Healthcare governance, professions and populism: Is there a relationship? An explorative comparison of five European countries

Health Risk Communication During COVID-19 Emergency in Italy: The Impact of Medical Experts' Debate on Twitter

The COVID-19 emergency underlined the importance of an effective public health communication to limit the spread of the outbreak. Physicians as "public experts" can play a crucial part in health risk communication, even if their role is challenged by transformations into the information system. Therefore, the major objective of this study was to investigate public perception of medical experts' opinions regarding the COVID-19 emergency. The Italian public debate involving medical experts in the Twitter sphere during the SARS-CoV-2 pandemic has particularly been examined. A content analysis was performed on 2,040 randomly selected tweets. The results of content analysis show that the medical experts who tend to mitigate the risk received a higher number of tweets supporting their positions when compared to the experts whose statements were aimed at intensifying the risk. Since a public expert is a communicator, but also an advisor who can affect how laypersons perceive and react to risk events, this study can provide more knowledge about the public perception of different communication strategies incorporated by medical experts.

The politics of vaccine hesitancy in Europe

BACKGROUND

Vaccine hesitancy threatens public health. Some evidence suggests that vaccine hesitancy in Europe may be linked with the success of populist parties, but more systematic analysis is needed.

METHODS

We examine the prevalence of individual-level vaccine hesitancy across the European Union (EU) and its association with political orientations. We also analyze whether success of populist parties is linked with vaccine hesitancy and uptake. We draw on individual-level Eurobarometer data from 2019, with a total of 27 524 respondents across the EU. We also rely on national and regional-level populist party vote shares. Finally, for a time-series analysis, we rely on aggregated populist party support as measured in the European Social Survey waves 1-9 (2002-18), and national immunization coverage rates from the WHO from 2002 to 2018.

RESULTS

While vaccine hesitancy is confined to a minority of the population, this group is large enough to risk herd immunity. Political orientations on a left-right dimension are not strongly linked to vaccine hesitancy. Instead, vaccine hesitancy is associated with anti-elite world views and culturally closed rather than cosmopolitan positions.

CONCLUSIONS

Vaccine hesitancy is not only present in all EU member states but also maps on broader dimensions of cultural conflict. Hesitancy is rooted in a broader worldview, rather than misperceptions about health risks. Pro-vaccine interventions need to consider the underlying worldview, rather than simply targeting misperceptions.

Evidence-based guiding principles to build public trust in personal data use in health systems

Objective

Public trust in health systems is pivotal for their effective and efficient functioning. In particular, public trust is essential for personal data use, as demonstrated in debates in many countries, for example, about whether data from COVID-19 contact tracing apps should be pooled or remain on individuals’ smartphones. Low levels of public trust pose a risk not only to health system legitimacy but can also harm population health.

Methods

Synthesising our previous qualitative and theoretical research in the English National Health Service which enabled us to conceptualise the nature of public trust in health systems, we present guiding principles designed to rebuild public trust, if lost, and to maintain high levels of public trust in personal data use within the health system, if not.

Results

To build public trust, health system actors need to not rush trust building; engage with the public; keep the public safe; offer autonomy to the public; plan for diverse trust relationships; recognise that trust is shaped by both emotion and rational thought; represent the public interest; and work towards realising a net benefit for the health system and the public.

Conclusions

Beyond policymakers and government officials, the guiding principles address a wide range of actors within health systems so that they can work collectively to build public trust. The guiding principles can be used to inform policymaking in health and health care and to analyse the performance of different governments to see if those governments that operate in greater conformity with the guiding principles perform better.

Medical Populism and COVID-19 Testing

This paper uses the lens of medical populism to analyze the impact of biocommunicability on COVID-19 testing through a case study approach. The political efficacy of testing is traced through two mini-case studies: the Philippines and the United States. The case studies follow the approach of populism scholars in drawing from various sources that ‘render the populist style visible’ from the tweets and press releases of government officials to media reportage. Using the framework of medical populism, the case studies pay attention to the ways in which coronavirus testing figured in (1) simplification of the pandemic; (2) spectacularization of the crisis; (3) forging of divisions; and (4) invocation of knowledge claims. Identifying and critically analyzing how knowledge is generated is an essential step to recognizing the impact that political styles have on the COVID pandemic. The political actors in each case study have shaped knowledge of the epidemic, in the way they construct the idea of ‘testing’, and in how they mobilize testing as an ‘evidence-making practice’. Their actions shaped how the pandemic—as well as their responses—is measured. This framework contributes to public policy debates by providing evidence of the impact of medical populism on pandemic response efforts.

A Scoping Review of Populist Radical Right Parties' Influence on Welfare Policy and its Implications for Population Health in Europe

BACKGROUND

In light of worrying public health developments such as declining life expectancy gains and increasing health inequalities, there is a heightened interest in the relationship between politics and health. This scoping review explores the possible welfare policy consequences of populist radical right (PRR) parties in Europe and the implications for population health. The aim is to map the available empirical evidence regarding the influence of PRR parties on welfare policy reforms and to understand how this relationship is mediated by political system characteristics in different countries.

METHODS AND ANALYSIS

A scoping review of peer-reviewed empirical literature addressing the relationship between PRR parties, political systems and welfare policy in Europe was performed using the methodology by the Joanna Briggs Institute. Data was charted on main study characteristics, concepts and relevant results, after which a qualitative content analysis was performed. The data was categorised according to the political system characteristics: constitution, political economy, interest representation and partisanship. Five expert interviews were conducted for validation purposes. Early evidence from 15 peer-reviewed articles suggests that exclusionary welfare chauvinistic positions of PRR parties are likely to have negative effects on the access to welfare provisions and health of vulnerable population groups. Differences in implementation of welfare chauvinistic policy reforms are partly explained by mediation of the constitutional order (judicial institutions at national and European Union [EU] level), political economy (healthcare system funding and European single market) and partisanship (vote-seeking strategies by PRR and mainstream parties). No clear evidence was found regarding the influence of interest representation on welfare chauvinistic policies.

DISCUSSION

While early evidence suggests that the welfare chauvinistic ideology of PRR parties is harmful for public health, the possible mediating role of political system characteristics on PRR welfare policy influence offers risk and protective factors explaining why the PRR ideology plays out differently across Europe.

Social amplification of risk and "probable vaccine damage": A typology of vaccination beliefs in 28 European countries

BACKGROUND

Despite lacking scientific support, vaccine hesitancy is widespread. While serious vaccine damage as a scientific fact is real yet statistically highly uncommon, emerging social and technological forces have amplified perceptions of risk for "probable vaccine damage", making it a widely shared intersubjective reality.

METHODS

Using the Eurobarometer 91.2 survey on a statistically representative EU27-UK sample interviewed in March 2019, we documented perceptions of vaccine risks and identified three belief configurations regarding vaccine effectiveness, safety, and usefulness, through exploratory cluster analysis.

RESULTS

The public beliefs in significant vaccine risks are frequent. Approximatively one-tenth of the EU27-UK population consider that vaccines are not rigorously tested before authorization, one-third believe that vaccines can overload or weaken the immune system and that they can cause the disease against which they protect, and almost one-half believe that vaccines can cause serious side effects. We identified three belief configurations: hesitant, confident, and trade-off clusters. The hesitant type (approx. 11% of EU27-UK respondents) is defined by the perception that vaccines are rather ineffective, affected by risks of probable vaccine damage, not well-tested, and useless; the confident type (approx. 59%) is defined by beliefs that vaccines are effective, safe, well-tested, and useful; and the trade-off type (approx. 29%) combines beliefs that vaccines are effective, well-tested and useful, with perceptions of probable vaccine damage. The vaccine-confident and the trade-off types have similar vaccination histories, indicating the significant role of other factors besides beliefs in inducing behavior.

CONCLUSIONS

The high proportion of varying public beliefs in significant vaccine risks and the presence of a trade-off type of vaccination assessment indicate the social normality of beliefs in probable vaccine damage. Communication campaigns should take into account the social normality of the perceived risk of "probable vaccine damage" across various social types, and patterns of concomitant trust and mistrust in vaccination.

Italian responses to the COVID-19 emergency: Overthrowing 30 years of health reforms?

This paper discusses the measures adopted by the Italian government to face the COVID-19 emergency after the first wave in March/April 2020. This study places these measures in light of the massive reform process based on the “managerialism” of healthcare, which started in the 1990s. These reforms, which were inspired by the ideas of ‘New Public Management’, introduced managerialism, regionalization and quasi-markets to the Italian National Health System. As a result, dramatic changes have been made in public healthcare, and the responsibility for healthcare was decentralized to regions, introducing a multi-level governance structure. The COVID-19 emergency has drawn the results of this approach into question. With the enactment of new decrees, the central government directly intervened in the management of the health system by introducing specific measures aiming to increase the number of hospital beds and personnel, which w previously downsized. We describe the main content of the new measures adopted to face the COVID-19 emergency and discuss how key points of the managerialization process in Italy are being questioned as a result of these measures. The COVID-19 emergency will likely redesign the trajectory of health reforms in Italy and other countries in Europe.

Populism, pestilence and plague in the time of coronavirus

Purpose

This paper aims to explore right wing populist government responses to the coronavirus pandemic.

Design/methodology/approach

This paper is a narrative overview of right-wing populist policies and strategies, which is loosely structured around fascistic themes set out in Albert Camus’ allegorical novel, The Plague.

Findings

Although individual responses to the coronavirus pandemic among right-wing populists differ, they appear to coalesce around four central themes: initial denial and then mismanagement of the pandemic; the disease being framed as primarily an economic rather than a public health crisis; a contempt for scientific and professional expertise; and the “othering” of marginal groups for political ends. Populist responses to the pandemic have given rise to increased levels of xenophobia, the violation of human rights and the denigration of scientific expertise.

Research limitations/implications

This is a narrative overview from a personal viewpoint.

Originality/value

Drawing on themes in Camus' novel The Plague, this is a personal perspective on right wing populist government responses to the coronavirus pandemic. Populist responses to the pandemic have given rise to increased levels of intolerance and xenophobia and the violation of human rights and civil liberties.

Understanding the impacts of NPM and proposed solutions to the healthcare system reforms in Indonesia: the case of BPJS

This study critically evaluates the adoption of a universal healthcare system recently introduced by the Indonesian government in 2014. Our study is driven by the lack of critical analysis of social and political factors and unintended consequences of New Public Management, which is evident in the healthcare sector reforms in emerging economies. This study not only examines the impact of economic and political forces surrounding the introduction of a universal health insurance programme in the country but also offers insights into the critical challenges and undesirable outcomes of a fundamental reform of the healthcare sector in Indonesia. Through a systematic and detailed review of prior studies, legal sources and reports from government and media organizations about the implementation and progress of an UHC health insurance programme in Indonesia, the authors find that a more democratic political system that emerged in 1998 created the opportunity for politicians and international financial aid agencies to introduce a universal social security administration agency called Badan Penyelenggara Jaminan Sosial (BPJS). Despite the introduction of BPJS to expand the health services' coverage, this effort faces critical challenges and unintended outcomes including: (1) increased financial deficits, (2) resistance from medical professionals and (3) politicians' tendency to blame BPJS's management for failing to pay healthcare services costs. We argue that the adoption of the insurance system was primarily motivated by politicians' own interests and those of international agencies at the expense of a sustainable national healthcare system. This study contributes to the healthcare industry policy literature by showing that a poorly designed UHC system could and will undermine the core values of healthcare services. It will also threaten the sustainability of the medical profession in Indonesia. The authors offer several suggestions for devising better policies in this sector in the developing nations.

Populism and health policy: three international case studies of right-wing populist policy frames

Over the past decade, some of the world's most stable parliamentary democracies have witnessed a revival in right-wing populist political parties, movements and leaders. Although there is a growing body of theoretical and empirical literature documenting the rise of populism, there has been very little exploration of the implications for health policy of this important political development. In this article, we draw from three illustrative international cases, originating from the USA, the UK and Italy, to explore the ways in which right-wing populism influences health policy: the election of President Trump in the United States (and subsequent healthcare reforms), the United Kingdom's vote to withdraw from the European Union (Brexit), and how this has played out in the context of the UK National Health Service, and the rise of a politically aligned anti-vaccination movement in Italy. Drawing on the work of the influential socio-political theorist Ernesto Laclau, we interpret populism as a performative political act, predicated on drawing logics of equivalence (and difference) between different actors. We use this theoretical framing to explore the ways in which the recent upsurge in right-wing populism creates a specific set of barriers and challenges for access to healthcare and the health of populations.

Migrant carers in Europe in times of COVID-19: a call to action for European health workforce governance and a public health approach

The present study explores the situation of migrant carers in long-term care (LTC) in European Union Member States and the disruptions caused by the COVID-19 pandemic from a public health perspective. The aim is to bring LTC migrant carers into health workforce research and highlight a need for trans-sectoral and European heath workforce governance. We apply an exploratory approach based on secondary sources, document analysis and expert information. A framework comprising four major dimensions was developed for data collection and analysis: LTC system, LTC health labour market, LTC labour migration policies and specific LTC migrant carer policies during the COVID-19 crisis March to May 2020. Material from Austria, Italy, Germany, Poland and Romania was included in the study. Results suggest that undersupply of carers coupled with cash benefits and a culture of family responsibility may result in high inflows of migrant carers, who are channelled in low-level positions or the informal care sector. COVID-19 made the fragile labour market arrangements of migrant carers visible, which may create new health risks for both the individual carer and the population. Two important policy recommendations are emerging: to include LTC migrant carers more systematically in public health and health workforce research and to develop European health workforce governance which connects health system needs, health labour markets and the individual migrant carers.

On Folk Devils, Moral Panics and New Wave Public Health

New wave public health places an emphasis on exhorting individuals to engage in healthy behaviour with good health being a signifier of virtuous moral standing, whereas poor health is often associated with personal moral failings. In effect, the medical is increasingly being collapsed into the moral. This approach is consistent with other aspects of contemporary neoliberal governance, but it fuels moral panics and creates folk devils. We explore the implications and dysfunctional consequences of this new wave of public health policy in the context of the latest moral panic around obesity.

New public management, physicians and populism: Turkey's experience with health reforms

Recent debates on the rise of right-wing or neoliberal populism globally have prompted public health and health systems researchers to explore its implications in the healthcare systems. This case study of Turkey's recent health reform initiative, the Health Transformation Program, aims to contribute to this debate by examining the nexus among populism, professionalism and the contemporary market and managerial reforms, often described as New Public Management (NPM). Building on document analysis and secondary sources, this article introduces a framework to explore whether and how populist agendas grow up in the shadow of NPM policies. We aim to deepen our understanding of the governance settings that might be used in different ways by right-wing populist leaders to advance their agendas. Our research reveals that the NPM reforms in Turkey have opened a 'backdoor' through which right-wing populist agendas were supported and the position of the medical profession as an important stakeholder in the institutional settings was weakened. However, what mattered most in the reform process was not the policies themselves but the ways new managerialist policies were implemented. Our analysis makes blind spots of the NPM reforms and healthcare governance research visible and calls for greater attention to implementation processes.

The governance of local health systems in the era of Sustainable Development Goals: reflections on collaborative action to address complex health needs in four country contexts

This analysis reflects on experiences and lessons from four country settings—Zambia, India, Sweden and South Africa—on building collaborations in local health systems in order to respond to complex health needs. These collaborations ranged in scope and formality, from coordinating action in the community health system (Zambia), to a partnership between governmental, non-governmental and academic actors (India), to joint planning and delivery across political and sectoral boundaries (Sweden and South Africa). The four cases are presented and analysed using a common framework of collaborative governance, focusing on the dynamics of the collaboration itself, with respect to principled engagement, shared motivation and joint capacity. The four cases, despite their differences, illustrate the considerable challenges and the specific dynamics involved in developing collaborative action in local health systems. These include the coconstruction of solutions (and in some instances the problem itself) through engagement, the importance of trust, both interpersonal and institutional, as a condition for collaborative arrangements, and the role of openly accessible information in building shared understanding. Ultimately, collaborative action takes time and difficulty needs to be anticipated. If discovery, joint learning and developing shared perspectives are presented as goals in themselves, this may offset internal and external expectations that collaborations deliver results in the short term.