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Trevor Hancock: Beyond voting, democracy is good for health

Is democracy related to health? Rudolf Virchow certainly thought so more than 150 years ago, in what was then Prussia.

Is democracy related to health? Rudolf Virchow certainly thought so more than 150 years ago, in what was then Prussia.

Asked to investigate an outbreak of typhus in the impoverished mining communities of Upper Silesia, this soon-to-be eminent pathologist produced a report that, among other things, advocated for democracy. When challenged by the Prussian government that this was not medicine but politics, he famously replied: “Medicine is a social science, and politics but medicine writ large.”

We have just been through a major exercise in representative democracy. How healthy do you feel? Should and democracy improve your health?

The usual connection drawn between democracy and our health is that through the democratic process we can, we hope, elect a government that will enact legislation and implement policies that will be good for our health. But democracy is not just about casting a ballot.

In fact, I argue — and I think many would agree — that real democracy is about getting involved in your community, and in the activities and decisions that affect your life, between elections

In the world of health promotion in which I work, the evidence shows that participation — real democracy — is good for health. In fact — and admittedly I am pushing the envelope here — I believe we can make the argument that democracy can prevent cancer.

Well, OK, I do not mean that literally; we should not expect cancer to decline after an election. But what does the evidence tell us about the health benefits of participation?

First, let me be clear what I mean by participation. The dictionary defines it as “the action of taking part in something.” That “something” might be any one of hundreds of activities, from singing in a choir to playing hockey with friends to fundraising for the Guides, and on and on. Social participation means getting involved in one’s community, and often that involves volunteering.

What does social participation and volunteering do for one’s health? There are several health benefits detailed in the literature, including more social inclusion, reduced anxiety and an increase in one’s sense of autonomy, control and self-worth. This seems to be particularly the case for older adults, whose self-rated health has been shown to increase, while their risk of mobility-disability decreased as they became more socially engaged.

It seems that this increased sense of empowerment, self-esteem and self-worth in turn has an interesting effect on immunity, through the psycho-neuro-immune system. In essence, your mind is connected to and influences your body’s defences.

While the concept of a mind-body connection is an old one, it is only in the past few decades that we have come to a more complete understanding of the mechanisms involved. A 2002 review by scholars at Ohio State University noted that both short-term and long-term stress can adversely affect the immune system, while positive mental states can enhance it.

Stress affects the secretion of hormones such as cortisol and adrenalin, which in turn modify the immune system. This can result in reduced response to vaccines, delayed wound healing, increased susceptibility to colds and other infections, and reduced “killer cell” activity. (These cells play a role in detecting and destroying abnormal cells that might otherwise go on to become cancer.)

In addition, stress can trigger an increase in the inflammatory response — chronic inflammation has increasingly been linked to a wide variety of chronic conditions and to aging.

But more importantly, these authors reported that “the link between personal relationships and immune function is one of the most robust findings” in this field. Strong social support — which can of course come from being involved in one’s community — is able to modify the effects of stress on the immune system and is associated with better immune function.

So while we might not have direct evidence that democracy and cancer are linked, we do have evidence for many of the steps in the causal chain that link them. It seems reasonable to me to take the position that engagement and participation in your community is good for your immune system and thus good for your health.

So now the election is over, it is time to get involved in real democratic participation so as to improve our health.


Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

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