Worsening Health and Voting Patterns in Nazi Germany

Gregori Galofré-Vilà, Christopher Meissner, Jacob Bor, Martin McKee, David Stuckler. Show Author details

“If we take the view that for at least a generation to come Germany cannot be trusted with even a modicum of prosperity … that year by year Germany must be kept impoverished and her children starved and crippled … If we aim deliberately at the impoverishment of Central Europe, vengeance, I dare predict, will not limp.”

J. M. Keynes, The Economic Consequences of the Peace.

A series of recent articles have found a striking and consistent correlation between deteriorating population health and support for populist right-wing parties. For instance, Jacob Bor showed that American counties in which life expectancy stagnated or declined from 1980 to 2014 exhibited substantially higher vote shares for Donald Trump in the 2016 presidential election (Bor 2017). Among others, David Autor and co-authors also found that U.S. areas that lost manufacturing jobs to Chinese competition in the 2000s saw increasing male midlife mortality and a shift among voters toward Republican candidates in U.S. House and Presidential elections (Autor et al. 2019, 2020). Similar patterns were observed in the United Kingdom, where worsening mortality, alongside budget reductions, was positively associated with greater votes for Brexit (Fetzer 2019, Koltai et al. 2020).Are these shifting voting patterns something unique of our turbulent times? Or are there factors that may lead to such situations under different circumstances? In a series of recent studies, we studied these two important questions by studying political developments during the first half of the 20^th century, and document similar findings to those discussed above (Galofré Vilà et al., 2021a; 2021b).

Local health and the rise of Nazism

We look at the political and social events that took place in Germany just before the rise of the Nazi party. The rise of Nazism in the early 1930s, in the wake of the Great Depression, coincided with worsening economic hardship, characterized by severe austerity policies, mass unemployment, and widespread discontent (see for instance Doerr et al. 2022). Yet, while other countries also faced economic insecurity, Germany experienced an increase in mortality starting in 1931 and 1932, at a time when mortality was declining in other European nations including Poland, France, and the Netherlands (read more about the modernization of health here). This unusual development motivates our main hypothesis: worsening mortality rates at the local level were associated with the rise of the Nazi Party, even after accounting for the potential impact of economic hardship and other potential confounding factors on voting patterns. 

To test this hypothesis, we collected voting data for the four elections that took place between 1933 and 1933: September 1930, July 1932, November 1932 and March 1933. Then, we linked this information to annual cause-specific mortality rates and income based on tax records, for nearly a thousand districts in Germany. Using various quantitative techniques (e.g. multivariate regressions models), we show a strong association between mortality and Nazi party vote shares at the district level, even when we account for the impact that income and other factors on political preferences. Our results suggest that each increase of 10 deaths per 1,000 population was associated with a 6.5-percentage-point increase in the Nazi vote share. Worsening health conditions influenced voting decisions and shifted the political orientation of an important part of the population to the extreme right.

Next, we also examine which specific causes of death were most closely associated with Nazi vote shares. To do this, we disaggregated all-cause mortality into those types that could plausibly be impacted by changes in contemporary social conditions, including suicides, homicides, and strokes; and diseases that were less responsive to sociopolitical changes in the short term, such as cancer deaths. Here, we find that while there is a strong relationship between Nazi vote shares and illnesses related to social conditions, the opposite is true for illnesses less responsive to short-term social conditions (e.g. cancer mortality). A deeper cause-specific study reveals that Nazi vote rises were most closely associated with infectious and communicable diseases – such as tuberculosis, measles, and lung infections – as well as the aforementioned deaths from suicides, alcohol consumption and stroke.

Could the German government have avoided this? We explored this question by evaluating the role of welfare payments to buffer economic suffering. Indeed, we find that including the role of welfare payments in our analyses significantly reduces the impact of mortality on the Nazi vote share. In addition, our results indicate that these payments are negatively related with support for the extreme right, which suggests that social security may have mitigated radicalization. This finding is further pointing out that the generosity (or stinginess) of welfare regimes may have been a common cause of the observed health and political trends. 

Finally, we looked at the political competitors of Nazi party, but this was the only one that managed to transform German suffering into more votes. Neither the communists, who traditionally were seen as guardians of the interests of working people, the Social Democrats, who were the political home of the workers’ movement and middle classes, nor the Center party, a conservative catholic party, saw gains in support with the declining health of the electorate. 

Health matters for political developments

While at this stage our observational analysis can only demonstrate correlation, rather than causal chains, our bottom line is that mortality increases appear to be an early-warning measure for political polarization. At times when people are suffering, they may be more open to the siren calls of right-wing radical populist parties. In other words, our historical work supports the notion that epidemiological data can serve as a ‘canary in the coal mine,’ identifying populations that are being left behind by social progress, which may in turn create fertile ground for receptivity to populist messages.

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• Autor, D., Dorn, D., Hanson, G. (2019) ‘When work disappears: Manufacturing decline and the falling marriage market value of young men’. American Economic Review: Insights, 1 (2), 161-178.
• Autor, D., Dorn, D., Hanson, G., Majlesi, K. (2020). ‘Importing political polarization?  The electoral Consequences of rising trade exposure’. American Economic Review, 110 (1):,3139-3183.
• Bor, J. (2017). ‘Diverging life expectancies and voting patterns in the 2016 US presidential election’. American Journal of Public Health, 107 (10), 1560-1562.
• Doerr, S., Gissler, S., Peydro, J. L., Voth, H.-J. (2022). ‘Financial Crises and Political Radicalization: How Failing Banks Paved Hitler’s Path to Power’. Journal of Finance, (forthcoming).
• Fetzer T. (2019). ‘Did austerity cause Brexit? ’ American Economic Review, 109 (11), 3849-3886.
• Galofré-Vilà, G., Meissner, C. M., McKee, M., Stuckler, D. (2021a). ‘Austerity and the rise of the Nazi party’. Journal of Economic History, 81 (1), 81-113.
• Galofré-Vilà, McKee, M., Bor, J., Meissner, C. M., Stuckler, D. (2021b). ‘A lesson from history? Worsening mortality and the rise of the Nazi Party in 1930s Germany’. Public Health,  195, 18-21.
• Koltai J., Varchetta, F. M., McKee, M., Stuckler, D. (2020) ‘Deaths of despair and Brexit votes: Cross-local authority statistical analysis in England and Wales’. American Journal of Public Health, 110 (3), 401-406.

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