“ Communities experiencing worsening health and feeling left behind by traditional politicians will search for hope elsewhere”
the share of the vote going to what was now a very different Republican Party increased by 10 percentage points during this time. In 2020, my colleagues and I found a similar association between health and votes for Brexit in the UK’s 2016 referendum. Our historical research showed an association between austerity and poor health and the rising vote share for the National Socialist Party in Weimar Germany, and between deaths from influenza in Italian cities in 1918 and votes for Mussolini in 1924. A particularly elegant study in 2024 by Nolan Kavanagh and Anil Menon, using the European Social Survey, showed how those in worse health were less likely to vote and, when they did, more likely to support populist right-wing parties. These findings are supported by an extensive body of other research, all finding essentially the same thing. Communities experiencing worsening health and feeling left behind by traditional politicians will search for hope elsewhere. This is where the second part of the equation comes in. For radical populist parties to succeed, it is not enough for health to deteriorate. Additional elements are needed. First is a sense that traditional left-wing parties have abandoned the working class while their former protectors – the trade unions – have been weakened to the point of impotence. Second is the emergence of a ADDRESSING THE POPULIST CHALLENGE charismatic individual who conveys a vision of a brighter and better world. It does not matter that their arguments are illogical and contradictory. Much research on cognition shows how partisan beliefs shape the interpretation of messages, even to the extent of preventing people from recognising clear contradictions in what their newfound heroes say. This evidence of a clear link between politics and health is unwelcome among some people. Some are in the health community, viewing the political sphere as something to avoid at all costs. At best, they see any engagement with politics as a distraction from their research. At worst, they view all politicians
as opportunistic, duplicitous and self-serving. Others, especially those populist politicians who benefit from ill health, reject the idea that those advocating for health should stray into politics at all, telling them to ‘stay in their lane’, especially when they challenge populist policies. This explains the current attacks on universities and public health institutes in some countries. These house people who promote values such as diversity, equality and inclusion. Populist leaders reject these values that underpinned the enlightenment and the scientific progress that have contributed to sustained improvements in health over decades and saved so many lives in the Covid-19 pandemic. Worryingly, we are realising how fragile these institutions are when faced with such attacks. Institutions built up over decades can be destroyed in days. Governments, rightly, now recognise the importance of preparing for a wide range of threats, including pandemics, extreme weather events and military action. Maybe it is time to ensure that our societies are also resilient to the threat posed by populism, an ideology that has, time and again, led to a kakistocracy. A necessary first step would be to invest seriously in those things that will improve the health of those who, over recent decades, have been left behind, creating societies that are inclusive, productive and, above all, resilient in the face of future threats. ▪
MARTIN MCKEE Martin McKee is a professor of European public health at the London School of Hygiene and Tropical Medicine. He is also co-director of the European Observatory on Health Systems and Policies and past president of the European Public Health Association and British Medical Association. He trained in medicine and public health and has written extensively on health and health policy, with a particular focus on countries undergoing political and social transition. martinmckee.bsky.social lshtm.ac.uk/aboutus/people/mckee.martin
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Health: A Political Choice – The Future of Health in a Fractured World
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