Regional interventions exploration

D9.4 — Regional interventions exploration 1 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 Regional interventions exploration Project title: Early environmental quality and life-course mental health effects Project Number: 874724 Project Acronym: Equal-Life Work package 9 - Deliverable D9.4 HISTORY OF CHANGES Version Publication date Change 1.1 14.03.2025 • Initial version for feedback 1.2 25.04.2025 • Final version D9.4 — Regional interventions exploration 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 (EqualLife), Project start date: Jan 1st 2020 Duration: 66 months Project Coordinator: Irene van Kamp (RIVM) WP (number and title) Equal-Life WP9 – Tools, Training, and Implementation Deliverable Number Equal-Life D9.4 Deliverable Title Regional interventions exploration Due date 30.04.2025 Actual date 25.04.2025 Dissemination Level Public Lead beneficiary TUD Responsible author Achilleas Psyllidis [email protected] Co-authors Sonja Jeram [email protected] Anna Sandionigi anna.sandionigi@ quantiaconsulting.com Marco Balduini marco.balduini@ quantiaconsulting.com Reviewers Kim van Wijk [email protected] Gabriele Bolte gabriele.bolte@ uni-bremen.de Payam Dadvand payam.dadvand@ isglobal.org Carmen Peuters carmen.peuters@ isglobal.org D9.4 — Regional interventions exploration 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 4 2. The Equal-Life Toolbox 5 3. The Workshops 5 3.1 Workshop in Cork, Ireland 5 3.1.1 Introduction 5 3.1.2 Regional Cases 6 3.2 Workshop in Amsterdam, the Netherlands 7 3.2.1 Introduction 7 3.2.2 Regional Cases 8 3.3 Workshop in Ljubljana, Slovenia 8 3.3.1 Introduction 8 3.3.2 Regional Cases 9 3.4 Future Workshops 10 4. Conclusion 11 5. References 12 D9.4 — Regional interventions exploration 4 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 Summary This deliverable describes the series of co-design workshops that were conducted as part of Equal-Life’s training sessions to support the integration of the exposome approach into local policies and interventions. The first session took place in Cork (May 2024), followed by Amsterdam (June 2024) and Ljubljana (November 2024), each refining the training structure and toolbox usability. These sessions brought together multidisciplinary stakeholders, including experts in public health, urban planning, education, and psychology, to explore the Equal-Life Toolbox and associated guidebook. Participants engaged in interactive activities to understand the exposome concept, apply it to local case studies, and assess the toolbox’s practical usability. Key insights included the need for clearer communication tools, such as a disciplinary glossary, searchable metrics and indicators, and better institutional support for cross-sector collaboration. Despite these challenges, stakeholders expressed enthusiasm for using a refined version of the toolbox in future interventions. Building on these experiences, additional training sessions are scheduled for May and June 2025 in Barcelona, Stockholm, and Izmir, with an emphasis on applying project findings to urban planning and child health policies. These sessions will ensure continued stakeholder engagement, feedback integration, and the refinement of the toolbox for real-world policy and intervention design. 1. Introduction One of the key objectives of the Equal-Life project is to support local stakeholders – including health experts, urban planners, and psychologists – in comprehensively understanding and applying the project’s findings. This effort aims to facilitate the replication of the developed methodologies and provide a robust evidence base for implementing health interventions. The primary mechanism enabling this objective is the Equal-Life Toolbox (https://www.equal-lifetoolbox.eu/), a core outcome of Work Package 9 (WP9), detailed in Deliverable D9.7. The toolbox serves as a central resource, consolidating knowledge and tools to inform interventions aimed at improving children's mental health and cognitive development. Deliverable D9.4 specifically focuses on guiding local stakeholders in leveraging the Equal-Life Toolbox for policymaking and interventions in children’s mental health and cognitive development. This guidance is implemented through a series of interactive workshops designed to provide hands-on training. Led by experts in both the toolbox and relevant knowledge domains, these workshops offer practical insights into using the toolbox for evaluating and shaping regional interventions. The workshops detailed in this document took place in Cork (Ireland), Amsterdam (the Netherlands), and Ljubljana (Slovenia). The associated training sessions are documented in Deliverable D9.6. During these workshops, regional intervention strategies from different countries were examined using the evidence base and analytical tools provided within the Equal-Life Toolbox. This document outlines the structure, methodology, and key outcomes of these sessions, along with insights gained from stakeholder feedback. Additionally, it provides an outlook on upcoming D9.4 — Regional interventions exploration 5 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 workshops planned in the months following the submission of this deliverable, ensuring the continued dissemination and practical application of the toolbox’s resources. 2. The Equal-Life Toolbox The Equal-Life Toolbox (https://www.equal-life-toolbox.eu/) is designed to support policymakers and practitioners working at the intersection of children’s mental health and environmental factors. It provides a structured framework to understand the project’s key concepts, findings, and underlying data. The toolbox facilitates assessments of early-life exposures to physical and social conditions, offering insights into their potential impacts on children's mental health and cognitive development. The toolbox comprises various components, each offering essential input data (e.g., indicators of environmental and social aspects of the exposome) and analytical tools. It serves as a valuable resource for informing regulations, urban and land-use planning, social and educational programs, and child health policies. Beyond data and analysis tools, the toolbox integrates policy recommendations and examples of health interventions, providing a comprehensive evidence base for decision-making. To ensure ease of use, a dedicated guidebook has been developed and integrated into the toolbox. This guidebook walks prospective users through the project’s core concepts, available datasets, analytical tools, key findings, and policy implications. To evaluate the practical usability of the Equal-Life Toolbox in shaping future health and policy interventions at the local level, it has been employed as the central resource in the series of dedicated workshop sessions detailed in this document. 3. The Workshops The following sections describe the dedicated workshops conducted as part of the training sessions in Cork (Ireland), Amsterdam (the Netherlands), and Ljubljana (Slovenia). These codesign workshops brought together local stakeholders from diverse disciplines and Equal-Life representatives to collaboratively explore regional interventions using the Equal-Life Toolbox. Participants examined both the toolbox’s potential and its limitations. Co-design was selected as the methodological approach because it fosters the discovery and exploration of opportunities rather than focusing solely on developing final solutions (Sanders & Stappers, 2008). 3.1 Workshop in Cork, Ireland 3.1.1 Introduction The Cork session marked the first pilot training case within the Equal-Life project and was held from May 21 to 23, 2024. Organized by RIVM, QUANTIA, INCHES, and TUD in collaboration with the City of Cork, the event brought together 27 local stakeholders from Ireland, Germany, Finland, Slovakia, the Netherlands, and the UK with diverse expertise, including psychology, speech and language training, primary education, urban planning, public health, nursing, and biology. The session aimed to introduce participants to the exposome concept and explore its practical applications in policy and intervention development across multiple disciplines. The training began with an introduction to the exposome concept, emphasizing its core components and relevance to various sectors, from spatial planning to primary education. Equal- D9.4 — Regional interventions exploration 6 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 Life’s conceptual model served as the reference framework, with presentations by Sonja Jeram (NIJZ) and Dirk Schreckenberg (ZEUS). The discussion highlighted how different environmental and social exposures interact to shape health outcomes over time. To reinforce comprehension, participants engaged in an interactive exercise where they were tasked with explaining the exposome concept to different audiences, such as a local media outlet, a municipal authority, or a community member. A common challenge that this exercise quickly revealed was the difficulty of establishing a shared vocabulary among professionals from different backgrounds. Terms that seemed straightforward in one discipline often led to confusion in another, underscoring the need for interdisciplinary communication strategies when applying exposomerelated insights to policy and practice. Following this activity, participants collaborated to identify local case studies where the exposome approach could offer meaningful insights. These cases were then used as a springboard to discuss the potential applications of the Equal-Life Toolbox. Given the pilot nature of the training, a preliminary version of the toolbox was presented, showcasing its key elements, underlying conceptual framework, and approach to exposome research. The demonstration included an overview of early results, as well as placeholders for features that would be incorporated in future iterations of the toolbox. Equal-Life experts facilitated a hands-on session, guiding participants in navigating the toolbox and exploring its main components. This practical engagement enabled stakeholders to critically assess the usability of the toolbox for their respective fields, identifying both its strengths and areas for improvement. 3.1.2 Regional Cases Participants delivered concise pitches outlining local cases they were currently working on or planned to develop, with the intention of integrating the exposome concept and the Equal-Life project’s conceptual model and approach. These cases reflected the diverse disciplinary backgrounds of the participants, spanning spatial planning, primary education, and speech training. To further illustrate the potential applications of the Equal-Life Toolbox in shaping local policies and interventions, an in-depth case study on play spaces in Utrecht, the Netherlands, was presented by Jeroen Koning, a representative of the City of Utrecht (CoU). This case highlighted CoU’s ongoing efforts to achieve a more equitable distribution of play spaces across Utrecht’s neighbourhoods, with the aim of improving children’s access to high-quality play environments. Following the pitches, the in-depth case study, and a comprehensive demonstration of the Equal-Life Toolbox, participants engaged in a hands-on exercise to explore how the toolbox and its associated guidebook could support the practical implementation of the exposome concept. Using both their local cases and the Utrecht play-space initiative as reference points, participants examined key components of the toolbox, including the conceptual model, the equity assessment tool, and various data and analytical resources. The session was facilitated by Equal-Life experts, led by QUANTIA, who provided guidance and support throughout the process. By the conclusion of the activity, participants acknowledged the significant benefits of using the toolbox in their daily work, while also recognising the challenges involved in integrating such an approach into policy and intervention design. A key concern was the difficulty of implementing exposome-based strategies without institutional support for cross-departmental collaboration D9.4 — Regional interventions exploration 7 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 within their organisations. The session provided a valuable opportunity for interdisciplinary cooperation, which participants strongly appreciated and wished to see further encouraged in their professional environments. Given the preliminary nature of the toolbox, some participants found it challenging to navigate its multiple features, tools, and complex concepts. They suggested that a more streamlined and intuitive structure would enhance usability. Additionally, as in previous discussions, differences in disciplinary terminology emerged as a recurring challenge. Participants emphasised the necessity of an easily accessible glossary to facilitate communication across fields. Despite these challenges, there was overall enthusiasm for using a refined version of the toolbox in future policy and intervention initiatives, with participants recognising its potential to enhance evidence-based decision-making in their respective domains. 3.2 Workshop in Amsterdam, the Netherlands 3.2.1 Introduction The Amsterdam session marked the second pilot training event within the Equal-Life project and took place on 25 June 2024. Building upon insights from the first pilot in Cork, the session followed a similar yet refined structure, incorporating feedback and lessons learned. Organised by RIVM, QUANTIA, and TUD in collaboration with the Amsterdam Municipal Health Service (GGD), the event convened thirteen Dutch stakeholders with expertise in public and mental health, paediatrics, psychology, and urban development and planning. As in the first pilot, participants were introduced to Equal-Life’s objectives, conceptual model, and exposome approach. A refined iteration of the presentation from Cork was delivered by Sonja Jeram (NIJZ) and Dirk Schreckenberg (ZEUS), providing a comprehensive overview of how environmental and social exposures interact to shape health outcomes. To reinforce comprehension, participants engaged in structured peer discussions, where they explained the exposome concept to one another and reflected on its interdisciplinary applications. In addition, they were encouraged to critically assess how the exposome approach could be integrated into new neighbourhood development plans, bridging the gap between scientific research and practical (urban) policy. A preliminary version of the Equal-Life Toolbox was then demonstrated, highlighting its core functionalities, conceptual underpinnings, and analytical tools. This allowed participants to familiarise themselves with the toolbox’s capabilities and explore its potential applications in their respective fields. Following this, a representative from a new neighbourhood development project in the south of Amsterdam—detailed in the next section—presented the planned intervention as a case study illustrating how the exposome framework could add value. Participants used insights from their peer discussions and the reference intervention to critically evaluate the toolbox’s applicability in the context of new urban developments. They explored both its potential benefits and its limitations, considering factors such as data availability, interdisciplinary collaboration, and policy integration. The session concluded with an open discussion, where participants shared their reflections on how the toolbox could be adapted to better support real-world decision-making processes in urban planning and public health. D9.4 — Regional interventions exploration 8 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 3.2.2 Regional Cases The dedicated workshop on regional interventions centred on the Schinkelkwartier urban development project in the south of Amsterdam. This large-scale transformation aims to convert a currently isolated industrial and office zone into an inclusive, vibrant, and green urban district. At the heart of the development is the construction of 11,000 homes, designed to accommodate a balanced mix of social (40%), middle-income (40%), and high-income (20%) housing. In addition to residential areas, the project will create 450,000 square metres of space for social and commercial facilities, alongside expanded office and business spaces. Once completed, the development is expected to host 22,000 residents and provide employment opportunities for over 45,000 people. The transformation of Schinkelkwartier will be carried out in phases over the next 25 years. During the hands-on session with the Equal-Life Toolbox, participants used the Schinkelkwartier project as a case study, alongside insights from their earlier discussions, to evaluate the toolbox’s practical applications. They explored key features, including the conceptual model, the equity assessment tool, and various data and analytical resources, while receiving guidance from Equal-Life experts. This exercise aimed to assess how the toolbox could be applied to large-scale urban interventions and whether its tools were effective in addressing the complex interplay of environmental and social factors in urban development. Unlike in the first pilot session, where participants focused on smaller-scale interventions, the specificity and scale of the Schinkelkwartier project led to slightly different conclusions. Participants noted that the toolbox was not always intuitive in guiding users on what to look for when assessing interventions of this magnitude. They emphasised the added value of incorporating specific indicators and best-practice examples to support evidence-based decision-making. In its then current structure, the toolbox functioned largely as a checklist to assess whether a policy or intervention considers different environmental and social determinants. However, participants expressed the need for a more user-friendly and structured approach, prioritising clarity over completeness. A key suggestion was the introduction of a search function to enhance the findability of results, metrics, indicators, and relevant best practices, enabling users to navigate the toolbox more efficiently. While differences in disciplinary terminology were a notable challenge in the Cork session, they were less prominent in this workshop. Instead, participants highlighted the importance of accounting for cultural differences when applying the toolbox across diverse urban contexts. Overall, participants acknowledged that if future iterations of the toolbox incorporate these refinements—such as improved navigation, clearer structuring, and a stronger emphasis on practical case-based applications—it could become a highly valuable tool for informing future urban policies and interventions across different domains. 3.3 Workshop in Ljubljana, Slovenia 3.3.1 Introduction The training and co-design session in Ljubljana, Slovenia, was held on November 11, 2024. Organized by NIJZ in collaboration with RIVM, QUANTIA, TUD, and UB, the event brought D9.4 — Regional interventions exploration 9 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 together fifteen local stakeholders from various Slovenian institutions and NGOs. Participants included representatives from the National Institute for Public Health, Jožef Stefan Institute, the City of Ljubljana, and the IZO Institute for Health and the Environment. Their expertise spanned multiple disciplines, including public and mental health, education, urban and landscape planning, environmental studies, and nature protection. The session began with a comprehensive overview of the Equal-Life project, including its conceptual model, exposome approach, and key findings to date. Jenny Selander (KI) presented preliminary results remotely, highlighting how ADHD, cognitive development, and internalizing/externalizing issues are linked to different physical and social indicators at various stages of childhood development. Jenny Ahrens and Justus Tönnies (UB) demonstrated the equity assessment tool developed in WP4, illustrating its application through a case study on Utrecht’s play space policy. This was followed by presentations from local stakeholders, who introduced four regional case studies detailed in the next section. The Equal-Life training team then delivered targeted presentations on topics relevant to these local cases. Additionally, participants engaged in a hands-on demonstration of the Equal-Life Toolbox, guidebook, and associated tools. Notably, the toolbox showcased in Ljubljana represented a more advanced iteration compared to its earlier demonstrations in Cork and Amsterdam. After an introductory walkthrough, participants engaged in an interactive session to assess the practical applicability of the toolbox. They explored its potential in revisiting and refining the local case studies and policy interventions, with a specific focus on the physical, social, and internal indicators of the exposome. Stakeholders examined the core concepts, analytical tools, and project findings, applying them to real-world scenarios. Throughout the session, Equal-Life experts facilitated discussion and ensure participants could effectively navigate and utilize the various toolbox components. 3.3.2 Regional Cases During the session, four local cases and policy interventions from Slovenian public institutes and NGOs were examined. Each case addressed different aspects of health, urban planning, and environmental policies. o Intersectional Approaches in Slovenia’s National Health Program Presented by the National Institute for Public Health, this case explored how intersectionality is integrated into Slovenia’s national health policies, and how health is considered a key factor in all governmental decisions and policies (‘Health-in-all-policies’ framework). The discussion highlighted the importance of cross-sectoral collaboration in addressing health inequalities and promoting inclusive public health strategies. o Building Inclusive and Healthier Cities: The Role of Cycling and Urban Stressors A representative from Jožef Stefan Institute presented a case study on cycling and urban stressors, using an Urban Living Lab (ULL) approach. The session emphasized how real-world experimentation and sensor-based monitoring can inform urban policy, particularly in promoting active mobility and reducing environmental stressors in cities. o Adolescent Policies in Ljubljana’s Polje Neighborhood This case, presented by the City of Ljubljana in collaboration with the ‘Young Dragons’ (‘Mladi Zmaji’) initiative, focused on youth-oriented urban policies. It examined