Abstract
Most population health researchers conceptualize social class as a set of attributes and material conditions of life of individuals. The empiricist tradition of ‘class as an individual attribute' equates class to an ‘observation', precluding the investigation of unobservable social mechanisms. Another consequence of this view of social class is that it cannot be conceptualized, measured, or intervened upon at the meso- or macro levels, being reduced to a personal attribute. Thus, population health disciplines marginalize rich traditions in Marxist theory whereby ‘class' is understood as a ‘hidden' social mechanism such as exploitation. Yet Neo-Marxist social class has been used over the last two decades in population health research as a way of understanding how health inequalities are produced. The Neo-Marxist approach views social class in terms of class relations that give persons control over productive assets and the labour power of others (property and managerial relations). We critically appraise the contribution of the Neo-Marxist approach during the last two decades and suggest realist amendments to understand class effects on the social determinants of health and health outcomes. We argue that when social class is viewed as a social causal mechanism it can inform social change to reduce health inequalities.
Highlights
The term ‘Neo-Marxism’ has been applied during the last century to a number of social science currents that expanded the work of Karl Marx with input from other intellectual developments
A social scientist influenced by Analytical Marxism has become influential in worldwide academic and policy circles dealing with income inequality (Piketty, 2014)
The theoretical and empirical research by Wright (1985, 2000) on Neo-Marxist class analysis has translated in new explanations and findings on the relation between class and health (Muntaner et al, 2013), a central question for the sociology of health (Hollingshead and Redlich, 1953)
Summary
The term ‘Neo-Marxism’ has been applied during the last century to a number of social science currents that expanded the work of Karl Marx with input from other intellectual developments. In population health research and theory, examples include prioritizing individual-level risk factors over population determinants of risk (that is, the risk of risk) (Rose, 1985); disqualifying as valid causal constructs any variables that are not manipulable in the current policy space (for example, ‘no causation without manipulation’) (Hernán, 2005); prioritizing research on commodifiable, purportedly biological mechanisms for socially conditioned physical and mental health problems (Burke et al, 2010); and re-reifying ‘race,’ for example, the re-emergence of genetic essentialism, rather than focus on the social processes of racialization and racism (Duster, 2005) This approach to social class has real consequences. This framework and its indicators have been applied to population health problems since the mid-1990s, producing a set of new findings appraised
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