Theorizing health inequalities: The untapped potential of dialectical critical realism

Abstract

We here extend our previous contributions to a neo-Marxist sociology of health inequalities via an engagement with Roy Bhaskar's dialectical critical realism (DCR). We argue that Bhaskar's re-grounding of the philosophies of Marx and Engels has the potential to re-invigorate sociology's input into: (a) explanations of health inequalities and (b) interventions to reduce health inequalities. We also show that DCR provides rationale and opportunity for an action sociology beyond current professional, policy, critical and public sociologies. We briefly summarize current sociological models of health inequalities before protesting their lack of theoretical ambition. We then proffer a professional-cumcritical theory that emphasizes the continuing causal efficacy of social class in general, and of Britain's 'governing oligarchy' in particular, for any credible sociological account of health inequalities. Bhaskar's basic and dialectical critical realism are then introduced and the frame supplied by the latter commended for a deepening of the neo-Marxist theories of health inequalities being developed by us among others. The article concludes by drawing on this same frame to insist on a logical and moral commitment to an action sociology beyond any institutional constraints faced by practitioners of the discipline.

Social practice, plural lifestyles and health inequalities in the United Kingdom

“…Moreover, the case‐based approach contributes to the need for a realist understanding of health inequalities (Byrne , Wainwright and Forbes , Scambler and Scambler ) that permits relational interpretation (Veenstra and Burnett , ) and admits a place for subjective orientations, practical logics and daily experience (Baum and Fisher , Blaxter ). Since the taxonomy of lifestyles is itself a product of the social system with its specific ‘class and command relations’ (Scambler ), it broaches the question of the social root causes of health.…”

“…Despite unprecedented attempts to address health inequalities strategically in the United Kingdom, inequalities continue to widen, and only little progress has been observed (Bambra , Mackenbach , Scambler and Scambler ). A frequently reiterated explanation for the UK programme's failure is that policy approaches ‘drifted’ (Popay et al .…”

The development of the new assistant practitioner role in the English National Health Service: a critical realist perspective

“…In particular, critical realism's exposure of an 'epistemic fallacy' (Bhaskar 1989) which suggests that knowledge alone drives our understanding of reality, gives way to a stratified social ontology rooted in: the empiricalwhat is experienced; the actualevents which might but also might not be experienced; and the real underlying generative causal mechanisms explaining (demi-)regularities in the realms of the empirical and the real. Such an approach has been viewed inter alia as adding explanatory depth and sensitivity to the complexities associated with the implementation and impact of healthcare policy and practice in different contexts including nursing (McEnvoy and Richards 2003), chronic illness (Williams 1999) and healthcare inequalities (Scambler and Scambler 2015). Data-driven research rooted in critical realism has been less common (Fletcher 2017) although Williams et al (2016) present various healthcare studies illustrating the approach's analytical value.…”

Dimensions of vulnerability salient for health: a sociological approach

“…The relevance of material assets for health and longevity has long been stressed, although the mechanisms linking low income with health remain much debated. Scambler and Scambler (2015) This has had the effect, politically expedient for rightof-centre parties, of circumscribing compassion and caring for others. Second, long-held (European) Enlightenment orientations towards progress and the common good (whether capitalist, socialist or communist in ethos) have yielded to a pluralism of "choices" about what is good and right and about what represents progress.…”