October 4, 2021

Anne Hicks on the Children’s Environmental Health Clinic as an example of precision health research

Anne Hicks

Photo submitted by Hicks.

Anne (Elizabeth) Hicks is an assistant professor in the Department of Pediatrics as well as the director and clinical lead at the Children’s Environmental Health Clinic. She is a pediatric pulmonary specialist with an interest in the impact of environmental exposures on children’s health.

As the sixth presenter for WCHRI’s Precision Health Research Seminar Series, Anne sat down with us to discuss the Children’s Environmental Health Clinic and the role of environmental exposures in children’s health.

Can you tell us a little about environmental health and explain how a child’s environment can affect that child’s health?

Environmental health looks at the relationship between a child’s environment, including different environmental exposures, and that child’s present and long-term health. Understanding environmental health means looking at all the things a child has been exposed to during their lifetime and how those exposures relate to health. This includes identifying which exposures have the biggest impact on children, understanding the role of a child’s developmental stages on how they are impacted and also taking into account the child’s genetic vulnerabilities and risk factors. 

For example, a pregnant woman being exposed to high levels of smoke or air pollution increases the chances of her baby being born prematurely or small for their age. A premature birth then increases the chances that the baby will have a higher sensitivity to inflammation from smoke or particles in the air, and an increased risk of chronic health problems such as asthma. For older infants and children, higher levels of air pollution increases the risk of being diagnosed with asthma. For adults, long-term exposure to air pollution is linked to a shorter lifespan and cardiorespiratory problems. 

What is the Children’s Environmental Health Clinic and how is it an example of precision health research?

The Children’s Environmental Health Clinic (ChEHC) started out providing evaluations for children who either had a known environmental exposure or who had a health issue where an environmental exposure may have been a factor. The ChEHC team grew to include pediatricians, researchers and specialized pediatricians in order to help answer these questions. The ChEHC considers all environmental factors when addressing the impact on children’s health by integrating clinical, research and educational components. The clinic also became part of an international network that promotes access to additional expertise. Almost immediately, it became apparent that research into the relationship between environmental exposures and child health is an area of significant need that is rapidly evolving because of climate change. ChEHC members are actively pursuing research in this area. As the research has evolved, ChEHC has also become involved in collaborations that bring understanding and evaluation of child environmental exposures and mitigation strategies into the context of global health practice.

What is your research focus and how did you get involved with the Children’s Health Environment Clinic?

I started my career as a microbiologist, first in molecular biology then in environmental microbiology and waste remediation before clinical training in pediatric pulmonology. Training in these areas helped me develop an understanding of the importance of the exposome (the measure of all the exposures of an individual in a lifetime and how those exposures relate to health) and epigenetics (the study of how your behaviours and environment can cause changes that affect the way your genes work) as well as a strong interest in environmental health which, linked with pediatric pulmonology, has evolved into my interest and research of the impact of acute and chronic exposures on pulmonary health and development. The main drivers of my clinical practice are complex asthma and disorders of immune regulation, which help to understand how specific vulnerabilities can fit with exposure profiles.

Why is this research important for the future health of women and children?

Environmental exposures are known to lead to acute and chronic health effects that influence longevity and quality of life, and adverse exposures are rapidly increasing due to climate change. Last year, 30 per cent of the air particulate matter in the USA was from wildfire smoke. Women and children are uniquely vulnerable populations who may bear the brunt of environmental exposures, and in utero, neonatal and child exposures are more likely to cause acute disease in infants and children as well as have chronic effects that may be amplified in the context of development. We need to have a better understanding of risks and mitigating factors in order to promote women’s and children’s health, and this need is increasing in urgency every year.

What is happening at the Children’s Health Environment Clinic right now?

ChEHC is active in several areas.

Clinical: We continue to provide clinical care to individual patients and are using the challenge of care during the pandemic to expand our virtual capacity, which is increasingly important for ensuring accessibility. One great opportunity is that the faculty at Western University are interested in creating a sister clinic. Combined with interest from pediatricians across the country who would like to see patients with environmental exposures, with some support from ChEHC expertise, this will allow our clinical service to extend nationally as we build partnerships. These partnerships will also identify further needs in expertise, research and educational opportunities that will push ChEHC’s growth as not just a provincial but also national and international resource.

Research: ChEHC is expanding on our research capacity by focusing on interdisciplinary collaborations. 

Education and knowledge translation: ChEHC has a longstanding tradition of providing information for health care practitioners, communities, parents and families. We are currently updating and building our fact sheet repository, however, an important goal we are focused on is sharing information nationally and globally. In this light, ChEHC has been working with the Canadian Pediatric Society, the World Health Organization and more recently the Pan-American Health Organization to develop up-to-date resources.

How can other researchers get involved?

ChEHC is always interested in active partnerships. Interested researchers can contact one of the principal investigators at ChEHC or the clinic itself through our website.

Join Anne Hicks for a seminar on the Children’s Environmental Health Clinic as an example of precision health research. Happening on October 13 at noon. Register now!

Hicks’ research has received funding from the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.