This chapter provides an illustration of the elements of what may be considered to be heterodox economic thinking on the nature of social welfare and social control, and the relationships between them. We assume that social welfare relates to a class of functions, such as education, economic security, health care, and housing, which are provided by, or associated with the welfare state in developed or high-income capitalist economies. 1 This is not to say that the state necessarily delivers services in those areas, but is responsible for their provisioning, implying also some varying forms of financial commitment. Our description departs from the neoclassical economic interpretation of social welfare, which is largely delineated by welfare economics, following utilitarian and/or Paretian reasoning in attempting to establish and measure well-being (Mandler 1999). Heterodox economic approaches reject the philosophical basis of this notion of social welfare (Lawson 2006). Instead, according to Lawson, heterodoxy is concerned with the analysis of the social structures and processes that influence material well-being.

This introductory article explores the intersection of healthcare and capitalism in order to introduce the concept of health capitalism in this special issue. It examines the structural changes within the healthcare sector, where welfare states—historically a barrier to commercialization have nevertheless facilitated capitalist expansion. It explores financialization, privatization, and commodification as key processes transforming healthcare. The article emphasizes the role of mainstream economics in legitimizing market-driven healthcare, promoting a financial logic that permeates healthcare decisions. The special issue contributes to the understanding of health capitalism by analyzing its multifaceted impact across various healthcare sectors.

This chapter critically examines the problematic conceptual and normative foundations of mainstream health economics in the context of the COVID-19 pandemic. Around the globe, this tradition has informed the development of both measures and policies relating to health and healthcare. For its proponents, this status reflects the utility of health economics as an objective 'toolkit': one that applies mainstream precepts to comprehend the value of medical procedures and treatments through generating a particular type of evidence of their potential consequences. We critically reflect on this account by noting problems in the 'three pillars' of conventional health economics and in its 'toolkit' approach. In doing so, we survey the mainstream analysis of infectious disease, emphasizing the individualism at its center. We contend that the 'toolkit' narrative of health economics masks its underlying value structure. All economics is value-laden, and health economics is no exception. Accordingly, we trace the value structure underlying the latter to its utilitarian orientation. Standard health economics equates agents' behavior with Homo Economicus, which centers on selfishness and atomistic individualism. This is based on 'I' language, whereas many health issues necessarily invoke 'we' language, with a range of associated ethical implications. Reflecting on these limitations, we contend that mainstream health economics is frequently inadequate in its examination of health and healthcare issues, such as that presented by the COVID-19 pandemic. In developing this critical reflection, we present the basis of an alternative approach emphasizing the importance of language in informing analysis. Our aim is to highlight the need for a broader basis for investigating health and illness: recognizing that the economy constitutes one element of a wider healthcare system that is constitutive of the provisioning processes through which societies produce and reproduce.

There is an increasing recognition of the need for sustainable shifts in consumption in order to address the climate crisis. Yet, too often, ethical consumption is taken to reflect the narrow concerns of certain individuals pursuing an identity and lifestyle. Based on our work with a UK junk-yard playground, we reflect on the methodological and thematic provocations that emerge from such a context. We focus on the need to build trust and to recognise existing behaviours with a different pathway to sustainability that is nonetheless socially valuable. The sharing behaviours and resource redistribution found in our case study, offered a model of sustainable behaviours outside of current framings, enabling a questioning of how we understand and look for less carbon-intensive ways of life in an urban context. Thus, we highlight the need for further research focused on deprived consumers and associated policy and practice implications.

The condition of European economic democracy is generally recognised to be in a fragile state. Recent discussions have centred on pressures to converge towards an Anglo-American model of flexible and deregulated employment relations and systems, consonant with a broader neoliberal economic governance discourse. Existing approaches suggest an uneven experience between countries around a general trend of deterioration. In this article we offer two new contributions to these debates. First, we introduce findings from an Economic Democracy Index (EDI) we have developed. This goes beyond existing indices of employment and industrial democracy to allow us to examine the changing nature of individual employment rights as well as collective bargaining conditions between European countries. Second, we depart from existing studies of European employment relations, which tend to take a comparative national approach, by situating national employment relations and trajectories within a wider set of spatial and social relations. Qualitative analysis of three country cases (Denmark, Portugal and Slovenia) supplements our EDI analysis. Our evidence suggests the importance of multi-scalar relational and institutional dynamics between social actors at the national scale and those at higher scales such as the European Union in understanding variations in country performance on the EDI.

The continual restructuring of energy systems, around the world, has generated widespread inequities-manifest as profound inequalities and hardship-across the energy continuum. These inequities include: energy unaffordability; access barriers like price or artefacts to utilise the services provided by energy for work and social practices; 'sacrifice zones' for new production sites with health, quality of life, and mortality impacts; and, diminished or absent participatory opportunity in production and regulatory decision-making. Fundamental to reaching solutions for the eradication of energy injustices, an exposition is required, we suggest, of the relationships between energy (in)justice, social justice, and inequality. To this end, we investigate two approaches to understanding injustice and inequality-Nancy Fraser's meta-(in)justice and Stratification Economics. We conclude that the social stratification exhibited through energy injustices, beyond the economic domain, demands solutions that do not replicate the contemporary neoliberal model privileging the private (economic) spheres of power in our societies.

The COVID-19 pandemic has exposed that the economic crisis is inseparable from the health and inequalities crisis. This commentary identifies the key overarching economic decisions that governments will make that are likely have a larger impact on the health of nations than the direct impact of COVID-19 itself. We present these economic decisions to a health audience. The public health profession will need to develop opinions on these key economic decisions if we are to shape the environment that has such a large impact on the work we do.

This paper departs from the standard abstract economics approach to health economics to develop a specifically contextualist approach to the subject emphasizing social and historical circumstances affecting health provision. Following Polanyi, it sees the economy as socially embedded and economic relationships as social relationships. The paper critically examines Grossman’s natural science utility maximization explanation of people’s demand for health and health care, and advances an alternative social science account using a two-way analysis between micro level social relationships and the macro level organization of health in society. Three significant trends affecting the future of health systems are discussed. The paper closes with comments on the influence of psychology in the form of behavioral economics on the future development of a contextualist approach to health economics.

Introduction Mortality rates in many high-income countries have changed from their long-term trends since around 2011. This paper sets out a protocol for testing the extent to which economic austerity can explain the variance in recent mortality trends across high-income countries. Methods and analysis This is an ecological natural experiment study, which will use regression adjustment to account for differences in exposure, outcomes and confounding. All high-income countries with available data will be included in the sample. The timing of any changes in the trends for four measures of austerity (the Alesina-Ardagna Fiscal Index, real per capita government expenditure, public social spending and the cyclically adjusted primary balance) will be identified and the cumulative difference in exposure to these measures thereafter will be calculated. These will be regressed against the difference in the mean annual change in life expectancy, mortality rates and lifespan variation compared with the previous trends, with an initial lag of 2 years after the identified change point in the exposure measure. The role of underemployment and individual incomes as outcomes in their own right and as mediating any relationship between austerity and mortality will also be considered. Sensitivity analyses varying the lag period to 0 and 5 years, and adjusting for recession, will be undertaken. Ethics and dissemination All of the data used for this study are publicly available, aggregated datasets with no individuals identifiable. There is, therefore, no requirement for ethical committee approval for the study. The study will be lodged within the National Health Service research governance system. All results of the study will be published following sharing with partner agencies. No new datasets will be created as part of this work for deposition or curation.

Background. Although there is a large literature examining the relationship between a wide range of political economy exposures and health outcomes, the extent to which the different aspects of political economy influence health, and through which mechanisms and in what contexts, is only partially understood. The areas in which there are few high-quality studies are also unclear. Objectives. To systematically review the literature describing the impact of political economy on population health. Search Methods. We undertook a systematic review of reviews, searching MEDLINE, Embase, International Bibliography of the Social Sciences, ProQuest Public Health, Sociological Abstracts, Applied Social Sciences Index and Abstracts, EconLit, SocINDEX, Web of Science, and the gray literature via Google Scholar. Selection Criteria. We included studies that were a review of the literature. Relevant exposures were differences or changes in policy, law, or rules; economic conditions; institutions or social structures; or politics, power, or conflict. Relevant outcomes were any overall measure of population health such as self-assessed health, mortality, life expectancy, survival, morbidity, well-being, illness, ill health, and life span. Two authors independently reviewed all citations for relevance. Data Collection and Analysis. We undertook critical appraisal of all included reviews by using modified Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria and then synthesized narratively giving greater weight to the higher-quality reviews. Main Results. From 4912 citations, we included 58 reviews. Both the quality of the reviews and the underlying studies within the reviews were variable. Social democratic welfare states, higher public spending, fair trade policies, extensions to compulsory education provision, microfinance initiatives in low-income countries, health and safety policy, improved access to health care, and high-quality affordable housing have positive impacts on population health. Neoliberal restructuring seems to be associated with increased health inequalities and higher income inequality with lower self-rated health and higher mortality. Authors' Conclusions. Politics, economics, and public policy are important determinants of population health. Countries with social democratic regimes, higher public spending, and lower income inequalities have populations with better health. There are substantial gaps in the synthesized evidence on the relationship between political economy and health, and there is a need for higher-quality reviews and empirical studies in this area. However, there is sufficient evidence in this review, if applied through policy and practice, to have marked beneficial health impacts. Public Health Implications. Policymakers should be aware that social democratic welfare state types, countries that spend more on public services, and countries with lower income inequalities have better self-rated health and lower mortality. Research funders and researchers should be aware that there remain substantial gaps in the available evidence base. One such area concerns the interrelationship between governance, polities, power, macroeconomic policy, public policy, and population health, including how these aspects of political economy generate social class processes and forms of discrimination that have a differential impact across social groups. This includes the influence of patterns of ownership (of land and capital) and tax policies. For some areas, there are many lower-quality reviews, which leave uncertainties in the relationship between political economy and population health, and a high-quality review is needed. There are also areas in which the available reviews have identified primary research gaps such as the impact of changes to housing policy, availability, and tenure.

Objectives: To examine existing definitions of health and health inequalities and to synthesise the most useful of these using explicit rationale and the most parsimonious text. Study design: Literature review and synthesis. Methods: Existing definitions of health and health inequalities were identified, and their normative properties were extracted and then critically appraised. Using explicit reasoning, new definitions, synthesising the most useful aspects of existing definitions, were created. Results: A definition of health as a structural, functional and emotional state that is compatible with effective life as an individual and as a member of society and a definition of health inequalities as the systematic, avoidable and unfair differences in health outcomes that can be observed between populations, between social groups within the same population or as a gradient across a population ranked by social position are proposed. Population health is a less commonly used term but can usefully be defined to encompass the average, distribution and inequalities in health within a society. Conclusions: Clarifying what is meant by the terms health and health inequalities, and the assumptions, emphasis and values that different definitions contain, is important for public health research, practice and policy. (C) 2019 The Author(s). Published by Elsevier Ltd on behalf of The Royal Society for Public Health.

This paper is motivated by the desire to contribute to the literature challenging the dominance of neo-liberal oriented reform, and offer an alternative vision founded on egalitarian values and social justice. Neo-liberalism has successfully challenged the vision of socialism and collective action: indeed, the rhetoric of globalisation, the hypermobility of finance capital and the dominance of multinational corporations are all cited as reasons why policies of nationalisation and public ownership are outdated, misguided, and highly inefficient. Notions of state failure have dominated the tenor of policy debate within mainstream economics over the past twenty or thirty years (see, for example, Fine, 2001; and Arestis and Sawyer, 2001), leading to the frequently held view that mainstream economics (if not economists) is associated with an endorsement of a ubiquity of markets.