Freedom of choice lies at the heart of American society. Every day, individuals decide what to eat, which doctors to see, who to connect with online, and where to educate their children. Yet, many Americans don’t realize that these choices are illusory at best. By the start of the 21st century, every major industrial sector in the global economy was controlled by no more than five transnational corporations, and in about a third of these sectors, a single company accounted for more than 40 percent of global sales. The available options in food, healthcare, education, transportation, and even online presence are largely constructed by corporations, whose sweeping influence have made them the public face and executive agents of 21st-century capitalism.

At What Cost confronts how globalization, financial speculation, monopolies, and control of science and technology have enhanced the ability of corporations and their allies to overwhelm influences of government, family, community, and faith. As corporations manipulate demand through skillful marketing and veto the choices that undermine their bottom line, individuals are left with only those options that increase profit, even if such decisions endanger our collective health. At What Cost argues that the world created by 21st-century capitalism is simply not fit to solve our most serious public health problems, from the covid pandemic and the climate emergency to opioid addiction and deaths of despair. However, author and public health expert Nicholas Freudenberg also shows that though the road is steep, human and planetary well-being constitute a powerful mobilizing idea for a new social movement, one that will restore the power of individuals and communities in our democracy.

With impeccably detailed research and an eye towards a better future, At What Cost arms ordinary citizens, activists, and health professionals with an understanding of how we’ve arrived at the precipice, and what we can do to ensure a healthier collective future.

At What Cost: Modern Capitalism and the Future of Health is available to be ordered from: Oxford University Press, Barnes and Noble, and Amazon.

Read the preface to At What Cost here.


At What Cost is a must-read for anyone who wants to understand why food insecurity, low-wage work, chronic disease, and environmental degradation are such widespread and seemingly intractable problems. Capitalism may not be their only cause, but it is common to all of them. This important book provides compelling evidence for the need to join together to change this system to one better for people and the planet.” — Marion Nestle, PhD, MPH, Professor Emerita of Nutrition, Food Studies, and Public Health, New York University and author of Unsavory Truth

“If there’s an upside to this era of heat and disease, it’s that we finally have no choice but to ask some very basic questions about the framework of our world. This book takes some important steps in precisely that direction!” — Bill McKibben, author of Falter: Has the Human Game Begun to Play Itself Out?

“In At What Cost, Freudenberg details the need for a better economic system and shows how only through this change can we hope to see global health and justice.” — Mark Bittman, author of Animal Vegetable Junk

“Freudenberg’s timely analysis of what he terms ‘modern capitalism’ is critical reading for health professionals who are seeking evidence and ideas to understand why and how globalized and national prioritizing of private profit and privatization wreak such harms to people’s health and planetary health. Analyzing the intertwined cases of food, education, healthcare, work, transportation, and social connection, he clarifies why movements for social change are crucial for building an equitable, sustainable, and healthy future.” — Nancy Krieger, PhD, Professor of Social Epidemiology, Harvard School of Public Health

“In At What Cost, Freudenberg offers an insightful analysis reminding us that the pathologies with which we must contend most urgently aren’t simply those that happen under our skin but those that happen at the level of our economics and politics. At What Cost is required reading for those who recognize the imperative for political action for public health.” — Abdul El-Sayed, MD, physician, epidemiologist, and progressive activist  


Review. KIRKUS, March 2021.

Food Politics Blog, Marion Nestle, Weekend Reading: Modern Capitalism and Health, February 21, 2021.

Podcast: Nicholas Freudenberg on Modern Capitalism and the Future of Health. Keen On, Podcast With Andrew Keen. 

Podcast. MIP Make It Plain with Mark Thompson. Dr. Nicholas Freudenberg on Death by Capitalism.

Podcast and YouTube. Like it or Not with Benjamin Dixon. Interview with Nicholas Freudenberg  

Interview. A new book asks whether capitalism is compatible with public health. (The answer is no), Dr. Nicholas Freudenberg says capitalism isn’t designed to keep our societies healthy. By Matthew Rozsa March 14, 2021, Salon.    

To protect health, rein in Big Tech: Influential companies must take responsibility for effects, Nicholas Freudenberg, NEW YORK DAILY NEWS, MAR 29, 2021.

An Interview with Nick Freudenberg on Food Policy and At What Cost. CUNY Urban Food Policy Monitor, March 30, 2021.

Corporate versus public control of science and technology: Forging a framework for the 21st Century, Nicholas Freudenberg, STAT, April 2, 2021.


P&P Live! Nicholas Freudenberg, Abdul El-Sayed, and Micah Johnson — American Healthcare: What’s Broken and How We Can Fix It, Monday, March 15, 2021 – 8 p.m., Politics and Prose, Washington, D.C. YouTube

The CUNY School of Public Health sponsored the launch and discussion of At What CostListen to the discussion here. At the event, Drs. Mary T. Bassett, Director of the FXB Center for Health and Human Rights at Harvard University and former Commissioner of the NYC Department of Health and Marion Nestle, Paulette Goddard Professor of Nutrition, Food Studies, and Public Health, Emerita, at New York University, join for a lively discussion. CUNY SPH Dean Ayman El-Mohandes moderates. The event was co-sponsored by the CUNY Urban Food Policy Institute and Scholars Strategy Network–NYC Chapter (a national network of scholars active in public policy, based at Harvard University). 

Broadcast on CSPAN Book Discussion on April 10, 2021, 2 pm ET and online thereafter.

Nicholas Freudenberg with Mark Bittman (livestream) Modern Capitalism and the Future of Health, Seattle Town Hall, March 24, 2021, 7:30 pm Pacific Daylight Time. YouTube

Nicholas Freudenberg discusses Modern capitalism and the future of health: assessing the costs and charting alternatives,  Tuesday April 20, 12:30- 1:30 pm,  Australian Eastern Standard Time, Australia National University, register here.