Do Elections Make You Sick?

In this episode of Lehigh University’s College of Business IlLUminate podcast, we are speaking with Chad Meyerhoefer about a study he co-authored titled: Do Elections Make You Sick?

Dr. Meyerhoefer holds the Arthur F. Searing Professorship in Economics in Lehigh’s College of Business. His research focuses broadly on the economics of health and nutrition.  Much of his work involves the use of microeconometric methods to evaluate and inform public policy. Dr. Meyerhoefer is also a Research Associate at the National Bureau of Economic Research, which published the elections study online.

He spoke with Jack Croft, host of the ilLUminate podcast. Listen to the podcast here and subscribe and download Lehigh Business on Apple Podcasts or wherever you get your podcasts.

Below is an edited excerpt from that conversation. Read the complete podcast transcript. This research was published in January 2020 by the National Bureau of Economic Research. 

Jack Croft: Let's start with a spoiler alert: What were the main takeaways from your study on the effects that elections in Taiwan had on the physical health of voters there? Do elections make you sick?

Chad Meyerhoefer: Yes, elections do indeed make you sick. And in fact, we found that health care costs increased during the campaign periods associated with elections. That increase was relatively large. So health care expenditures in Taiwan increased 19% during those legally mandated campaign periods. And if you extrapolate that result to the entire population and look at how large that number is as a fraction of total health care costs, it was 2% during the election period. The other thing we found was that the amount of money spent on treating illnesses from the election was actually higher than the amount of money that was spent by presidential candidates on their campaigns.

Croft: What were the main health issues that were being treated as a result of the elections?

Meyerhoefer: We found that election campaigns increased the incidence of acute respiratory infections, gastrointestinal diseases, and injuries. Interestingly, we didn't find any effects on mental health conditions, despite the fact that previous studies suggest that depressive symptoms and anxiety increased during the elections.

Croft: Your study is the first to look at the health care costs of elections, and most of us grew up believing that free and fair elections are one of the cornerstones of our system of government in the United States. So what led you to ask the question whether elections make us sick in the first place?

Meyerhoefer: We were interested in how the health care consequences of elections may be different now compared to in the past. And one of the things that's really changed over time is how acrimonious political debate has become. In the past, even though there was a two-party system in Taiwan and a two-party system in the United States, there was less negative campaigning. There was less bifurcation of views on as many issues. And there wasn't the intensity of campaigning that we see today. So we wondered whether this higher intensity of campaigning, what seemed to be higher stakes elections where social policies could shift more abruptly depending on who is elected, whether that would have any effect on health care utilization. Because there's been some anecdotal studies that found that, in more recent periods, stress levels of voters have become much higher.

Croft: Why look at Taiwan as opposed to, say, the United States?

Meyerhoefer: My co-author on this study is Hung-Hao Chang. And we've worked together for a number of years looking at issues in Taiwan. So there's a couple reasons why Taiwan is a good case study to look at this issue. The first is that they have a two-party system just like the United States. And the parties are fairly entrenched in their policy positions, again, like the United States. And the intensity of campaigning there is very high. So the island has been termed the “Island of Elections” because when the elections happen, it's almost like a soap opera that you can watch on television. And in fact, there's some people that follow elections in Taiwan very closely because they're so dramatic and interesting.

The other reason why we chose Taiwan is that we have, through my co-author, access to administrative health care claims data covering the entire population, which is something that doesn't exist in the United States because of the private insurance system. And so that's a very big asset from a methodological standpoint because it means that we don't have to worry about people having different access to health care like they would in the United States, where people who had better access to health care, maybe they had lower incidence of illness or something like that. In Taiwan, there's a national health insurance system. Everybody has access to care and we know exactly how much is spent to treat everybody's conditions.

Croft: We should note that the study … was conducted before the global COVID-19 pandemic. … You talked about the large, intensely impassioned rallies in Taiwan. And clearly, we've seen that phenomenon in the U.S. as well, as one of the cornerstones of President Trump's first campaign and continuing now during the pandemic. Should the results of your study give us concern about those rallies?

Meyerhoefer: I think that our results do suggest that there could be some negative consequences to rallies like that. And there's two reasons for that. One is, of course, during the COVID-19 era here, we're obviously very concerned about the spread of the illness through respiratory droplets. And if people are at a rally where they're standing very close to other people and they're cheering and they're shouting, … they’re going to be putting out a higher number of those respiratory droplets and increasing the risk of transmission of any virus, including COVID. So that is a concern. The fact that people are not wearing masks at some of these rallies increases the likelihood that there will be a transmission. …

Our data are not specific to individual rallies, so we weren't able to measure health care costs due to specific rallies. We just measure health care costs over this four-week campaign period. But we know in Taiwan that one of the main features of campaigning are these rallies. And the fact that we find these respiratory infections really suggests that that's where transmission is occurring. So this is really the first study to prove that those types of rallies do cause higher transmission of respiratory infections. So that should give people who attend them pause that, yes, the likelihood of getting a virus like COVID-19 is a lot higher at a rally like that than it would be otherwise. So that's one important concern.

The other factor that we find is, interestingly, if you look at many of the previous studies on this topic, they're really focused on stress and mental health. And they show that people report psychological distress because of the election, that they report depression, depressive symptoms. And they even measure people's biomarkers, so their cortisol levels or testosterone levels. They find elevated levels of cortisol and decreases in testosterone and these can be associated with depressive symptoms and psychological distress. … So it's interesting that we don't find any increases in mental health conditions in our data.

But that doesn't mean that this stress that people are feeling doesn't contribute to their physical illness because stress can … essentially increase fatigue and it can weaken immunity and that makes you more susceptible to respiratory infections like COVID-19. So if these campaign rallies are increasing people's stress levels, then that could also be bad.

Croft: One final question, then, to wrap up here. And that's, given the toll that elections take on our health, are they worth it?

Meyerhoefer: Oh, absolutely. If you look more broadly, of course, at authoritarian societies and democratic societies, there's no question that the overall health of the population is much better in democratic societies than in authoritarian regimes. So overall, elections are definitely worth it. There's this sort of balance that you … want to achieve with democratic elections.

Because candidates are competing, that's going to cause people to engage and it's going to cause a discourse between opposing groups. And that discourse is good because it … allows the information about what's going on in the government and the implications to spread. And we want more people to be informed about policies and things. So that's good. And it allows … people to learn about the opposing views of others and that's good too. So society can kind of hash out its problems through these elections.

We do want those benefits from elections and from campaigning, but at the same time, we don't want the social discourse to rise to a really high level. Of course, the extreme case is that there is so much conflict that's generated from elections that you get violence. And that, of course, is tremendously damaging. As a society, I think we have to look at where we are on that continuum. Have things risen to a level that, in addition to getting the benefits of the discourse, we're also now getting some negative effects because the campaigns are so negative and the debate is so acrimonious that it's actually leading to social strife or to negative feelings and stress? So I think it's not so much about the elections and the democratic process, it's about the campaigning and how the campaigning is done. And our study, I think, suggests that in the United States anyway and in Taiwan, that the intensity of campaigns and the conflict that results from them is getting to the point where there are some negative health consequences and higher health care costs as a result.