Brain biomarkers and effective interventions to tackle global poverty from birth

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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.