Individuals experiencing poor health are less likely to vote at election time, despite being the ones most affected by health policies implemented by the successful party. This paper investigates the relationship between health and voter turnout and political party choice in the 1979, 1987 and 1997 British general elections using the National Child Development Study (NCDS). It finds that poor health is associated with lower turnout, as the perceived costs of voting, such as the physical and mental effort involved, are greater than the perceived benefits, which are derived from the policy implications of the election outcome. In addition, the subset of unhealthy individuals who do vote at election time generally support Labour, as such voters are more likely to utilise the NHS and hence support parties that advocate public provision of health services. Given the low participation rates of the unhealthy, a political party which formulates an attractive policy package aimed at such potential voters could therefore mobilise a previously untapped source of the electorate.Health Status, Voter Turnout, Political Party Choice

Kevin Denny

Patrick Orla Doyle

English

Research Papers in Economics

 
 
 
 
 
 
UCD CENTRE  FOR  ECONOMIC  RESEARCH 
 
 
 
WORKING  PAPER  SERIES  
 
 2005 
 
 
             “…Take up thy Bed, and Vote” 
                     Measuring the Relationship between Voting Behaviour and 
                              Indicators of Health 
    
            Kevin Denny and Orla Doyle, University College Dublin  
 
 
 
WP05/22 
 
November 2005 
 
 
 
 
 
 
 
UCD SCHOOL OF ECONOMICS 
UNIVERSITY COLLEGE DUBLIN 
BELFIELD  DUBLIN  4 
 
 
 
 
 
 
 
 
 “…Take up thy Bed, and Vote” 
 
Measuring the Relationship between Voting Behaviour and 
Indicators of Health
*
 
 
 
Kevin Denny  ‡†  
Orla Doyle † 
 
 
 
‡ UCD School of Economics 
† UCD Geary Institute 
University College Dublin 
 
 
14
th November 2005 
 
 
 
 
Abstract 
Individuals experiencing poor health are less likely to vote at election time, despite 
being the ones most affected by health policies implemented by the successful party. 
This paper investigates the relationship between health and voter turnout and political 
party choice in the 1979, 1987 and 1997 British general elections using the National 
Child Development Study (NCDS). It finds that poor health is associated with lower 
turnout, as the perceived costs of voting, such as the physical and mental effort 
involved, are greater than the perceived benefits, which are derived from the policy 
implications of the election outcome. In addition, the subset of unhealthy individuals 
who do vote at election time generally support Labour, as such voters are more likely 
to utilise the NHS and hence support parties that advocate public provision of health 
services. Given the low participation rates of the unhealthy, a political party which 
formulates an attractive policy package aimed at such potential voters could therefore 
mobilise a previously untapped source of the electorate.  
 
 
Keywords: Health Status, Voter Turnout, Political Party Choice 
                                                 
* Corresponding author: kevin.denny@ucd.ie. Tel: (+353 1) 716 8399. Fax: (+353 1) 283 0068. 
Address: School of Economics, University College Dublin, Belfield, Dublin 4, Ireland. Permission to 
use the NCDS given by the ESRC Data Archive at Essex is gratefully acknowledged. Thanks to Liam 
Delaney, David Madden and Pat Wall for comments and suggestions. 
  1I. Introduction 
Individuals experiencing poor health are more affected by changes in health policy 
than those who are well. Therefore one might expect the unhealthy to be more likely 
to turnout to vote at election time, since the health policies implemented by the 
successful party will influence them directly. It is important to investigate if this is 
indeed true, given that poor health may also act as a barrier to voting. Unhealthy non-
voters, therefore, represent an untapped source of electoral support. If a political party 
formulates an attractive policy package aimed at the unhealthy it could succeed in 
mobilising a whole new set of voters.  
 
While a number of studies have documented the relationship between health and 
voting behaviour at a constituency level,
1 
2 none to date have investigated whether 
this relationship persists at an individual level, that is, whether an individual’s health 
influences their voting behaviour. This paper fills this gap by examining the 
association between health and two aspects of voting behaviour, participation in 
general elections and political party choice. Our indicators of health include a self-
assessed measure of general health, an index of mental health and smoking and 
alcohol consumption.  
 
It is likely that health status influences both voter turnout and political party choice. 
As voting requires a physical, and to some extent, a mental effort, poor health is likely 
to reduce the probability of voting. A study of voter turnout among the disabled finds 
that those with spinal cord injuries are 10% less likely to vote compared to otherwise 
similar individuals.
3 Studies investigating the direct link between health and voter 
turnout within the general population are few, and have typically relied on aggregate 
level data. For example, a study of mortality rates and turnout at a constituency level 
in Britain, finds a negative correlation between the two.
1 Similar results have been 
found in a study of life expectancy and turnout in Russia, and self-reported general 
health and state level voter turnout in the US.
 4 
5  
 
Health status may also influence political party choice. Voters with poor physical and 
mental health are likely to utilise health services, therefore, they will benefit from 
supporting a party which is favourable to the NHS. Two previous studies, which have 
  2examined mortality and voting behaviour in Britain, find that constituencies that 
support Labour have higher mortality rates than constituencies that support the 
Conservatives.
1 2 These results have been replicated in studies of America and Russia.
 
6 7 In addition, a positive relationship is found between dissatisfaction with health, 
adverse lifestyle factors and support for left-wing parties in Ireland.
8 Similarly, a 
study of outpatients with chronic mental health in Germany reveals that such 
individuals tend to support left-wing parties.
9 Political party choice, therefore, is an 
indicator of voters’ social policy preferences.
8
 
This paper examines whether the relationship between health and voting behaviour 
found at the aggregate level can be replicated at the individual level. We relate health 
status to electoral participation and political party choice over the course of three 
British elections. 
 
II. Data  and  Methods 
The data for the analysis is based on the National Child Development Study (NCDS) 
which follows a cohort born in 1958. Our two variables of interest are voter turnout 
and political party choice in the 1979, 1987 and 1997 elections. We restrict party 
choice to support for the Conservatives, Labour and the Liberal Democrats (for 
comparability across elections this includes support for the Liberal party, Social 
Democratic Party, and the Alliance). The first health variable is a self-assessed 
measure of general health indicating whether the respondent reported excellent/good 
health, or alternatively, poor/fair health. The second variable, reflecting mental health, 
is the “malaise inventory score” developed by Rutter et al and is based on the Cornell 
medical index.
10 This self-completed scale is derived from summing 24 psychological 
and somatic items, such as anxiety, sleeping problems, and irritability.
11 A score 
above 7 is associated with a high risk of psychiatric morbidity. The third health 
variable indicates whether the respondent is a smoker or not, and the final indicator 
measures the respondent’s alcohol consumption. The measure of alcohol consumption 
is derived from the number of alcoholic drinks consumed in the week prior to the 
survey. The total number of units of alcohol consumed is found by summing the 
number of units of beer (1 pint=2 units), wine (1 glass of wine=1.5 units), spirits (1 
measure=1 unit) and martini/sherry drinks (1 measure=1 unit) consumed in a week. 
  3Based on this, a variable indicating whether the respondent (1) abstains from drinking, 
(2) is a moderate drinker or (3) is a heavy drinker, is derived. Moderate drinking is 
defined as consuming 14 or less units per week for a woman and 21 for a man, while 
consuming above these units corresponds to excess drinking.   
 
As turnout is a binary outcome a probit regression model
12 is estimated for each 
election, with the four health indicators as covariates, in addition to a range of 
demographic and socio-economic controls. As our measure of political party choice is 
categorical, that is, the choice between Conservative, Labour or Liberal Democrats, 
we estimate a multinomial logit model
12. The empirical analysis is estimated using 
Stata, version 9. The tables report marginal effects: the effect of a unit change in the 
covariates on the probability of a given outcome. 
 
III. Results 
Table 1 reports the results of the voter turnout model for each election. Controlling for 
additional socio-economic and demographic factors, poor general health, poor mental 
health, smoking and abstaining from drinking are all associated with lower turnout. 
Individuals with poor general health are about 4% less likely to vote both in the 1979 
and 1997 elections. Similarly, smokers are 4% less likely to vote in the 1979 and 1997 
elections and 3% less likely to vote in the 1987 election compared to non-smokers. 
There is also a negative relationship between mental health and turnout in the first two 
elections. While this effect varies slightly over time, it is quantitatively rather small: a 
one standard deviation increase in the malaise score is associated with at most a 1.5% 
lower probability of voting. In addition, moderate drinkers are more likely to vote in 
all three elections than non-drinkers, while heavy drinkers have a greater probability 
of voting in the 1979 and 1997 elections.  
 
Table 2 reports the results of the political party choice model. Vote choice across all 
three elections appears to be influenced by health. While overall the unhealthy are less 
likely to turnout to vote, the subset of those who do vote consistently show less 
support for the Conservatives. This generates higher support for the other main 
parties, particularly Labour. Similarly, those with poor mental health show less 
support for the Conservatives and greater support for Labour in each election, while 
  4again having little impact on support for the Liberal Democrats. Being a smoker 
consistently increases support for Labour in each election, while it has the opposite 
effect on support for the Conservatives in 1987 and 1997. Smokers are less likely to 
support the Liberal Democrats in all three elections. The amount of alcohol consumed 
has no impact in 1979, however both moderate and heavy drinking are positively 
associated with support for the Conservatives in the latter two elections and 
negatively associated with support for Labour in 1997 and the Liberals in the 1987 
and 1997 elections. Additional analysis, not shown here, reveals that Labour voters 
are associated with beer drinking, while Conservatives are associated with wine and 
spirit drinking.  
 
IV. Discussion 
Electoral participation may be viewed as one form of social capital. A number of 
studies have noted the importance of social capital for generating both community and 
individual well-being.
13 
14 
15 Understanding the relationship between public health 
and political participation is therefore important. Previous work which has examined 
the relationship between health and voting behaviour has mainly relied on aggregate 
data at the constituency level. The type of health measures available at this level are 
quite restrictive, for example, most studies use either mortality rates or life 
expectancy, which may be viewed as extreme measures of ill health. In addition, some 
argue that such aggregate studies may suffer from the ecological fallacy.
1 This paper 
develops the literature by using individual level survey data to examine mental and 
physical health and two key determinants of health: smoking and alcohol 
consumption. 
 
Our results are consistent with the hypothesis that poor health is a contributory factor 
to individuals not engaging in political participation. As turnout among those with ill 
health is lower than those in good health, this suggests that the perceived cost of 
voting for unhealthy individuals, in regards the physical and mental effort involved in 
going to the polls, is greater than the perceived benefits of voting, which are derived 
from the policy implications of the election outcome. This may indicate that the main 
political parties do not differ enough in their policy positions on health to induce the 
unhealthy to turn out to vote for one party over another. If there were significant 
  5differences in the parties’ health policies, then the perceived benefits of voting may 
exceed the perceived costs and turnout among the unhealthy would be greater. 
Alcohol consumption is an exception to the bad health/low turnout hypothesis, in that 
higher consumption predicts a higher probability of voting. It is unclear why this is 
so. One might speculate that non-drinkers are, on average, less sociable and hence less 
likely to engage in pro-social activities such as voting. Without more detailed data on 
peoples’ drinking behaviour, we cannot test this hypothesis. 
 
For party choice we find that those characteristics that reduce the probability of 
turning out to vote increase the probability that an individual votes for Labour over 
the Conservatives. This confirms previous work that finds a positive relationship 
between ill health and support for left-wing parties. We also find that smokers are 
more supportive of Labour. That smokers identify with left-wing parties could reflect 
the traditional stereotype of working class Labour voters, however as we control for 
social background it appears that smoking has an independent influence. Our results 
therefore imply that voters with poor physical and mental health have different policy 
preferences to the healthy, specifically, unhealthy voters tend to favour parties that 
advocate greater public provision of health services. Indeed, further analysis of the 
data shows that Conservative voters are more in favour of private health insurance 
than Labour voters. As with turnout, alcohol is an exception to this principle: the more 
you drink the more likely you are to be a Conservative voter. However this is true for 
moderate (as well as heavy) levels of drinking which are not necessarily associated 
with poor health. That the Conservatives derive greater support from drinkers 
compared to smokers is unsurprising, as during the period 1979-1997 while the 
Conservatives were in power, taxes on cigarettes consistently rose, while taxes on 
alcohol either fell or remained unchanged.
16  
 
Voting is one barometer of the health of civil society, it is therefore important to know 
the extent to which individuals’ health constrains their political behaviour. This paper 
shows that poor health leads to lower electoral participation, which suggests that the 
interests of the unhealthy are less likely to be represented in government. A political 
party which succeeds in attracting the unhealthy non-voters into the electorate, by 
presenting a suitably targeted policy package, could help to minimise this inequality.  
 
  6Table 1 Modelling Voter Turnout   
 1979  1987  1997 
Poor General Health  -0.039** 
(0.017) 
-0.013 
(0.014) 
-0.046*** 
(0.013) 
Poor Mental Health  -0.005*** 
(0.002) 
-0.006*** 
(0.002) 
-0.003** 
(0.001) 
Smoker  -0.041*** 
(0.010) 
-0.031*** 
(0.010) 
-0.039*** 
(0.010) 
Moderate Drinker  0.027** 
(0.011) 
0.035*** 
(0.010) 
0.045*** 
(0.011) 
Heavy Drinker  0.025* 
(0.013) 
0.014 
(0.013) 
0.028** 
(0.012) 
      
Observations 11217  8638  8801 
Note: All models estimated using probit. The following variables are included but not reported – 
region of residence, gender, age left full-time education, whether stayed in school beyond 16, parental 
social class at birth and whether the respondent is married, has children, is unemployed or self-
employed at the time of each election. Marginal effects and standard errors (in parentheses) are 
reported. Significance levels: * : p <0.1 . **: p < 0.05. ***: p< 0.01 
 
Table 2 Modelling Political Party Choice 
 Conservatives  Labour  Liberal  Democrats 
   1979  Election   
Poor General Health  -0.069*** 
(0.024) 
0.044* 
(0.025) 
0.025 
(0.018) 
Poor Mental Health  -0.010*** 
(0.003) 
0.009*** 
(0.003) 
0.002 
(0.002) 
Smoker -0.016 
(0.013) 
0.040*** 
(0.014) 
-0.023** 
(0.009) 
Moderate Drinker  0.020 
(0.016) 
-0.021 
(0.017) 
0.001 
(0.011) 
Heavy Drinker  -0.009 
(0.019) 
0.018 
(0.020) 
-0.009 
(0.013) 
Observations   7076   
   1987  Election   
Poor General Health  -0.093*** 
(0.022) 
0.075*** 
(0.022) 
0.019 
(0.017) 
Poor Mental Health  -0.009*** 
(0.003) 
0.008*** 
(0.002) 
0.002 
(0.002) 
Smoker -0.067*** 
(0.015) 
0.098*** 
(0.015) 
-0.031*** 
(0.011) 
Moderate Drinker  0.039** 
(0.016) 
-0.012 
(0.015) 
-0.027** 
(0.011) 
Heavy Drinker  0.049** 
(0.021) 
-0.005 
(0.020) 
-0.044*** 
(0.013) 
Observations   6353   
   1997  Election   
Poor General Health  -0.065*** 
(0.017) 
0.051*** 
(0.019) 
0.014 
(0.014) 
Poor Mental Health  -0.004* 
(0.002) 
0.006*** 
(0.002) 
-0.002 
(0.001) 
Smoker -0.038*** 
(0.014) 
0.055*** 
(0.015) 
-0.017* 
(0.010) 
Moderate Drinker  0.038** 
(0.016) 
-0.039** 
(0.017) 
0.001 
(0.011) 
Heavy Drinker  0.061*** 
(0.018) 
-0.036* 
(0.019) 
-0.025** 
(0.012) 
Observations   6410   
Note: All models estimated using multinomial logit. The following variables are included but not 
reported – region of residence, gender, age left full-time education, whether stayed in school beyond 
16, parental social class at birth and whether the respondent is married, has children, is unemployed or 
self-employed at the time of each election. Marginal effects and standard errors (in parentheses) are 
reported. Significance levels: * : p <0.1 . **: p < 0.05. ***: p< 0.01 
  7References 
 
                                                 
1 Davey Smith G, Dorling D. “I’m all right, John”: Voting patterns and mortality in England and 
Wales. British Medical Journal 1996; 313: 1573-1577. 
 
2 Dorling D, Davey Smith G,  Shaw M. Analysis of trends in premature mortality by Labour voting in 
the 1997 general election. British Medical Journal 2001; 322: 1336-1337. 
 
3 Schur L.A, Douglas L.K. What determines voter turnout? Lessons from citizens with disabilities. 
Social Science Quarterly 2000; 81: 571-587. 
 
4 Reitan T.C. Too sick to vote? Public health and voter turnout in Russia during the 1990’s. Communist 
and Post-Communist Studies; 2003; 36: 49-68. 
 
5 Blakely T.A, Kennedy B.P, Kawachi I. Socioeconomic inequality in voting participation and self-
rated health. American Journal of Public Health 2001; 91: 99-104.  
 
6 Kondrichin S.V, Lester D. Voting conservative and mortality. Perceptual and Motor Skills 1998; 87: 
466. 
 
7 Kondrichin S.V, Lester D. “I’m all right Jack” in Russian too. Perceptual and Motor Skills 1999; 88: 
892. 
 
8 Kelleher C, Timoney A, Friel S, McKeown D. Indicators of deprivation, voting patterns, and health 
status at area level in the Republic of Ireland. Journal of Epidemiology and Community Health 2002; 
56: 36-44.  
 
9 Bullenkamp J, Voges B. Voting preferences of outpatients with chronic mental illness in Germany. 
Psychiatric Services, 2004; 55(12): 1140-1442. 
 
10 Rutter M, Tizard J, Whitmore K. Education, Health and Behaviour. London: Longmans, 1970. 
 
11 Rodgers B, Power C, Collishaw S, Maughan B. Validity of the malaise inventory in general 
population samples. Social Psychiatry and Psychiatric Epidemiology 1999; 34: 333–341. 
 
12 Long J.S. Regression Models for Categorical and Limited Dependent Variables. London; Thousand 
Oaks: Sage Publications, 1997. 
 
13 Putnam R.D. Bowling Alone The Collapse and Revival of American Community. New York, NY: 
Touchstone, 2000. 
 
14 Kelleher C, Lynch J, Harper S, Tay J, Nolan G.  Hurling alone? How social capital failed to save the 
Irish from cardiovascular disease in the United States. American Journal of Public Health 2004; 94: 
2162-2169. 
 
15 Wilkinson R.G. Health and Society: The Afflictions of Inequality. London, England: Routledge, 
1996.  
 
16 Stuart A. A survey of the UK tax system. Institute for Fiscal Studies (IFS) Briefing Note, BN09, 
2004. http://www.ifs.org.uk/publications.php?publication_id=1711 (accessed 8 Nov 2005). 
 
 
  8

“…Take up thy Bed, and Vote” Measuring the Relationship between Voting Behaviour and Indicators of Health

http://www.ucd.ie/economics/research/papers/2005/WP05.22.pdf

“…Take up thy Bed, and Vote” Measuring the Relationship between Voting Behaviour and Indicators of Health

Abstract

Similar works

Full text

Available Versions

Research Papers in Economics