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If you tuned in to the six hours of argument in the Supreme Court this spring on health insurance—the most time allotted for a case in more than four decades—you would have thought broccoli, medical costs, cars, and cell phones were in roughly the same category. They are, the judges reasoned, items bought and sold in a consumer market.

But getting insurance from your employer or landing in the hospital is different from buying a car—you have little choice and no bargaining power.

I realized this in July when, despite all of my usual efforts to stay healthy, a puncture wound in the palm of my hand became so infected that multiple doctor’s visits and several doses of oral antibiotics failed to stop bacteria from invading my lymph system. I was admitted to the hospital for observation and given a bed in an overflow room for two nights, next to an uninsured military vet who had developed gangrene after gashing his finger, and a woman with a rare disorder that gave her recurring blood clots. The hospital was a last resort for all of us. The thousands of dollars I would spend on this injury—even after my insurance covered a portion—were simply a necessary cost to keep myself alive.

Talking about our bodies and health as part of a consumer relationship gives us a sense of control, as if buying a gym membership or the right multivitamin is all you need to make your body beautiful and invulnerable. But treat your health as a shopping excursion, and you’re exposed to the manipulations of agribusiness, big pharma, and the health insurance industry. And (no surprise) profit, not health, drives those markets. Drug ads will never tell you that brisk walking may be at least as effective at fighting depression as medication, without the cost and side effects. For decades, food policy and the grocery industry have made it easier to put soda and corn chips into the hands of an inner-city teenager than a bunch of kale—though it’s no secret which one is healthier.

There’s a growing field of research—ecological medicine—that documents how intimately our bodies are connected to larger ecological, political, and societal factors . The science shows that what makes us sick or healthy goes well beyond individual choice—systems that foster inequality, pollution, and unsustainable agriculture contribute to ill health.

On a local level, city streets with no place to walk or play help make kids sedentary and susceptible to weight gain. States continue to slash funding for birth control and pass abortion laws that leave an increasing number of (especially low-income) women with few options when it comes to sex and pregnancy. Internationally, the tech market drives a demand for rare minerals that fuels one of the world’s most violent conflicts in the Congo—where women are beaten and sexually assaulted.

See: Eve Ensler: Freedom Starts with a “V”

Taking charge of our bodies means so much more than buying stuff. It means reckoning with the intersection between our biology and humanity and the political and environmental decisions our society makes. It means honest conversations about sex, birth, emotion, and dying. It means keeping toxics out of air, soil, and water, and thus out of our own cells and tissues. It means creating spaces for our bodies to play, exercise, and express themselves. This issue of ¾«¶«Ó°Òµ is about what happens when we stop treating our bodies as consumer objects and start making choices about how we live in them.

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Madeline Ostrander is a freelance science and environment journalist based in Seattle.

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