Integrating the social environment with an equity perspective into the exposome paradigm: A new conceptual framework of the Social Exposome

En i onmen al Resea ch 233 (2023) 116485
A ailable online 22 June 2023
0013-9351/© 2023 The Au ho s. Published by Else ie Inc. This is an open access a icle unde he CC BY-NC license (h p://c ea i ecommons.o g/licenses/by-
nc/4.0/).
In eg a ing he social en i onmen wi h an equi y pe spec i e in o he
exposome pa adigm: A new concep ual amewo k o he Social Exposome
Helene Gudi-Minde mann
*
, Maddie Whi e, Jana Roczen, Na alie Riedel, S e anie D ege ,
Gab iele Bol e
Uni e si y o B emen, Ins i u e o Public Heal h and Nu sing Resea ch, Depa men o Social Epidemiology, Ge many
ARTICLE INFO
Keywo ds:
Exposome
Inequali ies
Heal h equi y
En i onmen al heal h
Social de e minan s o heal h
En i onmen al jus ice
ABSTRACT
The impo ance o he social en i onmen and social inequali ies in disease e iology is well-known due o he
p o ound esea ch and concep ual amewo k on social de e minan s o heal h. Fo a long pe iod, in exposome
esea ch wi h i s classical o ien a ion owa ds de imen al heal h e ec s o biological, chemical, and physical
exposu es, his knowledge emained unde ep esen ed. Bu cu en ly i gains g ea awa eness and calls o in-
no a ions in e hinking he ole o social en i onmen al heal h de e minan s. To ill his gap ha exis s in e ms
o he social domain wi hin exposome esea ch, we p opose a no el concep ual amewo k o he Social Expo-
some, o in eg a e he social en i onmen in conjunc ion wi h he physical en i onmen in o he exposome
concep . The i e a i e de elopmen p ocess o he Social Exposome was based on a sys ema ic compila ion o
social exposu es in o de o achie e a holis ic po ayal o he human social en i onmen – including social,
psychosocial, socioeconomic, sociodemog aphic, local, egional, and cul u al aspec s, a indi idual and
con ex ual le els. In o de o mo e he Social Exposome beyond a me e compila ion o exposu es, h ee co e
p inciples a e emphasized ha unde ly he in e play o he mul i ude o exposu es: Mul idimensionali y, Reci-
p oci y, and Timing and con inui y. The key ocus o he concep ual amewo k o he Social Exposome is on
unde s anding he unde lying mechanisms ha ansla e social exposu es in o heal h ou comes. In pa icula ,
insigh s om esea ch on heal h equi y and en i onmen al jus ice ha e been inco po a ed o unco e how social
inequali ies in heal h eme ge, a e main ained, and sys ema ically d i e heal h ou comes. Th ee ansmission
pa hways a e p esen ed: Embodimen , Resilience and Suscep ibili y o Vulne abili y, and Empowe men . The
Social Exposome concep ual amewo k may se e as a s a egic map o , bo h, esea ch and in e en ion
planning, aiming o u he explo e he impac o he complex social en i onmen and o al e ansmission
pa hways o minimize heal h isks and heal h inequali ies and o os e equi y in heal h.
1. In oduc ion
A conside able p opo ion o he global bu den o disease is a ib-
u able o en i onmen al ac o s (WHO, 2016) and complex in e ac ions
be ween genes and he en i onmen (Rappapo , 2011; Sanka , 2004).
Bu wha is e e ed o when we alk abou en i onmen ? Rappapo and
Smi h (2010) de ine en i onmen , and pa icula ly he de imen al e -
ec s o en i onmen al exposu es, beyond pollu ion, clima e, and noise,
s a ing ha “(…) exposu es a e no es ic ed o chemicals ( oxican s)
en e ing he body om ai , wa e , o ood, o example, bu also include
chemicals p oduced by in lamma ion, oxida i e s ess, lipid pe oxida-
ion, in ec ions, gu lo a, and o he na u al p ocesses” (Rappapo and
Smi h, 2010, p. 460). K iege ’s eco-social heo y (2011) ex ends his
unde s anding o he scope o heal h- ele an en i onmen al exposu es
emphasizing he ele ance o he social domain: The eco-social heo y
pos ula es ha humans, as social beings who li e in socially o ganized
en i onmen s, embody he ecological, ma e ial, and social wo lds in
which hey li e, including he dis ibu ions o powe and weal h o e
ime and ac oss space (K iege , 2011). The unde lying concep o
embodimen (K iege , 2005) s esses ha being engaged wi h he su -
ounding wo ld ini ia es ans o ma ion o bodily cha ac e is ics
h ough he physical inco po a ion o ha en i onmen wi h conse-
quences o gene egula ion and exp ession. Simul aneously, his
ans o ma ion eeds back, changing his e y en i onmen . K iege ,
hus, emphasizes embodimen as an ac i e and ecip ocal p ocess ha is
“mo e han jus abou how social condi ions ‘ge unde he skin’“bu
* Co esponding au ho . G aze S . 4, 28359, B emen, Ge many
E-mail add esses: [email p o ec ed], [email p o ec ed] (H. Gudi-Minde mann).
Con en s lis s a ailable a ScienceDi ec
En i onmen al Resea ch
jou nal homepage: www.else ie .com/loca e/en es
h ps://doi.o g/10.1016/j.en es.2023.116485
Recei ed 16 Decembe 2022; Recei ed in e ised o m 21 Ap il 2023; Accep ed 20 June 2023
En i onmen al Resea ch 233 (2023) 116485
2
a he ep esen s “ou bodily engagemen (soma and psyche combined),
indi idually and collec i ely, wi h he biophysical wo ld and each
o he .” (K iege , 2011, p. 222). Examples o embodied social en i on-
men come om esea ch on bioma ke s o ch onic s ess and accele -
a ed physiologic aging such as elome e leng h and DNA me hyla ion
(Kawachi and Sub amanian, 2018; Vineis and Kelly-I ing, 2019). Fo
ins ance, in A ican Ame ican women, elome e a i ion has ecen ly
been ound o be in luenced by in e ac ions be ween ins i u ional acial
disc imina ion, educa ional a ainmen , and employmen s a us
(Thomas e al., 2021). O he examples o embodied social en i onmen
o igina e om esea ch on neu oendoc ine pa hways in he con ex o
he allos a ic load hypo hesis, linking ad e se li ing condi ions wi h
heal h dispa i ies (Johnson e al., 2017; Mo ello-F osch and Shenassa,
2006; Ribei o e al., 2018; Shanka dass, 2012; Szan on e al., 2005).
Acco ding o his e idence, en i onmen al in luences on heal h
comp ise biological, physical, chemical, and, pa icula ly social
exposu es.
In e es in explo ing he pa hogenic e ec s o en i onmen al expo-
su es has a long his o y. In he 1970s, o mal quan i a i e isk assess-
men s o chemicals ocused on single exposu es using simplis ic ‘one
exposu e – one ou come’ models (Sex on, 2012). Mo eo e , app oaches
o isk ac o epidemiology domina ed quan i a i e esea ch on en i-
onmen al heal h. Beginning in he 1980s, he need has been empha-
sized o de elop me hods o assess o al exposu e, aking all exposu e
pa hways in o accoun (Lioy, 1990; Wallace e al., 1987) and o conside
cumula i e and in e ac i e heal h e ec s o simul aneous exposu es
om a wide ange o en i onmen al s esso s (Sex on and Linde , 2011).
Agains he backg ound ha psychosocial s esso s linked o social in-
equi ies may inc ease ulne abili y o de imen al heal h e ec s o
en i onmen al exposu es, he app oach o cumula i e isk assessmen as
a way o e alua e combined e ec s o mul iple physical, chemical, and
social s esso s on heal h has been p oposed (Payne-S u ges e al.,
2018). This need o conside cumula i e e ec s o mul iple exposu es
has been ecen ly culmina ed in he concep o he exposome, concep-
ualized by Wild (2005, 2012) as he non-gene ic coun e pa o he
genome. In his wo k, Wild (2012) emphasized he need o inco po a e
he li e- ime complemen o he o ali y o all concei able non-gene ic
d i e s o heal h and disease including exposu es om in e nal and
ex e nal sou ces o physical, chemical, biological, and social in luences.
Despi e Wild’s holis ic app oach, ecen guiding wo k in he ield o
exposome esea ch con inues o ocus mainly on he e ec o biological,
physical, and chemical exposu es on heal h and isks o o e look he
ele ance o he social en i onmen in unde s anding disease e iology
(Neu cou e al., 2022). On he con a y, he poli ical mo emen and
scien i ic esea ch on social heal h de e minan s and en i onmen al
jus ice has emphasized o a long ime he in e ac ion o en i onmen al
and social ac o s in p oducing heal h inequi ies: En i onmen al haza ds
and bene i s end o be unequally dis ibu ed, he o me cong ega ing in
popula ions wi h un a o able socioeconomic and demog aphic ac o s
(D ege e al., 2019; E ans and Kan owi z, 2002; Fai bu n e al., 2019;
Schüle e al., 2019). While heal h inequali ies add ess gene al di e ences
in heal h wi hou no ma i e judgemen , unequal dis ibu ions which a e
assumed o be un ai , unjus , and a oidable, pa icula ly when linked o
social de e minan s o heal h, a e e e ed o as heal h inequi ies (CSDH,
2008; K uize e al., 2014; Sola and I win, 2010; WHO Regional O ice
o Eu ope, 2012; WHO Regional O ice o Eu ope, 2019a; WHO
Regional O ice o Eu ope, 2019b). The need o add ess he inequi able
dis ibu ion o exposu es o nega i e (en i onmen al haza ds, e.g.
pollu ion) and posi i e (en i onmen al bene i s, e.g. g een space)
en i onmen al heal h in luences ac oss popula ion g oups has been
s essed in e ms o dis ibu ional jus ice in addi ion o p ocedu al jus-
ice as equal ea men and in ol emen o all popula ion g oups in
en i onmen al decision-making (Bol e e al., 2011; B ulle and Pellow,
2006; Gee and Payne-S u ges, 2004; Zhuang e al., 2022). Mo eo e ,
besides hese exposu e di e en ials, social di e ences in ulne abili y o
he heal h e ec s o en i onmen al exposu es (e.g. e ec modi ica ion)
ha e been conside ed as impo an mechanism in en i onmen al jus ice
esea ch (Bol e e al., 2011; Gee and Payne-S u ges, 2004).
Despi e hese con e ging insigh s ha ecognize he en angled de-
pendencies be ween social in luences and heal h, social in luences a e
a ely being concep ualized in a heo e ically g ounded way and ha dly
in eg a ed in o exposome esea ch alongside o he ypes (e.g. physical)
o exposu es (Neu cou e al., 2022; Vineis and Ba ouki, 2022). Fo
ins ance, when sea ching o ‘exposome’ in he i le/abs ac o scien i ic
a icles up un il he end o 2021, 895 publica ions a e indexed in
PubMed. This numbe sh inks o only i e publica ions (A ias e al.,
2022; Bueke s e al., 2018; Jackson and A ah, 2020; Nwanaji-Enwe em
e al., 2021; Senie e al., 2017) when he keywo d ‘exposome’ is com-
bined wi h he sea ch e ms ‘social*’ o ‘socio*‘. Fu he mo e, only wo
o hese i e publica ions, namely he wo k by Nwanaji-Enwe em e al.
(2021) and Senie e al. (2017), elabo a ed on exposome- ela ed con-
cep s a all, wi h he idea o b oaden he unde s anding o he exposome.
Nwanaji-Enwe em e al. (2021) ad e ise a compound exposome
app oach, s essing he so-called social exposome as essen ial o a ho-
lis ic iew on exposu e-disease pa hways. In his a icle, he au ho s do
lis se e al social indica o s ha ha e been linked o heal h inequi ies
( e e ing in pa icula o s uc u al acism), howe e hey do no
elabo a e on a concep ual amewo k o a social exposome. Thus, o
hese publica ions, only Senie e al. (2017) p opose a concep ualiza ion
o social exposu es in he exposome, called he socio-exposome. The au-
ho s emphasize hei socio-exposome as a mul idisciplina y concep ual
amewo k ha conside s en i onmen al exposu es om indi idual,
local, and global le els and aims o in eg a e sociological, public heal h,
and en i onmen al jus ice schola ship (Senie e al., 2017). The au ho s
a gue agains a s ongly indi idualized pa h owa ds a pe sonalized
medicine app oach as i is ypically ollowed in genome esea ch, bu
ad e ise a mo e holis ic way in o de o achie e b oade public heal h
goals. One o he co e p inciples o hei amewo k is o link biological
disease pa hways and social en i onmen al o ces in o de o unco e
how egula o y p inciples (o e.g. au ho i ies, ins i u ions) unde lie
s uc u al inequali ies and en i onmen al isk inequali ies (Senie e al.,
2017). By a mo e ex ended sea ch, we iden i ied wo u he publica-
ions ha s ess he social and psychosocial domain wi hin he exposome
concep . The public heal h exposome om Jua ez e al. (2014) highligh s
popula ion-le el isks ac oss he social and policy en i onmen , pa ic-
ula ly s essing he socioeconomic ac o s wi h ega d o exposu e dis-
ibu ions and indi idual suscep ibili y. The au ho s de ail hei
amewo k’s aims o in eg a e complex ela ionships be ween exoge-
nous and endogenous exposu es, pa icula ly emphasizing hei li elong
occu ence. The concep o he psychoexposome om Colomina e al.
(2018) conside s psychosocial en i onmen al exposu es in he con ex
o psychopa hology, pa icula ly add essing he imp in ing e ec o
ea ly li e expe iences on neu al ci cui s ha may ad e sely al e
inc easing suscep ibili y owa ds psychological diso de s.
These ew pionee app oaches wi hin he ield o exposome esea ch
a e in line wi h he e y ecen claims om exposome esea che s o no
longe educe social de e minan s o heal h o con ounding a iables bu
o ea social in luences as o e a ching de e minan s as hey ha e
mani old downs eam e ec s on o he exposu es (Neu cou e al., 2022;
Vineis, 2022; Vineis and Ba ouki, 2022), as is well-known acco ding o
he p o ound esea ch and concep ual amewo k on social de e minan s
o heal h (CSDH, 2008; F iel and Ma mo , 2011; WHO Regional O ice
o Eu ope, 2019a).
Building on his wo k, we aim o ill he gap ha exis s in he social
domain o exposome esea ch. To achie e his, we ex end p e ious ap-
p oaches by di ec ing he ocus o a en ion on wo less explo ed aspec s:
a) sys ema ic and comp ehensi e cha ac e iza ion o he ‘ o ali y’ o
social exposu es and b) ansmission pa hways be ween exposu es and
ou comes, pa icula ly inco po a ing insigh s om heal h inequali y,
jus ice, and equi y esea ch. Combining hese ocus poin s, we p opose a
no el holis ic concep ual amewo k o he Social Exposome, wi h a
wo old goal. The i s goal is o b ing oge he he b ead h o social and
H. Gudi-Minde mann e al.
En i onmen al Resea ch 233 (2023) 116485
3
psychosocial exposu es included in he a o emen ioned concep s and
lines o esea ch in one all-encompassing concep ual amewo k. The
second goal, in o de o mo e beyond a me e compila ion o social ex-
posu es, is o unco e po en ial ansmission pa hways ha will ad ance
ou unde s anding o how ( he en i e y o ) indi idual and con ex ual,
s uc u al social exposu es ansla e in o heal h ou comes.
To achie e hese goals, he p oposed no el concep ual amewo k o
he Social Exposome was de eloped in an i e a i e li e a u e-based and
expe ise-d i en esea ch p ocess. We, i s ly, syn hesized p e ious
knowledge a) o sys ema ize and b) o iden i y he social en i onmen in
o de o unde s and s uc u ing mechanisms ha unde ly he in e play
o he mul i ude o exposu es. This sys ema ic conside a ion o social
in luences is an essen ial p e-s ep, as only a holis ic po ayal o he
human social en i onmen – including social, psychosocial, socioeco-
nomic, sociodemog aphic, local, egional, and cul u al aspec s – lays he
undamen al s ep o unde s and how he en i e y o social exposu es
a ec s heal h and disease. Secondly, we ex ended p e ious concep s by
iden i ying pa hways ha ansla e social exposu es in o heal h ou -
comes o u he unde s and he link be ween social en i onmen and
heal h. Pa icula ly, insigh s om esea ch on social s uc u es and
p ocesses behind heal h inequali ies need o be inco po a ed o unco e
how – especially in e ms o mechanisms and pa hways – social in-
equali ies in heal h eme ge, a e main ained, and sys ema ically d i e
heal h ou comes (Bol e e al., 2021; CSDH, 2008; F iel and Ma mo ,
2011; Galea e al., 2011; Gkiouleka e al., 2018; K uize e al., 2014;
Os lin e al., 2011; O e s een e al., 2017; Sola and I win, 2010; WHO
Regional O ice o Eu ope, 2012).
By means o his b oad me hod, we aimed o comp ehensi ely cap-
u e he a ailable esea ch on his opic, i espec i e o he unde lying
disciplina y ield in o de o complemen wha is, in i s concep ion, he
holis ic pe spec i e o he exposome. The esul s o ou esea ch,
he e o e, will no only be use ul o he exposome esea ch communi y,
bu can be seen as a esea ch in e ace o di e en disciplines anging
om social o heal h sciences.
2. Me hods
An explo a i e app oach o e iewing and syn hesizing heo ies was
applied o de elop a mul i-dimensional concep ual amewo k o he
Social Exposome. This app oach was inspi ed by a h ee-s age p ocedu e
by Bol e e al. (2021) and adap ed o he wo old goals o he cu en
pape . The i s wo s ages comp ised e iewing li e a u e and es ab-
lishing an o e iew o exis ing concep ual app oaches o desc ibe and
unde s and social exposu es and social inequali ies ele an o heal h.
The hi d s age e alua ed hese indings and in ol ed da a syn hesis and
e inemen o p elimina y concep ual amewo ks o de elop a no el
Social Exposome concep ual amewo k. The en i e de elopmen p ocess
las ed om 2020 o 2022.
This concep ual pape eme ged om he collabo a i e esea ch
p ojec Equal-Li e ( an Kamp e al., 2022) and p esen s a newly de el-
oped concep ual amewo k o he Social Exposome. The exposome
pe spec i e on child en’s and adolescen s’ men al heal h and cogni i e
de elopmen will be speci ically co e ed by ano he concep ual pape o
he Equal-Li e conso ium (Pe sson Waye e al., in p epa a ion o his
special issue). Equal-Li e comp ises expe ise om 21 Eu opean esea ch
ins i u ions om 11 Eu opean coun ies and aims o gain insigh on he
p o ound impac o physical and social en i onmen on heal h, looking
in pa icula a child en’s and young people’s men al heal h and
cogni i e de elopmen ( an Kamp e al., 2022).
2.1. S age One: Li e a u e sea ch on heo y-based concep s o he social
domain
In he i s s age, we assessed he cu en s a e o li e a u e ega ding
heo y-based concep s o social in luences ele an o heal h. The e
we e h ee unde lying me hodological conside a ions ha s uc u ed
his wo k. Fi s ly, based on ou expe knowledge in he ields o social
epidemiology, social de e minan s o heal h, and en i onmen al jus ice,
we iden i ied a numbe o in luen ial ex s ha ha e been widely
acknowledged as seminal and g oundb eaking in he scien i ic com-
muni y o social and heal h disciplines (e.g. Bol e e al., 2010; B ulle and
Pellow, 2006; CSDH, 2008; E ans and Kan owi z, 2002; Gee and
Payne-S u ges, 2004; Gkiouleka e al., 2018; Hanki sky e al., 2017;
K iege , 2011; Ma mo e al., 2012; Mo ello-F osch and Shenassa, 2006;
Whi ehead e al., 2016; WHO Regional O ice o Eu ope, 2019a). Sec-
ondly, in he ensuing ‘snowballing p ocess’ (Bol e e al., 2021) o
‘pea l-g owing app oach’ (Whi ehead e al., 2016), he li e a u e lis s o
hese selec ed publica ions we e hand sea ched o iden i y addi ional
ele an publica ions. Thi dly, his iden i ica ion o ele an publica-
ions i e a i ely con inued un il heo e ical sa u a ion was eached, i.e.
u he eading did no gain addi ional heo e ical insigh s. This inal
selec ion o ex s was used as a heo e ical ounda ion in o de o se he
scope o a b oad spec um o heal h- ela ed social exposu es and o
compile a se o sys ema iza ion ca ego ies needed o concep ually
s uc u e social exposu es. Fou ca ego ies we e iden i ied: a) ype o
exposu es, b) se ing o exposu es, c) iming o exposu es, d) exposu e
pa e ning. These de i ed ca ego ies we e used o sys ema ize social
exposu es in he subsequen S age Two, whe e we conduc ed a scoping
e iew o cap u e he b oadness o he social domain.
The i s wo ca ego ies add ess he quali y and ex en o exposu es,
e e ing a) o wha and b) in which se ings indi iduals can be exposed.
The iming ca ego y c) ela es o when and how o en exposu es occu ,
pa icula ly conside ing he li e-cou se app oach. The li e-cou se
pe spec i e s esses he cumula i e e ec o exposu es wi h ega d o
longi udinal heal h e ec s as well as sensi i e o c i ical pe iods o
disease de elopmen (Cable, 2014; Kuh e al., 2003; Lynch and Smi h,
2005). Al eady when i s in oducing he exposome concep , Wild
(2005) emphasized he need o conside he mul i ude o non-gene ic
exposu es o he en i e li e-cou se om concep ion onwa ds in o de
o unde s and he p og ession o heal h and disease. Con a y o he i s
h ee indi idual-le el ca ego ies, he ca ego y d) exposu e pa e ning
ep esen s he popula ion-le el o social exposu es, i.e. he embedded-
ness o indi idual expe iences in o he b oade (s uc u al) con ex . This
con ex ual ca ego y e e s o s uc u al mechanisms ha unde ly in-
equi ies in de elopmen al and heal h pa hways. Wi hin his pa e ning
con ex ual ca ego y, we pa icula ly included he socie al s uc u e
gende om an in e sec ionali y pe spec i e (Hanki sky e al., 2017; Me z
e al., 2021) as an impo an ac o con ibu ing o heal h inequi ies
(K iege , 2003).
2.2. S age Two: Sys ema ic o e iew o social and psychosocial
exposu es
To sys ema ically iden i y concep s and amewo ks ha assess he
social and psychosocial en i onmen and o in o m he de elopmen o
ou concep ual amewo k, a scoping e iew was conduc ed in acco -
dance wi h PRISMA ScR guidelines (T icco e al., 2018). The sea ch
syn ax included a wide ange o keywo ds and was designed o wo
sub-sea ches: a) Social en i onmen and b) Psychosocial en i onmen .
This subdi ision was in oduced o ensu e ha psychosocial in luences,
as an in eg al ea u e o he social en i onmen , will no be missed due
o po en ial di e ences in he use o e minology ac oss scien i ic dis-
ciplines. Fo he subsequen sc eening, eco ds o bo h sub-sea ches
we e me ged. The sea ch syn ax equi ed key wo ds o occu in he
i le and/o abs ac . Reco ds we e limi ed o e iew a icles published
in pee e iewed jou nals o as book chap e s be ween Janua y 2000
and Augus 2020. Only esea ch con ibu ions limi ed o humans and
published in English we e conside ed. The sea ch co e ed h ee da a-
bases ha di e ed in hei esea ch disciplines and emphasis: PubMed
(heal h sciences), Scopus (bio, social, na u al, heal h sciences) and
PsycIn o (psychology). The sea ch syn ax is summa ized in Box 1.
A e me ging he eco ds o all h ee da abases (sub-sea ch a): 2246
H. Gudi-Minde mann e al.
En i onmen al Resea ch 233 (2023) 116485
4
eco ds; sub-sea ch b): 1489), a semi-au oma ed de-duplica ion ou ine
was applied o he 3735 esul s o a oid con en o e lap (B ame e al.,
2016). 3686 publica ions we e iden i ied a e de-duplica ion. Two au-
ho s (MW, HGM) independen ly e iewed i les and abs ac s o all
publica ions. As we we e in e es ed in concep ually cap u ing he
b oadness o he social domain a he han add essing speci ic
exposu e-ou come associa ions, eligibili y c i e ia we e ul illed only i
he c i e ion o mul idimensionali y was ul illed, i.e. he publica ion
co e ed mo e han one ca ego y ( ype o exposu es, se ing o exposu es,
ime poin o exposu es, exposu e pa e ning) o mo e han one aspec
(e.g. exposu e, exposu es pa e ning mechanism) wi hin one ca ego y
iden i ied in S age One. Applying his c i e ion on all 3686 S age Two
eco ds, e iewe A iden i ied 56 and e iewe B iden i ied 42 ele an
publica ions. Any disag eemen s abou eligibili y o a publica ion we e
esol ed by discussion and, i necessa y, by consul a ion o a hi d
e iewe (GB) ( o al hi s: 68). Subsequen ly, a eam o eigh een expe s
om he Equal-Li e esea ch g oup a ed he abs ac s’ ele ance o
hese 68 publica ions o ull ex inclusion. This eam o eigh een
Equal-Li e esea che s comp ises expe ise om di e se scien i ic and
na ional backg ound on en i onmen al public heal h, (social) epidemi-
ology, en i onmen al jus ice, en i onmen al and de elopmen al psy-
chology, and en i onmen al medicine. The au ho s and expe s oge he
iden i ied a o al o 14 publica ions as ele an o a sys ema ic collec-
ion and a angemen o in luences o he social and psychosocial
en i onmen .
The e iew a icles we e so ed in wo classes based on hei p ima y
objec i e: “li e a u e o e iew” (n =7), o a li e a u e e iew wi h a
subsequen syn hesis o esul s in o a “ heo e ical concep / amewo k”
(n =7) ( e e ed o as a concep ual pape in he ollowing explana ion).
Con en ex ac ion was pe o med by wo au ho s (HGM, MW). Fo
ex ac ion, we used he ca ego ies ha we e de i ed in S age One ( ype
o exposu es, se ing o exposu es, ime poin o exposu es, exposu e
pa e ning – social inequi ies, gende pe spec i e). As we we e in e -
es ed in ex ending he exposome concep , a inal addi ional ca ego y
was included o indica e whe he he iden i ied exposu e-based publi-
ca ion was heo e ically linked o he exposome. In he ex ac ion able,
h ee e alua ion c i e ia indica ed whe he each o he ca ego ies
men ioned abo e was: No men ioned in publica ion (−); Men ioned in
publica ion wi hou in-dep h explana ion, o wi hou heo e ical inco -
po a ion in o he p oposed concep o a concep ual pape (+); A
de ailed elabo a ion o ca ego y was p o ided, o he ca ego y was
heo e ically g ounded in he p oposed concep (++).
As shown in Table 1 o all 14 e iewed publica ions, mul idimen-
sionali y o ype and se ing o exposu es, as equi ed by eligibili y
Box 1
Sea ch syn ax o sub-sea ches a) and b) o he scoping e iew.
Sub-sea ch a): Social en i onmen
1 “social en i onmen *”
2 “social and buil en i onmen *”
3 “social se ing*”
4 “social con ex *”
5 “socio-economic en i onmen *"OR “socioeconomic en i onmen *”
6 “socio-economic con ex *" OR “socioeconomic con ex *”
7 “socio-economic se ing*" OR “socioeconomic se ing*”
8 “socio-demog aphic en i onmen *” OR “sociodemog aphic en i onmen *”
9 “socio-demog aphic con ex *” OR “sociodemog aphic con ex *”
10 “socio-demog aphic se ing*” OR “sociodemog aphic se ing*“
11 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10
12 heo * OR mechanism* OR concep * OR pa hway* OR explana * OR amewo k*
13 #11 AND #12.
The inal sea ch 13 comp ises s eps 1 o 12, ha desc ibe he successi e sea ch s a egy. No di e en ia ion o esul s om sub-sea ches (sea ches
1–12) will be conside ed.
Sub-sea ch b): Psychosocial en i onmen
1 “psychosocial en i onmen *” OR “psycho-social en i onmen *”
2 “psychosocial se ing*” OR “psycho-social se ing*”
3 “psychosocial con ex *” OR “psycho-social con ex *”
4 “ amily en i onmen *” OR “home en i onmen *” OR “communi y en i onmen *” OR “school en i onmen *” OR “p e school en i onmen *”
OR “p e-school en i onmen *” OR “p eschool en i onmen *” OR “day ca e en i onmen *” OR “day-ca e en i onmen *” OR “dayca e
en i onmen *” OR “child ca e en i onmen *” OR “child-ca e en i onmen *” OR “childca e en i onmen *”
5 “ amily se ing*” OR “home se ing*” OR “communi y se ing*” OR “school se ing*” OR “p e school se ing*” OR “p e-school se ing*” OR
“p eschool se ing*” OR “day ca e se ing*” OR “day-ca e se ing*” OR “dayca e se ing*” OR “child ca e se ing*” OR “child-ca e se ing*” OR
“childca e se ing*”
6 “ amily con ex *” OR “home con ex *” OR “communi y con ex *” OR “school con ex *” OR “p e school con ex *” OR “p e-school con ex *”
OR “p eschool con ex *” OR “day ca e con ex *” OR “day-ca e con ex *” OR “dayca e con ex *” OR “child ca e con ex *” OR “child-ca e
con ex *” OR “childca e con ex *”
7 heo * OR mechanism* OR concep * OR pa hway* OR explana * OR amewo k*
8 #1 OR #2 OR #3 OR #4 OR #5 OR #6 9 #7 AND #8.
The inal sea ch 9 comp ises s eps 1 o 8, ha desc ibe he successi e sea ch s a egy. No di e en ia ion o esul s om sub-sea ches (sea ches
1–8) will be conside ed.
H. Gudi-Minde mann e al.
En i onmen al Resea ch 233 (2023) 116485
5
Table 1
Summa y o exposu e-based publica ions included in scoping e iew.
Focus o
con en *
Au ho s/Yea
(Alphabe ical
o de )
Scope o
publica ion
Type o exposu es Se ing o exposu es Timing o
exposu es**
Social inequi y** Gende
pe spec i e**
Link o
exposome
concep **
CF Alwin and
W ay (2005)
Li e-span
pe spec i e on
social s a us and
heal h
Mul idimensional
pe spec i e o social
s a us conside ing:
age, gende , e hnici y,
educa ion,
socioeconomic
di e ences, childhood
expe iences and
amily backg ound
Indi idual li e-
cou se, amily
backg ound, socie al
condi ions
++
Li e-cou se
++
Ins i u ional
ancho ing o
social dispa i ies
++
Embodied
gende
–
CF Be kman e al.
(2000);
Be kowi z
(2004)
Holis ic
conside a ion o
social in eg a ion/
social ne wo ks
and hei impac
on heal h
Social ne wo ks,
social suppo , social
ies and social
in eg a ion
Indi idual ne wo k
s uc u e wi hin
la ge social and
cul u al con ex
+
Rele ance o
in ancy, ele ance
o coho o
indi idual li e
his o y
+
Ne wo k
s uc u e shaped
by social con ex
– s a us,
inequali y
– –
LO Blai e al.
(2014)
Pa hways
linking
neighbo hood
cha ac e is ics and
dep ession
Neighbo hood
cha ac e is ics:
neighbo hood
dep i a ion;
diso de , c ime and
pe cei ed sa e y;
ins abili y, mobili y;
social ies, cohesion,
social capi al
Indi iduals,
neighbo hood:
physical and social
en i onmen al
cha ac e is ics
– – – –
CF Chen and
Sch eie
(2008)
E ec o social
en i onmen on
as hma
In e pe sonal
ela ionships a
di e en se ing
- amily: quali y o
ela ionships,
pa en al dep ession,
s ess
- pee s: social suppo
- neighbo hood:
communi y
socioeconomics,
iolence
Se ing o
in e pe sonal
ela ionships:
amily, pee s,
neighbo hood
– – – –
CF Ea ls and
Ca lson (2001)
E ec o dis al
social con ex
(social ecology) on
child en’s heal h
and well-being
Composi ion,
s uc u e, unc ion o
la ge social
con igu a ions: social
ela ionships o
eache s, police,
neighbo s, pa en s,
pee s
Ecological model:
amily p ocesses and
indi idual
de elopmen a e
embedded in
communi y and
o he mac osocial
s uc u es
– +
Social
inequali ies
d i en by
communi y
capaci y and
empowe men
– –
LO Egan e al.
(2008)
Psychosocial
heal h isks
Risk ac o s b idging
socio-s uc u al and
psychological
cha ac e is ics:
- au onomy and
con ol;
in ol emen ,
pa icipa ion and
empowe men ;
social capi al, social
cohesion, us and
belonging;
- social suppo
(including speci ic
ypes o suppo : e.g.
emo ional);
- social ne wo ks and
ecei ing posi i e
eedback
- social di e si y and
ole ance
- ulne abili y,
secu i y o sa e y
- demands, ole
con lic s o ole
imbalance
Psychosocial ac o s
as b idging o ‘meso-
le el’ be ween
indi idual and social
s uc u es
– – – –
CF Hemmingsson
(2014)
Causal link
be ween
Family
socioeconomics
Indi iduals
embedded in amily
+
In e gene a ional
+
Socioeconomic
– –
(con inued on nex page)
H. Gudi-Minde mann e al.

En i onmen al Resea ch 233 (2023) 116485
6
Table 1 (con inued)
Focus o
con en *
Au ho s/Yea
(Alphabe ical
o de )
Scope o
publica ion
Type o exposu es Se ing o exposu es Timing o
exposu es**
Social inequi y** Gende
pe spec i e**
Link o
exposome
concep **
socioeconomics
and child obesi y
media ing p o ec i e
ac o s: sel -es eem,
pee suppo ,
esilience (sel -
e icacy, op imism,
sel -es eem),
unc ional coping
skills
ansmission o
socioeconomic
disad an age
and
psychological
ansmission o
dis ess
LO Hol -Luns ad
(2018)
E ec o social
ela ionships on
heal h and
longe i y
Heal h p o ec i e
ac o s: social
ela ionships, social
con ac , amily ies,
social in eg a ion,
social suppo
Heal h isk ac o s:
lack o social
connec ion
(loneliness, social
isola ion), di o ce,
being single,
widowhood
Sys ems app oach:
indi idual exis s
wi hin a ne wo k
o ou sepa a e ye
embedded
dimensions:
indi idual, amily
and close
ela ionships,
communi y, socie y
+
Tempo al e olu ion
o social ne wo ks
– – –
LO Hong and
Espelage
(2012)
Bullying and
ic imiza ion
among pupils
Indi idual
cha ac e is ics
associa ed wi h
bullying pe pe a ion
and ic imiza ion:
age, gende , e hnici y,
sexual o ien a ion,
heal h s a us
(o e weigh ),
dep ession and
anxie y, lea ning and
de elopmen al
disabili ies, po e y
B on enb enne ’s
ecological app oach:
indi idual
cha ac e is ics
embedded in mic o-,
meso-, exo-, mac o-,
and ch onosys em
– – – –
CF K uize e al.
(2014)
En i onmen al
jus ice: ela ion
be ween
en i onmen al
inequali ies and
heal h e ec s
Dis ibu ional jus ice:
spa ial dis ibu ion o
en i onmen al isks a
places o wo k, li ing,
playing, e c.
P ocedu al jus ice:
dis ibu ion p ocess
i sel , including access
o and pa icipa ion
in decision-making
p ocesses and
p ocedu es ha c ea e
en i onmen al isks
Indi iduals, socie al,
communal,
ins i u ional-le el
e e s o spa ial
(s a e) and social
con ex (laws)
++
Li e-cou se
pe spec i e: causal
link be ween ime
and iming o
exposu es and
ou comes wi hin an
indi idual
li e cou se, ac oss
gene a ions, and in
popula ion-le el
diseases ends
++
En i onmen al
and psychosocial
isks
accumula e in
neighbo hoods
wi h lowe socio-
economic s a us
– –
LO Li e al. (2008) Mode ni y’s
pa adox:
Child en’s heal h
in an economically
imp o ing bu
unjus mode n
wo ld
Globally imp o ing
economy a he cos o
human heal h: suga
indus y, as ood,
a i icial milk,
seden a y beha io ,
ising wo king hou s,
wo king imes, hi e
a angemen s
Links indi idual
(mic o-le el) heal h
and socie al (mac o-
le el) condi ions.
+
In agene a ional
ansmission o
socioeconomic
disad an age
be ween li e s ages
++
S uc u al
inequali y
– –
LO Ma jo ibanks
(2005)
Rela ion be ween
amily lea ning
en i onmen and
school
pe o mance
Academic- ele an
amily cha ac e is ics:
wo k habi s, academic
guidance and suppo ,
s imula ion o explo e
and discuss ideas and
e en s, language
en i onmen a home,
pa en s’ academic
aspi a ions
Family en i onmen
is embedded in
social con ex
+
In e - and
in agene a ional
ansmission o
disad an ages
+
Impe meabili y
o social
ajec o ies
– –
CF Pea ce e al.
(2019)
Social
de e minan s o
child heal h and
pa hways owa ds
heal h inequi y
Socioeconomic
ad an ages lead o
g ea e access o
esou ces ha suppo
heal h (e.g. ood,
wa m clo hing/
oo wea , housing
quali y, sa e y)
Indi iduals, amily,
household,
communi y, cul u e
++
Li e-cou se
pe spec i e
++
Unequal
dis ibu ion o
social
de e minan s o
heal h lead o
heal h inequi y
– –
(con inued on nex page)
H. Gudi-Minde mann e al.
En i onmen al Resea ch 233 (2023) 116485
7
c i e ia, is an essen ial cha ac e is ic o each o he 14 publica ions. The
li e-cou se pe spec i e was inco po a ed in de ail in only h ee publi-
ca ions (Alwin and W ay, 2005; K uize e al., 2014; Pea ce e al., 2019),
and a u he ou embedded a social inequi y pe spec i e in hei wo k
by e e ing o s uc u al dispa i ies (Alwin and W ay, 2005; K uize
e al., 2014; Li e al., 2008; Pea ce e al., 2019). Only one (Alwin and
W ay, 2005) o he 14 publica ions elabo a ed on he gende pe spec-
i e. None o he pape s e e ed o he exposome concep ual
amewo k.
The e iew o heo y-based concep s o he social domain ac oss
hese 14 publica ions e ealed ha unde s anding he complex e ec s o
he social en i onmen on heal h and disease equi es he conside a ion
o he in e play o simul aneously ac ing exposu es as well as consid-
e ing pa e ning o exposu es a he popula ion-le el (ca ego y d). In
sum, despi e a high numbe o published e iew and concep ual pape s
on a ious social exposu es, pa e ning aspec s a e widely neglec ed in
his ield and he gende pe spec i e, in pa icula , is unde ep esen ed.
Thus, in he ollowing s age, we aimed a syn hesizing he ca ego ies o
ype, se ing, and iming o exposu es as well as exposu e pa e ning in o
a mul idimensional holis ic concep ual amewo k o he Social
Exposome.
2.3. S age Th ee: I e a i e p ocess o concep ual amewo k de elopmen
and e inemen
In he hi d s age, we e alua ed and in eg a ed he esul s om S age
One (sys ema iza ion ca ego ies o social and psychosocial exposu es)
and S age Two (iden i ica ion o social and psychosocial exposu es).
Speci ically, in S age One we e iewed heo y-based concep s o heal h-
ele an social in luences o es ablish a sys ema iza ion concep ha we
used as a basis o ou line he ‘en i e y’ o po en ially ele an social
exposu es o be used in an o e all concep a a la e s age. In S age Two,
we conduc ed a scoping e iew o iden i y he wide a ie y o social and
psychosocial exposu es ha ha e been discussed in p e ious li e a u e
and how hey ha e been in eg a ed in o concep ual amewo ks. Based
on hese wo s eps, in S age Th ee we syn hesized his p e ious
knowledge om di e en disciplines o o ganize he agg ega ed heal h-
ele an exposu es in o a new concep ual amewo k and a isual ep-
esen a ion o a holis ic Social Exposome ha goes beyond he b ead h
o he social exposu es and he associa ed concep ual amewo ks
iden i ied in S age Two. We de i ed h ee co e p inciples o s uc u e he
exposu es beyond a me e compila ion: Mul idimensionali y, Reci-
p oci y, Timing and con inui y. These co e p inciples unde pin he ex-
posu es’ in e ela edness and help o ex end ou unde s anding on how
he in e play o exposu es, a he han a mul i ude o single exposu es,
shapes heal h, sugges ing exposu e-heal h ansmission pa hways.
This amewo k o med he basis o he subsequen i e a i e p ocess
o de elopmen and e inemen , in ol ing discussions and scien i ic
exchange, consecu i ely wi hin he eam o he Depa men o Social
Epidemiology a Uni e si y o B emen (also a WHO Collabo a ing
Cen e o En i onmen al Heal h Inequali ies), he in e disciplina y
eam o he Social Exposome wo k package o Equal-Li e, he b oade
Equal-Li e esea ch g oup, and he scien i ic communi y o he Eu opean
Human Exposome Ne wo k (EHEN). The i e a i e p ocess ook place
om 2020 o 2022. The cu en pape p esen s he concep ual ame-
wo k o he Social Exposome ha comp ehensi ely po ays he mul i-
dimensional social en i onmen and aims o sys ema ically de ec
ansmission pa hways ha ansla e social exposu es in o heal h ou -
comes in o de o b idge he indi idual- and popula ion-le els.
3. Resul s: Social Exposome – A no el concep ual amewo k
Based on he syn hesis o e iewed li e a u e, ele an social and
psychosocial heo ies and i e a i e model e inemen in discussion
wi hin he Equal-Li e eam, we p opose a no el concep ual amewo k o
he Social Exposome. This amewo k aims o po ay he b ead h o
in luences om he social en i onmen . To s uc u e he a ie y o social
and psychosocial exposu es h ee unde lying co e p inciples a e p o-
posed: Mul idimensionali y, Recip oci y, and Timing and con inui y).
The key ocus o he concep ual amewo k o he Social Exposome is on
unde s anding he unde lying mechanisms ha ansla e social expo-
su es in o heal h ou comes. Fig. 1 is an o e all isual ep esen a ion o
he concep ual amewo k o he Social Exposome
3.1. Mul idimensionali y
The Social Exposome concep ual amewo k is based on he key
assump ion ha he en i e y o a pe son’s social en i onmen sys em-
a ically impac s upon de elopmen and heal h. This social en i onmen
anges om he immedia e social en i onmen (indi idual-le el), up o
he b oades socie al con ex (popula ion-le el) in which he indi idual-
le el social expe iences a e embedded. These mul iple dimensions,
isually ep esen ed as bedded ci cles and in e sec ing iangles a ound
he cen ally placed indi idual (Fig. 1), symbolize he cons an p esence
o a huge a ie y o social exposu es ha , u he mo e, con inuously
e ol e o e ime. The co e p inciple o mul idimensionali y in his
concep ual amewo k s esses he idea ha hese exposu es all oge he
de e mine he quali y o he social en i onmen and ha he social
en i onmen canno be adequa ely desc ibed by conside ing only a
single a ibu e om he spec um o social exposu es. Fo a mo e
de ailed explana ion see legends o Figs. 1 and 2, Table 2 and Supple-
men 1.
3.1.1. Social en i onmen dimensions
The inne mos ci cle, Social in e ac ions, ep esen s he mos im-
media e dimension o he social en i onmen wi hin he Social Expo-
some. The ole ha social in e ac ions play in con ex o he social
en i onmen canno be o e s a ed, as hey a e a p e equisi e o connec
he indi idual wi h he ou e wo ld and a he same ime in luence hese
connec ions. We use he in e linked assembly o h ee puzzle pieces
(Table 2 Supplemen 1) su ounding he indi idual membe o a socie y
o e lec on wha we conside o be he h ee cen al elemen s ha allow
a comp ehensi e cha ac e iza ion o social in e ac ions.
Table 1 (con inued)
Focus o
con en *
Au ho s/Yea
(Alphabe ical
o de )
Scope o
publica ion
Type o exposu es Se ing o exposu es Timing o
exposu es**
Social inequi y** Gende
pe spec i e**
Link o
exposome
concep **
LO Seeman and
C immins
(2001)
Rela ion be ween
heal h and social
ne wo ks,
socioeconomics,
communi y-le el
cha ac e is ics
Social ne wo ks,
socioeconomics,
communi y-le el
cha ac e is ics
Indi iduals and
communi ies
+
Link be ween
communi y and
indi idual
inequali ies
– – –
*CF Theo e ical concep / amewo k; LO Li e a u e o e iew.
**++In-dep h elabo a ion in LO o heo e ically g ounded in CF; +Men ioned wi hou in-dep h explana ion in LO o wi hou heo e ical inco po a ion in CF; - No
men ioned.
H. Gudi-Minde mann e al.
En i onmen al Resea ch 233 (2023) 116485
8
a) Ac o s: Who is pa o a pe son’s social ne wo k?
b) Rela ional dynamics: Wha is he na u e o in e ac ion be ween in-
di iduals, wi hin and ac oss g oups?
c) Places: Whe e do social in e ac ions ake place?
The Social Exposome concep emphasizes social in e ac ions as
pa icula ly ele an wi hin he Social Exposome, ha is unde s ood as
he en i e y o social exposu es. I is he social in e ac ions ha make he
indi idual expe ience he ou e social wo ld and can be ega ded as
il e s ha need o be c ossed o connec ion wi h he social en i onmen
in which indi iduals a e embedded. Thus, in he Social Exposome
concep he impac o he b oade socie al con ex eaches indi iduals
h ough social in e ac ions. Fo example, Lipina (2016) emphasizes in his
o e iew pape on he link be ween po e y and child en’s neu o-
cogni i e de elopmen , ha language exposu e and s ess egula ion a e
wo o he mos impo an media ion mechanisms in ol ed in he dy-
namic in e play o indi idual and en i onmen al ac o s ha in luence
de elopmen and heal h. Bo h o hese mechanisms a e pe ained o
social in e ac ions, highligh ing he essen ial impac o social
in e ac ions.
The explici cha ac e iza ion o social in e ac ions is essen ial o
unde s and he e ec o he social en i onmen , no only because social
in e ac ions link he indi idual wi h he ou e wo ld bu also because o
he signi icance o social ela ionships o heal h and de elopmen . The
body o e idence examining he associa ion be ween social in e ac ions
and heal h ou comes con e ges on he assump ion ha social ela ion-
ships ha e a conside able impac on well-being (e.g. Ea ls and Ca lson,
2001), men al heal h (e.g. Seeman and C immins, 2001), physical heal h
(e.g. Umbe son and Mon ez, 2010), and longe i y and mo ali y (e.g.
Hol -Luns ad, 2018; Seeman and C immins, 2001) o name only a ew
ou comes. The ecen Social Baseline Theo y om he ield o neu osci-
ence sugges s ha social (suppo i e ela ionships) and me abolic (ox-
ygen, glucose) esou ces a e ea ed almos in e changeably by he
human b ain, pa icula ly in socially challenging si ua ions (Coan and
Sba a, 2015). The au ho s claim ha he p esence o social ela ion-
ships (measu ed in e ms o in e dependence, sha ed goals, join a en-
ion) is expec ed in he b ain’s de aul s a e, while hei absence is
pe cei ed as lacking a ailable esou ces and esul s in physiological and
cogni i e e o and nega i e consequences o heal h and well-being
(Coan and Sba a, 2015).
In he Social Exposome amewo k, social in e ac ions a e embedded
wi hin he b oade socie al con ex , which is ep esen ed by ou
in e ela ed dimensions: Socioeconomic ci cums ances and Socio-
demog aphic cha ac e is ics; Sys ems, ins i u ions and p io i ies o
he poli ical economy; Social no ms; and Cul u al alues.
Socioeconomic ci cums ances and Sociodemog aphic cha ac-
e is ics a e unde s ood as dynamic in luences ha change in hei
ele ance and impac ac oss he li e-cou se. Fo child en, Socioeco-
nomic ci cums ances a e he esul o he socioeconomic backg ound
o pa en s and ca egi e s: he household he child li es in, as well as he
su ounding neighbo hood con ex (e.g. a ea-le el socioeconomic
dep i a ion) (G aham and Powe , 2004; Pea ce e al., 2019). The
in e gene a ional impac o pa en al socioeconomic a ainmen means
ha he socioeconomic ou comes o he child a e essen ially a ec ed by
he socioeconomic s a us o hei pa en s (Alwin and W ay, 2005; G a-
ham and Powe , 2004; Kaplan, 2004), al hough hese in luences may
ea ange and change along wi h he indi idual, e.g. in he cou se o
educa ion and lea ing home p ocesses. Simila ly, Sociodemog aphic
cha ac e is ics, e e ed o as indi idual a ibu es a a ce ain poin in
ime, such as age, mig a ion backg ound, eligious a ilia ion, e hnici y,
and ma i al s a us, e ol e du ing he li e cou se and may pa ially
change. Addi ionally, hese a ibu es could be easons o expe iencing
disc imina ion and s uc u al injus ice.
Sys ems, ins i u ions and p io i ies o he poli ical economy
de e mine and egula e poli ical decisions and s uc u es a socie al
le el. The scope o he poli ical economy and impo an aspec s o i in
Fig. 1. The concep ual amewo k o he Social Exposome.
The Social Exposome concep is based on he key assump ion ha he en i e y
o social exposu es sys ema ically impac s upon de elopmen and heal h. The
omnip esence o he social en i onmen is symbolized by bedded ci cles su -
ounding an indi idual. The mul iple dimensions o he social domain a e hi-
e a chically a anged in laye s. The mos immedia e laye o he social
en i onmen comp ises Social in e ac ions, which a e ep esen ed by he as-
sembly o h ee in e linked puzzle pieces (Ac o s, Rela ional dynamics, Pla-
ces) ha oge he cha ac e ize he s uc u e, unc ion, and quali y o a pe son’s
social ne wo k. Social in e ac ions a e embedded wi hin he b oade socie al
con ex and can be ega ded as il e s h ough which he social en i onmen
eaches he indi idual. This b oade socie al con ex is ep esen ed by ou
in e ela ed dimensions, symbolized by g ey-shaded embedded ci cles and a
g ey in e sec ing iangle: Socioeconomic ci cums ances and Sociodemo-
g aphic cha ac e is ics; Sys ems, ins i u ions and p io i ies o he poli ical
economy; Social no ms; and Cul u al alues. All hese g ey-shaded di-
mensions, oge he wi h he puzzle pieces, ep esen he en i e y o social ex-
posu es ha shapes men al and physical de elopmen and heal h. The dashed
lines be ween laye s highligh ecip oci y o shaping p ocesses and in e con-
nec edness be ween dimensions. The in e sec ing shape o a iangle, in addi-
ion o he bedded ci cles, symbolizes he ecip ocal impac o Social no ms
and Cul u al alues on all dimensions o exposu es, by also s essing ha
no ms and alues can each igh o he indi idual and hei social in e ac ions
(symbolized by he g ey ing c ossing he puzzle pieces), di ec ly imp in ing
hei belie s, a i udes, and beha io . The in e sec ing blue iangle is high-
ligh ed in colo o sepa a e i om g ey-shaded dimensions o socie al exposu es.
I ep esen s Social inequali ies and S uc u al injus ices: In e sec ionali y
and Gende pe spec i e ha symbolize socie al o ces, which o m he expo-
su es’ in e play and sys ema ically main ain and agg a a e inequi y ha , ul i-
ma ely, eeds back h ough all dimensions up o he indi idual a he cen e ,
a ec ing hei de elopmen and heal h.
In he Social Exposome amewo k, he inne igu e ep esen s he indi idual as
an in e ac i e p oduc o he su ounding social en i onmen . Fig. 2 depic s a
zoomed in e sion o he inne igu e o ensu e eadabili y. A selec ion o in-
di idual cha ac e is ics ha a e shaped in ecip ocal in e ac ion wi h he social
en i onmen is lis ed inside he inne igu e, e.g. s ess sensi i i y, pe son-
ali y, iden i y, skills and abili ies, knowledge. Th ee ansmission pa hways,
ep esen ed by ounded a ows, ansla e social exposu es in o heal h ou -
comes: Embodimen , Resilience and Suscep ibili y o Vulne abili y, and
Empowe men . The in e locked wheels symbolize ex e nal e en s ha addi-
ionally a ec he social en i onmen . Fo u he de ails, see Fig. 2, Table 2,
Supplemen 1.
H. Gudi-Minde mann e al.
En i onmen al Resea ch 233 (2023) 116485
9
e ms o policy, p ac ice, p ocesses, ins i u ions, and legal ules is b oad,
as i s impac on popula ion heal h ope a es ac oss mul iple sec o s and
mul iple le els. As ou lined in a e iew o he impac o he poli ical
economy on popula ion heal h by McCa ney e al. (2019), his includes
he wel a e s a e, economic policy, public spending, he p o ision o
educa ion and heal h ca e se ices, and housing policy and p o ision.
These policies, ins i u ions, and p io i ies a e la gely in o med by
sha ed social no ms and cul u al alues, as illus a ed in Fig. 1 by he
in e sec ing g ey iangle, ha eaches h ough all dimensions o expo-
su es o he indi idual. In he Social Exposome concep ual amewo k,
Social no ms a e ega ded as being he expec ed and accep able s an-
da ds o beha io in pa icula se ings and social con ex s. Social no ms
ha a e p e alen in amilies, pee g oups, and wide socie al sys ems,
including o he cul u al g oups, can play an impo an ole in es ab-
lishing a sense (o lack he eo ) o belongingness and accep ance ha a e
cen al o he heal hy de elopmen o a pe son’s own iden i y (G ay,
2001). Fu he mo e, hese social no ms can be unde s ood bo h in e ms
o he pe cei ed no ms (indi idual’s belie abou ypical o s anda d
beha io in a g oup) as well as he ac ual no ms ( he belie s and ac ions
o he g oup) (Be kowi z, 2004), and includes bo h o malized (i.e. wi h
legalized consequences) and non- o malized no ms. Cul u al alues in
he Social Exposome ep esen he ame wi hin which social no ms a e
es ablished, sha ed and main ained and includes assump ions and be-
lie s, as well as ules o mo ali y. Cul u al alues can e e o a na ional
Table 2
Social Exposome’s mos immedia e dimension o social exposu es: Social in e ac ions, consis ing o he in e play o Ac o s, Rela ional dynamics, and Places.
Rela ional
dynamics
Examples Place Examples Ac o s Examples
Social clima e/
a mosphe e
Ha mony/disha mony, sa e y,
psychological dis ess, pa en al s yles
Home Home en i onmen (s), oom(s),
sha ed spaces
Family Pa en s, siblings, o he amily
membe s, and ela i es
Social suppo Emo ional suppo , ins umen al suppo ,
app aisal suppo , in o ma ional suppo ,
pa en al in es men , social modelling
Places o lea ning
and wo king
C eche, kinde ga en, school,
uni e si y; O ice, ac o y, s o e, a m
Pee s Classma es/ ellow s uden s/
colleagues, iends, spo s
eam/ac i i y g oup membe s
Social capi al Access o esou ces d i en by membe ship
wi hin ne wo ks, social us , ecip oci y,
pa icipa ion
Digi al wo ld Vi ual places in digi al wo ld (i.e.
whe e games a e se , cha ooms,
social media)
Companions Close iends, oman ic/
in ima e pa ne s
Medium o
in e ac ion
ace- o- ace, elecommunica ions, online
communica ion, digi al iden i y
Places o leisu e
ime
F iends’ homes, museums, mo ie
hea es, music halls, spo s ields,
communi y cen e s
O icial igu es Teache s, ins uc o s,
educa o s, coaches, men o s,
doc o s, social se ice agen s,
eligious leade s
Neighbo hood
physical
en i onmen
(Physical domain)
Na u al en i onmen
e.g. ai , clima e, soil, wa e
Acquain ances Family iends, neighbo s,
andom con ac s
Buil en i onmen
Buildings (e.g. housing),
anspo a ion (e.g. s ee
connec i i y), open spaces (e.g. blue
spaces, g een spaces i.e. pa ks)
Digi al
con ac s
Cha g oups, in luence s,
social media con ac s
Neighbo hood
social en i onmen
Economic domain
Heal h- ele an economic esou ces
e.g. supe ma ke s, comme cial ou le s
Ins i u ional domain
Schools, clinics, educa ional
ins i u ions, p o essional bodies,
eligious acili ies, municipal se ices
(policing, sani a ion)
In he Social Exposome amewo k he me apho o h ee in e linked puzzle pieces (Ac o s, Rela ional dynamics, and Places) is used o isualize social in e ac ions,
o unde sco e ha social in e ac ions e ol e as an in e play o hese pieces. Ac o s, in in e ac ion wi h one ano he , c ea e ela ional dynamics ha de ine he
a mosphe e in which hey in e ac and a e o en bound wi h Places, o example amily wi h home o classma es (pee s) wi h school. The li e-cou se pe spec i e,
building one o he co e p inciples o he Social Exposome concep , is implemen ed in o he dimension o social in e ac ions. Each puzzle piece comp ises se e al
componen s ha change – as indica ed by double-headed whi e a ows – in composi ion (numbe o componen s) and hei ele ance (size o componen s wi hin a
dimension) ac oss he cou se o li e co espondingly al e ing hei impac . Fo example, en e ing kinde ga en/school is na u ally accompanied by he dec ease in
ele ance o he Place home. Simila ly, he di e en ia ion wi hin he dimension Ac o s e ol es wi h age, ex ending o include iends, classma es, spo s ma es, e c.,
e lec ing he inc easing di e si y in Rela ional dynamics. This age-dependen cou se o e ol ing social in e ac ions exempli ies, on he one hand, a (cul u ally
accen ua ed) p o o ypical imeline, whe eas, on he o he hand, i p ese es indi idual ajec o ies o a li e wi h i s own his o y, including he indi idual accumula ion
o isk, suscep ibili y, e c.
Fu he explana ions and implica ions o he h ee dimensions o Social In e ac ions a e summa ized in Supplemen 1.
H. Gudi-Minde mann e al.
En i onmen al Resea ch 233 (2023) 116485
16
mul idimensional Social Exposome concep ual amewo k, especially
when da a analyses a e pe o med wi h al eady comple ed epidemio-
logical s udies. Nwanaji-Enwe em e al. (2021), when calling o hei
compound exposome app oach, go in his di ec ion, s essing a ea-based
socioeconomic measu es such as neighbo hood seg ega ion. Al hough
he au ho s ocus on he conside a ion o s uc u al ac o s ela ing o
acial heal h dispa i ies, i s call o ac ion can also be unde s ood as an
a gumen o he conside a ion o s uc u al ac o s in exposome
esea ch mo e gene ally because o how hese in e ac , os e ing ineq-
ui y. In his way, ou concep ual model – which embeds Social in-
equali ies and S uc u al injus ices as pa o an indi idual’s b oade
con ex alongside o he exposu es om wi hin a pe son’s social en i-
onmen – can be seen as a concep ual building block o u he wo k in
his ield.
To demons a e he p ac icabili y o he concep in exposome
esea ch and o alida e he Social Exposome amewo k wi h ega d o
he p oposed ansmission mechanisms and heal h pa hways was
beyond he scope o his pape . The i s p ac ical applica ions o he
concep ual amewo k o pa s o i in s a is ical analyses using da a
om en i onmen al epidemiological coho s udies and school s udies
o child en and young people in Eu ope a e planned in he o hcoming
esea ch o ou Equal-Li e p ojec ( an Kamp e al., 2022). These
empi ical esea ch applica ions o he amewo k will con ibu e o i s
imp o emen h ough alida ion and e inemen .
5. Conclusion
We p opose a no el concep ual amewo k o he Social Exposome.
Up o now, a ho ough heo y-based concep ualiza ion ha comp e-
hensi ely cap u es and in eg a es he mani old social domain wi hin he
exposome esea ch has been lacking. The concep ual amewo k o he
Social Exposome was de eloped o ill his gap. Based on he syn hesis o
e iewed li e a u e and ele an social and psychosocial heo ies ha
in o med ou wo k, we inco po a ed he en i e y o social exposu es and
ocused on he unde lying mechanisms om heal h equi y, en i on-
men al jus ice, in e sec ionali y, and sex/gende pe spec i es. We ou -
lined social exposu e dimensions and h ee co e p inciples ha unde pin
he p oposed concep ual amewo k: Mul idimensionali y, Recip oci y,
and Timing and con inui y. In his amewo k, ansmission om social
exposu es o heal h de elopmen ac oss he li e span ope a es ia
Embodimen , Resilience and Suscep ibili y o Vulne abili y, and
Empowe men . Ou concep ual amewo k may se e as a s a egic map
o bo h esea ch and in e en ion planning aiming o decode he impac
o he complex social en i onmen and o al e ansmission pa hways o
minimize heal h isks and heal h inequali ies and o os e equi y in
heal h.
C edi au ho s a emen
Helene Gudi-Minde mann: Concep ualiza ion, Me hodology,
W i ing – o iginal d a , Visualiza ion; Maddie Whi e: Concep ualiza-
ion, Me hodology, W i ing – o iginal d a , Visualiza ion; Jana Roczen:
Concep ualiza ion, Me hodology, Visualiza ion; Na alie Riedel: W i ing
– Re iew & Edi ing, Funding acquisi ion; S e anie D ege : W i ing –
Re iew & Edi ing, Funding acquisi ion; Gab iele Bol e: Concep ualiza-
ion, W i ing – e iew & edi ing, Visualiza ion, Supe ision, Funding
acquisi ion
Funding
This wo k was suppo ed by he Eu opean Union’s Ho izon 2020
esea ch and inno a ion p og am unde g an ag eemen No 874724.
Au ho ag eemen and disclosu e s a emen
All au ho s ha e seen and app o ed he inal e sion o he
manusc ip being submi ed. They wa an ha he a icle is he au ho s’
o iginal wo k, has no ecei ed p io publica ion and is no unde
conside a ion o publica ion elsewhe e.
The au ho s decla e no inancial o pe sonal con lic o compe ing
in e es s.
Decla a ion o compe ing in e es
The au ho s decla e ha hey ha e no con lic s o in e es .
Da a a ailabili y
No da a was used o he esea ch desc ibed in he a icle.
Acknowledgemen s
We hank he Equal-Li e esea ch g oup, and pa icula ly ou col-
leagues om Equal-Li e’s wo k package on he Social Exposome o
aluable commen s and discussion du ing he p og ess o concep
de elopmen . Special hanks wi hin he Equal-Li e eam go o Sonja
Je am, A zu A a , and Sammie Jansen.
Appendix A. Supplemen a y da a
Supplemen a y da a o his a icle can be ound online a h ps://doi.
o g/10.1016/j.en es.2023.116485.
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