If you fail to vote or fail to vote responsibly, are you a killer?

I remember a confrontational road-safety campaign poster that proclaimed: “If you drink and drive, you are a killer.”

The message was deliberately uncomfortable. It challenged people to recognise that personal choices could have deadly consequences for others.

With this week’s municipal elections, I find myself more and more convinced that from a public health perspective, this is also the case.

“Excuse me,” I hear you saying. ‘How can my choice of candidate be equated with killing someone while driving drunk?”

Before you dismiss the comparison, stay with me.

All of us can be quicker to defend our political loyalties than examine their consequences. This is normal and driven by our subconscious biases. I am asking whether we give enough weight to health and safety when deciding who should govern our municipalities.

Every year, South Africans suffer illness, injury and death from hazards that functioning municipal services should help prevent.

For many households, failing services are not inconveniences they can pay to escape. Those who can afford alternatives should not imagine that money provides complete protection. It cannot. Municipal failure can become a matter of life and death for everyone.

Modern public health has some of its roots in the cholera epidemics and sewage-filled streets of Victorian London.

Edwin Chadwick’s 1842 report on appalling sanitary conditions helped pave the way for the Public Health Act of 1848.

In 1854, physician John Snow traced a Soho cholera outbreak to the Broad Street water pump and persuaded the authorities to remove its handle – a founding episode of modern epidemiology. Four years later, the “Great Stink” from the Thames spurred political support for engineer Joseph Bazalgette’s sewer network.

At the heart of this origin story was a recognition that remains fundamental today: protecting people’s health requires government to make the places where they live safe.

Let me clarify what I mean by public health. I am not referring to government hospitals and clinics. Public health is a discipline concerned with what makes whole communities healthy or ill and how we prevent harm.

Public health services put that knowledge into practice through vaccination, disease surveillance, food safety and other measures that protect us collectively. Irrespective of whether we use private doctors or a government clinic, we all depend on these protections.

Nearly 170 years after London’s Great Stink, South Africa is neglecting the same public health protections.

The government’s 2025 Green Drop report, assessing the 2023/24 financial year, classified 396 of 848 municipal wastewater systems – 47% – as being in a critical state, compared with 39% in the 2022 report.

When sewage treatment plants fail, we risk drinking water becoming contaminated with human waste and the risk – to everyone in that community – increases for cholera, typhoid fever, dysentery and hepatitis A.

In Hammanskraal in May and June 2023, a cholera outbreak killed dozens of people amid long-standing failures in water and sanitation.

Government confirmed that the malfunctioning Rooiwal wastewater works polluted the river feeding the drinking-water supply but could not attribute that as being the cause.

Food safety is another protection we cannot afford to neglect.

In October 2024, six children in Naledi, Soweto, died from exposure to terbufos, a highly hazardous pesticide.

Cabinet’s June 2025 update said the exact exposure circumstances remained uncertain, although contaminated food purchased from a spaza shop was considered the most plausible explanation.

Transport Minister Barbara Creecy reported on September 2 this year that 6 457 people died on South Africa’s roads between 1 January and 23 August. Pedestrians accounted for 48% of those deaths – about 3 100 people killed while on foot.

The reality is poor urban design exposes people who depend on walking to fast-moving traffic, often without adequate pavements or safe crossings.

Speeding, alcohol and poor lighting compound the danger.

Municipalities cannot prevent every road death. But the design and maintenance of municipal roads, pavements, crossings and street lights are practical ways local government can protect people who walk.

When we vote in municipal elections, we are making choices about life and death — for ourselves, our families and for our community.

A ballot is a decision about candidates and parties we trust with the conditions on which our lives depend.

Staying away does not stop a council being elected or a budget being spent. Nor should loyalty to a party excuse us from examining the competence and conduct of its candidates.

We cannot guarantee what an elected representative will do. We can demand evidence before entrusting them with power – and hold them accountable afterwards.

A ward councillor does not personally run these services. Their role is to represent residents, scrutinise decisions and hold the municipal administration accountable.

Ask five questions about the candidates seeking your vote:

1. Will they help protect the water my family drinks? What evidence is there that they understand water safety, sewage treatment and the maintenance needed to prevent contamination and disease?

2. Will they help protect my community from preventable illness? What are their plans for waste collection, food safety inspections, environmental pollution and communicable-disease prevention? Are those plans funded and measurable?

3. Will they help make our streets and public spaces safer? What are their proposals for reducing road injuries, protecting pedestrians, maintaining street lights, managing flood risks and ensuring functioning emergency services?

4. What have they achieved, or demonstrated the competence to achieve? For those holding office, what does the record show? For newcomers, what qualifications, experience and credible plans do they bring to the responsibilities they seek?

5. How will I know whether they have delivered? Will they support publishing reliable service-delivery indicators, infrastructure maintenance plans, budgets, audit findings and progress reports? Will residents know who is accountable when commitments are not met?

Whatever our political loyalties, these are questions we should ask every candidate. These are questions about the fundamental responsibilities of local government and the evidence voters can use to assess competing candidates.

The drunk-driving campaign understood something important about human behaviour: people often underestimate the consequences of decisions that have become routine.

Perhaps we have become equally accustomed to treating local government elections as political contests rather than decisions about the institutions on which our health and safety depend.

The consequences of municipal failure are not measured only in missing money, broken pipes and uncollected rubbish. They are also measured in lives.

• Dr Wolvaardt is the founder of the Foundation for Profession-al Development and has recently stepped down as managing director.

Dr Gustaaf Wolvaardt