Neoliberalism: The politics of health writ large

Drawing on our book Neoliberal Epidemics: How politics makes us sick (2nd edition, 2025), this article sets out how neoliberalism - the hegemonic political–economy of the last 50 years - has operated as a powerful upstream determinant of population health acting through four interlocking and mutually reinforcing pathways: widening socioeconomic inequality, chronic psychosocial stress, pervasive economic and social insecurity, and the growing power of the commercial determinants of health. Together, these pathways explain how political and economic choices translate into biologically embodied health outcomes over the life course. We illustrate our argument with a case study of austerity. Following Virchow’s insight that politics is medicine “on a large scale”, we conclude that under neoliberalism, health inequalities are inevitable. Addressing them therefore requires public health to confront the political and economic structures that systematically generate stress, insecurity, inequality and commercial harm, rather than relying on downstream or individual‑level interventions.