Poor Health May Be Driving Voters Toward Populist Party

Populist movements often find their strongest support among those who feel left behind. Now, a new study from Imperial College London suggests that poor health itself may be one of the strongest predictors of that sentiment. Researchers reporting in BMJ Open Respiratory Research found that English constituencies with higher rates of chronic disease, especially conditions linked to breathlessness such as obesity and COPD, cast more votes for Reform UK in the 2024 general election.

The analysis linked detailed health data from the NHS with constituency-level voting returns. Reform UK, a right-wing populist party that emerged from the Brexit movement, won five seats in England and 14 percent of the overall vote. While the number of seats was small, the health patterns behind those votes were striking. Constituencies where Reform UK candidates succeeded had the highest average prevalence of 15 out of 20 major chronic conditions, including depression, diabetes, and heart disease.

Votes Rise With Worsening Health

The research team examined twenty common conditions drawn from NHS performance data, ranging from asthma and hypertension to stroke and schizophrenia. Across England, Reform UK’s vote share ranged from zero to 46 percent. When plotted against local disease prevalence, the line of best fit tilted unmistakably upward. Even after adjusting for age, sex, and deprivation levels, fifteen of the twenty conditions remained significantly linked to higher Reform vote shares.

Obesity showed the strongest relationship: for every 10 percent rise in votes for Reform UK, local obesity rates were 1.5 percent higher on average. The same vote increase corresponded to a 0.3 percent higher prevalence of chronic obstructive pulmonary disease and a 0.1 percent rise in both asthma and depression rates. In many of the winning Reform constituencies, all three conditions clustered together, amplifying the effects of deprivation and aging populations.

Three of the five Reform seats were in the most deprived fifth of England. Those districts also had the largest proportion of residents over 65, a demographic often managing multiple chronic conditions and reporting difficulty accessing care. These patterns mirror findings from studies in the United States, where Republican voting has been tied to poorer local health, and in Italy, where dissatisfaction with public services correlates with support for the populist right.

“In the UK, the introduction of austerity policies, aggravated by the effects of the COVID-19 pandemic, has contributed to the fact that many people with long term lung conditions are missing out on basic aspects of care, which may fuel frustration with the status quo,” the researchers wrote.

The authors note that lung health is an especially sensitive barometer of inequality. Conditions such as COPD and asthma are shaped by factors beyond individual behavior: air quality, damp or cold housing, and access to consistent medical support. In several Reform strongholds along England’s coast, these structural factors converge. The 2021 Chief Medical Officer’s report warned that coastal communities experience poorer health outcomes, higher deprivation, and weaker healthcare provision—a pattern sometimes called the inverse care law.

Frustration And The Politics Of Breathlessness

Health can shape political behavior in subtle ways. People living with chronic illness may feel reduced control over their lives, mirroring the loss of agency that populist messages often exploit. Depression, in particular, is associated with pessimism and alienation, emotions that can make messages about national decline or institutional betrayal more resonant.

Lead author Dr. Anthony Laverty and co-author Professor Nicholas Hopkinson stress that their analysis is ecological, not individual. It cannot prove that ill health caused any single vote. But at the population level, the correlations are robust enough to highlight a policy blind spot: the political consequences of unequal health outcomes. The results suggest that neglecting public health does not just harm individuals; it may reshape the political landscape itself.

“For Reform UK policy makers, the analyses demonstrate that there are profound health issues in their constituencies which should be addressed. For those elsewhere on the political spectrum, these results should provide a further incentive to take steps to improve public health and reduce inequalities,” the authors concluded.

The study’s limitations include mismatched timeframes (health data from 2022–23 versus voting data from 2024) and the ecological fallacy, since constituency averages cannot describe individual motives. Still, the broad picture is clear: areas where breathlessness, obesity, and depression are most common are also where populist anger finds the most fertile ground.

The authors argue that governments across parties hold the levers to change this trajectory. Investment in housing, transport, air quality, and preventive healthcare could narrow health gaps and reduce the sense of neglect that fuels populist politics. As the researchers put it, England’s next major public health challenge may not only be medical but political: rebuilding trust by rebuilding health.

BMJ Open Respiratory Research: 10.1136/bmjresp-2025-003526