Dying too young: How worsening health and loss of trust in politics gives us the worst possible governments
In 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, 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.
Addressing the populist challenge
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 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. ▪
