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By Ghyslaine Bruna Djeunang Dongho, Odette Kibu, Solange Dabou, Ronald Gobina

Elections, as democratic processes, are fundamental to good governance [1]. The year 2024 in Africa is filled with several elections, ranging from presidential to parliamentary, in 19 countries. Majority of these elections are taking place in a context where a single party has long dominated despite the multiple existing parties within the country. The timing and nature of these elections will determine the future of governance and security in the region [2].Elections and public health are inextricably linked. The policies and priorities set by elected officials directly impact the health and well-being of a population [3]. Successful elections, characterized by high voter turnout, accurate vote counting, and peaceful transitions of power, contribute to a healthy and stable society. Conversely, electoral crises, marred by violence or fraud, can disrupt essential health services and undermine public trust in institutions [4].This policy brief explores the intricate relationship between elections and public health, highlighting key areas of concern and providing recommendations for mitigating them.

The Impact of Elections on Public Health

Public Health in Africa has gone a long way to fight against several threats and most countries on the continent are yet to achieve Universal health coverage [5]. However, the manner in which elections are conducted can significantly impact public health [6].Elections, characterized by mass gatherings, heightened tensions, and increased mobility, can create conditions conducive to the spread of infectious diseases [7]. Additionally, electoral processes can disrupt essential health services, and political instability arising from elections can exacerbate existing health vulnerabilities [1].Understanding the relationship between Elections and Public Health highlights the clear impact Elections could have on health outcomes.

  • Infectious Diseases Transmission: Elections present a unique environment for infectious disease transmission. Large gatherings, campaigns, and voting day activities can facilitate the transmission of infectious diseases and lead to disease outbreaks. The close proximity of people with increased human contact, often in poorly ventilated spaces and inadequate sanitation at polling stations, creates ideal conditions for the rapid spread of pathogens [7]. This could lead to increased morbidity and mortality.
  • Worsening of health disparities: Election-derived activities such as investments in health infrastructures and equipment can divert resources and personnel, then increasing inequalities in the delivery of essential health services. This could lead to decline in immunization coverage and other preventive health services, exacerbation of maternal and child health challenges, and delays in the management of chronic diseases [3, 8]. A study conducted in 14 African countries shows that, 40% to 48% of the aid received from China was more likely to be allocated by the Government, to areas with the highest concentration of their voting supporters [9]. Thus, creating more opportunities for healthcare personnel in the funded areas and disadvantaging regions with less or no funding.
  • Political Instability and Health: Electoral disputes and violence can result in physical injuries, deaths, and psychological trauma, disrupt healthcare systems, displace populations, and create conditions of insecurity that negatively impact mental health and overall well-being [10].

Indirect Impacts

Beyond the immediate impact of elections on public health, the policies and decisions implemented by elected officials have long-term consequences.

  • Socioeconomic factors: Economic instability, displacement, and food insecurity resulting from elections could negatively impact public health [1]. Indeed, conflicts arising from political instability in sub-Saharan Africa in the 2000s led to an increase of 12% in infant mortality and a decrease of more than two years in life expectancy in affected regions [11].
  • Governance and Policy: Election outcomes could influence policies and resource allocation such as decisions on access to clean water, environmental regulations, and other health determinants [12]. This could lead to a long-term impact on health systems and human development. Additionally, the ability of Governments to respond effectively to public health crises is shaped by the strength of their public health infrastructure, which is often influenced by political priorities [1, 10].
  • Social cohesion: Election-related tensions could erode social cohesion and trust in health institutions[13]. A study conducted on the 2020 US presidential elections in the midst of the COVID-19 pandemic revealed that public health behaviors are linked to political identities, thus reflecting societal divisions [14].

Public Health Crises and Electoral Processes

Public health crises could significantly disrupt electoral processes, influencing voter turnout, campaign strategies, and overall election outcomes.

Case study: COVID-19 and Elections

The COVID-19 pandemic highlighted the critical interplay between elections and public health. Elections held during the pandemic required innovative approaches to ensure voter safety while maintaining democratic principles. This included measures like early voting, mail-in ballots, and social distancing protocols at polling stations [15].Moreover, between February 2020 and August 2021, 42% (106/251) of the elections scheduled worldwide were postponed due to COVID-19. The postponed elections concerned more than 42 countries and were both sub-national and national. By the end of the study period 28% (30/106) of the postponed elections had not taken place; among which 37% (11/30) did not have a new date yet [15].

Mitigating the Impact of Elections and Public Health Interplay

After diving into the complex relationship between elections and public health, a step-by-step approach to limiting the negative impact of Electoral processes on Public Health is suggested as follows:

  • Pre-Election Planning:
  • Conduct a comprehensive risk assessment to identify potential public health threats.
  • Develop a detailed election health plan that outlines roles and responsibilities.
  • Strengthen surveillance systems to monitor disease outbreaks and other health indicators.
  • Promote healthy behaviors through mass media campaigns.
  • Election Day Management:
  • Ensure adequate hand-washing facilities and sanitation at polling stations.
  • Provide personal protective equipment (PPE) for election officials.
  • Implement crowd control measures to maintain physical distancing.
  • Mobilize health workers to provide emergency medical services.
  • Post-Election Period:
  • Conduct rapid assessments to evaluate the impact of the elections on health services.
  • Restore essential health services and address any service gap.
  • Provide psychosocial support to affected populations.
  • Strengthen early warning systems for disease outbreaks.

Overall, to consistently minimize the negative health consequences of elections over the long term, a multi-sectoral approach is essential. Key strategies include:

  • Strengthening health systems to respond to election-related health crises
  • Promoting peaceful elections and conflict prevention
  • Integrating public health considerations into election planning and implementation
  • Enhancing collaboration between health and electoral stakeholders
  • Investing in research and data collection on the impact of elections on public health.

Elections are essential democratic processes, but their impact on public health cannot be ignored. Elections are not merely political events; they are crucial determinants of public health outcomes. By implementing effective strategies, governments, health authorities, and election management bodies could mitigate the risks and protect the health and well-being of the population. Moreover, understanding the complex relationship between elections and public health, could help policymakers to ensure that democratic processes contribute to a healthier and more equitable society. Collaboration and coordination among all stakeholders are crucial for achieving successful health outcomes.