Populist movements frequently garner their strongest backing from those who perceive themselves as marginalized. A recent study from Imperial College London indicates that poor health may be one of the most significant predictors of such feelings. Researchers published in BMJ Open Respiratory Research discovered that English constituencies with elevated rates of chronic illnesses, particularly those associated with breathlessness like obesity and COPD, leaned more towards voting for Reform UK in the 2024 general election.
The study correlated comprehensive health data from the NHS with voting results at the constituency level. Reform UK, a right-wing populist party that emerged from the Brexit initiative, secured five seats in England along with 14 percent of the total vote. Although the number of seats was limited, the health trends behind these votes were notable. Constituencies where Reform UK candidates triumphed exhibited the highest average occurrence of 15 out of 20 principal chronic conditions, including depression, diabetes, and heart disease.
Votes Increase With Deteriorating Health
The research group analyzed twenty prevalent conditions derived from NHS performance statistics, encompassing asthma and hypertension to stroke and schizophrenia. Throughout England, Reform UK’s vote share fluctuated between zero and 46 percent. When mapped against local disease prevalence, the trend line was clearly upward. Even after accounting for age, gender, and deprivation status, fifteen of the twenty conditions continued to show a significant correlation with increased Reform vote shares.
Obesity displayed the strongest correlation: for every 10 percent increase in votes for Reform UK, local obesity rates were, on average, 1.5 percent higher. The same increase in voting corresponded to a 0.3 percent increase in chronic obstructive pulmonary disease prevalence and a 0.1 percent rise in both asthma and depression. In numerous winning Reform constituencies, these three conditions were found to cluster together, intensifying the effects of deprivation and aging populations.
Three of the five Reform seats were located in the most disadvantaged fifth of England. These areas also had the highest proportion of residents over 65, a group often managing several chronic conditions and reporting challenges in accessing care. These patterns align with findings from studies in the United States, linking Republican voting with poorer local health, and in Italy, where dissatisfaction with public services correlates with support for the populist right.
“In the UK, the implementation of austerity measures, compounded by the consequences of the COVID-19 pandemic, has led to many individuals with long-term lung conditions missing out on fundamental aspects of care, potentially intensifying frustration with the existing situation,” the researchers noted.
The authors highlight that lung health serves as a particularly sensitive indicator of inequality. Conditions like COPD and asthma are influenced by factors beyond individual choices: air quality, inadequate housing conditions, and access to reliable medical assistance. In several Reform bastions along England’s coastline, these structural elements converge. The 2021 Chief Medical Officer’s report cautioned that coastal areas experience poorer health results, heightened deprivation, and inadequate healthcare services—a phenomenon sometimes referred to as the inverse care law.
Frustration And The Politics Of Breathlessness
Health can subtly influence political behavior. Individuals living with chronic illnesses may experience diminished control over their lives, reflecting the loss of agency that populist rhetoric often capitalizes on. Depression, in particular, is associated with feelings of hopelessness and alienation, emotions that can amplify messages about national decline or institutional betrayal.
Lead author Dr. Anthony Laverty and co-author Professor Nicholas Hopkinson emphasize that their analysis is ecological, not individual. It cannot definitively establish that poor health caused any specific vote. However, at the population level, the correlations are strong enough to reveal a policy oversight: the political ramifications of unequal health outcomes. The findings imply that neglecting public health not only harms individuals but could also alter the political landscape itself.
“For policymakers in Reform UK, these analyses reveal profound health challenges in their constituencies that require attention. For those anywhere on the political spectrum, these results should offer an additional motivation to take action aimed at enhancing public health and alleviating inequalities,” the authors concluded.
The study acknowledges limitations, including mismatched timeframes (health data from 2022–23 versus voting data from 2024) and the ecological fallacy, as constituency averages cannot encapsulate individual motivations. Nonetheless, the overarching picture is evident: regions where breathlessness, obesity, and depression are prevalent are also where populist discontent finds ample support.
The authors contend that governments across the political spectrum possess the means to alter this trajectory. Investing in housing, transportation, air quality, and preventive healthcare could help bridge health disparities and mitigate the feelings of neglect that fuel populist sentiments. As the researchers articulate, England’s next significant public health challenge may extend beyond medical considerations to political realities: rebuilding trust through health restoration.
BMJ Open Respiratory Research: 10.1136/bmjresp-2025-003526
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