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‘A smorgasbord of insights into the world of healthcare, this volume begins with an informative
explanation of political economy with its focus on class power and class struggle, and proceeds to
offer a wealth of studies from veterans in the field as well as a sprinkle of contributions from early,
and very promising, career academics. The chapters offer a plurality of theoretical approaches,
demonstrating the diversity and versatility of the interdisciplinary basis of political economy, and
cover issues from many different regions and countries of the world. The Handbook is, indeed,
a convincing portrayal of health and healthcare under the exorbitant and inexorable demands of
capitalism, particularly as experienced with the historically recent shift to neoliberal governance.
It is a celebration of the very best of political economy with its capacity to make sense of economic
and social issues with immediate relevance for the health and well-being of humans.’
Fran Collyer, Professor of Sociology, University of Wollongong,
and President RC08 International Sociological Association
‘Coming fifteen years after the report of the 2008 World Health Organization (WHO) Commission
on the Social Determinants of Health, and the all-too-predictable soft-pedaling and depoliticiza-
tion of this widely-adopted framework, this volume constitutes a timely return to – and expansion
of – critical political economy critiques of health and healthcare. Mainly concerned with the harm-
ful impacts of neoliberal/market fundamentalist capitalism, its rich chapters usefully build a case
for systemic political-economic change, mindful of the interdependent material and ecological
world that provides the basis for life and death on this planet.’
Nancy Krieger, Professor of Social Epidemiology and American Cancer
Society Clinical Research Professor, Harvard University
‘Challenged by capitalism and chipped away by neoliberalism, the global COVID-19 pandemic
brought into sharp focus longstanding concerns with the political economy of health and health-
care. This Handbook rises to the occasion by providing readers with theory- and problem-driven
coverage that does not sacrifice depth for breadth, offering a comprehensive analysis befitting its
pressing subject matter. The book will surely move studies in political economy, and be of interest
to anyone seeking to better understand the contours of health and healthcare today.’
Heather Whiteside, Associate Professor
of Political Science, University of Waterloo
The Routledge Handbook of the Political
Economy of Health and Healthcare
This handbook provides a comprehensive and critical overview of the gamut of contemporary
issues around health and healthcare from a political economy perspective. Its contributions present a
unique challenge to prevailing economic accounts of health and healthcare, which narrowly focus on
individual behaviour and market processes. Instead, the capacity of the human body to reach its full
potential and the ability of society to prevent disease and cure illness are demonstrated to be shaped by
a broader array of political-economic processes. The material conditions in which societies produce,
distribute, exchange, consume, and reproduce – and the operation of power relations therein –
influence all elements of human health: from food consumption and workplace safety, to inequality,
healthcare and housing, and even the biophysical conditions in which humans live.
This volume explores these concerns across five sections. First, it introduces and critically en-
gages with a variety of established and cutting-edge theoretical perspectives in political economy
to conceptualise health and healthcare – from neoclassical and behavioural economics, to Marxist
and feminist approaches. The next two sections extend these insights to evaluate the neoliber-
alisation of health and healthcare over the past 40 years, highlighting their individualisation and
commodification by the capitalist state and powerful corporations. The fourth section examines
the diverse manifestation of these dynamics across a range of geographical contexts. The volume
concludes with a section devoted to outlining more progressive health and healthcare arrange-
ments, which transcend the limitations of both neoliberalism and capitalism.
This volume will be an indispensable reference work for students and scholars of political
economy, health policy and politics, health economics, health geography, the sociology of health,
and other health-related disciplines.
David Primrose is in the Menzies Centre for Health Policy and Economics, University of Sydney,
Australia.
Rodney Loeppky is in the Department of Political Science, York University, Canada.
Robin Chang is in the Department of Political Science, York University, Canada.

THE ROUTLEDGE
HANDBOOK OF THE
POLITICAL ECONOMY OF
HEALTH AND HEALTHCARE
Edited by David Primrose, Rodney Loeppky

and Robin Chang
Designed cover image: © Getty Images
First published 2024
by Routledge
4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
605 Third Avenue, New York, NY 10158
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2024 selection and editorial matter, David Primrose, Rodney Loeppky
and Robin Chang; individual chapters, the contributors
The right of David Primrose, Rodney Loeppky and Robin Chang to be
identified as the authors of the editorial material, and of the authors for their
individual chapters, has been asserted in accordance with sections 77 and 78
of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording,
or in any information storage or retrieval system, without permission
in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identification
and explanation without intent to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
ISBN: 9780367861360 (hbk)

ISBN: 9781032650678 (pbk)
ISBN: 9781003017110 (ebk)
DOI: 10.4324/9781003017110
Typeset in Times New Roman
by codeMantra
CONTENTS
List of illustrations xi
List of contributors xiii
1 Revitalizing the political economy of health and healthcare

in a context of crisis 1
David Primrose and Rodney Loeppky
PART I
Theorizing health and healthcare 17
2 Mainstream health economics and the COVID-19 pandemic 19

John B. Davis, Geoffrey M. Hodgson,
Gerry McCartney and Robert McMaster
3 The economics of conventions and healthcare 34

Philippe Batifoulier and Nicolas Da Silva
4 Understanding Marx on health: Towards a class-based approach 47

Raju Das
5 Feminist political economy, health and care 60

Tamara Daly
6 Post-Keynesian economics and healthcare 74

Steven Pressman
7 New materialisms and the (critical) micropolitical economy of health 86

Nick J. Fox
vii
Contents
8 A lopsided reflation: The limited contribution of behavioral economics

to the political economy of obesity 98
David Primrose
PART II
Contemporary political-economic dimensions of health 117
9 A critical political economy of health inequities 119

Arnel M. Borras
10 Issues of social reproduction and the political economy of health 131

Sarah Redikopp
11 Health and the corporate agri-food system 143

Jennifer Lacy-Nichols and Gyorgy Scrinis
12 Neoliberalism and health in global context: The role of international

organizations 154
Timon Forster, Thomas H. Stubbs and Alexandros E. Kentikelenis
13 Neoliberalism and mental health 166

Jana Fey
14 Occupational health and safety in the global garment industry 177

Patrick Neveling
15 Political economy and social epidemiology in the context

of the HIV epidemic in sub-Saharan Africa 190
Kevin Deane
16 Digital health and capitalism 202

Olivia Banner
17 The political economy of health and place: From the Great Compression
to COVID-19 210
Clare Bambra
PART III
Contemporary political-economic dimensions of healthcare 221
18 Commodified healthcare, profits, priorities and the disregard for

life under capitalism 223
Isaac Christiansen
viii
Contents
19 The financialization of long-term care in Canada: The case of Ontario 234

Jackie Brown
20 The anatomy of Big Pharma 245

Marc-André Gagnon
21 Automating the welfare state: The case of disability benefits and services 259
Georgia van Toorn
22 Understanding the health-politics nexus in the shadow of populism:

Towards a political science of, and for, health 271
Volkan Yilmaz
23 Trade and investment: The re-ordering of healthcare and public health policy? 281
Deborah Gleeson and Belinda Townsend
24 Universal health coverage: A case-study of the political economy of

global health 293
David G. Legge
PART IV
Geographical varieties of health and healthcare 307
25 Critical political economy of Latin America’s healthcare systems:

A century of struggles 309
Laura Nervi and Anne-Emanuelle Birn
26 The political economy of healthcare policy in Africa in the age

of COVID-19 322
Jean-Germain Gros
27 Transformation of healthcare in China: The pre-and post-Maoist eras 336

Rama V. Baru and Madhurima Nundy
28 The political economy of health and healthcare in India 346

Shailender Kumar Hooda
29 The political economy of the postsocialist mortality crisis 359

Gabor Scheiring and Lawrence King
30 Healthcare in Australia: Contesting marketized provision 371

Ben Spies-Butcher
ix
Contents
31 The political economy of the National Health Service in

the United Kingdom 382
Jonathan Filippon
32 Health and healthcare in the United States 392

Rodney Loeppky
33 The new health politics of austerity in Europe 404

Scott L. Greer and Margitta Mätzke
PART V
Alternative paths toward health and healthcare 417
34 Social welfare and alternative forms of health provision: The UK

experience and radical new frontiers 419
Chris Thomas
35 The need for comprehensive primary healthcare 432

Toby Freeman and Fran Baum
36 The political economy of healthcare as commons: Exploring the

commons health system and Indigenous peoples 444
Young Soon Wong
37 Diverse economies of care-full healthcare: Banking and sharing human milk 459
Lindsay Naylor
38 The political economy of health and degrowth 471

Jean-Louis Aillon and Mauro Bonaiuti
39 Cuban medical internationalism: A radical alternative approach to

medical ‘aid’ 484
John M. Kirk
40 The transition to post-capitalist health and healthcare 496

Howard Waitzkin
Index509
x
ILLUSTRATIONS
Figures
12.1 Impact of neoliberalism on health – overview of mechanisms 156
26.1 Healthcare spending as a percentage of GDP in Africa, 2000–13 329
26.2 Healthcare spending per capita in Africa, 2000–13 330
27.1 Rural government and health system in 1960s–70s China, depicting
the three-tier network 338
27.2 Average proportion of Chinese households with catastrophic health
expenditure (percent) 344
28.1 Medical education received according to status across class and caste 349
28.2 Toward modernization of health and medical care 352
37.1 Diverse economies iceberg 461
37.2 Diverse and community economies of human milk 463
37.3 Assemblage of the collective of care 465
38.1 Preston curve 473
38.2 Diminishing marginal returns curve 474
40.1 Rinky-dink revolution 500
Tables
3.1 Plurality of orders of worth in healthcare 39
3.2 Two conventions of quality of healthcare labor 42
11.1 Big Food’s oppositional political strategies 145
11.2 Big Food’s corporate health promotion activities 146
12.1 Structural adjustment and health systems, direct and indirect effects 158
15.1 Examples of definitions of migration and mobility used in epidemiological studies 195
20.1 Global drug spending and growth in selected countries, 2021 (or nearest year) 246
20.2 Global medicine spending by product type, 2021 246
20.3
Pharmaceutical companies included among the world’s 200 largest
corporations in terms of market value, February 2019 249
20.4 Top 30 drugs by global sales, 2020 252
xi
Illustrations
26.1 Top ten African exporters, 2018 327

26.2 Central government spending as a percentage of GNI in the top 10 African
exporters, 2000–13 329
34.1 Conceptualizing state involvement in health creation 422
35.1 Contrasts between selective and comprehensive PHC 434
37.1 Labor relations in contemporary exchanges of human milk 466
37.2 Transactions in contemporary exchanges of human milk 467
Box
17.1 Place 211
xii
CONTRIBUTORS
Jean-Louis Aillon is a medical doctor and psychotherapist, PhD in Social Science at Università
degli Studi di Genova, Genoa, and researcher at the Interdisciplinary Research Institute on Sus-
tainability, Torino.
Clare Bambra is Professor of Public Health in the Faculty of Medical Sciences, Newcastle
University.
Olivia Banner is Associate Professor of Critical Media Studies at the University of Texas at
Dallas.
Rama V. Baru is Professor at the Centre of Social Medicine and Community Health, Jawaharlal
Nehru University, and Honorary Fellow at the Institute of Chinese Studies, Delhi.
Philippe Batifoulier is Professor of Economics and Deputy Director of the CEPN Society, Plural-
ism and Institutions Team, Université Sorbonne Paris Nord.
Fran Baum is Professor of Health Equity at Stretton Institute, University of Adelaide.
Anne-Emanuelle Birn is Professor of Global Development Studies, and Social and Behavioural
Health Sciences at the University of Toronto.
Mauro Bonaiuti is Professor of Economics and Statistics at the University of Turin, and a co-
founder of the Italian Degrowth Association.
Arnel M. Borras is Assistant Professor in the School of Nursing, St. Francis Xavier University.
Jackie Brown is an independent researcher who received her MES in Environmental Studies from
York University.
Robin Chang is a PhD candidate in the Department of Political Science at York University.
xiii
Contributors
Isaac Christiansen is Associate Professor of Sociology at Midwestern State University.
Tamara Daly is Professor in the School of Health Policy and Management, York University.
Raju Das is Professor in the Faculty of Environmental and Urban Change, York University.
Nicolas Da Silva is Lecturer in Economics at Université Sorbonne Paris Nord.
John B. Davis is Professor Emeritus of Economics at Marquette University, and Professor and
Chair of History and Philosophy of Economics at the University of Amsterdam.
Kevin Deane is Senior Lecturer in Economics at Open University, UK.
Jana Fey is Lecturer in Public Health at the Brighton and Sussex Medical School, University of
Sussex.
Jonathan Filippon is Senior Lecturer in Health Systems at the Wolfson Institute of Population
Health, Queen Mary University of London.
Timon Forster is Postdoctoral Research Fellow in the School of Economics and Political Science,
University of St. Gallen.
Nick J. Fox is Professor of Sociology at the University of Huddersfield.
Toby Freeman is Senior Research Fellow of Health Equity at Stretton Institute, University of
Adelaide.
Marc-André Gagnon is Associate Professor in the School of Public Policy and Administration,
Carleton University.
Deborah Gleeson is Associate Professor in the School of Psychology and Public Health, La Trobe
University.
Scott L. Greer is Professor of Health Management and Policy, Global Public Health, and Political
Science at the University of Michigan, and Senior Expert Advisor on Health Governance for the
European Observatory on Health Systems and Policies.
Jean-Germain Gros is Professor of Political Science and Public Policy Administration at the
University of Missouri-St. Louis.
Geoffrey M. Hodgson is Professor Emeritus in Management at Loughborough University, and

Editor-in-Chief of the Journal of Institutional Economics.
Shailender Kumar Hooda is Associate Professor at the Institute for Studies in Industrial Devel-
opment, New Delhi.
xiv
Contributors
Alexandros E. Kentikelenis is Associate Professor of Political Economy and Sociology at Boc-

coni University.
Lawrence King is Professor in the Department of Economics, University of Massachusetts Am-

herst, and former Professor of Sociology and Political Economy at the University of Cambridge.
John M. Kirk is Professor Emeritus of Latin American Studies at Dalhousie University.
Jennifer Lacy-Nichols is Research Fellow in the Melbourne School of Population and Global
Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne.
David G. Legge is Scholar Emeritus in Public Health at La Trobe University.
Rodney Loeppky is Associate Professor in the Department of Politics, York University.
Margitta Mätzke is Professor of Politics and Social Policy, and Chair of the Institute of Politics
and Social Policy, Johannes Kepler University of Linz.
Gerry McCartney is Professor of Wellbeing Economy in Sociology at the University of Glasgow.
Robert McMaster is Professor of Political Economy in the Adam Smith Business School, Uni-
versity of Glasgow.
Lindsay Naylor is Associate Professor in the Department of Geography and Spatial Sciences at
the University Delaware.
Laura Nervi is Associate Professor in the College of Population Health at the University of New
Mexico, United States.
Patrick Neveling is Senior Lecturer in the Department of Social Sciences, Bournemouth

University.
Madhurima Nundy is Fellow at the Centre for Social and Economic Progress, New Delhi, and
Visiting Fellow at the Institute of Chinese Studies, Delhi.
Steven Pressman is Professor Emeritus of Economics and Finance at Monmouth University, and
Part-Time Professor of Economics at the New School for Social Research.
David Primrose recently completed his PhD in the Department of Political Economy, and is an
Academic Fellow in the Menzies Centre for Health Policy and Economics, at the University of
Sydney.
Sarah Redikopp is a PhD candidate in Gender, Feminist, and Women’s Studies at York
University.
xv
Contributors
Gabor Scheiring is an Assistant Professor at Georgetown University Qatar, and a former member
of the Hungarian Parliament.
Gyorgy Scrinis is Associate Professor of Food Politics and Policy at the University of Melbourne.
Thomas H. Stubbs is Reader in Global Political Economy at Royal Holloway, University of Lon-
don, and Research Associate in Political Economy at the Centre for Business Research, University
of Cambridge.
Ben Spies-Butcher is Associate Professor of Economy and Society at Macquarie University.
Chris Thomas is Head of the Commission of Health and Prosperity at the Institute for Public
Policy Research, and Editor of Progressive Review.
Belinda Townsend is Fellow in the School of Regulation and Global Governance, Australian
National University.
Georgia van Toorn is a Lecturer in the School of Social Sciences, University of New South Wales.
Howard Waitzkin is Distinguished Professor Emeritus in the Department of Sociology, Univer-

sity of New Mexico, and Adjunct Professor in the Department of Internal Medicine, University
of Illinois.
Young Soon Wong is an independent researcher and community development worker who
received his PhD at the School of Medicine and Health Sciences, Monash University Malaysia.
Volkan Yilmaz is Lecturer (Assistant Professor) in Social Policy at the School of Applied Social
and Policy Sciences, Ulster University.
xvi
1
REVITALIZING THE POLITICAL
ECONOMY OF HEALTH
AND HEALTHCARE
IN A CONTEXT OF CRISIS
Exasperated by the teleological assumption of neoclassical economics that, free from government
‘intervention’, markets will eventually return to equilibrium, John Maynard Keynes (2013 [1923]:
65) sardonically quipped: ‘in the long run we are all dead’. The ongoing Global Coronavirus
Crisis (GCC) – the most pervasive and lethal epidemiological calamity since the 1918–19 Spanish
Influenza pandemic – has recently reinforced a parallel, if more morbid, precept. As recurrently
demonstrated throughout the history of capitalism (Szreter 2005; Leys 2009; Chernomas and
Hudson 2013), the GCC grimly confirmed that restructuring socio-ecological life around market
processes increases the likelihood of illness and death in the short run, too. Put differently, con-
trary to the assumption of both mainstream political discourse and media outlets, the pernicious
health impacts of the Crisis are not merely biological in character – the deadly result of an easily
transmissible pathogen run rampant. Nor are they simply the inadvertent product of collective
individual irrationality and recklessness in flouting government directives to wear masks and iso-
late. Rather, the global health disaster engendered by the spread of the SARS-CoV-2 virus cannot
be understood removed from the wide-reaching institutionalization and deepening of pro-market
neoliberal programs in place since the 1970s (Primrose et al. 2020; Luisetti 2022; Sparke and Wil-
liams 2022; Wamsley and Benatar 2023).
Four decades of neoliberal efforts to restructure socio-ecological spheres through a narrowly
economistic lens have, ultimately, intensified the scope of the pandemic in at least three ways. First,
the commodification of healthcare systems – reorienting them from public goods to profit-making
domains – lessened both the accessibility and quality of healthcare services. States have been left
ill-equipped to handle a public health crisis on the scale of COVID-19, with hospital capacity
scaled back, essential healthcare components privatized or outsourced, and austerity imposed on
health budgeting, particularly following the Global Financial Crisis of 2007/08 (Schrecker and
Bambra 2015; Labonté and Stuckler 2016; Fouskas and Gokay 2020; Navarro 2020).
Second, diminished public investment in infrastructure, equipment, vaccine research and
development, and medicines has occasioned states to cede ground on preventative medicine, instead
relying on pharmaceutical companies to devise strategies for a pathogenic response. Typically, the
for-profit imperatives of the pharmaceutical sector have made it less inclined to invest in non-
remunerative research and development on infectious diseases or preventive medicine in general.
Unless the state has been willing to bestow guaranteed revenues (such as those available under
1 DOI: 10.4324/9781003017110-1
so-called ‘Operation Warp Speed’ in the United States), the development of more profitable post
facto treatments remained the focus of industry (Harvey 2020; Anderson 2023). Third, neoliberal-
ism has left populations broadly vulnerable to the epidemic, by negatively influencing the social
determinants of human health. By aggravating economic inequality, making work increasingly
precarious, and undermining the quality and affordability of public services (such as public hous-
ing, childcare, and aged care), significant portions of the population faced higher risk in relation to
the pathogen and possessed fewer resources to cope with its consequences (Navarro 2020; Bambra
et al. 2021; Davy and Dickinson 2023).1
These outcomes correspond with the longer-term structural dynamics of global capitalism,
which are marked by systemic contradictions. In particular, sustained capital accumulation de-
pends on the conditions of social reproduction, such as birthing and raising children, caring for
friends and family, and preserving household and community networks. These very same necessi-
ties, however, tend to be undermined by the systemic compulsion of capitalism toward perpetual
accumulation (Fraser 2016, 2022). Accordingly, while health and healthcare might be use values
par excellence, they are of limited interest to capital unless they can be converted into exchange
value, or otherwise configured to the pursuit of expanding accumulation (Doyal 1979; Baer 1982;
Leys 2009). Indeed, prior to the outbreak of the GCC, the rapid globalization of the corporate
agri-food regime clearly contributed to the precipitous emergence and rapid dissemination of
pathogens through its ongoing disruption and commodification of local socio-ecological processes
(Wallace 2016, 2020; Akram-Lodhi 2021; Waitzkin 2021). Similarly, in the midst of the pandemic,
capitalist states were frequently willing to risk the spread of infection and heightened mortality
rates as a means to maintain a minimum level of accumulation. Advice from public health officials
around quarantine measures was often rebuffed to keep the non-essential economy open and/or en-
able resumption of regular production and consumption practices (Knott 2020; Leake et al. 2020).
It is hard, in this context, to avoid the conclusion that death, disease, and ill-health are inexo-
rably interrelated with their political-economic context (Bambra 2011; Chernomas and Hudson
2013). Both individual and population health are structured by the complex interactions between
ideas, interests, and institutions that are, in turn, inexorably interrelated with the material condi-
tions in which societies produce, distribute, exchange, consume, and reproduce. These political-
economic processes shape the capacity of the human body to reach its full potential, and the ability
of society to prevent disease and cure illness. Accordingly, they influence all elements of human
health – from food consumption and occupational health and safety, to inequality, healthcare,
and housing, and even the biophysical conditions in which humans live (Doyal 1979; Leys 2009;
Marya and Patel 2021).
Indeed, it was precisely this premise with which we hoped to engage when originally proposing
the present book to Routledge in June 2019 – less than six months before the initial outbreak of
SARS-CoV-2 in Wuhan. Prior to the crisis, a suite of complex challenges already confronted the
enduring health and well-being of humanity: persistent occupational health and safety disasters;
declining mental health standards in myriad social spheres; uneven access to quality healthcare
services; and ongoing concerns with the spread of HIV/AIDS in sub-Saharan Africa, to name but
a few. As with the pandemic, these ‘health’ or ‘healthcare’ matters cannot be understood outside of
their political-economic context. Rather, contemporary capitalism, particularly the extension of its
neoliberal form, has proven to be a pivotal factor in constituting these phenomena (Schrecker and
Bambra 2015; Sell and Williams 2020; Sparke 2020). Accordingly, while scholarly and political
attention to the efficacy of healthcare systems has burgeoned over the course of the pandemic, our
purpose in preparing this volume was to compile a series of critical reflections on these abiding
political-economic determinants and their health-related implications.
2
Revitalizing the political economy of health and healthcare
Among the explosion of valuable politically-minded health studies that have arisen in the last
decade or so, there are simply no extensive samplings of the critical political economy of health
and healthcare that might be of wide service to academics and practitioners alike. The Handbook
aims to redress this lacuna by taking stock of established and cutting-edge theoretical approaches
to the field; the political-economic dimensions of key contemporary issue-areas and their mani-
festation in geographically varied settings; and a plethora of alternative health and healthcare
configurations for a post-neoliberal (even post-capitalist) world. All of this has been done with an
open – somewhat agnostic – view of the boundaries of political economy, as a means to open the
volume as much as possible to the diverse perspectives and empirical foci comprising the field.
In doing so, our intention is to revitalize scholarly interest in the political economy of health and
healthcare by demonstrating its epistemological pertinence for comprehending a range of pressing
social concerns. Equally, we aspire to exhibit the strategic relevance of political economy as a field
of study for scholars and activists committed to transforming the world in more progressive, even
radical, directions. Most obviously, this is manifest in multiple chapters establishing healthcare
as a site of political contestation: between commercial forces seeking to commodify it further,
and other movements striving to retain it as a public good and reduce extant gross inequalities
of access. In both respects – as an invitation to intellectual controversy and stimulus for political
activity – we hope that the book contributes to ‘illuminat[ing] the world in which we live so that
we may act in it intelligently and effectively’ (Baran and Sweezy 1966: 27–8).
The contours of political economy

Before reflecting on its novel contribution to critical accounts of matters relating to health and
healthcare, it is first necessary to delineate briefly the contours of political economy as a field
of social inquiry. Political economy constitutes a critical social science, examining the complex
constellation of interrelated factors that determine the material basis of human societies, both
individually and collectively. Pertinently, this use of the term distinguishes it from its common
deployment to refer to the normative study of government policies, as distinct from the study of
‘economics’ as the study of market functions (e.g. Little 2002). It also remains distinct from the
‘economics imperialism’ of particular traditions of neoclassical economics – such as the ‘public
choice’ theories of James M. Buchanan and others at the Virginia School (see: Candela 2018) –
which use these principles to examine public policy processes (Fine and Milonakis 2009; Madra
and Adaman 2010). Accordingly, as understood in this book, political economy is not concerned
with broadening the topics to which neoclassical economic tools are applied – in this case, to the
study of health and healthcare (e.g. Furton et al. 2022). Rather, it constitutes a more complex ap-
proach to understand real-world economic issues. In this endeavor, it builds on a rich historical
legacy, stretching back at least to the Physiocrats and Adam Smith in the Eighteenth Century,
through scholars such as David Ricardo, Karl Marx, Thorstein Veblen, John Maynard Keynes,
Joan Robinson, and John Kenneth Galbraith. While diverging in their conceptual and ideological
orientations, these figures commonly sought to comprehend the progress and dynamics of soci-
ety through the study of accumulation, growth, and distribution processes (Stilwell 2002, 2023;
Stilwell et al. 2022b).
More concretely, political-economic inquiry may be understood – somewhat taxonomically –
as grounded in at least four methodological commitments (Stilwell 2019). First, political econ-
omy entails critical engagement with mainstream economic thought, centered on a neoclassical
theory of hyper-rational individuals each seeking to maximize their utility and interacting in self-
equilibrating markets. Such abstract and unrealistic accounts are devoid of social and historical
3
analysis, particularly due to their methodological individualism and implied separation between
politics and economics (Hodgson 2001; Lawson 2015). As such, they provide little explanatory
insight into the complexity and unpredictability of real-world economic systems, especially that
of capitalism (Arnsperger and Varoufakis 2008; Fine 2015; Westra 2021). Second, political econo-
mists make the case for adopting alternative theoretical traditions that articulate more realistic and
holistic accounts of economic processes as a means to comprehend their real-world complexity.
Various ‘schools’ have developed in this regard, ranging from Marxism and institutionalism, to
feminism and ecological economics (see: Lee 2009; Stilwell et al. 2022a).
Third, political economy embarks from the ontological proposition that real-world phenom-
ena do not fit neatly into boxes labeled ‘economy’, ‘society’, ‘politics’, and so forth. In turn,
practitioners seek to foster constructive transdisciplinary interchanges with other social scientific
disciplines – such as geography, psychology, and sociology – and utilize insights from them in
order to foster an interdisciplinary approach to the study of economic issues (Fine and Milonakis
2009; Crespo 2017). Fourth, and finally, because it recognizes that economic issues are inexorably
entwined with socio-ecological concerns and political judgments, political economy recognizes
that questions of ideology inevitably pervade the study of these matters (Myrdal 1969; Fine 1980;
Heilbroner 1989; Jo 2022). Accordingly, contrary to the positive-normative distinction commonly
deployed within neoclassical economics (see: Grivaux and Badiei 2022), it is futile to present the
discipline as somehow ‘value-free’ (Davis 2022). Instead, the objective is to make these ideologies
explicit and subject to scrutiny.
In practice, because political economy has been extended in distinct directions by different
schools, its commitments have commonly engendered a broader scope of inquiry than that found
in neoclassical economics. The latter attempts to replicate the formalism and universalism of the
natural sciences, such that it narrowly focuses on questions of allocative efficiency and stabil-
ity in markets (Mirowski 1991). Conversely, political economy adopts a more critical and social
scientific epistemology, thereby opening up more complex lines of research that analyses the inter-
relations between economic, political, social, cultural, historical, and ecological dynamics.
Two interrelated lines of substantive investigation may be identified in this regard (Munro
2004: 146–7). First, political economy explores the complex provisioning processes through which
goods, services, income, and wealth are produced, distributed, exchanged, and consumed within
historically specific socio-economic systems, such as capitalism or communism (Lee 2009; Jo
and Todorova 2017; Stilwell et al. 2022b). It also examines the manner in which this provisioning
process occurs within both commodified and non-commodified social spheres (for instance, within
the home, family, or community), thereby highlighting the necessary nexus between reproduc-
tion of human life and preservation of socio-economic existence (Bhattacharya 2017; Mezzadri
et al. 2022). Political economy addresses how the organization of these processes is structured by
constellations of ideas, interests, and institutions, and the resulting winners and losers engendered
by this formation – particularly through exploring the operation of power therein (Stilwell 2002;
Spies-Butcher et al. 2012). Second, political economy simultaneously explores the systemic im-
plications of such provisioning processes. It considers how their specific societal configurations,
along with the imperatives arising from them, generate (often-contradictory) dynamics and power
relations (such as those of class). These, in turn, influence the direction of virtually all other socio-
ecological structures – from family life and institutions of governance, to our collective function-
ing within extant biophysical arrangements (Moore 2015; Ferguson 2020). Thereby, it deliberates
on the broader repercussions of these processes for the material reproduction of both humanity and
the ecological systems we inhabit (Jo and Todorova 2017).
4
Reconsidering the prevailing study of health and healthcare

The chapters in this book elaborate on this agenda as a means to comprehend, and revitalize schol-
arly interest in, the complex drivers and social implications of contemporary issues of health and
healthcare. Over the course of recent decades, health and healthcare have been subject to intel-
lectual curiosity, scrutiny, and political contestation (e.g. People’s Health Movement et al. 2022).
Such discussions have provoked their fair share of ethical and political conundrums, and it is an
understatement to say that very little has been academically or practically settled in this broad
arena (Birn et al. 2017; Parker and García 2018). How should ‘health’ and ‘healthcare’ be defined?
Who should be the primary focus of analysis when dealing with human health? How much health
is enough? What kinds of social mechanisms help generate healthy societies? Which social actors
and institutions should be involved in delivering healthcare, and which should not? These are but
a few of the questions that immediately spring to mind when reflecting on the intricate domains
of health and healthcare, and a wealth of corollary and subsidiary issues could easily accompany
them.
Of course, it is possible to approach these matters from multiple conceptual and disciplinary
perspectives, all of which contribute to our understanding of certain elements of them (Collyer
2015). In this respect, health and healthcare are prisms through which concerns relating to identity,
economics, politics, sociology, science, and philosophy are refracted, rendering them rich and per-
plexing fields of study. Nevertheless, conventional explanations for health and morbidity within
scholarly and policy discourse have, until recently, largely fallen into one of two broad traditions:
biomedical and behavioral (for critical surveys, see: Chernomas and Hudson 2013: 4–5; Birn et al.
2017: 90–2).
The former approach conceives of health as a primarily individual and biological phenomenon,
in which the human body is the locus and source of ill-health, subject to biomedical manipulation
and/or interventions. From this perspective, health is comprehended predominantly as the lack of
disease, rather than as a more holistic (social, psychological, cultural) state of well-being. Con-
cretely, illness and disease are deemed the product of a combination of ‘natural’ factors – genes
and germs – and treatment focuses on restructuring individual biology, largely through pharma-
ceuticals, surgery, or genetic intervention (Clarke et al. 2003; Yuill et al. 2011: 7–10). Conversely,
behavioral approaches examine health and illness as a function of individual or household behav-
ior and beliefs, such that poor health is typically imputed to poor decisions or lack of volition. Ac-
cordingly, normative recommendations center on utilizing a combination of education, counseling
or incentive-based measures to eliminate, regulate, or circumvent self-destructive activities, as a
means to engender desirable health outcomes (Cockerham 2005; Baum and Fisher 2014). In differ-
ent ways, both the biomedical and behavioral approaches decontextualize health from its broader
socio-political environment, instead attributing poor health to the individual human body and/
or mind while formulating corresponding remedial measures targeting these spheres (Birn et al.
2017: 90–4; Rocca and Anjum 2020).
More recently, however, an alternative approach has sought to transcend this methodologi-
cal individualism and, in doing so, has become increasingly popular within mainstream public
health scholarship and political discourse. The social determinants of health (SDH) approach (e.g.
Marmot and Wilkinson 2005; WHO 2008) recognizes that health outcomes stem from myriad
social factors beyond healthcare alone, and are not reducible to the products of economically or-
ganized medical science. Alternatively, in seeking to discern the complex determinants of human
health, this tradition highlights the importance of indicators of socio-economic status (SES), such
5
as income, wealth, and education (Braveman et al. 2011; Braveman and Gottlieb 2014). The now
extensive literature in this area predominantly isolates such indicators as a means to demonstrate
their causal association with negative and/or positive health outcomes, thereby implying that se-
curing the correct balance of SES indicators would precipitate more favorable societal and/or
global health consequences (Birn et al. 2017: Chapter 7).
Undoubtedly, SDH approaches have heightened our analytical and public awareness of in-
justices surrounding health and health delivery – a fact that was plainly evident during succes-
sive COVID waves, as the relations between inequality and ill-health became increasingly stark
(Bambra et al. 2021). Without pre-existing, broad institutional acceptance of the association of
SES with health status among public health institutions, researchers, hospitals, and international
organizations, discussions concerning inequality and COVID would not have occurred with such
potency within media and governmental circles (WHO 2021; Bonner 2023). Nevertheless, despite
this important contribution in identifying a broad nexus of social factors shaping health outcomes,
the SDH literature tends to disregard the ‘upstream’ social conditions and power structures that ad-
versely affect health (Navarro 2009; Schofield 2015). That is, the tradition largely fails to progress
further up the causal chain to address how the social determinants of poor health (such as inequal-
ity) are, themselves, determined by structural factors, such as class or the systemic imperative of
capitalism toward perpetual capital accumulation. As David Coburn (2004: 44) saliently notes
with regard to SDH, ‘inequality or [socioeconomic status] simply refer to individuals or families
who are higher or lower on some characteristic without any real social relationships between these,
and without any necessary antagonism between those lower or higher’.
Hence, while recognizing the significance of SDH studies in refocusing scholarly and political
attention on social factors as the fulcrum of health and healthcare studies, the political-economic
orientation of this collection seeks to shift how we comprehend associations between SES and
health. It places the locus of causality not so much on socio-economic status, but rather on the
embodied structural forces, power, and political struggles that bring about the proximate status
of SES indicators in the first place (Labonté and Ruckert 2019; Sell and Williams 2020; Waitzkin
et al. 2020). As formulated across this volume, the political economy of health is concerned with
critically analyzing the historically specific nexus of political-economic structures, processes, and
social relations that constitute conditions in which people live and work, and thereby engender
particular individual and societal patterns of health, illness, and well-being (Krieger 2011; Cher-
nomas and Hudson 2013). Concomitant to this, the political economy of healthcare addresses
the impact of these political-economic forces on the production, distribution, and consumption
of health services, and the manner in which the latter reflects the power relations of the societies
within which medical institutions operate (Waitzkin 1978; Baer 1982).
In short, the capacity of individuals and societies to enjoy a healthy life is not solely a ttributable
to biomedical factors, individual lifestyles, or the presence of particular socio- economic
indicators. Rather, all of these are shaped by systemic political-economic dynamics and social
relations that determine the environment in which we function (Mooney 2012; Marya and Patel
2021). In the context of antagonistic class relations within capitalism, political economy stresses
the degree to which capital utilizes its structurally advantageous position to effect political and
organizational outcomes that bring about or maintain the inequalities taxonomized by SDH re-
searchers (Navarro 2002; Navarro and Muntaner 2004). While the latter appositely points to the
social nature of health injustice – for example as arising from factors such as uneven access to
affordable social housing, poor education, income and wealth inequality, or inadequate welfare
systems – political economy insists that the latter is neither incidental nor accidental. Rather,
class power and class struggle – however subtly arranged, regulated, or reinforced – are largely
6
responsible for the inequalities we now recognize more broadly as affecting health and well-
being (Coburn 2010).
To illustrate, many recent studies of mental health have usefully avoided biologically deter-
ministic explanations of problems such as anxiety and depression, by instead locating their social
determinants in factors such as employment instability, discrimination, inequality, adverse life
experiences, poor education, familial instability, and isolated or destitute residential and working
conditions (e.g. Compton and Shim 2015; Alegría et al. 2018). Yet, as Jana Fey’s contribution to
this volume reveals, the proliferation of such factors must be comprehended as, at least partly,
having been propelled by efforts from capital and capitalist state institutions to neoliberalize the
governance of multiple spheres of social life over recent decades. As a means to secure ongoing
capital accumulation, however, these endeavors have undermined the social conditions for mental
health – whether through the commodification of desire and leisure, codifying increasingly pre-
carious working conditions and homeownership, or introducing multiple rounds of fiscal austerity
(Matthews 2019). Thus, as Vicente Navarro (2009: 423) pithily quips: ‘[i]t is not inequalities that
kill people […] it is those responsible for these inequalities that kill people’.
In idiosyncratically developing this agenda across their respective chapters, the contributions
to this Handbook stand on the shoulders of giants in the field – from Louis-René Villermé, Rudolf
Virchow, and Friedrich Engels, to Lesley Doyal, Howard Waitzkin, Vicente Navarro, Julian Tudor-
Hart, and Gavin Mooney – to analyze the complex political-economic determinants of myriad
contemporary health and healthcare issues. In doing so, as with political-economic analysis more
broadly, there is also a strong tendency among chapters to develop their accounts through eschew-
ing the traditional division of labor erected between disciplines within the social sciences (see
also: Navarro 1976: viii). Instead, the volume brings together an array of authors seeking to dem-
onstrate the saliency of political economy for comprehending contemporary health and healthcare
practices by embracing interdisciplinary insights from diverse scholarly domains, such as history,
epidemiology, political science, anthropology, and sociology. The resulting studies present wide-
ranging and critical reflections on the pernicious effects of neoliberalism and capitalism on health,
while also demonstrating the need to rethink the political means to redress these concerns.
Structure of the volume

In articulating this agenda, the chapters in this volume are apportioned across five distinct sec-
tions. Part one features chapters reflecting on the political economy of health and healthcare from
different theoretical traditions. The objective of this section is not to provide a meta-theoretical
framework for the Handbook as a whole. Indeed, the volume interprets political economy as
an irreducibly pluralist endeavor, characterized by multiple, overlapping schools of thought.
Accordingly, as a means to enable readers to engage with and juxtapose ideas from each, this
opening section introduces and critically reflects on the contribution of multiple contemporary
schools – both mainstream and more critical – within the political economy of health and health-
care (see also: Mooney 2009; Davis and McMaster 2017). Each chapter focuses on an individual
theoretical approach: (neoclassical) health economics, the economics of conventions, Marxism,
post-Keynesianism, feminism, new materialism, and behavioral economics.
Building on these conceptual insights, parts two and three examine the political-economic char-
acter of a variety of long-standing health and healthcare issues from around the globe. Each chap-
ter reflects critically on the form and implications of these issues, by investigating their relation
to developments in contemporary capitalism and, in particular, the contemporary extension of
neoliberalism. The Constitution of the World Health Organization (WHO 1948: 1) proclaims that
7
‘[t]he enjoyment of the highest attainable standard of health is one of the most fundamental rights
of every human being’. Moreover, ‘[g]overnments have a responsibility for the health of their
peoples which can be fulfilled only by the provision of adequate health and social measures’. From
this perspective, by means of their capacity to influence both the social determinants of health and
prevailing healthcare system, states should play a key role in securing the health and well-being
of its citizens as a basic right. Nevertheless, as demonstrated by the chapters in these sections, the
increasingly pervasive influence of neoliberalism as a rationality of governance over the preced-
ing four decades has seen states largely abrogate this obligation. Instead, widespread neoliberal
policies and governance mentalities have undermined the socio-ecological conditions determin-
ing health, while cultivating and institutionalizing commodified healthcare primarily as a site of
capital accumulation (see also: Sparke 2020). Put simply, the present political-economic context
has generated many noxious consequences for human health and well-being.
Part four is organized around exploring the interplay of these dynamics in determining health
trends and the direction of healthcare systems in geographically specific environments. Con-
centrating on a diversity of countries and regions – from sub-Saharan Africa and post-Soviet
Eastern Europe, to the European Union and Australia – chapters critically investigate how the
vicissitudes of health and healthcare delivery are intertwined with contextually specific histori-
cal and contemporary political-economic processes, as well as the broader dynamics of global
capitalism. As grimly revealed by the GCC, the interplay of these factors engenders substantial
divergences in population health and well-being, as well as the capacity of healthcare systems to
prevent and treat illness and disease (Sheehan and Fox 2020; Serikbayeva et al. 2021; Jones and
Hameiri 2022). Consistent with the preceding two sections, these chapters also collectively re-
veal a common ‘red-thread’ running through their case-studies: neoliberalism has fostered a shift
from healthcare as a public good to a novel site of capital accumulation via its commodification,
while simultaneously producing deleterious consequences for the broader social determinants of
population health.
Given the multifaceted malaise afflicting health and healthcare outlined over the preceding
four sections, it remains prudent to ask: what political-economic conditions are necessary to se-
cure a more positive, equitable course in global population health and well-being, and how can
healthcare systems be geared toward this end? Can such outcomes be engendered through recon-
figuring capitalism in more progressive directions, or are broader, revolutionary socio-ecological
transformations required? In addressing these complex normative questions, part five concludes
the volume by surveying the opportunities and challenges associated with constructing alterna-
tive political economies of health and healthcare that transcend their extant neoliberal, or even
capitalist, forms (see also: Deppe 2010; Waitzkin et al. 2018; Adler-Bolton and Vierkant 2022).
To this end, contributions analyze a range of existing systems that diverge from prevailing in-
stitutions and ideologies – such as those of Cuban internationalism and commons-based health-
care arrangements – and the more general lessons for political economy that can be extrapolated
from their operation in practice. This final section also includes more speculative accounts of
how alternative health and healthcare processes may be restructured – for instance, according to
principles of degrowth or post-capitalism – to foster more socially just, inclusive, and effective
outcomes. In both cases, chapters unanimously favor extending practices of decommodification
and reinstitutionalizing more democratic political practices, upon which fundamentally different
health systems might be constructed.
Across each section, in keeping with our commitment to foster renewed interest in the political
economy of health and healthcare as a valuable field of study, we have sought to include a diver-
sity of germane perspectives and issues. Nevertheless, some apposite theoretical approaches and
8
topics did not ‘make the cut’, or only receive brief mention within existing chapters. For instance,
the traditions of institutional economics (Champlin and Knoedler 2008; Hodgson 2008; Josifidis
and Supic 2022) and social economics (Davis 2001; Davis and McMaster 2017) present powerful
theoretical alternatives to the prevailing neoclassical school informing mainstream ‘health eco-
nomics’ and, thus, warrant further elaboration in future research. Moreover, the particular implica-
tions of capitalism for the health and healthcare needs of Indigenous groups (Saggers and Walter
2007; Ullah 2016) and queer communities (Padilla et al. 2007; Bell 2020) are germane issues that
remain comparatively underexplored within extant political-economic literature.
Moreover, as acutely highlighted during the GCC, capitalism also engenders contradictory
political-economic processes that have deleteriously affected population health by perpetuating
racialized (Laster Pirtle 2020; McClure et al. 2020) and developmental inequalities (Birn et al.
2017; Labonté and Ruckert 2019) within and between countries. Such inequalities have also fed
into contemporary problems of addiction (Young and Markham 2017; Courtwright 2019), which
have been especially pronounced in the ongoing opioid epidemic sweeping across the Americas
(Pereira 2021; Hansen et al. 2023). Finally, as the ecological rhythms of the Earth continue to be
detrimentally affected by climate change, the complex interrelations between these and capital-
ism in determining global planetary health (Gill and Benatar 2020; Baer and Singer forthcom-
ing) promise to become an increasingly prominent topic in coming decades. Readers interested
in further exploring these important themes should consult the illustrative sources for each listed
above, in conjunction with the broader reflections on the political economy of health and health-
care explored in this volume.
Looking forward
This Handbook was prepared in the midst of yet another capitalist crisis that menaced the con-
tinued well-being of societies. In turn, it was submitted in early 2023 when COVID-19 remained
a virulent – if less politically deliberated – threat to population health, especially in the con-
text of the continued obstinacy of neoliberalism (Šumonja 2021; Wood et al. 2023). The volume,
thereby, emerges in a context in which the importance of health for politics, as well as the political-
economic character of health, could not be more prescient. Since early 2020, the world has been
in the grips of the novel coronavirus, its variants, and now subvariants. With close to 610 million
reported cases and 6.5 million deaths at the time of writing, COVID-19 has demonstrated not only
the critical importance of public health, but also the general centrality of political-economic issues
to health and well-being. Whether considering geographical disparities and resource-poor health-
care settings; unequal access to care; deep relationships between inequality, race, and poor health
outcomes; North-South disparities in access to medicines; or the extraordinarily ageist results of
austerity, long-term care, and residential outbreaks, the ongoing pandemic has thrust the political-
economic character of health and healthcare heavily into the spotlight.
By subjecting the latter to scrutiny with regard to a wide range of issues and within diverse geo-
graphical contexts, we hope that this volume facilitates a rejuvenation of debate over the complex
social determinants of health. Indeed, we consider the book less a ‘handbook’ in the conventional
sense – as an introductory reference to various topics – and more a ‘reader’ compiling a range of
argumentative pieces, deliberately designed to provoke critical discussion and future scholarly
work. That is, we wish for the chapters contained herein to contribute to shifting the epistemologi-
cal locus of deliberations on health and healthcare from the confines of neoclassical economics
and neoliberal policies, toward more capacious formulations of their political-economic character.
In the present conjuncture, this task is more salient than ever.
9
Nevertheless, while necessary, this step alone remains insufficient as a means to achieve more
amenable conditions for human health. Renewed scholarly concern with the political economy
of health and healthcare as a field of study must be complemented by the involvement of social
movements capable of struggling for progressive or radical political alternatives across this ter-
rain (Panitch and Leys 2009; Waitzkin et al. 2018). We do not, in this regard, predict any sudden
regression of the current neoliberal orientation of health and healthcare due to the publication of
this volume. Instead, for scholars and activists seeking to secure transformative health outcomes
in a post-GCC era, we tender this Handbook as a kind of clarion call for political strategy. As the
following chapters demonstrate, the quality of health and healthcare systems remain products of
material and ideological determinants that, themselves, must be contested and reoriented in order
to effect alternative outcomes.
For instance, as Patrick Neveling’s contribution reveals, the appalling occupational health and
safety (OH&S) conditions confronting workers in the global garment industry have not simply
arisen from the actions of negligent individual employers. Rather, they stem from numerous his-
torical institutions, policies, and laws codified by capitalist states that prioritize accumulation over
worker safety, as well as globalized commodity chains that both minimize capital investment in
technology and circumvent expenditure on OH&S for ‘undeserving’ workers. Effectively redress-
ing such concerns necessitates locating the capitalist state, the garment industry, and the exploita-
tive dynamics of global capitalism as sites of political contestation (see also: Heino 2013; Lax
2020). The broader implication here is that, while illness and death are an inevitable part of human
life, the dynamics of neoliberalism and capitalism accelerate and magnify this reality in avoidable
ways. As such, ‘the demand for a healthier society is, in itself, the demand for a radically different
socio-economic order’ (Doyal 1979: 296–7).
In this respect, while its constitutive chapters adopt multiple, sometimes incommensurable po-
litical angles on issues of health, the volume as a whole should contribute to the formulation of
political strategies centered on what Slavoj Žižek (2017) has called the ‘courage of hopelessness’.
For Žižek, it is self-defeating to trust in the deceptive optimism of a promised progressive future
when confronted by breakdowns in the existing political-economic order. Indeed, ‘the light at
the end of the tunnel is probably the headlight of another train approaching us from the opposite
direction’ (Žižek 2017: xii). Conversely, despairing at the perpetual failure of techno-managerial
and neoliberal reforms within the status quo and, thus, acknowledging the gravity of the current
conjuncture may foster decisive political action and the pursuit of more radical transformation
(see also: Žižek 2023). To paraphrase Romain Rolland’s (1920) famous maxim, the necessary
optimism of the will for emancipatory political action must first be nourished by a substantial pes-
simism of the intellect.
The chapters of the Handbook contribute to this orientation by explicating (i) the scope and
scale of contemporary health and healthcare challenges, and (ii) their intimate relation to the rou-
tine operation of neoliberal policies and the structural dynamics of capitalism. Hence, the volume
challenges critical scholars and activists hoping to address (i) to confront the inherent limitations –
the ‘hopelessness’ – of acquiescing to (ii) as the ultimate horizon for action and, thus, of pursuing
incremental political solutions to eventually render the status quo more palatable. In the crisis-
ridden conjuncture of contemporary capitalism, the effects of neoliberalism in eviscerating the
socio-ecological conditions of health have been recognized and weaponized by Far-Right move-
ments (Stuckler 2017; Falkenbach and Heiss 2021; Labonté and Baum 2021). For instance, the
latter have promulgated forms of ‘welfare chauvinism’ – promising maintenance or augmentation
of welfare benefits for core constituencies, while disregarding minorities (Greer 2017). This was
notoriously exemplified in 2016 by placards adorning the ‘Brexit bus’ undertaking to remedy UK
10
health concerns upon leaving the EU by reallocating an additional £350 million each week to
the NHS. Analogously, we hope that the contents of the book may prompt progressive and radi-
cal social forces to reflect on the need to embrace the inescapably dire consequences for health
and healthcare propagated by neoliberalism and capitalism. The associated ‘despair’ arising from
recognizing the hopelessness of attempting to ‘fix’ the status quo via perennial techno-managerial
tinkering may, in turn, prompt these movements to channel their efforts toward systemic political-
economic change to secure more efficacious and equitable health outcomes.
On this semi-sanguine note, we would like to take the opportunity to acknowledge and express
our appreciation to those who have helped bring this undertaking to fruition. Despite the demand-
ing, often gloomy context in which it was conceived and organized over the past few years, it has
been a pleasure to work together to prepare the Handbook. In this respect, we first wish to thank
each other, as co-editors, for the opportunity to develop a project collectively in a research area of
substantial social import. We are also sincerely grateful to all chapter authors for their excellent
contributions and ongoing commitment to the project, especially when many divided their exper-
tise between academia and working as medical professionals during the GCC. Our heartfelt thanks
go out to Andy Humphries at Routledge for his patience, enthusiasm, and sage advice on the
volume during its extended compilation and gestation. Thank you, too, to the team at Routledge
for their fine work in helping to ensure the book’s production was a straightforward and positive
experience. Finally, to our families and loved ones, we must extend our warm appreciation for
your enduring support while the book was completed – especially given two new additions were
born during its production! We hope that this volume will contribute in some small way to revital-
izing debate over the complex political economy of health and healthcare so that they and future
generations may contribute to a world in which capital accumulation is subordinated to the health
and welfare of humanity and the planet.
Note
1 Similarly, despite the GCC manifestly demonstrating the pernicious repercussions of neoliberalism for
both population health and healthcare systems, the latter continues to delimit the ideological horizon
for public health discourse (Primrose et al. 2020). Since the outbreak of the pandemic, mainstream po-
litical deliberations have largely disregarded the potential for introducing alternative measures designed
to restructure the neoliberal subsumption of social reproduction to capital through reconfiguring exist-
ing health systems. Instead, public policy aspirations have remained been oriented toward facilitating
the prompt resumption of economic activity within extant neoliberal structures (Šumonja 2021; Wallace
2023; Wood et al. 2023) – that is within ‘the partition of the sensible’ (Rancière 1998).
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12
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peace have expressed at Shakspeare. The veriest churl and Jacobin
cannot resist the influence of the style and manners of these haughty
lords. We are affected, as boys and barbarians are, by the
appearance of a few rich and wilful gentlemen who take their honor
into their own keeping, defy the world, so confident are they of their
courage and strength, and whose appearance is the arrival of so
much life and virtue. In dangerous times they are presently tried, and
therefore their name is a flourish of trumpets. They, at least, affect us
as a reality. They are not shams, but the substance of which that age
and world is made. They are true heroes for their time. They make
what is in their minds the greatest sacrifice. They will, for an injurious
word, peril all their state and wealth, and go to the field. Take away
that principle of responsibleness, and they become pirates and
ruffians.[127]
This self-subsistency is the charm of war; for this self-subsistency
is essential to our idea of man. But another age comes, a truer
religion and ethics open, and a man puts himself under the dominion
of principles. I see him to be the servant of truth, of love and of
freedom, and immovable in the waves of the crowd. The man of
principle, that is, the man who, without any flourish of trumpets, titles
of lordship or train of guards, without any notice of his action abroad,
expecting none, takes in solitude the right step uniformly, on his
private choice and disdaining consequences,—does not yield, in my
imagination, to any man. He is willing to be hanged at his own gate,
rather than consent to any compromise of his freedom or the
suppression of his conviction. I regard no longer those names that so
tingled in my ear. This is a baron of a better nobility and a stouter
stomach.
The cause of peace is not the cause of cowardice. If peace is
sought to be defended or preserved for the safety of the luxurious
and the timid, it is a sham, and the peace will be base. War is better,
and the peace will be broken. If peace is to be maintained, it must be
by brave men, who have come up to the same height as the hero,
namely, the will to carry their life in their hand, and stake it at any
instant for their principle, but who have gone one step beyond the
hero, and will not seek another man’s life;—men who have, by their
intellectual insight or else by their moral elevation, attained such a
perception of their own intrinsic worth that they do not think property
or their own body a sufficient good to be saved by such dereliction of
principle as treating a man like a sheep.
If the universal cry for reform of so many inveterate abuses, with
which society rings,—if the desire of a large class of young men for a
faith and hope, intellectual and religious, such as they have not yet
found, be an omen to be trusted; if the disposition to rely more, in
study and in action, on the unexplored riches of the human
constitution,—if the search of the sublime laws of morals and the
sources of hope and trust, in man, and not in books, in the present,
and not in the past, proceed; if the rising generation can be provoked
to think it unworthy to nestle into every abomination of the past, and
shall feel the generous darings of austerity and virtue, then war has
a short day, and human blood will cease to flow.
It is of little consequence in what manner, through what organs,
this purpose of mercy and holiness is effected. The proposition of the
Congress of Nations is undoubtedly that at which the present fabric
of our society and the present course of events do point. But the
mind, once prepared for the reign of principles, will easily find modes
of expressing its will. There is the highest fitness in the place and
time in which this enterprise is begun. Not in an obscure corner, not
in a feudal Europe, not in an antiquated appanage where no onward
step can be taken without rebellion, is this seed of benevolence laid
in the furrow, with tears of hope; but in this broad America of God
and man, where the forest is only now falling, or yet to fall, and the
green earth opened to the inundation of emigrant men from all
quarters of oppression and guilt; here, where not a family, not a few
men, but mankind, shall say what shall be; here, we ask, Shall it be
War, or shall it be Peace?
VI
THE FUGITIVE SLAVE LAW
ADDRESS TO CITIZENS OF CONCORD 3 MAY,

1851
The Eternal Rights,

Victors over daily wrongs:
Awful victors, they misguide
Whom they will destroy,
And their coming triumph hide
In our downfall, or our joy:
They reach no term, they never sleep,
In equal strength through space abide;
Though, feigning dwarfs, they crouch and creep,
The strong they slay, the swift outstride;
Fate’s grass grows rank in valley clods,
And rankly on the castled steep,—
Speak it firmly, these are gods,
Are all ghosts beside.
THE FUGITIVE SLAVE LAW

Fellow citizens: I accepted your invitation to speak to you on the
great question of these days, with very little consideration of what I
might have to offer: for there seems to be no option. The last year
has forced us all into politics, and made it a paramount duty to seek
what it is often a duty to shun. We do not breathe well. There is
infamy in the air. I have a new experience. I wake in the morning with
a painful sensation, which I carry about all day, and which, when
traced home, is the odious remembrance of that ignominy which has
fallen on Massachusetts, which robs the landscape of beauty, and
takes the sunshine out of every hour. I have lived all my life in this
state, and never had any experience of personal inconvenience from
the laws, until now. They never came near me to any discomfort
before. I find the like sensibility in my neighbors; and in that class
who take no interest in the ordinary questions of party politics. There
are men who are as sure indexes of the equity of legislation and of
the same state of public feeling, as the barometer is of the weight of
the air, and it is a bad sign when these are discontented, for though
they snuff oppression and dishonor at a distance, it is because they
are more impressionable: the whole population will in a short time be
as painfully affected.
Every hour brings us from distant quarters of the Union the
expression of mortification at the late events in Massachusetts, and
at the behavior of Boston. The tameness was indeed shocking.
Boston, of whose fame for spirit and character we have all been so
proud; Boston, whose citizens, intelligent people in England told me
they could always distinguish by their culture among Americans; the
Boston of the American Revolution, which figures so proudly in John
Adams’s Diary, which the whole country has been reading; Boston,
spoiled by prosperity, must bow its ancient honor in the dust, and
make us irretrievably ashamed. In Boston, we have said with such
lofty confidence, no fugitive slave can be arrested, and now, we must
transfer our vaunt to the country, and say, with a little less
confidence, no fugitive man can be arrested here; at least we can
brag thus until to-morrow, when the farmers also may be corrupted.
The tameness is indeed complete. The only haste in Boston, after
the rescue of Shadrach,[128] last February, was, who should first put
his name on the list of volunteers in aid of the marshal. I met the
smoothest of Episcopal Clergymen the other day, and allusion being
made to Mr. Webster’s treachery, he blandly replied, “Why, do you
know I think that the great action of his life.” It looked as if in the city
and the suburbs all were involved in one hot haste of terror,—
presidents of colleges, and professors, saints, and brokers, insurers,
lawyers, importers, manufacturers: not an unpleasing sentiment, not
a liberal recollection, not so much as a snatch of an old song for
freedom, dares intrude on their passive obedience.
The panic has paralyzed the journals, with the fewest exceptions,
so that one cannot open a newspaper without being disgusted by
new records of shame. I cannot read longer even the local good
news. When I look down the columns at the titles of paragraphs,
“Education in Massachusetts,” “Board of Trade,” “Art Union,” “Revival
of Religion,” what bitter mockeries! The very convenience of
property, the house and land we occupy, have lost their best value,
and a man looks gloomily at his children, and thinks, “What have I
done that you should begin life in dishonor?” Every liberal study is
discredited,—literature and science appear effeminate, and the
hiding of the head. The college, the churches, the schools, the very
shops and factories are discredited; real estate, every kind of wealth,
every branch of industry, every avenue to power, suffers injury, and
the value of life is reduced. Just now a friend came into my house
and said, “If this law shall be repealed I shall be glad that I have
lived; if not I shall be sorry that I was born.” What kind of law is that
which extorts language like this from the heart of a free and civilized
people?
One intellectual benefit we owe to the late disgraces. The crisis
had the illuminating power of a sheet of lightning at midnight. It
showed truth. It ended a good deal of nonsense we had been wont
to hear and to repeat, on the 19th of April, the 17th of June, the 4th
of July. It showed the slightness and unreliableness of our social
fabric, it showed what stuff reputations are made of, what straws we
dignify by office and title, and how competent we are to give counsel
and help in a day of trial. It showed the shallowness of leaders; the
divergence of parties from their alleged grounds; showed that men
would not stick to what they had said, that the resolutions of public
bodies, or the pledges never so often given and put on record of
public men, will not bind them. The fact comes out more plainly that
you cannot rely on any man for the defence of truth, who is not
constitutionally or by blood and temperament on that side. A man of
a greedy and unscrupulous selfishness may maintain morals when
they are in fashion: but he will not stick. However close Mr. Wolf’s
nails have been pared, however neatly he has been shaved, and
tailored, and set up on end, and taught to say, “Virtue and Religion,”
he cannot be relied on at a pinch: he will say, morality means
pricking a vein. The popular assumption that all men loved freedom,
and believed in the Christian religion, was found hollow American
brag; only persons who were known and tried benefactors are found
standing for freedom: the sentimentalists went downstream.[129] I
question the value of our civilization, when I see that the public mind
had never less hold of the strongest of all truths. The sense of
injustice is blunted,—a sure sign of the shallowness of our intellect. I
cannot accept the railroad and telegraph in exchange for reason and
charity. It is not skill in iron locomotives that makes so fine civility, as
the jealousy of liberty. I cannot think the most judicious tubing a
compensation for metaphysical debility. What is the use of admirable
law-forms, and political forms, if a hurricane of party feeling and a
combination of monied interests can beat them to the ground? What
is the use of courts, if judges only quote authorities, and no judge
exerts original jurisdiction, or recurs to first principles? What is the
use of a Federal Bench, if its opinions are the political breath of the
hour? And what is the use of constitutions, if all the guaranties
provided by the jealousy of ages for the protection of liberty are
made of no effect, when a bad act of Congress finds a willing
commissioner? The levity of the public mind has been shown in the
past year by the most extravagant actions. Who could have believed
it, if foretold that a hundred guns would be fired in Boston on the
passage of the Fugitive Slave Bill? Nothing proves the want of all
thought, the absence of standard in men’s minds, more than the
dominion of party. Here are humane people who have tears for
misery, an open purse for want; who should have been the
defenders of the poor man, are found his embittered enemies,
rejoicing in his rendition,—merely from party ties. I thought none, that
was not ready to go on all fours, would back this law. And yet here
are upright men, compotes mentis, husbands, fathers, trustees,
friends, open, generous, brave, who can see nothing in this claim for
bare humanity, and the health and honor of their native State, but
canting fanaticism, sedition and “one idea.” Because of this
preoccupied mind, the whole wealth and power of Boston—two
hundred thousand souls, and one hundred and eighty millions of
money—are thrown into the scale of crime: and the poor black boy,
whom the fame of Boston had reached in the recesses of a vile
swamp, or in the alleys of Savannah, on arriving here finds all this
force employed to catch him. The famous town of Boston is his
master’s hound. The learning of the universities, the culture of
elegant society, the acumen of lawyers, the majesty of the Bench,
the eloquence of the Christian pulpit, the stoutness of Democracy,
the respectability of the Whig party are all combined to kidnap him.
The crisis is interesting as it shows the self-protecting nature of the
world and of the Divine laws. It is the law of the world,—as much
immorality as there is, so much misery. The greatest prosperity will in
vain resist the greatest calamity. You borrow the succour of the devil
and he must have his fee. He was never known to abate a penny of
his rents. In every nation all the immorality that exists breeds
plagues. But of the corrupt society that exists we have never been
able to combine any pure prosperity There is always something in
the very advantages of a condition which hurts it. Africa has its
malformation; England has its Ireland; Germany its hatred of
classes; France its love of gunpowder; Italy its Pope; and America,
the most prosperous country in the Universe, has the greatest
calamity in the Universe, negro slavery.
Let me remind you a little in detail how the natural retribution acts
in reference to the statute which Congress passed a year ago. For
these few months have shown very conspicuously its nature and
impracticability. It is contravened:
1. By the sentiment of duty. An immoral law makes it a man’s duty
to break it, at every hazard. For virtue is the very self of every man. It
is therefore a principle of law that an immoral contract is void, and
that an immoral statute is void. For, as laws do not make right, and
are simply declaratory of a right which already existed, it is not to be
presumed that they can so stultify themselves as to command
injustice.
It is remarkable how rare in the history of tyrants is an immoral
law. Some color, some indirection was always used. If you take up
the volumes of the “Universal History,” you will find it difficult
searching. The precedents are few. It is not easy to parallel the
wickedness of this American law. And that is the head and body of
this discontent, that the law is immoral.
Here is a statute which enacts the crime of kidnapping,—a crime
on one footing with arson and murder. A man’s right to liberty is as
inalienable as his right to life.
Pains seem to have been taken to give us in this statute a wrong
pure from any mixture of right. If our resistance to this law is not
right, there is no right. This is not meddling with other people’s
affairs: this is hindering other people from meddling with us. This is
not going crusading into Virginia and Georgia after slaves, who, it is
alleged, are very comfortable where they are:—that amiable
argument falls to the ground: but this is befriending in our own State,
on our own farms, a man who has taken the risk of being shot, or
burned alive, or cast into the sea, or starved to death, or suffocated
in a wooden box, to get away from his driver: and this man who has
run the gauntlet of a thousand miles for his freedom, the statute
says, you men of Massachusetts shall hunt, and catch, and send
back again to the dog-hutch he fled from.
It is contrary to the primal sentiment of duty, and therefore all men
that are born are, in proportion to their power of thought and their
moral sensibility, found to be the natural enemies of this law. The
resistance of all moral beings is secured to it. I had thought, I
confess, what must come at last would come at first, a banding of all
men against the authority of this statute. I thought it a point on which
all sane men were agreed, that the law must respect the public
morality. I thought that all men of all conditions had been made
sharers of a certain experience, that in certain rare and retired
moments they had been made to see how man is man, or what
makes the essence of rational beings, namely, that whilst animals
have to do with eating the fruits of the ground, men have to do with
rectitude, with benefit, with truth, with something which is,
independent of appearances: and that this tie makes the
substantiality of life, this, and not their ploughing, or sailing, their
trade or the breeding of families. I thought that every time a man
goes back to his own thoughts, these angels receive him, talk with
him, and that, in the best hours, he is uplifted in virtue of this
essence, into a peace and into a power which the material world
cannot give: that these moments counterbalance the years of
drudgery, and that this owning of a law, be it called morals, religion,
or godhead, or what you will, constituted the explanation of life, the
excuse and indemnity for the errors and calamities which sadden it.
In long years consumed in trifles, they remember these moments,
and are consoled. I thought it was this fair mystery, whose
foundations are hidden in eternity, which made the basis of human
society, and of law; and that to pretend anything else, as that the
acquisition of property was the end of living, was to confound all
distinctions, to make the world a greasy hotel, and, instead of noble
motives and inspirations, and a heaven of companions and angels
around and before us, to leave us in a grimacing menagerie of
monkeys and idiots. All arts, customs, societies, books, and laws,
are good as they foster and concur with this spiritual element: all
men are beloved as they raise us to it; hateful as they deny or resist
it. The laws especially draw their obligation only from their
concurrence with it.
I am surprised that lawyers can be so blind as to suffer the
principles of Law to be discredited. A few months ago, in my dismay
at hearing that the Higher Law was reckoned a good joke in the
courts, I took pains to look into a few law-books. I had often heard
that the Bible constituted a part of every technical law library, and
that it was a principle in law that immoral laws are void.
I found, accordingly, that the great jurists, Cicero, Grotius, Coke,
Blackstone, Burlamaqui, Montesquieu, Vattel, Burke, Mackintosh,
Jefferson, do all affirm this. I have no intention to recite these
passages I had marked:—such citation indeed seems to be
something cowardly (for no reasonable person needs a quotation
from Blackstone to convince him that white cannot be legislated to
be black), and shall content myself with reading a single passage.
Blackstone admits the sovereignty “antecedent to any positive
precept, of the law of Nature,” among whose principles are, “that we
should live on, should hurt nobody, and should render unto every
one his due,” etc. “No human laws are of any validity, if contrary to
this.” “Nay, if any human law should allow or enjoin us to commit a
crime” (his instance is murder), “we are bound to transgress that
human law; or else we must offend both the natural and divine.” Lord
Coke held that where an Act of Parliament is against common right
and reason, the common law shall control it, and adjudge it to be
void. Chief Justice Hobart, Chief Justice Holt, and Chief Justice
Mansfield held the same.
Lord Mansfield, in the case of the slave Somerset, wherein the
dicta of Lords Talbot and Hardwicke had been cited, to the effect of
carrying back the slave to the West Indies, said, “I care not for the
supposed dicta of judges, however eminent, if they be contrary to all
principle.” Even the Canon Law says (in malis promissis non expedit
servare fidem), “Neither allegiance nor oath can bind to obey that
which is wrong.”
No engagement (to a sovereign) can oblige or even authorize a
man to violate the laws of Nature. All authors who have any
conscience or modesty agree that a person ought not to obey such
commands as are evidently contrary to the laws of God. Those
governors of places who bravely refused to execute the barbarous
orders of Charles IX. for the famous “Massacre of St. Bartholomew,”
have been universally praised; and the court did not dare to punish
them, at least openly. “Sire,” said the brave Orte, governor of
Bayonne, in his letter, “I have communicated your majesty’s
command to your faithful inhabitants and warriors in the garrison,
and I have found there only good citizens, and brave soldiers; not
one hangman: therefore, both they and I must humbly entreat your
majesty to be pleased to employ your arms and lives in things that
are possible, however hazardous they may be, and we will exert
ourselves to the last drop of our blood.”[130]
The practitioners should guard this dogma well, as the palladium
of the profession, as their anchor in the respect of mankind. Against
a principle like this, all the arguments of Mr. Webster are the spray of
a child’s squirt against a granite wall.
2. It is contravened by all the sentiments. How can a law be
enforced that fines pity, and imprisons charity? As long as men have
bowels, they will disobey. You know that the Act of Congress of
September 18, 1850, is a law which every one of you will break on
the earliest occasion. There is not a manly Whig, or a manly
Democrat, of whom, if a slave were hidden in one of our houses from
the hounds, we should not ask with confidence to lend his wagon in
aid of his escape, and he would lend it. The man would be too strong
for the partisan.
And here I may say that it is absurd, what I often hear, to accuse
the friends of freedom in the North with being the occasion of the
new stringency of the Southern slave-laws. If you starve or beat the
orphan, in my presence, and I accuse your cruelty, can I help it? In
the words of Electra in the Greek tragedy, “’Tis you that say it, not I.
You do the deeds, and your ungodly deeds find me the words.” Will
you blame the ball for rebounding from the floor, blame the air for
rushing in where a vacuum is made or the boiler for exploding under
pressure of steam? These facts are after laws of the world, and so is
it law, that, when justice is violated, anger begins. The very defence
which the God of Nature has provided for the innocent against
cruelty is the sentiment of indignation and pity in the bosom of the
beholder. Mr. Webster tells the President that “he has been in the
North, and he has found no man, whose opinion is of any weight,
who is opposed to the law.” Oh, Mr. President, trust not the
information! The gravid old Universe goes spawning on; the womb
conceives and the breasts give suck to thousands and millions of
hairy babes formed not in the image of your statute, but in the image
of the Universe; too many to be bought off; too many than they can
be rich, and therefore peaceable; and necessitated to express first or
last every feeling of the heart. You can keep no secret, for whatever
is true some of them will unreasonably say. You can commit no
crime, for they are created in their sentiments conscious of and
hostile to it; and unless you can suppress the newspaper, pass a law
against book-shops, gag the English tongue in America, all short of
this is futile. This dreadful English Speech is saturated with songs,
proverbs and speeches that flatly contradict and defy every line of
Mr. Mason’s statute. Nay, unless you can draw a sponge over those
seditious Ten Commandments which are the root of our European
and American civilization; and over that eleventh commandment, “Do
unto others as you would have them do to you,” your labor is vain.
3. It is contravened by the written laws themselves, because the
sentiments, of course, write the statutes. Laws are merely
declaratory of the natural sentiments of mankind, and the language
of all permanent laws will be in contradiction to any immoral
enactment. And thus it happens here: Statute fights against Statute.
By the law of Congress March 2, 1807, it is piracy and murder,
punishable with death, to enslave a man on the coast of Africa. By
law of Congress September, 1850, it is a high crime and
misdemeanor, punishable with fine and imprisonment, to resist the
reënslaving a man on the coast of America. Off soundings, it is
piracy and murder to enslave him. On soundings, it is fine and prison
not to reënslave. What kind of legislation is this? What kind of
constitution which covers it? And yet the crime which the second law
ordains is greater than the crime which the first law forbids under
penalty of the gibbet. For it is a greater crime to reënslave a man
who has shown himself fit for freedom, than to enslave him at first,
when it might be pretended to be a mitigation of his lot as a captive
in war.
4. It is contravened by the mischiefs it operates. A wicked law
cannot be executed by good men, and must be by bad. Flagitious
men must be employed, and every act of theirs is a stab at the public
peace. It cannot be executed at such a cost, and so it brings a bribe
in its hand. This law comes with infamy in it, and out of it. It offers a
bribe in its own clauses for the consummation of the crime. To serve
it, low and mean people are found by the groping of the government.
No government ever found it hard to pick up tools for base actions. If
you cannot find them in the huts of the poor, you shall find them in
the palaces of the rich. Vanity can buy some, ambition others, and
money others. The first execution of the law, as was inevitable, was
a little hesitating; the second was easier; and the glib officials
became, in a few weeks, quite practised and handy at stealing men.
But worse, not the officials alone are bribed, but the whole
community is solicited. The scowl of the community is attempted to
be averted by the mischievous whisper, “Tariff and Southern market,
if you will be quiet: no tariff and loss of Southern market, if you dare
to murmur.” I wonder that our acute people who have learned that
the cheapest police is dear schools, should not find out that an
immoral law costs more than the loss of the custom of a Southern
city.
The humiliating scandal of great men warping right into wrong was
followed up very fast by the cities. New York advertised in Southern
markets that it would go for slavery, and posted the names of
merchants who would not. Boston, alarmed, entered into the same
design. Philadelphia, more fortunate, had no conscience at all, and,
in this auction of the rights of mankind, rescinded all its legislation
against slavery. And the Boston “Advertiser,” and the “Courier,” in
these weeks, urge the same course on the people of Massachusetts.
Nothing remains in this race of roguery but to coax Connecticut or
Maine to outbid us all by adopting slavery into its constitution.
Great is the mischief of a legal crime. Every person who touches
this business is contaminated. There has not been in our lifetime
another moment when public men were personally lowered by their
political action. But here are gentlemen whose believed probity was
the confidence and fortification of multitudes, who, by fear of public
opinion, or through the dangerous ascendency of Southern manners,
have been drawn into the support of this foul business. We poor men
in the country who might once have thought it an honor to shake
hands with them, or to dine at their boards, would now shrink from
their touch, nor could they enter our humblest doors. You have a law
which no man can obey, or abet the obeying, without loss of self-
respect and forfeiture of the name of gentleman. What shall we say
of the functionary by whom the recent rendition was made? If he has
rightly defined his powers, and has no authority to try the case, but
only to prove the prisoner’s identity, and remand him, what office is
this for a reputable citizen to hold? No man of honor can sit on that
bench. It is the extension of the planter’s whipping-post; and its
incumbents must rank with a class from which the turnkey, the
hangman and the informer are taken, necessary functionaries, it may
be, in a state, but to whom the dislike and the ban of society
universally attaches.
5. These resistances appear in the history of the statute, in the
retributions which speak so loud in every part of this business, that I
think a tragic poet will know how to make it a lesson for all ages. Mr.
Webster’s measure was, he told us, final. It was a pacification, it was
a suppression, a measure of conciliation and adjustment. These
were his words at different times: “there was to be no parleying
more;” it was “irrepealable.” Does it look final now? His final
settlement has dislocated the foundations. The state-house shakes
likes a tent. His pacification has brought all the honesty in every
house, all scrupulous and good-hearted men, all women, and all
children, to accuse the law. It has brought United States swords into
the streets, and chains round the court-house. “A measure of
pacification and union.” What is its effect? To make one sole subject
for conversation and painful thought throughout the continent,
namely, slavery. There is not a man of thought or of feeling but is
concentrating his mind on it. There is not a clerk but recites its
statistics; not a politician but is watching its incalculable energy in the
elections; not a jurist but is hunting up precedents; not a moralist but
is prying into its quality; not an economist but is computing its profit
and loss: Mr. Webster can judge whether this sort of solar
microscope brought to bear on his law is likely to make opposition
less. The only benefit that has accrued from the law is its service to
education. It has been like a university to the entire people. It has
turned every dinner-table into a debating-club, and made every
citizen a student of natural law. When a moral quality comes into
politics, when a right is invaded, the discussion draws on deeper
sources: general principles are laid bare, which cast light on the
whole frame of society. And it is cheering to behold what champions
the emergency called to this poor black boy; what subtlety, what
logic, what learning, what exposure of the mischief of the law; and,
above all, with what earnestness and dignity the advocates of
freedom were inspired. It was one of the best compensations of this
calamity.
But the Nemesis works underneath again. It is a power that makes
noonday dark, and draws us on to our undoing; and its dismal way is
to pillory the offender in the moment of his triumph. The hands that
put the chain on the slave are in that moment manacled. Who has
seen anything like that which is now done? The words of John
Randolph, wiser than he knew, have been ringing ominously in all
echoes for thirty years, words spoken in the heat of the Missouri
debate. “We do not govern the people of the North by our black
slaves, but by their own white slaves. We know what we are doing.
We have conquered you once, and we can and will conquer you
again. Ay, we will drive you to the wall, and when we have you there
once more, we will keep you there and nail you down like base
money.” These words resounding ever since from California to
Oregon, from Cape Florida to Cape Cod, come down now like the
cry of Fate, in the moment when they are fulfilled. By white slaves,
by a white slave, are we beaten.[131] Who looked for such ghastly
fulfilment, or to see what we see? Hills and Halletts, servile editors
by the hundred, we could have spared. But him, our best and
proudest, the first man of the North, in the very moment of mounting
the throne, irresistibly taking the bit in his mouth and the collar on his
neck, and harnessing himself to the chariot of the planters.
The fairest American fame ends in this filthy law. Mr. Webster
cannot choose but regret his law. He must learn that those who
make fame accuse him with one voice; that those who have no
points to carry that are not identical with public morals and generous
civilization, that the obscure and private who have no voice and care
for none, so long as things go well, but who feel the disgrace of the
new legislation creeping like miasma into their homes, and blotting
the daylight,—those to whom his name was once dear and honored,
as the manly statesman to whom the choicest gifts of Nature had
been accorded, disown him: that he who was their pride in the
woods and mountains of New England is now their mortification,—
they have torn down his picture from the wall, they have thrust his
speeches into the chimney. No roars of New York mobs can drown
this voice in Mr. Webster’s ear. It will outwhisper all the salvos of the
“Union Committees’” cannon. But I have said too much on this
painful topic. I will not pursue that bitter history.[132]
But passing from the ethical to the political view, I wish to place
this statute, and we must use the introducer and substantial author
of the bill as an illustration of the history. I have as much charity for
Mr. Webster, I think, as any one has. I need not say how much I
have enjoyed his fame. Who has not helped to praise him? Simply
he was the one eminent American of our time, whom we could
produce as a finished work of Nature. We delighted in his form and
face, in his voice, in his eloquence, in his power of labor, in his
concentration, in his large understanding, in his daylight statement,
simple force; the facts lay like the strata of a cloud, or like the layers
of the crust of the globe. He saw things as they were, and he stated
them so. He has been by his clear perceptions and statements in all
these years the best head in Congress, and the champion of the
interests of the Northern seaboard: but as the activity and growth of
slavery began to be offensively felt by his constituents, the senator
became less sensitive to these evils. They were not for him to deal
with: he was the commercial representative. He indulged
occasionally in excellent expression of the known feeling of the New
England people: but, when expected and when pledged, he omitted
to speak, and he omitted to throw himself into the movement in those
critical moments when his leadership would have turned the scale.
At last, at a fatal hour, this sluggishness accumulated to downright
counteraction, and, very unexpectedly to the whole Union, on the 7th
March, 1850, in opposition to his education, association, and to all
his own most explicit language for thirty years, he crossed the line,
and became the head of the slavery party in this country.
Mr. Webster perhaps is only following the laws of his blood and
constitution. I suppose his pledges were not quite natural to him. Mr.
Webster is a man who lives by his memory, a man of the past, not a
man of faith or of hope. He obeys his powerful animal nature;—and
his finely developed understanding only works truly and with all its
force, when it stands for animal good; that is, for property. He
believes, in so many words, that government exists for the protection
of property. He looks at the Union as an estate, a large farm, and is
excellent in the completeness of his defence of it so far. He adheres
to the letter. Happily he was born late,—after the independence had
been declared, the Union agreed to, and the constitution settled.
What he finds already written, he will defend. Lucky that so much
had got well written when he came. For he has no faith in the power
of self-government; none whatever in extemporizing a government.
Not the smallest municipal provision, if it were new, would receive his
sanction. In Massachusetts, in 1776, he would, beyond all question,
have been a refugee. He praises Adams and Jefferson, but it is a
past Adams and Jefferson that his mind can entertain.[133] A present
Adams and Jefferson he would denounce. So with the eulogies of
liberty in his writings,—they are sentimentalism and youthful rhetoric.
He can celebrate it, but it means as much from him as from
Metternich or Talleyrand. This is all inevitable from his constitution.
All the drops of his blood have eyes that look downward. It is neither
praise nor blame to say that he has no moral perception, no moral
sentiment, but in that region—to use the phrase of the phrenologists
—a hole in the head. The scraps of morality to be gleaned from his
speeches are reflections of the mind of others; he says what he
hears said, but often makes signal blunders in their use. In Mr.
Webster’s imagination the American Union was a huge Prince
Rupert’s drop, which, if so much as the smallest end be shivered off,
the whole will snap into atoms. Now the fact is quite different from
this. The people are loyal, law-loving, law-abiding. They prefer order,
and have no taste for misrule and uproar.
The destiny of this country is great and liberal, and is to be greatly
administered. It is to be administered according to what is, and is to
be, and not according to what is dead and gone. The union of this
people is a real thing, an alliance of men of one flock, one language,
one religion, one system of manners and ideas. I hold it to be a real
and not a statute union. The people cleave to the Union, because
they see their advantage in it, the added power of each.
I suppose the Union can be left to take care of itself. As much real
union as there is, the statutes will be sure to express; as much
disunion as there is, no statute can long conceal. Under the Union I
suppose the fact to be that there are really two nations, the North
and the South. It is not slavery that severs them, it is climate and
temperament. The South does not like the North, slavery or no
slavery, and never did. The North likes the South well enough, for it
knows its own advantages. I am willing to leave them to the facts. If
they continue to have a binding interest, they will be pretty sure to
find it out: if not, they will consult their peace in parting. But one thing
appears certain to me, that, as soon as the constitution ordains an
immoral law, it ordains disunion. The law is suicidal, and cannot be
obeyed. The Union is at an end as soon as an immoral law is
enacted. And he who writes a crime into the statute-book digs under
the foundations of the Capitol to plant there a powder-magazine, and
lays a train.
I pass to say a few words to the question, What shall we do?
1. What in our federal capacity is our relation to the nation?
2. And what as citizens of a state?
I am an Unionist as we all are, or nearly all, and I strongly share
the hope of mankind in the power, and therefore, in the duties of the
Union; and I conceive it demonstrated,—the necessity of common
sense and justice entering into the laws. What shall we do? First,
abrogate this law; then, proceed to confine slavery to slave states,
and help them effectually to make an end of it. Or shall we, as we
are advised on all hands, lie by, and wait the progress of the
census? But will Slavery lie by? I fear not. She is very industrious,
gives herself no holidays. No proclamations will put her down. She
got Texas and now will have Cuba, and means to keep her majority.
The experience of the past gives us no encouragement to lie by.
Shall we call a new Convention, or will any expert statesman furnish
us a plan for the summary or gradual winding up of slavery, so far as
the Republic is its patron? Where is the South itself? Since it is
agreed by all sane men of all parties (or was yesterday) that slavery
is mischievous, why does the South itself never offer the smallest
counsel of her own? I have never heard in twenty years any project
except Mr. Clay’s. Let us hear any project with candor and respect.
Is it impossible to speak of it with reason and good nature? It is really
the project fit for this country to entertain and accomplish. Everything
invites emancipation. The grandeur of the design, the vast stake we
hold; the national domain, the new importance of Liberia; the
manifest interest of the slave states; the religious effort of the free
states; the public opinion of the world;—all join to demand it.
We shall one day bring the States shoulder to shoulder and the
citizens man to man to exterminate slavery. Why in the name of
common sense and the peace of mankind is not this made the
subject of instant negotiation and settlement? Why not end this
dangerous dispute on some ground of fair compensation on one
side, and satisfaction on the other to the conscience of the free
states? It is really the great task fit for this country to accomplish, to
buy that property of the planters, as the British nation bought the
West Indian slaves. I say buy,—never conceding the right of the
planter to own, but that we may acknowledge the calamity of his
position, and bear a countryman’s share in relieving him; and
because it is the only practicable course, and is innocent. Here is a
right social or public function, which one man cannot do, which all
men must do. ’Tis said it will cost two thousand millions of dollars.
Was there ever any contribution that was so enthusiastically paid as
this will be? We will have a chimney-tax. We will give up our
coaches, and wine, and watches. The churches will melt their plate.
The father of his country shall wait, well pleased, a little longer for his
monument; Franklin for his, the Pilgrim Fathers for theirs, and the
patient Columbus for his. The mechanics will give, the needle-
women will give; the children will have cent-societies. Every man in
the land will give a week’s work to dig away this accursed mountain
of sorrow once and forever out of the world.[134]
Nothing is impracticable to this nation, which it shall set itself to do.
Were ever men so endowed, so placed, so weaponed? Their power
of territory seconded by a genius equal to every work. By new arts
the earth is subdued, roaded, tunnelled, telegraphed, gas-lighted;
vast amounts of old labor disused; the sinews of man being relieved
by sinews of steam. We are on the brink of more wonders. The sun
paints; presently we shall organize the echo, as now we do the
shadow. Chemistry is extorting new aids. The genius of this people,
it is found, can do anything which can be done by men. These thirty
nations are equal to any work, and are every moment stronger. In
twenty-five years they will be fifty millions. Is it not time to do
something besides ditching and draining, and making the earth
mellow and friable? Let them confront this mountain of poison,—
bore, blast, excavate, pulverize, and shovel it once for all, down into
the bottomless Pit. A thousand millions were cheap.
But grant that the heart of financiers, accustomed to practical
figures, shrinks within them at these colossal amounts, and the
embarrassments which complicate the problem; granting that these
contingencies are too many to be spanned by any human geometry,
and that these evils are to be relieved only by the wisdom of God
working in ages,—and by what instrument, whether Liberia, whether
flax-cotton, whether the working out this race by Irish and Germans,
none can tell, or by what sources God has guarded his law; still the
question recurs, What must we do? One thing is plain, we cannot
answer for the Union, but we must keep Massachusetts true. It is of
unspeakable importance that she play her honest part. She must
follow no vicious examples. Massachusetts is a little state: countries
have been great by ideas. Europe is little compared with Asia and
Africa; yet Asia and Africa are its ox and its ass. Europe, the least of
all the continents, has almost monopolized for twenty centuries the
genius and power of them all. Greece was the least part of Europe.
Attica a little part of that,—one tenth of the size of Massachusetts.
Yet that district still rules the intellect of men. Judæa was a petty
country. Yet these two, Greece and Judæa, furnish the mind and the
heart by which the rest of the world is sustained; and Massachusetts
is little, but, if true to itself, can be the brain which turns about the
behemoth.
I say Massachusetts, but I mean Massachusetts in all the quarters
of her dispersion; Massachusetts, as she is the mother of all the New
England states, and as she sees her progeny scattered over the face
of the land, in the farthest South, and the uttermost West. The
immense power of rectitude is apt to be forgotten in politics. But they
who have brought the great wrong on the country have not forgotten
it. They avail themselves of the known probity and honor of
Massachusetts, to endorse the statute. The ancient maxim still holds

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The Routledge Handbook of the

Political Economy of Health and

The Routledge Handbook of the Political Economy of

The Routledge Handbook of Anthropology and Global

Routledge Handbook of Health Geography Valorie A Crooks

Making Medicines in Africa: The Political Economy of

The political economy of European banking union 1st

The Routledge Handbook of the Philosophy and Science of

The Rise of Empires: The Political Economy of

Rodney Loeppky is in the Department of Political Science, York University, Canada.

Robin Chang is in the Department of Political Science, York University, Canada.

Edited by David Primrose, Rodney Loeppky

ISBN: 9780367861360 (hbk)

1 Revitalizing the political economy of health and healthcare

2 Mainstream health economics and the COVID-19 pandemic 19

3 The economics of conventions and healthcare 34

4 Understanding Marx on health: Towards a class-based approach 47

5 Feminist political economy, health and care 60

6 Post-Keynesian economics and healthcare 74

7 New materialisms and the (critical) micropolitical economy of health 86

8 A lopsided reflation: The limited contribution of behavioral economics

9 A critical political economy of health inequities 119

10 Issues of social reproduction and the political economy of health 131

11 Health and the corporate agri-food system 143

12 Neoliberalism and health in global context: The role of international

13 Neoliberalism and mental health 166

14 Occupational health and safety in the global garment industry 177

15 Political economy and social epidemiology in the context

16 Digital health and capitalism 202

18 Commodified healthcare, profits, priorities and the disregard for

19 The financialization of long-term care in Canada: The case of Ontario 234

20 The anatomy of Big Pharma 245

22 Understanding the health-politics nexus in the shadow of populism:

24 Universal health coverage: A case-study of the political economy of

25 Critical political economy of Latin America’s healthcare systems:

26 The political economy of healthcare policy in Africa in the age

27 Transformation of healthcare in China: The pre-and post-Maoist eras 336

28 The political economy of health and healthcare in India 346

29 The political economy of the postsocialist mortality crisis 359

30 Healthcare in Australia: Contesting marketized provision 371

31 The political economy of the National Health Service in

32 Health and healthcare in the United States 392

33 The new health politics of austerity in Europe 404

34 Social welfare and alternative forms of health provision: The UK

35 The need for comprehensive primary healthcare 432

36 The political economy of healthcare as commons: Exploring the

38 The political economy of health and degrowth 471

39 Cuban medical internationalism: A radical alternative approach to

40 The transition to post-capitalist health and healthcare 496

26.1 Top ten African exporters, 2018  327

Fran Baum is Professor of Health Equity at Stretton Institute, University of Adelaide.

Isaac Christiansen is Associate Professor of Sociology at Midwestern State University.

Nicolas Da Silva is Lecturer in Economics at Université Sorbonne Paris Nord.

Kevin Deane is Senior Lecturer in Economics at Open University, UK.

Nick J. Fox is Professor of Sociology at the University of Huddersfield.

Geoffrey M. Hodgson is Professor Emeritus in Management at Loughborough University, and

Alexandros E. Kentikelenis is Associate Professor of Political Economy and Sociology at Boc-

Lawrence King is Professor in the Department of Economics, University of Massachusetts Am-

John M. Kirk is Professor Emeritus of Latin American Studies at Dalhousie University.

David G. Legge is Scholar Emeritus in Public Health at La Trobe University.

Rodney Loeppky is Associate Professor in the Department of Politics, York University.

Gerry McCartney is Professor of Wellbeing Economy in Sociology at the University of Glasgow.

Patrick Neveling is Senior Lecturer in the Department of Social Sciences, Bournemouth

2 Mainstream health economics and the COVID-19 pandemic 19

3 The economics of conventions and healthcare 34

4 Understanding Marx on health: Towards a class-based approach 47

5 Feminist political economy, health and care 60

6 Post-Keynesian economics and healthcare 74

7 New materialisms and the (critical) micropolitical economy of health 86

9 A critical political economy of health inequities 119

10 Issues of social reproduction and the political economy of health 131

11 Health and the corporate agri-food system 143

13 Neoliberalism and mental health 166

14 Occupational health and safety in the global garment industry 177

16 Digital health and capitalism 202

19 The financialization of long-term care in Canada: The case of Ontario 234

20 The anatomy of Big Pharma 245

27 Transformation of healthcare in China: The pre-and post-Maoist eras 336

28 The political economy of health and healthcare in India 346

29 The political economy of the postsocialist mortality crisis 359

30 Healthcare in Australia: Contesting marketized provision 371

32 Health and healthcare in the United States 392

33 The new health politics of austerity in Europe 404

35 The need for comprehensive primary healthcare 432

38 The political economy of health and degrowth 471

40 The transition to post-capitalist health and healthcare 496

26.1 Top ten African exporters, 2018 327