What if abstention said as much about health as it did about democracy? A team from the University of Helsinki followed more than three million adults for more than twenty years and highlights an unexpected signal. Voting no longer appears only as a civic gesture, but as a social marker linked to health and longevity. Published in the Journal of Epidemiology & Community Healththe analysis places electoral participation at the heart of the social determinants of health.
Abstention and mortality: what the Finnish study reveals
The researchers cross-checked participation in the legislative elections of March 21, 1999 with Statistics Finland records, for all citizens aged at least 30 living in mainland Finland. In total, 3,185,572 people were included; the participation rate was 71.5% among men and 72.5% among women (proportions much higher than those found in France…). Monitoring continued until December 31, 2020. Over the period, 1,053,483 deaths were recorded, including 95,350 linked to external causes (accidents, violence or alcohol-related deaths) and 955,723 to other causes, while 2,410 deaths from undetermined causes were excluded from the final analysis.
Results: not voting is associated with an excess risk of death from all causes, greater for external causes than for other causes.
- The differences are marked: among people who did not vote, the risk of death is higher by 73%
in men and 63% in women. After taking into account the level of education, the gap remains clear, at 64% for men and 59% for women. The difference of
mortality between voters and non-voters even exceeds that observed between low and high levels of education. And it is even more pronounced for external causes and among the youngest; - The gap is greatest among men under 50. After adjusting for age, the risk of death was approximately twice as high among nonvoters as among voters, for both men and women;
- Among those aged 75 to 94, women who did not vote had a higher risk of death than men who voted;
- And among men belonging to the quarter of households with the lowest income, not voting was accompanied by an additional excess risk of 9 to 12% compared to other income groups.
Who is most at risk and why voting matters for health
For the authors, electoral participation refers to
share capitala widely documented lever in population health. “Voting, as a form of participation, is a type of social capital, which is linked to health benefits. Additionally, voting can increase other forms of civic participation“, explain the researchers. In this reading, abstention can signal more fragile trajectories, where isolation, precariousness and difficulties in accessing services intertwine. The study remains observational and does not demonstrate a cause and effect link, which the authors specify.
Refusing to vote can also reflect health obstacles that slow down participation. “Health problems and associated difficulties in functioning can also negatively affect many conditions necessary for participation, including increased resources, motivation to vote, and political mobilization.“, they add.
The results were published in a BMJ Group journal, with a cross-sectional observation: the association between abstention and mortality goes beyond the educational gradient classically observed in epidemiology. “Information on voting may be useful in clinical settings, for example giving up the habit of voting may be an early signal of significant health decline, and for monitoring well-being, health and health inequalities within the population. Additionally, a strong association between voting and mortality raises concerns about equality of political representation“, they conclude.