IMPROVING GLOBAL HEALTH INSTITUTIONS AND INSTRUMENTS 8.8
Martin McKee, professor of European public health, London School of Hygiene and Tropical Medicine I n August 1644, a clergyman, Paul Gosnold, used a previously unheard word in a sermon in Oxford. Referring to the events of the English Civil War that had begun two years earlier, he used the word ‘kakistocracy’ to describe rule by ‘Sanctimonious Incendiaries, who have fetched fire from heaven to set their Country in combustion [and] have pretended Religion to raise and maintaine a most wicked rebellion’. Derived from the Greek words for ‘worst’ and ‘rule’, it was rarely used, at least until the 21st century. Today kakistocracy is understood as government by the worst, least qualified or most unscrupulous citizens. The Economist named it the 2024 word of the year. How does an electorate that is better informed than ever before seem to keep voting for leaders who act against their interests? The answer is that they have lost trust in politics and, especially, in the ability of politicians to prevent them from dying too young. POLITICISING HEALTH Thomas Franks, in his 2004 book What’s the Matter with Kansas? , attributed the seismic shift in US voting patterns to how blue-collar workers, especially those suffering from deindustrialisation in the rust belt, felt left behind by the Democratic Party. Anne Case and Angus Deaton later coined the term ‘deaths of despair’ to describe the rising toll of deaths from drug overdose, alcohol and suicide that afflicted these communities. In 2021 Chris Whitty, England’s chief medical officer, highlighted the worsening health of communities ‘left behind’ by the loss of heavy industry and, in some coastal towns, domestic tourism. It was, however, the first election of Donald Trump, in 2016, that led scholars to bring these strands together. Jacob Bor showed how Trump fared poorly in counties where life expectancy had increased between 2008 and 2014, but where it had stagnated or declined since 2008,
Dying too young: How worsening health and loss of trust in politics gives us the worst possible governments Worsening health and rising inequality are fuelling disillusionment with politics, driving populism’s rise. As health declines and trust erodes, investing in health must be seen as an essential part of political infrastructure
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Health: A Political Choice – The Future of Health in a Fractured World
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