A Healthy Democracy? Evidence of Unequal Representation Across Health Status

Julianna Pacheco & Christopher Ojeda

Health affects nearly every aspect of our lives and recent research finds that politics is no different. American citizens who are in better health participate more often and hold different policy preferences than those who are in poor health. But do these health-related disparities in participation and opinions have political consequences? Are the voices of the those in good health privileged over those in poor health? And are some politicians more responsive to health-disparities among their constituents than are other politicians?

To answer these questions, we analyzed data from the 2012 Congressional Cooperative Election Study, which is a nationally representative survey of Americans. We compared the preferences of constituents to the votes of their member of Congress (MC) to determine how responsive politicians are to the public. We find that MCs are more likely to vote in line with the preferences of constituents in good health. This is especially true in districts where constituency preferences diverge across health status. We call this finding a “health bias” in representation.

But we didn’t stop there. We also wanted to know whether this unequal responsiveness cut across party lines and what factors might explain it. To determine if Republican or Democratic MCs were especially unequal in their response, we re-analyzed the data based on the party identification of the politician. We found extreme differences: Republican MCs were especially responsive to those in good health, while Democratic MCs were not any more responsive to one group or another. In short, the extent to which health is a basis for unequal responsiveness is entirely driven by Republicans.

We tested two explanations for this unequal responsiveness. The first explanation is based on health-disparities in participation. If those in good health participate more than those in poor health, then politicians might come to believe that their electoral fortunes depend on satisfying their constituents who are in good health. The second explanation is based on health-disparities in preferences. Shifts in health lead could lead to shifts in preferences that break a prior alignment between constituents and representatives. Both of these patterns could explain our findings, but in fact we find mixed evidence to support either explanation. More research is required to better understand why we observe this unequal responsiveness.

Over the past fifteen years, scholarship has highlighted the ways in which politicians privilege the voices of some citizens over others. This research has revealed that the rich, men, and White Americans are disproportionately represented in the roll call votes of representatives. To this line of research, we would add that health inequalities matter too. We hope that scholars continue to study the politics of health disparities and how they undermine the success of our democracy.



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