20 years of exposomics: How the field can improve clinical care and public health policy

What you need to know about the state of exposome research and how it could impact public health policy.

What causes someone to get asthma? Genetics may play a role, of course, but so might the level of air pollution in your city. Considering the ways our everyday living environment interacts with our genes could better help us understand the drivers of human health.

Chronic diseases, such as heart disease, cancer, stroke, and diabetes, have been on the rise in the U.S. for the past 20 years and make up 8 of the 10 leading causes of death in the country. The pervasiveness and cost of these health issues is only expected to grow, and traditional risk assessments and prevention strategies are falling short of solving the underlying problems impacting people’s health.

This calls for a more holistic approach that considers factors beyond genetics, according to Fenna Sillé, director of the Johns Hopkins University Exposome Collaborative and deputy director of the Center for Alternatives to Animal Testing, which co-organized the Exposome Moonshot Forum at the Johns Hopkins University Bloomberg Center in 2025. Stakeholders from over 25 different countries, including universities and research centers, government institutions including the National Institutes of Health and Food and Drug Administration, non-profit organizations such as WHO and UNESCO, industry, patient advocacy groups, and the public gathered at the forum to collaborate on exposome-informed health policy and practices, launching the Global Exposome Summit series.

The exposome is all the environmental exposures, both internal and external, across someone’s lifetime. Sillé investigates how this shapes immune function and disease throughout a person’s life, and she leads a study on how the exposome contributes to childhood asthma in Baltimore. Now, Sillé’s research will help build a new dashboard that integrates patient health records with data from the exposome to paint a more holistic picture of their health.

External exposures usually relate to someone’s living environment, including the physical, social, and psychological factors someone encounters. Some examples of external exposures include:

Internal exposures, on the other hand, refer to biological processes, including hormone and immune signaling, a person’s internal microbiome, and the metabolic processes that keep their body working normally. Examples of internal exposures include:

None of these exist in a silo, Sillé said. They interact with people’s genes, and they also interact with one another, producing a number of health factor combinations that can better explain what someone’s body is susceptible to.

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Why is exposomics important right now?

Experts say there is a greater need for a holistic examination of people’s health—both at the individual level and the population level—and technology is now advanced enough to help researchers get there.

Increase of chronic health issues

While individual health behaviors—such as smoking or excessive drinking—and genetics affect someone’s risk of developing a chronic condition, 70-90% of disease risks are probably attributable to differences in environments, according to researchers.

The way we measure those types of health risks isn’t as precise as it should be to tackle the rise in chronic diseases, experts say. For example, current systems that the Environmental Protection Agency or the FDA use to measure how toxic a specific chemical might be if someone ingests it or if it’s added to an environment typically include a study involving animal models. These often don’t provide the granularity needed to understand the full extent of an exposure risk or how it may interact with preexisting factors like someone’s specific health conditions.

Exposomics can help tell the full story.

“There will always be those unknowns, but we have enough critical mass now that we could, especially with AI technology, infer and correlate, in a sense, how the exposome influences health,” Sillé said.

Some risk factors, such as poor nutrition and lack of regular exercise, may seem like individual choices, but they’re often influenced by someone’s environment. For instance, someone may not have easy access to healthy food because they don’t have a grocery store nearby, or their neighborhood may not be safe enough to encourage physical activity.

Technology capabilities

Technological advancements over more than a decade enabled scientists to sequence the entire human genome in 2022, improving our understanding of how genetics contribute to certain diseases. Sillé sees this parallel in exposomics with omics technologies. These are most commonly sequencing or mass-spectrometry techniques that comprehensively analyze biological molecules, such as DNA, RNA, and proteins. This allows scientists to detect and measure internal factors contributing to someone’s health status, including molecular signatures, or measurable “imprints,” of past exposures.

Artificial intelligence. AI can help researchers quickly analyze complex environmental data.

Advanced sensors. Improved capabilities provide real-time monitoring of numerous environmental factors.

Enhanced analytics. Today, experts have the capacity to process and interpret massive datasets.

“Similarly, and I think even more so [than the Human Genome Project], we can hit the ground running because we already have quite advanced technologies to generate the data,” Sillé said. “There are already a lot of things that we know and can infer that we can put together to characterize the human exposome.”

Individual and community-level impact

The information derived through exposomics can help doctors treat individual patients and also help public health officials support entire communities, experts say.

Clinical uses. Integrating exposomics with electronic health records, for example, can fill an information gap in precision medicine by producing data on how exposures influence health. Using this information at the individual level would help doctors make data-driven decisions to better detect, prevent, or treat a disease based on a person’s overall environmental exposures, lifestyle, socioeconomic factors, and more. It could also inform new treatments and medications that address symptoms driven by the exposome.

Collecting this data could be as simple as having patients fill out a questionnaire at the clinic. It could also involve collecting and analyzing biospecimens like blood or saliva for biomarkers that indicate a specific exposure.

Publicly available geospatially coded data, based on a person’s address or area code, could also be used to estimate environmental and community-level exposures, such as air pollution, green space, noise, climate-related factors, access to healthy foods, or socioeconomic conditions.

Public health uses. By identifying the effects of cumulative and interacting exposures— such as air pollution, contaminated water, chemical mixtures, and other environmental factors that affect broader populations—exposomics can help inform public health interventions and evidence-based policy decisions to keep communities healthy and potentially lower healthcare costs and spending.

“The big message is that people need to realize that both at the public health, but also at the individual health [level], it’s not one exposure at the time that you are influenced by,” Sillé said. “You need to look at the whole picture, and that’s what the exposome is trying to represent.”

What progress has the field made over the past 20 years?

Investments in exposomics projects in the U.S. has picked up in the past five to 10 years, Sillé said, in part because funding is usually allocated for research that tests hypotheses, and exposomics generates hypotheses.

Countries within the European Union, as well as Australia and Japan, have also invested in exposomics, and some initiatives are now starting to connect with policy. For instance, the URBANOME Final Conference in July 2025 built on four years of research and collaboration across Europe to inform policy that aligns with the World Health Organization’s Health in All Policies approach, which addresses social determinants of health—such as transportation, housing, and education—to better support a population’s overall well-being.

Exposomics is primarily applied in research rather than in commercial or clinical settings right now. But there are some small companies and startups that are starting to link a person’s exposome with a single omic, or class of biological molecules, to help explain a current disease or predict one that might develop. For example, Linus Bio created a biochemical test that can pinpoint a molecular signature that predicts autism spectrum disorder. Using the test, healthcare providers can better rule out autism in children 1 to 36 months.

“We’re at a little bit of a tipping point where we’re now finally starting to see [application of research], whereas before it was just in the research space and not so much at the application or the translation [stage],” Sillé said.

What’s the next step in exposomics?

In April 2026, researchers, policymakers, and industry stakeholders gathered in Barcelona for the Global Exposome Summit to advance cooperation and support the between different human exposome research programs and projects around the world. A few targets are top of mind for exposomics experts.

Measurement. Researchers want to develop a scoring system that can identify which exposures are contributing the most to someone’s disease. At the population level, public data on different exposures like air pollution and contaminated water currently exist separately. To connect the dots and score a region based on its external exposures would require manually overlaying these different data points. An integrated dashboard could provide a more useful picture, something Sillé said the Netherlands is currently experimenting with.

Application. Sillé wants to see exposomics help doctors treat patients better, but how clinicians access and use the data is yet to be determined. Her team is talking with healthcare professionals, patients, and policymakers to see what information they want to see and how. This could involve creating a new platform to layer data in one place or integrating exposomics data into existing dashboards.

Ethical considerations. As this data is collected and used, privacy and ethical guardrails must be in place to protect patients and vulnerable populations. If not, their exposomic profile could, for example, determine their health insurance rate, or their unique exposome exposures could inadvertently identify where they live. Sillé said policymakers should guide these types of decisions early on.

How can exposomics inform public policy?

While there’s still work to be done before scientists can fully characterize the combined impact of all the exposures that affect human health, there’s still an opportunity to leverage the data that exists today.

“We don’t need to wait until 2040 for politicians to use the data,” Sillé said. “It’s very informative already to look at exposome or exposome-like projects and what they mean and what they can tell us.”

Policymakers can use existing research on the health effects of an array of regional exposures like heat waves or wildfire smoke to inform policy and regulatory decisions for public health, especially for their specific states and cities. In this way, exposomics could support the design of healthier cities by integrating environmental monitoring with urban planning, infrastructure, and public services.

“It’s not just what happens right now to your population; it’s also your population that you carry forward,” Sillé said, noting that how someone’s body reacts to these exposures may drive changes in genetic activity that can change gene expression. In some cases, this can be passed on to future generations. “For that reason, governments should care about the exposome because they want to keep their population healthy and their healthcare costs low.”

“[The exposome] affects the health of an individual, but also the health of a population. For that reason, governments should care about the exposome, because they want to keep their population healthy and their healthcare costs low.”

Exposomics has applications beyond public health, too. It can inform elements of planetary health, such as the health of aquaculture populations that impact food systems, the development of safer chemicals, and more.

“We should make those connections, and we should think about the bigger picture, because we live in an ecosystem,” Sillé said.

How is Johns Hopkins advancing exposomics?

Combining exposure assessment and multi-omics data for childhood asthma, Sillé’s team built a tool called tidyexposomics that integrates and analyzes these different data streams to provide a more holistic view of the exposome’s impact on child asthma. The tool is broadly applicable and can be adapted to study the influence of the exposome on a wide array of health outcomes.

They intend to use this tool to develop an exposome dashboard prototype for precision medicine that would integrate exposome data with electronic health records to show doctors and researchers how environmental factors influence patients’ health. The dashboard will also use advanced machine learning models to assess patients’ risk factors as well as generate an exposome risk score. They hope to eventually transition the dashboard from a research prototype into a scalable, widely adopted clinical tool.