ABSTRACT
Although biological factors affect human health, their impacts are mediated by social processes. This is rightly stressed by the social determinants of health (SDH) approach. There is, however, the need for a more critical perspective on SDH themselves. It is not enough to suggest that health has many social (i.e. non-biological) determinants. Instead, there is a further need to unpack the nature of the social itself in SDH. This chapter argues that class is the most important aspect of the social, such that any political-economic analysis of health centers on its class dimensions. The specific class character of capitalist society, in other words, strongly impacts health. The chapter begins with a re-articulation of Marx’s ideas in Capital on how multiple aspects of capitalist production and exchange perniciously shape health. It then builds on these insights to develop a broader class-based approach. Apart from production and exchange, such an approach includes processes germane to capitalist society: alienation, social oppression, environmental damage, the state, and working-class power. This class approach has specific practical implications for humanity’s efforts to construct a healthier society than the one currently configured by capitalist social relations.
