Alienation has been used as a crucial concept to describe the negative psychosocial impacts that stem from the ways production and consumption are organised in Marxist and non-Marxist traditions. The psychosocial impacts it generates are mediated through stress pathways to increase non-communicable physical and mental illnesses. There has been little empirical research on the impact of alienation on health and ways in which the impact might be reduced. This paper sets out an Alienation, Health and Well-being research agenda. We propose two hypotheses: (1) that processes of production and consumption in 21st century capitalism leads to alienation which underpins a significant degree of mental illness and non-communicable disease; and (2) reductions in prevalence of mental illness and non-communicable disease requires public policies which regulate market behaviour in favour of measures which reduce the alienating impacts of processes of production and consumption.

Concepts of alienation, first used in the 19th century to describe the way in which economic and political systems affected people’s well-being,1 are still highly relevant today for understanding why many countries are experiencing a chronic physical and mental disease epidemic.2 Indeed, attention on the health and well-being impacts of alienation generated through the processes of production and consumption is increasing, however, much of this literature is theoretical3–5 and there is a dearth of empirical studies. We examine the links between alienation generated in contemporary capitalist societies and physical and mental health. We conclude by setting out an Alienation, Health and Well-being research agenda.

Alienation has been used by social theorists to describe the negative psychosocial impacts that stem from the ways production and consumption are organised.3 4 6 7 Most prominently, Marx’s work consistently used concepts associated with alienation to examine how capitalism affected the whole of society by shaping the ways in which people interacted in their work, with each other, within themselves and with nature.8 The division between the labour class and the capital class endures today in the form of dehumanising working conditions9 (eg, gig insecure work, zero hour contracts), and workplaces that seek only to maximise profits and leave workers feeling disempowered. Marxist analysis of alienation is not uncontroversial within Marxist thought. The main debates are well described by Mészáros who discusses whether the strong focus on alienation was present in the early writings of Marx survived in his later work. Mészáros is clear that it remained a vital part of Marxist theory and remains relevant to contemporary social issues.

Alienation becomes more evident as economic inequities widen, as the inherent unfairness of the systems that support and sanction the growing inequities is recognised and resented. Øversveen10 notes the concept is vital to understanding how to respond to inequities. Marx11 saw economic inequities as an inevitable consequence of the capitalism system of production. Today, inequities are increasing. For example, the world’s five richest men have more than doubled their fortunes to $869 billion (£681.5 billion) since 2020, while those of the world’s poorest 60% have stagnated.12

Alienation also manifests in people’s lives when they experience institutional obstructions and injustice, frustrating or dehumanising organisational processes,13 and systems that deny or undermine their control.14 Alienation felt by those who experience structural unfairness can create disaffection and dissent and push people towards populist political parties5 and ‘strong’ leaders (eg, Trump in the USA, Milei in Argentina).

In the 21st century, alienation is an issue of consumption and how gaining access to services and products is structured in such a way that leads to powerlessness and frustration. This aspect of alienation was not central to Marxist theory. There are various ways in which destructive consumption practices fuel alienation (eg, the marketing and high consumption of commodities which promise satisfaction, yet do not deliver long-term well-being). Many societies are characterised by individualism, constant pressure to consume, constantly evolving sociocultural processes that have profound effects on social relationships and identities.15 Matthews16 argues that hyper-consumerism ultimately breeds dissatisfaction as the desire to substitute old products for new turns maintaining one’s position in society into a relentless pursuit of an unobtainable standard. This consumerism is driven by corporations which spend large amounts on advertising to manufacture demand for products that are unhealthy for people and the planet and engender emptiness and degradation.17 Social media intensifies the pressures to conform and consume.18 Alienation is also generated by business practices such as dealing with online, phone services AI ‘chatbots’ which impose long waiting times as part of their ‘lean’ staffing business models, thereby externalising business costs and frustration to the customer. Øversveen et al 10 note that the dismantling and replacement of democratic institutions by market mechanisms is also alienating, including the widespread privatisation of health and social care services.

Contemporary commentators have theorised that the sense of malaise, social and economic powerlessness and disconnection from society that follows alienation explains the increase in loneliness, stress and mental despair that is rife across market economies.10 ,19 The mechanisms by which alienation likely creates stressors in contemporary capitalist society and range of ill health effects are shown in figure 1.

Our contention is that contemporary capitalist societies are generating widespread alienation which, in turn, creates chronic stresses that underlie multiple health problems. Stress results from dehumanising, insecure work, conducted in low control, uncaring workplaces where workers face terms and conditions calculated to maximise their employers’ profits but creates stress, anxiety, depression for workers and expressions of this include self-harm.20 21 The Whitehall studies demonstrated the impact of lack of control at work on health.22 Studies in the USA indicate that some classes of workers suffer more harms from workplaces and that middle managers are particularly susceptible given they are complicit with employers.21 Sennett23 suggests such workers’ experiences result in a ‘corrosion of character’ which leads on to the stress and health impacts shown in figure 1. A range of non-communicable diseases are affected by chronic stress arousal, contributing to increased risk of physical conditions, such as premature heart disease, or a mental health problem, such as a depressive or anxiety disorder.24 A review25 showed the impact of stressors on multiple physical pathways—the immune system,26 cardiovascular system, multiple effects on nutrition, and the gastrointestinal system. Physiological changes associated with chronic stress include increased blood pressure, heart rate and blood glucose levels, and changes to immune system functions.27 These processes increase the risk of a variety of physical and mental disorders showing a robust pathway from alienation-induced stress to health outcomes.28 More research is required into understanding these pathways and how they can be disrupted, and next we set out a research agenda to achieve this.

Despite the potential usefulness of alienation as an explanatory concept for some of the increase in mental illness and the non-communicable disease epidemic witnessed in many countries, it has rarely been used by public health scholars in empirical studies. Consequently, we propose that the concept should be used as an explanatory factor in analyses of contemporary structures that generate illness and inequities. Our hypotheses are that:

Testing these hypotheses requires empirical and applied studies of the alienating processes of the types of examples listed below:

Creating communities free of alienation is a tall order in capitalist societies. It is possible, however, to reduce its levels if measures are taken to create a society which is more supportive of human connectedness and fairness. The price of not doing so is rising levels of chronic disease and the human and financial costs of its treatment. Putting alienation on the public health agenda will improve our understanding and responses to its individual impact and equip us to tackle its structural causes.

Thanks to Jaye Louise Litherland-De Lara for assistance with literature searching.

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  Journal of Epidemiology & Community Health 2025; 79 477-478 Published Online First: 04 Apr 2025. doi: 10.1136/jech-2025-223762