Social Determinants of Health (SDoHs) are usually defined as non-medical social and environmental factors that impact health and also health inequity. Social Determinants of Mental Health (SDoMHs) include the common SDoHs but also some additional ones that are unique to mental illnesses and mental health. While the SDoHs have received growing attention during the last two decades, the definition and conceptualization of the construct are still controversial.

Even the terms “social” and “determinant” are open to debate. The list of proposed SDoHs has grown many folds, and there is no clear definition or characterization of the SDoHs. It is also apparent that different individuals living in the same environment develop different levels of health-related impairments. This fact points to varied subjective perception of as well as experience with the same SDoH, leading to differing levels of subjective stress with differing impact on health. Thus, from the perspective of its impact on a person’s health, individually perceived or experienced level of an SDoH may be more critical than its objectively assessed severity at the community level. Similarly, some individuals are able to cope with similar SDoHs (social stresses) with different amounts of resilience and coping abilities. A critical limitation of the commonly proposed SDoHs is that they only include adverse factors and no positive factors such as community-level resilience and compassion, positive social connections, and social support.

The term determinant is highly questionable because most of the published studies of SDoHs are cross-sectional, thereby suggesting associations rather than causality. Indeed, many such associations are likely to be bidirectional. Moreover, very few factors including genes can be considered determinants of health or a disease, given the strong interactions among various putative predictors or risk and protective factors.  The literature on biology of the effects of SDoMHs on health in people with and without mental illnesses is even more limited.

Two years after decoding of the human genome, the term “exposome” was introduced to describe a field that provided the environmental complement to the genome. The exposome concept strives to capture the diversity and range of exposures to environmental toxins such as synthetic chemicals, social stressors, physical factors, and dietary constituents as well as their corresponding biological responses. Technological advances such as high-resolution mass spectrometry and network science have allowed us to take the first steps toward a comprehensive assessment of the exposome. Given the increased recognition of the dominant role that nongenetic factors play in disease, an effort to characterize the exposome at a scale comparable to that of the human genome is warranted.

SDoHs and Exposome  are remarkably overlapping constructs – and may even be identical, except that the concept of  SDoHs came primarily from a public health perspective whereas that of exposome was derived from a biological perspective related to genome,. Yet, both these constructs have social and biological roots with clear impact on physical, mental, and cognitive health.