Brain biomarkers and effective interventions to tackle global poverty from birth

生命早期的贫困可能对认知发展和心理健康产生破坏性影响。婴儿的头1000天（从受孕到两岁）是易受社会经济和健康挑战（即贫困/营养不良/早产）影响的关键窗口期。在英国，据估计，与英国典型的生活水平相比，有400万儿童在相对贫困的家庭中长大。在全球一级，贫困的影响反映在发展中国家三分之一的儿童未能达到其认知和/或社会情感成长的发展里程碑。这套与年龄相适应的核心技能的发展受到损害，对随后的学业成就、心理健康和经济状况产生重大影响。然而，贫困对随后的大脑和认知发展的影响很少被研究，直到童年后期，直到成年，干预策略变得不那么有效。对于这样一个全球性的健康挑战——发育障碍——使用神经科学工具研究高收入环境下早期大脑发育的前瞻性纵向研究，在发现生命第一年的早期风险生物标志物方面取得了重大进展。这些研究最近导致了几个有希望的干预方案的应用。然而，为了将该模型应用于低收入环境中跨文化全球健康挑战的研究，我们首先需要在以下方面取得重大进展；（一）脑成像在实验室以外的研究中的适用性，以便更好地接触到社会弱势群体；（二）我们对贫困对大脑发育影响的理解；（三）制定针对人群的早期干预战略。迄今为止，全球健康研究在很大程度上仅限于使用行为评估来衡量早期贫困的影响。然而，可观察到的行为变化通常只在生命的第二年才明显——尽管大脑功能和解剖特异性在早期发生了显著变化——这可能限制了我们有效干预的能力。评估学龄期的损害，并试图回顾性地解读早期环境损害的级联效应，不太可能揭示出明确可靠的干预目标。因此，有必要对神经认知发展进行纵向研究，同时对大脑功能进行测量，同时对暴露于环境挑战进行测量。这个跨学科奖学金的目标是推动贫困对大脑发育影响研究的前沿，并干预早期逆境中固有的全球性、跨文化挑战。这一目标将通过研究婴儿从出生到生命最初几个月和几年的大脑和认知发展来实现。我的长期目标是，在完成这项研究后，我将提供一种机制，使国家和国际全球卫生项目的重点从衡量儿童后期和成年期的贫困结果，转向通过在生命的最初几天和几个月进行干预来提供保护婴儿的途径。为了实现这一目标，我将(I)确定适当的低成本、针对人群的早期逆境干预措施，与广泛适用的发育性脑成像工具包同时使用；（ii）建立一个公众参与平台，为父母和家庭提供早期支持；（iii）寻求机会影响英国儿童发展领域的政府政策和合作地点。

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.