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26 April 2023

New research suggests that health is a larger concern for Indian voters than previously believed

The first-ever survey on electoral perceptions around health in India shows that health, though not a top priority, does influence voting decisions.

Voters lining up to cast their vote, India

A long-held belief among scholars and observers of Indian elections has been that voters in India do not view health as an important electoral issue.

New research from King’s India Institute and partners suggests this assumption is incorrect and health does influence voting decisions, particularly at the state level.

A pilot survey of Indian voters conducted by Lokniti, Centre for the Study of Developing Societies, revealed health is one of three priority areas for voters. While it is not the determining factor, it ranks alongside education and behind employment. Voters from poor and marginalised backgrounds were also more likely to identify health as a top priority.

It has long been assumed that low political prioritisation of health in India reflects a lack of voter demand. This study demonstrates that when we unpack the idea of ‘development’, voters see health as a crucial component of the fortunes of their household and their local area. For older voters and those from more disadvantaged backgrounds, it looms even larger as a priority.

Professor Louise Tillin, lead investigator and Professor of Politics

The researchers found that voters who perceive an improvement in public health services are 10% more likely to vote for the ruling party in state-level elections than voters who perceived no change or worsening health services. However, voting decisions in national-level elections appear to be less impacted by the perceived performance of government hospitals.

Many voters were also unclear about which level of government – local, state or national – was responsible for the condition of healthcare services, despite 80% of voters saying it was the government’s responsibility to provide healthcare.

Most (37%) correctly identified state governments as bearing responsibility for running hospitals, but a substantial number attributed responsibility to all three levels (21%), and to the central government (14%) or to the local government (17%).

The findings suggest that state-level governments do have incentives to invest in health services, given the latent demand from voters and the potential for electoral rewards. However, the unclear attribution of responsibility may blur lines of accountability with voters uncertain about who to credit or blame for health system improvements.

Professor Louise Tillin

The survey involved face-to-face interviews with 1,522 citizens across five Indian states – Bihar, Gujarat, Rajasthan, Tamil Nadu and Uttar Pradesh – conducted between March to April 2022. It sought to answer four broad questions: How much do voters care about health? How satisfied are voters with the provision of health services in India? Who do voters credit (or blame) for the provision of health services? And, does healthcare impact voting decisions?

The survey and report are part of a collaborative project involving Dr Tillin, King’s India Institute, Lokniti-Centre for the Study of Developing Societies (CSDS), Royal Holloway (University of London) and the Centre for Social and Economic Progress (CSEP).

The outcomes of the study have been published on the Lokniti-CSDS website and in The Hindu.

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Louise Tillin

Professor of Politics