This paper starts from a critique of the dominant and largely empiricist paradigm within which sociologists have approached the relationship between social class and health. Referring to the transformational model of social activity and the relational model of society advanced by Bhaskar, the nature and reality of class relations and the preconditions for their theorisation are discussed. A neo-Marxist theory of class relations owing much to Clement and Myles is outlined. The relevance of this theory for a revised and more sociological consideration of health inequalities is then explored and some pointers offered for future empirical enquiry. The authors contend that this theory may throw some light too on the theoretical and political timidity medical sociologists characteristically show in their current research on health inequalities.