Prosperity as Health—Recentring Care to Guide Health System Reform | Paper by Tim Jackson

CUSP Working paper | March 2026

Health systems are struggling not because they are failing, but because they are being asked to manage illness generated elsewhere. Across advanced economies, rising chronic disease, early onset multimorbidity and widening inequalities reflect the conditions in which health is produced, not simply the performance of healthcare.

This paper (commissioned for Enlighten’s NHS 2048 initiative in Scotland) argues that these pressures arise from a deeper misalignment between a wealth-centred model of prosperity and the requirements of human health. It explores how the social and material conditions of modern economies become biologically embodied over time, generating an unsustainable demand for healthcare.

In response, the paper proposes a reframing of prosperity as health and offers a simple policy test to distinguish reforms that reduce future harm from those that merely seek to absorb it. Recentring care as essential infrastructure becomes key to aligning policy with long-term health outcomes.