Latin American Framework Challenges Mental Health Models

In a debate article published in Globalization and Health, a group of researchers argues that mainstream global mental health approaches have become overly focused on individual-level risk factors and biomedical treatments, effectively sidelining the structural forces that shape mental distress. The authors, including Franco Mascayano, María Teresa Muñoz-Quezada, and Cristian Montenegro, propose a social determination framework for mental health rooted in Latin American social medicine traditions. This perspective challenges the prevailing reductionist frameworks that fragment structural causation into depoliticized lists of risk factors, urging a shift toward analyzing the historical and political organization of social life.

The central critique of the article is that while policy and research have increasingly acknowledged social determinants, they often neglect how structural phenomena such as globalization, colonialism, and neoliberal reforms directly drive mental health inequities. The authors draw on the paradigm of social determination of health developed by Jaime Breilh, a central figure in Latin American critical epidemiology. Breilh’s work argues that health and illness arise from complex, dialectical social processes and historical structures, rather than being merely shaped by isolated determinants. This approach centers power, collective agency, and the transformation of unjust systems, viewing health as inseparable from struggles for justice.

The proposed framework distinguishes itself from conventional social determinants of health (SDH) models by emphasizing the multi-level embodiment of power relations. In this view, mental health is not treated as bounded individual pathology but as embedded in broader historical, economic, and political systems. The authors describe social determination as a relational and historically situated process through which health and mental distress are produced and reproduced within configurations of power. Unlike mechanical causation models, this perspective recognizes that social arrangements are historically changeable and that collective action can modify the conditions that generate suffering.

A key feature of the framework is its focus on dialectical social processes, which denote the dynamic interactions between structure and agency. This includes the mutual constitution of macroeconomic arrangements and everyday life, where collective practices and struggles may in turn reshape institutional configurations. Mental health outcomes, therefore, emerge from reciprocal and often contradictory processes rather than from additive or linear models of causation. The authors argue that this dialectical perspective emphasizes historicity and structured power relations, offering a more comprehensive understanding of how global political economy and institutional arrangements become embodied as mental distress.

To illustrate the application of this framework, the article presents three concise case vignettes from Latin America, focusing on employment, discrimination, and the environment. In the employment vignette, the authors examine young women working in maquila factories in northern Honduras. These workers face short-term contracts, intense production quotas, wage theft, and harassment, conditions rooted in the region’s neoliberal trade policies and weak labor protections. Surveys and labor-rights reports document high rates of anxiety, chronic stress, and depressive symptoms among these workers, who also face the strain of family separation and hazardous occupational exposures.

From a social determination perspective, these conditions are not understood as isolated workplace stressors but as reflections of the historically structured organization of global production. Trade liberalization, subcontracting systems, and gendered labor markets generate precarious forms of employment, leading to mental distress as the embodiment of broader political–economic arrangements. The authors note that labor organizing, transnational advocacy networks, and legal challenges have sought to transform working conditions, illustrating how collective action can reshape the institutional arrangements that structure workers’ everyday lives. Mixed-methods research combining quantitative mental-health screening with participatory life-history interviews can help reconstruct how global trade regimes become embodied as workers’ mental suffering.

The second vignette addresses discrimination in rural Oaxaca, Mexico, where Zapoteco adolescents encounter persistent racism in schools, clinics, and public spaces. This reflects a long history of land dispossession, cultural marginalization, and political exclusion. Population studies report elevated depressive symptoms, suicidal ideation, and substance use among Indigenous youth, while qualitative research links these outcomes to linguistic discrimination, cultural devaluation, and chronic social exclusion. The social determination framework situates these experiences within the structural violence of coloniality, viewing racism not as an isolated risk factor but as a historically produced system of power that organizes everyday interactions and constrains life opportunities.

Community responses in Oaxaca demonstrate that these dynamics are historically mutable. Indigenous organizations, youth collectives, and intercultural education initiatives have mobilized to defend language rights, strengthen cultural recognition, and challenge discriminatory institutional practices. Programs such as the UNESCO-supported Indigenous youth network in Oaxaca have produced mental-health materials in Zapoteco and promoted culturally grounded mental-health initiatives. These efforts illustrate how collective agency can reshape the institutional contexts that generate psychosocial stress, linking cultural revitalization with mental-health promotion through historically grounded research and community-based action.

The third vignette focuses on the environment, specifically the coastal towns of Quintero–Puchuncaví in Chile, which are widely known as environmental “sacrifice zones.” These areas have been shaped by decades of export-oriented industrial development and permissive environmental governance, where regulatory decisions and economic priorities have historically concentrated environmental risks in specific communities. Similar dynamics are observed in rural areas of the Maule Region, where large-scale pig farming and agro-industrial operations have generated chronic environmental exposure. Environmental monitoring has identified pesticide residues in soil and household water supplies, with higher concentrations in homes located near agricultural and livestock operations.

Quantitative analyses link these contamination patterns to elevated depressive symptoms and psychological distress. Within a social determination framework, these findings are interpreted not simply as exposure–outcome associations but as expressions of territorially organized governance and uneven political power. Environmental degradation reshapes everyday life by altering routines, eroding trust in institutions, and producing persistent uncertainty about health and safety. Community organizations have responded through environmental justice campaigns, legal action, and participatory research initiatives that combine environmental monitoring with community-based mental-health assessments, demonstrating how knowledge production and collective mobilization can challenge the institutional arrangements that generate environmental harm.

The authors argue that adopting a social determination lens can reorient global mental health policy and scholarship toward structural justice. This aligns with recent international calls to decolonize and politicize mental health research, addressing epistemic injustice, colonial legacies, and the global diffusion of Western psychiatric models that often marginalize local perspectives. The framework emphasizes that mental health equity is not solely a technical or epidemiological challenge but a matter of social justice and rights accountability. The 2020 report of the UN Special Rapporteur on the Right to Mental Health documented the iatrogenic effects of biomedical-dominant approaches and called for a fundamental reorientation toward power redistribution, meaningful participation, and the protection of human dignity.

Methodologically, the authors suggest that historically grounded research involves reconstructing policy trajectories and institutional transformations over time, such as trade liberalization, labor deregulation, and environmental governance. This requires combining documentary and policy analysis with quantitative mental health data, while also incorporating biographical or life-course approaches that trace how structural arrangements become embodied across time. Mixed-method and participatory research designs are particularly valuable in this context, as they allow researchers to link macro-level political–economic processes with institutional practices and lived experience. Rather than focusing solely on exposure–outcome associations, this approach seeks to analyze the institutional decision-making processes, power relations, and forms of collective action through which mental health inequalities are produced and contested.

The article concludes that centering social determination does not replace or dismiss the contributions of the social determinants tradition but broadens and deepens its analytical scope. It shifts attention from identifying and intervening upon risk factors toward interrogating and transforming the historically constituted systems that produce vulnerability. By foregrounding collective praxis, historical analysis, and structural transformation as constitutive elements of inquiry, this framework offers complementary resources that can strengthen and politicize global mental health scholarship and action. The authors assert that only by addressing these upstream structural determinants can the field of mental health fulfill its promise to advance global population well-being and social justice, moving beyond clinics into labor law, land rights, education policy, and environmental regulation.

Subject of Research: A social determination framework for mental health based on Latin American critical epidemiology

Article Title: A social determination framework for mental health

Article References: Mascayano, F., Muñoz-Quezada, M. T., Urzúa, A., Burrone, M. S., Casanueva, R., Rojas-Navarro, S., Grandón, P., Saldivia, S., & Montenegro, C. (2026). A social determination framework for mental health. Globalization and Health, 22(1), Article 64. https://doi.org/10.1186/s12992-026-01222-y

Image Credits: AI Generated

DOI: 10.1186/s12992-026-01222-y

Keywords: mental health, social determinants, Latin America, global health, structural violence, critical epidemiology, decolonization, public policy, social justice, health equity, social, determination