Turning Structures Into Attributes: The Marginalisation of Critical Theory in Research on Social Determinants of Health

Critical theory has provided important resources for understanding the social determinants of health (SDOH). Yet less is known about what happens to these explanatory resources as SDOH becomes increasingly institutionalised in research and policy. We examine this question through a scoping review of 298 peer-reviewed SDOH reviews published between 2005 and 2025, together with a close analysis of the 15 reviews with the highest annualised Web of Science citation rates. The findings show a pronounced and widening discursive asymmetry: mainstream, technically oriented reviews dominate the literature and have expanded substantially over time, whereas explicitly critical approaches have remained rare. At the same time, critical concepts such as class, exploitation and social reproduction have not disappeared. Instead, they are often retained in attenuated form, reframed as indicators of risk, vulnerability or group difference rather than as concepts for explaining how health inequalities are produced. This process is described here as explanatory marginalisation. Greater engagement with critical theory can therefore strengthen the capacity of SDOH research to explain, rather than merely describe, the structural production of health inequality.