Structural determination and social practice: towards a new understanding of ‘structure’ in health inequality research

Abstract

The relationship between social position and health is a central issue in medical sociology. While researchers typically agree that health inequalities are ultimately determined by structural factors, the concept of ‘structure’ is often unspecified and vaguely understood. This paper contributes to our understanding of structure by clarifying and critiquing two main understandings of structure within health inequality research, respectively, ‘structure’ as synonymous with socioeconomic inequality and ‘structure’ as an arrangement of pre-given components. Inspired by the concept of structuration, I then outline a more practice-oriented conception hinging on a threefold distinction between structural determinants, structuring practices and structural outcomes. A model is then presented in which ‘structure’ is understood as the evolving conditions and outcome of practices in which actors produce, distribute and consume resources according to social schemas. The conclusion discusses the concept’s implications for researchers aiming to examine and reduce social inequalities in health.