A Healthy Democracy? Evidence of Unequal Representation Across Health Status

  • Julianna PachecoEmail author
  • Christopher Ojeda
Original Paper


Research on the link between health and political behavior has flourished, yet there have been no analyses regarding the political consequences of health inequalities. Using data from the 2012 CCES, we find that health is associated with representation. Healthy individuals are better represented compared to unhealthy citizens; this positive association is particularly true for individuals in the top third income group and when citizens are represented by Republicans. We explore two mechanisms that may account for this association. The participatory mechanism suggests that healthy individuals are better represented due to differences in political participation while the preferential mechanism suggests that differences are due to shifts in policy preferences. Overall, we find little evidence that either mechanism fully accounts for the association between health and representation. While the results clearly suggest that political clout is not just about income, but also health, scholars are encouraged to further explain this association.


Representation Health Political participation Responsiveness 



A previous version of this paper was presented at the Annual Meeting of the Midwest Political Science Association. We thank members of the Rooney Center of Democracy at the University of Notre Dame, the American Politics Group at the University of North Carolina, and the Public Policy Center at the University of Iowa as well as anonymous reviewers for their insightful comments and suggestions. All errors are our own.

Supplementary material

11109_2019_9541_MOESM1_ESM.docx (342 kb)
Supplementary material 1 (DOCX 342 kb)


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.The University of IowaIowa CityUSA
  2. 2.The University of TennesseeKnoxvilleUSA

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