Right wing populism – a la Trump, Marie Le Pen and others – is on the march. In the US we are already seeing how such populism threatens democracy and civil liberties. Which begs the question: Could “alt-right” policies threaten public health?
There is evidence to suggest that as authoritarianism rises, indicators of health fall. A 2004 article in the British Medical Journal (BMJ) compared health outcomes to a "freedom index" calculated by an independent watchdog. The researchers found that countries with a high freedom index (they had well established civil liberties and democracy) had a higher life expectancy and lower infant and maternal mortality than less free states.
Separate research revealed how public health improved in Eastern European countries as they moved from Communist rule to a more democratic society. Empowerment and better access to information about health appear to have a broad brush positive impact on health.
But problems persist. According to the Open Society Foundations, in Eastern Europe, ambulances routinely refuse to answer calls for help from Roma communities. In countries of the former Soviet bloc, people with mental disabilities are forced to live in dilapidated institutions, without access to education or healthcare.
Russia, which had a freedom index of 22 out of 100 in a 2016 assessment, has an average life expectancy some 10 years lower than that of the US, whose most recent freedom index is 90.
Open Society Foundations' public health policy director, Jonathan Cohen, says Russia has the largest HIV epidemic in the European region, and one of the fastest growing HIV epidemics in the world.
But perhaps one of Cohen's most interesting observations is how, in the recent US presidential election, public health statistics were a remarkably accurate predictor of voting behaviour. "Counties with high numbers of drug overdose deaths in Ohio and Pennsylvania, two states that were crucial to Trump's victory, also had relatively high numbers of people voting for Trump.
"An analysis by The Economist found that counties with high rates of obesity, diabetes, alcohol intake, and lack of exercise – in other words, poor public health – accounted for 43 per cent of Trump's gains among Republicans compared to Mitt Romney, the Republican candidate for president in 2012," he writes. And Trump won all 16 states with the highest mortality rates, according to a study from the University of Pittsburgh.
Another fascinating piece of politico-health research from the University of Michigan showed how infant mortality differed significantly between Republican and Democratic presidents in the period 1965 to 2010. The 2014 paper in the International Journal of Epidemiology showed that Republican presidents slowed down the improvement of infant mortality nationally and increased health inequality between black and white infants.
“We found a robust, quantitatively important association between US infant mortality rates and the party affiliation of the president,” the authors concluded before going on to note, “there may be overlooked ways by which macro-dynamics of policy impact microdynamics of physiology, suggesting the political system is a component of the underlying mechanism generating health inequality in the USA”.
In expressing dissatisfaction with shorter lives and poorer health, could the typical Trump voter have unwittingly voted for a man whose health policy proposals make previous Republican presidents appear left of centre by comparison?
The biggest problem with Trump, to paraphrase Donald Rumsfeld, another Republican, is that he vacillates so much he is a known unknown. Take the following tweet he made as a candidate: "Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn't feel good and changes – AUTISM. Many such cases!"
Now if he follows through with a health policy reflecting this belief, he could quickly destroy national childhood vaccination programmes. The massive negative effect on infant mortality alone doesn’t bear thinking about.
History suggests a Trump presidency will be bad for US public health. Just how much damage he and his policies will do remains to be seen.