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How pandemics past and present fuel the rise of mega-corporations

How pandemics past and present fuel the rise of mega-corporations

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In June 1348, people in England began reporting mysterious symptoms. They started off as mild and vague: headaches, aches, and nausea. This was followed by painful black lumps, or buboes, growing in the armpits and groin, which gave the disease its name: bubonic plague. The last stage was a high fever, and then death.

Originating in Central Asia, soldiers and caravans had brought bubonic plague – Yersina pestis, a bacterium carried on fleas that lived on rats – to ports on the Black Sea. The highly commercialised world of the Mediterranean ensured the plague’s swift transfer on merchant ships to Italy, and then across Europe. The Black Death killed between a third and a half of the population of Europe and the Near East.

This huge number of deaths was accompanied by general economic devastation. With a third of the workforce dead, the crops could not be harvested and communities fell apart. One in ten villages in England (and in Tuscany and other regions) were lost and never re-founded. Houses fell into the ground and were covered by grass and earth, leaving only the church behind. If you ever see a church or chapel all alone in a field, you are probably looking at the last remains of one of Europe’s lost villages.

The traumatic experience of the Black Death, which killed perhaps 80% of those who caught it, drove many people to write in an attempt to make sense of what they had lived through. In Aberdeen, John of Fordun, a Scottish chronicler, recorded that:

This sickness befell people everywhere, but especially the middling and lower classes, rarely the great. It generated such horror that children did not dare to visit their dying parents, nor parents their children, but fled for fear of contagion as if from leprosy or a serpent.

These lines could almost have been written today.


This article is part of Conversation Insights
The Insights team generates long-form journalism derived from interdisciplinary research. The team is working with academics from different backgrounds who have been engaged in projects aimed at tackling societal and scientific challenges.


Although the death rate from COVID-19 is far lower than that of the Black Death, the economic fallout has been severe due to the globalised, highly-integrated nature of modern economies. Add to this our highly mobile populations today and coronavirus, unlike the plague, has spread across the globe in a matter of months, not years.

While the Black Death resulted in short term economic damage, the longer-term consequences were less obvious. Before the plague erupted, several centuries of population growth had produced a labour surplus, which was abruptly replaced with a labour shortage when many serfs and free peasants died. Historians have argued that this labour shortage allowed those peasants that survived the pandemic to demand better pay or to seek employment elsewhere. Despite government resistance, serfdom and the feudal system itself were ultimately eroded.

The people of Tournai bury victims of the Black Death, c.1353. Wikimedia Commons

But another less often remarked consequence of the Black Death was the rise of wealthy entrepreneurs and business-government links. Although the Black Death caused short-term losses for Europe’s largest companies, in the long term, they concentrated their assets and gained a greater share of the market and influence with governments. This has strong parallels with the current situation in many countries across the world. While small companies rely upon government support to prevent them collapsing, many others – mainly the much larger ones involved in home delivery – are profiting handsomely from the new trading conditions.

The mid-14th century economy is too removed from the size, speed, and interconnectedness of the modern market to give exact comparisons. But we can certainly see parallels with the way that the Black Death strengthened the power of the state and accelerated the domination of key markets by a handful of mega-corporations.

Black Death business

The sudden loss of at least a third of Europe’s population didn’t lead to an even redistribution of wealth for everyone else. Instead, people responded to the devastation by keeping money within the family. Wills became highly specific and wealthy businessmen, in particular, went to great lengths to ensure that their patrimony was no longer divided up after death, replacing the previous tendency to leave a third of all their resources to charity. Their descendants benefited from a continued concentration of capital into a smaller and smaller number of hands.

At the same time, the decline of feudalism and the rise of a wage-based economy following peasant demands for better labour conditions benefited urban elites. Being paid in cash, rather than in kind (in the granting of privileges such as the right to collect firewood), meant that peasants had more money to spend in towns.

This concentration of wealth greatly accelerated a pre-existing trend: the emergence of merchant entrepreneurs who combined trade in goods with their production on a scale only available to those with significant sums of capital. For example, silk, once imported from Asia and Byzantium, was now being produced in Europe. Wealthy Italian merchants began to open silk and cloth workshops.

Europe in 1360. Wikimedia Commons

These entrepreneurs were uniquely positioned to respond to the sudden labour shortage caused by the Black Death. Unlike independent weavers, who lacked the capital, and unlike aristocrats, whose wealth was locked up in land, urban entrepreneurs were able to use their liquid capital to invest in new technologies, compensating for the loss of workers with machines.

In southern Germany, which became one of Europe’s most commercialised areas in the late 14th and 15th centuries, companies such as the Welser (which later ran Venezuela as a private colony) combined growing flax with owning the looms on which workers span that flax into linen cloth, which the Welser then sold. The trend of the post-Black Death 14th and 15th centuries was a concentration of resources – capital, skills, and infrastructure – into the hands of a small number of corporations.

The age of Amazon

Rolling forward to the present, there are some clear similarities. Certain large organisations have stepped up to the opportunities provided by COVID-19. In many countries across the world, entire ecologies of small restaurants, pubs and shops have suddenly been closed down. The market for food, general retail and entertainment has gone online, and cash has pretty much disappeared.

The percentage of calories that restaurants provided has had to be rerouted through supermarkets, and much of this supply has now been taken up by supermarket chains. They have plenty of large properties and lots of staff, with the HR capacity to recruit more rapidly, and there are many underemployed people who now want jobs. They also have warehouses, trucks and complex logistics capacity.

The other big winner has been the giants of online retail – such as Amazon, who run a “Prime Pantry” service in the US, India and many European countries. High street shops have been suffering from price and convenience competition from the internet for years, and bankruptcies are regular news. Now, much “non-essential” retail space is closed, and our desires have been re-rerouted through Amazon, eBay, Argos, Screwfix and others. There has been a clear spike in online shopping, and retail analysts are wondering whether this is a decisive move into the virtual world, and the further dominance of big corporations.

Keeping us distracted as we wait at home for our parcels is the streaming entertainment industry – a market sector which is dominated by big corporations including Netflix, Amazon Prime (again), Disney and and others. Other online giants such as Google (which owns YouTube), Facebook (which owns Instagram) and Twitter provide the other platforms that dominate online traffic.

The final link in the chain is the delivery companies themselves: UPS, FedEx, Amazon Logistics (again), as well as food delivery from Just Eat and Deliveroo. Through their business models are different, their platforms now dominate the movements of products of all kinds, whether your new Toshiba branded Amazon Fire TV, or your stuffed crust from Pizza Hut (a subsidiary of Yum! Brands, which also owns KFC, Taco Bell and others).

The other swing to corporate dominance has been the move away from state-backed cash towards contactless payment services. It’s obviously a corollary of online marketplaces, but also means that the money moves though big corporations that take their slice for moving it. Visa and Mastercard are the largest players, but Apple Pay, PayPal, and Amazon Pay (again) have all seen increases in their transaction volume as cash sits unused in people’s purses. And if cash is still imagined to be a vector for transmission, then retailers won’t take it and customers won’t use it.

Small business has taken a really decisive hit across a wide range of sectors as COVID-19, like the Black Death, results in big companies gaining market share. Even those working at home to write pieces like this are working on Skype (owned by Microsoft), Zoom and BlueJeans, as well using email clients and laptops made by a small number of global organisations. Billionaires are getting richer while ordinary people lose their jobs. Jeff Bezos, Amazon’s CEO, has increased his wealth by US$25 billion since the start of the year.

But this is not the whole story. The other big trend in the response to the virus has been the strengthening of the power of the state.

Governing pandemics

At a state level, the Black Death caused the acceleration of trends towards centralisation, the growth of taxation, and government dependence upon large companies.

In England, the declining value of land and consequent falls in revenue prompted the crown – the country’s biggest landowner – to attempt to cap wages at pre-plague levels with the 1351 Statute of Labourers, and to impose additional taxes upon the populace. Previously, the government was expected to fund itself, only imposing taxes for extraordinary expenses such as wars. But the post-plague taxes set a major precedent for government intervention in the economy.

These governmental efforts were a significant increase in the crown’s involvement in people’s daily lives. In subsequent plague outbreaks, which occurred every 20 years or so, movement began to be restricted through curfews, travel bans, and quarantines. This was part of a general concentration of state power and the replacement of the previous regional distribution of authority with a centralised bureaucracy. Many of the men running the post-plague administration, such as the poet Geoffrey Chaucer, were drawn from English merchant families, some of which gained significant political power.

Giovanni di Bicci de’ Medici, founder of the Medici Bank. Wikimedia Commons

The most outstanding example of this was the de la Pole family, who in two generations went from being Hull wool merchants to earls of Suffolk. With the temporary collapse of international trade and finance after the Black Death, Richard de la Pole became the crown’s greatest lender and an intimate of Richard II. When Italian mega-companies re-emerged in the late 14th and 15th centuries, they also benefited from the crown’s ever-growing reliance upon merchant companies. The Medici family, who eventually came to rule Florence, are the most striking example.

Merchants also gained political influence by purchasing land, the price of which had fallen after the Black Death. Land ownership allowed merchants to enter the land-based gentry or even the aristocracy, marrying their children to the sons and daughters of cash-strapped lords. With their new status, and with the help of influential in-laws, the urban elites gained political representation within parliament.

By the end of the 14th century, the government’s extension of state control and its continued ties to merchant companies drove many nobles to turn against Richard II. They transferred their allegiance to his cousin, who became Henry IV, in the (vain) hope that he would not follow Richard’s policies.

Richard II meeting with the rebels of the Peasants’ Revolt of 1381. Wikimedia Commons

This, and the subsequent Wars of the Roses, generally depicted as a clash between the Yorkists and the Lancastrians, were actually partly driven by the nobility’s hostility towards the centralisation of government power. Henry Tudor’s defeat of Richard III in 1489 ended not only the war but also quashed any further attempts by the English baronage to regain regional authority, paving the way for the continued rise of corporations and central government.

The state we are in

The power of the state is something that we largely assume in the 21st century. Across the world, the idea of the sovereign nation has been central to the imperial politics and economy of the last few centuries.

But from the 1970s onwards, it became common among intellectuals to suggest that the state was less important, its monopoly of control within a given territory contested by multinational corporations. In 2016, of the largest 100 economic entities, 31 were countries and 69 were companies. Walmart was larger than the economy of Spain, Toyota larger than India. The capacity of these large companies to influence politicians and regulators has been clear enough: consider the effects of oil companies on climate change denial.

And since Margaret Thatcher, prime minister of the UK from 1979 to 1990, pronounced that she intended to “roll back the state”, more and more parts of previously state-owned assets now operate as companies, or as players in state engineered quasi-markets. Roughly 25% of the UK’s National Health Service, for example, is delivered through contracts with the private sector.

Across the globe, transport, utilities, telecommunications, dentists, opticians, the post office and many other services used to be state monopolies and are now run by profit-making companies. Nationalised, or state owned, industries are often described as slow, and in need of market discipline in order to become more modern and efficient.

But thanks to coronavirus, the state has come rolling back in again like a tsunami. Spending on a level which was mocked as “magic money tree” economics only a few months ago has been aimed at national health systems, addressed the problem of homelessness, provided universal basic income for millions of people, and offered loan guarantees or direct payments to a host of businesses.

This is Keynesian economics on a grand scale, in which national bonds are used to borrow money backed by future income from taxpayers. Ideas about balancing the budget appear to, for now, be history, with entire industries now being reliant on treasury bailouts. Politicians the world over have suddenly become interventionist, with wartime metaphors being used to justify gigantic spending.

Less often remarked is the astonishing restriction on personal freedoms. The autonomy of the individual is central to neoliberal ideas. “Freedom loving peoples” are contrasted with those who live their lives under the yoke of tyranny, of states that exercise Big Brother surveillance powers over their citizens behaviour.

Yet in the last few months, states around the world have effectively restricted movement for the vast majority of people and are using the police and armed forces to prevent assembly in public and private spaces. Theatres, pubs and restaurants are closed by fiat, parks have been locked, and sitting on benches can get you a fine. Running too close to someone will get you shouted at by someone in a high vis vest. A medieval king would have been impressed with this level of authoritarianism.

The pandemic seems to have allowed the fiscal and administrative powers of big government to bulldozer arguments about prudence and liberty. The state’s power is now being exercised in ways that haven’t been seen since the second world war, and there has been widespread public support.

Popular resistance

To return to the Black Death, the growth in wealth and influence of merchants and big business seriously aggravated existing anti-mercantile sentiment. Medieval thought – both intellectual and popular – held that trade was morally suspect and that merchants, especially wealthy ones, were prone to avarice. The Black Death was widely interpreted as a punishment from God for Europe’s sinfulness, and many post-plague writers blamed the church, governments, and wealthy companies for Christendom’s moral decline.

William Langland’s famous protest poem Piers Plowman was strongly anti-mercantilist. Other works, such as the mid-15th century poem the Libelle of Englysche Polycye, tolerated trade but wanted it in the hands of English merchants and out of the control of Italians, whom the author argued impoverished the country.

As the 14th and 15th centuries progressed and corporations gained a greater share of the market, popular and intellectual hostility grew. In the longer term, this was to have incendiary results. By the 16th century, the concentration of trade and finance into the hands of corporations had evolved into a near-monopoly upon royal and papal banking by a small number of companies who also held monopolies or near-monopolies over Europe’s major commodities – such as silver, copper, and mercury – and imports from Asia and the Americas, especially spices.

Sistine Chapel ceiling, Vatican City, painted by Michelangelo between 1508 and 1512. Amandajm/Wikimedia Commons

Martin Luther was incensed by this concentration and especially the Catholic Church’s use of monopolistic firms to collect indulgences. In 1524, Luther published a tract arguing that trade should be for the common (German) good and that merchants should not charge high prices. Along with other Protestant writers, such as Philip Melancthon and Ulrich von Hutten, Luther drew upon existing anti-mercantile sentiment to criticise the influence of business over government, adding financial injustice to their call for religious reform.

The sociologist Max Weber famously associated Protestantism with the emergence of capitalism and modern economic thought. But early Protestant writers opposed multinational corporations and the commercialisation of everyday life, drawing upon anti-mercantile sentiment that had its roots in the Black Death. This popular and religious opposition eventually led to the break from Rome and the transformation of Europe.

Is small always beautiful?

By the 21st century we have become used to the idea that capitalist firms produce concentrations of wealth. Whether Victorian industrialists, US robber barons or dot com billionaires, the inequalities generated by business and its corrupting influence over governments have shaped discussion of commerce since the industrial revolution. For critics, big business has often been characterised as heartless, a behemoth that crushes ordinary people in the wheels of its machines, or vampirically extracts the profits of labour from the labouring classes.

As we have seen, the arguments between small business localists and those who favour corporations and the power of the state date back many centuries. Romantic poets and radicals bemoaned the way that the “dark satanic mills” were destroying the countryside and producing people who were no more than appendages to machines. The idea that the honest craftsman was being replaced by the alienated employee, a wage slave, is common to both nostalgic and progressive critics of early capitalism.

By the 1960s, the idea that there was some fundamental difference between small and large forms of business added environmentalism to these longstanding arguments. “The man” in his skyscraper was opposed to the more authentic artisan.

This faith in local business combined with a suspicion of corporations and the state have flowed into the green, Occupy and Extinction Rebellion movements. Eating local food, using local money, and trying to tilt the purchasing power of “anchor institutions” like hospitals and universities towards small social enterprises has become the common sense of many contemporary economic activists.

But the COVID-19 crisis questions this small is good, big is bad dichotomy in some very fundamental ways. Large scale organising has appeared to be necessary to deal with the huge range of issues that the virus has thrown up, and the states that appear to have been most successful are those which have adopted the most interventionist forms of surveillance and control. Even the most ardent post-capitalist would have to admit that small social enterprises could not fit out a gigantic hospital in a few weeks.

And though there are plenty of examples of local businesses engaging in food delivery, and a commendable amount of mutual aid taking place, the population of the global north is largely being fed by large supermarket chains with complex logistics operations.

After coronavirus

The long-term result of the Black Death was the strengthening of the power of big business and the state. The same processes are happening much more rapidly during the coronavirus lockdown.

But we should be cautious of easy historical lessons. History never really repeats itself. The circumstances of each time are unique, and it simply isn’t wise to treat the “lesson” of history as if it were a series of experiments that prove certain general laws. And COVID-19 will not kill a third of any population, so though its effects are profound, they will not result in the same shortage of working people. If anything, it has actually strengthened the power of employers.

The most profound difference is that the virus comes in the middle of another crisis, that of climate change. There is a real danger that the policy of bouncing back to a growth economy will simply overwhelm the necessity of reducing carbon emissions. This is the nightmare scenario, one in which COVID-19 is just a prequel to something much worse.

But the huge mobilisations of people and money which governments and corporations have deployed also shows that big organisations can reshape themselves and the world extraordinarily rapidly if they wish. This gives real grounds for optimism concerning our collective capacity to re-engineer energy production, transport, food systems and much else – the green new deal which many policy makers have been sponsoring.

The Black Death and COVID-19 seem to have both caused concentration and centralisation of business and state power. That is interesting to note. But the biggest question is whether these potent forces can be aimed at the crisis to come.


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The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

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Rand Paul Teases Senate GOP Leader Run – Musk Says “I Would Support”

Rand Paul Teases Senate GOP Leader Run – Musk Says "I Would Support"

Republican Kentucky Senator Rand Paul on Friday hinted that he may jump…

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Rand Paul Teases Senate GOP Leader Run - Musk Says "I Would Support"

Republican Kentucky Senator Rand Paul on Friday hinted that he may jump into the race to become the next Senate GOP leader, and Elon Musk was quick to support the idea. Republicans must find a successor for periodically malfunctioning Mitch McConnell, who recently announced he'll step down in November, though intending to keep his Senate seat until his term ends in January 2027, when he'd be within weeks of turning 86. 

So far, the announced field consists of two quintessential establishment types: John Cornyn of Texas and John Thune of South Dakota. While John Barrasso's name had been thrown around as one of "The Three Johns" considered top contenders, the Wyoming senator on Tuesday said he'll instead seek the number two slot as party whip. 

Paul used X to tease his potential bid for the position which -- if the GOP takes back the upper chamber in November -- could graduate from Minority Leader to Majority Leader. He started by telling his 5.1 million followers he'd had lots of people asking him about his interest in running...

...then followed up with a poll in which he predictably annihilated Cornyn and Thune, taking a 96% share as of Friday night, with the other two below 2% each. 

Elon Musk was quick to back the idea of Paul as GOP leader, while daring Cornyn and Thune to follow Paul's lead by throwing their names out for consideration by the Twitter-verse X-verse. 

Paul has been a stalwart opponent of security-state mass surveillance, foreign interventionism -- to include shoveling billions of dollars into the proxy war in Ukraine -- and out-of-control spending in general. He demonstrated the latter passion on the Senate floor this week as he ridiculed the latest kick-the-can spending package:   

In February, Paul used Senate rules to force his colleagues into a grueling Super Bowl weekend of votes, as he worked to derail a $95 billion foreign aid bill. "I think we should stay here as long as it takes,” said Paul. “If it takes a week or a month, I’ll force them to stay here to discuss why they think the border of Ukraine is more important than the US border.”

Don't expect a Majority Leader Paul to ditch the filibuster -- he's been a hardy user of the legislative delay tactic. In 2013, he spoke for 13 hours to fight the nomination of John Brennan as CIA director. In 2015, he orated for 10-and-a-half-hours to oppose extension of the Patriot Act

Rand Paul amid his 10 1/2 hour filibuster in 2015

Among the general public, Paul is probably best known as Capitol Hill's chief tormentor of Dr. Anthony Fauci, who was director of the National Institute of Allergy and Infectious Disease during the Covid-19 pandemic. Paul says the evidence indicates the virus emerged from China's Wuhan Institute of Virology. He's accused Fauci and other members of the US government public health apparatus of evading questions about their funding of the Chinese lab's "gain of function" research, which takes natural viruses and morphs them into something more dangerous. Paul has pointedly said that Fauci committed perjury in congressional hearings and that he belongs in jail "without question."   

Musk is neither the only nor the first noteworthy figure to back Paul for party leader. Just hours after McConnell announced his upcoming step-down from leadership, independent 2024 presidential candidate Robert F. Kennedy, Jr voiced his support: 

In a testament to the extent to which the establishment recoils at the libertarian-minded Paul, mainstream media outlets -- which have been quick to report on other developments in the majority leader race -- pretended not to notice that Paul had signaled his interest in the job. More than 24 hours after Paul's test-the-waters tweet-fest began, not a single major outlet had brought it to the attention of their audience. 

That may be his strongest endorsement yet. 

Tyler Durden Sun, 03/10/2024 - 20:25

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‘I couldn’t stand the pain’: the Turkish holiday resort that’s become an emergency dental centre for Britons who can’t get treated at home

The crisis in NHS dentistry is driving increasing numbers abroad for treatment. Here are some of their stories.

This clinic in the Turkish resort of Antalya is the official 'dental sponsor' of the Miss England competition. Diana Ibanez-Tirado, Author provided

It’s a hot summer day in the Turkish city of Antalya, a Mediterranean resort with golden beaches, deep blue sea and vibrant nightlife. The pool area of the all-inclusive resort is crammed with British people on sun loungers – but they aren’t here for a holiday. This hotel is linked to a dental clinic that organises treatment packages, and most of these guests are here to see a dentist.

From Norwich, two women talk about gums and injections. A man from Wales holds a tissue close to his mouth and spits blood – he has just had two molars extracted.

The dental clinic organises everything for these dental “tourists” throughout their treatment, which typically lasts from three to 15 days. The stories I hear of what has caused them to travel to Turkey are strikingly similar: all have struggled to secure dental treatment at home on the NHS.

“The hotel is nice and some days I go to the beach,” says Susan*, a hairdresser in her mid-30s from Norwich. “But really, we aren’t tourists like in a proper holiday. We come here because we have no choice. I couldn’t stand the pain.”

Seaside beach resort with mountains in the distance
The Turkish Mediterranean resort of Antalya. Akimov Konstantin/Shutterstock

This is Susan’s second visit to Antalya. She explains that her ordeal started two years earlier:

I went to an NHS dentist who told me I had gum disease … She did some cleaning to my teeth and gums but it got worse. When I ate, my teeth were moving … the gums were bleeding and it was very painful. I called to say I was in pain but the clinic was not accepting NHS patients any more.

The only option the dentist offered Susan was to register as a private patient:

I asked how much. They said £50 for x-rays and then if the gum disease got worse, £300 or so for extraction. Four of them were moving – imagine: £1,200 for losing your teeth! Without teeth I’d lose my clients, but I didn’t have the money. I’m a single mum. I called my mum and cried.

Susan’s mother told her about a friend of hers who had been to Turkey for treatment, then together they found a suitable clinic:

The prices are so much cheaper! Tooth extraction, x-rays, consultations – it all comes included. The flight and hotel for seven days cost the same as losing four teeth in Norwich … I had my lower teeth removed here six months ago, now I’ve got implants … £2,800 for everything – hotel, transfer, treatments. I only paid the flights separately.

In the UK, roughly half the adult population suffers from periodontitis – inflammation of the gums caused by plaque bacteria that can lead to irreversible loss of gums, teeth, and bone. Regular reviews by a dentist or hygienist are required to manage this condition. But nine out of ten dental practices cannot offer NHS appointments to new adult patients, while eight in ten are not accepting new child patients.

Some UK dentists argue that Britons who travel abroad for treatment do so mainly for cosmetic procedures. They warn that dental tourism is dangerous, and that if their treatment goes wrong, dentists in the UK will be unable to help because they don’t want to be responsible for further damage. Susan shrugs this off:

Dentists in England say: ‘If you go to Turkey, we won’t touch you [afterwards].’ But I don’t worry because there are no appointments at home anyway. They couldn’t help in the first place, and this is why we are in Turkey.

‘How can we pay all this money?’

As a social anthropologist, I travelled to Turkey a number of times in 2023 to investigate the crisis of NHS dentistry, and the journeys abroad that UK patients are increasingly making as a result. I have relatives in Istanbul and have been researching migration and trading patterns in Turkey’s largest city since 2016.

In August 2023, I visited the resort in Antalya, nearly 400 miles south of Istanbul. As well as Susan, I met a group from a village in Wales who said there was no provision of NHS dentistry back home. They had organised a two-week trip to Turkey: the 12-strong group included a middle-aged couple with two sons in their early 20s, and two couples who were pensioners. By going together, Anya tells me, they could support each other through their different treatments:

I’ve had many cavities since I was little … Before, you could see a dentist regularly – you didn’t even think about it. If you had pain or wanted a regular visit, you phoned and you went … That was in the 1990s, when I went to the dentist maybe every year.

Anya says that once she had children, her family and work commitments meant she had no time to go to the dentist. Then, years later, she started having serious toothache:

Every time I chewed something, it hurt. I ate soups and soft food, and I also lost weight … Even drinking was painful – tea: pain, cold water: pain. I was taking paracetamol all the time! I went to the dentist to fix all this, but there were no appointments.

Anya was told she would have to wait months, or find a dentist elsewhere:

A private clinic gave me a list of things I needed done. Oh my God, almost £6,000. My husband went too – same story. How can we pay all this money? So we decided to come to Turkey. Some people we know had been here, and others in the village wanted to come too. We’ve brought our sons too – they also need to be checked and fixed. Our whole family could be fixed for less than £6,000.

By the time they travelled, Anya’s dental problems had turned into a dental emergency. She says she could not live with the pain anymore, and was relying on paracetamol.

In 2023, about 6 million adults in the UK experienced protracted pain (lasting more than two weeks) caused by toothache. Unintentional paracetamol overdose due to dental pain is a significant cause of admissions to acute medical units. If left untreated, tooth infections can spread to other parts of the body and cause life-threatening complications – and on rare occasions, death.

In February 2024, police were called to manage hundreds of people queuing outside a newly opened dental clinic in Bristol, all hoping to be registered or seen by an NHS dentist. One in ten Britons have admitted to performing “DIY dentistry”, of which 20% did so because they could not find a timely appointment. This includes people pulling out their teeth with pliers and using superglue to repair their teeth.

In the 1990s, dentistry was almost entirely provided through NHS services, with only around 500 solely private dentists registered. Today, NHS dentist numbers in England are at their lowest level in a decade, with 23,577 dentists registered to perform NHS work in 2022-23, down 695 on the previous year. Furthermore, the precise division of NHS and private work that each dentist provides is not measured.

The COVID pandemic created longer waiting lists for NHS treatment in an already stretched public service. In Bridlington, Yorkshire, people are now reportedly having to wait eight-to-nine years to get an NHS dental appointment with the only remaining NHS dentist in the town.

In his book Patients of the State (2012), Argentine sociologist Javier Auyero describes the “indignities of waiting”. It is the poor who are mostly forced to wait, he writes. Queues for state benefits and public services constitute a tangible form of power over the marginalised. There is an ethnic dimension to this story, too. Data suggests that in the UK, patients less likely to be effective in booking an NHS dental appointment are non-white ethnic groups and Gypsy or Irish travellers, and that it is particularly challenging for refugees and asylum-seekers to access dental care.


This article is part of Conversation Insights
The Insights team generates long-form journalism derived from interdisciplinary research. The team is working with academics from different backgrounds who have been engaged in projects aimed at tackling societal and scientific challenges.


In 2022, I experienced my own dental emergency. An infected tooth was causing me debilitating pain, and needed root canal treatment. I was advised this would cost £71 on the NHS, plus £307 for a follow-up crown – but that I would have to wait months for an appointment. The pain became excruciating – I could not sleep, let alone wait for months. In the same clinic, privately, I was quoted £1,300 for the treatment (more than half my monthly income at the time), or £295 for a tooth extraction.

I did not want to lose my tooth because of lack of money. So I bought a flight to Istanbul immediately for the price of the extraction in the UK, and my tooth was treated with root canal therapy by a private dentist there for £80. Including the costs of travelling, the total was a third of what I was quoted to be treated privately in the UK. Two years on, my treated tooth hasn’t given me any more problems.

A better quality of life

Not everyone is in Antalya for emergency procedures. The pensioners from Wales had contacted numerous clinics they found on the internet, comparing prices, treatments and hotel packages at least a year in advance, in a carefully planned trip to get dental implants – artificial replacements for tooth roots that help support dentures, crowns and bridges.

Street view of a dental clinic in Antalya, Turkey
Dental clinic in Antalya, Turkey. Diana Ibanez-Tirado, CC BY-NC-ND

In Turkey, all the dentists I speak to (most of whom cater mainly for foreigners, including UK nationals) consider implants not a cosmetic or luxurious treatment, but a development in dentistry that gives patients who are able to have the procedure a much better quality of life. This procedure is not available on the NHS for most of the UK population, and the patients I meet in Turkey could not afford implants in private clinics back home.

Paul is in Antalya to replace his dentures, which have become uncomfortable and irritating to his gums, with implants. He says he couldn’t find an appointment to see an NHS dentist. His wife Sonia went through a similar procedure the year before and is very satisfied with the results, telling me: “Why have dentures that you need to put in a glass overnight, in the old style? If you can have implants, I say, you’re better off having them.”

Most of the dental tourists I meet in Antalya are white British: this city, known as the Turkish Riviera, has developed an entire economy catering to English-speaking tourists. In 2023, more than 1.3 million people visited the city from the UK, up almost 15% on the previous year.


Read more: NHS dentistry is in crisis – are overseas dentists the answer?


In contrast, the Britons I meet in Istanbul are predominantly from a non-white ethnic background. Omar, a pensioner of Pakistani origin in his early 70s, has come here after waiting “half a year” for an NHS appointment to fix the dental bridge that is causing him pain. Omar’s son had been previously for a hair transplant, and was offered a free dental checkup by the same clinic, so he suggested it to his father. Having worked as a driver for a manufacturing company for two decades in Birmingham, Omar says he feels disappointed to have contributed to the British economy for so long, only to be “let down” by the NHS:

At home, I must wait and wait and wait to get a bridge – and then I had many problems with it. I couldn’t eat because the bridge was uncomfortable and I was in pain, but there were no appointments on the NHS. I asked a private dentist and they recommended implants, but they are far too expensive [in the UK]. I started losing weight, which is not a bad thing at the beginning, but then I was worrying because I couldn’t chew and eat well and was losing more weight … Here in Istanbul, I got dental implants – US$500 each, problem solved! In England, each implant is maybe £2,000 or £3,000.

In the waiting area of another clinic in Istanbul, I meet Mariam, a British woman of Iraqi background in her late 40s, who is making her second visit to the dentist here. Initially, she needed root canal therapy after experiencing severe pain for weeks. Having been quoted £1,200 in a private clinic in outer London, Mariam decided to fly to Istanbul instead, where she was quoted £150 by a dentist she knew through her large family. Even considering the cost of the flight, Mariam says the decision was obvious:

Dentists in England are so expensive and NHS appointments so difficult to find. It’s awful there, isn’t it? Dentists there blamed me for my rotten teeth. They say it’s my fault: I don’t clean or I ate sugar, or this or that. I grew up in a village in Iraq and didn’t go to the dentist – we were very poor. Then we left because of war, so we didn’t go to a dentist … When I arrived in London more than 20 years ago, I didn’t speak English, so I still didn’t go to the dentist … I think when you move from one place to another, you don’t go to the dentist unless you are in real, real pain.

In Istanbul, Mariam has opted not only for the urgent root canal treatment but also a longer and more complex treatment suggested by her consultant, who she says is a renowned doctor from Syria. This will include several extractions and implants of back and front teeth, and when I ask what she thinks of achieving a “Hollywood smile”, Mariam says:

Who doesn’t want a nice smile? I didn’t come here to be a model. I came because I was in pain, but I know this doctor is the best for implants, and my front teeth were rotten anyway.

Dentists in the UK warn about the risks of “overtreatment” abroad, but Mariam appears confident that this is her opportunity to solve all her oral health problems. Two of her sisters have already been through a similar treatment, so they all trust this doctor.

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An Istanbul clinic founded by Afghan dentists has a message for its UK customers. Diana Ibanez-Tirado, CC BY-NC-ND

The UK’s ‘dental deserts’

To get a fuller understanding of the NHS dental crisis, I’ve also conducted 20 interviews in the UK with people who have travelled or were considering travelling abroad for dental treatment.

Joan, a 50-year-old woman from Exeter, tells me she considered going to Turkey and could have afforded it, but that her back and knee problems meant she could not brave the trip. She has lost all her lower front teeth due to gum disease and, when I meet her, has been waiting 13 months for an NHS dental appointment. Joan tells me she is living in “shame”, unable to smile.

In the UK, areas with extremely limited provision of NHS dental services – known as as “dental deserts” – include densely populated urban areas such as Portsmouth and Greater Manchester, as well as many rural and coastal areas.

In Felixstowe, the last dentist taking NHS patients went private in 2023, despite the efforts of the activist group Toothless in Suffolk to secure better access to NHS dentists in the area. It’s a similar story in Ripon, Yorkshire, and in Dumfries & Galloway, Scotland, where nearly 25,000 patients have been de-registered from NHS dentists since 2021.

Data shows that 2 million adults must travel at least 40 miles within the UK to access dental care. Branding travel for dental care as “tourism” carries the risk of disguising the elements of duress under which patients move to restore their oral health – nationally and internationally. It also hides the immobility of those who cannot undertake such journeys.

The 90-year-old woman in Dumfries & Galloway who now faces travelling for hours by bus to see an NHS dentist can hardly be considered “tourism” – nor the Ukrainian war refugees who travelled back from West Sussex and Norwich to Ukraine, rather than face the long wait to see an NHS dentist.

Many people I have spoken to cannot afford the cost of transport to attend dental appointments two hours away – or they have care responsibilities that make it impossible. Instead, they are forced to wait in pain, in the hope of one day securing an appointment closer to home.

Billboard advertising a dental clinic in Turkey
Dental clinics have mushroomed in recent years in Turkey, thanks to the influx of foreign patients seeking a wide range of treatments. Diana Ibanez-Tirado, CC BY-NC-ND

‘Your crisis is our business’

The indignities of waiting in the UK are having a big impact on the lives of some local and foreign dentists in Turkey. Some neighbourhoods are rapidly changing as dental and other health clinics, usually in luxurious multi-storey glass buildings, mushroom. In the office of one large Istanbul medical complex with sections for hair transplants and dentistry (plus one linked to a hospital for more extensive cosmetic surgery), its Turkish owner and main investor tells me:

Your crisis is our business, but this is a bazaar. There are good clinics and bad clinics, and unfortunately sometimes foreign patients do not know which one to choose. But for us, the business is very good.

This clinic only caters to foreign patients. The owner, an architect by profession who also developed medical clinics in Brazil, describes how COVID had a major impact on his business:

When in Europe you had COVID lockdowns, Turkey allowed foreigners to come. Many people came for ‘medical tourism’ – we had many patients for cosmetic surgery and hair transplants. And that was when the dental business started, because our patients couldn’t see a dentist in Germany or England. Then more and more patients started to come for dental treatments, especially from the UK and Ireland. For them, it’s very, very cheap here.

The reasons include the value of the Turkish lira relative to the British pound, the low cost of labour, the increasing competition among Turkish clinics, and the sheer motivation of dentists here. While most dentists catering to foreign patients are from Turkey, others have arrived seeking refuge from war and violence in Syria, Iraq, Afghanistan, Iran and beyond. They work diligently to rebuild their lives, careers and lost wealth.

Regardless of their origin, all dentists in Turkey must be registered and certified. Hamed, a Syrian dentist and co-owner of a new clinic in Istanbul catering to European and North American patients, tells me:

I know that you say ‘Syrian’ and people think ‘migrant’, ‘refugee’, and maybe think ‘how can this dentist be good?’ – but Syria, before the war, had very good doctors and dentists. Many of us came to Turkey and now I have a Turkish passport. I had to pass the exams to practise dentistry here – I study hard. The exams are in Turkish and they are difficult, so you cannot say that Syrian doctors are stupid.

Hamed talks excitedly about the latest technology that is coming to his profession: “There are always new materials and techniques, and we cannot stop learning.” He is about to travel to Paris to an international conference:

I can say my techniques are very advanced … I bet I put more implants and do more bone grafting and surgeries every week than any dentist you know in England. A good dentist is about practice and hand skills and experience. I work hard, very hard, because more and more patients are arriving to my clinic, because in England they don’t find dentists.

Dental equipment in a Turkish treatment room
Dentists in Turkey boast of using the latest technology. Diana Ibanez-Tirado, CC BY-NC-ND

While there is no official data about the number of people travelling from the UK to Turkey for dental treatment, investors and dentists I speak to consider that numbers are rocketing. From all over the world, Turkey received 1.2 million visitors for “medical tourism” in 2022, an increase of 308% on the previous year. Of these, about 250,000 patients went for dentistry. One of the most renowned dental clinics in Istanbul had only 15 British patients in 2019, but that number increased to 2,200 in 2023 and is expected to reach 5,500 in 2024.

Like all forms of medical care, dental treatments carry risks. Most clinics in Turkey offer a ten-year guarantee for treatments and a printed clinical history of procedures carried out, so patients can show this to their local dentists and continue their regular annual care in the UK. Dental treatments, checkups and maintaining a good oral health is a life-time process, not a one-off event.

Many UK patients, however, are caught between a rock and a hard place – criticised for going abroad, yet unable to get affordable dental care in the UK before and after their return. The British Dental Association has called for more action to inform these patients about the risks of getting treated overseas – and has warned UK dentists about the legal implications of treating these patients on their return. But this does not address the difficulties faced by British patients who are being forced to go abroad in search of affordable, often urgent dental care.

A global emergency

The World Health Organization states that the explosion of oral disease around the world is a result of the “negligent attitude” that governments, policymakers and insurance companies have towards including oral healthcare under the umbrella of universal healthcare. It as if the health of our teeth and mouth is optional; somehow less important than treatment to the rest of our body. Yet complications from untreated tooth decay can lead to hospitalisation.

The main causes of oral health diseases are untreated tooth decay, severe gum disease, toothlessness, and cancers of the lip and oral cavity. Cases grew during the pandemic, when little or no attention was paid to oral health. Meanwhile, the global cosmetic dentistry market is predicted to continue growing at an annual rate of 13% for the rest of this decade, confirming the strong relationship between socioeconomic status and access to oral healthcare.

In the UK since 2018, there have been more than 218,000 admissions to hospital for rotting teeth, of which more than 100,000 were children. Some 40% of children in the UK have not seen a dentist in the past 12 months. The role of dentists in prevention of tooth decay and its complications, and in the early detection of mouth cancer, is vital. While there is a 90% survival rate for mouth cancer if spotted early, the lack of access to dental appointments is causing cases to go undetected.

The reasons for the crisis in NHS dentistry are complex, but include: the real-term cuts in funding to NHS dentistry; the challenges of recruitment and retention of dentists in rural and coastal areas; pay inequalities facing dental nurses, most of them women, who are being badly hit by the cost of living crisis; and, in England, the 2006 Dental Contract that does not remunerate dentists in a way that encourages them to continue seeing NHS patients.

The UK is suffering a mass exodus of the public dentistry workforce, with workers leaving the profession entirely or shifting to the private sector, where payments and life-work balance are better, bureaucracy is reduced, and prospects for career development look much better. A survey of general dental practitioners found that around half have reduced their NHS work since the pandemic – with 43% saying they were likely to go fully private, and 42% considering a career change or taking early retirement.

Reversing the UK’s dental crisis requires more commitment to substantial reform and funding than the “recovery plan” announced by Victoria Atkins, the secretary of state for health and social care, on February 7.

The stories I have gathered show that people travelling abroad for dental treatment don’t see themselves as “tourists” or vanity-driven consumers of the “Hollywood smile”. Rather, they have been forced by the crisis in NHS dentistry to seek out a service 1,500 miles away in Turkey that should be a basic, affordable right for all, on their own doorstep.

*Names in this article have been changed to protect the anonymity of the interviewees.


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Diana Ibanez Tirado receives funding from the School of Global Studies, University of Sussex.

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Beloved mall retailer files Chapter 7 bankruptcy, will liquidate

The struggling chain has given up the fight and will close hundreds of stores around the world.

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It has been a brutal period for several popular retailers. The fallout from the covid pandemic and a challenging economic environment have pushed numerous chains into bankruptcy with Tuesday Morning, Christmas Tree Shops, and Bed Bath & Beyond all moving from Chapter 11 to Chapter 7 bankruptcy liquidation.

In all three of those cases, the companies faced clear financial pressures that led to inventory problems and vendors demanding faster, or even upfront payment. That creates a sort of inevitability.

Related: Beloved retailer finds life after bankruptcy, new famous owner

When a retailer faces financial pressure it sets off a cycle where vendors become wary of selling them items. That leads to barren shelves and no ability for the chain to sell its way out of its financial problems. 

Once that happens bankruptcy generally becomes the only option. Sometimes that means a Chapter 11 filing which gives the company a chance to negotiate with its creditors. In some cases, deals can be worked out where vendors extend longer terms or even forgive some debts, and banks offer an extension of loan terms.

In other cases, new funding can be secured which assuages vendor concerns or the company might be taken over by its vendors. Sometimes, as was the case with David's Bridal, a new owner steps in, adds new money, and makes deals with creditors in order to give the company a new lease on life.

It's rare that a retailer moves directly into Chapter 7 bankruptcy and decides to liquidate without trying to find a new source of funding.

Mall traffic has varied depending upon the type of mall.

Image source: Getty Images

The Body Shop has bad news for customers  

The Body Shop has been in a very public fight for survival. Fears began when the company closed half of its locations in the United Kingdom. That was followed by a bankruptcy-style filing in Canada and an abrupt closure of its U.S. stores on March 4.

"The Canadian subsidiary of the global beauty and cosmetics brand announced it has started restructuring proceedings by filing a Notice of Intention (NOI) to Make a Proposal pursuant to the Bankruptcy and Insolvency Act (Canada). In the same release, the company said that, as of March 1, 2024, The Body Shop US Limited has ceased operations," Chain Store Age reported.

A message on the company's U.S. website shared a simple message that does not appear to be the entire story.

"We're currently undergoing planned maintenance, but don't worry we're due to be back online soon."

That same message is still on the company's website, but a new filing makes it clear that the site is not down for maintenance, it's down for good.

The Body Shop files for Chapter 7 bankruptcy

While the future appeared bleak for The Body Shop, fans of the brand held out hope that a savior would step in. That's not going to be the case. 

The Body Shop filed for Chapter 7 bankruptcy in the United States.

"The US arm of the ethical cosmetics group has ceased trading at its 50 outlets. On Saturday (March 9), it filed for Chapter 7 insolvency, under which assets are sold off to clear debts, putting about 400 jobs at risk including those in a distribution center that still holds millions of dollars worth of stock," The Guardian reported.

After its closure in the United States, the survival of the brand remains very much in doubt. About half of the chain's stores in the United Kingdom remain open along with its Australian stores. 

The future of those stores remains very much in doubt and the chain has shared that it needs new funding in order for them to continue operating.

The Body Shop did not respond to a request for comment from TheStreet.   

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