Mapping the marketplace

Mapping the marketplace Project title: Early Environmental quality and life-course mental health effect Project Number: 874724 Project Acronym: Equal-Life Work package 10 – Deliverable D10.7 Table 1. History of changes Version Publication date Change 01 September 2024 • Draft manuscript shared with a selection of partners 02 May 2025 • Revised based on comments 03 June 2025 • Final version submitted D10.7 2 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 H2020 program Grant agreement numbers 874724 (Equal-Life), Project start date: Jan 1st 2020 Duration: 66 months Project Cooödinator: Irene van Kamp (RIVM) WP (number and title) EQUAL-LIFE WP10 Deliverable Number EQUAL-LIFE D10.7 Deliverable Title Mapping the marketplace Due date M45 Actual date M65 Dissemination Level Public Lead beneficiary RIVM Responsible authors Irene van Kamp, Hendriek Boshuizen E-mail / phone responsible authors [email protected] +31 30886893222 +31 30886892934 Co-authors Sonja Jeram [email protected] Dirk Schreckenberg [email protected]> Peter van den Hazel [email protected] Marco Balduini [email protected] Kim van Wijk [email protected] Miriam Weber [email protected] Reviewers Erik Lebret [email protected] Maud Dohmen [email protected]> D10.7 3 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 Contents Summary .................................................................................................................................................... 4 1. Introduction ........................................................................................................................................ 5 2. Identification of end users and stakeholders ..................................................................................... 5 3. Determination of roles ....................................................................................................................... 7 4. Methods of stakeholder involvement (see also D10.3) ..................................................................... 8 4.1 Delphi survey .............................................................................................................................. 8 4.2 Co design workshops .................................................................................................................. 9 4.3 Stakeholder fora ......................................................................................................................... 9 5. Conclusion and future action ........................................................................................................... 10 D10.7 4 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 Summary The Equal-Life project aims to assess the developmental consequences of the environments European children grow up in for their mental health and cognitive development from conception to young adulthood. Equal-Life has, for the first time, joined the new and innovative concept of the exposome, defined as the totality of all exposures during a lifetime with the joint study of physical and social environment determinants. This is an innovation in itself. Thus, the outcomes of Equal-Life are novel and many need further corroboration in subsequent studies. Nonetheless, several products that have been developed in the project are sufficiently mature and suitable to be used by different end-users (researchers, policymakers, urban planners and health professionals). These include conceptual frameworks, definitions, interventions, prevention models, tools and guidance documentation, training protocols, access to data and metadata, statistical codes (statistical scripts to run procedures on data), etc. For an overview of products, we refer to D10.6. For optimal dissemination, interdisciplinary collaboration between different types of practitioners and decision-makers is pivotal. This does not only include the people who shape public health and care and people who shape environments through urban planning, It also includes the people who influence programs and policies in a wide variety of other aspects of the public sector (including education, housing, transportation, environment, and economic development), and in the non-profit and for-profit sectors (e.g., childcare, education, free time activities). Successfully addressing these dissemination challenges requires a combination of methods, including communication outreach, marketing, advocacy, illustrated with successful examples, technical and training assistance, and enabling the adaptation of evidence-based models to new circumstances. However, we hereby need to bear in mind that the level of evidence for many environmental determinants of mental health and cognitive development is not at the point that commercial activities are already warranted, let alone involving commercial marketing. Also, there are other limitations. Within the context of a multinational research consortium, we deal with a limited timeframe and limited funds. As a consequence, we need to limit ourselves to a simple approach by sketching a framework of opportunities for commercial and non-profit parties. Focus hereby should be in the first place on exposome-related industries such as biomarker analysis, diagnostic machine learning tools and the like. This deliverable comprises a initial exploration of who the end-users might be, both commercial and non-commercial. The principal objective for exploitation in the Equal-Life project is to implement a strategy to facilitate the successful exploitation and adoption of results and benefits within public health initiatives, research communities and policy advisers. Exploitation activities in the Equal-Life project aim to ensure the longevity of the project’s results through either policy uptake, further research or non-commercial applications. Key products are the Equal-Life Guidebook and toolbox, which were described in D9.5 and D9.7. But the products include much more, as described in detail in D10.5 and D10.6. For the actual business plan, we refer to D10.8, in which training protocols, mental health biomarker patents, and innovative environmental exposure models are presented as potential products to be further developed. In this document, a first analysis is made into the marketplace, the group of stakeholders to which the exploitation of Equal-Life might be targeted. D10.7 5 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 1. Introduction Early life stage exposures to physical and social environments have a strong impact on mental health, cognitive development and health inequalities later on in life. However, the combined effects of physical and social environmental factors are thus far understudied. The overall aim of the Equal-Life project was to assess the developmental consequences of the environments in which European children grow up for their mental health and cognitive development from conception to young adulthood. This will form the basis for improving unfavourable environments and the development of supportive and restorative environments for children and adolescents. Thus, Equal-Life might contribute to the reduction of the burden of disease due to mental ill-health and problems in cognitive development, o by providing insight in the key social and physical predictors of mental ill-health and cognitive development of children; o by linking exposures to biological indicators of mental ill-health and cognitive development; o by better understanding the key mechanisms linking the exposome (internal, external, social) via intermediate effects (biomarkers) to a distinct set of outcomes symptoms, and diagnosed disorders); o by laying a scientific base for a set of interventions improving children's health and cognitive development; o by providing instructions for risk assessment of physical and social exposures associated with (mental) health and cognitive development of children; o by delivering a toolbox for policymakers, urban planners, educational, social, and health practitioners, which will be publicly available; o with guidance to identify, acquire and use the information needed to assess hazards, negative as well as beneficial exposures and the corresponding (mental) health risks and improvements in their given social context at local and/or national level; and o access to information about implementation and good practice examples for interventions. Artificial Intelligence (AI) and Machine Learning (ML) are changing the way stakeholders access information. We are experimenting with this in the Equal-Life toolbox. We can use the toolbox approach as a driver for proposing consultancy and training, bearing in mind that the AI approach is not a product in itself. A key question is who will and can use this information, and what the spin-off could be of Equal-Life results, and what the requirements are to do so in an effective and sustainable way. 2. Identification of end users and stakeholders The key message above is that evidence-based public health interventions require dissemination activities of a broad range of actors. Not only are people who shape public health, health care and policies considered. Relevant stakeholders also include people who influence programs and policies in a wide variety of other aspects of the public sector (including urban planning, education, housing, transportation, environment, social systems and economic development), and in the non-profit and for-profit sectors (e.g., childcare, education, specialised care for young people, leisure activities care etc). This implies D10.7 6 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 integration and necessarily a need for collaboration between parties involved in creating physical and social environments and between the profit and non-profit sectors. Equal-Life at an early stage worked on identifying and involving key stakeholders in the domain of mental health and cognitive development of children and adolescents (D8.1). It should be noted that not all stakeholders are automatically the people who will use the Equal-Life tools. A distinction should be made between different sectors of stakeholders and end-users who have different needs and requirements (see below). The Equal-Life project focuses on the exposome of young people between 0-21 and their mental health and cognitive development. Stakeholders are defined as those parties with an interest in the execution and outcomes of the project, including those affected by, or dependent on, the outcome, or further innovation. For the project EqualLife, these include organisations, institutions, offices, and departments involved in young people’s (mental) health, public health, environmental quality, and research at local, regional, national and European level. But also, the private sector, schools, day care centres, leisure time activities/places, playgrounds, parks, swimming pools, skating parks, libraries, youth clubs, sports and dancing clubs, mental health care and youth organisations, and patient advocates. Categories of potential end-users of the Equal-Life tools can be broadly subdivided into the private, public and research sector. In the table below in green are those stakeholders that were at least contacted and/or at some stage involved in the framework of the Equal-Life project. Private sector • Environment: o City planners, architects, landscapers, traffic planners, traffic consultants, noise consultants/acousticians, experts for air pollution… o Housing associations, building societies o NGOs for environmental issues (Greenpeace, etc., or more local associations) o Tourism business, leisure industry, sports o CCI: Chamber of Commerce and Industry (healthy environment as a selling factor for job recruitment and/or local economy) • Children's health, cognition o Physicians, health consultants, NGOs for child health/protection o Health insurance companies o Child care organisations, child health institutions o Educational consultants/experts o Social/welfare workers, psychologists (educational psychologists, child therapists) o CCI: Chamber of Commerce and Industry (child's health as a selling factor for job recruitment and/or local economy) Research sector • Children's health, cognition, and social issues: D10.7 7 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 o Medical scientists: physical/mental health o Psychological scientists: mental health cognition (e.g. child/developmental or clinical psychologists) o Educators/teachers: cognition, mental health • Environment o City/urban, land-use planning o Traffic science o Environmental psychology o Environmental epidemiology o Environmental science: noise impact, air pollution o Tourism/leisure/sports science Public sector • Environmental authorities: o Local, regional, national, EU (e.g. EEA) authorities for environmental issues o Local, regional, national, EU (authorities for transportation issues) o Local, regional, national, EU authorities for land-use planning o City networks (WHO Healthy Cities Network and Eurocities) o Cities, municipalities: Environmental, housing, transport departments o • Health, cognition, social: o National organisations o Supra-national authorities (EC, UNICEF, WHO) o City networks (WHO Healthy Cities Network) o Cities, municipalities: Health, family, social, school departments 3. Determination of roles The different roles the above-mentioned stakeholders and end-users could play can be subdivided into three main categories: 1. Those identifying the knowledge gaps. 2. Those who perform health promotion /prevention/knowledge into policy translation. 3. Those professionals who are involved in relevant domains, from the perspective of implementing policy recommendations as e.g. in health in all policies. This distinction is not per se a strict one: practitioners are very well capable of addressing knowledge gaps as well. While identifying knowledge gaps is primarily the task of researchers and prevention/health promotion and planning, education, health care, etc, happens at the planning and policy end, public health workers, planners, etc, are very well capable of addressing knowledge gaps at different scale levels such as: o Developing preventive strategies to improve public health for young people (and related costs); D10.7 8 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 o Urban planning o Addressing priority goals of established policies on Environment and Health, such as in EU or WHO declarations. o Working towards the reduction of the environmental burden of disease. o Teaching, education. In summary, knowledge generators’ or ‘knowledge holders’ are not always the ‘researchers’ or ‘scientists’. And ‘knowledge users’ are not always the ‘decision-makers’ or ‘practitioners’. All stakeholders offer important knowledge as well as concerns, aspirations, values and experiences which can serve as valuable contributions to co-designed solutions-oriented research. 4. Methods of stakeholder involvement (see also D10.3) Five main methods of stakeholder involvement have been used in Equal-Life: a Delphi survey, interviews, co-design workshops, stakeholder forum and focus (World Café) groups. The Delphi survey and personal interviews reached a broad group of stakeholders (NDelphi = 181 partly, 34 completed) , NInterviews = 61). The focus and 3 world café groups (Ntot= 17) and (co-design) workshops (NSkopje= 9 + 11 EqualLife)(NMilano= 18)(NComo=6)(NHelsinki =15 + 18 Equal-Life partners)(NCork =27)(NAmsterdam2024= 4) NAmsterdamApril2025= 7 + 7 Equal-Life partners)(NtheHAgue= 7 + 7 Equal-Life partners) and stakeholder forum (NLjubljana= 32) involved a broad range of the stakeholders 4.1 Delphi survey Using the Delphi Survey method in Task 8.1 (Connecting science to policy), a bi-directional dialogue was initiated between the Equal-Life project and (inter)national stakeholders in order to 1) translate project results into effective children's health policies and 2) inject knowledge about best practices and health policies into the project. The Delphi method is a structured communication technique or method, originally developed as a systematic, interactive forecasting method which relies on a panel of experts. The Delphi method is based on the assumption that group judgments are more valid than individual judgments. Participants usually answer questionnaires in two or more rounds. In Equal-Life, stakeholders will be asked for their input in three consecutive rounds. The results of the Delphi survey sent out to stakeholders show the information needs of the stakeholders and were linked to the results of the scientific members of the consortium. The stakeholder consultations and internal expert discussions also took place within two sets of Delphi consultations with three rounds: internal and external. The ‘internal’ Delphi aimed to harvest ideas and generate early discussion and inputs from Equal-Life researchers and the advisory committee for the topics of interest to EqualLife. As a result of these discussions, 66 questions were proposed as possible questions of interest to the project and rated on relevance and testability within the consortium (Benz, 2020). The results of this internal Delphi informed the overarching research questions list of Equal-Life (Annex 9). The ‘external’ Delphi collected information about the needs that the stakeholders are facing in relation to children’s and adolescent mental health and cognitive development. The results of the external Delphi guided the research formulation process by providing insight on what stakeholders advise us to do research on (D8.1) D10.7 9 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 4.2 Co-design workshops Co-design workshops were organised in Skopje (2022) and Helsinki (2023). Co-design is the act of creating interaction with stakeholders (policymakers, end-users) specifically within a design development process to ensure that the results and the toolbox meet their needs and are usable. Its aim is to create something not only for people, but also with them. Stakeholders can become creators of a product being actively involved in the creation process. Co-design is often a transdisciplinary process and the results can be incorporated in toolbox, guidelines etc. In Equal-Life the co-design was used as a tool to enable stakeholders to use EqualLife results for policy making or to draft interventions. The task “Co-design workshops with consortium and stakeholders” related to D8.4 had the objective to establish a bi-directional dialogue between the Equal-Life project and (inter)national policy makers to 1) translate project results into effective children's health policies and 2) inject knowledge about best practices and health policies into the project. This task ensures that the generated knowledge (on exposome, mechanisms, and health effects) is developed in line with the needs of the broader society, and that knowledge of the involved (public and private) stakeholders will help to interpret the results and make it usable. This sciencepolicy interaction gives a better understanding of the societal impact and relevance of the Equal-Life research both for the scientists within the project as for the stakeholders. We have identified key stakeholders (policy makers, regulators and research networks), set up a formal codesign workshop and two stakeholder fora and established regular interaction between scientists and stakeholders. 4.3 Stakeholder fora Stakeholder fora or workshops were organised in Ljubljana (2022), Milan (2022), Como (2023). Cork (2024), Amsterdam (2024), Amsterdam (2025) and the Hague (2025). Stakeholder Forum means a platform open to representatives of institutions, national, regional and local authorities, organised interests and individual entities from different domains, higher education, research, associations, civil society and cluster organisations, as well as other interested parties from across a selected knowledge or policy focus. During the workshop events, discussions between stakeholders and researchers were held to interpret the results, to identify common features of the different models and discuss evidence-based recommendations for (categories of) interventions aiming to improve children's mental health and cognitive development. It turns out that Equal-Life results are explorative only, and that it might be too early to formulate scientific evidence-based recommendations for interventions. Important feedback during the discussions in the stakeholders’ workshops and fora in Equal-Life was that evidence-based interventions would be considered by stakeholders as very helpful and useful. This information has landed in the equal-Life toolbox, the guidebook and the training protocol. Specifically, at the topic-specific policy level — such as youth policies, urban planning, environment, or public health sectors — policymakers and advisory bodies need more targeted interpretations. Here, Equal-Life’s results can be used to develop specific policy recommendations that directly relate to sectoral goals. For instance, findings about how urban greenspace exposure in early childhood links to better cognitive outcomes can guide recommendations for child-friendly urban design. Equal-Life also shows how social environment factors become increasingly important after preschool age, informing youth development strategies or mental health support programs. Finally, at the implementation level, local governments, NGOs, schools, health practitioners, and community organizations need actionable tools and guidelines. They turn policy recommendations into real world interventions. Equal-Life’s results help field organizations design and justify targeted actions, such as creating safe green play spaces, adapting school environments to support mental wellbeing, or community-based family support interventions.