Two decades of Neo-Marxist class analysis and health inequalities: A critical reconstruction.
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. YetNeo-Marxist social classhas 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.
Bloomberg School of Nursing, Dalla Lana School of Public Health, University of Toronto , 155 College Street, Suite 386, Toronto, Ontario, Canada M5T 1P8 ; Department of Public Health Sciences, Korea University , Suite 365, Hana Science Building, 145 Anam-Ro, Seongbuk-Gu, Seoul, 136-713 Republic of Korea . E-mail: hpolicy@korea.ac.kr.
Carles
C
Muntaner
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute , 209 Victoria Street, 3rd Floor, Toronto, Ontario, Canada M5B 1C6. E-mail: nged@smh.ca.
Edwin
E
Ng
Department of Public Health Sciences, Korea University , Suite 365, Hana Science Building, 145 Anam-Ro, Seongbuk-Gu, Seoul, 136-713 Republic of Korea . E-mail: hpolicy@korea.ac.kr.
Haejoo
H
Chung
Department of Epidemiology, Columbia University, Mailman School of Public Health , 722 West 168th Street, Suite #720C, New York, NY 10032, USA . E-mail: sjp2154@columbia.edu.
Seth J
SJ
Prins
Neo-Marxist; exploitation; health inequalities; mechanism; social class