Social Gradients and Structural Determinants: Epidemiological Insights for Advancing Health Equity

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Abstract
Health inequities remain one of the most persistent challenges in global public health. This review analyzes international epidemiological evidence on the structural determinants shaping disease distribution, with contextual reference to middle-income countries such as Mexico, Colombia, and Ecuador. Using a structured narrative approach grounded in the social determinants of health framework, the study examines how socioeconomic position, income inequality, structural discrimination, and differential access to preventive services influence measurable health outcomes. The synthesis highlights consistent social gradients in avoidable mortality, preventive service coverage, and cardiometabolic risk factors, demonstrating that inequities are not random variations but patterned reflections of social organization. Evidence further indicates that health disparities can widen during periods of societal crisis, reinforcing the importance of equity-sensitive resilience strategies. The findings underscore that effective public health policy must extend beyond clinical care and incorporate multisectoral action targeting structural determinants. By linking epidemiological measurement with policy translation, this review emphasizes the role of evidence-informed governance in reducing avoidable and unjust health disparities.