Introduction to Christopher Wild’s Exposoma Concept
In 2005, Christopher Wild introduced a groundbreaking idea that reshaped the way we think about health and disease. He called it the “exposoma,” defining it as the totality of environmental exposures affecting the human body throughout life, including prenatal periods (1). In my view, this concept directly challenges the dominant biomedical paradigm by proposing an integrated, accumulative, and context-based perspective on the relationship between environment and organism.
Wild’s Disruptive Proposal
Wild’s proposal serves as a crucial counterbalance to the overly genome-centric biomédical view, addressing what medicine had left out of its field of vision. He proposed a new conceptual framework to recognize and include the complexity of living beings in health analyses. In a disruptive move, Wild identified what medicine had overlooked and suggested an integrated approach to understanding the intricate relationship between environment and organism.
Adoption, Challenges, and Tensions
Two decades later, the exposoma has been adopted as a conceptual reference in various research spaces and has stimulated significant methodological developments. However, it is still not a consolidated field nor widely accepted; it remains a contentious proposal with real advances but also resistances, gaps, and unresolved tensions. Although some international consortia have embraced it as an organizing principle, its status as a field of knowledge remains fragile and seeks solid institutional consensuses, self-structured training programs, and a committed interdisciplinary community.
Conceptual Ambition vs. Technical Viability
The exposoma was not intended as another technical tool or a simple extension of environmental or molecular epidemiology. It is—and remains—a conceptual proposal for complexity, not a disciplinary adjustment (2). Its power lies in challenging the classic compartments of health science: breaking down the barrier between biological and environmental, internal and external, individual and surroundings.
Epistemological Tensions
Two epistemological tensions are evident regarding the exposoma. The first echoes the age-old debate between realism and nominalism. From a realist perspective, exposures exist outside the body, objectively affecting the organism and can be detected, measured, or estimated through statistical models. However, nominalism reminds us that every category is also a construction. Measuring isn’t registering reality in its raw form but organizing it through a particular viewpoint, interest, or language (3).
The second tension opposes the drive to measure with the need for understanding. Measuring is necessary but insufficient. Accumulating data doesn’t equate to comprehension. We can detect toxic compound levels in a pregnant woman’s blood, but without understanding the systems that placed them there—consumption models, environmental inequality, “healthy” product advertising—we don’t advance towards just and transformative solutions. Measuring without understanding is merely recording without transforming.
The Allure of Complementing Precision Medicine
This conceptual-technical discrepency has tempted a shortcut: presenting the exposoma as a complement to precision medicine. Instead of transforming our understanding of health and its complex determinants, the focus shifts to refining individual prediction. The emphasis moves from shared environment to predictable bodies, favoring personalized intervention over structural change.
Why Bet on the Exposoma, Even in Its Infancy?
Despite its current limitations—methodological, technological, and epistemological—the exposoma remains one of the most fertile and unsettling proposals in 21st-century health thought. It doesn’t resolve the complexity of health-disease processes but dares to articulate them differently. It’s not about another measuring tool but a conceptual shift transcending technique:
- Shifting focus from isolated molecules to life trajectories;
- Moving from viewing disease as a point event to understanding health as history, becoming, or an environmental inscription on the body.
Exposures aren’t merely detectable chemicals in blood or urine; they’re also environments, narratives, family stories, school climates, work experiences, structural violence, forced migrations. There’s a qualitative dimension—experiential, situated, historical—that is essential to the exposoma. To access this dimension, biology alone isn’t enough; a genuinely transdisciplinary approach incorporating sociological, anthropological, psychological, historical, and critical geographical knowledge is necessary.
The Exposoma’s Value
The exposoma’s value lies not only in its sensors or algorithms but in its potential to articulate questions unaddressed by traditional biomedical paradigms. How do the effects of living in a polluted neighborhood accumulate in the body? What traces does housing precarity leave on a child’s metabolism? How are intergenerational trauma and gene expression linked?
These questions can’t be resolved through a single language, yet the exposoma brings them to the forefront as both scientific and political challenges demanding new intervention forms.
Conclusion
The exposoma began as an invitation to think in terms of networks, processes, and histories. Defending it means resisting the impulse to fragment it into variables, capture it solely through laboratory means, or strip it of experience. In a world where environmental inequalities grow, chronic diseases proliferate, and dominant narratives tend toward reductionism, the exposoma is a bold bet on complex, situated, and world-engaged public health.
References
- 1. Wild, C. P. (2005). Complementing the genome with an “exposome”: The outstanding challenge of environmental exposure measurement in molecular epidemiology. Cancer Epidemiology, Biomarkers & Prevention, 14(8), 1847–1850. https://doi.org/10.1158/1055-9965.EPI-05-0456
- 2. Vineis, P. (2022). The exposome as the science of social-to-biological transitions. Environment International 165. https://www.sciencedirect.com/science/article/pii/S0160412022002392
- 3. Krieger, N. (2021). Structural racism, health inequities, and the two-edged sword of data: structural problems require structural solutions. The Lancet, 397(10273), 1253–1254. https://pubmed.ncbi.nlm.nih.gov/33937178/
- 4. Wild, C. P. (2025). The exposome at twenty: A personal account. Exposome, 5(1), osae003. https://doi.org/10.1093/exposome/osae003
*The author is a Tenured Professor in the Department of Public Health, Faculty of Medicine, UNAM, and an Emeritus Professor in the Department of Health Measurement and Evaluation, University of Washington.
The opinions expressed in this article do not represent the position of the institutions where the author works.
[email protected]; [email protected]; @DrRafaelLozano
