Environmental Health and the First 1,000 Days: Professional Perceptions and Territorial Dynamics

Abstract Background In France, the First 1,000 Days Program highlights the importance of early environmental exposures, particularly to endocrine disruptors on long-term health, in line with the Developmental Origins of Health and Disease (DOHaD) concept. This period of vulnerability requires coordinated actions among perinatal professionals to promote healthier environments and raise families’ awareness of environmental risks. In this context, the ProSET study (Promotion of Environmental Health at the Territorial Level) explores how perinatal health professionals and policymakers in a rural area perceive and incorporate environmental health into their practices. Methods A qualitative study was conducted in a rural area of Auvergne-Rhône-Alpes with 44 healthcare professionals, pharmacists, and local policymakers. Interviews were performed until data saturation; they were thematically analysed using NVivo15. Results Among the 44 participants (82% women), 29 acknowledged the relevance of environmental health, though understanding was often partial and informally acquired. Endocrine disruptors were mentioned by 26 participants, yet exposure pathways remained poorly understood. The First 1,000 Days concept was partially known (n = 22), and only 11 participants referred to the DOHaD framework. Preventive actions were reported by 33 participants but remained fragmented and uncoordinated. Informal learning predominated, with 27 expressing a need for structured training. Barriers included time constraints, scarce resources, and limited governance (n = 11). Ethical concerns (n = 22) and intergenerational responsibility (n = 21) were strong motivators. Pharmacists (n = 8) recognised a preventive role yet cited a lack of tools. Engagement was primarily driven by personal values rather than national guidance. Conclusions Environmental health integration in perinatal care offers a promising opportunity, but hinges on stronger governance, shared knowledge, and cross-sectoral collaboration. Key messages • Policymakers, professionals need structured support to integrate environmental health effectively. • Training and territorial governance are key levers to reduce inequalities and improve early prevention.