Expert Commentary

Adults with health problems, disabilities are less likely to vote but could swing elections

Adults with health problems are less likely to vote during elections -- and racial minorities, seniors and voters with physical and intellectual disabilities are most likely to have health problems.

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Adults with health problems are less likely to vote during elections — and racial minorities, seniors and voters with physical and intellectual disabilities are most likely to have health problems, finds a recent analysis of 40 academic papers published during the past three decades.

The study, published in the journal Public Health Reviews, also reveals that not voting can have harmful consequences for these individuals in the short and long term.

The analysis shows that the number of people whose health deters them from casting ballots is substantial. It can be enough to swing an election, co-author Danyaal Raza, an assistant professor at the University of Toronto’s Department of Family & Community Medicine, told Journalist’s Resource.

Raza predicts the coronavirus pandemic will make a troubling situation worse by making in-person voting more difficult. Across the U.S., elections officials have struggled to hire enough staff at voting locations. For the primary elections earlier this year, elections offices across the country consolidated polling locations, partly because they were short-staffed. That, according to news reports, created longer wait times and confused voters accustomed to going to the same polling place for years.

While registered voters in many states can request mail-in ballots, research indicates a significant portion of those ballots might not be counted for a range of reasons. They could arrive late, for example, or lack a required signature or have a signature that does not match the official one on file.

Raza warns that recent news reports highlighting the likelihood of long lines, poll staffing shortages and voter intimidation efforts during next week’s general election might also dissuade voters.

“In the absence of a brand new infectious disease, we already knew that people who are sick are less likely to vote and less likely to have a political voice,” he says. “And now, layer on top of that a pandemic. It’s layer upon layer, and it’s going to make the situation even more problematic.”

When Raza and his colleagues examined research on voting patterns, they discovered one overarching theme: people coping with any of a range of health issues — regardless of severity — were less likely to vote compared with healthy individuals. They learned that mental health and addiction can influence voting, as can physical ailments, physical disabilities and intellectual disabilities.

The researchers also noted differences in voting participation based on factors such as a person’s age, race, gender and type of health problem.

They went back decades, poring over the academic literature on the link between voting and personal health in several countries. They discovered 49 studies that investigated the issue in the U.S., Canada and Europe but decided to exclude papers that had not been peer-reviewed or were not specific enough in their focus. They ended up with 40 studies published between 1991 and 2018 in their analysis.

Some studies conclude that acute illnesses — seasonal flu, for example — can reduce voter turnout. A study on chronic conditions finds that adults with cancer or chronic obstructive pulmonary disease tend to vote more often than do those with neurodegenerative brain disease, addictions and mental health disorders.

The authors of that study suggest that adults with cancer might be more likely to vote because of the “de-stigmatised nature of how cancer is perceived in the society (e.g., former patients are often portrayed as heroic survivors rather than as guilty for their condition) and the high membership rate of influential cancer–patient associations.”

Raza and his colleagues also reviewed research that looks at how racial inequality has affected the health of Black Americans and led to a loss of votes. The authors of one such study, “Black Lives Matter: Differential Mortality and the Racial Composition of the U.S. Electorate, 1970–2004,” estimate that an additional 1 million Black adults would have voted during the 2004 general election if the death rates of Black and white Americans had been the same between 1970 to 2004.

Raza urges journalists to find ways to educate audiences about this problem and how personal health can impact other types of civic engagement, including attending local government meetings and donating to political campaigns.

In their recent analysis, published in July, Raza and his colleagues discuss medical professionals’ efforts to increase civic engagement as a way to change public policies in areas such as public health and housing over time.

One study, published in the Annals of Family Medicine in 2014, scrutinizes a voter registration drive at two health centers in the Bronx led by nurses, physicians, local college students and other volunteers in 2012. The 12-week project was a success — 89% of eligible voters who were approached ended up registering.

“In New York City, citizens can register to vote in person or by mail; however, lack of individual initiative, time constraints, work schedules, limited income, and transportation issues can make this process more difficult,” write that study’s authors, researchers from the Albert Einstein College of Medicine and Yale University.

They describe the project as “an instructive example of how health care professionals can address broader social determinants of health through clinic interventions.”

Raza urges journalists to spotlight such programs and monitor whether and how they impact voting in local communities. He says news outlets also should remember that COVID-19 is not the only health issue influencing voter turnout this year.

“It’s not just a story about COVID and voting — it’s a story about power,” says Raza, who also is a family physician and serves as chairman of Canadian Doctors for Medicare, an advocacy organization that supports Canada’s public health care system. “What our review found was if you’re not as healthy, you’re going to vote less and the downstream consequences of that are political power and resource allocation for things that impact your health like housing, social safety nets and childcare and the quality of the healthcare system itself.”

Another great story idea for after the 2020 presidential election: Trying to gauge how personal health, including COVID-19, influenced voters this year. This will show the significant impact voter health can have on election outcomes, Raza adds.

“It’s not just losing a few votes here and there, but can affect which candidates win or lose,” he says. “It actually can have meaningful outcomes on how elections are won or lost.”

Want to know more about this topic? Check out our collection of research on how health affects voter turnout. Not only does it provide more details about some of studies included in this analysis, it spotlights additional studies, including one that looks at whether the parents of newborns tend to skip voting.

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