Exposomics and public health ethics

Exposomics measures all the exposures of an individual over the lifespan and how they impact health. This presentation will describe this emerging field and the ethical issues it raises. Current assessments of environmental exposure tend to limit themselves to measuring one exogenous chemical or toxic exposure at a single point in time. Exposomics emphasizes the lifetime cumulative health impact of all exposures. It calls special attention to exposures in the intrauterine environment and how these exposures impact gene expression in the fetus. Knowledge of the profound effects of “fetal programming” on subsequent development and susceptibility to disease will impose greater moral responsibility on both parents and society. Exposomics takes into account not only environmental pollutants, chemicals, and toxins but also diet, life-style, psychosocial stressors, and social determinants of health. By using the tools of “big data” to assess the impact of these different stressors, it is hoped we will gain a better understanding of their synergistic effects.  This approach holds the promise of facilitating research that will lead to interventions that address health disparities. The presentation will examine the methodological and ethical challenges raised by this holistic, systemic approach of exposomics. Pooling data from various disciplines and data bases will demand major efforts in transdisciplinary training, research, and collaboration. To make this enormous pool of “big data” amenable to analysis will require standardizing and collating data sets, including more local, granular data. In order to be maximally useful for health interventions, the data will have to be linked to individual data and health records, which will raise issues of privacy and confidentiality. The public awareness of exposures and their consequences will generate social discussions that pit the scientific determination of risk against the public’s value judgments regarding safety. Public health ethics will have a significant role to play in translating the science of exposomics into the language of values that can resonate with the public. Finally, the presentation will explore how exposomics can help the field of public health achieve consensus on its reach and purpose and thereby guide ethical analysis and decision making in public health practice.