Social determinants of health in Colombia: Regional analysis and challenges

Published

2025-10-27

Determinantes sociales de la salud en Colombia: análisis regional y desafíos

Social determinants of health in Colombia: Regional analysis and challenges

Determinantes sociais da saúde na Colômbia: análise regional e desafios

Keywords:

Determinantes Sociales de la Salud, Equidad, Factores Socioeconómicos, Disparidades en el Estado de Salud, Colombia (es)
Social Determinants of Health, Health Status Disparities, Colombia, Equity, Socioeconomic Factors (en)
Determinantes Sociais da Saúde, Equidade, Fatores Socioeconômicos, Disparidades nos Níveis de Saúde, Colômbia (pt)

Downloads

Authors

Diana Paola Betancurth Loaiza University of Caldas https://orcid.org/0000-0001-7620-2336
Consuelo Vélez Álvarez University of Caldas
Lucas Patiño Fernández University of Caldas https://orcid.org/0009-0000-7755-6398

Diana Paola Betancurth Loaiza

Diana Paola Betancurth Loaiza is a full-time professor and researcher at Universidad de Caldas, Manizales, Colombia (2010 – present). She is the Director of the Master’s in Epidemiology (2023 – present) and has served as Director of the Health Research Institute (2023), Director of the Social and Human Sciences Research Program (2022 – 2023), Director of the Epidemiology Specialization (2019 – 2023), and editor of Revista Hacia la Promoción de la Salud (2018 – 2023).

Dr. Betancurth Loaiza holds a PhD in Public Health, a Master’s in Nursing with a focus on Family Health, a Master’s in Research in Primary Care, and a Specialization in Health Promotion and Health Administration. She is an Associate Researcher recognized by Minciencias and a member of the Latin American and Caribbean Scientists Network.

Her research focuses on Health Promotion, Parenting, Primary Health Care, Health Education, Family Health, and strategies to foster family and social development aligned with the Buen Vivir philosophy. She has actively worked with communities, especially women facing forced displacement, vulnerability, rurality, migration, sexual exploitation, as well as adolescents and older adults.

Key publications:

Betancurth Loaiza D, Vélez Álvarez C, Sánchez Palacio C, et al. Equidad y trabajo sexual: un análisis a la luz de los determinantes sociales de la salud. Equidad y Desarrollo. Doi: https://doi.org/10.19052/eq.vol1.iss44.3
Pico Fonseca SM, Betancurth Loaiza DP, Guarín García LF. Breastfeeding in indigenous communities: A meta-ethnography of knowledge and practices. Breastfeeding Review. 2024;32(1):33-34: https://search.informit.org/doi/abs/10.3316/informit.T2024032200014200483814322
Patiño-Fernández L, Vélez Álvarez C, Betancurth Loaiza DP, et al. Exploring the invisible threads: Social determinants of health and emotional self-perception in Colombia. International Journal of Social Psychiatry. 2024;0(0):1-10. doi:1177/00207640241293387

Objetivo: caracterizar los determinantes sociales de la salud por regiones geográficas en Colombia.

Materiales y métodos: entre 2023 y 2024, se realizó un estudio descriptivo correlacional con 2.725 participantes de cinco regiones del país, utilizando el instrumento DESOSA81. Se efectuaron análisis univariados y bivariados, aplicando la prueba de Chi-cuadrado de Pearson para identificar asociaciones y los coeficientes Tau-b y Tau-c de Kendall para determinar la fuerza de las relaciones.

Resultados: predominaron las mujeres con una edad promedio de 36,5 años. Se evidenciaron diferencias regionales en las condiciones sociales y económicas, con
inequidades en el acceso a servicios básicos como el empleo, la educación y la salud. Factores como el género, el nivel educativo y la situación laboral influyeron en los
hábitos de vida, el estrés y el bienestar, evidenciando desigualdades estructurales e intermedias entre regiones.

Conclusiones: este estudio resalta las disparidades rural-urbanas y confirma que las inequidades sociales y económicas, agravadas por el género y la ubicación geográfica, constituyen determinantes clave de la salud y el bienestar en Colombia.

Objective: To characterize the social determinants of health across geographic regions in Colombia.

Materials and methods: A descriptive correlational study was conducted between 2023 and 2024 using the DESOSA81 instrument with a sample of 2,725 participants from five Colombian regions. Univariate and bivariate analyses were performed. Pearson’s Chisquare test was applied to examine associations between variables, and Kendall’s Tau-b and Tau-c coefficients were used to assess the strength of association.

Results: Women predominated in the sample, with a mean age of 36.5 years. Significant regional differences were observed in social and economic conditions, revealing inequities in access to employment, education, and health services. Gender, educational attainment, and employment status were found to influence health-related behaviors,
stress levels, and overall well-being, reflecting structural and
intermediate inequalities that vary across territories.

Conclusions: This study highlights rural–urban disparities and confirms that social and economic inequities, compounded by factors such as gender and geographic location, are key determinants of health and well-being in Colombia.

Objetivo: caracterizar os determinantes sociais da saúde por regiões geográficas na Colômbia.

Materiais e métodos: Entre 2023 e 2024, realizou-se um estudo descritivo correlacional com 2.725 participantes de cinco regiões do país, utilizando o instrumento DESOSA81. Foram feitas análises univariadas e bivariadas, aplicando-se o teste quiquadrado de Pearson para identificar associações e os coeficientes tau-b e tau-c de Kendall para determinar a força das relações.

Resultados: as mulheres predominaram na amostra, com idade média de 36,5 anos. Observaram-se diferenças regionais nas condições sociais e econômicas, revelando
iniquidades no acesso ao emprego, à educação e aos serviços de saúde. Fatores como gênero, nível educacional e situação laboral influenciaram os hábitos de vida, o estresse
e o bem-estar, evidenciando desigualdades estruturais e intermediárias entre as regiões.

Conclusões: O estudo evidencia disparidades rural-urbanas e confirma que as iniquidades sociais e econômicas, agravadas pelo gênero e pela localização geográfica,
continuam sendo determinantes-chave da saúde e do bem-estar na Colômbia, reforçando a necessidade de políticas públicas adaptadas aos contextos regionais.

Downloads

Download data is not yet available.

References

(1) Hahn RA. What is a social determinant of health? Back to basics. J Public Health Res. 2021;10(4):2324. https://pmc.ncbi.nlm.nih.gov/articles/PMC8672311/

(2) Frank J; Abel T; Campostrini S; Cook S; Lin VK; McQueen DV. The social determinants of health: Time to re-think? Int J Environ Res Public Health. 2020;17(16):5856. https://doi.org/10.3390/ijerph17165856

(3) Schenkman S; Bousquat A. From income inequality to social inequity: Impact on health levels in an international efficiency comparison panel. BMC Public Health. 2021;21:668. https://doi.org/10.1186/s12889-021-10395-7

(4) García-Ramírez JA; Vélez-Álvarez C. América Latina frente a los determinantes sociales de la salud: Políticas públicas implementadas. Rev. salud pública. 2013;15(5):731-742. http://www.scielo.org.co/pdf/rsap/v15n5/v15n5a09.pdf

(5) República de Colombia. Departamento Administrativo Nacional de Estadística (DANE). Empleo y desempleo. 2022. https://www.dane.gov.co/index.php/estadisticas-por-tema/mercadolaboral/empleo-y-desempleo

(6) República de Colombia. Departamento Administrativo Nacional de Estadística (DANE). Boletín Técnico Principales Indicadores del Mercado Laboral. Febrero de 2024; 2024 https://www.dane.gov.co/files/operaciones/GEIH/bol-GEIH-feb2024.pdf

(7) República de Colombia. Departamento Administrativo Nacional de Estadística (DANE). Boletín técnico Ocupación informal Trimestre móvil diciembre 2023 - febrero 2024; 2024. https://www.dane.gov.co/files/operaciones/GEIH/bol-GEIHEISS-dic2023-feb2024.pdf

(8) Franco-Giraldo Á. Modelos de promoción de la salud y determinantes sociales: una revisión narrativa. Hacia Promoc. Salud. 2022;27(2):237-254. https://doi.org/10.17151/hpsal.2022.27.2.17

(9) Pimienta Lastra R. Encuestas probabilísticas vs. no probabilísticas. Política y Cultura. 2000;(13):263-276. https://www.redalyc.org/pdf/267/26701313.pdf

(10) Holguín Zuluaga JA; Vélez Álvarez C; Betancurth Loaiza DP. Instrumento para medición de los determinantes sociales de la salud: diseño, validez facial y contenido. Diversitas. 2024;20(1):215-232. https://doi.org/10.15332/22563067.10230

(11) World Health Organization (WHO). World health statistics 2020: monitoring health for the SDGs, sustainable development goals; 2020. https://www.who.int/publications/i/item/9789240005105

(12) Coelho DM; Andrade ACS; Silva UM; Lazo M; Slesinski SC; Quistberg A et al. Gender differences in the association of individual and contextual socioeconomic status with hypertension in 230 Latin American cities from the SALURBAL study: A multilevel analysis. BMC Public Health. 2023;23(1):1532. https://doi.org/10.1186/s12889-023-16480-3

(13) López-Ruiz M; Artazcoz L; Martínez JM; Rojas M; Benavides FG. Informal employment and health status in Central America. BMC Public Health. 2015;15:698. https://doi.org/10.1186/s12889-015-2030-9

(14) Roberti J; Leslie HH; Doubova SV; Ranilla JM; Mazzoni A; Espinoza L et al. Inequalities in health system coverage and quality: A crosssectional survey of four Latin American countries. Lancet Glob Health. 2024;12(1):e145-155. https://pubmed.ncbi.nlm.nih.gov/38096887/

(15) República de Colombia. Departamento Administrativo Nacional de Estadística (DANE). Boletín Técnico Encuesta Nacional de Calidad de Vida (EC V) 2022; 2022. https://www.dane.gov.co/files/investigaciones/condiciones_vida/calidad_vida/2022/Boletin_Tecnico_ECV_2022.pdf

(16) Arias-Ortiz NE; de Vries E. Health inequities and cancer survival in Manizales, Colombia: A population-based study. Colomb Med. 2018;49(1):63-72. https://doi.org/10.25100/cm.v49i1.3629

(17) Alcaraz A; Pichon-Riviere A. Tobacco control in Latin America: Achievements, gaps and new challenges. Rev Peru Med Exp Salud Publica. 2023;40(3):264-266. https://doi.org/10.17843/rpmesp.2023.403.13284

(18) Osorio Henao EF. Determinantes sociales de la salud y estilos de vida de los estudiantes del programa de Trabajo Social de la Universidad de Caldas. Manizales: Universidad de Caldas; 2022. https://repositorio.ucaldas.edu.co/server/api/core/bitstreams/ae6c2de3-3ddb-4c1e-8473-0aa67bdba4e2/content

(19) Hernández-Vásquez A; Chacón-Torrico H; Vargas-Fernández R; Grendas LN; Bendezu-Quispe G. Gender differences in the factors associated with alcohol binge drinking: A population-based analysis in a Latin American country. Int J Environ Res Public Health. 2022;19(9):4931. https://pubmed.ncbi.nlm.nih.gov/35564326/

(20) Xu Y; Geldsetzer P; Manne-Goehler J; Theilmann M; Marcus ME; Zhumadilov Z et al. The socioeconomic gradient of alcohol use: An analysis of nationally representative survey data from 55 low-income and middle-income countries. Lancet Glob Health. 2022;10(9):e1268-1280. https://doi.org/10.1016/S2214-109X(22)00273-X

(21) Prada López G. Aproximación desde los determinantes sociales a la Seguridad Alimentaria y Nutricional en hogares de mujeres con exceso de peso en Girardot. Bogotá: Universidad Nacional de Colombia; 2021. https://repositorio.unal.edu.co/bitstream/handle/unal/79824/1030582280.2021.pdf

(22) Werneck AO; Baldew SS; Miranda JJ; Díaz Arnesto O; Stubbs B; Silva DR et al. Physical activity and sedentary behavior patterns and sociodemographic correlates in 116,982 adults from six South American countries: The South American physical activity and sedentary behavior network (SAPASE N). Int J Behav Nutr Phys Act. 2019;16(1):68. https://doi.org/10.1186/s12966-019-0839-9

(23) Arlettaz ME; Ramos G. Socioeconomic inequities and barriers to physical activity in Argentina. Prev Med. 2023;173:107555. https://doi.org/10.1016/j.ypmed.2023.107555

(24) Thomson RM; Igelström E; Purba AK; Shimonovich M; Thomson H; McCartney G et al. How do income changes impact on mental health and wellbeing for working-age adults? A systematic review and metaanalysis. Lancet Public Health. 2022;7(6):e515-e528. https://doi.org/10.1016/S2468-2667(22)00058-5

(25) Patiño-Fernández L; Vélez Álvarez C; Betancurth Loaiza DP; Sánchez Palacio N. Exploring the invisible threads: Social determinants of health and emotional self-perception in Colombia. Int. J. Soc. Psychiatry. 2024;71(2):392-403. https://doi.org/10.1177/0020764024129338

(26) Schiltz NK; Chagin K; Sehgal AR. Clustering of Social Determinants of Health Among Patients. J. Prim. Care Community Health. 2022;13:1-7. https://doi.org/10.1177/21501319221113543

License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

All articles published by Avances en Enfermería are licensed under the Creative Commons Attribution 4.0 International License. Starting 2020, we added the CC-BY-NC recognition to the license, which means anyone is allowed to copy, redistribute, remix, transmit and transform our contents with non-commercial purposes, and although new works must adequately cite the original work and source and also pursue non-commercial purposes, users do not have to license derivative works under the same terms.