Drivers of health equity in the Americas: a scoping review

Abstract

Abstract Background The term “driver” is often used inconsistently in the literature, referring to diverse analytical levels, from structural determinants to individual risk factors, frequently without a clear distinction. This lack of precision challenges theoretical consistency and health equity operationalization. This scoping review aims to harmonize the conceptual meanings of “drivers,” their relationship with social determinants of health (SDoH), methodological strategies, and research gaps within the Americas. Methods Following PRISMA-ScR guidelines, 286 documents (2008–2026) were analyzed. The review utilized the JBI PCC framework to address four research questions on the global and regional application of “drivers”. The general population was analyzed across PROGRESS-Plus axes, treated as relational dimensions of inequality that structure social positions. Data synthesis integrated descriptive mapping with conceptual analysis of drivers and their interplay with SDoH. Results Findings reveal a conceptual evolution toward “Social Drivers of Equity in Health” (SDEH) as operational engines of power. While 36.4% of the literature uses “driver” and “determinant” interchangeably, 38.5% identifies drivers as independent forces putting SDoH in motion. Methodologically, 33.3% were primary quantitative studies; 46 utilized multivariate modeling to isolate structural effects. In the Americas, structural racism (80.0%) and socioeconomic status (79.3%) predominate as primary engines. PROGRESS-Plus analysis identified emerging axes, such as digital and commercial dimensions, mediating geographic inequities. A significant “research inequity” persists, with 79.3% of the regional evidence concentrated in the United States, leaving substantial knowledge gaps regarding the structural drivers specific to Latin America and the Caribbean. Conclusions While the term “driver” presents tensions with established SDoH models, adopting a “hierarchy of drivers” (Upstream-Midstream-Downstream) could offer a pragmatic framework for identifying precise levers of power, such as legal reforms and social protection. The term should be used cautiously, ensuring its articulation with robust theoretical frameworks to act as an operational catalyst for structural intervention. Registration The protocol was registered on the Open Science Framework platform under ID 48azj.