The Upstream Team is founded and coordinated by a small group of mostly young researchers that are embedded within the Department of Epidemiology and Data Science at the Amsterdam University Medical Center - location VUmc, part of the Amsterdam Public Health Research Institute. We closely collaborate with renowned experts in and across the domains of environment, lifestyle behaviours and chronic diseases.
Jeroen Lakerveld, PhD
"Our environment matters for our behaviour and health.
It is complex, but it matters."
'I would consider myself to be an ‘upstreamist’, as I truly believe that our environment shapes our behaviour and thus our health. For some more than others – and for very few in a simple, linear way.
In several projects we try to entangle what environmental characteristics (or clusters of characteristics) matters for whom, and how. Nationally, but also in international settings. As an epidemiologist I am interested in the individual and environmental determinants of lifestyle behaviours and risk of non-communicable chronic diseases. To do so I think it is of utmost importance to get the picture - or the 'exposome' - as complete as possible by mapping all types of exposures and lifestyle behaviours in a longitudinal way, and find measures and methods to make sense of these data.'
Joreintje D. Mackenbach, PhD
“An ounce of prevention is worth a pound of cure” – Benjamin Franklin
'I am particularly interested in understanding why and how our living environments influence behaviours and health, with the aim to support the primary prevention of lifestyle-related chronic diseases through upstream interventions. This stems from the idea that behavioural choices are always made within a local context such as our social network or our neighbourhood, and influenced by the broader national and global context. I am trained as an epidemiologist but aim to integrate insights and methods from other disciplines such as geography and psychology in my work in order to better understand how the social, built, economic and political environment influences our behaviours and health.'
Maria Gabriela M. de Pinho, PhD
"When “I” is replaced by “We” even Illness becomes Wellness" – Unknown Author
'People's behaviour and health status largely depend on the context in which they live – the upstream factors. Considering the challenges and opportunities of these upstream factors fascinates me. In the last decades we witnessed overweight and obesity become an epidemic. As a nutritionist interested in Public Health I decided to focus on how we can improve environments to enable people to behave healthier, and so reduce the health burden. Within this perspective I obtained my Bachelor and Master degree in Nutrition from Federal University of Santa Catarina, Brazil. Then, pursuing new challenges and opportunities to learn from and share knowledge with colleagues from different disciplines I started my PhD trajectory at the VUmc University Medical Center and the Amsterdam Public Health research institute in Amsterdam. My main research interests are in the individual and upstream determinants of dietary behaviours and obesity.'
Nicole R. den Braver
"Treatment without prevention is simply unsustainable.” – Bill Gates
'I am fascinated by unravelling the how’s and why’s of behaviour and health status. I like to study complex issues in epidemiology, find the right tools and methods to do so and attempting to peek inside the black box. This interest was ignited during my master at the Wageningen University with a specialization in Epidemiology and Public Health, where during my education I have been involved in different projects at different places. I have studied associations between nutritional intake and disease, as well as behavioral constructs and lifestyle behaviour change in preventing type 2 diabetes. Now I am wondering what shapes these patterns of behavior and health at a higher level, namely by looking at the environment that one lives in. The environment is immensely complex, containing built environment, perceptions of environment, social environment, and the interactions between these constructs. The ENDEAVOR project enables me to pursue my interests in a PhD project. I am eager to get a grasp on these concepts and apply advanced epidemiological and statistical methods to contribute to our understanding of these pathways.'
"A man's health can be judged by which he takes two at a time - pills or stairs.” – Joan Welsh
'I strongly believe that adjustments to the environment can promote healthy living, and in turn prevent chronic diseases. During my bachelor Health and Life Sciences at the VU University I became convinced that prevention is better than cure. My interest in prevention was further fuelled during my master Health Sciences (specialization Prevention and Public Health) and internship at the VU University Medical Centre, department of Epidemiology and Biostatistics. By tackling upstream factors such as social disadvantage and social inequities we can improve health and diminish health disparities. Therefore, my PhD project will help tackle social inequities stemming from socio-economic status by helping make the healthy choice a cheaper choice.'
"The idea is to die young, as late as possible" – Ashley Montagu
'Growing old in optimal health – who does not want that? How to accomplice a high age, free from chronic diseases and disabilities, is a question that keeps on intriguing me. With a background in Nutrition and Dietetics and Health Sciences, I have experienced and learned about the impact of dietary choices and lifestyle behaviours on the prevention of several diseases, along with the major influence of social inequalities. Not all of us receive equal opportunities in life and not all dietary and lifestyle choices are a conscious choice of the individual.
I am convinced that environmental adjustments to promote healthy choices and behaviours, specifically targeting those who are at high risk of chronic diseases, can enhance equal chances of longevity in optimal health. During my PhD research for the SUPREME NUDGE project, I will focus on the implementation and evaluation of a large scale supermarket intervention trail, which aims to improve cardiometabolic health through nudging dietary behaviours and physical activity among low socioeconomic status adults.'
Geography has shaped our ancestors to what we are today and will no doubt keep telling us how to move and how to eat for the rest of our days. I know from my daily shopping routine how easy my ecological principles are outsmarted by compelling geographic factors like walk- or cycle distance. The common supermarket located between home and work wins often from the organic food shop which is slightly off route. So location does matter: change location –> change behavior.
Being a geographer myself I do not question if spatial variables matter for our health, but how they matter. Happily, within the Upstream Team I have plenty of space in the GECCO project to indulge myself with the collection and construction of relevant environmental variables and I may be able to support you to link these environmental-level data to your individual-level data. If you look for a specific spatial variables, need assistance in using GIS or have a good idea, I am happy to help you!
''Without the curiosity that moves me, that drives me, that encourages me to research, I neither learn nor teach'' – Paulo Freire
'It is reassuring to read in the Constitution of the World Health Organization (WHO) that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being”. However, unfortunately, that still does not happen “without distinction of race, religion, political belief, economic or social condition”. I truly believe that research in public health has an essential role in reducing health inequalities and in promoting a healthy environment for people. My interested in Public Health (Nutrition) led me to pursue a BSc in Nutrition by the Federal University of Santa Catarina (Brazil) and a MSc in Epidemiology by Radboud University. Later, as researcher at the division of Human Nutrition at Wageningen University, I further developed my skills. Within my PhD trajectory, I aim to unravel the link between the social setting in which people live (the so-called social environment) and their cardiometabolic health.'
“Without data you’re just another person with an opinion” – W. Edwards Demin
“Without an opinion you’re just another Artifical intelligance with some data” – Kirk Borne
The environment in which we live has an impact on our health. Despite the existing risk factors, be they behavioral or environmental, a better understanding of the interactions between social, environmental and individual characteristics and how they are related to the health of various populations, can change our chances of healthy ageing.
When I was a student in General Medicine (Yerevan State Medical University, Armenia), I was surprised to meet so many patients suffering from obesity, diabetes, heart diseases, stroke, infarctus etc. Knowing that these conditions can be prevented by the right lifestyle choices, I believed that raising the awareness can help to make a difference. With a group of medical students we decided to invest ourselves in a promotion of healthy lifestyle among young people. We started a volunteering program, which aimed to organize weekly seminars in schools of different regions in Armenia. During this seminars, we were talking about the need and the benefits of a healthy diet, physical activity etc. This experience has played an important role in my later career choices.
My determination to study abroad and the passion for scientific research have brought me to France, where I obtained a MSc’s degree in Public Health, with specialization in Biostatistics (Université Paris-Saclay, France). I started my career as a biostatistician in the clinical research unit of Avicenne hospital (Paris, France), where I worked during one and half year. After this multidisciplinary training, I joined to the departments of Epidemiology and Data Science at Amsterdam University Medical Center and Institute of Risk Assessment Sciences in University of Utrecht as a PhD student. My current research uses data science methods to unravel complex interrelations of a multitude of individual and environmental factors, referred as urban exposome, to study how they affect cardiometabolic disease risk outcomes.
Unhealthy dietary behaviour has historically been linked to flaws of character and personal failure. Over the course of various ineffective public health interventions, we slowly learned that the problem is much more complicated than this. Our behaviours are shaped by our environments, and our environments are the result of complex societal systems. Current intervention research is more sensitive to this systemic context in which individuals and interventions operate, and I feel we can make incredible steps forward if we keep this in mind.
The move from individual to systemic focus is a fairly recent one, and one which mirrored itself in my own development. I started with a degree in biomedical sciences, where I developed an interest in the role of nutrition in our physical health, and the intricate mechanisms at play in human. Seeking to expand on this subject I left the biomedical field for a more society focussed track at the Athena Institute, where I became acquainted with intervention research, and the challenges many such initiatives run into when they seek to expand to a broader scale. Finally, my PhD at SUPREME NUDGE allowed me to fully emerge myself in systems theory, and I have become convinced that far-reaching changes in our societal systems are required. So that is what I am now working towards, one step at a time.
Lieke van den Brekel
The complex interplay between people, environment and health fascinates me. If we design our living environment so that all populations benefit equally, we create equal opportunities for optimal health.
I graduated as a medical doctor from Utrecht University and after some clinical work I will now focus on researching the role of the environment in ethnic inequalities in cardiovascular disease. I truly believe that the cause of these inequalities can largely be found in non-genetic factors (including the social and physical environment and policies).
With this research, I hope that we can contribute to a partial shift in focus from curative to preventive medicine, because I believe prevention is the key to improving public health and an efficient healthcare system. I will do this research within a PhD program that is a collaboration between the University Medical Center Utrecht and the Amsterdam University Medical Center and is part of the larger Exposome-NL research project.
"Its methods may be scientific, but its objectives are often thoroughly human.” Alex Broadbent, University of Johannesburg philosopher commenting on epidemiology in The Epi Monitor
We have good reason to believe that the environment in which we live influences our behavior, and in turn, our health. But the more we study something the more complex it always turns out to be. Luckily, this means that there is a whole field of knowledge left to discover, which can hopefully lead to new strategies to prevent chronic diseases on a large scale. During my bachelor’s and master’s degree in biomedical science I developed an interest in epidemiology and cardiovascular disease. Currently I am a PhD candidate at the department of cardiovascular epidemiology of the University Medical Center Utrecht. My research is embedded in exposomeNL and aims to improve our understanding of the relation between an individual’s environment and cardiovascular health and the mechanisms that are underlying that relation. I am excited to go upstream with the Upstream Team and discover new opportunities to make our environment and our lives healthier.