BAD HOFGASTEIN, Austria — Declining health is driving more citizens to support far-right, populist parties and reducing overall participation in the democratic process, according to a new review of studies from a World Health Organization-backed (WHO) think tank.

The report, released Wednesday by the European Observatory on Health Systems and Policies, analyzed 97 studies at the intersection of health, democracy and populism. 

“There are two findings. One of them is that ill health reduces political participation. The other, possibly more shocking, is that ill health leads to a substantially larger likelihood that you’re going to vote for whatever your local populist radical right party is,” said Scott Greer, lead author of the report and professor of Global Health Management and Policy at the University of Michigan.

Europe faces a perfect storm of health challenges that could shake its political foundations, the study warns. An ageing population, rising chronic illness rates, and COVID-19’s after-effects combine with looming threats from climate change, conflict-driven migration, and widening income gaps. 

These pressures have exposed weaknesses in health systems and put health at the center of the European political battleground for the foreseeable future, with over half of Europeans saying health is their top political priority, according to Comission data.

“The stakes if you’re an elected politician are really high,” Greer said. 

The report found that people in poor health are significantly less likely to vote, often by margins of 10 to 20 percentage points compared to healthier individuals. This trend has been documented across Europe, the United States, and Canada.

When those in poor health do vote, they are primarily supporting far-right populist parties. Greer pointed to the 2016 Brexit referendum as an example of how health issues can influence major political outcomes. 

“Moving from self-reported fair to poor health makes you about 16-20% more likely to vote for the populist radical right,” Greer explained. “It is mathematically possible that the number of people in the United Kingdom whose health state deteriorated as a fairly clear consequence of the Cameron government’s austerity budgets and who therefore voted for Brexit is larger than the Brexit victory margin.” 

Protecting health, rebuilding trust in democracy

“Policies that protect health and ability are not only essential to preserving the economic and social well-being of Europe – but they may also be essential to rebuilding trust in democracy and democratic institutions,” the authors state.

While the study focuses on how health influences political behaviour, experts caution that the relationship between health and politics is complex and potentially bidirectional. For instance, research has shown that political affiliations can influence health behaviors, from Trump supporters frequently rejecting COVID-19 precautions in the United States to Labour supporters in the United Kingdom more likely to smoke. 

Untangling the causal relationships between health, socioeconomic factors, and political preferences presents significant challenges. However, the authors argue that the mounting evidence is compelling enough to warrant serious attention from policymakers.

“To be clear, population health is unlikely to be the primary driver of the rise in anti-democratic politics,” the authors explain. “Even so, the connection between the two highlights an important shortcoming in the performance of democratic institutions: people in poor health have systematically low trust in their health systems and governments.” 

The shift towards populism marks a dramatic change from historical patterns. Until recently, people in poorer health typically favored left-leaning parties that supported greater health and social protections. However, the rise of right-wing populist movements has provided a new outlet for voters frustrated with existing institutions.

“Why does becoming seriously sick seem to lead to this change in political behaviour? The answer is trust,” Greer said. “People whose health status gets worse tend to lose trust in the healthcare system, the political system, the elements of society at large, and they tend to lose a sense of agency.”

This loss of trust appears to be driving support for parties that promise to reshape what they describe as a “failing” political establishment, even when these parties often oppose public health measures.

The study cites examples such as the National Rally in France, the Alternative for Germany (AfD), and Vox in Spain as typical European populist parties that have attracted support from voters in poor health.

Historical data identified in the report suggests this is not a unique phenomenon. German communities with worsening mortality in the 1930s became more supportive of the Nazi Party, while Italian cities hit harder by the 1918 influenza pandemic showed greater support for the Fascist Party in the 1924 election.

“Governments are moving through uncharted waters, facing new crises that threaten both health and the long-standing political order,” the report states. “A better understanding of the interplay between these forces and their impact on political thought and action can help policy-makers protect not only the health of populations but also democratic institutions.” 

If we aren’t fixing health – why expect votes? 

Minutes before the new data was presented, Clemens Martin Auer, President of the European Health Forum Gastein, challenged the health policy experts in attendance: Does anyone believe our system is properly addressing the impending crises of health workforce shortages? 

No hands were raised. 

“The healthcare sector has to be clear that it contributes to populism,” Martin Auer said. “Stop just talking about problems without operationally solving them… … just wait until they throw our incompetence to solve health problems to delegitimise democratic legitimacy.” 

Martin Auer didn’t mince words at a closed-door presser earlier Wednesday either. Populism, in his view, isn’t just about finger-pointing. EU citizens keep flagging health as their top concern and demanding reform in the sector. And when they don’t see the changes they’re after? Well, their ballots are doing the talking.

“We have to act, we have to make people not vote for populists, and we have to act in these areas where people are affected by health policy measures,” Martin Auer said. “Every single person is affected by the healthcare sector. 

“If we don’t do anything, that is why people support populists.”

EU Health Commissioner controversy

Meanwhile, Austrian Health Minister Johannes Rauch joined the chorus of European officials alarmed at the appointment of a far-right, EU-skeptic, Viktor Orban loyalist with no health experience to lead the bloc’s health policy for the next five years. 

“This is a very important department,” Rauch said on Wednesday, speaking at a closed-door press briefing at Gastein. “I am worried that if a representative of an EU-hostile government is appointed, this will lead to problems.” 

Olivér Várhelyi, Hungary’s nominee for EU commissioner, has faced fierce backlash from Brussels insiders since Commission Chief Ursula von der Leyen announced last week he would head Health and Animal Welfare in her next commission.

European Parliament members have ample reasons to oppose Várhelyi’s appointment as health commissioner – chief among these an incident last year when he was heard on a hot microphone calling MEPs “idiots.”

MEPs also remain furious at his unilateral declaration last year that the EU would cut off all aid to Palestinians, which he had no authority to do and was quickly overruled by Von der Leyen. His close ties to Israeli officials, including meeting with Prime Minister Benjamin Netanyahu and Defense Minister Noav Gallant after the International Criminal Court issued arrest warrants for their arrests for war crimes, have left MEPs worried he could impact EU assistance to Gazans. 

Former staff and Hungarian officials are also not fans of Várhelyi, variously describing him to Politico as “incredibly rude,” having an “appetite to humiliate,” and running his office in an environment of “emotional terror.” 

Várhelyi’s loyalty to Orban has also raised fears that, should he be appointed, no action at the EU level on abortion protections or reproductive rights will be possible during his mandate – a goal many states had hoped to advance. 

The complex European health portfolio handed to Várhelyi is set to include major files such as a complete revamp of EU pharmaceutical regulations, the European data space, and building a European Health Union, continuing efforts to combat cancer, and promoting preventive health,” von der Leyen said.

Várhelyi is also viewed in some MEP circles as being friendly to pharmaceutical interests given his three years as the leader of the EU’s intellectual property rights division from 2008 to 2011 – a potential conflict of interest given that, as Commissioner, he would oversee the reworking of pharmaceutical regulations. 

His appointed has to be agreed to by the European Parliament’s environment and health committee, and there is widespread expectation that he is unlikely to get past the MEPs represented there. 

But if he does, some solace can be found in that he is not the only Commissioner with power to influence health given the EU’s labyrinthine structure.

Health-related responsibilities will be spread across several portfolios. Commissioners from Spain and Romania will share oversight of certain health tasks, while a Belgian representative will focus on emergency preparedness and medical supplies. Meanwhile, France’s nominee to the Industrial Strategy role is set to spearhead efforts in biotechnology and pharmaceutical policy development.

Image Credits: European Commission.