Why Diseases Persist: Health System Structures, Inequality, and Long-Term Epidemiological Outcomes
DOI:
https://doi.org/10.64784/103Palabras clave:
Health systems, disease persistence, epidemiology, health inequalities, effective coverage, primary care, governance, health system resilienceResumen
Persistent disease burden remains a defining challenge for health systems worldwide, even in contexts where biomedical knowledge and health coverage have expanded substantially. Patterns of sustained incidence, preventable mortality, avoidable complications, and enduring health inequalities indicate that disease persistence cannot be explained solely by biological processes or individual behaviors. This review examines disease persistence from an epidemiological perspective, emphasizing the role of health system determinants in shaping long-term population health outcomes. Drawing on international literature and comparative insights relevant to Mexico, Colombia, and Ecuador, the analysis synthesizes evidence on governance, financing, service delivery, quality of care, resilience, and inequality monitoring. The findings suggest that disease persistence is strongly associated with structural inequalities, uneven access and quality of care, weak continuity, and persistent gaps between nominal access and effective coverage. Governance and financing emerge as enabling factors that shape how services are organized and distributed, while system resilience influences long-term outcomes by mediating the impact of shocks on essential health functions. Persistent health gradients are most evident in settings where disaggregated monitoring is limited, obscuring subpopulation burdens behind national averages. Overall, the review highlights disease persistence as a systemic outcome produced by the interaction of social stratification and health system performance over time, underscoring the importance of integrated, equity-oriented approaches to strengthening health systems and improving population health.
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