A hole in our thinking: a response to Scambler’s ‘Health inequalities’

Abstract

Marxist-oriented theory in medical sociology over the last twenty years or so has fallen into decline and perhaps even disrepair since the collapse of state socialism in Eastern Europe and the former Soviet Union. Cockerham (2007), for one, suggests that the theoretical andpractical failure of Marxism to produce healthy societies in the former communist states substantially undermines its utility in medical sociology, while Callinicos (2007) has gone so far as to depict Marxist theory in sociology generally as ‘a dead dog.’ Yet we are beginning towitness something of a revival of Marxist thought in medical sociology with the recent appearance of works, such as De Maio’s Health & Social Theory (2010) and now Scambler’s essay in this journal on health disparities. What Scambler accomplishes with his review is to call our attention to an unfilled hole or gap in our thinking about the effects of social structures on health and longevity. He points out that SEC (socio-economic classification in the UK) or SES (socio-economic status in theUS) is much more than a collection of variables measuring class position; rather, class itself constitutes a structural variable whose properties combine to cause health (either good or bad). While this view is consistent with fundamental cause theory (Link and Phelan 1995) and the work of others (Coburn 2004, Cockerham 2007) promoting current neo-structural approaches to theorising about health disparities in medical sociology, Scambler goes further. He reminds us how capitalism is an inherently unequal economic system with safety nets for the poor provided by state intervention. When state benefits are reduced or curtailed by economic crisis, the adverse condition of being poor with its corresponding negative effects on health are accelerated.