ABSTRACT
Chapter 4 introduces another critical realist, Margaret Archer. Her approach to the structure/agency issue and her theories of morphogenesis, morphogenetic cycles and reflexivity are drawn upon to throw further light on financial capitalism and to show how agency is socially structured, if never socially determined. Developing her idea of reflexive ‘internal conversations’, I introduce two ideal types of special salience for health inequalities: the focused autonomous reflexive and the vulnerable fractured reflexive. The former are instrumental in the production and reproduction of health inequalities, the latter most at risk of sickness and premature mortality. Four middle-range theories that help explain the social structuring of agency that impacts on health are outlined: effort/reward imbalance, relative risk aversion, ego adjustment and activity reinforcement.
