The polite fiction disseminated in too many sixth-form classes is that political leaders enter public life to further a vision of what is best for their society, or at least the segments of that society they care most about and whose interests they claim to advance.  Why, then, do we see many politicians following their egos down paths that are thoroughly destructive of those interests?  Since the origins of so many health inequalities lie outside the health sector, and specifically in political choices made outside that sector, public health researchers and practitioners need at least to think about such questions.

Two examples from Canada, where I lived for most of my life before moving to the UK, come to mind.  In early 2018 Kathleen Wynne, the Liberal party premier of Ontario, Canada’s largest province, hung on as party leader in the face of opinion polls placing her party in a distant third place behind the Conservatives and the (mildly) social democratic New Democratic Party (NDP).  Her unpopularity had many sources, most tied to the performance of her Liberal predecessor’s government (in which she had held a Cabinet post unrelated to the sources of unpopularity).

Who knows whether another leader could have overcome this barrier?  Even before the June, 2018 election, Wynne conceded that she could not.  The election decimated Wynne’s Liberals, depriving them of official party status in the provincial Legislature.  The winner was a retrograde Conservative party led by Doug Ford, who sometimes acts like a Trump clone and has already been buffeted by multiple scandals.  His government has among other actions cancelled Ontario’s participation in a cap-and-trade programme to reduce greenhouse gas emissions, whilst opposing a national carbon tax; cancelled a pilot guaranteed income scheme in three Ontario communities; and cut education and public health budgets.  This happened despite the fact that Ford’s Conservatives won just 40 percent of the popular vote, against more than 53 percent for the Liberals and NDP, running on essentially identical left-of-centre platforms.  (There is a lesson here about the perniciousness of first-past-the-post electoral systems, but that is another post.)

Canada’s multimillionaire prime minister Justin Trudeau (son of a former prime minister revered by some and reviled by others) faces a tight re-election battle in October after having been found by an official ethics overseer to have violated conflict-of-interest guidelines by pressuring former Attorney General Jody Wilson-Raybould to offer the engineering transnational SNC-Lavalin, based in Trudeau’s home province of Québec, a deferred prosecution agreement.  Federal prosecutors, backed by Wilson-Raybould, wanted to pursue criminal charges on multiple bribery counts involving the corporation’s attempt to win foreign contracts.  Wilson-Raybould and another high-profile cabinet minister, Jane Philpott, eventually resigned from cabinet and were expelled from the Liberal caucus, taking with them much of the gloss that brought Trudeau’s Liberals to power in 2015 after a decade of increasingly inward-looking and parochial Conservative government.  Trudeau’s chief of staff and the head of Canada’s public service also quit; Trudeau is unrepentant.

Should Trudeau step aside?  There have been no calls for him to do so, and it remains to be seen whether he can win re-election, in a multi-party context made more complicated (that issue of electoral systems, again) by a surging Green party and a far-right People’s Party started by a breakaway Conservative legislator and climate change denier.  Pollsters are not (yet) asking, but it is certainly conceivable that a senior member of Trudeau’s cabinet like foreign affairs minister Chrystia Freeland would stand a better chance.

Now we come, of course, to Brexit and its (mostly negative) potential implications for public health, even if the worst short-term calamities of a ‘no-deal’ Brexit can be avoided.  A majority of British parliamentarians and almost half the British population are opposed to the megalomaniac no-deal Brexit trajectory of Boris Johnson and his crew.  Just as clearly, a parliamentary coalition backing any government led by Labour leader Jeremy Corbyn as a way of avoiding a no-deal Brexit is highly improbable, and would be widely unpopular.  The relevance of this observation could change within hours, of course.  Meanwhile, it may be too provocative to compare the independent accomplishments of Chrystia Freeland and Sir Keir Starmer (among others) to those of the heads of their respective parties, neither of whom has many, but in a time of crisis I’ll do it anyway.

The analytical point is: today’s brinkmanship is like long-ago outlaw hot rodders’ game of chicken, with a crucial difference: in that game only direct participants are at risk.  In the event of a no-deal Brexit, as in post-Wynne Ontario, negative externalities and casualties will spread across the entire jurisdiction and will be concentrated amongst those without protective coatings of money and class privilege.  Those actually making the decisions will not be left hungry, sick or homeless whatever happens.  With the clock ticking, will the relevant political protagonists rise to the occasion? If they do not, another polite fiction – that those in power care about the harm they do – will be demolished.  Will a sense of overarching public purpose, analogous to that associated with wartime, kick in?  All of us concerned with public health and health inequalities must worry about the outcome if it does not.