Population Health Screening after Environmental Pollution

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.