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While the health of both aging presidential candidates has become a campaign issue, after Hillary Clinton was recently diagnosed with pneumonia, another different physical condition has been on the minds of voters for a lot longer — their looks.

Seemingly more than in the case of any other public figure, Mrs. Clinton’s perceived unattractiveness has been an object of intense derision. For as long as she’s been in the national spotlight, social media, blogs, cartoons, TV skits and email spam have all hyperbolized her big eyes, 68-year-old countenance, dyed hair, stodgy figure, skin wrinkles, multi-colored pant suits and bassoon-like attempts at voice projection, as if such superficialities were a legitimate category of political criticism.

It’s a safe bet that anyone reading this has received at least one anti-Hillary link or forwarded email that instead of rebutting her policy positions, expressed distaste either verbally or graphically for the cosmetic image or sexuality of the former secretary of state.

A few I’ve seen are unsuitable for publication in a family newspaper.

A more common example is the photograph pairing Clinton’s face with that of a blond, goggle eyed, scar ravaged face of the doll in the horror film “The Conjuring,” with the caption, “Separated at Birth.”

She has also been unflatteringly contrasted with the likes of Monica Lewinsky, Sarah Palin and Melania Trump, and her features twisted and caricatured into those of a groundhog, a witch, an evil fairy godmother and a cow.

This is someone running for president, and you’d expect that Americans were better than this. But the truth inherent in Japanese author Haruki Murakami’s often quoted statement, “Image is everything,” appears to apply to politics, big time.

That how we vote is influenced by a candidate’s image, or physical and sensual impact, is hardly a surprise. Debonair John F. Kennedy benefited from his good looks in defeating Richard Nixon, as did George W. Bush in eking out victory over Al Gore, and Ronald Reagan over both Carter and Mondale. Mitt Romney’s male model looks not helping him overcome his unsympathetic corporate image was the exception that proved the rule.

Writing in Psychology Today (“Why Image Is Everything,” Aug. 16, 2015), Douglas Van Praet cited a university study showing that visual impressions are so compelling that people often opt for the more beautiful or pleasing image, even if facts and logic show them it’s the poorer choice.

Though the study specifically related to the marketing of cars or other retail goods on the basis of feel-good advertising, rather than on proven reliability, it may also explain some voters’ affinity for pretty faces like Michele Bachmann’s or Dan Quayle’s, absent any other good reasons to vote for them. Researchers called it the ” ‘I like it, but I don’t know why effect.”

How else to explain the eruption of popularity for the fetching Alaska Gov. Sarah Palin, after she was chosen by John McCain to be his running mate? Even after the infamous interview by Katie Couric in 2008 that displayed Palin’s lack of knowledge or understanding of both foreign and domestic issues, “consumers” even as erudite as journalist William Kristol could not shake their infatuation.

The opposite is true with regard to Secretary Clinton, who is being penalized by the, “I disliker her, but I don’t know why,” converse effect.

But in Clinton’s case, I infer motives that go beyond perceptions of her hair, clothes and laugh.

For Hillary Clinton is not unattractive. When she allows as much time for make-up and grooming as people are supposed to before appearing on television, she’s been capable of radiating a Meryl Streep glow and elegance, especially when displaying her comely smile.

Clearly, other influences are factoring in.

Sexism, for example, remains an undeniable factor. Clinton’s intelligence, outspokenness and independence, qualities which are extolled and admired in a male candidate, still threaten the personal and world view of many men

Additionally, there are likely misogynistic, psychological and even Oedipal issues with a contingent of Hillary Haters, like those at the Republican National Convention wearing the buttons that read, “Life is a Bitch, Don’t Vote for One.”

Trump fans may counter that their candidate takes a beating for his own looks, as well. But Donald’s hair has been a popular mystery years before this. Whereas, as a male candidate for president, the 70-year-old Trump has gotten pretty much a free pass on his clothes, his voice, that neck and his overall excess weight.

It stands to reason that after 250 years, the prospect of the first woman president of the United States is going to provoke some feelings and reactions that we’re familiar with, and some we’ve never seen before.

So do your homework before you cast your vote. List on paper or a computer screen the reasons you’re voting for a particular candidate.

Read and review: Are they logical? Are they capricious?

Are they fair?

Surely, it’s what we always should do before we vote. But this year, in the race pitting a man against a woman, it’s more important than ever.

David McGrath is emeritus English professor at the College of DuPage and author of “The Territory.”

mcgrathd@dupage.edu