Ill health impacts political participation, pushing voters to populist parties, new study shows

New research suggests a close relationship between the state of our health and our political behaviour. Ill health doesn't only reduce political participation; it also increases the likelihood of voting for a populist radical right party.

'Trust' was the word heard in almost all conversations during this year's European Health Forum Gastein (EHFG), especially where health digitisation and democracy were the topics of discussion.

In one session, the sense of the political weight of health was explained using data illustrating populist ideas gaining ground around the world. The research by the European Observatory on Health Systems and Policies, which collected data across multiple countries, identified the role of health status, and especially the role ill health plays,

Euractiv spoke to Scott Greer, a Professor of Health Management and Policy, Global Public Health, and Political Science (by courtesy) at the University of Michigan and a Senior Expert Advisor on Health Governance for the European Observatory on Health Systems and Policies, about the review's outcomes.

"Poor health is bad for your democratic participation," he commented. The mechanism, as he explained it, is related to trust.

"You suffer a decline in your health, and then you suffer a decline in trust in the health care system, which spreads over into trusted other elements of society," including the political system.

Ill health 'injures' democratic participation.

The research showed that ill health reduces political participation. It also revealed that ill health leads to a substantially larger likelihood of voting for local populist radical right parties.

The second, more shocking outcome, according to Greer, was that moving from self-reported fair to poor health makes one about 16 to 20% more likely to vote for the populist radical right.

"The magnitude of the effect surprised me," he said to Euractiv. "The mechanism is ill health, poor care or other discrimination, loss of trust, and then one of two things happen in some combination: you kind of drop out of formal politics, you vote extreme."

Rebuilding trust

However, it's a mechanism that can be amended; it is trust as affected by healthcare.

"An individual event, we know, for example, bad childbirth, can affect people's attitudes towards healthcare for a very long time if they're treated badly," he said.

Another example is poorly managed diabetes. "There are so many opportunities for the health system to treat you badly in the course of diagnosing and managing diabetes for the rest of your life," Greer added.

"So, thinking hard about ways to avoid breaching faith with patients in the process of healthcare is a thing we can do. We can think about ways this linkage is not created," he explained.

Patient involvement

"Promoting patient engagement and making health policies that win the trust of patients is a way to reduce this mechanism," Greer points out.

As he explained, in the case of health, work should be done on "the individual and hospital system, at doctor level, to increase trust and engagement in the health system."

"On the ground, patient associations and their own engagement really matter to the patient's faith in the health system," he said. "A thriving support group, that kind of engagement builds efficacy and trust".

"You're alienating and stigmatising patients if you don't," he added. Moreover, "having people not be fed up is a good policy idea."

Speak people's language.

Dr Pamela Rendi-Wagner, Director of the European Centre for Disease, also raised the issue of trust. Alongside communication, they ought to be the pillars of preparedness for the next pandemic, but also means to fight misinformation.

Talking about misinformation at the EHFG panel discussion, she underlined the importance of investing in awareness initiatives to teach people the concept of science, the concept of evidence and knowledge, to battle uncertainty and fear, which she described as the best breeding ground for fake news.

"Secondly, I think it needs clear and understandable language. And in particular, when it's about crisis communication, we need communication in the language of the people," she added.

Noticeable policies

Designing health policies with visible benefits is another key message derived from the Observatory's research.

"Make policies people can see, make policies people can understand," Greer told Euractiv but distinguished the difference between policies that empower citizens and ones that could carry a stigma.

"If you want people to understand what you've done for them, do something simple that they can understand; and the second is don't make your benefits stigmatising. Otherwise, don't be surprised if you manage to give somebody a benefit and simultaneously make them resent you," he noted.

According to the professor, the broadest way to address inequalities is to address disparities in economic fortune.

Belgium's approach

"Populist movement gains traction over this idea that nothing is working anymore," Gloria Ghéquière, adviser on European affairs and pharmaceutical policies to Deputy Prime Minister and Minister of Social Affairs and Public Health Frank Vandenbroucke, said during the panel discussion.

However, "You cannot promise people that you will solve everything. You should always have three or four concrete measures up your sleeve that are tangible, that people really care and feel strongly about, and that you can solve", she clarified.

Ghéquière described the pressure that healthcare systems are under "because of austerity, surely, and also because of the ageing population," but claimed that health budgets are growing naturally. We are not reducing the money that we spend; it's just that what we are giving to it is not enough."

According to Ghéquière, health systems need strong long-term reforms.

[Edited by Brian Maguire | Euractiv's Advocacy Lab]