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The assessment of the health implications of human exposure to low doses of multiple environmental chemical pollutants represents an important challenge for environmental epidemiology. Current studies must go beyond simple exposure-disease associations and need further characterization of a complete exposure disease continuum, including exposure routes, adverse outcome pathways, potential subclinical effects, interactions between chemicals, and intra-individual susceptibility. This needs an effective synergism with basic sciences, which can enrich epidemiologic findings with very detailed information at a molecular level, but also with clinicians, who would help to provide accurate diagnoses and interpretation in a real-world scenario. On the other hand, environmental exposures can affect the general population at different levels, including economic and social dimensions, which have been frequently overlooked. These approaches would require specific methodologies that are relatively novel in the field of environmental epidemiology, such as cost-benefit analyses and qualitative techniques. Public health campaigns can clearly benefit from these mixed approaches.

Integrated approaches for the assessment of health impacts of environmental chemicals: our experience in the GraMo cohort study