URBANOME: An exposome-based framework linking urban interventions to molecular, health, and policy-relevant outcomes

Urban environments expose residents to multiple simultaneous stressors that often act synergistically (e.g. air pollution and extreme heat amplifying cardiovascular risks), contributing to a major urban health burden – an estimated 13% of all deaths in the European Union are attributable to environmental factors, largely via chronic diseases. However, traditional one-hazard-at-a-time approaches fail to capture such combined effects, motivating adoption of an exposome paradigm that holistically assesses the totality of an individual’s environmental and social exposures across the lifespan. In a four-year study across nine European cities, URBANOME implemented an integrated exposome framework combining participatory co-creation in Urban Living Labs (ULLs) with advanced tools, extensive ambient monitoring and personal exposure assessment (e.g. wearable sensors and smartphone apps), agent-based modeling, multi-omics analysis (metabolomics and transcriptomics), and cost–benefit evaluation, to link urban interventions with health outcomes. Key findings included the identification of a 4-metabolite biomarker panel (L-tyrosine, ascorbic acid, choline, coenzyme Q10) that classified participants’ pre- vs. post-intervention status with perfect accuracy (AUROC = 1.0). Parallel improvements were observed in both perceived and objective health outcomes: participants reported less air-pollution annoyance and better sleep (fewer sleep-related breathing issues), and pollution-related declines in lung function were significantly attenuated, especially in highly polluted neighborhoods. An economic analysis estimated an exceptional return of ~€57–€143 in combined health and societal benefits for every €1 invested. URBANOME’s exposome-based approach yielded rapid health gains at the molecular, individual, and community levels and supports policy measures such as bundled interventions (combining traffic reduction, greening, and active mobility) for synergistic benefits, real-time environmental and biomarker monitoring, and prioritization of high-exposure or low-SES communities to maximize health equity. These findings demonstrate that interventions yielding cleaner air, less noise, and more green space are among the most cost-effective public health investments, resulting in measurably healthier and more equitable cities.