By Liz Scott:

The current U.S. political system is deeply polarized, defined by partisan animus and infighting. A contentious election cycle culminated in an armed insurrection of the U.S. Capitol and a violent attack on U.S. democratic institutions. The political stakes of these events seem straightforward, but what can be said about the health care costs of these political events and the lasting impact they have on collective mental and physical health?

Recent evidence has confirmed that political conflict and division can lead to elevated stress levels and psychological distress. Election-related events led to a documented increase in negative emotions and elevated cortisol levels in young adults in the days before election night (Hoyet et al, 2018). Cortisol is the body’s primary stress hormone. Additionally, the Stress in America Survey conducted around the time of the 2016 U.S. presidential election revealed that over half of all Americans found the election to be a “very” or “somewhat” significant source of stress in their lives (American Psychological Association, 2017).

While anecdotal and survey results point toward an impact on health, researchers Hung-Hao Chang and Chad Meyerhoefer investigate whether elections and political campaigns negatively impact physical health and health expenditures, as measured in healthcare visits. Their work highlights an increase in health care usage and health care expenditures during presidential and mayoral elections in Taiwan during various electoral cycles. Taiwan has a compressed election schedule and allows a four-week campaign for presidential elections and a one-week campaign period for mayoral elections. Consequently, this shortened timeframe for elections is associated with intense political rallies and events.

Political campaigns lead to a substantial increase in health care utilization

A recent data analysis, based on health care claim data collected from 900,000 insurants and combined with administrative voting records during mayoral elections in 2005 and 2009 and presidential races in 2008 and 2012, indicates a sharp rise in health care usage during the electoral periods. It notes that campaigns during national presidential elections increased health care use and expenditure by 17% to 19%, and local mayoral campaigns increased health care use and expenditure by 7% to 8%. Elevated health care use occurred only during the campaign period and did not continue after the election. Researchers found that campaigns increased physical ailments, including acute respiratory infections, gastrointestinal conditions, and injuries. Health care use and expenditures were more significant for the voting age population than those not yet eligible to vote. Overall, the research suggests that political campaigns lead to a substantial increase in health care utilization and health care costs.

Interestingly, researchers did not find an increase in the utilization of mental health resources. The authors speculate that this may be due to similar stress and anxiety levels in the voting age population and non-voting eligible population. Perhaps this difference could also be attributed to temporal barriers in access to mental health care. The quick electoral timeframe in Taiwan may not provide individuals with sufficient time to find a mental health provider.

Of course, the results of this study are specific to Taiwan and cannot be easily generalized or transferred to all electoral systems due to variations in local regulations, timelines, and political systems. Patterns observed during the compressed campaign structure may not result in similar patterns in peer nations with extended electoral timelines. Additionally, Taiwan utilizes a single-payer health care system in which care is relatively accessible and not cost-prohibitive. The relative ease and quality of care in Taiwan may encourage people to seek medical care more quickly and frequently than individuals in peer nations in which they may face greater barriers to accessing affordable, quality care.

Still, this study offers valuable findings to public health practitioners regarding potential patient volume around extensive collective experiences and targeted intervention design. Providers may wish to develop targeted strategies to direct resources, preventative interventions, and clinical care to communities experiencing high-intensity political activity. Additionally, health care providers may anticipate increased patient volume during these times and increase staffing or facility capacity.

The findings of this study may also be influential and informative to policymakers. Regulation that encourages campaigns to operate over a more extended period and with fewer high-intensity political activities may ultimately help lower the health care costs of politics and improve the overall wellbeing of the community.