The influence of various measures of health on different types of political participation

Date01 November 2019
Published date01 November 2019
DOI10.1177/0263395719844700
Subject MatterArticles
https://doi.org/10.1177/0263395719844700
Politics
2019, Vol. 39(4) 480 –513
© The Author(s) 2019
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DOI: 10.1177/0263395719844700
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The influence of various
measures of health on
different types of political
participation
Daniel Stockemer
University of Ottawa, Canada
Carolin Rapp
University of Copenhagen, Denmark
Abstract
Recent research in political behaviour suggests that poor health can be an impediment for individuals
to vote. At the same time, researchers argue that health may both hinder and reinforce other forms
of political participation. With respect to these ambiguous expectations, our study asks: does the
relationship between health and political involvement depend on how we measure health? We
answer this question for two of the most widely used health indicators, self-reported health and
being hampered by illness in daily activities. We use the European Social Survey (ESS) (N = 35,000)
covering 20 European countries and find that the measurement of health indeed matters: our
results illustrate that bad self-reported health is an impediment to voting, but not to other forms
of political activity. When it comes to our second indicator, being hampered in daily activities, we
also find a negative relationship with voting. Yet, our results also indicate that most individuals, who
are hampered by illness in their daily lives, have a tendency to participate more regularly in most
other forms of political activity, including boycotting, contacting a politician, or signing a petition.
Robustness checks including waves 1–6 of the ESS support these findings.
Keywords
Europe, hampered by illness, health, political participation
Received: 26th June 2018; Revised version received: 21st March 2019; Accepted: 27th March 2019
Introduction
The question of why, when, and how individuals participate in the political process is
probably one of the best-researched questions in Political Science. We know that an
Corresponding author:
Daniel Stockemer, School of Political Studies, University of Ottawa, 120, University, Ottawa, ON K2N 6G2,
Canada.
Email: dstockem@uottawa.ca
844700POL0010.1177/0263395719844700PoliticsStockemer and Rapp
research-article2019
Article
Stockemer and Rapp 481
individual’s likelihood to actively engage in politics is determined by money, time, and
civic skills (Brady et al., 1995); by socio-economic and socio-demographic factors (Smets
and van Ham, 2013); by personality traits (Gallego and Oberski, 2012); as well as by feel-
ings of deprivation and unequal treatment (Taylor et al., 1987). However, recently, a new
factor, an individual’s health, has become prominent in the political participation litera-
ture (Gollust and Rahn, 2015; Wass et al., 2017). Several studies unambiguously under-
score that poor health hampers an individual’s likelihood to vote (among others Mattila
et al. 2013; Söderlund and Rapeli, 2015). Yet, the influence of poor health towards other
forms of political action seems to be more complex. In this article, we aim at disentan-
gling this relationship by going back to a more conceptual level, that is, the way we
measure poor health. In detail, we ask the following research question: does the relation-
ship between individual health and political involvement depend on how we assess poor
health?
To answer this question, we distinguish two health indicators – self-reported health
and being hampered by illness in daily activity – and test both indicators’ relationship
with different forms of political engagement (Barnes, 1979; van Deth, 2009). In doing
so, we combine insights from prior research on the effects of different health indicators
(Burden et al., 2017; Mattila et al. 2018; Wass et al., 2017) as well as the numerous
research measuring the influence of poor health on different forms of political participa-
tion (Söderlund and Rapeli, 2015). Using data from the European Social Survey (ESS)
(2014; N = 35,000), we receive a nuanced picture about the relationship between differ-
ent health indicators and different forms of political participation.
In sum, we can conclude that both forms of health put a drain on voting. In contrast,
the effect of any of the two health measures on the six other types of political participation
– contacting a politician, signing a petition, participating in a boycott, wearing a cam-
paign badge, being a member of a political party, and contacting a politician – is more
nuanced. For one, self-reported health does not have any relevant relationship with any of
these types of political activities. In contrast, the second health indicator, being hampered
by illness in daily activity, shows a positive, albeit small, relationship with most of these
forms of political participation: individuals, who feel hampered by illness in daily activ-
ity, have a slightly higher likelihood to contact a politician, sign a petition, wear a cam-
paign badge, and boycott. These findings hold if we test their robustness with others
waves of the ESS (waves 1–6).
This article proceeds as follows: first, we briefly situate this study within the health
and political participation literatures and explain our contribution; second, we explain our
variables, data, and methods; third, we present our results; and finally, we conclude and
provide some avenues for future research.
Theory and measurement of health
The literature on the relationship between poor health and various forms of political par-
ticipation has made great advances in recent years. Theoretically, scholars have identified
two rather contradicting mechanisms. The first relies on an amended form of the resource
model of political participation (Brady et al., 1995). In its original form, the model con-
siders time, money, and civic skills as essential communication and organizational capac-
ities to engage in political action (Brady et al., 1995). Scholars in the field of health and
political participation add health as an additional individual resource (Gollust and Rahn,
2015). If this resource, that is, being in good health, is not present or scarce, then
482 Politics 39(4)
individuals’ levels of participation in political activities should be lower. The assumption
is that poor health can hamper political participation both directly and indirectly (Couture
and Breux, 2017). Directly, ailing health might make it physically harder to go to the
polls, turn out for a rally, or walk in a demonstration (Schur and Kruse, 2000).
More indirectly, dealing with illness (both mentally and physically) might consume a
lot of time and energy, which makes political engagement harder or simply impossible
(Mattila et al., 2013). In addition, individuals who suffer from severe health conditions
might also be disadvantaged professionally, for example, they have higher rates of unem-
ployment, a lower educational level, or, if they have a job, they might not climb the pro-
fessional ladder as quickly as the more healthy ones. Therefore, they might not acquire
the same amount of civic skills as healthy individuals, which, in turn, can lower their
likelihood to participate politically. Finally, citizens with a physical or mental impairment
are also likely to lose their political interest – a well-known indicator pushing political
behaviour (Marx and Nguyen, 2016).
The second mechanism explaining the relationship between individual health and
political involvement takes a rational choice perspective.1 This approach focuses on the
costs and benefits of participation and encourages the idea that even though poor health
is accompanied by less resources, those suffering from poor health could be more likely
to take part in various forms of political participation such as boycotting or signing a peti-
tion to make their voices heard (Taylor et al., 1987). According to Stryker et al. (2000),
individuals with health issues have an increased self-interest, which makes them more
likely to be activated through collective action. To overcome certain disadvantages – such
as less favourable policies or unequal political representation – they might even engage
in rather unconventional forms of collective action, such as demonstrating or boycotting.
Partaking in these intense forms of political actions can ensure that the government pro-
vides the necessary social services they need or aim for. Alternatively, participation in
these actions might allow them to make their voices heard as well as attract political and
societal attention (Söderlund and Rapeli, 2015).
But which of these two perspectives prevails? There is a consensus in the academic
literature on voting behaviour that poor health discourages voting by directing attention
away from political matters to more personal ones (Pacheco and Fletcher, 2015). Poor
health makes citizens feel less politically efficacious (Mattila et al., 2013; Schur and
Kruse, 2000). Furthermore, it reduces an individual’s general interest in electoral politics
(Pacheco and Fletcher, 2015). Yet, for other forms of political participation, the literature
is less clear whether the resource theory or its competitor, the rational choice perspective,
prevails. For example, while confirming that poor self-reported health diminishes some-
body’s likelihood to vote, Söderlund and Rapeli (2015) find no influence of perceived
health on contacting a politician, signing a petition, and boycotting. Mattila et al. (2018)
evaluate the effect of two indicators of health – self-reported health and disability – on six
different forms of political participation, that is, voting, contacting a politician or public
official, working for an organization or association besides a political party, signing a
petition, boycotting a product, and expressing a political opinion on social media. In
a nutshell, the authors confirm that poor health, regardless of how it is measured, triggers
a decreased likelihood to cast one’s vote. Yet, in their study, the relationship between
health and other forms of political participation is more complex; sometimes it is positive
and sometimes it is negative.
We try to advance our knowledge between health and political engagement on a more
conceptual level. We ask the question, does it matter how we measure poor health in

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