As the United States’ 2020 election draws closer, we explore the complex two-way relationship between health and voting.

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Research suggests that the complex relationship between health and voting existed before COVID-19.

Voting is the mainstay of a democratic society. It is the primary means for a population to show their support or rejection of policies, political parties, and politicians.

Despite this, for a wide range of reasons, many people do not vote. According to the Pew Research Center, in the 2016 election, 40% of adults in the U.S. who were eligible to vote did not vote. In many states, this figure was closer to 50%.

Not all sections of society are equally likely to vote. For instance, white people are more likely to vote than Black people, who are more likely to vote than Latin and Asian people. People with lower household incomes are less likely to vote than people with higher incomes, while younger people are less likely to vote than older people.

If you would like to check your registration status or register to vote, we have added some useful links at the bottom of this article.

Although there are many reasons that people do not cast their ballot, in this article, we will be focusing on the relationship between health and voting.

Of course, healthcare is a priority for many people in the U.S., and it will help guide many people’s voting decisions. As a Kaiser Family Foundation poll from February 2020 found:

“More than 8 months before the 2020 general presidential election, healthcare (26%) and the economy (23%) are the top issues that registered voters say will be most important in deciding their vote for president.”

In no small way, the power of a democratic vote can have wide-ranging implications for a nation’s healthcare. The road, however, travels both ways. According to a wealth of research, an individual’s health may influence whether or not they vote.

Article highlights:

A review from July 2020, which appears in the journal Public Health Reviews, takes a long look at the relationship between health and voting.

The authors examine earlier research to understand the impact of poor health on an individual’s chance of voting. They also ask how to increase voter turnout among people with chronic health conditions.

Looking for associations between voting and health, the authors identified 17 relevant studies. Overall, they found that “[l]ower voting rates are consistently associated with poor self-rated health.”

One study that the researchers included in the review took information from the 2005 European Social Survey. In total, this included data from 2,286 people in Ireland. It found that people who reported poorer health were less likely to vote than people who reported good health.

The authors of the Irish study also found that, paradoxically, people who were less satisfied with the health service were less likely to vote. However, to demonstrate the complexity of these matters, the researchers found that people with poor health who were also dissatisfied with the health service were more likely to vote.

Interestingly, in this study, mental well-being did not appear to influence voter turnout. Contrary to this but in general agreement overall, a study in Britain found that “individuals with poor general and mental health and [people who smoke] are less likely to vote at election time.”

Meanwhile, the authors of a Norwegian study echo the findings of others, reporting that voting participation in local elections “is positively associated with self-assessed health.”

Looking at the world at large, one study took information from the World Value Survey, which included data from 50,859 people in 44 countries. Its authors write:

“People who participated in voting and voluntary social activities tended to report better subjective health than those who did not vote or participate in social activities, after controlling for sociodemographic factors at the individual level.”

Another study, which looked at data from 30 countries in Europe, once again found that poorer health predicted worse voter turnout. In this analysis, the team also identified that the relationship between health and voting was more pronounced in older adults.

Taking a slightly different approach, researchers in Sweden looked at the relationship between mortality and voter registration, among other factors. They followed approximately 95,000 people for 4–21 years.

They found that males aged 65 or older who lived in regions with lower voting turnout had an increased risk of all-cause mortality. They also found that, for males, a “higher election participation rate [was] negatively and significantly associated with the mortality risk from cancer.”

It is worth reiterating that correlation does not prove causation, but there are clearly deep lines running between health and voting.

For information on how to vote safely, download our Safe Voting Guide here:

In the Public Health Reviews paper, the authors also dig into the impact of specific health conditions. Overall, they summarize that “[p]eople with physical, intellectual, and psychological disabilities have lower rates of voting.”

One study included in the review looks at the relationship between depression and political participation. Currently, healthcare experts are concerned about the global mental health impact of COVID-19, making this topic particularly relevant to the upcoming election.

The author found that depression was associated with reduced voting participation. He explains how “voter turnout and other forms of participation decrease as the severity of depressed mood increases.” The paper argues that this might be, at least in part, due to feelings of hopelessness and apathy.

Turning to physical illness, one 2017 study looked at the impact of influenza outbreaks on voting behavior in Finland and the U.S. Using statistical models, the authors conclude that, in both countries, influenza outbreaks were associated with lower voting rates.

Another study, which focused on five chronic conditions, found differing effects. After adjusting their analysis for a range of factors, including sociodemographic characteristics, the authors conclude:

“[I]ndividuals with cancer diagnoses are more likely to vote, while those with heart disease diagnoses are less likely to vote.”

Other research supports this finding. A study that researchers conducted in Finland, which appears in the Journal of Epidemiology and Community Health, showed that people with chronic obstructive pulmonary disease and people with cancer were more likely to vote than people with mental health conditions, alcohol abuse disorder, or neurodegenerative conditions.

The team also found that “[h]aving more than one condition at a time further decreased voting probability.”

Some experts believe that having strong support networks within the cancer community might help encourage voting behavior. As the authors of the article in Public Health Reviews write, “For example, people with breast cancer form more than 40 times more support groups than people with heart disease.”

The authors also explain that there might be less stigma attached to cancer than there is to other health conditions.

Looking at disabilities in general, one study analyzed data from the U.S. elections in 1998. The researchers found that voter turnout was 20% lower in people with disabilities than in people without disabilities.

Among those with a disability, voting rates were lowest for people without employment, people aged 65 or older, people who recently experienced the onset of a disabling condition, and individuals who have difficulty going outside alone. This is despite the availability of absentee ballots.

Although scientists are still teasing out the various strands of this phenomenon, the mechanisms behind it are likely to be complex and vary by condition.

Some researchers argue that social connectedness might play a part. As the authors of the study that investigated 30 European countries write, “poor health may weaken an individual’s social network, which, in turn, depresses electoral participation.”

Individuals who are embedded in a social network might discuss the election, reinforcing voting patterns.

Another relevant issue is that some people attach stigma to certain conditions, which might reduce a person’s desire to participate. And, as we mentioned earlier in this article, the symptoms of some mental health conditions can include apathy and hopelessness, both of which can reduce motivation to participate.

Speaking specifically about depression, one author explains how people with this condition can express lower levels of internal efficacy, leading to thoughts such as “I’m incapable of making a difference,” and external efficacy, leading to thoughts such as “the government doesn’t care what I think.”

The authors of another paper explain how “disability, apart from imposing resource constraints, often has social and psychological effects that decrease voter turnout through decreased social capital and identification with mainstream society, particularly among [older adults].”

“Social capital” is a term that appears commonly in this body of research. Experts define the term as “shared norms, values, beliefs, trust, networks, social relations, and institutions that facilitate cooperation and collective action for mutual benefits.”

Research suggests that lower levels of social capital are associated with poorer self-reported health and all-cause mortality.

Although connections are apparent, scientists will need to conduct more research to explore the complex links between social capital, health, and voting.

The authors of the Public Health Reviews article explain how the impact of health on voting can cause a negative cycle. People with ongoing health concerns are more likely to support a party that offers more comprehensive healthcare reforms.

However, as we have learned, these individuals are less likely to vote. The authors explain:

“[W]orse health leads to lower voting rates, leading to policy that does not prioritize addressing inequities, leading to worsening health inequities.”

A literature review that addresses this issue calls on “nurses, their employers, and policymakers [to ensure] that patients can exercise their right to vote.”

Other authors “call for social work professionals to develop, implement, and evaluate interventions that increase civic engagement opportunities for [residents in nursing homes].”

Some studies have focused on ways in which governments might adapt the voting process to increase voting among individuals with poor health. One study found that, in particular, proxy voting boosted participation for these people. The authors suggest that offering this service at hospitals could go some way toward reducing the impact of ill health on voter turnout.

Using a direct approach, one team of researchers “undertook a clinician-led, nonpartisan voter registration drive within two university-affiliated federally qualified health centers in the Bronx, New York.”

Voter registration volunteers approached 304 patients in clinic waiting areas over a 12-week period. Of these, 128 patients were eligible to vote but not registered. In total, 114 (89%) registered to vote through this project. The authors conclude:

“Clinics are not only health centers, but also powerful vehicles for bringing a voice to civically disenfranchised communities.”

This is a complex and multifaceted issue. There is no quick fix, but by being aware of the issue, we can begin to look at ways to solve it.

With mental health at the forefront of people’s minds in these troubling times, it is worth reaching out to our networks to promote the benefits of voting.

To check your voter registration status, click here to visit the website of VoteAmerica, a nonprofit, nonpartisan organization dedicated to increasing voter turnout. They can also help you register to vote, vote by mail, request an absentee ballot, or find your polling place.