The Rise of Post-truth Populism in Pluralist Liberal Democracies: Challenges for Health Policy

Recent years have witnessed the rise of populism and populist leaders, movements and policies in many pluralist liberal democracies, with Brexit and the election of Trump the two most recent high profile examples of this backlash against established political elites and the institutions that support them. This new populism is underpinned by a post-truth politics which is using social media as a mouthpiece for ‘fake news’ and ‘alternative facts’ with the intention of inciting fear and hatred of ‘the other’ and thereby helping to justify discriminatory health policies for marginalised groups. In this article, we explore what is meant by populism and highlight some of the challenges for health and health policy posed by the new wave of post-truth populism

The anonymity paradox in patient engagement: reputation, risk and web-based public feedback.

The UK National Health Service (NHS) has long espoused patient and public engagement. Recent years have seen increasing use of internet-based methods of collecting feedback about patient experience and public and staff views about NHS services and priorities. Often hailed as a means of facilitating participative democratic patient engagement, these processes raise a number of complex issues. A key aspect of it is the opportunity for comment to be made anonymously. Our research reveals an anonymity paradox whereby patients clearly demonstrate a perception that anonymity is a prerequisite for effective use of these feedback processes, whereas professionals demonstrate a perception that patient anonymity is a barrier to effective use. The risks of anonymity are constructed very differently by patients and professionals. Patient concerns around anonymity were not motivated by a general concern about a loss of privacy, but more that a positive identification might compromise future care. For professionals, concerns were voiced more around risks of reputational damage for specific practitioners or practices (in that anyone could say anything) and also that this anonymous feedback was available publicly and that it might go against the medical opinion of the professional. These concerns pointed to important differences in perceptions of patient and professional vulnerability. In the qualitative analysis that follows the key finding was that while anonymity makes service users feel less vulnerable, it can have the opposite effect on managers and clinical staff. This raises important implications for the use and utility of internet-based methods of collecting patient feedback

Stigma and Mental Health: Exploring Potential Models to Enhance Opportunities for a Parity of Participation

Over the past two decades, stigma in mental health has become an increasing concern for researchers, practitioners, service users, and policymakers. This has led to a number of international government funded campaigns to reduce stigma and discrimination against people with mental health problems. In this paper, we examine the theoretical and conceptual foundations of these stigma campaigns in order to critically examine what version of mental health is being presented and what the implications are of the campaign messages for people with mental health problems and wider society. We present two models, one which deals with the stigma of mental illness, and another that deals with a stigma in mental health. We propose these models underpin much anti-stigma work in mental health, and that they are respectively predicated on individual or social aetiology models. Both of these models present problems for anti-stigma campaigns that must be addressed if opportunities for an ethics of inclusion for people with emotional distress are to be advanced. In connecting this paper to the themes of the special edition we argue that Mad Studies and associated forms of ‘epsitemic resistance’ need to be incorporated into anti-stigma campaigns in order to truly represent the plurality of perspectives from survivor movements

Populism, pestilence and plague in the time of Coronavirus

Purpose To explore right wing populist government responses to the coronavirus pandemic. Design/methodology/approach 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 This is a narrative overview from a personal viewpoint. Originality 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

The Rise of Post-truth Populism in Pluralist Liberal Democracies: Challenges for Health Policy

Recent years have witnessed the rise of populism and populist leaders, movements and policies in many pluralist liberal democracies, with Brexit and the election of Trump the two most recent high profile examples of this backlash against established political elites and the institutions that support them. This new populism is underpinned by a post-truth politics which is using social media as a mouthpiece for ‘fake news’ and ‘alternative facts’ with the intention of inciting fear and hatred of ‘the other’ and thereby helping to justify discriminatory health policies for marginalised groups. In this article, we explore what is meant by populism and highlight some of the challenges for health and health policy posed by the new wave of post-truth populis

NICE rapid guidelines: exploring political influence on guidelines

The National Institute for Health and Care Excellence (NICE) has been presented as politically independent, asserting it is free from industry influence and conflicts of interest so that its decisions may be led by evidence and science. We consider the ways in which soft political factors operate in guideline development processes at NICE such that guidelines are not truly led by science. We suggest that while NICE procedures explicitly incorporate scientific principles and mechanisms, including independent committees and quality assurance, these fail to operate as scientific practices because, for example, decisions may only be challenged through the courts, which regard NICE as a scientific authority. We then examine what the NICE rapid guideline procedure for COVID-19 reveals about the practical reality of claims about the scientific integrity of NICE guidelines. Changes to guideline development processes during the COVID-19 emergency demonstrated how easy it is to undermine the scientific integrity of NICE’s decision-making. The cancellation of the guideline programme and the publication of a rapid guideline process specifically to address the COVID-19 pandemic removed scientific checks and balances, including independent committees, stakeholder consultation and quality assurance, demonstrating that the relationship between NICE and the UK government is more complex than a scientific principle truism. We suggest that NICE is not (and indeed cannot be) truly independent of government in practice, nor can it be truly led by science, in part because of its relationship to the state, which it is simultaneously constituted by and constitutive of

Getting the Problem Definition Right: The Radical Right, Populism, Nativism and Public Health Comment on "A Scoping Review of Populist Radical Right Parties’ Influence on Welfare Policy and its Implications for Population Health in Europe"

Building on Rinaldi and Bekker’s scoping review of articles on the impact of populist radical right (PRR) politics on welfare and population health, this short article formulates three pointers towards a framework that might help structure future research into PRR, populist politics more generally, and coronavirus disease 2019 (COVID-19) and other health issues. First, we discuss the centrality of welfare chauvinism to the PRR’s impact on health, taking this as a cue for a broader reflection on the importance on distinguishing between the nativist and populist dimensions of PRR politics. Secondly, we turn our attention to the potential moderating effect of the PRR’s welfare chauvinism on the welfare cuts proposed by their right-wing coalition partners, comments we see as pointing to the need to focus on nativist, populist, neoliberal and other threats to welfare policy more generally, rather than on the PRR only. Thirdly, we reflect on the paradoxical nature of welfare chauvinism – its negative consequences for the health of the ‘own people’ it proclaims to defend – as a starting point for a brief discussion of the need to consider carefully the not-so-straightforward relation between the PRR’s political rhetoric, its (impact on) policy and institutions, and the outcomes of such policy

Quality-of-life measurement in depression trials: A consumerist relic

Quality-of-life measurement in depression is advocated as a patient-centred indicator of recovery, but may instead enhance the mimetic authority of randomised controlled trials (RCTs) which have been roundly critiqued in mental health. In this paper we draw on the social life of methods approach to extend the well-developed critique of RCTs into the field of quality-of-life measurement. We accomplish this through consideration and critique of the conceptual and epistemological development of quality-of-life measurement in depression, including the role of psychometrics in its development. Examining conceptual developments from the 1970s onwards, we consider how the scientific literature on quality-of-life in depression aligns with behavioural economics and consumerism but falls short of engaging with genuinely patient-centred approaches to recovery. We argue that quality-of-life measures in depression were developed within a consumerist model of healthcare in which the medical model was a central pillar and ‘choice’ a rhetorical device only. While quality-of-life instrument development was largely funded by industry, psychometrics provided no coherent solution to the ‘affective fallacy’ (high correlations between quality-of-life and depressive symptoms). Industry has largely abandoned the measures, while psychotherapy research has increasingly endorsed them. We argue that in their design and implementation, quality-of-life measures for depression remain based on a commercial model of healthcare, are conceptually flawed and do not support concepts of patient-centred healthcare