A Dutch nationwide action program to tackle geographical inequalities in birth outcomes

Abstract Emerging evidence highlights that where and how we live profoundly shapes our health - potentially even more than our genetic code. Yet, most studies linking living environment and health focus on general populations, overlooking the critical early life phase. This nationwide action program applies a ‘Health in All Policies’ focus to investigate how both outdoor (neighborhood-level) and indoor (housing-level) environmental factors impact health from the preconception phase through pregnancy and the first four years of life. This program is a collaboration between researchers from medical and technical universities and policymakers from the Ministries of Health, Internal Affairs, and Social Affairs, aimed at advancing public health. It was initiated in government-identified high-risk areas with poor livability. Moreover, this program is embedded in the national Solid Start program. We will explore how modifiable aspects of the built and social environment - such as noise, access to green space, crime, temperature, air quality, and access to safe, sustainable housing - interact to influence maternal and child health outcomes, including birth outcomes and child development. This project examines how these determinants differ between neighborhoods in the Netherlands, interact with individual factors, and shape the early-life exposome. Our approach integrates an international literature review with data analysis of national health and socio-spatial datasets based on birth cohorts. This dual strategy is guided by literature gaps and ministry priorities, ensuring research meets current needs and informs interventions. The goal is to co-develop a policy-oriented knowledge agenda with stakeholders, including ministries and public health organizations. By linking early-life health to housing and neighborhood policy, this project offers new insights to guide interventions and shows how urban planning and housing policy can reduce health inequalities from the start of life. Key messages • Where and how we live - starting even before birth - has a powerful impact on lifelong health, making housing and neighborhood conditions critical public health priorities. • This national program connects research and policy to uncover how environmental factors shape early-life health, aiming to reduce health inequalities through better urban and housing policies.