Our lives depend on the choices of the politicians who represent us. This is the harsh, and largely unrecognised, reality of politics and why our choices when we go out to vote are so important. The full spectrum of factors which determine our health (aka wellbeing) are complex and way beyond the control of any single politician, organisation or even country. But I think it’s fair to say that national politicians have a disproportionate opportunity to influence our lives.  Bad choices by politicians kill people. Good choices can save lives.

Two examples:

Climate policy – Our lives depend on the stability of our climate. The slower we decarbonise our lives the more unstable our climate system will become, the more disruption we will see to our food supplies, the more conflict and forced migration we will be faced with. The faster we go the more our communities can thrive and the better our health will be. The critical issue for climate change is speed of action. This has been recently brilliantly described by Alex Steffen in his manifesto for action entitled ‘The Last Decade’. The predatory delay being shown by vested interests, and the politicians who accept without challenge the framing of climate change by these interests, is arguably the single biggest barrier to rapid climate action. In the UK the Conservative government supports fracking for more fossil fuels and wants to maximise economic returns from North Sea oil and gas. This is not going as fast as we can on climate change. We shouldn’t shy away from putting this bluntly. This will kill people.

Austerity –  Underfunding health and social care, relative to need, is the most obvious example of austerity harming health but across many sectors there are missed opportunities to improve the determinants of health.  Austerity makes it harder to do this. It makes it harder to prepare for and respond to threats to health, everything ranging from infectious disease to terrorism. For more on how austerity kills see this NY Times editorial by Stuckler and Basu.  But what of the counter argument that ‘living within our means’ is necessary for a thriving economy, and wellbeing depends on a thriving economy. This might be a valid counterargument if the health gain from this could be shown to outweigh the many deaths caused by austerity measures.  But does it? Nobel Laureate Amartya Sen has argued convincing against austerity here. Recently an astonishing array of economists came out in favour of UK Labour’s proposed approach to national economics. In the UK the political arguments for austerity have used a metaphor of a personal or household budget and the need to live within this. But it is rare to hear someone pointing out a national budget is not a household budget. Spending in a country largely remains within that country’s budget. Household budgets and national budgets are not the same thing.  That’s before we even get into the relationship between GDP and wellbeing. Here’s a commentary in Nature about this.  Austerity doesn’t make sense. Austerity kills.

There are many other examples of where poor political choices have harmed heath. Until we start to describe policy, all major policy, in terms of its impact on wellbeing it should be no surprise when our politicians continue to make choices which result in more of us dying than would otherwise have.

This week we have a opportunity to choose politicians who understand that the primary concern of politicians should be the wellbeing of those whom they serve. If they don’t support strong action on climate change, if they don’t want to stop austerity, if they don’t plan to put consideration of health into all policies, chances are their choices in the future will kill people. Don’t vote for them.

Postscript 1: Who to vote for

I deliberately haven’t said vote for a particular party, although it should be pretty apparent from what I’ve said who I  think you shouldn’t vote for. At a local level there will be tactical and personal considerations to take into account. Personally I’ve decided to vote Green. In Cambridge we have excellent Green, Labour and Lib Dem candidates, and I could have easily voted for any of them. There isn’t a strong Conservative vote so this isn’t a consideration as it would be elsewhere. I think a Green vote sends the strongest signal that I want much greater action on climate change.

Postscript 2: Reframing our dialogue after the election

Whatever happens on Thursday, chances are there will be many politicians, and voters, who still support austerity, continued fossil fuel use and GDP as a measure of national success.  Our challenge after Thursday is to talk to those who disagree with us. My experience is that in a one to one conversation most people, regardless of who they vote for, agree on the importance of wellbeing and most people are concerned for others. For me this is the most intriguing part of all of this. Why do people with similar values come to radically different political conclusions? It’s only through engaging with people, sharing our understanding, and listening to theirs that we will be able to get the transformational change we need to address the existential, and more everyday, threats to our wellbeing which we face.