Brain biomarkers and effective interventions to tackle global poverty from birth

Poverty in early years of life can have devastating effects on cognitive development and mental health. A baby's first 1000 days (from conception to two years of age) are a critical window of vulnerability to exposure to socio-economic and health challenges (i.e. poverty/undernutrition/prematurity). In the UK, it is estimated that 4 million children are raised in households in relative poverty compared with typical UK living standards. At a global level, the impact of poverty is reflected by one third of children in developing countries failing to reach their developmental milestones in cognitive and/or socio-emotional growth. This compromised development, of a core set of age-appropriate skills, has a significant impact on subsequent academic achievement, mental health and economic status. However, the impact of poverty on subsequent brain and cognitive development is rarely studied until later childhood, and into adulthood, when intervention strategies become less effective. For one such global health challenge - developmental disorders - prospective longitudinal studies using neuroscientific tools to study early brain development within high-income settings, have allowed major advances in finding early biomarkers of risk during the first year of life. These studies have recently led to the application of several promising intervention programmes. However, in order to apply this model to the study of cross-cultural global health challenges in low-income settings, we first need to make significant advances in; (i) the applicability of brain imaging for research outside of the lab to better access socially disadvantaged populations, (ii) our understanding of the impact of poverty on brain development and (iii) the development of population-tailored early intervention strategies

To date, global health research has been largely limited to the use of behavioural assessments to measure the effect of exposure to early poverty. However, observable changes in behaviour are often only evident towards the second year of life - despite significantly earlier changes in brain functional and anatomical specialisation - potentially limiting our ability to effectively intervene. Assessing impairment at school age and attempting to retrospectively decode the cascading effects of early environmental insults is unlikely to reveal clear and reliable targets for intervention. It is therefore imperative that neurocognitive development is studied longitudinally, taking contemporaneous measurements of brain function in parallel with measurements of exposure to environmental challenges.

The objective of this interdisciplinary fellowship is to push frontiers in the study of the impact of poverty on brain development, and to intervene in the global, cross-cultural challenges inherent in early adversity. This objective will be pursued through the study of brain and cognitive development in infants from birth, through their first months and years of life across multiple populations. My long-term goal is that, upon completion of this fellowship, I will have provided a mechanism for a shift in the focus of national and international global health projects - away from measuring outcome of poverty in later childhood and adulthood, and towards providing a pathway for protecting infants through intervention in the first days and months of life. To achieve this, I will have (i) determined appropriate low cost, population-tailored early adversity interventions for use in parallel with a widely-applicable developmental brain imaging toolkit, (ii) established a public engagement platform providing early support for parents and families, and (iii) sought opportunities to influence government policy in the area of child development in the UK and partnering sites.

Approximately 1 in 4 children in the UK are estimated to be living in poverty, with estimates of those living in extreme poverty ($1.9 per day) in Europe at 1.4%, rising to ~50% in Sub-Saharan Africa (UNICEF and World Bank report, 2016). Socially disadvantaged families living in poverty experience considerable burden and the cost to the individual, their family and society can be long-lasting, affecting educational attainment, mental health and wellbeing and subsequent economic growth. Recent estimates of the UK annual societal cost of poverty exceed £78 billion. For children's services the amount spent on poverty equates to 40% of the early years budget. While the development of new methodology has led to huge advances in our understanding of brain and cognitive development over the last decade, this research has been largely restricted to financially mobile participants within high-income settings. Whether in the UK, or at a global level, socially, culturally or financially disadvantaged groups - those most at risk for experiencing socio-economic and health challenges - are far less likely to participate in research. Given that the majority of research is undertaken in cities, where a child lives may also affect access to research and support, as 8 in 10 children living in extreme poverty are from rural, rather than urban, areas. I want to radically change the way that we study families living in low resource areas by bringing tools to measure brain development into the home- and community- settings.

This innovative approach will have benefit to a range of users: for the purposes of my fellowship it will allow me realise my goals to: (1) better understand the impact of poverty on neurocognitive development in the understudied but critical early post-natal period within individuals living in low resource families in the UK; (2) develop appropriate intervention programmes for parents to support early child development and; (3) be of minimum burden to families with young infants. Alongside this, I aim to take a contextualised approach to my research, empowering and engaging the community to provide input to my research plans; and discover who will, and how, they would most benefit from this work. Following this, I want to expand appropriate intervention development to Africa. Initially I will target a sub-set of the population for significant impact in rural Gambia to address undernutrition, then building on this to target an urban population in South Africa to address early adversity. Subsequently, my work will have a wider reach to other African sites and potentially a range of global contexts. I will continue to monitor, review and update impact policies during the project lifecycle, focusing initially on the UK and thereafter moving to an African and multinational perspective.

I envisage several groups of non-academic beneficiaries for our research; (i) individuals with a general interest in child development, and those about to transition into parenthood; (ii) industry and researchers who require access to new tools for research and clinical care; (iii) policy-makers within government interested in tackling poverty and supporting early child development (e.g. "The 1001 critical days" Cross-party manifesto, 2014) to improve economic growth and welfare by increasing the effectiveness of early life public services; (iv) policy makers and associations in Africa interested in investment in science, technology and social prosperity across the continent (i.e. African Academy of Sciences' strategy to drive scientific and technological development in Africa) by enhancing skills development within rural regions and fostering improvements in economic growth and; (v) charities and associations both in the UK (Child Poverty Action Group,) and at an international level (Academics Against Poverty), who provide educational resources, support and healthcare for individuals living in poverty.