Governing the social production of care: the hidden foundation of health systems

Jo An Occhipinti; Ante Prodan; John Buchanan; Mike Martin; Saman Khalatbari-Soltani; Pawel Swieboda; Harris Eyre; Paul Crosland; Seyed Hossein Hosseini; Anita van Zwieten; Suraj Samtani; Mouna Sawan; Daniel Cobos Muñoz; Shohei Okamoto; Jo Robinson; David Norris; Dilip V. Jeste; Frederic Destrebecq; Mark Heffernan; Marcel Tanner; J. Jaime Miranda

doi:10.1038/s41591-026-04535-y

Governing the social production of care: the hidden foundation of health systems

Jo An Occhipinti
, Ante Prodan
, John Buchanan
, Mike Martin
, Saman Khalatbari-Soltani
, Pawel Swieboda
, Harris Eyre
, Paul Crosland
, Seyed Hossein Hosseini
, Anita van Zwieten
, Suraj Samtani
, Mouna Sawan
, Daniel Cobos Muñoz
, Shohei Okamoto
, Jo Robinson
, David Norris
, Dilip V. Jeste
, Frederic Destrebecq
, Mark Heffernan
, Marcel Tanner

J. Jaime Miranda

University of Sydney
University of Zurich
Western Sydney University
University of Sydney
European Policy Centre
NeuroCentury
Rice University
University of Texas Medical Branch
Faculty of Medicine and Health
Sydney Children’s Hospital Network
University of New South Wales
Swiss Tropical and Public Health Institute Swiss TPH
University of Basel
University of Tsukuba
Center for Youth Mental Health
Brain Health Clinic
Social Determinants of Health Network
European Brain Council

Research output: Contribution to journal › Comment/debate

Abstract

Health systems rely on unpaid care that is poorly measured and governed. We argue that unpaid care, and the wider social production system behind it, is a productive input whose breakdown drives avoidable admissions, delayed discharge, and labor-force exit. We propose a national accounting framework, a diagnostic lens, and five policy priorities.

Original language	English
Journal	Nature Medicine
DOIs	https://doi.org/10.1038/s41591-026-04535-y
State	Accepted/In press - 2026
Externally published	Yes

Access to Document

10.1038/s41591-026-04535-y

Cite this

Occhipinti, J. A., Prodan, A., Buchanan, J., Martin, M., Khalatbari-Soltani, S., Swieboda, P., Eyre, H., Crosland, P., Hosseini, S. H., van Zwieten, A., Samtani, S., Sawan, M., Cobos Muñoz, D., Okamoto, S., Robinson, J., Norris, D., Jeste, D. V., Destrebecq, F., Heffernan, M., ... Miranda, J. J. (Accepted/In press). Governing the social production of care: the hidden foundation of health systems. Nature Medicine. https://doi.org/10.1038/s41591-026-04535-y

@article{320c890e0466472296e3cbf97ae97596,

title = "Governing the social production of care: the hidden foundation of health systems",

abstract = "Health systems rely on unpaid care that is poorly measured and governed. We argue that unpaid care, and the wider social production system behind it, is a productive input whose breakdown drives avoidable admissions, delayed discharge, and labor-force exit. We propose a national accounting framework, a diagnostic lens, and five policy priorities.",

author = "Occhipinti, \{Jo An\} and Ante Prodan and John Buchanan and Mike Martin and Saman Khalatbari-Soltani and Pawel Swieboda and Harris Eyre and Paul Crosland and Hosseini, \{Seyed Hossein\} and \{van Zwieten\}, Anita and Suraj Samtani and Mouna Sawan and \{Cobos Mu{\~n}oz\}, Daniel and Shohei Okamoto and Jo Robinson and David Norris and Jeste, \{Dilip V.\} and Frederic Destrebecq and Mark Heffernan and Marcel Tanner and Miranda, \{J. Jaime\}",

note = "Publisher Copyright: {\textcopyright} Springer Nature America, Inc. 2026.",

year = "2026",

doi = "10.1038/s41591-026-04535-y",

language = "Ingl{\'e}s",

journal = "Nature Medicine",

issn = "1078-8956",

}

Occhipinti, JA, Prodan, A, Buchanan, J, Martin, M, Khalatbari-Soltani, S, Swieboda, P, Eyre, H, Crosland, P, Hosseini, SH, van Zwieten, A, Samtani, S, Sawan, M, Cobos Muñoz, D, Okamoto, S, Robinson, J, Norris, D, Jeste, DV, Destrebecq, F, Heffernan, M, Tanner, M & Miranda, JJ 2026, 'Governing the social production of care: the hidden foundation of health systems', Nature Medicine. https://doi.org/10.1038/s41591-026-04535-y

TY - JOUR

T1 - Governing the social production of care

T2 - the hidden foundation of health systems

AU - Occhipinti, Jo An

AU - Prodan, Ante

AU - Buchanan, John

AU - Martin, Mike

AU - Khalatbari-Soltani, Saman

AU - Swieboda, Pawel

AU - Eyre, Harris

AU - Crosland, Paul

AU - Hosseini, Seyed Hossein

AU - van Zwieten, Anita

AU - Samtani, Suraj

AU - Sawan, Mouna

AU - Cobos Muñoz, Daniel

AU - Okamoto, Shohei

AU - Robinson, Jo

AU - Norris, David

AU - Jeste, Dilip V.

AU - Destrebecq, Frederic

AU - Heffernan, Mark

AU - Tanner, Marcel

AU - Miranda, J. Jaime

PY - 2026

Y1 - 2026

N2 - Health systems rely on unpaid care that is poorly measured and governed. We argue that unpaid care, and the wider social production system behind it, is a productive input whose breakdown drives avoidable admissions, delayed discharge, and labor-force exit. We propose a national accounting framework, a diagnostic lens, and five policy priorities.

AB - Health systems rely on unpaid care that is poorly measured and governed. We argue that unpaid care, and the wider social production system behind it, is a productive input whose breakdown drives avoidable admissions, delayed discharge, and labor-force exit. We propose a national accounting framework, a diagnostic lens, and five policy priorities.

UR - https://www.scopus.com/pages/publications/105045363084

U2 - 10.1038/s41591-026-04535-y

DO - 10.1038/s41591-026-04535-y

M3 - Comentario/Debate

AN - SCOPUS:105045363084

SN - 1078-8956

JO - Nature Medicine

JF - Nature Medicine

ER -

Governing the social production of care: the hidden foundation of health systems

Abstract

Access to Document

Other files and links

Cite this