Understanding the social determinants of Aedes-borne diseases in Iran: A qualitative exploration of challenges and policy solutions.

BACKGROUND: Aedes-borne diseases pose escalating public health challenges globally, influenced not only by ecological and biological factors but critically by social determinants of health (SDH). In Iran, emerging local transmission of dengue highlights these diseases as effective proxies to examine the impact of social and environmental factors on health equity. However, evidence on context-specific drivers and effective responses remains scarce. This study aimed to identify key SDH and propose prioritized interventions to inform evidence-based policymaking. METHODS: This mixed-method study included a two scoping review on SDH of Aedes-Borne Diseases and SDH-focused interventions, complemented by qualitative data from in-depth interviews with 21 national and provincial health experts in Iran. Data were analyzed using an inductive content analysis approach and MAXQDA 25 software was used throughout the analysis. The identified interventions were prioritized through a multi-criteria decision analysis, incorporating expert input via an online checklist and digital platform, based on four key criteria: effectiveness, feasibility, social acceptability, and political support. RESULTS: Findings reveal that socioeconomic inequalities, weak community awareness, and limited health system capacity substantially drive disease risk. Notably, the local emergence and spread of dengue serve as a sensitive indicator reflecting broader social vulnerabilities affecting health outcomes. Integrated multisectoral strategies-encompassing health education, environmental management, digital surveillance, and cross-sector collaboration-are vital for effective control. Priority actions include healthcare worker training, embedding disease prevention within educational curricula, and tailored communication leveraging native languages and trusted community leaders. CONCLUSION: The study underscores that Aedes-borne diseases are not only biological threats but also reflections of underlying social and structural inequities. By framing dengue and related diseases as sentinel indicators of SDH, policymakers can better design integrated and equity-oriented strategies. Controlling Aedes-borne diseases requires a shift from disease-centric approaches toward comprehensive, SDH-informed strategies that strengthen community engagement, improve environmental and health infrastructure, and enhance cross-sector coordination. The prioritized interventions identified in this study provide a practical roadmap for strengthening preparedness and response in Iran and similar settings.