Abstract
Following environmental pollution exposure, calls to screen the population for disease or disease markers are often made. Population screening is a cross-sectional review of a population to find latent cases or biomarkers of disease that indicate the possibility of disease development; it differs from environmental screening or an epidemiological survey. Recognized standard approaches have been developed over 60 years to ensure quality and effectiveness in complex programs. We surveyed the literature for papers on health screening following environmental exposures and checked them for reference to accepted criteria such as those of Wilson and Jungner. We applied these criteria to three situations covering source/hazard (arsenic contaminated land), pathway/exposure (radiation release), and receptor/disease (lead poisoning). We identified 36 relevant papers. Although across the papers the whole range of criteria were addressed, no paper or program utilized recognized criteria. Issues and gaps identified included limited strategic approaches, lack of treatment, environmental prevention being seen as the screening outcome instead of treatment of identified individuals, and programs which did not fit the World Health Organization screening description. Robust discussion in the literature is needed to consider the organization and role of health screening following environmental exposures.
Highlights
Pollution is the largest environmental cause of premature death and disease in the world today, with a greater impact on global health than cancer
We did not limit the search to any particular years: The term “mass screening” was added to PubMed in 1968, “environmental exposure” and “environmental pollution” were introduced in 1974, while diagnostic screening programs was added in 2019
Following review of the title and abstract we identified 36 papers from 1979 to 2019 on environmentally relevant population health screening programs
Summary
Pollution is the largest environmental cause of premature death and disease in the world today, with a greater impact on global health than cancer. The enormous number of contaminated land sites in low- and middle-income countries from industrial and commercial activities, large and small, put the health of possibly more than million people at risk [2]. Following the identification of an exposure to environmental pollution, it can be appropriate to consider whether it is possible to identify those people who may be developing disease, in order to give them early treatment and reduce morbidity and mortality. Screening differs from impact assessment, whether environmental or health, since these are risk assessments and not designed to identify individuals with disease. It differs from the monitoring or screening of potential pollutants in the environment
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