Doctors: You can increase voting in the U.S. [PODCAST]

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“Our country is facing a voting crisis with multiple layers: chronically low overall voter participation, even lower voter participation among physicians and — to add insult to injury — an increasing number of laws that make voting more difficult, especially for those with chronic health conditions. Voter registration in health care settings can be part of the solution to all these problems — problems that threaten the health of a democratic society. Through these civic health conversations, both physicians and patients will increase their awareness and be empowered to raise their voices by voting. It is time for the clinic be a place for civic health as well as physical health.”

Rio Barrere-Cain is a medical student.

She shares her story and discusses her KevinMD article, “Doctors: You can increase voting in the U.S.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. And today on the show we have Rio Barrere-Cain. She is a medical student, and she wrote the KevinMD article “Doctors: You can increase voting in the U.S.” Rio, welcome to the show.

Rio Barrere-Cain: Thank you so much for having me. This is exciting.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Rio Barrere-Cain: So I grew up in the Bay Area, and I went to UCLA for undergrad, and now I’m at UCSF. At UCLA, in undergrad, I was in a lot of health fairs and involved in organizing health care. So I fell in love with the clinical aspect through that, and through interacting with patients at the health fairs. And then I was also able to do research at UCLA, which got me interested in looking at epigenetic mechanisms and the regulation of gene expression, and how they can help us understand health disparities in our communities. So I’m a PhD student at UCSF, trying to bridge those two worlds.

Kevin Pho: So you wrote the KevinMD article tying civic duty with medicine. So tell me, how did you get interested in that?

Rio Barrere-Cain: Last August, I came across an email, when I was first starting at UCSF, my first month here, about doing voter registration phone calls, helping call voters across the country and helping them register to vote if they were interested. And so I joined that Zoom call and loved the energy and enthusiasm folks had for helping more people be involved with the democratic process. And also, these were residents; these were providers in all different fields coming together, dedicating a whole evening to doing this.

And most of the phone calls that I made that evening were in Spanish, and so I decided it would be great to have one of these Zoom calls to reach folks who are interested in voting who spoke Spanish. So I began to organize another phone bank. I put out the email, and suddenly I got lots of colleagues I was just meeting: “Oh, great to meet you. I saw your email. I’d be super interested.” And so through that, I was able to connect with Vot-ER, which is an organization that helps connect patients who are in clinical spaces with registering to vote.

You know, we should be learning about how to do this in our curriculum. We should be learning about how to do outreach in a nonpartisan way to get more of our patients to vote. And it seemed like we’re seeing in these last few years the impact that policies can have on health. Through all this news with COVID, policies have really direct impacts on our health. And that’s the role of providers: to help our patients advocate, to give patients the ability to advocate for their own health needs. And so what better way to do that than through voting?

So we’ve been able to think about how to incorporate civic health into the medical school curriculum. I was able to meet with some of the leaders at UCSF, and by having lots of conversations with mentors and my colleagues here at UCSF, I was able to flesh out what that would mean and how that could be put into practice.

Kevin Pho: So let’s talk about the KevinMD article that you wrote. It’s titled “Doctors: You can increase voting in the U.S.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to write it?

Rio Barrere-Cain: Yeah. I think it comes from this idea that, you know, it’s crystal clear in the last few years how much government policies impact our health and our communities’ health. The U.S. is 28th out of 35 nations with similar government structures in terms of voting turnout, and so this is something that we need to address. And providers, specifically physicians, vote 14 percentage points lower than the general population. And so this is an area of growth.

So, thinking about how we can make change in this area, one idea is in our medical school curriculum, and in the curriculum in other health professions, as trainees are learning to practice: incorporating civic health into the social history. When you’re talking to a patient, asking, “Are you interested in voting?” and “Can I provide resources to help you register to vote, if you are interested?”

So, thinking then about what some of the barriers to implementing this are. And I think I should back up and describe what civic health is. To us, the term civic health describes the extent to which communities are able to effectively access democratic resources and draw attention and resources to the problems that they themselves and their communities face, so the extent of participating in that process. That can be at the local level or the national level.

We’re thinking, OK, well, what are some of the barriers to implementing this? And I think one key thing that came up in conversation was, OK, well, some providers may not think this is part of the scope of their practice, to talk to patients about voting. So I think two things came to mind. One is that the role of providers and health care systems is in flux and changing, and they can and should evolve. Our understandings do evolve. And the other component to that is that I think we’ve grown in our understanding of how much someone’s context and social environment impact health. I think social determinants of health has become a term that is more widely used now, understanding the social environment that impacts someone’s health. And lastly, we’ve seen how much, in the last few years, government policy can impact a community’s health. And this is the core goal of being a provider: to help give patients the tools and the ability to advocate for their own health. And what better way to do that than through voting?

So I think that was one aspect, to address why this should be something that health providers do. The second is, how do we do this in a nonpartisan way? And I think one thing that comes to mind is we’re not advocating for policy change. We’re advocating just for those who are eligible to vote to get involved in that process, and this is a core American value, to be involved in that democratic process.

Another point that came up in these conversations was that providers are very busy and have a lot going on. With all the things that are on a provider’s plate, how are they going to find time and energy to add this into their social history, to talk about voting, when it’s already a very packed schedule? One thing that came to mind is that medical students have more individual time with patients than, say, a doctor. And the other thing is that this can be something that all health professionals do. So this can be something that nurses, social workers, doctors, and other allied professions do. This can be an interprofessional team effort.

And lastly, I think when we talk about burnout and feeling like there’s too much going on, it can often come from a place of not feeling like you can make change. Giving someone access to voting resources, providing them with a QR code that links them to where they can register to vote, that’s a very direct thing that you can do to help increase someone’s empowerment. There are a lot of issues and a lot of social needs, like perhaps housing or food access, that we have a role in helping with, but not in as direct a way as providing help in registering to vote. I think giving them this very direct way to help a patient with a social need is something that can actually provide a lot of purpose and meaning and fight burnout.

Kevin Pho: We’re talking to Rio Barrere-Cain. She is a medical student. She wrote the KevinMD article “Doctors: You can increase voting in the U.S.” Rio, talk about some of the challenges that people have, people that you talked to during your work at the phone banks. Talk about some of the challenges that they have to access voting.

Rio Barrere-Cain: So I was talking to folks, actually even someone in New York, at times when there were high levels of COVID. And so one fear was, “How do I do this safely during this time?” And I think we advocated a lot for mailing in your vote. So that’s one aspect: how to vote safely during COVID. Another was feeling a sense of disenfranchisement, kind of like, “The government isn’t representing me, and I don’t have a voice in this process,” and kind of feeling a little bit down about how the democratic process is working in the U.S.

I think a lot of times, also, phone banks were really inspirational, because we talked to someone who did just vote, and we talked to them: “OK, well, how can you reach out to your friends and family? How can you motivate others?” Especially in times when we’re not able to gather in big groups, “Can you call your friends and family members and talk about the issues that matter to you?” And I saw a lot of folks who are really passionate about how these different issues connect, whether it be employment opportunities with COVID and how that could connect to creating green jobs and help with employment, or thinking about how economic recovery and health care will look after COVID.

I think another issue is language, and having enough resources in the language the voter is most comfortable in. It’s one thing to be able to access voting materials, but then to have them in the language that’s most comfortable for you.

Kevin Pho: If you’re taking a social history and you ask that patient if they’re interested in registering to vote and they say yes, please share some of the resources that we can offer them.

Rio Barrere-Cain: Yeah. So Vot-ER has a wonderful list of resources. This can be linking to, for example in California, the DMV, where you can register to vote. This can also be getting a very nonpartisan description of what the issue is on this next ballot, so you understand the propositions that are coming up, or the people that are running and the platforms that the candidates are running on. So I would recommend resources like Vot-ER.

And actually, with Vot-ER, for example, on your ID badge you can have QR codes that link specifically to these resources. So Vot-ER, in different states, will have QR codes that specifically link to the state’s, like in California, to the DMV, where you can register to vote. And so having that on your badge when you’re walking around clinic, if someone’s interested, you flip your badge over, show the QR code, and they can scan it right there and then.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Rio Barrere-Cain: Consider incorporating talking about registering to vote with patients during the social history. I think also, stay informed on the policies that are being voted on now, and use your expertise in the clinical field and what you know about how policies impact health, and turn out and vote yourself. So I think, in the social history, asking patients if they’re interested in voting and if they’ve registered to vote, and then staying informed on the issues yourself and voting.

And I think talking with colleagues and friends. I think a lot of folks are interested, and it’s something that, when I talk to them, they’re like, “Oh, that would be interesting. I haven’t thought about that before.” So, starting a conversation in the lunchroom, asking your colleagues what they’re thinking about for the next election. I think that dialogue, that discourse, is so important for the democratic process. And providers have a lot of privilege and a lot of knowledge, knowing and seeing firsthand how policies impact health, and so to take that knowledge to the polls.

Kevin Pho: Rio, thank you so much for sharing your time and insight, and thanks again for being on the show.

Rio Barrere-Cain: Absolutely. It was a pleasure.

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