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Health and Political Engagement

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Mikko Mattila
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This review presents a short overview of the current state of research in the field of health, disability, and political engagement. I focus on the individual-level relationship between health and political behaviour or political attitudes. Most of the existing studies have analysed the effects of health or disability on electoral turnout, and almost all of these studies have found a negative association between poor health, disability, and turnout. The relationships between health and other forms of political participation are more complex; poor health and disability can actually promote certain types of participation (e.g., signing petitions or participation in social media). However, studies of political attitudes show that poor health and disability are connected to lower levels of trust and external political efficacy and that this disengagement may even lead, for example, to increased support for right-wing populist parties. In general, political actors and researchers need to be encouraged to implement new, more inclusive solutions to bridge the health and disability gaps in political engagement.
Mikko Mattila
added a research item
Depression is one of the most common health problems in the developed world. Previous research has primarily investigated the relationship between depression and voting, largely overlooking its cognitive foundations. We turn to political efficacy as a key political attitude and precondition for political engagement. We build on research into the cognitive aspects of depression to construct arguments linking depression, political efficacy, and voting. Using cross-sectional (European Social Survey) and longitudinal (UK Household Longitudinal Study) data, we find evidence for a negative relationship between depression and political efficacy, that depression reduces external but not necessarily internal political efficacy, and for an accumulation effect of depression on (external) political efficacy. We also show that political efficacy is a crucial mechanism for the depression-voting gap. Our research has important implications for political representation.
Mikko Mattila
added a research item
Interest in politics is a key indicator of citizens’ attitudes towards politics. Scholars disagree whether interest is a stable trait developed during adolescence, or if it changes over the life course. We hypothesise that deteriorating health can destabilise the stable sense of political interest because worsening health makes individuals more dependent on public healthcare and increase their attention to politics. Furthermore, we assume that the impact of health on interest is conditional on income as people with low incomes are dependent on public healthcare. Our results show only limited support for the first hypothesis. However, we found a negative relationship between declining health and increasing interest in the lowest income group. The results are consistent with the life-cycle theory, which presumes that important events in life have consequences even for the most endurable political attitudes. Deteriorating personal health can be a source of motivation to make persons more interested in politics.
Mikko Mattila
added a research item
Recently, awareness of the importance of health in explaining political participation has grown considerably. Studies have focused on individual participation forms but not on broader participation modes. Furthermore, analyses of the mechanisms explaining the health effects have been lacking. Here, structural equation models are employed to study the relationship between health, political trust, and institutional and non-institutional participation using data from Finland. Poor health is related to increased non-institutional participation, while good health boosts traditional institutional participation, although the latter relationship is very weak. These observations are explained by differences in political trust. Those in good health have stronger trust in the political system, while poor health is connected with reduced trust. These differences manifest themselves in varying behaviour. Poor health decreases trust which leads to increased non-institutional participation, while good health leads to a high trust and institutional activities.
Mikko Mattila
added a research item
Recent research has shown the effect of health on voter turnout, arguing that attenuated health depresses voting. However, we know little about how health is connected to the psychological factors, such as party identification, that precede actual political participation. Employing data from the German Socio-Economic Panel (SOEP), we show that when a person’s health deteriorates, the degree of partisan attachment declines, whereas health improvement does not automatically restore the level of party identification to previous levels.
Mikko Mattila
added a research item
Katsauksessa kootaan yhteen terveyden vaikutuksesta poliittiseen kiinnittyneisyyteen tehtyjä tutkimustuloksia. Nämä ovat jaoteltu neljään osa-alueeseen: 1) terveyden yhteys poliittisen osallistumisen eri muotoihin, 2) terveyden yhteys arvoihin, asenteisiin, preferensseihin ja luottamukseen, 3) arvot ja asenteet välittäjinä terveyden vaikutuksessa poliittiseen osallistumiseen sekä 4) kontekstin vaikutus terveyden ja poliittisen kiinnittymisen väliseen yhteyteen. Terveyserot näyttäisivät olevan suurimmillaan äänestysaktiivisuudessa, mutta heikko terveys on yhteydessä myös matalampaan poliittiseen luottamukseen. Toisaalta sairaus, vamma tai muu terveysvaiva voi joissakin tapauksissa motivoida ihmisiä osallistumaan ja yhteyden suunta vaihtelee osallistumismuotojen, terveysongelmien ja eri kontekstien välillä. Tämä korostaa vertailevan tutkimusotteen ja erilaisten aineistotyyppien tarvetta.
Lauri Rapeli
added a research item
Turnout and party choice are widely held to be habitual, but little attention has been paid to factors that disrupt the pattern. Good health is an important determinant of political behaviour and a key component in the quality of life. Based on the developmental theory of turnout, we hypothesize that declining health lowers voting propensity over the life course. We employ issue ownership theory to assume that declining health increases the likelihood of voting for leftist parties. Using the British Household Panel Survey data, we show how deteriorating health significantly lowers the propensity to vote, but if a person in poor health votes, she is more likely to support Labour than the Conservatives. As expected by the developmental theory, major life events, such as declining health, affect voting propensity. Results also support issue ownership theory: declining health increases Labour voting which implies that British voters turn to the party that owns the health issue when the issue becomes salient.
Mikko Mattila
added a research item
Social scientists have only recently begun to explore the link between health and political engagement. Understanding this relationship is vitally important from both a scholarly and a policy-making perspective. This book is the first to offer a comprehensive account of health and political engagement. Using both individual-level and country-level data drawn from the European Social Survey, World Values Survey and new Finnish survey data, it provides an extensive analysis of how health and political engagement are connected. It measures the impact of various health factors on a wide range of forms of political engagement and attitudes and helps shed light on the mechanisms behind the interaction between health and political engagement. This text is of key interest scholars, students and policy-makers in health, politics, and democracy, and more broadly in the social and health and medical sciences.
Mikko Mattila
added a research item
Previous studies show that people with poor health have a lower propensity to vote. With individual-level register data on sickness allowance episodes and voting in three Finnish elections, we address the following questions: (1) What degree of sickness allowance days negatively influences turnout? (2) Are sickness absences on election day more harmful than absences that occur before the elections? (3) What is the effect of cumulative sickness allowance spells before the elections over a period of several years? We use a threefold categorisation approach, which differentiates between immediate, short-term and long-term health effects on voting. The results show that multiple sickness allowance spells over several years are more strongly connected to turnout than health problems experienced only in the year prior to the elections. Falling ill at the time of the elections had no consistent additional negative relationship with voting. We suggest that the demobilising effects of immediate health problems are associated with tangible factors, while long-term effects are related to lowered levels of political efficacy, interest and social connectedness.
Mikko Mattila
added 4 research items
This study analyses the effect of individuals’ self-assessed health on their likelihood of turning out in parliamentary elections in Finland and in Europe. An examination of previous studies in the field of politics and health shows that the field is still very patchy, diffuse and undertheorized. Because of the wide variation in research designs, data and methodological choices the existing studies cannot provide for a solid understanding of the relationship between health and political behavior. This article proposes that matching methods could be a partial solution for the methodological problems affecting the field. In the empirical section, the magnitude of the effect of poor health on voting propensity is calculated with traditional multivariate methods and matching methods. The results show that traditional methods over-estimate the size of the effect but only slightly. In all, the results show that voting is hampered by health problems both in Finland and wider in Europe.
Disability affects the lives of hundreds of millions across the world. People with disabilities often experience discrimination and unequal treatment. Sometimes the mere categorization of people into groups, i.e., ‘healthy’ vs. ‘disabled’, is enough to trigger discriminatory behaviour against people with disabilities. Previous studies show that in general disabilities depress political participation. However, the effect of disability-based discrimination on participation has received little scholarly attention. We study how perceptions of discrimination affect three forms of political participation: voting, contacting politicians and participating in demonstrations. Results show that disability decreases voting, especially when associated with perceptions of discrimination. The analysis points in the opposite direction when the other two forms of political participation are analysed. People with disabilities are more likely to partake in demonstrations and contact politicians than non-disabled. Thus, disability-based discrimination is not always a hindrance to participation. It sometimes further motivates people with disabilities to participate.
Background: While poor self-rated health is known to decrease an individual's propensity to vote, disaggregation of the components of health on turnout has thus far received only little attention. This study deepens on the understanding of such relationships by examining the association between chronic diseases and voting. Methods: The study uses an individual-level register-based data set that contains an 11% random sample of the entire electorate in the 1999 Finnish parliamentary elections. With information on hospital discharge diagnoses and reimbursements for drugs prescribed, we identify persons with chronic hospital-treated diseases (coronary heart disease, chronic obstructive pulmonary disease (COPD) and asthma, depression, cancer, psychotic mental disease, diabetes, cerebrovascular disease, rheumatic disease, epilepsy, arthrosis, alcoholism, dementia, atherosclerosis, Parkinson's disease, other degenerative brain diseases, multiple sclerosis and kidney disease). Results: After adjusting for gender, age, education, occupational class, income, partnership status, cohabitation with underaged children and hospitalisation during Election Day, neurodegenerative brain diseases had the strongest negative relationship with voting (dementia OR=0.20, 95% CI 0.18 to 0.22; others up to OR=0.70). Alcoholism (OR=0.66) and mental disorders also had a negative association (depression OR=0.91; psychotic mental disease OR=0.79), whereas cancer and COPD/asthma had a positive association (both OR=1.05). Having more than one condition at a time further decreased voting probability. Conclusions: By showing how different health conditions are related to voter turnout, this study provides essential information for identifying gaps in the potential for political participation and for further inquiries aiming to develop models that explain the link between health and voting probability.
Lauri Rapeli
added 3 research items
In search of a better understanding of inequalities in citizen political engagement, scholars have begun addressing the relationship between personal health and patterns of political behavior. This study focuses on the impact of personal health on various forms of political participation. The analysis contributes to existing knowledge by examining a number of different participation forms beyond just voting. Using European Social Survey data from 2012/2013 for Denmark, Finland, Iceland, Norway and Sweden ($N=8,060$), self-reported turnout and six alternative modes of political engagement were modeled as dependent variables. Contrary to expectations, poor health did not depress participation across all forms. As assumed by the increased activism hypothesis, all else equal, people with poor health were more active than their healthy counterparts in direct contacts with power holders and demonstrations. The results reveal a “reversed health gap” by showing that people with health problems are in fact more politically active than what previous research, which has focused on voting, has suggested. Although the magnitude of the gap should not be overdramatized, our results stress the importance of distinguishing between different forms of participation when analyzing the impact of health on political engagement. Nevertheless, the findings show that poor health can stimulate people into political engagement rather than depressing activity. This finding holds when the effects of several sociodemographic and motivational factors are controlled for.
We explore two theoretical possibilities for why personal health may affect political trust: the psychological-democratic contract theory and the role of personal experience in opinion formation. We argue that citizens with health impairments are more likely to experience the direct effects of political decisions, as they are more dependent on public health services. Negative subjective evaluations of public services can lower trust levels, especially if people’s expectations are high. Using European Social Survey data, we analyse the association between health and trust in 19 Western European states. The results indicate that people in poor health exhibit lower levels of trust towards the political system than people in good health. The differences in trust between those in good and poor health are accentuated among citizens with left-leaning ideological values. Our results suggest that welfare issues may constitute a rare context in which personal, rather than collective, experiences affect opinion formation.
Hanna Wass
added 2 research items
Several studies suggest that people suffering from ill health or disabilities have a lower propensity to vote. Using six rounds of the European Social Survey, we examine whether the effect of health or functional disabilities on electoral participation is less or more pronounced in countries which utilize a wider range of facilitation instruments, such as advance or postal voting, proxy voting and voting outside the polling stations. Our findings show that with the exception of proxy voting, voter facilitation instruments not only have insignificant main effects but also a negative interaction effect with poor health/functional ability (FA). As a result, voter facilitation intensifies the health-related differences but not by activating those who are more active to begin with, as suggested in previous studies. The endogeneity argument thus seems most warranted explanation for our findings: countries with low turnout among people with impaired FA or health are more likely to adapt facilitation practices.
An increasing number of eligible citizens in North America and Europe were born outside of these countries. As remarked by Heath et al. [2011. “Ethnic Heterogeneity in the Social Bases of Voting at the 2010 British General Election.” Journal of Elections, Public Opinion and Parties 21 (2): 255–277], in the case that voters with migration background respond differently to established correlates of turnout, understanding the role of immigration-specific factors becomes particularly important. On the basis of individual-level register data from the 2012 Finnish municipal elections (n = 585,839), we examine whether the effect of socioeconomic status on turnout differs according to citizenship status and test which indicators of social and political integration boost participation among foreign-born voters. We find, in line with the different response model, that the impact of age and education is weaker among voters with migration background. In addition, having a native spouse and minor children, past eligibility and being born in a democratic country increase turnout among foreign-born voters, lending support for the assimilation, exposure and transferability models. Finally, the findings concerning the resistance model were opposite to our expectations. Older age at the time of immigration increases participation, but only among migrants born in a democratic country.