicals. The human exposure biomarkers included the hair-mercury concentration and was collected in 17 European countries based on children aged 6–11 years and their mothers. A common European protocol, developed by the COPHES project, was followed in each country. The main inclusion and exclusion criteria were (1) residence in the study area for at least five years, and (2) not having metabolic disturbances. The period of sampling was September 2011 to February 2012. A total of 1,875 child-mother pairs were recruited from urban and rural communities in the participating countries, while excluding exposure hot-spots. Major efforts were carried out to achieve high quality and comparability of data. Standard operational procedures for total mercury concentrations in hair were developed and validated by the Laboratory of Environmental Toxicology in Spain, to ensure comparable measurements, which included a strict quality assurance programme, in which seventeen European laboratories participated. Each DEMOCOPHES partner contributed information to allow estimation of the underlying distribution of exposures in the population, where rural and urban results were merged. In addition, each partner provided the frequencies of results above the cut-off levels of 0.58 μg/g, 1.0 μg/g, and 2.5 μg/g. The latter corresponds to WHO’s tolerable limit, which takes into account likely toxicity compensation by beneficial nutrients in seafood [22].

Additional information on MeHg exposures in Europe was obtained to complement the DEMOCOPHES data. Thus, information of similar quality was extracted from published articles (Miklavčič, unpublished data), and distribution information from comparable studies was obtained from Belgium, Denmark, France, Norway, Slovenia, and the United Kingdom. As explained below, missing information was calculated assuming a log-normal distribution of the exposures.

Exposure distributions

Using the number of births in 2008 and the observed hair-Hg concentrations, we estimated the number of births exceeding the three exposure limits for each country and obtained the sum for all of the EU. For missing EU member states, MeHg exposures were assumed to be the same as a neighbouring country. The year 2008 was chosen as the closest to the time during which the exposure data had been collected, and it allowed complete information for the calculations envisaged. Due to the existence of sampling uncertainty, “smoothed” proportions exceeding the three limits were calculated assuming log-normal distributions. Because log-transformed concentrations would follow a normal distribution, the parameters in the log-normal distributions could be estimated by standard normal distribution methods. Each data set included probabilities (prob) for being below specific percentiles (perc). The parameters in the logarithmic distributions were therefore obtained as the intercept and slope when regressing log(perc) on Φ-1(prob), where Φ is the cumulative distribution function of the standard normal distribution. Using the total numbers of births in 2008, numbers of births exceeding the three cut-off limits in each country were calculated from observed and smoothed distributions.

Calculation of IQ benefits

A linear dose-response function was applied as the default model [14]. Thus, as a 1 μg/L increase of the cord-blood mercury concentration is associated with an average adverse impact on IQ of 0.093 times the standard deviation (which is standardised to be 15), each increase in the maternal hair-mercury by 1 μg/g is associated with an average loss of 0.465 IQ points [10]. This slope is based on a range of neuropsychological tests and subtests administered in the Faroe Islands study at age 7 years [23]. As some recent studies [18-21] suggest MeHg-associated deficits close to or below the cut-off level of 0.58 μg/g hair, the calculations may represent an underestimate. In addition, the slope may be steeper at low exposure levels. Thus, a log model was used for sensitivity analyses. In this model, a doubling in prenatal MeHg exposures is associated with a delay in development of 1.5–2 months at age 7, which corresponds to about 10% of the standard deviation, i.e. 1.5 IQ points [1]. Again, we applied this slope for exposures above the 0.58 μg/g the cut-off point.

To estimate the benefits at exposures above the cut-off point, we calculated the average hair-mercury concentration in women exceeding 0.58 μg/g based on 1,000,000 simulations from the estimated log-normal distribution (as described above). After deduction of the 0.58 μg/g and multiplication by the slope factor, an average IQ benefit was obtained. This amount was then multiplied by the annual number of births exceeding the cut-off level. A similar calculation was made in the logarithmic dose-response model except that here we calculated the average log-transformed mercury concentration in women exceeding 0.58 μg/g, deducted log(0.58) and multiplied by the slope factor of the logarithmic dose-response model (1.5/log(2)).

Annual benefits of exposure reduction

The major component of the social costs incurred by an IQ reduction is loss of productivity and thus a lower earning potential [9,24]. The economic consequence of prenatal exposure to MeHg is valued as the lifetime earning loss per person. We assumed singleton births only, so that the number of women was equal to the cohort size. We also assumed that IQ deficits present at age 7 years or preschool ages are permanent [25]. The estimated individual benefits are the avoided lifetime costs using 2008 data (slightly lower benefits are obtained if referring to more recent years, and benefits are only minimally affected by subsequent membership of the Euro zone). The benefit estimates originate from the 2008 figure of €17,363 per IQ point as recently calculated for France based on data from the United States [24]. For the various European countries involved, this value is adjusted for differences in purchasing power. While simple currency exchange conversion and Gross Domestic Product (GDP) per capita do not adjust for price differences, Purchasing Power Parity (PPP) conversion rates allow for comparison based on a common set of average international prices [26,27]. We also carried out the calculations after adjustment for productivity as the ratio of PPP-adjusted real GDP/capita in each country in relation to the US as a reference. The estimated value of an IQ point then takes into account the impact of labour costs and productivity (Additional file 1).


Results

Table  1 and Additional file 2 show summary information on MeHg exposures in the European countries covered by DEMOCOPHES or other exposure studies. There is a clear trend from north and east to southern countries, most likely due to differences in dietary habits and availability of large fish species from the Mediterranean (the sources of exposure were not considered in the present study). In Table  1, exposures in Austria were assumed to be similar to those in Germany, as suggested by available data [28]. Exposure information from the Flemish part of Belgium [29,30] do not differ much from the national data obtained in DEMOCOPHES, which were therefore used for the calculations. The Flemish data were used to represent exposures in The Netherlands. In the absence of exposure data from Estonia, Finland, Latvia, and Lithuania, the DEMOCOPHES exposure information from Sweden was applied. National data from France are available [31] and have been used in recent economic calculations [8]. Data for Croatia and Greece were obtained from a recent birth cohort study [32]. Two exposure studies had been carried out in Italy, one in the northeast [32] and one in Naples [33], and a joint distribution was therefore used to obtain national exposure distributions that would also apply to Malta. Thus, a log-normal distribution was first fitted to each Italian data subset, and then the parameters of a joint log-normal distribution were determined as the mean of the parameters for the two distributions. Recent results from the Norwegian national birth cohort were used for this country [34]. As DEMOCOPHES data from the United Kingdom covered only a small rural sample, we relied on data on blood-mercury in pregnant women obtained from the ALSPAC birth cohort study in the 1990s [35]. Additional exposure data from Ukraine [36] supported the notion that MeHg exposures in Eastern Europe are low, with only small percentages exceeding the cut-off level, but this study was considered too small to be used for detailed calculations. The same applied to several other sources identified (Miklavčič, unpublished data).

The estimated number of annual births in the EU that exceed the 0.58 μg/g cut-off is about 1.8 million (Table  1, Additional file 3). The EPA limit is exceeded in about 900,000 births, and the WHO limit in 200,000 births within the EU. As each study is subject to sampling uncertainty, log-normal distribution models showed similar, though sometimes slightly higher, proportions exceeding the 0.58 cut-off level (Table  2). The data from Eastern European countries and from Croatia, the Faroe Islands, Norway, and Switzerland suggest that, within Europe, the great majority of births exceeding the various limits occur in EU member states.

Table  2 presents the estimated IQ losses associated with the MeHg exposures using the linear model, along with the estimates of economic impacts. We used both the observed data and the modelled distributions, and only small differences were seen, thus supporting the notion that the log-normal exposure distribution has an appropriate fit. The greatest benefits accrue for the largest countries with the highest proportions of subjects with exposures above the cut-off level. The total benefit from control of MeHg exposure was the highest for Spain and the lowest for Hungary. On a per capita basis, the calculated benefits are the greatest in the Faroe Islands and the southern countries, Spain, Greece, Portugal, Italy, and Croatia. The total annual benefits in terms of IQ points within the EU were estimated to be in excess of 600,000 per year for the linear DRC. With an average benefit of €13,579 per IQ point, the total economic benefits are estimated to exceed €9,000 million per year. When adjustment for productivity is included, the benefits are somewhat lower for several countries, and the EU total is slightly less than €8,000 million per year (Additional file 3).

For comparison, Table  3 shows the estimated IQ losses and economic benefits using the log transformed DRF. Due to the steeper curve shape at exposures close to the cut-off point of 0.58 μg/g, the estimated benefits are about 4-fold greater, at about 2.7 million IQ points per year, which correspond to total benefits for the EU of approximately €39,000 million or, after productivity adjustment, €33,000 million.


Discussion

This study provides for the first time regional European data on economic benefits of controlling MeHg exposure in relation to prevention of developmental neurotoxicity. It relies on data from a multi-country study of hair-Hg concentrations with a high level of quality assurance and with similar population sampling criteria. In addition, available data from other studies have been taken into consideration to provide supplementary information, thereby allowing EU-wide estimates to be calculated. Given the low MeHg exposures in Eastern Europe and the relatively small contributions from Croatia, the Faroe Islands, Norway, and Switzerland, the results suggest that benefits for all of Europe will not be substantially above the benefits calculated for the EU.

Several assumptions and caveats must be acknowledged. The hair-Hg concentration is an established biomarker of human MeHg exposure and is generally considered reliable [14]. We used available data from DEMOCOPHES and other sources, with most studies including only about 120 subjects. The sampling size and strategy may have underestimated the occurrence of uncommon high-level exposures, which would weigh more in the calculation of IQ benefits. Adjustment for this bias is obtained in the modelled distributions, which tended to show slightly greater benefits. Although these calculations rely on an assumption of a log-normal distribution of the exposures, the concurrence of the two sets of estimates support the validity of this assumption.

In calculating the IQ benefits, we used a linear dose-response function for the decrease in IQ at increased prenatal MeHg exposures, and this curve shape is an approximation of unknown validity. As has been documented for lead [37], a logarithmic DRF may be plausible, and a log curve shows a slightly better fit [16]. As the results for the log curve (Table  3) are about 4-fold higher than those obtained for the linear curve, the benefits calculated in Table  2 must be considered likely underestimates. In recent calculations using French data using similar methods [8], the logarithmic curve shape also resulted in substantially higher estimates.

The cut-off level assumed to be 0.58 μg/g hair may also result in underestimated benefits. Recent data from Poland [20], Japan [21] and the United States [18,19] suggest that a lower threshold is likely. If the threshold is indeed lower than we have assumed, the benefits of controlling MeHg exposures will likely be greater, although an additional effort may be required to achieve such lower exposures. Further, given that the much higher tolerable limit of 2.5 μg/g is likely exceeded by 200,000 births in the EU per year, clear benefits will accrue already from controlling the very highest exposures.

The IQ benefits from controlling mercury pollution were translated into economic impacts based on the calculated current life-time income benefits from a higher IQ level. These benefits are mainly based on studies carried out in the United States [24,38], and it is possible that IQ-linked differences in life-time incomes may not be the same in Europe. Adjustment for differences in purchasing power has been included to take this issue into partial account. We used data from 2008 to secure complete data sources; the use of more recent records would change the estimates only slightly. An alternative approach might be to calculate benefits from prevention of specific diseases, e.g. for mental retardation or autism, associated with MeHg exposure. However, the attributable risks associated with increases in MeHg exposure are unknown, and such calculations are therefore uncertain [10,39].

Some sources of imprecision in exposure estimates must be emphasized. Thus, in several cases when exposure information was not available for an EU member state, data from a neighbouring country were used as a proxy. Further, the results reported in DEMOCOPHES and in published reports may not be representative for each country. Although high fish consumers may possibly have been oversampled, it is more likely that the avoidance of known exposure hot-spots resulted in lowered exposure estimates. In addition, especially for small studies, an element of uncertainty exists with regard to the frequencies of the highest exposures, although this problem was addressed by modelling a log-normal distribution of exposures. Temporal variation and time trends may also play a role, especially in regard to older data. We have assumed stable diets, so that any seasonal or other time trends as well as the time dependence of MeHg sensitivity during brain development would not matter for the calculation of impacts.

Our focus on the loss in life-time earnings is similar to the avoidable costs previously calculated in relation to lead exposure [24]. Other costs were ignored, such as direct medical costs linked to treatment or interventions for children with neurodevelopmental disorders. We also neglected indirect costs, such as those related to special education or additional years of schooling for children as a consequence of these disorders, as well as intangible costs. In addition, our study did not consider other avoided direct health care costs in the longer term, such as those potentially related to the treatment of cardiovascular or neurodegenerative effects of MeHg exposure, which could be important for high fish consumers [2], but would be difficult to estimate. Any compensation of the IQ benefit due to special education and other remedies was not taken into account. Overall, the estimates presented in Table  2 are likely underestimates of the total benefits of MeHg exposure abatement.

Clear differences are apparent between European countries. Seafood and freshwater fish constitute the main source of exposure, but countries with high fish consumption levels, such as Spain and Norway, clearly show great differences in MeHg exposure that are undoubtedly related to the choice of fish species consumed as well as the contamination level. The high exposure levels observed in Spain are in accordance with other studies [40,41]. The elevated exposures in the Faroes are likely related to the occasional consumption of pilot whale meat [23].

Calculations from the United States have resulted in several greatly varying estimates, depending on the DRF assumptions. One comparable estimate put the aggregate economic benefit for each annual birth cohort in the US at $8.7 billion (range: $0.7–$13.9 billion for year 2000) [10]. We recently calculated the annual benefit for the US at about 264,000 IQ points, which would correspond to benefits of approximately $5 billion [42]. The EU benefits of over 600,000 IQ points are much higher. However, in comparing the figures for the US and the EU, note should be taken that annual number of births in the EU (5.4 million) are 27% greater than the 4.2 million births in the US per year. In addition, MeHg exposures in parts of Europe are higher than in the US [4]. On a global scale, benefit estimates can be extended on the basis of GDP values adjusted for PPP and productivity, but the validity of such calculations is limited by the lack of exposure assessments [43]. However, the present study leaves little doubt that global benefits substantially exceed $20 billion.

The present study did not aim at calculating annual costs of investments in pollution abatement due to the paucity of available data. Relevant investment costs would consider mercury emissions controls in coal-fired power plants, reduction of mercury usage in the chlorine industry, measures taken in dentistry, plus expenses for recycling and treatment of mercury releases. Some information is available and suggests that one-time expenses may be quickly balanced by the cumulated annual benefits from exposure abatement [9]. However, mercury emissions control needs to be carried out on a global level due to the regional and hemispherical dispersion of mercury releases [43]. These costs would likely have additional socioeconomic yields from better control of mercury emissions, e.g. job creation and modernization of capital equipment.

The control of inorganic mercury emissions will only result in diminished MeHg exposure in the long term, and the benefits will therefore be delayed. As MeHg exposure mainly originates from seafood and freshwater fish, public health advice on dietary choices is an important element of the intervention [6,44]. Due to the essential nutrients present in seafood [3], a reduction in MeHg exposure should not be sought through a decrease or replacement of fish in the diet. A prudent advice would be to maintain fish consumption and minimise the MeHg exposure by consumption of fish known to have lower MeHg concentrations, e.g., smaller species, younger fish, and catches from less polluted waters. Such advice should be directed toward women during pregnancy as the most cost-effective preventive action. Restricted consumption of large, piscivorous fish species may also benefit overfished populations of pelagic fish, such as tuna [45].

The successful completion of the DEMOCOPHES project and the complements from other exposure studies in Europe illustrate the feasibility and usefulness of biological monitoring approaches, in particular when relying on hair samples that may be easily obtained, stored and transported. While such studies have become a routine function in the United States through the National Health And Nutrition Examination Survey [4], and the biomonitoring reports from the Centers for Disease Control and Prevention have become key resources for research on human exposures to environmental chemicals, Europe has lagged behind. Following international policy decisions to decrease global mercury pollution, such human biomonitoring studies will be crucial to monitor the effects of the interventions.


Conclusions

Annual benefits of removing Hg exposure can be estimated to be approximately €9 billion in Europe. While our results support enhanced public policies for the prevention of MeHg exposure, the economic estimates are highly influenced by uncertainties regarding the dose-response relationship. Thus, a logarithmic response curve results in 4-fold higher benefit estimates. In addition, benefits might be underestimated because costs linked to all aspects of neurotoxicity and long-term disease risks have not been considered. These European data and the calculated economic benefits support the need for interventions to minimize exposure to this hazardous pollutant.


Abbreviations

DRF: Dose-response Function; EPA: Environmental Protection Agency; EU: European Union; GDP: Gross Domestic Product; hair-Hg: Mercury concentration in hair; MeHg: Methylmercury; IQ: Intelligence Quotient; perc: Percentile; PPP: Purchasing Power Parity; prob: Probability; RfD: Reference Dose; US: United States; WHO: World Health Organization.


Competing interests

PG is an editor of this journal but did not participate in the editorial handling of this manuscript. The authors declare that they have no competing interests.


Authors’ contributions

MB, CP, EBJ and PG planned the economic evaluation, carried out the calculations, and drafted the manuscript. AM reviewed published data on MeHg exposure. DA coordinated the contributions of the 17 DEMOCOPHES countries. AC and ME were responsible for the development and follow-up of the Standard Operating Procedures and Quality Assurance for hair sampling and mercury analyses in support to comparability of DEMOCOPHES measurements. DA, MB2, AC, MČ, PC, FD, MEF, AEG, KH, AK, LEK, MK-G, GK, DL, AM, MFR, PR, JST, and PW contributed unpublished exposure data from European countries and act as guarantors of the data applied. All authors commented on the draft manuscript, and all authors read and approved the final version.


Authors’ information

National guarantors of the DEMOCOPHES data are listed as co-authors. The DEMO/COPHES Consortium that established and tested harmonised human biomonitoring on a European scale (http://www.eu-hbm.info) also included Jürgen Angerer, Pierre Biot, Louis Bloemen, Ludwine Casteleyn, Milena Horvat, Anke Joas, Reinhard Joas, Greet Schoeters, and Karen Exley.


Supplementary Material Additional file 1

Conversion rates, 2008.


Click here for additional data file (1476-069X-12-3-S1.docx)

Additional file 2

Exposure distributions.


Click here for additional data file (1476-069X-12-3-S2.doc)

Additional file 3

IQ calculation spreadsheet.


Click here for additional data file (1476-069X-12-3-S3.xls)


Acknowledgements

Exposure data were contributed from the DEMOCOPHES project (LIFE09 ENV/BE/000410) carried out thanks to joint financing of 50% from the European Commission programme LIFE + along with 50% from each participating country (see the national implementation websites accessible via http://www.eu-hbm.info/democophes/project-partners). Special thanks go to the national implementation teams. The COPHES project that provided the operational and scientific framework was funded by the European Community's Seventh Framework Programme - DG Research (Grant Agreement Number 244237). Additional exposure data were supported by the PHIME project (FOOD-CT-2006-016253) and ArcRisk (GA 226534). We are grateful to Yue Gao and colleagues for sharing Flanders exposure data from the Flemish Center of Expertise on Environment and Health, financed and steered by the Ministry of the Flemish Community. National exposure data from the 2006–2007 French national survey on nutrition and health (Etude Nationale Nutrition Santé) were made available by Nadine Fréry, French Institute for Public Health Surveillance. Data from the Norwegian Mother and Child Cohort Study (a validation sample) were kindly provided by Anne Lise Brantsæter, National Institute of Public Health, Oslo. The UK mercury data were obtained from the ALSPAC pregnancy blood analyses carried out at the Centers for Disease Control and Prevention with funding from NOAA (the US National Oceanographic and Atmospheric Administration). The studies in the Faroe Islands were supported by the US National Institutes of Health (ES009797 and ES012199). The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the funding agencies.


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Tables
[TableWrap ID: T1] Table 1 

Annual numbers of births and numbers exceeding three cut-off limits, as indicated by hair-mercury analyses (in μg/g) in population samples in European countries


Countrya
Annual number of births (2008)
Number of samplesb
Above 0.58 μg/g
Above 1.0 μg/g
Above 2.5 μg/g
      Proportion in sample (%) Estimated number of births Proportion in sample (%) Estimated number of births Proportion in sample (%) Estimated number of births
Austria
77,800
NA
(6.7)
5,213
(0.8)
622
(0)
0
Belgium
127,200
129
28.7
36,506
9.3
11,830
0
0
242c
23.2
29,510
7.2
9,158
0
Bulgaria
77,700
NA
(4.2)
3,263
(1.2)
932
(0.8)
622
Croatia
43,800
234d
52.0
22,776
22.0
9,636
4.7
2,059
Cyprus
9,200
60
36.7
3,376
18.3
1,684
3.3
304
Czech Republic
119,600
120
5.0
5,980
0.8
957
0
0
Denmark
65,000
145
36.6
23,790
13.1
8515
0.7
455
Estonia
16,000
NA
(10.0)
1,600
(2.0)
320
(0)
0
Faroe Islands
675
505e
62.6
423
30.2
204
5.3
36
Finland
59,500
NA
(10.0)
5,950
(2.0)
1,190
(0)
0
France
829,300
126f
44.0
364,892
14.51
120,331
0.61
5,059
Germany
682,500
120
6.7
45,728
0.8
5,460
0
0
Greece
118,300
454d
78
92,274
57
67,431
14
16,562
Hungary
99,100
120
0.83
823
0
0
0
0
Ireland
74,000
120
10.8
7,992
2.5
1,850
0
0
Italy
576,700
891d + 115g
(65.6)
378,315
(36.8)
212,226
(5.7)
32,872
Latvia
23,834
NA
(10.0)
2,383
(2.0)
477
(0)
0
Lithuania
35,100
NA
(10.0)
3,510
(2.0)
702
(0)
0
Luxembourg
5,600
55
32.7
1,831
18.2
1,019
0
0
Malta
4,100
NA
(65.6)
2,690
(36.8)
1,509
(5.7)
234
Netherlands
184,600
NA
(23.2)
42,827
(7.2)
13,291
(0)
0
Norway
60,500
119h
27.7
16,759
5.9
3,570
0
0
Poland
414,500
120
1.7
7047
0
0
0
0
Portugal
104,600
120
90.8
94,977
57.5
60,145
8.3
8,682
Romania
221,900
120
4.2
9,320
1.2
2,663
0.8
1,775
Slovakia
57,400
129
5.43
3,117
0.8
459
0
0
Slovenia
21,800
156
22.0
4,796
7.7
1,679
1.9
414
Spain
519,800
120
88.5
460,023
74.2
385,692
31.7
164,777
Sweden
109,300
100
10.0
10,930
2.0
2,186
0
0
Switzerland
76,700
120
5.0
3,835
2.1
1,611
0
0
United Kingdom
794,400
4134h
31.0
246,264
5.1
40,200
0
0
Total EU (27) 5,400,000     1,865,416   903,169   231,754

Exposures in EU countries without recent data are estimated from neighbouring countries (modelled results not based on observed distributions are given in parenthesis).

a For countries without available exposure data (for number of samples, NA denotes not available), data from a neighbouring country have been applied to allow EU-wide estimates, and frequencies are given in parenthesis. This applies to Austria (data from Germany were used), Bulgaria (Romania), Netherlands (Flanders [30]), and Estonia, Finland, Latvia, and Lithuania (Sweden); b All data are from DEMOCOPHES, unless otherwise noted; c[30]; d[32]; e Pal Weihe, unpublished data; f[31]; g[33]; h Jean Golding, pers.comm.


[TableWrap ID: T2] Table 2 

Annual number of births with excess exposure, average hair-Hg concentration, IQ benefit from prevention of excess exposure, and the value of the IQ benefits


Country
Number of births above 0.58 μg/g
Average concentration above 0.58 μg/g
Benefit in IQ points
Value of 1 IQ point (Euro)
Total benefit (million Euro)
  Modelled Observed   Modelled Observed   Modelled Observed
Austria
3,812
5,213
0.917
597
817
16,044
9.6
13.1
Belgium
39,686
36,506
0.939
6,625
6,094
16,458
109.0
100.3
Bulgaria
3,186
3,263
1.455
1,296
1,328
7,529
9.8
10.0
Croatia
21,769
22,776
1.355
7,845
8,208
11,320
88.8
92.9
Cyprus
3,514
3,376
1.311
1,195
1,148
13,747
16.4
15.8
Czech Republic
5,143
5,980
0.847
639
742
10,797
6.9
8.0
Denmark
22,815
23,790
1.027
4,742
4,945
20,220
95.9
100.0
Estonia
1,840
1,600
0.846
228
198
10,339
2.4
2.0
Faroe Islands
406
423
1.323
140
146
20,220
2.8
2.9
Finland
6,843
5,950
0.846
846
736
17,288
14.6
12.7
France
405,528
364,892
0.989
70,186
69,397
17,363
1,218.6
1,204.9
Germany
33,443
45,728
0.917
5,241
7,166
15,292
80.1
109.6
Greece
94,403
92,274
1.563
50,131
49,000
13,201
661.8
646.9
Hungary
892
823
0.884
126
116
9,691
1.2
1.1
Ireland
7,104
7,992
0.946
1,209
1,360
17,927
21.7
24.4
Italy
378,315
(378,315)
1.045
81,801
(81,801)
17,062
1,395.7
(1,395.7)
Latvia
2,741
2,383
0.846
339
295
11,568
3.9
3.4
Lithuania
4,037
3,510
0.846
499
434
9,661
4.8
4.2
Luxembourg
1,870
1,831
1.212
550
538
17,062
9.4
9.2
Malta
2,690
(2,690)
1.045
582
(582)
11,111
6.5
6.5
Netherlands
45,227
42,827
0.909
6,919
6,552
15,857
109.7
103.9
Norway
16,759
16,759
0.866
2,237
2,229
20,051
44.8
44.7
Poland
6,218
7,047
0.751
494
560
9,979
4.9
5.6
Portugal
94,349
94,977
1.482
39,573
39,836
12,221
483.6
486.8
Romania
9,098
9,320
1.455
3,702
3,797
8,187
30.3
31.1
Slovakia
2,468
3,117
0.899
366
462
10,037
3.7
4.6
Slovenia
4,840
4,796
1.194
1,382
1,369
11,939
16.5
16.3
Spain
479,775
460,023
2.136
347,137
332,845
13,558
4,706.5
4,512.7
Sweden
12,570
10,930
0.846
1,555
1,352
17,167
26.7
23.2
Switzerland
6,520
3.835
0.902
976
574
18,346
17.9
10.5
United Kingdom
248,647
246,200
0.81
26,593
26,338
15,324
407.5
403.5
EU Total 1,926,652 1,865,365   654,551 639,804   9,458 9,256

Data are for European countries with information on methylmercury exposure distributions. For countries without detailed observed data available, the modelled results are given in parenthesis. Sources of underlying data are as in Table  1.


[TableWrap ID: T3] Table 3 

Annual number of births with excess exposure, the average log hair-Hg concentration, and IQ benefit and value from prevention of excess exposure (logarithmic dose-effect relationship)


Country Number of births above 0.58 μg/g Average log concentration above 0.58 μg/g Benefit in IQ points Value of 1 IQ point (Euro) Total benefit (million Euro)
Austria
3,812
−0.157
3,199
16,044
51.3
Belgium
39,686
−0.128
35,790
16,458
589.0
Bulgaria
3,186
0.128
4,638
7,529
34.9
Croatia
21,769
0.142
32,350
11,320
366.2
Cyprus
3,514
0.109
4,972
13,747
68.3
Czech Republic
5,143
−0.216
3,658
10,797
39.5
Denmark
22,815
−0.060
23,932
20,220
483.9
Estonia
1,840
−0.214
1,317
10,339
13.6
Faroe Islands
406
0.139
600
20,220
12.1
Finland
6,843
−0.214
4,897
17,288
84.7
France
405,528
−0.053
368,742
17,363
6,402.5
Germany
33,443
−0.157
28,060
15,292
429.1
Greece
94,403
0.355
183,808
13,201
2,426.4
Hungary
892
−0.186
692
9,691
6.7
Ireland
7,104
−0.132
6,345
17,927
113.7
Italy
378,315
−0.036
416,490
17,062
7.106.2
Latvia
2,741
−0.214
1,962
11,568
22.7
Lithuania
4,037
−0.214
2,889
9,661
27.9
Luxembourg
1,870
0.053
2,419
17,062
41.3
Malta
2,690
−0.036
2,961
11,111
32.9
Netherlands
45,227
−0.155
38,144
15,857
604.8
Norway
16,759
−0.198
12,574
20,051
252.1
Poland
6,218
−0.312
3,131
9,979
31.2
Portugal
94,349
0.277
167,777
12,221
2,050.4
Romania
9,098
0.128
13,245
8,187
108.4
Slovakia
2,468
−0.173
1,986
10,037
19.9
Slovenia
4,840
0.034
6,061
11,939
72.4
Spain
479,775
0.561
1,148,026
13,558
15,564.9
Sweden
12,570
−0.214
8,996
17,167
154.4
Switzerland
6,520
−0.167
5,329
18,346
97.8
United Kingdom
248,647
−0.244
161,816
15,324
2,479.7
EU Total 1,884,563   2,645,953   39,061

Data from European countries, sources of underlying data are as in Table  1.



Article Categories:
  • Research

Keywords: Economic evaluation, Methylmercury, Prenatal exposure, Neurodevelopmental deficits.

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