Flemish human biomonitoring program

The impact of environmental pollution is generally monitored by measurements of pollutants in air, water, soil and food.

To collect data on environmental exposure and related health effects, and to obtain better information for public policy decision, the Flemish government initiated a five-year (2002-2006) systematic human biomonitoring programme covering around one-fifth of both its territory and population.

Human Biomonitoring (HBM) can be defined as "monitoring activities in human beings, using biomarkers, that focus on environmental exposures, diseases and/or disorders and genetic susceptibility, and their potential relationships".

Flemish Environment and Health Studies (FLEHS)

The first generation 'Flemish Centre of Expertise on Environment and Health' implemented the Flemish human biomonitoring programme, which measures concentrations of well characterized pollutants inside the human body by using biomarkers. The aim was to examine whether living in different areas in Flanders results in differences in exposure and early biological effects of pollutants in the human body. The programme collects a variety of biomarkers of exposure (including e.g. DDE, heavy metals, dioxins, exposure to PAHs and benzene) and effect (including e.g. DNA damage, asthma and allergy, ...) in eight areas and for three age groups (newborn babies, adolescents, elderly). The selected areas are characterized by different environmental loads and include two urban areas (Antwerp and Ghent), a fruit growing area, a rural area and four industrial areas (the harbours of Antwerp and Ghent, non ferrous melter, chemical industry and household waste incinerators). In the 8 areas 1196 mothers and their newborn babies, 1679 adolescents (14-15 years) and 1583 adults (50-65 years) were recruited. The study showed differences in biomarker values of exposure and effect for the different areas and found measurable biological effects at exposure levels well below current standards.

A participatory process was used in FLEHS II (2007-2011) to propose and finally select 2 hotspots of interest for human biomonitoring. The hypothesis was tested whether in the hot spot areas specific biomonitoring data (exposure and effects) are different from reference values that have been obtained over Flanders. As part of the second cycle of the biomonitoring program we obtained reference data for a much wider set of exposure biomarkers compared to the first cycle, this was emphasized by the slogan “What are you carrying with you?” Reference values for more than 50 biomarkers were generated.

The third cycle of the program (2012-2015) has allowed to generate time trends of internal pollutant levels in humans of the general population of Flanders. The program has also allowed to evaluate the associations between exposure levels and different health outcomes in prospective cohorts of the first two cycles of the Flemish environmental health surveys (FLEHSI and FLEHSII). In addition we have used the HBM data to estimate the positive effects on health as we have seen decreases in biomarker levels of specific metals and persistent organic pollutants over time. However FLEHS III has also shown that for some chemicals no decreasing time trends can be observed yet. Many other chemicals that emerge from new lifestyles and habits have never been investigated. Besides, we demonstrated that levels of environmental exposures are related to differences in socio- economic status (SES) of the study participants emphasizing inequity of exposures and presumably also in health risks. The need for targeted environmental protection guidance for subgroups in the population in relation to lifestyle and SES related is warranted.

A fourth FLEHS cycle is ongoing (2016-2020). This fourth cycle builds on strengths and experiences from the past and also addresses new upcoming challenges.

All reports and newsletters are available on the website of the Flemish Centre of Expertise on Environment and Health (www.milieu-en-gezondheid.be).


The Flemish Human Biomonitoring Programme (VHBP) and the resulting policy translation also put Flanders on the international map and are a source of inspiration for many European member states and the European Commission. On 1 January 2017, the European Human Biomonitoring Initiative was launched under the name HBM4EU, in which Flanders plays a major role. This Horizon 2020 project, in the form of a European Joint Programme (EJP), aims to generate cooperation between Member States within the field of human biomonitoring (HBM). It focuses specifically on improving knowledge about the exposure of the European population to chemicals and their potential health effects and on translating the results into concrete policy action at European, national and regional level. The European Commission foresees to invest a maximum of € 50 million over a period of five years on the basis of a co-financing of 70% for the total project.


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