Chagas Disease in Context: How Social, Economic, and Cultural Realities Shape Risk

Chagas disease remains one of the most pressing and under-addressed neglected tropical diseases in Latin America and beyond. While conventionally understood through a biomedical lens centered on vectors and reservoirs, the persistence and global spread of Chagas disease cannot be fully explained without considering the social, economic, and political structures that sustain vulnerability and hinder equitable access to care. This narrative review reframes Chagas disease risk by integrating the concepts of hazard, exposure, and vulnerability into a broader socioecological framework. We explore how poverty, migration, housing precarity, weak health systems, and fragmented public policies interact to shape transmission dynamics and clinical outcomes across endemic and non-endemic settings. We further examine how climate change, urban expansion, and global economic systems—particularly those driven by extractivism and neoliberal reforms—compound risk and limit institutional response. Drawing on multidisciplinary research and case studies from Latin America and migrant populations in the United States and Europe, we argue that addressing Chagas disease requires going beyond vector control and pharmaceutical interventions. It demands a structural approach that accounts for environmental degradation, institutional invisibility, and sociocultural disconnects between policy and community needs. We conclude with policy and research recommendations grounded in equity, transdisciplinarity, and human ecology. Our review contributes to a growing body of literature calling for the reconceptualization of neglected diseases as the product of biosocial processes, rather than isolated pathogenic events.