Dr. Irene van Kamp, from the National Institute for Public Health and the Environment, discusses the exposome concept to study the role of the environment in human disease
Mental health is the result of complex interplay between genetic, psychological, environmental factors and experiences. The exposome concept, referring to the totality of exposures from conception onwards, is emerging as a very promising approach to studying the role of the environment in human disease.
The EU funded Equal-Life project, which is part of the European Human Exposome Network employs the exposome concept in an integrated study of multiple exposures in relation to a child’s development and life course mental health. A novel approach is used which looks at exposure data at a high spatial and temporal resolution combining physical and social aspects to understand influences on mental health and cognitive development at different ages and developmental stages. The goal is to propose the best supportive environments for children.
Mental Health is of growing concern
Mental ill health is one of the fastest growing public health issues in Europe and awareness about this has increased. Its contribution to the burden of disease weighs heavily on societies and economies. In Europe, the cost of mental ill health was estimated to be over 4% of GDP1 in 2018. Children’s mental ill health predicts to a large extent mental ill health in later life with impacts on quality of life and work situation.
It is therefore of growing concern that at school age, one in ten children has a mental health problem that warrants support and treatment. These figures vary in time. More recently, for example, research shows that there is mixed evidence that children and adolescents have experienced significant anxiety and depression during the coronavirus pandemic and that these symptoms increased as compared to the pre-pandemic period.
Sensitivity and Child development
Children are sensitive for a whole range of social and physical influences from the moment they are conceived up until adulthood. Not because they are vulnerable per se, but because they are in a sensitive period for their development. As mental health, neurodevelopment is also affected by complex interplay between genetic, psychological, environmental factors and experiences. This has become painfully visible during the pandemic as well: there is growing evidence that the Covid-19 situation has had strong effects on children’s development.
There are claims that the environ-mental changes associated with the pandemic have negatively affected infant and child cognitive development. These effects would be stronger in children born into lower socio economic families. Underlying causes one could think of are parental stress, lack of parental attentiveness, lack of physical activity, poor indoor climate, anxiety and depression, lack of guidance, crowding, chaotic circumstances all together forming the child’s exposome.
What is the exposome and why is it important?
The exposome is an umbrella term for all the environmental exposures throughout the life course of a person. It encompasses all types of exposures. Some exposures arise from internal and external processes at individual level (e.g., smoking, diet, physical activity, infectious agents, psychosocial stress, parental support). Other exposure sources are shared at population level (e.g., climate, air quality, built environment, green space, noise and social capital). The exposome concept serves as a counterpart of the human genome and strives to map every exposure an individual is subjected to from conception to death, providing a DNA-like detailed level of exposure information.
Equal-Life discerns the external (physical, social) and internal exposome. The physical exposome is directly related to the description of the state of the environment – such as green spaces, sound and air quality, access to high quality and safe public spaces and playgrounds.
The social exposome focuses the social and psychosocial environment as well as on social (in)equities on mental health and cognitive development. This pertains to (in)equities in exposure distribution and accumulation across generations, vulnerability to exposures and potential equity impacts of urban (planning) policies on different societal groups.
Internal exposome is a consequence of external exposome filtered by personal vulnerabilities and lifestyle. It is measured in the person and can include biomarkers (i.e., indicators of exposure, susceptibility or outcome) but can also include processes that happen in the body and that can be analysed as a whole. Biomarkers are biological indicators measurable in saliva, hair, blood or urine. A well-known example is cortisol as a marker of stress.
The exposome contains a vast number of possible exposures during various phases of life. To reduce the complexity and make the broadness of the concept manageable, Equal-Life poses the questions: what is needed for a child /person to realise his or her own potential? What setting (e.g., kindergarten, school, recreational and sports facilities) and activities are relevant in view of mental health and development and at what age/life phase? From this we assess the possible mechanisms linking the exposome to mental health and cognitive development. Key mechanisms studied are stress and restoration, sleep and self-regulation.
How do we study this?
For a distinct set of outcomes related to cognition, mental symptoms and behaviour, well-being and diagnosed mental illnesses, the role of the exposome and underlying mechanisms is studied by making use of data from almost 250.000 EU children.
What will we do with this knowledge?
Equal-Life will develop and test interventions, such as improving housing environment, based on results of analyses and in close collaboration with stakeholders. Interventions and best practices will be included in a tool and a guidance document primarily aimed at context specific policies that affect children in Europe, thus contributing to healthier environments for European children. Intervention at an early age could benefit society as a whole by enhancing mental health and education outcomes, thus also addressing the contextual and root causes of social inequalities.
The EU Charter of Fundamental Rights states: The EU and EU countries must respect, protect and promote children’s rights. All EU policies that have an impact on children must be designed in line with the best interests of the child. Compliance to this will depend heavily on national and local policy actions as well. Our tools will therefore primarily be aimed at them.
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© 2019. This work is licensed under a CC BY 4.0 license.
