Healthy voting: The effect of self-reported health on turnout in 30 countries Mikko Mattila a , Peter Söderlund b , Hanna Wass a, * , Lauri Rapeli c, d a Department of Political and Economic Studies, University of Helsinki, Helsinki, Finland b Department of Political Science, Åbo Akademi University, Finland c Department of Political Science and Contemporary History, University of Turku, Finland d Aronia Research and Development Institute, Raseborg, Finland article info Article history: Received 2 April 2013 Received in revised form 28 June 2013 Accepted 9 July 2013 Keywords: Health Turnout Social connectedness European social survey abstract Based on five rounds of European social survey (ESS), we examine both the direct and indirect effect of health, channelled by social connectedness, on turnout in 30 countries. Our analysis is the first attempt to make a comprehensive account of the magnitude of health in electoral participation. The results show that health has an effect on turnout and that it is notably larger among older people. The impact of health is partly mediated by social connectedness, which suggests that attenuated health may weaken an individual’s social network which in turn depresses voting. Ó 2013 Elsevier Ltd. All rights reserved. 1. Introduction A vast amount of research has shown that electoral participation is connected to demographic, socioeconomic and sociopsychological factors such as religiosity, party identification, political interest and a sense of political ef- ficacy. The potential of health-related explanatory variables has, however, remained largely unexplored. In their meta- analysis of 90 studies published in ten top journals in po- litical science between 2000 and 2010, Smets and van Ham (2013) found that altogether 170 different independent variables were used to account for turnout. Whereas none of them addressed physical health and only three mental health, a few studies published in other political science or medical journals have reported a statistically significant effect between physical or mental health and voting (e.g. Denny and Doyle, 2007a,b; 2009; Schur and Kruse, 2000; Schur et al., 2002). Based on European social survey (ESS) data, we examine both the direct and indirect effect of health on turnout in 30 countries. Given that previous studies have been restricted to individual countries, our analysis is the first attempt to make a comprehensive account of the magnitude of health in electoral participation. We argue that paying attention to the relationship between health and turnout is relevant for several reasons. Admittedly, the direct effect of health on participation may seem like stating the obvious: people with poor health have a lower capacity and motivation to follow politics and thus a lower propensity to vote. The overall effect may, however, be more nuanced. Given that poor health often weakens a person’s social relations, and thus prerequisites for the social aspect of voting (e.g. Bhatti and Hansen, 2012a), part of the impact of poor health may be indirectly channelled by weakened social connectedness and thus lower potential for mobilization (Denny and Doyle, 2007a; Schur et al., 2002, 169). Increase in our knowledge of the interplay and causal relations between * Corresponding author. E-mail address: hanna.wass@helsinki.fi (H. Wass). Contents lists available at ScienceDirect Electoral Studies journal homepage: www.elsevier.com/locate/electstud 0261-3794/$ – see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.electstud.2013.07.010 Electoral Studies 32 (2013) 886–891