Studying the exposome: 'On the front line for people and the planet'

Climate change exacerbates our health risks. This is associated with the exposome, the cumulative environmental exposures and concomitant biological responses an individual is subjected to over their lifetime.

Even though environmental factors play a decisive role in health, there are currently very few useful tools to measure their effects on humans. Research in this field usually examines only one pollutant at a time in relation to only one associated health outcome. However, experts say that this might not be the right approach. What is needed is a “systemic” vision, which would allow us to link environmental factors to genetic factors along the course of an individual’s life.

These are some of the objectives of the European Human Exposome Network. It brings together nine different EU-funded projects and seeks to develop methods to pinpoint an individual’s environmental exposure with the same precision with which their genome can be identified.

So far, there has been much more investment in genomic research than there has been in environmental exposure research. Genome studies allow the sequencing of genomic chains at non-prohibitive costs. In addition, the genome remains the same throughout a person’s life.

Martine Vrijheid, Research Professor at the Global Health Institute (ISGlobal) in Barcelona and coordinator of the ATHLETE project, one of the Network’s projects: “Research on the environmental exposome is much more complex because it changes continuously and the variables that can come into play are many.” – Read the full interview Martine Vrijheid

The current pandemic, along with other present and future challenges such as the progressive concentration of the European population in urban areas, make it clear that environmental exposure factors can no longer be underestimated or ignored.

Roel Vermeulen, Professor at the Department of Population Health Science, University of Utrecht, and coordinator of the Expanse Project, also part of the European Human Exposome Network: “There are major health differences between European urban populations and also within European cities. We can’t explain this by known factors. To reduce the observed health inequalities, we need to understand the interconnections and how this relates to health.” – Read the full interview Roel Vermeulen

Another challenge is the effective dissemination of the relatively new “exposome” concept. According to the experts, adequate health prevention policies must be developed to promote virtuous behaviour: we should be more aware of our environment. and how it can affect our health. This social and scientific challenge requires us to build bridges between disciplines to achieve the shared goal of a more inclusive and equitable public health system.

In a 2016 article, Howard Koh, the Harvey V. Fineberg Professor of the Practice of Public Health Leadership at the Harvard T. H. Chan School of Public Health, explained that doctors have a unique opportunity to frame climate change as a public health issue and to raise awareness not only among the public, but also among policy makers.

A position statement by the Royal College of Paediatricians and Child Health takes the same view. Paediatricians and general practitioners certainly are in a unique position. As Koh explains in his editorial, numerous studies confirm the general level of trust that people have in their family doctors, even if that trust may change from country to country and from one time period to another.

For doctors to take on this awareness-raising task, it is necessary to re-evaluate medical training curricula to take into consideration how they can be integrated and updated with respect to environmental and climate issues. A 2014 George Mason University report found that 80% of doctors interviewed would consider it appropriate for their curriculum to include climate and environmental health impacts.

An editorial published two years ago in the scientific journal Academic Medicine reaffirmed the same concepts. “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”.

Sylvain Sebert, project leader at the centre for life-course health research, University of Oulu, and coordinator for the LongITools project, one of the Network’s projects: “One practical solution may lie within the framework of Marie Skłodowska-Curie training networks and other international programmes.” – Read the full interview Sylvain Sebert

Professor Roel Vermeulen: “The challenge is to [transform] a collective goal, such as the goal for protecting the environment and climate, into something that takes on personal importance and urgency.”

Looking further ahead, this challenge affects not only doctors but the academic community and society as a whole.

Sylvain Sebert: “There are training opportunities and a need for reform and, ideally, both should go beyond the medical curricula. The nine projects of the European Human Exposome Network advocate for the integration of disciplines, ranging from the humanities to the hard sciences, to bridge gaps for evidence-based policies and reforms.”