# Two decades of Neo-Marxist class analysis and health inequalities: A critical reconstruction

## TL;DR

This paper examines how Neo-Marxist class analysis has been used to understand health inequalities over the past 20 years and suggests improvements for future research.

## Contribution

The paper offers a critical reconstruction of Neo-Marxist class analysis to better understand health inequalities through social mechanisms.

## Key findings

- The Neo-Marxist approach views class as a social mechanism involving control over productive assets and labor.
- Population health disciplines often reduce class to an individual attribute, ignoring broader social structures.
- Realist amendments to class analysis can inform social change to reduce health inequalities.

## 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.