A new conceptual framework of the Social Exposome

Title	Integrating the social environment with an equity perspective into the exposome paradigm: A new conceptual framework of the Social Exposome
Sources	Gudi-Mindermann H, White M, Roczen J, Riedel N, Dreger S, Bolte G.  Environ Res.
Level of evidence	Systematic scoping literature review and development of a theory-based conceptual model
What	Concepts and frameworks on social and psychosocial environment, theory-based concepts of social influences relevant for health and mechanisms.
Notes	Nearly 4000 publications screened, 14 selected
Findings	Socioeconomic circumstances and Sociodemographic characteristics are dynamic influences that change in relevance and impact across the life-course.  For children, socioeconomic circumstances are the result of the socioeconomic background of parents and caregivers: the household the child lives in, as well as the surrounding neighbourhood context (e.g. area-level socioeconomic deprivation). The intergenerational impact of parental socioeconomic attainment means that the socioeconomic outcomes of the child are affected by family socioeconomic status, although these influences change over the course of education and leaving home. Sociodemographic characteristics, referred to as individual attributes at a certain point in time, such as age, migration background, religious affiliation, ethnicity, and marital status, evolve during the life course and may partially change. Additionally, these attributes could be reasons for experiencing discrimination and structural injustice. Social inequalities and structural injustices. Social inequalities refer to population-level differences in social conditions; these inequalities are not mere consequences of differing socioeconomic and sociodemographic aspects, but are systematically maintained and aggravated by economic, political, and sociocultural forces that define distribution patterns of risks (distributive justice) and access to resources and opportunities for taking action and participation in processes of decision-making (procedural justice). In this way, they determine structural inequities and injustices in circumstances in which people grow, live, work, and age. Social norms and cultural values not only inform societal regulations in terms of the systems, institutions, and priorities of the political economy, they can also influence the construction, definition, and perception of particular groups in a society that may be distinguished based on certain characteristics and disadvantaged as a result of structural injustices. This dynamic can create potential for discrimination or stigmatization. Intersectionality: Social inequities can accumulate through intersecting risks and unequally distributed power relations. Gender is one of the most important social determinants of health. Despite the progressing debate of the need to integrate sex/gender to ensure validity of health research and insights from the intersectionality approach, sex/gender is often seen as a fixed innate individual characteristic in conceptual models of social determinants of health, or even neglected in health sciences and in the exposome research field. The Social Exposome conceptual framework focuses on a person’s social environment for their development and health. The simultaneous consideration of multiple exposures highlights how the interplay of social influences, as stressed by the intersectionality perspective, underpins privilege and discrimination in societal systems, and reveals how explicit and non-explicit rules and laws, norms, and values drive structural inequities and injustices. The Social Exposome conceptual framework includes the natural and built environment as the physical domain of Places and acknowledges the interrelatedness of social and physical exposures with regard to effect modification, mediating mechanisms, and social inequalities in environmental exposures from an environmental justice perspective.
Recommendations	Health equity, environmental justice research, and exposome research should no longer operate in separate silos. Tracing a person’s social environment and integrating this alongside the physical environment within the exposome may help to systematically approach evolving health pathways and identify intersections where health pathways diverge in response to social inequities and structural injustices. The Social Exposome conceptual framework stresses multi-dimensionality, reciprocity, and continuity and timing of the social environment, and avoids sociodemographic or socioeconomic variables being seen as individual-level characteristics independent of structural forces. It can serve as a strategic map for both research and intervention planning to decode the impact of the complex social environment, with the aim of reducing health risks and inequalities, and fostering health equity.

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