With dismay I came across the term “exposome”. It was originally coined in 2005 as a way to think about influences that are external to the body on the human genome and disease, recognising that genomics alone generally cannot explain disease causation. A quick google search suggests the term has more recently been gaining traction in the research literature, with over 9000 uses of the term in 2025.

Just under twenty years later the Banbury Consortium gathered to advance the field of so called “exposomics” to develop a definition, identify which biomedical areas of research would benefit from the approach and the challenges that need to be tackled by the field of exposomics (alongside genomics). It is also the case, as a made-up word, that it does warrant a definition so we can understand what it means. The definition they developed is as below:

“the exposome is posited as an integrated compilation of all physical, chemical, biological, and (psycho) social influences that “impact biology.” The field of exposomics thus examines the comprehensive and cumulative effects of these factors by integrating data from interdisciplinary methodologies and data streams to drive discovery”.

To be clear, the idea that there are a range of social, economic, cultural, and physical exposures that directly influence our health is not new, and not radical. This thinking is the foundation of public health and the underlying science of epidemiology. I am also in perfect agreement with the sentiment that we should be thinking about the complex interaction of all factors when thinking about human wellbeing, disease causation and disease prevention.

My dismay comes from what is erased in the scientific ambition to capture all of these determinants of disease by an abstract, medicalised, single word.

Sure, it is easier to say in one word what we otherwise have to say in many words. But what happens when we do that? I am reminded of the advice of an Aboriginal Elder about how scientific (and other) abstractions allow racism to be objectified and dehumanised, silencing the people who live it. The exposome allows us not to say the words poverty, or racism, or colonisation with their emotional consequences, instead we can stay in the world of science with racism reduced to a variable in a mathematical model.

Further, the abstraction allows us to remove ourselves from the harsh reality of our role, directly or not in the maintenance of the systems which enable poverty and racism, for example, to continue. When complex social realities are compressed into a single scientific term, we lose sight of what has shaped them: history, power, and violence. System change needs an in-depth understanding of rules of the system, how the system is reinforced and our role in it. How can “exposomics”, which silences these social structures, help us to understand the system in all its complexity to improve human wellbeing?

Health is highly medicalised and becoming more so. There is a drive towards precision medicine, genomics driven healthcare and pharmaceuticals for every problem. The vast amount of direct resources for public health are spent on health system interventions, such as vaccines and screening programs. This is despite our understanding that many of the underlying causes of poor health and health inequity sit outside the health system, in the broader social, structural and environmental conditions in which people live. The term “exposome” fits neatly within this medical paradigm, even going so far as to borrow from the Greek language that underlies much of medical nomenclature. It reinforces a hyper individualised framing of health when what is needed is a focus on the underlying social economic and physical structures to support wellbeing at the population level. Doing this work requires genuine partnership with communities, which needs clear communication in a common language. The ‘exposome’ is a barrier to community conversations, not the bridge that is required.

Research such as this should be about benefiting the community. Words like exposome are alienating, abstracting, erasing and I think unlikely to benefit those that need it. We should not be replacing the words racism, colonisation, poverty and discrimination as they are not simply environmental variables – rather they are lived experiences shaped by history, systems and power.  They should be made more visible, not less.

References

Banbury Consortium | Columbia University Mailman School of Public Health

Miller, Banbury Exposomics Consortium. Integrating exposomics into biomedicine: Assessing a full range of environmental exposures will improve human health. Science, 2025;388(6745):356-358.