A new review paper published in the New England Journal of Medicine reports that a growing body of empirical evidence shows how presidential elections can have effects on physical and mental health, and can influence behavior. Specifically, they found evidence that suggests that the campaign and subsequent election of Donald Trump has had a negative effect on the mental well-being of Americans, and in particular those in marginalized groups who are vulnerable to discrimination. According to lead author David R. Williams of Harvard University, “Elections can matter for the health of children and adults in profound ways that are often unrecognized and unaddressed.” In the article, the authors summarize specific studies to support their claim and provide potential solutions to the Trump-induced negative health effects.

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Empirical research has documented how campaigns that give a voice to the marginalized can have positive effects on health, at least in the short term. Notable examples include heightened psychological well-being and self-esteem among South Africans during Nelson Mandela’s 1994 election, among black Americans during Jesse Jackson’s 1988 presidential campaign, and among minorities when Barack Obama was elected president in 2008. But President Obama and Jesse Jackson famously ran on campaigns of hope and unity. It is no secret that Donald Trump ran on a message of fear and revenge. Fear of Muslims and minorities, and revenge against the Washington establishment that they believe is responsible for all the hardships the country is facing, from terror to healthcare to the economy. Understanding the negative effects of such a psychologically-centered campaign is of great interest, seeing as how Donald Trump and his White House staff continue to use the same tactics to keep their political base riled up and engaged.

By observing the news, behavior on social media, or out in public, it is easy to see that hostility towards minorities—especially with Muslims and Mexican immigrations—has increased since Donald Trump emerged on the political scene. While this may be obvious, it is important to have empirical data to clarify and quantify this aggression and its effects on health.

In a recent survey study with a massive sample size of 2000 elementary and high school teachers, over half of respondents reported that since the 2016 presidential campaign began, they have observed an increase in racial and ethnic slurs and general hostility among students. 67% of these teachers said that students who were immigrants, children of immigrants, or Muslims, felt fear and worry over how they or their family might be treated after the election. Furthermore, a separate study by the Southern Poverty Law Center has reported a growing number of incidents of harassment and intimidation since Trump’s election, with most of these occurring in public schools.

There is no doubt that this increased hostility would have measurable emotional effects on those affected by it. A national survey study conducted by the American Psychological Association in January of 2017 found that minorities (69% of blacks, 57% of Asians, and 56% of Hispanics), as well as Democrats compared to Republicans, reported that the outcome of the 2016 presidential election was a significant source of stress. Additionally, two-thirds of all adults in the U.S. said they were stressed about the future of the country.

The review article also makes it clear that these effects on psychological well-being have real effects on physical health and mortality. An August 2016 study conducted at UC Berkeley that surveyed 1,836 U.S. counties found that there was an elevated risk of death from heart disease among both white and black residents in areas where there was high prejudice, with a particularly strong effect among blacks.

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A 2006 study at the University of Chicago, which assessed birth outcomes among females of various racial and ethnic groups in California, showed that six months after 9/11—when hostility towards Arab Americans was intense—there was a significant increase in low-birthweight babies and premature births among Arab American women. Given the present increase in hostility towards Muslims, one might expect to see similar trends today.

The authors also describe how negative health effects may occur from distress over the threat of repeal of the Affordable Health Care Act, which could make medical treatment and prescriptions inaccessible to many Americans, especially those in poor and marginalized populations. Studies conducted after similar cuts were made early in the Reagan administration showed increases in chronic diseases among adults, infant mortality, and preventable childhood diseases.

However, the review article isn’t all doom and gloom. The authors make a number of suggestions for health care providers that can alleviate the negative health effects of a Trump presidency. For example, clinicians should be particularly aware of the mental distress that their minority patients might be experiencing in the wake of the election, and should offer special attention and care in addressing their needs with the appropriate psychotherapy or medication. They also suggest that health care professionals become more involved in the community and the overall political discussion, so that they can help foster a positive environment and stimulate research which could provide effective methods for reducing the Trump-induced adverse effects on health.

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Bobby Azarian is a freelance writer with a PhD in neuroscience. His research has been published in journals such as Cognition & Emotion and Human Brain Mapping, and he has written for The Atlantic, The New York Times, BBC Future, Scientific American, Psychology Today, and others. Follow him on twitter @BobbyAzarian.