The outcome of the French presidential election, in which the Republican Francois Fillon, Front National’s Marine Le Pen, and the Socialist Party will be vying for position in April 2017, could have wide reaching implications for public health in Europe.

Concerns over living standards in France will influence the vote—could income inequality and poor health also influence voting, as it seems to have done in the UK referendum and the US presidential election? Marine Le Pen has already argued that Donald Trump’s victory in the US is a precursor to her own impending success.

The strongest predictor of a rise in Republican voting for Donald Trump was a decline in the health of the residents in their local area. An age adjusted index showing falls in local life expectancy, obesity, and diabetes—as well as heavy drinking and lack of regular physical activity—best predicted those areas that swung the most to Trump.

Donald Trump repeatedly cited the UK Brexit vote as a precedent, suggesting that he could win “Brexit times ten.” In the UK, self reported health has fallen each year since 2010, and in the year to June 2015, UK death rates rose for all age groups apart from people aged 25-29 and younger than 10. Public health spending was a key issue in both the Brexit debate and the US presidential election. In the UK, Leave voters were more likely than Remain voters to believe that wealth was unfairly distributed, especially those on lower incomes.

However, France is different. By 2020 France is set to spend 54% of its gross domestic product on public services, compared with 36% in the UK and 35% in the US.

Public Spending in proportion to GDP in twelve rich countries

Public Spending in proportion to GDP in twelve rich countries

read more on this website and at the BMJ

And to find out more about what the figure above shows and how else France differs so much from the UK and US see the free PDF of the book it is from