Archer, morphogenesis and the role of agency in the sociology of health inequalities

Abstract

There is a sense in which agency, or the individual or collective power to make a difference, is too readily assumed within sociological discourse on health inequalities. The very choice of health inequalities as a phenomenon appropriate for sociological investigation, together with the presumption that ‘appropriate’ here implies a purposive commitment to their reduction, are (1) normative, and (2) too frequently pass without comment let alone analysis. Health inequalities, like diseases, are to be eliminated wherever possible, and this is part and parcel of the sociological as well as the public health project. Health inequalities, in short, are in significant measure health inequities. In this chapter I argue that a great deal more needs to be said. Drawing on the rigorous and sustained body of work of Margaret Archer, best known as a realist social theorist and sociologist of education, I contend that credible concepts of agency and agential (and transformatory) power are crucial for a sociology of health inequalities; that agency is necessarily structured but not structurally determined; and that agency and structure alike need to be analyzed against the backcloth of neo-Marxist notions of ‘contradiction’. Archer’s published work can be characterized as critical realist, owing much to thephilosopher Roy Bhaskar, but her sociological innovations are uncompromisingly independent (as anyone who knows her would recognize). In this chapter’s opening paragraphs I draw on her own exposition of critical realist thought to catch something of its thrust, before venturing into a more detailed account of her sociological appropriation.