Ian C. Ellul

n a few days time we will be having our general election. Obviously all three parties are promoting those candidates which in their opinion are the most suitable to woo those floaters who will ultimately determine which party will lead the country for the next 4-5 years. Funnily enough I have recently even witnessed agnostics starting to attend the church. Upon investigating I overheard one of them saying to another, something like “There is a God after all! … everything which is possibly good for the society is going to be [miraculously] implemented during the next 5 years … defying history, one must add … but this is another story.” However this article will put aside this all this bla bla bla and focus instead on some interesting facts linking elections to our own (and our patients’) health.

Well, elections are not good for our health (it goes without saying, unless you are related to some candidate), especially the current one since we have been experiencing one of the longest campaigns ever. Election periods can have a direct or indirect negative effect on our health. During the voting period, we tend to experience a rise in CRF, cortisol and epinephrine which increase our blood pressure which in turn augments the overall risk for cardiac and cerebrovascular events. After the election results are published we also experience different settings which however pose a common risk … a negative effect on our population’s health, most notably the cardiovascular system, albeit one is more of an acute nature than the other. 

On one hand we see people celebrating intensely, often with excessive drinking and eating which could easily land them in our emergency department, and on the other hand, for the losing party supporters, we may see increased signs of post-election depression, even sub-clinically. One must also be aware that post-election depression may also lead to a relapse from past problems or conditions such as alcohol, drugs or mental problems. Other reported factors which are also sources of hospitalisation during election periods include traffic accidents, fights, occupational injuries and domestic violence. People also tend to refrain from being operated on the election day, obviously where it is considered possible. However fortunately for us, we do not have those long voting queues which we see abroad, so Maltese citizens do not run the risk of skipping meals (have I already state that there is God after all?), or their daily medication. The latter has also been reported as negatively affecting our health on the election day.

Interestingly, nearer to us, a study measuring the impact political elections have on the heart was carried out during the 2008 general election. The study spearheaded by Dr Mark Sammut revealed that the number of people admitted with acute cardiac coronary events during the election period was 184 (compared to 127 during the Euro 2008 football championship and 117 and 130 during the quieter control periods). Furthermore, there were 25 people who died of a heart attack in the week after the election, compared to 13 deaths during the Euro 2008 and 12 each in the other two quieter periods. It will be quite interesting to repeat the study during this election for comparative reasons.

So it is of the utmost importance to advice regular exercise, adequate water intake as well as some time to unwind at the end of the day for all our patients, but especially for those who we know are involved in campaigning. These preventive measures should be balanced by an increased awareness from our end for possible warning signs of depressive states shown by patients during visits following the election period such as increased anxiety, reported mood swings, insomnia etc.

And continuing with the election talk we have also included two related articles. One focuses on the positive impact which physical activity can have on mental health. And with the hot debate on the cost of electricity we could not resist the temptation of publishing some ideas on how businesses could save on electricity bills … in fact inside this issue there is an academic article by Coleiro et al on how an estimated €580 can be saved during the summer months by local pharmacies …enjoy!