The role of health and health systems in shaping political engagement and rebuilding trust in democratic institutions

Summary: Around the world, institutional trust is declining while democratic discontent is rising. What role do health and health systems play in this crisis? We review decades of interdisciplinary research to describe how health and health systems are linked to democratic trust and engagement. When...

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Main Authors: Anil Menon, Nolan M. Kavanagh, Michelle Falkenbach, Matthias Wismar, Scott L. Greer
Format: Article
Language:English
Published: Elsevier 2025-06-01
Series:The Lancet Regional Health. Europe
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2666776225001188
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author Anil Menon
Nolan M. Kavanagh
Michelle Falkenbach
Matthias Wismar
Scott L. Greer
author_facet Anil Menon
Nolan M. Kavanagh
Michelle Falkenbach
Matthias Wismar
Scott L. Greer
author_sort Anil Menon
collection DOAJ
description Summary: Around the world, institutional trust is declining while democratic discontent is rising. What role do health and health systems play in this crisis? We review decades of interdisciplinary research to describe how health and health systems are linked to democratic trust and engagement. When individuals or communities experience a decline in their health, they feel “let down” by the health system and other public institutions meant to support their well-being. Consequently, they are less likely to vote. Those who continue to vote are increasingly drawn to anti-establishment, anti-democratic parties that promise to radically reform the system. Once in power, however, these parties often weaken public health protections or exclude select populations from the health system. The result can be a self-reinforcing feedback loop between declining health and political discontent. We conclude by offering concrete suggestions for improving population health while rebuilding trust in health systems and democratic institutions more broadly.
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spelling doaj-art-e55fa7db8b78427fab32e69ca91676b02025-08-20T01:51:00ZengElsevierThe Lancet Regional Health. Europe2666-77622025-06-015310132610.1016/j.lanepe.2025.101326The role of health and health systems in shaping political engagement and rebuilding trust in democratic institutionsAnil Menon0Nolan M. Kavanagh1Michelle Falkenbach2Matthias Wismar3Scott L. Greer4Department of Political Science, University of California, Merced, CA, USA; Corresponding author. 313 Classroom Office Building 2, 5200 N. Lake Rd., Merced, CA 95343, USA.Interfaculty Initiative in Health Policy, Harvard University, Cambridge, MA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USAEuropean Observatory on Health Systems and Policies, Brussels, Belgium; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USAEuropean Observatory on Health Systems and Policies, Brussels, BelgiumEuropean Observatory on Health Systems and Policies, Brussels, Belgium; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USASummary: Around the world, institutional trust is declining while democratic discontent is rising. What role do health and health systems play in this crisis? We review decades of interdisciplinary research to describe how health and health systems are linked to democratic trust and engagement. When individuals or communities experience a decline in their health, they feel “let down” by the health system and other public institutions meant to support their well-being. Consequently, they are less likely to vote. Those who continue to vote are increasingly drawn to anti-establishment, anti-democratic parties that promise to radically reform the system. Once in power, however, these parties often weaken public health protections or exclude select populations from the health system. The result can be a self-reinforcing feedback loop between declining health and political discontent. We conclude by offering concrete suggestions for improving population health while rebuilding trust in health systems and democratic institutions more broadly.http://www.sciencedirect.com/science/article/pii/S2666776225001188Health politicsPolitical determinants of healthHealth policyTrust
spellingShingle Anil Menon
Nolan M. Kavanagh
Michelle Falkenbach
Matthias Wismar
Scott L. Greer
The role of health and health systems in shaping political engagement and rebuilding trust in democratic institutions
The Lancet Regional Health. Europe
Health politics
Political determinants of health
Health policy
Trust
title The role of health and health systems in shaping political engagement and rebuilding trust in democratic institutions
title_full The role of health and health systems in shaping political engagement and rebuilding trust in democratic institutions
title_fullStr The role of health and health systems in shaping political engagement and rebuilding trust in democratic institutions
title_full_unstemmed The role of health and health systems in shaping political engagement and rebuilding trust in democratic institutions
title_short The role of health and health systems in shaping political engagement and rebuilding trust in democratic institutions
title_sort role of health and health systems in shaping political engagement and rebuilding trust in democratic institutions
topic Health politics
Political determinants of health
Health policy
Trust
url http://www.sciencedirect.com/science/article/pii/S2666776225001188
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