This review article considers how social-ecological systems change is transforming human health in the Anthropocene. From hunting and gathering bands through modern globalized societies, human health has been shaped by circular feedbacks between ecological processes, available energy sources, levels of social complexity, and cultural ontologies. As the environmental crises of the early Anthropocene (biodiversity loss, climate change, land use changes) push ecosystems across thresholds into new configurations, we are experiencing an equally profound transition for human health. Drawing on literatures from medical anthropology, sociology, complexity science, and ecological economics, this article argues that promising alternatives for health systems in the Anthropocene are emerging beyond the boundaries of the formal healthcare sector in community-based practices that can take root in a context of ecological limits, economic contraction, and growing networks of reciprocal care.

Environmentalists have long warned of a coming shock to the system. COVID-19 exposed fragility in the system and has the potential to result in radical social change. With socioeconomic interruptions cascading through tightly intertwined economic, social, environmental, and political systems, many are not working to find the opportunities for change. Prefigurative politics in communities have demonstrated rapid and successful responses to the pandemic. These successes, and others throughout history, demonstrate that prefigurative politics are important for response to crisis. Given the failure of mainstream environmentalism, we use systemic transformation literature to suggest novel strategies to strengthen cooperative prefigurative politics. In this paper, we look at ways in which COVID-19 shock is leveraged in local and global economic contexts. We also explore how the pandemic has exposed paradoxes of global connectivity and interdependence. While responses shed light on potential lessons for ecological sustainability governance, COVID-19 has also demonstrated the importance of local resilience strategies. We use local manufacturing as an example of a possible localized, yet globally connected, resilience strategy and explore some preliminary data that highlight possible tradeoffs of economic contraction.

Ecological economics has relied too much on priorities and institutional conventions defined by the high energy/throughput era of social democracy. Future research should focus on the political economy of a survival unit (Elias) based upon Livelihood as counterbalance to both State and Market. Drawing on the work of Polanyi, Elias, Gellner and Ong, capitalist modernization is analyzed in terms of the emergence of a society of individuals and the replacement of the survival units of place-bound bound family and community by one in which the State acts in concert with the Market. The operation of welfare systems is shown to depend upon ongoing economic growth and a continual flow of fiscal resources. The politics of this survival unit depends upon high levels of mutual identification and an affective-cognitive ‘we imaginary’. Increasing diversity, a political rejection of nationalism as a basis for politics and limits to economic growth, are likely to present an existential threat to the State–Market survival unit. A reversal of globalization, reconsolidation of the nation-state, a reduction in the scope of national and global markets and the expansion of informal processes of manufacture and distribution may provide a plausible basis for a hybrid Livelihood–Market–State survival unit. The politics of such a reorientation would straddle the existing left–right divide in disruptive and unsettling ways. Examples are given of pre-figurative forms of reciprocation and association that may be indicative of future arrangements.