Poor health, particularly respiratory conditions, is linked to a higher proportion of votes for Reform UK in England.
These are the findings of a new analysis, led by researchers at Imperial and published today in the journal BMJ Open Respiratory Research, which explore the links between health outcomes and voting patterns during the 2024 general election.
It finds that at the constituency level, areas where Reform UK performed well had a higher prevalence of people living with chronic diseases – particularly conditions associated with breathlessness, and poor lung heath.
The researchers say their findings align with trends seen in Europe and the United States and should prompt policy-makers from all parties to step up efforts to improve public health and tackle health inequalities in their constituencies and nationwide.
Associate Professor Anthony Laverty, from Imperial's School of Public Health, said: "In recent years, we have seen a significant rise in the support for populist right wing political movements internationally, including Reform UK. Clearly, how people vote is driven by numerous complex societal and political factors, like housing, crime, education and immigration. But we know there is evidence for a strong link between voting habits and worsening public health and people becoming less satisfied with healthcare services.
"It wasn't clear whether this held true for the UK, but our analysis suggests it may well be the case. We found that areas of the country with some of the greatest health inequalities and worst health may be most likely to support parties like Reform UK."
Professor Nick Hopkinson, National Heart & Lung Institute at Imperial, said: "It's well established that lung health is a key indicator of health inequalities, and that corresponds with what we're seeing here. Areas of England which voted overwhelmingly for Reform UK were among the most affected by chronic conditions associated with breathlessness – like asthma, COPD and obesity.
"This could be a strong contributory factor for voting habits, where many people are missing out on basic aspects of care, which may fuel their frustration with the status quo."
Rise of Reform
In the 2024 UK general election, Reform UK secured 14% of total votes, winning five constituency seats in England. The party has since won a substantial number of council seats in local authority elections this year.
Internationally, countries in Europe and elsewhere have seen a rise in the support for populist right wing political parties. Previous studies have suggested that in Europe and the US, this support may be linked to worsening health outcomes and reduced satisfaction with healthcare services.
In the latest study, Imperial researchers set out to see if the same trends seen internationally applied to the UK.
Analysing parliamentary data from the 2024 general election, they included the size of the electorate, number of valid votes, and votes cast for each political party for every constituency in England (543 in total).
They then applied two measures of the strength of support for Reform UK: constituencies where Reform UK won were compared with those won by other parties; and the proportion of votes for Reform UK across all constituencies.
In addition, the researchers looked at the prevalence of 20 common chronic diseases for all constituencies, based on NHS performance data from 2022–3. The conditions were: asthma; atrial fibrillation; cancer; chronic kidney disease; chronic obstructive pulmonary disease (COPD); coronary heart disease; dementia; depression; type 2 diabetes; epilepsy; heart failure; high blood pressure; learning disabilities; non-diabetic high blood glucose levels; obesity; osteoporosis; peripheral arterial disease; rheumatoid arthritis; and a combined measure for schizophrenia, bipolar disorder, and psychoses; and stroke/mini stroke (TIA) combined.
Health inequalities
In the 2024 general election, Labour won 347 seats, the Conservatives 116, the Liberal Democrats 65, the Green Party four, and Reform UK won five (total of 537 constituency seats in England). Seats won by an independent MP (5), as well as the constituency of the Speaker of the House, were excluded from the analysis.
Analysis reveals that three of the five constituencies (60%) where Reform UK won seats were in the most deprived fifth of the country, compared with 103 (30%) of Labour constituencies. Reform UK areas also had the highest proportions of residents aged over 65 – with 24% for Reform vs 17% for Labour and 23% for the Conservatives.
Reform UK constituencies had the highest average prevalence of 15 out of the 20 health conditions, except for atrial fibrillation; cancer; osteoporosis; schizophrenia, bipolar, and psychoses; and non-diabetic high blood glucose.
On average, Reform UK constituencies had an average asthma prevalence of 7.5% and an average COPD prevalence of almost 3% compared with 7% and 2%, respectively, for Labour constituencies. They also had a higher average prevalence of coronary heart disease (4%) compared with 3% in Conservative constituencies, and an average depression prevalence of 14% compared with 13% in Liberal Democrat constituencies.
Reform UK's vote share across the country ranged from 0% to 46% in individual constituencies, with positive correlations between vote share and the prevalence of 19 of the health measures, 7 of which were strong correlations and 10 of which were moderately sized. The strongest correlations were for obesity, COPD, and epilepsy.
After factoring in age, sex, and deprivation levels, statistically significant positive associations emerged between Reform UK vote share and the prevalence of 15 of the 20 conditions. The largest of these was for obesity, where a 10% increase in Reform UK vote share was associated with a +1.5% increase in obesity prevalence.
For the UK's political parties, the takeaway from this analysis is crystal clear – public health is an urgent priority, irrespective of voting preference. Professor Nick Hopkinson NHLI
For each 10% increase in Reform UK vote share, there was a +0.3% higher prevalence of COPD, a +0.1% greater prevalence of asthma, and a +0.1% increased prevalence of depression.
The researchers acknowledge various limitations to their findings. For example, election data came from 2024, while health indicators came from 2022–3, and both health and political sentiment are influenced by long term trends which their study didn't capture. However, they believe their findings are in line with those with voting behaviour in the USA and data on voting patterns for the Far Right in Italy.
They add that lung health, which is affected by obesity, COPD, asthma and cardiovascular disease, is a key indicator of health inequalities. While the structural determinants of health, such as medical care and housing, are likely to have a role in voting patterns, additional factors are likely at play in the UK, they suggest.
Professor Hopkinson added: "It's important to highlight that three of the five Reform UK constituencies are coastal – Boston and Skegness, Great Yarmouth, and Clacton. Previous reports have highlighted particular health issues in coastal areas in the UK, due to greater ill health in older poorer populations and reduced healthcare provision.
"For the UK's political parties, the takeaway from this analysis is crystal clear – public health is an urgent priority, irrespective of voting preference. For Reform UK, it highlights there are profound health issues in their constituencies which must be addressed. For other political parties, the potential implications of losing further seats to populist right-wing parties should provide further incentive to take urgent steps to improve public health and reduce inequalities, right across the board."
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'What is the relationship between population health and voting patterns: an ecological study in England' by Hopkinson, N., and Laverty, A. is published in BMJ Open Respiratory Research. DOI: 10.1136/bmjresp-2025-003526
This article is based on materials from BMJ
