Structural determinants of health and transitions between functioning and disability: a narrative review

Abstract

This study presents a state-of-the-art review of the structural determinants of functioning and disability human in the Brazilian context, highlighting the importance of these approaches for a critical understanding of population health conditions. A narrative review of the literature was conducted in the SciELO, BVS/LILACS, and PubMed/Medline databases, using the descriptors: “social determinants of health,” “structural determinants of health,” “social determination of health,” “ICF,” “international classification of functioning, disability and health,” “biopsychosocial model,” “functioning,” and “disability.” From 322 identified studies (2005-2025), after detailed analysis of titles, abstracts, and full texts, 10 articles specifically addressing the relationships among race, gender, and social inequalities with levels of activity and social participation were included. A significant gap was identified in research directly addressing the relationship between social and structural determinants and transitions between functioning and disability. Most studies adopted the biopsychosocial model as a critical counterpoint to the traditional biomedical perspective. Future research is recommended to deepen intersectional perspectives, emphasizing race, gender, territory, class, and disability as fundamental categories to understand the complexity of health experiences.