What’s Exposome Data and Can It Lead to Healthier Kids?

LISBON, Portugal — Europe needs a Child Health Exposome Mission to better understand how to prevent, diagnose, and treat diseases over the life course, protecting the health and well-being of future generations, said Peter van den Hazel, MD, PhD, vice president of the European Public Health Association’s environment and health section.

The exposome is the integrated compilation of all physical, chemical, biological, and psychosocial exposures that affect biology over a complete lifetime. Its application to child mental health was the focus of a session held at the 17th European Public Health Conference (EPH) 2024.

“In Europe and globally, we are lacking a mission with a focus on children’s mental health,” said van den Hazel. “There is huge potential for a transformative impact on child health outcomes. There’s a European mission on cancer but nothing similar for children.”

“A lot of focus is on general health and lots of money is spent on clinical settings and curing diseases, but the money would be well spent on establishing an exposome project on child mental health,” van den Hazel told Medscape Medical News in an interview following the session.

He emphasized that the benefits would be felt in the long term over generations. “If we protect children early in life, then not only do we prevent many mental diseases but also physical diseases. In the end, this will reduce the burden on the clinical setting, and it would be cost saving to use mental health interventions early in life.”

van den Hazel highlighted that the proposed Child Health Exposome Mission aims to build an infrastructure network for standardized research, protocols, and exposome assessment tools and to establish Europe-wide birth cohorts with an emphasis on longitudinal tracking of exposures. This should help identify health determinants and modifiable risk factors for interventions. “Until now, there’s been a lack of tools and processes for research, so although many interventions have been done, only a few have been scientifically evaluated.”

Better Social Exposome Optimizes Health Outcomes

A total of 250 million children are at risk of not meeting their development potential globally, said van den Hazel, adding that only 6% of children live in countries meeting at least half the sustainable development goal targets.

van den Hazel highlighted the growth in understanding around the link between the social exposome (social environmental health determinants) and the physical exposome and how they can work together and strengthen each other. “We can spend loads of money to try and reduce air pollution, for example, but if we don’t reduce the social exposome of children, then it can be a waste of time, effort, and money and impacts health later in life. We know that people exposed to adverse social settings live shorter lives and are in worse health than those not exposed.”

He stressed that exposures during the first 1000 days were very important in shaping the later health effects in children. “Studies show us that the impact of social exposures is much higher than we realized.”

A child’s social exposure also affects later generations, continued van den Hazel. “Importantly, this will also reap benefits when these children later become parents themselves.”

Obesity is a case in point. “We see some children receiving the worst foods, and the obesity epidemic is testament to this,” he explained. “Much is due to parents themselves being uneducated.”

Karin Boode, MBA, strategic youth policy advisor for the National Association of Regional Public Health Services, the Netherlands, built on van den Hazel’s discussion around prioritization of the social exposome. She referred to the importance of this across three settings: The home, the school, and the community.

Boode made 10 top recommendations across the three contexts. She spoke to Medscape Medical News after the session and highlighted the three most important.

“Nurturing care is crucial and protective for mental health because the foundations for mental health are laid early — during the first 1000 days,” she said. “We need greater availability of good parental leave so they can be there for the child to bond properly. It’s so important, and this means taking time with the child; ideally good stress-free time.”

In the school setting, she emphasized that inclusivity is key. “Nowadays, the pressure of getting high grades and being the best is enormous. And, yes, it goes on throughout life, but in school, children should feel included and be part of the community without bullying. Everyone should be respected.”

Communities built around sports, music, or theatre, for example, also have a key part to play, said Boode. “The leaders of these organizations can help by being there for these children and having time and funds to support them. If they see a good young football player, then they should encourage that and give the child opportunity.”

Discussing adolescent exposome research, Jutta Lindert, PhD, professor of public health from the University of Emden/Leer, Emden, Germany, said, “Multiple factors affect mental health. The more risk factors adolescents are exposed to, the greater the potential impact on their mental health.”

She added that, globally, 1 in 7 10- to 19-year-olds experience a mental disorder, accounting for 15% of the global burden of disease in this age group. “Depression, anxiety, and behavioral disorders are among the leading causes of illness and disability among adolescents, and the consequences of failing to address adolescent mental health conditions extend to adulthood.”

Lindert highlighted a study launched earlier this year called the EARLY Project that aims to address youth mental health issues with researchers from 14 countries cross Europe. It is looking at mental health conditions such as depression, anxiety, stress disorders, and substance use disorders in youth and the extent to which mental illnesses can be recognized in youth through the development of a versatile exposure matrix designed to adapt to emerging risks and provide a deeper understanding of the factors influencing youth mental health.

van den Hazel, Boode, and Lindert had disclosed no relevant financial relationships.