Analyzing David Ansell's Work Through the Lens of Muntaner et al.
From my understanding, I see social class is not just an individual attribute (like income or education) but a social relationship defined by someone's position within the system of economic production. I believe that health inequalities are produced by the mechanisms of exploitation (the material welfare of one class depending on the deprivation of another) and domination (control over the labor of others).
"The Neo-Marxist approach views social class in terms of class relations that give persons control over productive assets and the labour power of others." - Muntaner et al.
Ref: The Death Gap, Ch. 3
Ref: The Death Gap, Ch. 7 & 9
Ref: The Death Gap, Ch. 5
Ref: The Death Gap, Ch. 11
The physical and psychological toll of living in an exploited class position.
How the healthcare system reinforces and reproduces class-based inequalities.
The greatest health inequality caused by class: a large, unfair, and predictable gap in life expectancy between social classes, clearly visible across different neighborhoods.
A 16-Year Life Expectancy Gap Across Chicago
"Where you live dictates when you die." - The Death Gap, Preface Page 8
Muntaner et al. argue against focusing on "policy implications" for elites and instead call for engaging with working-class movements to challenge the structures of inequality. This aligns perfectly with Ansell's focus on community activism.
Community organizing and direct action (like the trauma center campaign or transplant hunger strikes) are types of class struggle that push powerful institutions (big businesses or elites) to meet the needs of the community and working class.
Developing "collective efficacy" and creating "anchor institutions" are strategies to build economic and social power within disadvantaged communities to resist exploitation and improve material conditions.
"An important contribution of Neo-Marxist class analysis is to break the chain between health inequality research and the 'policy mystique.'" - Muntaner et al.
I think that Muntaner et al.’s Neo-Marxist framework gives us a strong way to explain and connect the patterns described in The Death Gap. While Ansell uses the term “structural violence,” I think that Muntaner et al. give it a clear, materialist meaning: exploitation. For me, I see his perspective as a way to explain why the death gap exists it goes beyond simply describing inequality to identifying its cause. It also argues that the comfort and health of the wealthy don’t just exist apart from poverty; they actually depend on it. As Muntaner et al. describe through the “inverse interdependent welfare principle,” “the material welfare of exploiters causally depends upon the material deprivations of the exploited” (p. 278). I see Ansell’s discussions of redlining, blockbusting, and predatory lending not just as examples of racial discrimination they also show this principle at work, where wealth is deliberately taken from Black communities to benefit speculators and financial institutions. Ansell recognizes this dynamic himself, noting that inequality is “perpetuated by the actions of the powerful to enrich themselves at the expense of others” (p. xiii, One Street, Two Worlds). I think that Muntaner’s framework also clarifies why the healthcare system is separate and unequal. I believe that this isn’t a mistake or design flaw, it’s the predictable result of a system that treats healthcare as a commodity, where access depends on class position, and class itself is shaped by ongoing relations of exploitation.
I believe that a strict Neo-Marxist class analysis, just like the one by Muntaner et al., puts economic production and class relations at the center of social inequality. I think that this is a great framework, but I also think that it can sometimes overlook how other hierarchies, especially race, work as big, and sometimes independent, forces shaping the death gap in the U.S. context. I think that Ansell does a great job in making it clear that race is not just a stand-in for class. For example, he notes that even when income is the same, “blacks have higher disease and mortality rates than whites” (Ansell, p. 62, Chapter Five). I think that Muntaner’s model also struggles to explain forms of structural violence that aren’t directly connected to economic production, such as exclusion based on immigration status. Ansell’s discussion of undocumented immigrants being denied organ transplants shows a kind of exclusion that comes from legal and national boundaries, not simply in class position. While undocumented people are almost always part of the exploited working class, their particular and deadly barrier to care is shaped by law and nationality. I believe that this shows that class exploitation, though central, is not the only powerful structure producing inequality.
To better explain the patterns shown in The Death Gap, I think that Muntaner et al.’s Neo-Marxist theory should be reworked to fully include ideas from racial capitalism and intersectionality. Rather than treating race as secondary to class, I think that this revised model would see class exploitation and racialization as interconnected and mutually reinforcing forces that can’t be separated in the U.S. context. I also think that this updated framework would also broaden the concept of “exploitation” beyond the extraction of labor in the workplace to include, for example, the ways value and resources are taken through systems of racialized control. These include the loss of wealth through racist housing practices like redlining, the extreme exploitation of communities through mass incarceration, and the denial of essential resources such as healthcare based on the effects of class, race, and legal status. By moving its focus from only the ownership of the means of production to the interaction of multiple systems of domination, I think that this reconstructed theory would give a fuller explanation of how social structures create premature death, capturing what Ansell calls “structural violence” in its complete form. "