Structural Inequality Exhaustion Theory: A Transdisciplinary Framework Linking Socioeconomic Strain to Bidirectional Exhaustion

Background: Socioeconomic inequality is a primary determinant of global health disparities, yet the mechanistic pathways linking structural strain to individual exhaustion remain poorly defined. Current models often fail to bridge the gap between macro-level socioeconomic indicators and micro-level biological mediators. This study introduces the Structural Inequality Exhaustion Theory (SIET) to provide a unified, bidirectional framework for understanding systemic depletion across different social strata. Methods: Utilizing a transdisciplinary theoretical synthesis, this research integrates empirical evidence from neuroscience, psychobiology, and behavioral economics. The development of the SIET model followed a systematic approach to address five primary literature gaps, specifically focusing on the disconnect between biological biomarkers and executive cognitive functions. The study protocol was prospectively registered in the PROSPERO database (Registration No: CRD420251249096) to ensure methodological transparency and rigorous evidence integration. Results: The study formulates a bidirectional exhaustion model: Socioeconomic Exhaustion (SE) and Psychosocial Exhaustion (PE). SE identifies chronic cognitive bandwidth depletion in lower-income groups due to scarcity, while PE characterizes unique stress-processing burdens in higher-income strata. The theory introduces the Structural Exhaustion Index (SEI) as a novel metric to quantify the cumulative impact of these systemic pressures on individual resilience and biological “wear-and-tear.” Conclusions: SIET advances public health theory by providing a mechanistic bridge between structural inequality and health outcomes. By identifying distinct pathways of exhaustion, the theory offers a foundation for targeted public health interventions and policy recommendations aimed at mitigating systemic disparities.