Rates of chronic illness are rising in the UK, taking a toll on the NHS, the public finances and the wider economy. But illness is not produced in the health service alone. Understanding where it comes from has profound ramifications for our vision of progress.
The UK has a health problem. Around 16 million working-age adults now live with a long-term health condition and almost three million are outside the labour market because of long-term sickness (Arshi et al, 2026). Healthy life expectancy in the UK fell by around two years over the decade to 2024.
These trends are usually discussed as pressures on the NHS, welfare budgets or labour supply (Darzi, 2024). But they also raise a more basic question: what if part of the demand now overwhelming the health system is being created by the economy itself?
How can an economy make us sick?
To see why that question matters, we need to start by asking where health ‘comes from’. Health is not produced primarily in hospitals or doctors’ surgeries. It is shaped over time by the conditions in which people live and work. Nutrition, income security, housing quality, employment conditions, social connection and time to rest all exert continuous effects on people’s physical and mental health.
When adverse conditions persist, the strain becomes embodied in chronic disease. The result is visible in early-onset multi-morbidity (having more than one chronic illness at once), widening health inequalities, and rising demand for healthcare.
So, rising pressure on the NHS is not simply evidence of a health service struggling to cope. It also reflects the gradual erosion of what we might call the ‘terrain’ of health: the material and social conditions in which people navigate physical, psychological and social wellbeing (Bacia et al, 2017; Jackson, 2025).
This territory is traditionally described in terms of the ‘social determinants’ of health (World Health Organization, WHO, 2008, WHO, 2025). Increasingly now, attention is being paid to a related idea: health also has commercial determinants – the systems, practices and pathways through which commercial actors influence the terrain of health (Kickbusch et al, 2017; Lambie-Mumford and Kennedy, 2025).
WHO Europe estimates that commercial products and practices – including tobacco, alcohol and processed food – contribute to around a quarter of all deaths in its European region (WHO Europe, 2024). Their analysis highlights the role of lobbying, conflicts of interest, the strategic use of evidence and the framing of ill health as a matter of personal responsibility among the ways in which commercial interests not only undermine health but also weaken effective public health policy.
But there is a deeper economic force behind these pressures. Companies operating in competitive markets are expected to grow: to expand sales, increase revenues, capture market share and deliver returns to investors. In sectors such as food, alcohol or digital media, that can mean encouraging people to consume more, more often or in more profitable forms. Product design, marketing and political influence are not incidental to this process. They are part of the machinery through which commercial growth is achieved.
This matters because the pursuit of growth can reward activities whose private returns are positive even when their wider social consequences are damaging. What count as economic gains for the company generate losses elsewhere: in households, workplaces, welfare budgets and the NHS.
This is not just about unscrupulous corporate behaviour, although that certainly sometimes exists. The commercial determinants of health are rooted in an economic model in which expanding output, sales and profit remain central measures of success.
This perspective changes how we think about chronic disease. Rather than simply being the unfortunate consequence of individual behaviour, genetics or clinical failure, ill health is generated systematically by the way in which the economy is organised.
What happened to the nation’s diet?
These dynamics are clearly illustrated by debates around food and health. The link between diet and health has been known about since the time of Hippocrates (Smith, 2004). Today, that link provides a formidable challenge to our healthcare services.
When the NHS was founded in 1948, its primary role was treating injuries and infectious diseases. Today, most of its resources are used for the treatment of chronic non-communicable (non-infectious) diseases such as diabetes or heart conditions (Hayes, 2023). Many of these diseases are linked to metabolic dysfunction, which in its turn is caused by the food that we eat.
The endocrinologist Robert Lustig has spent more than four decades treating a rising tide of metabolic disorders – in ever-younger kids. Food, in the biological sense, he argues, should support the energy metabolism of the human body (Lustig, 2024). What he calls ‘real food’ must protect the liver, feed the gut and support the brain. It must contribute to metabolic function at every level of the organism.
Much of what passes for food today defies those characteristics. Fast food, ultra-processed food, ready meals, convenience food: all of these may start from real food. But then processing gets to work. Saturated fats, refined starches, sugars and preservatives are added in – in quantities inimical to human health. Fibre and micronutrients – vital to support the metabolism – are stripped out. Products are engineered for shelf life, convenience and a neurophysiological ‘bliss point’ rather than for nourishment or metabolic health (van Tulleken, 2024).
Lustig’s provocation isn’t just rhetorical: it’s a claim that our diet has been engineered in ways that frustrate the biological functions that food is supposed to perform. In a very real sense, our food system is increasingly in the business not of feeding people, but of manufacturing ‘irresistible’ products whose commercial success comes at the expense of human health.
The consequences are catastrophic for public health. Statistics from the United States suggest that around 90% of the adult population now suffer from some form of diet-related metabolic dysfunction (O’Hearn et al, 2022). We don’t have equivalent stats for the UK, but there’s little doubt we’re heading in the same direction, as an epidemic of obesity, diabetes and diet-related chronic illness attests (NHS, 2024).
In a report for the Food Farming and Countryside Commission (FFCC), my own research finds that unhealthy diets now impose health-related costs of around £298 billion a year in the UK (Jackson, 2026). Around £67 billion of this is attributable to healthcare, £20 billion to social care and £18 billion to health and disability-related welfare payments. Lost productivity adds an estimated £119 billion to the hidden costs, while diminished quality of life accounts for a further £75 billion.
Conventional economics describes these hidden costs as externalities. The market price of a product does not necessarily reflect all the costs associated with producing and consuming it. But technocratic language hides a punishing underlying dynamic. Profits accrue to companies and shareholders. The costs are borne by individual people, families, employers, taxpayers and the NHS. Benefits are privatised. Losses are socialised.
This is nothing other than extractivism – pure and simple (EY 2026). It leads inevitably to health and food inequalities. Healthier food remains more expensive per calorie than less healthy food. A family with children in the poorest fifth of households would need to spend around 85% of its disposable income after housing costs to afford a diet consistent with the government’s Eatwell Guide (Food Foundation, 2026).
My study for FFCC finds that the additional cost of ensuring that every household in the land could afford an Eatwell-compliant diet is just £51 billion a year (Figure 1). But that number is only one-sixth of the hidden health costs and less than half of the £104 billion spent each year on healthcare, social care and welfare costs from eating badly (Jackson, 2026).
This disparity is the essence of a false economy. We maintain a food system in which healthy eating is difficult and, for some households, unaffordable, and then spend vast sums of money trying (increasingly unsuccessfully) to deal with the consequences.
Figure 1: The hidden health costs of the British diet and what it would take to change it
Source: Jackson, 2026.
Where does this leave healthcare?
The comparison needs care. Spending £51 billion differently would not instantly save £298 billion. Nor is £298 billion a pot of money waiting to be recovered by the Treasury. Chronic disease has multiple causes. Health improvements take time. Productivity losses are not equivalent to government expenditure. Losses in quality of life are real social costs, but they do not appear directly in public accounts.
The £51 billion is not necessarily a proposal for a universal food subsidy – although that would be one way of addressing the problem of affordability. It is rather an estimate of the gap between current household food expenditure and the aggregate cost of an Eatwell-compliant diet. Closing it could also involve higher incomes, better regulation of the food supply chain, targeted support for poorer households, public procurement policies that prioritise health, product reformulation guidelines and support for healthier, more sustainable agriculture.
There is uncertainty in all such estimates. The significant point is the scale and direction of the imbalance. Reasonable changes in assumptions do not overturn the basic conclusion that the economic burden associated with unhealthy diets is very large relative to the resources required to make healthy diets more accessible.
Unfortunately, the NHS sits mainly downstream of these forces. It treats diabetes, cardiovascular disease, cancer and obesity-related illnesses after the conditions contributing to them have taken hold. This creates an almost impossible task. Environments that generate ill health faster than it can be prevented or reversed will create rising demand for healthcare regardless of how efficiently the health service is managed.
A shift in the focus of healthcare from treatment to prevention is essential. But prevention itself is particularly vulnerable when a health system comes under pressure. Care and prevention require continuity, coordination, stable investment and long-run time-horizons. Their benefits emerge slowly. Acute treatment delivers more immediate and measurable outputs. When resources become tight, the system is repeatedly pulled towards dealing with today’s crisis rather than preventing tomorrow’s demand (Darzi, 2024).
The government’s ten-year health plan Fit for the Future recognises this problem (Department of Health and Social Care, DHSC, 2025). One of its three stated shifts is from ‘sickness to prevention’, alongside moving care from hospital to community, and from analogue to digital.
Food policy is moving in a similar direction. The government’s food strategy aims to create a healthier, more affordable, sustainable and resilient food system, and it explicitly identifies the need to tackle the feedback loops and market failures that sustain poor outcomes (Department for Environment, Food and Rural Affairs, DEFRA, 2025).
The challenge is to connect these agendas. A health service committed to prevention cannot succeed if the wider economy continues to degrade the conditions in which health is produced.
What would it mean to reframe prosperity as health?
This is where the argument goes beyond correcting individual market failures. For much of the post-war period, prosperity has been associated primarily with economic wealth: rising GDP, productivity, incomes and consumption (Coyle, 2014; Jackson, 2017). This framing shapes what society measures, what governments pursue and what attracts investment.
Systems organised around growth privilege expansion, scale and throughput. Activities that sustain health over time – maintenance, continuity, prevention and care – deliver their benefits more slowly and are correspondingly easier to undervalue.
This is why the problem cannot be reduced simply to a few badly behaved companies or badly designed products. When prosperity is identified primarily with rising GDP, consumption and profit, growth becomes both a political objective and a commercial imperative. Activities that expand markets are rewarded even when they erode the conditions on which health depends.
The food example illustrates the paradox neatly. The commercial food system is routinely valued for the jobs, revenues, exports and profits that it creates. Political support for the food industry rests partly on its contribution to employment, investment and economic growth.
But if part of that growth depends on expanding the sale of products that contribute to chronic disease, the apparent economic gains should be set against the health and social costs created elsewhere. The revenues appear on one side of the economic accounts – many of the health costs appear somewhere else.
What appears to be economic growth turns out to be ‘uneconomic growth’ – as the late ecological economist Herman Daly named it: economic activity that adds to measured output while diminishing the conditions of prosperity itself (Daly, 2014). What appear to be ‘economic goods’ can, over time, generate substantial ‘economic bads’.
This paradox suggests an intriguing possibility. What would it mean to reframe prosperity in terms of health rather than wealth? The distinction matters because wealth and health operate according to different dynamics. The pursuit of wealth is governed by accumulation: more is generally better. The pursuit of health is governed by balance. Living organisms survive and thrive by maintaining and restoring equilibrium in changing circumstances (Cannon, 1932).
A useful corollary follows from this. The fundamental organising principle of economic life shifts from growth towards care. Growth promotes accumulation. Care sustains health – it is the essential restorative force that maintains and restores balance (Jackson, 2025).
In this sense, care becomes more than a cost on the public finances. Prevention becomes more than an optional extra whose value depends on demonstrating short-term savings to the NHS. Both can instead be understood as investments in one of society’s most important and irreplaceable assets: health.
The economy does not inevitably make us sick. But an economy organised around the pursuit of growth without sufficient regard for its effects on health can reward activities that generate avoidable illness while making prevention look expensive. Reversing that logic means treating health not simply as something the economy pays for, but as the ultimate end towards which the economy should strive.
Where can I find out more?
- Commercial determinants of health: WHO fact sheet on how commercial activities influence health.
- The false economy of Big Food: 2026 update: FFCC report on the wider costs of the food system.
- Prosperity as health: recentring care to guide health system reform: Tim Jackson explores how a focus on health and care could reshape health system reform.
- The care economy: Tim Jackson examines the economic importance of care and its role in building a more sustainable and prosperous society.
Who are experts on this question?
- Emma Dowling – Professor of Sociology, University of Vienna
- Nancy Folbre – Professor Emerita of Economics, University of Massachusetts Amherst
- Tim Jackson
- Joan Tronto – Professor of Political Science, University of Minnesota
- Chris van Tulleken – Professor of Infection and Global Health, University College London
