Viktor Orban’s re-election to a third consecutive term in Hungary offers a preview for western countries of what the health consequences could be for governments that value populism and economic strength over the health of their people. The controversial populist was swept back into power by a wave of support, with a manifesto that included a crackdown on liberal non-governmental organisations. Orban said before the election that his opponents will face “moral, political, and legal revenge”, in the aftermath.
An OECD Country Health Profile on Hungary in 2017 offers a stark comparison with health outcomes in other European Union (EU) countries. Life expectancy in Hungary is nearly 5 years below the EU average, and Hungary has a gap of 9 years between the average lifespan of those with the most education and those with the least. This life expectancy is also lower than all of Hungary’s immediate neighbours with the exception of Romania. The report puts this gap down to cardiovascular disease and cancer rates. Hungary has significantly higher rates of smoking, obesity, and alcohol abuse than the EU average, despite a poverty and unemployment rate lower than the EU average.
Under Orban’s leadership, the number of new cases of HIV/AIDS has more than doubled in a decade, rising from 1·0 per 100 000 in 2005 to 2·7 per 100 000 in 2015. Hungary has fallen from 20th to 29th on the Euro Health Consumer Index in the time Orban has been in charge. Spending on health has fallen from an 8% share of gross domestic product (GDP) in 2005 to 7·2% now, compared with the EU average of 9·9%. Out-of-pocket payments currently account for 29% of all health spending in Hungary. Only 56% of Hungarians report themselves as being in good health, lower than all of Hungary’s neighbouring countries, which include Croatia, Slovenia, and Slovakia. This is an underfunded system, and the Hungarian population are paying for it with their health.
Furthermore, Hungary has an increasingly important part to play in the ongoing migrant crisis facing the EU, but at least part of Orban’s continuing electoral appeal is based on a populist rejection of Hungary’s responsibilities. In the build-up to the election, Hungary clamped down on migrants entering the country from the border with Serbia. In 2015, Hungary built a fence on its formerly open border with Serbia in direct response to the number of refugees transiting through the country on to Germany. In 2016, 60 asylum seekers a day were allowed into “transit zones” in the country. It was then reduced to 30, then to ten, and in February this year it stood at two per day. Rather than recognise Hungary’s role in the health and protection of refugee people, Orban has built a political platform on scapegoating them. In 2016, Orban described the arrival of asylum seekers in Hungary as “a poison”, stating “every single migrant poses a public security and terror risk”. The continuing electoral success of this position should be a deep worry to everyone who values human health and global security, and it remains important for us all to state the positive case for taking in refugees.
One of the reasons for Orban’s popularity is the relative strength of the Hungarian economy. Growth has quadrupled under Orban, deprivation has fallen by half, and official unemployment is down by two-thirds. Hungary is, however, unusually reliant on EU funding, which constitutes 4% of GDP. Hungarians have also left the country to find work in other EU member states. The EU is clearly working for Hungarians, but, at the same time, its voters repeatedly elect a leader actively hostile to the EU.
The economic gains that the data suggest have been made under Orban’s premiership have not been translated into improved health for the populace. Healthdata.org says Hungary, compared with its economic peers, fails to deliver anything like the performance in death and disability ratings that would be expected. Hungary has the opportunity to fund a better health for its population and to assist in the health of migrants who desperately need its assistance, but it chooses to do neither, pursuing economic gain at the expense of population health. According to the World Bank, Hungary has become more corrupt at a time when its fellow central European countries are setting corruption aside. The pursuit of economic growth above all else, supported by the scapegoating of those most in need, has become a familiar theme in western countries in the years since Orban swept to power. Hungary offers a salutary lesson in the pitfalls of growth without investment in population health.