A Population Health Perspective on the Trump Administration, Brexit, and Right-Wing Populism in Europe

Population health, not individual health, drives support for populist parties

Recent electoral shifts toward populist parties may have been partly driven by deteriorating health, although empirical evidence on this link is primarily confined to ecological designs. We performed both ecological- and individual-level analyses to investigate whether changes in health are associated with changes in the support for populist parties. Data were used on the strategic Dutch case, the only liberal democracy featuring leftist and rightist populist politicians in parliament for over a decade. We used: (a) fixed effects models to examine whether changes in the standardized mortality ratios and self-assessed health (SAH) in municipalities were associated with changes in the populist vote share in four parliamentary elections (2006/2010/2012/2017); and (b) 10 waves of panel data collected in 2008 to 2018 to investigate if changes in individual-level SAH were linked to movement in the sympathy, intention to vote, and actual voting for populist parties. The ecological analyses showed that: changes in municipality mortality ratios were positively linked to changes in the vote share of right-wing populist parties, while changes in the prevalence of less-than-good SAH were negatively associated with changes in the vote share for left-wing populist parties. The individual-level analyses identified no such associations. Our findings imply that support for populist parties may be driven by health concerns at the ecological, but not the individual, level. This suggests that sociotropic (e.g. perceiving population health issues as a social problem), but not egotropic (e.g. relating to personal health issues like experienced stigma), concerns may underlie rising support for populist parties.

The COVID-19 pandemic and war

Could there be a symbiotic relationship between COVID-19 and conflict? On the one hand, circumstances associated with armed conflicts may give rise to greater spread of the virus, while, on the other hand, the COVID-19 pandemic may create conditions for violence through heightened xenophobia and nationalism or may change the dynamics of existing conflicts. We illustrate this with the example of war in the South Caucasus, one of the hot spots of the pandemic. Elsewhere, COVID-19 may have reduced the intensity of conflicts in some places, but it also may have contributed to anti-government protests and communal violence. We call for greater emphasis on traditional public health measures in unstable settings coupled with actions to hasten the peaceful resolution of ongoing conflicts.

Suicide rates and voting choice in the UK's 2016 national Brexit referendum on European Union membership: cross-sectional ecological investigation across England's local authority populations

BACKGROUND

Individual- and area-level risk factors for suicide are relatively well-understood but the role of macro social factors such as alienation, social fragmentation or 'anomie' is relatively underresearched. Voting choice in the 2016 referendum on the UK's membership of the European Union (EU) provides a potential measure of anomie.

AIMS

To examine associations between percentage 'Leave' votes in the EU referendum and suicide rates in 2015-2017, the period just prior to, and following, the referendum.

METHOD

National cross-sectional ecological study of 315 English local authority populations. Associations between voting choice in the EU referendum and age-standardised suicide rates, averaged for the years 2015, 2016 and 2017, were examined.

RESULTS

Overall there was a weak, but statistically significant, positive correlation between the local authority-level percentage 'Leave' vote in 2016 and the suicide rate 2015-2017: Pearson's correlation coefficient, r = 0.17; P = 0.003. This relationship was explained by populations having an older age distribution, being more deprived and lacking ethnic diversity. However, there was divergence (likelihood ratio test for interaction, χ2 = 7.2, P = 0.007) in the observed associations between London and the provincial regions with Greater London having a moderately strong negative association (r = -0.40; P = 0.02) and the rest of England a weak positive association (r = 0.17; P = 0.004).

CONCLUSIONS

Deprivation, older age distribution and a lack of ethnic diversity seems to explain raised suicide risk in Brexit-voting communities. A greater sense of alienation among people feeling 'left behind'/'left out' may have had some influence too, although multilevel modelling of individual- versus area-level data are needed to examine these complex relationships. The incongruent ecological relationship observed for London likely reflect its distinct social, economic and health context.