Within the European Human Exposome Network, what role do climatic variables play?
Sylvain Sebert: The European Human Exposome Network focuses on the relationship between a number of environmental exposures that relate directly or indirectly to climatic variables. First of all, it is important to explain the concept of ‘climatic variables’: these can include variables related to objective measures such as yearly or seasonal average temperatures, rainfall, snow cover, wind, pressure, and frequency of extreme weather conditions.
These are highly relevant and concern a wide range of environmental exposures that are being examined.
In many cases, the outdoor environmental exposome is directly associated with climatic factors and may have a synergistic effect on health. This can be the case for the regulation of blood pressure, which can be affected by ambient temperature, traffic noise and air pollution, for example.
In addition, we must take into account the social and psychosocial contexts when considering ‘cause-consequence’ scenarios linking the human exposome, the climate and human health outcomes. One of the several possibilities under examination in the LongITools project is how climatic exposures may affect health through the modification of people’s behaviour and how these observed effects are also the result of other social factors.
The project aims to develop a holistic approach to determine the best stages in life to intervene to reduce these risks. What role does communication play in this context?
Sylvain Sebert: Testing the exposome (literally, the sum of all possible exposures) is an empirical approach to being holistic. In this context, we have a life-course and longitudinal approach to clarify the relationship between risk factors through time. It also hypothesises that, first, risk factors are transferred from one generation to the next through genetic and non-genetic inheritance and, second, risks tend to accumulate throughout your life.
From an interventionist’s viewpoint, we recognise that there are opportunities to step in at each stage of the life course. However, the chance for sustainable effects may depend on our ability to identify and act on the source of the problem.
From an economist’s point of view, the Nobel Prize winning American economist James Heckman has demonstrated the cost-efficiency of early prevention, so it’s best to act before the problem appears.
Explaining the concept of the exposome in different ways to different audience groups to guarantee understanding is critical. Communication plays a vital role in any research project in order to simplify complex science – such as the exposome concept – into easily digestible messages. The selected tools (e.g. video or graphics) and communication channels (e.g. social media) are important here and play a key role in reaching a wide range of people.
What policy tools could be developed from these new research frontiers?
Sylvain Sebert: The research will enable us to determine what impact the exposome has on the risk of developing cardiovascular and metabolic diseases. This evidence will enable:
- targeted health impact assessments of decisions taken at different levels of government;
- educational material for policymakers on the social determinants of health (environmental exposures that we are investigating) and on how decision-making can impact the risk of long-term health problems;
- interventions and “windows of opportunity” for public health policymakers to adopt a “Health in All Policies” prevention approach to the health of the population;
- and arguments for financial investment in healthcare-related prevention measures (with evidence to suggest where financial investment should be directed), thereby resulting in longer-term savings for acute services.
In your opinion, would it be useful to reformulate the medical curricula to include more training on environmental and climate risks?
Sylvain Sebert: It is true that, so far, climate-related environmental factors might have been too often underestimated in their effect on pulmonary diseases. I am very much in favour of bringing the environmental determinants of health into the medical curricula. This could be done at various stages of the curriculum. One practical solution may lie within the framework of Marie Skłodowska-Curie training networks and other international programmes.
In your opinion, could doctors, because of their widespread presence throughout society, be the spokespersons of a new exposome awareness?
Sylvain Sebert: The current COVID-19 pandemic has indeed taught us the importance of having such expert spokespersons.
However, it is more important that healthcare professionals and policy makers work together to improve the population’s health at the prevention level and tackle the impact of the climate and the environment on long-term health conditions. If doctors can contribute to this by making their voices heard and by backing a health in all policies approach, then that would be good for the health of the whole population.