Towards an Orthodox Marxist Critique of Critical Health Policy

Critical health policy researchers have, over the past few decades, shown beyond doubt the connection between socioeconomic inequalities and disparities in health and disease outcomes. The evidence is strong enough that mainstream outlets like the World Health Organization now acknowledge the centrality of the social determinants of health. However, researchers and activists have largely been frustrated in their attempts to mobilize this knowledge into practice. By most accounts, social health inequalities are increasing on intranational and global scales, especially following the 2008 economic crisis (Cash-Gibson, et al., 2018). The present Covid-19 pandemic – which has caused unemployment levels to rise to historic heights in most advanced economies – has made understanding the connection between socioeconomics and individual health even more urgent. The concept of health inequality as a field of study emerged alongside the pioneers of the socialist tradition; Frederick Engels’ 1845 The Condition of the Working Class in England is a seminal work in the field, and his lifelong collaborator Karl Marx elaborated at length the deleterious (physical, psychological, and spiritual) effects of capitalism on the lower classes. However, a properly Marxist tradition is largely absent even in more radical circles of health research today. To the extent that it is present, it is “neo-Marxist” – that is, it comes from a second generation of Marxists who took influence from Marx, but use fundamentally different methodological and theoretical assumptions. I argue that this is because, for the past century, a mathematical inconsistency (the “transformation problem”) in Marx’s original political economy was thought to make it internally incoherent, and as a result it has been excluded from serious academic consideration. However, in recent years, a school of Marxist economists have disproven the inconsistency, and in doing so paved the way for the possibility of a reclamation of the Marxist tradition in the social sciences. In this paper I argue that a Marxist political economy could serve as a superior methodological basis for the study of social health inequities.