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Purpose – The aim of this chapter is to explore the current trend for new ‘mutual’ models of public service delivery as part of a process of personalisation and commodification of health and social care design and service delivery.

Design/methodology/approach – The authors use the thesis of commodification and the concept of value to explore, with the aid of three examples from previous research, the complexity of transfer of large-scale services from local government and health bodies and the potential contribution of co-operatives and mutuals to this agenda.

Findings – Mutuals may provide an alternative to the supposedly inevitable progression to wholly commodified health and social care provision. However, a top-down push to encourage employee-owned enterprises may fail to take account of significant issues: high capital and labour costs; transfer of risk to consumers purchasing services; quality of care assurance; scope and scale of services; and enabling policies and structures to support democratic ownership and control of enterprises.

Research implications/limitations – Although the chapter focuses on Welsh experience, there are implications for the future provision of public services more generally.

Originality/value – This chapter contributes to a growing discourse and critical awareness of co-operatives and mutuals as potential public service providers. In particular, the nature of democratic engagement and involvement; models of co-ownership and co-construction of public services and the role of the State in promoting alternative non-marketised systems of design and delivery for the public good as well as maintaining accountability through local and national democratic processes.

The present crisis in the global economy is more serious than anything that we have witnessed since the 1930s, yet policies designed to tackle it are limited and inadequate. Those that have been proposed, in terms of fiscal stimulus, rely on an outmoded view of the economy, where money can be used to force economic growth. Since the recognition of planetary limits such a strategy is no longer admissible. Instead, we need a global system where countries agree to limit their carbon dioxide emissions: this chapter outlines the Contraction and Convergence model (C&C), which proposes that countries do this within a framework of equal per capita emissions for all global citizens. However, within the existing financial architecture such a policy would do nothing to prevent the United States from continuing to print dollars and to use these to gain an unfair share of world production. Other countries controlling reserve currencies would also be able to avoid strict limits. The policy answer proposed is that of the Ebcu (environment-backed currency unit) – a neutral global trading currency to be used by countries that have also signed up to the C&C model.

The Bureau of Economics in the Federal Trade Commission has a three-part role in the Agency and the strength of its functions changed over time depending on the preferences and ideology of the FTC’s leaders, developments in the field of economics, and the tenor of the times. The over-riding current role is to provide well considered, unbiased economic advice regarding antitrust and consumer protection law enforcement cases to the legal staff and the Commission. The second role, which long ago was primary, is to provide reports on investigations of various industries to the public and public officials. This role was more recently called research or “policy R&D”. A third role is to advocate for competition and markets both domestically and internationally. As a practical matter, the provision of economic advice to the FTC and to the legal staff has required that the economists wear “two hats,” helping the legal staff investigate cases and provide evidence to support law enforcement cases while also providing advice to the legal bureaus and to the Commission on which cases to pursue (thus providing “a second set of eyes” to evaluate cases). There is sometimes a tension in those functions because building a case is not the same as evaluating a case. Economists and the Bureau of Economics have provided such services to the FTC for over 100 years proving that a sub-organization can survive while playing roles that sometimes conflict. Such a life is not, however, always easy or fun.

Since the development of the COVID-19 vaccinations, questions surrounding race have been prominent in the literature on vaccine uptake. Early in the vaccine rollout, public health officials were concerned with the relatively lower rates of uptake among certain racial/ethnic minority groups. We suggest that this may also be patterned by racial/ethnic residential segregation, which previous work has demonstrated to be an important factor for both health and access to health care.

In this study, we examine county-level vaccination rates, racial/ethnic composition, and residential segregation across the U.S. We compile data from several sources, including the American Community Survey (ACS) and Centers for Disease Control (CDC) measured at the county level.

We find that just looking at the associations between racial/ethnic composition and vaccination rates, both percent Black and percent White are significant and negative, meaning that higher percentages of these groups in a county are associated with lower vaccination rates, whereas the opposite is the case for percent Latino. When we factor in segregation, as measured by the index of dissimilarity, the patterns change somewhat. Dissimilarity itself was not significant in the models across all groups, but when interacted with race/ethnic composition, it moderates the association. For both percent Black and percent White, the interaction with the Black-White dissimilarity index is significant and negative, meaning that it deepens the negative association between composition and the vaccination rate.

The analysis is only limited to county-level measures of racial/ethnic composition and vaccination rates, so we are unable to see at the individual-level who is getting vaccinated.

We find that segregation moderates the association between racial/ethnic composition and vaccination rates, suggesting that local race relations in a county helps contextualize the compositional effects of race/ethnicity.