Drawing on survey and interview evidence, this chapter explores the effect of coverage denials on patients’ health and economic security. Most Americans report an inability to pay an unexpected $1,000 bill, so, with notably expensive health care, denials can be devastating. Too often, when coverage is denied, patients abandon their treatments, a dynamic shown not only through physician surveys, but also through original survey evidence of patients, half of whom reported delaying or abandoning their prescribed care. Further, the people most likely to do so are typically Black or Hispanic or less affluent, and nearly half of patient respondents reported that their health condition declined. In fact, some patients may not survive at all. Marginalized patients are also more likely to postpone non-medical purchasing to accommodate unexpected health insurance barriers, suggesting the far-reaching consequences of prior authorization. The evidence shows not only that tools of managed care produce frequent coverage denials, but also that this practice shifts risk from insurers to patients, yielding new health and economic insecurities, especially for patients from marginalized backgrounds.

The assassination of UnitedHealthcare CEO Brian Thompson generated nationwide discourse about delays and denials of coverage by private health insurers. Many denials are driven by managed health care practices such as prior authorization, or required insurer pre-approval for prescribed care. These denials can destabilize American patients, who are forced to endure a substantial “time tax” and administrative burdens of appealing, which some patients can more successfully navigate than can others. This book was also inspired by the author’s personal experience being denied coverage by a health insurer while conducting a postdoctoral fellowship, which highlighted that, even with academic fortune, these processes can be destabilizing to one’s financial, health, and emotional wellbeing. While scholars had examined administrative burdens and time taxes in the setting of navigation of government programs, this framework had not been extended to the setting of privatization, in which many of these barriers also can be identified and are highly consequential. This exploration of health and economic inequities driven by health insurance barriers and administrative burdens seeks to do just that.

This chapter introduces the central theme of a dual crisis threatening humanity: a planetary crisis driven by environmental degradation and climate change, and a societal crisis rooted in extreme wealth concentration. The author recounts the foundational work on “planetary boundaries,” highlighting climate change and biodiversity loss as the two most critical threats. Despite the overwhelming complexity of global issues, the text argues that solutions are already known—ending fossil-fuel extraction and shifting to plant-based diets. However, implementation remains elusive due to political, economic, and societal inertia. The narrative explores humanity’s climate “niche,” showing how most people live in a narrow temperature range and how global warming threatens to push billions outside that comfort zone. Parallel to the environmental crisis, the chapter delves into the implications of wealth inequality, illustrating how economic power undermines democratic institutions and perpetuates the very systems harming the planet. The author stresses that inequality arises not from merit but from structural mechanisms, both in society and in nature.

Chapter 6 explores three plausible trajectories for humanity’s future: a “failed world,” a “good Anthropocene,” and a middle path of “buying time.” The failed-world scenario envisions societal collapse fueled by self-reinforcing feedbacks between environmental degradation, power concentration, stress, and eroding trust. In this trajectory, far-right populism and rising inequality lead to nationalism, global cooperation breakdown, and mass displacement due to climate change. Conversely, the good Anthropocene imagines democratic resilience, institutional reform, carbon neutrality, and a cultural shift away from materialism. It emphasizes prosocial values, equitable governance, and low-footprint lifestyles grounded in leisure and morality rather than consumption. The third scenario, buying time, reflects the complexities of slow global transformation, proposing adaptive migration and geoengineering as interim measures. Drawing on history, the chapter argues that systemic change—though gradual—can unfold over a century, as with past social reforms. However, unchecked delays risk irreversible damage.

Chapter 3 offers a sweeping exploration of how civilizations transform. It begins with the transition from hunter-gatherer groups to civilizations, highlighting how certain organizational structures—hierarchy, centralized power, and shared belief systems—emerge as natural attractors. Civilizations, however, are inherently unstable and often collapse due to compounded internal and external pressures, including climate stress, inequality, and elite conflict. The concept of “senescence” suggests that societies grow more fragile with age, making them prone to systemic failure. Examples range from the Late Bronze Age collapse to the Progressive Era in the USA, showcasing both destructive collapses and constructive reforms. Norm shifts—such as the abolition of slavery, women’s suffrage, and anti-smoking movements—are explored as nonviolent transformations driven by activism and shifting values. Technological revolutions, from fire to the Green Revolution, are seen as double-edged, solving problems while creating new ones.

Chapter 5 analyzes contemporary societal transformations through the lens of emerging technologies, political trends, and cultural shifts. It emphasizes how social media and artificial intelligence (AI), especially large language models, are reshaping communication, public perception, and decision-making processes. Social media amplify discontent, promote self-organization, and facilitate both progressive movements and misinformation. A concerning trend is the apparent societal shift from rational, collective discourse toward more intuitive, individualistic, and emotionally driven communication. This is evidenced by linguistic analyses of books, search trends, and journalistic styles. The chapter also explores the effects of neoliberal economic policies, which have fueled inequality and stress, potentially impacting cognitive function and social cohesion. Concurrently, a rise in populism and democratic backsliding is observed, driven by perceived grievances, xenophobia, and manipulation of public opinion. Together, these interconnected developments suggest humanity is at a critical juncture.

This chapter seeks to shed light on the strategic reorientation of social democratic parties in the 1990s and the reasons why these parties have lost support among working-class voters while failing to expand their electoral base among other voters. Focusing on the Swedish experience, the chapter addresses three topics: (1) what social democrats have done in government; (2) how the social background and practices of social democratic politicians have changed; and (3) how the decline of trade unions and changing trade union practices have undermined working-class support for social democratic parties.

International investment law is designed to encourage the movement of capital toward optimally productive uses, thus generating economic gains and fostering development. At the same time, treaty-based protections of foreign investors can restrict host governments’ ability to pass rules that negatively impact on foreign investments even when such rules are for socially desirable goals such as poverty reduction. Applied to the question of new technologies, this framework theoretically leaves access to and utilization of new technologies between the technology-pulling impact of investment protections and the equity-hindering impacts of regulatory measures to reduce poverty in all its forms. Does the practice of international investment law dispute resolution indicate that this tension is resolved in favor of technology investors or in favor of equality-enhancing measures?

This chapter examines the various aspects of the digital divide and the provisions of the Sustainable Development Goals (SDGs) that contain states’ promises on the relationship to promote access to new technologies as a way of reducing poverty. It then looks at several early investment disputes that have arisen out of new technology investments in order to draw conclusions about whether investment protections help bridge the divide or exacerbate it. The result is more ambiguous than expected.

Food security is a common term within the region, but its meaning is unclear. This chapter argues that the term is a means to demarcate the Gulf’s access to food from the rest of the region; it submits it as a form of biopolitics that rationalises circulation, access and consumption. It shows how food imports are central to economic growth and development and how this is managed by governments. It also argues that food security is a basis for political legitimacy and the identification of problem and solution is a performative act.

India was a poor and unequal country in 1947. Much of its labour force was in low-productivity agriculture, but it had a significant, if small, industrial sector. A plausible trajectory going forward was that rapid industrial growth would draw labour into higher-productivity areas, reducing poverty and inequality. But India went down a different path, beginning with an emphasis on heavy industry. This increased the economy’s productive capacity, but did not generate enough jobs to dent poverty and inequality. Over-regulation and neglect of exports contributed to slow growth until 1980, though agricultural productivity rose with the introduction of new high-yielding varieties of crops in some areas. After 1980, and especially after 1991, policies became more friendly to markets and business and India grew rapidly, led by growth in the services sector. This, however, did not create jobs at the same rate, because the growth was skill- and capital-intensive. Poverty fell substantially, but inequality spiked, and job creation remains a big concern.

Gender inequality in India arises from widespread societal attitudes that prioritize the economic and social status of men and, as a result, favour investment in male children. Policy actions have resulted in significant improvements in women’s educational attainment and political representation, but there has been only limited progress in women’s labour force participation, in rates of domestic violence and rape, and in the abatement of trends in the selective abortion of girls. Attitudes pertaining to the status of women also show limited improvement.

India’s states or regions – heterogeneous by population size, language, geography, creed and culture – have broadly followed the national economic performance and structural transformation. However, inter-regional inequality (among its other dimensions) has risen unabated, with stability in their ranks and shares of output and employment. There are few signs of unconditional convergence. Yet interstate labour migration has remained modest, though rising. Mandatory tax-sharing methods and policy goals have failed to dent rising inequalities. Though following national policy templates, states have charted varied development paths, with contrasting outcomes. A rising ‘north–south’ divide is discernible, with Kerala in pole position in social progress, while Gujarat prioritizes output growth. Large north Indian ‘BIMARU’ states remain bimaru, with persistent gaps in health and social development outcomes relative to the national average. Beneath the seeming state-level stability, discernible churn among districts, crops, clusters and urban enclaves is evident, without significantly transcending the states’ pecking order.