Paul Crawshaw
By situating health within networks of exposure and dependency rather than individual optimisation, metabolic justice revives the ambitions of Health for All and its descendants as a materially grounded, politically transformative project for an era of social inequality and stratified medicine.
In 1997, 3 years ahead of WHO's target of delivering Health for All, critical health scholarship was energised by the mainstreaming of social determinants and the optimism of the new public health. Yet alongside these collective ambitions, lifestyle discourses, rooted in 1970s healthism, proliferated across consumer cultures, framing health as a matter of personal responsibility. Over the past three decades, these individualising logics have intensified. Initially expressed through behavioural risk management, they now extend into molecular and algorithmic regimes, producing the 'genomic citizen', tasked with managing biological futures via data-driven infrastructures and market-mediated technologies. Framed as empowering, these paradigms obscure structural determinants and embed health within a political economy of anticipation, where promissory narratives justify investment while deepening responsibilisation. The COVID-19 syndemic exposed the fragility of individualised discourses, reaffirming the salience of systemic inequality. In response, this paper reflects on the concept of metabolic justice, a framework that reframes the relationship between behavioural and biological discourses while foregrounding redistribution, ecological embeddedness and systemic reform. By situating health within networks of exposure and dependency rather than individual optimisation, metabolic justice revives the ambitions of Health for All and its descendants as a materially grounded, politically transformative project for an era of social inequality and stratified medicine.