Understanding responses to the political context of health inequalities in research and policy: can post-structural theories of power help?

It is now widely accepted that health inequalities are directly linked to inequalities in power and material resources. Reflecting this, persuasive accounts of both the production of health inequalities and the failure of high-income countries to reduce these inequalities have been underpinned by references to structural (particularly neo-Marxist) theories of power. Such accounts highlight the importance of macro-level political and economic policies for health outcomes and, in particular, the unequally damaging impacts of policy reforms collectively referred to as ‘neoliberal’. This paper draws on interviews with researchers, civil servants, politicians, documentary makers and journalists (all of whom have undertaken work concerning health inequalities) to examine what these conversations reveal about these actors’ perceptions of, and responses to, the political context of health inequalities in the UK. In so doing, it illustrates the fluid and networked nature of political ‘power’ and ‘context’; findings that point to the potential utility of post-structural theories of power. This article argues that, if conceived of in ways which do not deny power differentials, post-structural theories can help: (i) call attention to ‘neoliberal’ inconsistencies; and (ii) explain how and why individuals who are critical of dominant policy approaches nonetheless appear to participate in their on-going production.