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At What Cost: Modern Capitalism and the Future of Health
An incisive and powerful investigation of corporate impact on human and planetary well-being
Freedom of choice lies at the heart of American society. Every day, individuals decide what to eat, which doctors to see, who to connect with online, and where to educate their children. Yet, many Americans don't realize that these choices are illusory at best. By the start of the 21st century, every major industrial sector in the global economy was controlled by no more than five transnational corporations, and in about a third of these sectors, a single company accounted for more than 40 percent of global sales. The available options in food, healthcare, education, transportation, and even online presence are largely constructed by corporations, whose sweeping influence have made them the public face and executive agents of 21st-century capitalism.
At What Cost confronts how globalization, financial speculation, monopolies, and control of science and technology have enhanced the ability of corporations and their allies to overwhelm influences of government, family, community, and faith. As corporations manipulate demand through skillful marketing and veto the choices that undermine their bottom line, free consumer choice has all but disappeared, and with it, the personal protections guarding our collective health. At What Cost argues that the world created by 21st-century capitalism is simply not fit to solve our most serious public health problems, from climate change to opioid addiction. However, author and public health expert Nicholas Freudenberg also shows that though the road is steep, human and planetary well-being constitute a powerful mobilizing idea for a new social movement, one that will restore the power of individual voice to our democracy.
With impeccably detailed research and an eye towards a better future, At What Cost arms ordinary citizens, activists, and health professionals with an understanding of how we've arrived at the precipice, and what we can do to ensure a healthier collective future.
Freedom of choice lies at the heart of American society. Every day, individuals decide what to eat, which doctors to see, who to connect with online, and where to educate their children. Yet, many Americans don't realize that these choices are illusory at best. By the start of the 21st century, every major industrial sector in the global economy was controlled by no more than five transnational corporations, and in about a third of these sectors, a single company accounted for more than 40 percent of global sales. The available options in food, healthcare, education, transportation, and even online presence are largely constructed by corporations, whose sweeping influence have made them the public face and executive agents of 21st-century capitalism.
At What Cost confronts how globalization, financial speculation, monopolies, and control of science and technology have enhanced the ability of corporations and their allies to overwhelm influences of government, family, community, and faith. As corporations manipulate demand through skillful marketing and veto the choices that undermine their bottom line, free consumer choice has all but disappeared, and with it, the personal protections guarding our collective health. At What Cost argues that the world created by 21st-century capitalism is simply not fit to solve our most serious public health problems, from climate change to opioid addiction. However, author and public health expert Nicholas Freudenberg also shows that though the road is steep, human and planetary well-being constitute a powerful mobilizing idea for a new social movement, one that will restore the power of individual voice to our democracy.
With impeccably detailed research and an eye towards a better future, At What Cost arms ordinary citizens, activists, and health professionals with an understanding of how we've arrived at the precipice, and what we can do to ensure a healthier collective future.
416 pages, Hardcover
Published March 16, 2021
14 people are currently reading
398 people want to read
About the author
Nicholas Freudenberg
11 books19 followersNicholas Freudenberg is Distinguished Professor of Public Health at the City University of New York School of Public Health. For more than 30 years, he has worked with community groups, public agencies and others to create programs and policies that improve community health and reduce health inequalities. He is also co-director of the New York City Food Policy Center at Hunter College. His 2014 book Lethal but Legal, published by Oxford University Press,describes how corporations contribute to global epidemics of chronic diseases and injuries and how activists and health professionals can take action to change health-damaging corporate practices
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Displaying 1 - 7 of 7 reviews
July 2, 2022
I picked this up as Richard Horton mentioned it in an aside in the Lancet, thinking it would be about capitalisms impact on health care and a worthy read. It is much more than that and more interesting than I expected. Taking a wide perspective on health and wellbeing, and exploring social and economic influences on health determined by multiple sectors Professor Freudenberg offers a searing indictment of neoliberal economics and the physical and mental health harms it inflicts. This is all the more powerful because of its measured, rigorous tone. The focus is mainly on the united states of America but some of the problems are global. Throughout successful challenges to harmful practices are highlighted and the last chapters offer constructive thoughts on pathways to improve the situation.
June 12, 2021
I am disappointed with this book. Maybe I thought it would be different. Essentially to me it felt like a synthesis of a bunch of research papers, that just goes through the numbers, with a few flourishes.
But I had a real hard time making my way through this book even though the topics covered within are 100% a passion of mine. I will keep this as reference though as there may be times I can jump back into a section to help with my own studies.
But I had a real hard time making my way through this book even though the topics covered within are 100% a passion of mine. I will keep this as reference though as there may be times I can jump back into a section to help with my own studies.
September 7, 2023
This text reviews major areas of marketing, capitalism, industry, and health systems that operate (mainly within the US) to highlight that we CAN make a different world if we collectively act and learn from the COVID-19 social/mutual aid movements. The examples are clear, the actionable steps are tangible, and the broken system we live within is well researched. The power that certain businesses and industries have, from energy to technology, can dictate the planet’s future. Our collective voice can transform this system if we ACT.
Favorite quotes:
“More recently, in public health scholarship, the term “commercial determinants of health” has been used to describe how markets and the quest for profits shape health and disease, a term that may further obscure the roots of global threats to health”
“Capitalism as we have known it is dead… This obsession we have with maximizing profits for shareholders alone has led to an incredible inequality and a planetary emergency.”
“Another report released at the 2020 Davos forum, this one by Oxfam International, found that the world’s 2,153 billionaires now have more wealth than the 4.6 billion people who make up 60 percent of the planet’s population.”
“One of the most pernicious effects of privatization is that it shifts the focus of government from ensuring access, quality, equity, and efficiency in the administration of public services to that of a business manager ensuring that contractors are fulfilling the letter of their contracts and remain satisfied so they will continue to provide services”
“Nothing better promotes lifetime health than education. At every stage of life, more education leads to better health. The reverse is also true: throughout the lifespan, healthier people achieve more academic success and learn more easily.”
“From a public health perspective, the question is not what ingredients companies should add or remove from a processed product. The more meaningful ask is “What kind of diet and food supply will best protect the well-being of children?” This is a question the global food industry wants to avoid”
“In today’s economy, as one analyst observed, “The pay structure at present does not provide financial incentives to find a cure for cancer”
“On the most basic questions, however, there is not much discussion or consensus. Is child care and early child education a charity for the needy like food pantries or free clinics or is it a universal right in any civilized society?”
“The mutual aid efforts inspired by the pandemic show the potential for this strategy to build a movement that can confront the recurrent crises and disasters that characterize modern capitalism”
Excerpts From
At What Cost
Nicholas Freudenberg
https://books.apple.com/us/book/at-wh...
This material may be protected by copyright.
Favorite quotes:
“More recently, in public health scholarship, the term “commercial determinants of health” has been used to describe how markets and the quest for profits shape health and disease, a term that may further obscure the roots of global threats to health”
“Capitalism as we have known it is dead… This obsession we have with maximizing profits for shareholders alone has led to an incredible inequality and a planetary emergency.”
“Another report released at the 2020 Davos forum, this one by Oxfam International, found that the world’s 2,153 billionaires now have more wealth than the 4.6 billion people who make up 60 percent of the planet’s population.”
“One of the most pernicious effects of privatization is that it shifts the focus of government from ensuring access, quality, equity, and efficiency in the administration of public services to that of a business manager ensuring that contractors are fulfilling the letter of their contracts and remain satisfied so they will continue to provide services”
“Nothing better promotes lifetime health than education. At every stage of life, more education leads to better health. The reverse is also true: throughout the lifespan, healthier people achieve more academic success and learn more easily.”
“From a public health perspective, the question is not what ingredients companies should add or remove from a processed product. The more meaningful ask is “What kind of diet and food supply will best protect the well-being of children?” This is a question the global food industry wants to avoid”
“In today’s economy, as one analyst observed, “The pay structure at present does not provide financial incentives to find a cure for cancer”
“On the most basic questions, however, there is not much discussion or consensus. Is child care and early child education a charity for the needy like food pantries or free clinics or is it a universal right in any civilized society?”
“The mutual aid efforts inspired by the pandemic show the potential for this strategy to build a movement that can confront the recurrent crises and disasters that characterize modern capitalism”
Excerpts From
At What Cost
Nicholas Freudenberg
https://books.apple.com/us/book/at-wh...
This material may be protected by copyright.
This entire review has been hidden because of spoilers.
Want to read
July 3, 2021https://lccn.loc.gov/2020044862
https://global.oup.com/academic/produ... bookpagina
https://www.youtube.com/watch?v=E0y7H... book presentation 1:19:26
Table of Contents
Preface
Acknowledgments
Part I. Introduction
1. The Changing Face of U.S. and Global Capitalism
Part II. The Pillars of Health
2. Food: Ultraprocessed Products Become the Global Diet
3. Education: Private Capital Goes to School
4. Health Care: the Medical Care Industry's War on Cancer
5. Consequences of the Growth of Low-Wage and Precarious Work
6. Transportation: Uber and Autonomous Vehicles vs. Mass Transit
7. Social Connections: Extracting Profit from Human Relations
Part III. Conclusion
8. Transitions from 21st-century Capitalism
9. From Now to Next: To Build a Movement for Another World
References
https://global.oup.com/academic/produ... bookpagina
https://www.youtube.com/watch?v=E0y7H... book presentation 1:19:26
Table of Contents
Preface
Acknowledgments
Part I. Introduction
1. The Changing Face of U.S. and Global Capitalism
Part II. The Pillars of Health
2. Food: Ultraprocessed Products Become the Global Diet
3. Education: Private Capital Goes to School
4. Health Care: the Medical Care Industry's War on Cancer
5. Consequences of the Growth of Low-Wage and Precarious Work
6. Transportation: Uber and Autonomous Vehicles vs. Mass Transit
7. Social Connections: Extracting Profit from Human Relations
Part III. Conclusion
8. Transitions from 21st-century Capitalism
9. From Now to Next: To Build a Movement for Another World
References
June 6, 2021
A very interesting look at how 21st century capitalism isn't good for us. I had already read how the wealthy GOP has been stealing our country from us but this book dug deeper on how they are imperiling out health to satisfy their greed. We need to take back our health, our economy & our country ... and stop mucking about other countries as well.
July 12, 2021
Relevant, insightful and a bit longwinded.
October 9, 2025
Tautological, sure, but still an incredibly important and stimulating read you'll find yourself referencing
Displaying 1 - 7 of 7 reviews