The national electorate often is framed in terms of partisan or generational divides. But there’s another important polarization of the electorate to consider: the health divide.
In short, people with chronic illnesses, mental health concerns and disabilities — not to mention people suffering from the seasonal flu — are less likely to vote. One study estimates that over 3 million voters in the United States did not vote in the 2010 elections due to the so-called “disability gap” in turnout. (One notable exception: Having cancer is associated with an increased likelihood of voting, according to multiple studies.)
The upshot? As one featured paper explains, “if healthy people are more likely to turn out and have systematically different policy preferences than the unhealthy…then electoral results and the policies that are enacted may have a ‘health bias.’ This suggests a feedback cycle linking population health to politics: increasing health disparities may produce increasing inequalities in policy representation, which in turn produces policies that may be detrimental to the unhealthy, which in turn creates even greater health disparities, and so on.”
To get a better sense of the connections between health and voting, this research roundup gathers the latest scholarship on the subject.
“Influenza and Voter Turnout”
Urbatsch, R. Scandinavian Political Studies, March 2017.
Election season and cold and flu season tend to overlap in the U.S. and many other countries. Researchers exploited this coincidence to determine whether voter turnout in Finland and the U.S. change with varying rates of local influenza prevalence.
- In both the U.S. and Finland, influenza outbreaks were associated with lower voting rates.
- In the U.S., the authors estimate that a state reporting “widespread” influenza rather than “no activity” would have reduced turnout by 4.9 percentage points.
- In places within the U.S. with a higher density of generalist health care providers, there are stronger turnout-dampening effects from influenza – in other words, even fewer people vote.
“The Bodies Politic: Chronic Health Conditions and Voter Turnout in the 2008 Election”
Gollust, Sarah E.; Rahn, Wendy M. Journal of Health Politics, Policy and Law, December 2015.
Does voter turnout vary by particular chronic illnesses? This study looks at turnout in the 2008 U.S. presidential election among voters with five different chronic conditions – cancer, diabetes, arthritis, heart disease and asthma.
Here’s what they found:
- People with cancer were 2.6 percentage points more likely to vote in the 2008 election than people with any of the four other conditions.
- People with heart disease were 2.4 percentage points less likely to vote.
- Socioeconomic status and race played into these “chronic condition effects.” The authors found that among respondents who had cancer, African Americans and people without a college education were more likely to vote than their white and well-educated peers.
- People with poor self-rated health, no insurance, disabilities, and less emotional support were also less likely to vote than the general population.
“How Different Forms of Health Matter to Political Participation”
Burden, Barry C.; et al. The Journal of Politics, January 2017.
This study analyzes longitudinal data collected for over 50 years on more than 18,000 Americans. The researchers looked at various health measures, including walking speed, cognitive functioning and scores from a general health index, to determine whether there were associations between these metrics and political participation (as measured by voter turnout and campaign contributions).
- Those who maintained their cognitive functioning (as compared with those who experienced cognitive decline) were more likely to vote.
- Higher general health scores and faster walking speeds (which were used as an indicator of physical health) were also associated with higher rates of voting.
- The health measures studied had weak or no associations with campaign contributions.
“Health and Voting in Young Adulthood”
Ojeda, Christopher; Pacheco, Julianna. British Journal of Political Science, July 2017.
Using a longitudinal dataset that tracks responses from 9,000 youths annually, this study analyzes the impact of physical health, mental health and overall well-being on voter turnout.
- Poor self-rated physical health reduces a young adult’s likelihood of voting in their first election, but not later elections.
- The opposite held for depression—it had little influence on the likelihood a young adult would vote in their first election, but was associated with changes in voting over time.
- “Physical limitations do not have a statistically significant effect on either the initial probability of voting or a citizen’s trajectory in young adulthood.”
“Can You Deliver a Baby and Vote? The Effect of the First Stages of Parenthood on Voter Turnout”
Bhatti, Yosef; et al. Journal of Elections, Public Opinion and Parties, April 2018.
This study looks at voter data from Denmark and Finland to analyze whether new parents were less likely to vote in local elections. It turns out it’s hard to juggle a newborn and civic responsibilities.
- In Denmark, parents generally were good about voting, with turnout around 60 percent over the two years studied. However, turnout dropped sharply among parents to children born close to the election. The results from Finland were similar.
- “Parents with a child born one to seven days before the elections are 19 percentage points (Denmark) and 10 percentage points (Finland) less prone to vote than the base group. For parents with children born 8 to 14 days before the elections were held, the corresponding figures are diminished to six and one percentage points.”
- Childbirth had a larger effect on turnout among women than men.
“Expanding Medicaid, Expanding the Electorate: The Affordable Care Act’s Short-Term Impact on Political Participation”
Haselswerdt, Jake. Journal of Health Politics, Policy and Law, August 2017.
When more people have health insurance coverage, what happens to voter turnout? This paper uses district-level elections data from 2012 and 2014 U.S. House races to probe this question.
- “Increases in Medicaid enrollment associated with the expansion are related to considerably higher voter turnout.”
- “This effect was likely due to both an increase in turnout for new beneficiaries and a backlash effect among conservative voters opposed to the law and its implementation.”
“Sick Leave from Work and the Voting Booth? A Register-Based Study on Health and Turnout”
Mattila, Mikko; et al. Acta Politica, July 2018.
This study looks at voting data from Finland to see whether people who had taken sick leave from work in the months leading up to an election were more or less likely to vote.
- People who took multiple sick leaves over several years were less likely to vote than people who had immediate or short-term health issues.
- “This finding indicates that chronic health impairments tend to have a stronger negative relationship with voting than acute problems.”
“Depression and Political Participation”
Ojeda, Christopher. Social Science Quarterly, November 2015.
This study looks at two survey datasets that measure depressed mood and self-reported turnout among adults and adolescents as they come of voting age in the U.S.
- Among adults, the likelihood someone will vote decreases as the severity of depressed mood increases.
- Among adolescents, depressed mood affected both turnout and other forms of political participation, such as participating in a political club or organization or contributing money to a political party.
“Incorporating Health into Studies of Political Behavior: Evidence for Turnout and Partisanship”
Pacheco, Julianna; Fletcher, Jason. Political Research Quarterly, March 2015.
This study analyzes U.S. data from two surveys on self-reported health status and political behavior, which includes turnout and party affiliation.
- People who view their health as excellent are more likely to vote. They’re also more likely to identify as Republicans.
- The authors suggest that health inequalities can have “significant political consequences.” For example, the authors suggest that health policies enacted might favor the healthy (e.g., denying health insurance coverage to people with pre-existing conditions).
“Sidelined or Mainstreamed? Political Participation and Attitudes of People with Disabilities in the United States: Disability, Political Participation, and Attitudes”
Schur, Lisa; Adya, Meera. Social Science Quarterly, September 2013.
Are disabled Americans more or less likely to vote than their peers without disabilities? This study combines four datasets to examine this question in the context of the 2008 and 2010 elections.
- “Citizens with disabilities remain less likely than nondisabled citizens to vote.”
- “While there are few differences in political preferences and party affiliations, people with disabilities tend to favor a greater government role in employment and healthcare, and give lower ratings on government responsiveness and trustworthiness.”
- Extrapolating from the sample of over 90,000, the authors conclude that 3 million more voters would have participated in the 2008 election and 3.2 million more would have voted in 2010 if disabled people voted at the same rates as people without disabilities.
“How Voter Turnout Varies between Different Chronic Conditions? A Population-Based Register Study”
Sund, Reijo, et al. Journal of Epidemiology and Community Health, May 2017.
This study breaks down voter turnout in Finland by specific chronic conditions through analysis of a random sample of 11 percent of the entire electorate in the country’s 1999 parliamentary elections.
- Neurodegenerative brain diseases like dementia had the strongest negative correlation with voting.
- Alcoholism and mental disorders were also associated with a reduced likelihood of voting.
- Cancer and asthma were associated with an increased likelihood of voting.
- Having multiple chronic conditions decreased the likelihood of voting.
“Voting While Ailing? The Effect of Voter Facilitation Instruments on Health-Related Differences in Turnout”
Wass, Hanna; et al. Journal of Elections, Public Opinion and Parties, October 2017.
This study looks at whether voter facilitation measures like proxy voting (having a delegate vote on your behalf), early voting and voting by mail exacerbate or decrease discrepancies in turnout between healthy and sick or disabled people by comparing survey data collected across 30 countries in Europe. Over 240,000 responses were collected from six survey rounds conducted over 11 years, from 2002 through 2012.
- “Among voters with health problems or activity limitations… the higher the level of facilitation, the lower the level of turnout.” In other words, the more opportunities offered by the government for people to vote without going to the polls on Election Day, the less likely it is that people with health problems or other limitations will vote.
- “As a result, voter facilitation in fact intensifies the health-related differences, as suggested in previous studies. It is important to notice, however, that this is solely because facilitation has (practically) zero effect on voting propensity among the healthy but a negative interaction effect with poor health/functional ability.” The authors theorize as an explanation for these results that countries with low turnout among those with health or activity limitations in turn adopt voter facilitation practices as a means to boost turnout among these individuals.
- “Only proxy voting appears to (relatively) increase participation among those with activity limitations.”
We’ve summarized research that shows how rural areas, which tend to have fewer health care resources, have worse health outcomes than their better-resourced, urban peers. For more research on health equity, check out our roundups on toxic waste sites and environmental justice, the Children’s Health Insurance Program and health interventions in non-traditional settings.