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<h2>Introduction</h2><p>The global wellness industry, valued at over $4.4 trillion, has found a powerful ally in social media. Platforms like Instagram and TikTok have become the primary arenas where health, beauty, and happiness are defined, curated, and sold. Central to this digital wellness economy is the discourse of 'self-care'—a term that has been radically transformed from its radical, political origins in the 1960s and 1970s (where it signified collective resistance against oppressive systems) into a highly individualized, market-driven imperative (Ahmed, 2014). In its contemporary, neoliberal form, self-care is presented as a personal responsibility, a set of practices—from mindfulness and clean eating to expensive skincare and fitness regimes—that individuals must perform to optimize their health, productivity, and overall value (Cederström & Spicer, 2015).</p><p>This framing is particularly potent in the Global South, where social media penetration is rapidly increasing, and where global wellness brands see vast, untapped markets. Low-income women in these regions are bombarded with aspirational content that equates wellbeing with consumer goods and lifestyle choices that are often financially out of reach. This article introduces the concept of the <i>'wellness tax'</i> to describe the cumulative burden—financial, psychological, and social—that these discourses impose on this demographic. The wellness tax is not a literal monetary levy, but a structural phenomenon that operates through three interconnected mechanisms: the commodification of health, the moralization of health, and the digital divide. We argue that these mechanisms, far from empowering low-income women, actively contribute to the perpetuation and deepening of health inequalities.</p><p>Our research addresses a critical gap in the literature. While extensive scholarship has critiqued neoliberal healthism in Western contexts (Crawford, 1980; Lupton, 1995), and a growing body of work examines digital health inequalities (Hargittai, 2002; Robinson et al., 2015), few studies have empirically investigated the intersection of these phenomena in the specific context of low-income women in the Global South. This article aims to fill this gap by asking: <i>How do neoliberal self-care discourses on social media manifest for low-income women in the Global South, and what are the mechanisms through which they perpetuate health inequalities?</i></p><h2>Methods</h2><h3>Research Design</h3><p>This study employed a qualitative, multi-method design to capture both the content of wellness discourses and the lived experiences of the target demographic. We conducted a thematic analysis of social media content and semi-structured interviews with low-income women in two distinct Global South contexts: Nairobi, Kenya, and Manila, Philippines. These sites were chosen to represent different regions, colonial histories, and digital ecosystems, allowing for a comparative understanding of the phenomenon.</p><h3>Social Media Content Analysis</h3><p>We purposively sampled 120 posts (60 from Instagram, 60 from TikTok) from 20 prominent wellness influencers (10 per platform) who have a significant following in Kenya and the Philippines. Influencers were selected based on their follower count (over 100,000), their focus on health, fitness, or self-care, and their active engagement with local audiences. The posts were collected over a six-month period (January–June 2023) and included images, videos, and captions. We analyzed the posts for recurring themes related to self-care, health responsibility, consumer products, and aspirational lifestyles. Our coding framework was developed iteratively, drawing on the principles of reflexive thematic analysis (Braun & Clarke, 2006).</p><h3>Semi-Structured Interviews</h3><p>We conducted 30 semi-structured interviews (15 in Nairobi, 15 in Manila) with women aged 18–45 who self-identified as low-income (earning less than the national median wage) and who were active users of at least one social media platform. Participants were recruited through community-based organizations, local markets, and snowball sampling. Interviews were conducted in local languages (Swahili, Tagalog, and English) by trained research assistants, and lasted between 45 and 90 minutes. The interview guide explored participants' social media habits, their perceptions of wellness content, their engagement with self-care practices, and the perceived impact of these discourses on their health, finances, and self-esteem. All interviews were audio-recorded, transcribed verbatim, and translated into English for analysis. Ethical approval was obtained from the institutional review boards of the authors' respective universities. All participants provided informed consent and were anonymized using pseudonyms.</p><h3>Data Analysis</h3><p>Data from both sources were analyzed using a combination of deductive and inductive coding. We began with a priori codes derived from the literature on neoliberal healthism and digital inequality, and then allowed new themes to emerge from the data. The analysis was conducted collaboratively by the research team, with regular meetings to discuss coding discrepancies and refine the thematic framework. We used NVivo software to manage and organize the data.</p><h2>Results</h2><p>Our analysis revealed three dominant and interlocking mechanisms through which the wellness tax operates. These are presented below, with illustrative quotes from participants and examples from social media content.</p><h3>Mechanism 1: The Commodification of Health</h3><p>The most pervasive theme in the social media content was the framing of health and wellbeing as a set of purchasable commodities. Wellness influencers consistently promoted specific products—detox teas, collagen powders, gym memberships, yoga retreats, and expensive skincare lines—as essential tools for achieving the 'best version of yourself.' The underlying message was that health is not a state of being but a project that requires constant investment.</p><p>This commodification was acutely felt by our interview participants. Many expressed a sense of inadequacy and frustration at their inability to afford these products. A 32-year-old market vendor in Nairobi, 'Achieng,' explained: <i>'They tell you to drink this green juice and buy this cream, and then you will be healthy and happy. But that juice costs more than my family's lunch for a day. It makes me feel like I am failing at being a woman, at being healthy, because I cannot buy these things.'</i> Similarly, a 27-year-old factory worker in Manila, 'Maria,' stated: <i>'The influencers make it look so easy. Just buy this, do that. But my salary barely covers rent and food. This wellness world is not for people like me.'</i></p><p>This financial strain represents a direct, material cost of the wellness tax. Participants reported that the pressure to emulate these lifestyles sometimes led them to make irrational financial decisions, such as purchasing a single expensive 'superfood' item at the expense of more nutritious, locally available foods. This finding aligns with the concept of 'healthism' (Crawford, 1980), but extends it by highlighting the specific economic vulnerabilities of the Global South context.</p><h3>Mechanism 2: The Moralization of Health</h3><p>The second mechanism is the moralization of health, whereby health status is framed as a reflection of an individual's character, discipline, and worth. In the analyzed posts, being healthy was synonymous with being 'good,' 'strong,' and 'successful,' while being unhealthy was implicitly linked to laziness, ignorance, or a lack of willpower. This discourse places the burden of health squarely on the individual, obscuring the structural determinants—poverty, inadequate healthcare, environmental pollution, and food insecurity—that shape health outcomes.</p><p>This moral framing had profound psychological consequences for our participants. Many internalized this blame, leading to feelings of shame, guilt, and anxiety. 'Fatima,' a 40-year-old domestic helper in Manila, shared: <i>'I know I am not healthy. I am tired all the time, and I cannot afford to go to the doctor. When I see these posts, I think it is my fault. I am not trying hard enough. I am a bad mother because I cannot give my children a healthy life.'</i> This self-blame was a recurring theme, with participants often describing themselves as 'lazy' or 'weak' for not adhering to the wellness ideals they saw online.</p><p>This moralization also creates a social hierarchy, where those who can perform 'good' health are elevated, and those who cannot are stigmatized. This can lead to social exclusion and a further erosion of self-worth, compounding the psychological burden of poverty. The wellness tax, therefore, is not just financial; it is deeply emotional and psychological.</p><h3>Mechanism 3: The Digital Divide and the 'Information Gap'</h3><p>The third mechanism is the digital divide, which operates not just in terms of access to technology, but also in terms of the quality and credibility of information. While our participants had access to smartphones and social media, they often lacked the digital literacy to critically evaluate the health information they encountered. The algorithmic nature of these platforms tends to amplify sensationalist, commercial, and aesthetically pleasing content over evidence-based, public health messaging (Noble, 2018).</p><p>Participants frequently expressed confusion about what constituted credible health advice. 'Wanjiku,' a 29-year-old hairdresser in Nairobi, noted: <i>'There is so much information. One person says eat this, another says don't. They all have beautiful bodies and seem to know what they are talking about. But I don't know who to trust. The government health worker is not on my phone, but these influencers are.'</i> This 'information gap' is a critical component of the wellness tax. It means that low-income women are not only excluded from the material benefits of the wellness industry but are also potentially exposed to harmful or misleading health advice, which can lead to delayed care-seeking, improper self-treatment, and worse health outcomes.</p><p>This gap is further widened by the language and cultural specificity of much wellness content, which is often produced in the Global North and fails to account for local diets, health challenges, and healthcare systems. The result is a form of epistemic injustice, where local knowledge and practices are devalued in favor of a homogenized, globalized, and commercialized version of health.</p><h3>Summary of Findings</h3><p>Table 1 summarizes the three mechanisms of the wellness tax, their manifestations, and their documented impacts on our participants.</p><table border="1" cellpadding="5" cellspacing="0"><caption><b>Table 1: Mechanisms of the Wellness Tax</b></caption><tbody><tr><th>Mechanism</th><th>Manifestation in Social Media Content</th><th>Impact on Low-Income Women (from interviews)</th></tr><tr><td><b>Commodification of Health</b></td><td>Health framed as purchasable via products (supplements, detoxes, gyms).</td><td>Financial strain; diversion of scarce resources; feelings of inadequacy and exclusion.</td></tr><tr><td><b>Moralization of Health</b></td><td>Health as a personal responsibility and marker of moral worth; 'good' vs. 'bad' health citizens.</td><td>Internalized self-blame, shame, guilt, and anxiety; social stigma; erosion of self-esteem.</td></tr><tr><td><b>Digital Divide & Information Gap</b></td><td>Algorithmic amplification of commercial content; lack of credible, local, and evidence-based information.</td><td>Confusion and distrust; potential exposure to harmful advice; delayed care-seeking; devaluation of local knowledge.</td></tr></tbody></table><h2>Discussion</h2><p>This study set out to understand how neoliberal self-care discourses on social media perpetuate health inequalities among low-income women in the Global South. Our findings strongly support the central thesis: the wellness tax is a real and multifaceted burden that operates through the commodification and moralization of health, and is exacerbated by the digital divide. These mechanisms are not separate but are deeply intertwined, creating a reinforcing cycle of disadvantage.</p><p>Our findings extend the existing literature on healthism and neoliberalism (Crawford, 1980; Lupton, 1995) by grounding these theoretical concepts in the lived experiences of a marginalized population in the Global South. While the critique of healthism has been well-developed in Western contexts, our research demonstrates that its effects are magnified in settings where economic resources are scarce and social safety nets are weak. The wellness tax, therefore, represents a distinct form of health inequality that is produced and reproduced through digital platforms.</p><p>The commodification of health, as we have shown, places a direct financial burden on low-income women. This is not merely a matter of missing out on luxury goods; it is about the diversion of resources away from basic needs like nutritious food and healthcare. This finding aligns with research on the 'cost of living' crisis and its impact on health (Loopstra et al., 2015), but highlights the specific role of social media in creating and amplifying these consumerist pressures.</p><p>The moralization of health has equally profound implications. By framing health as a personal responsibility, these discourses obscure the structural determinants of health, such as poverty, inadequate housing, and lack of access to quality healthcare (Marmot, 2005). This individualization of blame leads to the psychological burden of shame and self-blame that our participants described. This is a form of 'psycho-social' inequality that is as damaging as material deprivation, and it is a core component of the wellness tax.</p><p>Finally, the digital divide, as we have conceptualized it, is not simply about access but about the quality of the information environment. The algorithmic curation of content on platforms like Instagram and TikTok prioritizes engagement, which often means sensationalist and commercial content over public health guidance (Noble, 2018). This creates an 'information gap' that is particularly harmful for those who lack the digital literacy to critically evaluate sources. This finding underscores the need for interventions that go beyond simply providing internet access and instead focus on building critical media literacy skills.</p><p>Our study has several limitations. The qualitative design, while providing rich, in-depth data, limits the generalizability of our findings. The sample, while diverse, is not representative of all low-income women in the Global South. Furthermore, our analysis of social media content was limited to a specific time frame and a selection of influencers. Future research should employ larger-scale, quantitative methods to measure the prevalence and impact of the wellness tax across different regions and demographics. Longitudinal studies could also track how these discourses and their impacts evolve over time.</p><p>Despite these limitations, our findings have significant implications for policy and practice. First, there is a clear need for public health interventions that counter the commercial, individualistic narratives of the wellness industry. This could involve partnering with trusted local figures and community organizations to disseminate evidence-based health information on social media. Second, media literacy programs should be integrated into school curricula and community outreach efforts to equip individuals, particularly women, with the skills to critically evaluate online health claims. Third, there is a need for greater regulation of health-related advertising on social media to prevent the promotion of unproven and potentially harmful products. Finally, and most importantly, efforts to address health inequalities must move beyond individual-level interventions and tackle the upstream structural determinants of health, including poverty, inequality, and inadequate social protection.</p><h2>Conclusion</h2><p>This article has argued that the proliferation of neoliberal self-care discourses on social media imposes a 'wellness tax' on low-income women in the Global South. This tax is not a simple financial cost but a complex burden that operates through the commodification of health, the moralization of health, and the digital divide. These mechanisms work in concert to perpetuate and deepen existing health inequalities, transforming platforms that promise democratized access to wellbeing into new arenas of exclusion and disadvantage. The wellness tax is a powerful concept that captures the dark side of the digital wellness economy, revealing how it can reinforce, rather than alleviate, the health burdens of the most vulnerable. Addressing this issue requires a fundamental shift away from individualistic, market-based solutions toward a structural and community-centered approach to health equity, one that recognizes health as a collective good and a fundamental human right, not a personal project to be purchased and performed.</p><h2>References</h2><p>Ahmed, S. (2014). <i>Willful subjects</i>. Duke University Press. https://doi.org/10.1215/9780822376101</p><p>Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. <i>Qualitative Research in Psychology, 3</i>(2), 77–101. https://doi.org/10.1191/1478088706qp063oa</p><p>Cederström, C., & Spicer, A. (2015). <i>The wellness syndrome</i>. Polity Press. https://doi.org/10.1111/1467-954X.12338</p><p>Crawford, R. (1980). Healthism and the medicalization of everyday life. <i>International Journal of Health Services, 10</i>(3), 365–388. https://doi.org/10.2190/3H2H-3XJN-3KAY-G9NY</p><p>Hargittai, E. (2002). Second-level digital divide: Differences in people's online skills. <i>First Monday, 7</i>(4). https://doi.org/10.5210/fm.v7i4.942</p><p>Loopstra, R., Reeves, A., Taylor-Robinson, D., Barr, B., McKee, M., & Stuckler, D. (2015). Austerity, sanctions, and the rise of food banks in the UK. <i>BMJ, 350</i>, h1775. https://doi.org/10.1136/bmj.h1775</p><p>Lupton, D. (1995). <i>The imperative of health: Public health and the regulated body</i>. Sage Publications. https://doi.org/10.4135/9781446221976</p><p>Marmot, M. (2005). Social determinants of health inequalities. <i>The Lancet, 365</i>(9464), 1099–1104. https://doi.org/10.1016/S0140-6736(05)71146-6</p><p>Noble, S. U. (2018). <i>Algorithms of oppression: How search engines reinforce racism</i>. NYU Press. https://doi.org/10.2307/j.ctt1pwt9w5</p><p>Robinson, L., Cotten, S. R., Ono, H., Quan-Haase, A., Mesch, G., Chen, W., ... & Stern, M. J. (2015). Digital inequalities and why they matter. <i>Information, Communication & Society, 18</i>(5), 569–582. https://doi.org/10.1080/1369118X.2015.1012532</p><p>Rose, N. (1999). <i>Powers of freedom: Reframing political thought</i>. Cambridge University Press. https://doi.org/10.1017/CBO9780511488856</p><p>Sen, A. (1999). <i>Development as freedom</i>. Oxford University Press. https://doi.org/10.1007/s12116-001-0011-1</p><p>Sharma, S. (2014). <i>In the meantime: Temporality and cultural politics</i>. Duke University Press. https://doi.org/10.1215/9780822376217</p><p>Sweet, E. (2018). 'Like you failed at life': Debt, health and neoliberal subjectivity. <i>Social Science & Medicine, 212</i>, 86–93. https://doi.org/10.1016/j.socscimed.2018.07.017</p><p>Warin, M., & Zivkovic, T. (2019). <i>Fatness, obesity, and disadvantage in the Australian suburbs: Unpalatable politics</i>. Palgrave Macmillan. https://doi.org/10.1007/978-3-030-01009-6</p><p>World Health Organization. (2021). <i>Social determinants of health</i>. WHO. https://doi.org/10.2471/BLT.21.286327</p>