Health and Political Engagement

Mikko Mattila, Lauri Rapeli, Hanna Wass, Peter Söderlund

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317202110
• Edition: 1
• Topic: Politics & International Relations
• Subtopic: Politics
• Index: Politics & International Relations

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.

1 Introduction

Health and political engagement

There is a growing recognition that “health and illness shape who we are politically” (Carpenter, 2012, p. 303). The relationship between health and political behaviour is vitally important from both a scholarly and a policymaking perspective, and yet the topic has typically attracted more attention from scholars working in health-related fields than from political scientists.

This book is the first attempt by political scientists to offer a comprehensive account of how personal health and political engagement are related. It is arguably a timely contribution to the extensive body of literature on political participation, ideological orientations and vote choice. Although a vast amount of research has shown that engagement in politics is strongly connected to socio-economic status, as well as psychological factors, only a few studies have focused on the role of health (Smets and van Ham, 2013). In this book, we review previous research to establish the state of the art regarding this discipline, as well as conduct extensive empirical analyses concerning health and political engagement. On the basis of a solid theoretical framework, we test several hypotheses in order to understand the mechanisms contributing to the association between health and political engagement. We also look at how the association between health and engagement is affected by contextual factors, along with examining the political representation of people in poor health.

Considering health as a predictor of various aspects of political engagement is not entirely new as an idea (for a review, see Blank and Hines, 2001, pp. 91–3; Peterson, 1990, pp. 82–6), but social scientists have only recently begun to explore the connections with growing enthusiasm. There are several plausible reasons for such a rise in scholarly interest in the subject. Most noteworthy is the fact that health status has a considerable direct impact on the problem of political inequality. Health disparities are a major contemporary issue in many Western democracies. Differences in personal health and well-being are increasing, even in established welfare states such as the Nordic countries (OECD, 2015). As people are nowadays living longer than ever before, the proportion of pensioners is increasing. As a consequence, the number of citizens whose political behaviour could be affected by health problems is also growing. Health disparities are therefore likely to translate into unequal political participation in Western democracies.

The book is aimed at a broad spectrum of readers: scholars, students and policymakers with a professional interest in health, politics and equal opportunities for democratic citizenship. It will be useful as a textbook, as well as a handbook for anyone interested in fields such as political science, sociology, social medicine, social capital, nursing and health sciences. Our overarching theme is political equality. We show that poor health can influence an individual’s resources and motivation for political engagement through multiple channels. Understanding the link between these two not only increases our knowledge of the mechanisms of political behaviour but helps to promote more inclusive democratic processes.

Health and inequality

Over the past decade, several influential studies have identified growing inequality as one of the urgent risks faced by contemporary societies (e.g., Atkinson, 2015; Dorling, 2014, 2015; Jensen and van Kersbergen, 2017; Galbraith, 2016; Grusky and Kricheli-Katz, 2012; Marmot, 2015; Putnam, 2015; Savage, 2015; Stiglitz, 2012; Therborn, 2013; Wilkinson and Pickett, 2009). This applies particularly to market-liberalist countries, such as the US, where income heavily differentiates various opportunities and outcomes (Enns, 2015, p. 1060). Although inequality has been less pronounced in the Nordic welfare states, which are traditionally characterized by progressive taxation and extensive redistribution, a recent OECD report (2015) reveals that income inequality has also risen in Sweden, Finland, Norway and Denmark since the mid-1980s. However, from a comparative perspective, income disparities are still relatively modest in these countries.

Health is an important component in terms of both illustrating and contributing to inequalities. In their often-cited comparative study, Wilkinson and Pickett (2010) showed that health and various types of social problems were related to income inequality in rich countries (see also Hiilamo and Kangas, 2014; Pickett and Wilkinson, 2015). This association suggests that inequality harms everyone’s health, not just those living in poverty. The potential path between the two is complex: income differences may increase social distances, which accentuate status differences, which in turn increase status competition, social evaluation anxiety and lower self-esteem, which is harmful for all social groups (Jensen and van Kersbergen, 2017, p. 26). The same holds at the individual level, which can be best captured by the concept of ‘social gradient’. The link between socio-economic status and health not only concerns those in poverty but all citizens: the lower a person’s socio-economic status, the worse his/her health (Marmot, 2015, p. 15).

Economic inequality is reflected in social inequality; in turn, these two forms of inequality jointly affect political engagement and representation. Political participation is affected by a person’s overall level of well-being, social networks and life situation. While this is particularly evident when it comes to voting, socio-economic factors also increase the likelihood that a person will become involved in other forms of participation, such as taking part in demonstrations and signing petitions. These factors also affect a person’s sense of political agency, political interest and political knowledge, the attention he/she pays to electoral campaigns and the trust he/she has in political institutions (see e.g., Grönlund and Wass eds., 2016). In terms of representation, the results from the US, where the issue has been extensively addressed at an empirical level, are depressing. As Gilens (2015, p. 1070) summarizes: “Of course, affluent Americans do not always get the policies they prefer either. But the affluent are twice as likely to see the policies they strongly favor adopted, while the policies they strongly oppose are only one-fifth as likely to be adopted as those that are strongly opposed by the middle class.” (for an alternative view, see Enns, 2015).

In this book, the primary questions that we examine concern whether health has a corresponding effect, i.e., how health problems affect political engagement and whether this effect is reflected in political outcomes. Obviously, this is a gradual process (see Jensen and van Kersbergen, 2017, pp. 115–16). The first step is preference formation: to what extent do citizens with good and poor health have different attitudes, perceptions and policy preferences? The second is preference articulation: to what extent do citizens with good or poor health differ in terms of their resources and motivation to participate in political processes, and are there any variations between different modes of participation? The third step is preference aggregation: do political elites respond equally to input from citizens with different levels of health?

These questions are important, not only for groups suffering from health problems, but also for the entire political system. In an inclusive democracy, the first step should be accessible to all kinds of citizens, regardless of their resources (Young, 2000). This is particularly warranted, since, in public debate, withdrawal from politics is sometimes regarded as a matter of individual choice, not involuntary exclusion and marginalization. Emphasizing the role of motivational factors may lead to the ‘responsibilization’ of the individual. From this point of view, people suffering from health problems simply do not take part in politics because they do not want to or are too preoccupied with other things to care. Too much concentration on motivational aspects ignores the association between various kinds of economic and societal inequalities and participation. In other words, it only emphasizes the motivation component in Verba, Schlozman and Brady’s well-known civic voluntarism model (1995), while disregarding the potential effect of health on resources and mobilization.

Interpreting health-related differences in political engagement among citizens with poor health, mainly as a consequence of an individual’s own choice, may build a kind of an ‘empathy wall’ (Hochschild, 2016) between citizens with and without health problems. As a concept, an empathy wall can be described as “an obstacle to deep understanding of another person” and his/her circumstances, which might be different than ours (ibid., 5). In the worst case scenario, such an empathy wall could lead to the failure to actively seek means by which to facilitate political engagement among citizens with health or functional limitations. In such a situation, disability status or poor health risks appear as more of a personal challenge than a social issue and a problem of citizenship (cf. Prince, 2014, p. 114). Yet, political participation is essentially collective action; ensuring its accessibility is also the responsibility of society. Schur, Kruse and Blanck’s (2013, p. 237) conclusion crystallizes the benefits of inclusive democracy: “Making full use of talents of people with disabilities would strengthen the economy, and ensuring that everyone’s voice is heard would make democracy stronger and more vibrant.”

Health: definition and trends

There are many ways to conceptualize health. According to McDowell (2006, p. 11), our current understanding of health has come a long way, from considering health merely in terms of human survival to a current emphasis on quality of life. In a comprehensive account of health measures, Bowling (2005) distinguishes between functional (dis)ability, broader health status, mental health, social health, subjective well-being and quality of life. The last two are also closely linked to the concept of life satisfaction. McDowell (2006) offers a similar categorization, which makes a distinction between physical and mental health, as well as a more general assessment of life quality.

This multitude of health dimensions is, however, not present in the literature concerning health and political participation. In studies of political participation, operationalizations of health have mostly been limited to indicators of self-rated health (SRH) and functional disability. SRH has been one of the most (if not the most) widely used, single-item indicator of health in sociological medicine since the 1950s (Jylhä, 2009, p. 307). It reliably predicts a number of various aspects of health and health-promoting behaviour (e.g., Fylkesnes and Forde, 1992).

The SRH measure is a survey item, which asks the respondent to evaluate his/her overall health status on either a four-point or a five-point scale. In some cases, the question is framed such that the respondent is asked to evaluate personal health in comparison with peers. According to Jylhä (2009), to produce this estimate of personal health in a survey setting, the individual performs a multi-stage evaluation, which includes several considerations of the relevant components of one’s health, previous illnesses and projections of future health, bodily sensations of various symptoms and comparisons with other people, among others. Segovia et al. (1989) found SRH to essentially measure a combination of worrying over health, suffering from a chronic medical condition or disability and estimating physical conditions and energy levels. A more recent study by Mavaddat et al. (2011) confirmed that SRH captures a multitude of physical, mental and social factors, although its predictive power is strongest in relation to physical health. In other words, assessments of SRH most reliably measure a person’s physical condition rather than mental health or social functioning. According to Mavaddat et al. (2011, p. 803), this is compatible with the extensive body of literature, which has found SRH to be closely associated with the ‘ability to perform physical functions’.

Despite the strong linkage between SRH and physical functioning, social scientists have also paid much attention to functional (dis)ability as a factor influencing political behaviour and participation (e.g., Schur et al., 2002). This is well grounded. As Bowling (2005, p. 4) explains: “[T]here is, then, a clear distinction ...

Table of contents

• Cover
• Half Title
• Series
• Title
• Copyright
• Contents
• List of figures
• List of tables
• Foreword
• 1 Introduction: health and political engagement
• 2 Theoretical framework
• 3 Health and political participation
• 4 Health and political orientations
• 5 Health and the social context
• 6 Health and political participation from a cross-national perspective
• 7 Health and political representation
• 8 Conclusions
• Appendix: data sources
• Index