Policy-makers across political spectrum should step up efforts to tackle health inequalities

Poorer health is linked to a higher proportion of votes for the populist right wing political party, Reform UK, indicates an analysis of the 2024 general election voting patterns in England, published online in the open access journal BMJ Open Respiratory Research.

The findings should prompt policy-makers of all political stripes to step up efforts to improve public health and tackle health inequalities, suggest the researchers.

Reform UK secured 14% of votes in last year’s UK general election, winning five of the English constituency seats available. And in May this year, it won a substantial number of council seats in local authority elections in England, note the researchers.

Many countries in Europe, and elsewhere, have witnessed a surge in the popularity of similar populist parties, and it’s thought that support for them may be linked to both health outcomes and satisfaction with healthcare services, explain the researchers.

To explore this further, they analysed parliamentary data from the 2024 general election, including the size of the electorate, number of valid votes, and votes cast for each political party returned in every constituency in England.

They applied two measures of the strength of support for Reform UK: constituencies in England returning a Reform MP compared with those electing an MP from the Labour, Conservative, Liberal Democrats, or Green parties; and the proportion of votes for Reform UK across all constituencies.

They looked at 20 common health outcomes, provided in parliamentary data for each constituency, and based on the NHS performance data from 2022–3.

These 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; schizophrenia, bipolar disorder, and psychoses; and stroke/mini stroke (TIA) combined.

Analysis of all the data showed that of the 543 constituencies in England, Labour won 347, the Conservatives 116, the Lib Dems 65, the Green Party four, and Reform UK five (total of 537) in the 2024 general election. Constituencies returning an independent MP (5), as well as the constituency of the Speaker of the House, were excluded.

Three of the five areas (60%) returning a Reform UK MP 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 over 65s: 24% vs 17% for Labour and 23% for the Conservatives.

The five areas that returned a Reform UK MP had the highest average prevalence of 15 out of the 20 health conditions, the exceptions being atrial fibrillation; cancer; osteoporosis; schizophrenia, bipolar, and psychoses; and non-diabetic high blood glucose.

For example, 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.

And these constituencies had an average coronary heart disease prevalence of 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 associations between vote share and the prevalence of 19 of the health measures, 7 of which were strong and 10 of which were moderately sized. The strongest associations 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 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.

But these findings are in line with those associated with Republican party voting behaviour in the USA and data on voting patterns for the Far Right in Italy, note the researchers.

And lung health, which is affected by obesity, COPD, asthma and cardiovascular disease, is a key indicator of health inequalities, say the researchers. 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 to have a role in the UK, they suggest.

“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,” they suggest.

And they conclude: “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.”

14/10/2025

Notes for editors
Research: What is the relationship between population health and voting patterns: an ecological study in England Doi: 10.1136/bmjresp-2025-003526
Journal: BMJ Open Respiratory Research

External funding: None declared

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Observational; data analysis
Subjects: People

The post Poorer health linked to more votes for Reform UK, 2024 voting patterns suggest first appeared on BMJ Group.

“Open access publishing ensures the publications are available to everyone, including scientists and policymakers in low-resourced settings.”

Dr Bruce Kirenga,
Chief research scientist and founding director of the Makerere University Lung Institute (MLI)

Compared to most publications in the biomedical and clinical sciences field, which usually receive 2-3 citations, this study stands out with 32 citations. Twenty-four policy documents and two clinical guidelines across four countries also reference it. These numbers highlight the significant impact this research has on evidence-based global health practices.

Dr Kirenga and his team chose open access to ensure their research reached a global audience without barriers, facilitating faster dissemination of critical findings. Making their work freely available enabled healthcare professionals and policymakers in LMICs to access the latest evidence on affordable and accessible therapies. 

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Findings challenge idea that heightened vulnerability to cigarette smoke is to blame

Women’ are around 50% more likely than men to develop COPD, the umbrella term for chronic lung conditions, such as emphysema and bronchitis, even if they have never smoked or smoked much less than their male counterparts, suggests observational research, published in the open access journal BMJ Open Respiratory Research.

The findings challenge the widely held belief that women’s increased vulnerability to cigarette smoke likely explains this disparity, conclude the researchers.

Smoking is the principal cause of COPD. But despite significant falls in cigarette smoking over the past 50 years, it remains a leading cause of death in the USA, with the prevalence of COPD in women approaching that of men, say the researchers.

Women with COPD tend to have more severe symptoms, and at a younger age, than their male counterparts, prompting the suggestion that the explanation may lie in a heightened susceptibility to the effects of cigarette smoke, explain the researchers.

To clarify the associations between gender, cigarette smoke, and COPD, and to update previous estimates of the prevalence and impact of COPD, the researchers drew on a large nationally representative US survey of adults from the 2020 National Health Interview Survey (NHIS). 

Respondents (12,638 women and 10,390 men aged at least 40) were asked about their smoking history, what tobacco products they used, and whether they vaped.

Women reported lower rates of both current and former cigarette, cigar, and pipe smoking, and smokeless tobacco use than men, but similar rates of vaping.

The prevalence of COPD was just under 8% for women and 6.5% for men. Women with COPD were more likely to have never smoked cigarettes than men with COPD (26.5% vs just over 14%), and less likely to use other tobacco products except for e-cigarettes (26.5% vs 20%).

Women also reported smoking fewer daily cigarettes than men, averaging around 18 compared with around 22, and to have done so for fewer years. And they were less likely than men to have started smoking before the age of 15:19% vs 28%.

Yet the prevalence of COPD was higher among women who had ever smoked than it was among men: 16% vs 11.5%.  And among women who had never smoked the prevalence of COPD was almost twice as high as it was in male non-smokers: just over 3% compared with just over 1.5%.

In further analysis, female gender was associated with a significantly (47%) higher risk of being diagnosed with COPD after accounting for potentially influential factors.

This gender difference in risk persisted, irrespective of smoking history: among those who had never smoked, women were 62% more likely to be diagnosed with COPD, and among those who had ever smoked they were 43% more likely to do so.

The researchers acknowledge that their study relied on self report rather than objectively measured data. And they lacked potentially important information on hormonal influences, family history, or infectious, occupational, and environmental exposures.

But they nevertheless suggest: “These findings should raise questions about whether differing susceptibility to tobacco smoke is the key factor driving the increased COPD prevalence in women in the USA.

“If women were more susceptible to the effects of smoking, we would not expect to see a nearly identical risk per 10 pack-year exposure, nor would we expect to see a similarly increased relative risk among those who had never smoked.”

And they conclude: “Our findings refine prior estimates of COPD among those without a smoking history and re-emphasise the high burden of COPD in women, underscoring the need for thoughtful efforts to prevent, diagnose, and treat their disease.”

09/04/2026

Research: Gender, tobacco and chronic obstructive pulmonary disease: analysis of the 2020 National Health Interview Survey Doi: 10.1136/bmjresp-2024-002462
Journal: BMJ Open Respiratory Research

External funding: National Institutes of Health (NIH)

Externally peer reviewed? Yes
Evidence type: Observational; survey results
Subjects: People

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Healthy sleep pattern linked to lower risk in adults, large study shows
Spotting and treating sleep disorders early on might lessen risks, irrespective of genes

Poor quality sleep may bolster a person’s genetic susceptibility to asthma, potentially doubling their risk of being diagnosed with the condition, suggests a large UK Biobank study, published in the open access journal BMJ Open Respiratory Research.

A healthy sleep pattern seems to be linked to a lower risk of asthma, prompting the researchers to suggest that spotting and treating sleep disorders early on might lessen the risks, irrespective of genetic predisposition.

People with asthma often report sleep disturbances, including broken/short sleep and insomnia. But it’s not clear if sleep quality itself might influence asthma risk, or whether healthy sleep patterns might lessen this risk, say the researchers. 

In a bid to find out, they drew on 455,405 UK Biobank participants who were between 38 and 73 years old when enrolled between 2006 and 2010. 

Participants were asked about their sleep patterns, based on five specific traits: early or late chronotype (‘morning lark’ or ‘night owl’); sleep duration; insomnia; snoring; and excessive daytime sleepiness.

A healthy sleep pattern was defined as early chronotype; clocking up 7–9 hours of sleep every night; never or rare insomnia; no snoring; and no frequent daytime sleepiness.

Based on their responses, 73,223 people met the criteria for a healthy sleep pattern; 284,267 an intermediate sleep pattern; and 97,915 a poor sleep pattern.

The genetic make-up of all UK Biobank participants is routinely mapped, and a genetic asthma risk score for each of the 455,405 people in this study was drawn up according to the number of genetic variants associated with asthma in their genome. 

Around 1 in 3 participants were classified as ‘high’ genetic risk (150,429) and another third (151,970) as ‘intermediate’ risk. The remainder were classified as ‘low’ risk.

Participants’ respiratory health was tracked up to the date of an asthma diagnosis, death, or until 31 March 2017, whichever came first.

During a monitoring period of just under 9 years, 17,836 people were diagnosed with asthma. They were more likely to have potentially influential risk factors than those who weren’t diagnosed with the condition.

These were: lower levels of education and a greater likelihood of unhealthy sleep traits and patterns; obesity; higher genetic asthma risk scores; higher levels of smoking and drinking; high blood pressure, diabetes, depression, acid reflux; and greater exposure to air pollution.

Some 7,105 people at high genetic risk of asthma and 5,748 at intermediate genetic risk were diagnosed with the condition during the monitoring period.

Compared with those at low genetic risk, those with the highest risk were 47% more likely to be diagnosed with asthma, while those with a poor sleep pattern were 55% more likely. 

But people at high genetic risk who also reported poor sleep patterns were 122% more likely to be diagnosed with asthma than those with both a healthy sleep pattern and a low genetic risk—in other words, they were more than twice as likely to be diagnosed with asthma.

All five sleep traits were independently associated with lower risks for asthma, with never/rare insomnia and sleep duration of 7-9 hours a night seemingly the most influential, with risk reductions of 25% and 20%, respectively.

Further in-depth analysis on a smaller group of people indicated that a healthy sleep pattern might reduce the risk of asthma in those at high genetic risk by 37%, suggesting that a healthy sleep pattern might help offset asthma risk, regardless of genetic susceptibility, say the researchers.

In theory, at the population level, a low genetic risk combined with a healthy sleep pattern might translate into 19% fewer cases of asthma, suggest the researchers.

The association between sleep and asthma may be two-way, they suggest, offering some possible explanations for their findings.

“The negative impact of sleep disorders on asthma, which is generally considered a chronic inflammatory disease, might be mediated by sleep-induced chronic inflammation. Previous studies have demonstrated that sleep disorders, such as unfavourable sleep duration and insomnia, are associated with chronic inflammation.

“In theory, the immune response to inflammation could generate pro-inflammatory cytokines that result in cellular infiltration and airway inflammation, further increasing the risk of asthma,” they write.

This is an observational study, and as such can’t establish cause, and the researchers acknowledge several limitations to their findings.

As the UK Biobank only provided information on 38–73 year olds, the effect on children and younger adults is still unclear, added to which the findings apply only to people of European ancestry. Lastly, the UK Biobank may be subject to a ‘healthy volunteer’ selection bias.

Nevertheless, the researchers conclude: “Considering that poor sleep combined with high genetic susceptibility yielded a greater than twofold asthma risk, sleep patterns could be recommended as an effective lifestyle intervention to prevent future asthma, especially for individuals with high-risk genetics.”

03/04/23

Notes for editors
Research: Highlighting the importance of healthy sleep patterns in the risk of adult asthma under the combined effects of genetic susceptibility: a large-scale prospective cohort study of 455405 participants Doi: 10.1136/bmjresp-2022-001535
Journal: BMJ Open Respiratory Research

Funding: Future Program for Young Scholars and National Key Research and Development Program

Link to AMS press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Observational (cohort study)
Subjects: People

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