Poor health can negatively impact any and all aspects of our lives, often discouraging us from participating fully in activities we otherwise would. It shouldn’t be surprising, then, that those with worse health are also less likely to vote, or that voter participation is inversely associated with time spent in inpatient care. And while we may accept this at face value, the downstream consequences of this are often left unexplored in popular political discourse: If sick people don’t vote, their interests are less likely to be politically represented. In other words, they are disenfranchised. Consequently, topics that may be more important to them (i.e., health care) are less likely to rank as high on the political agendas of their elected representatives, and when it is a hot-button issue, their representatives are less likely to be politically aligned with them.
The exceptions to this, unfortunately, are likely to only worsen health equity. Poor health has been associated with lower voter participation, but this effect is significantly mitigated among those with higher incomes. The consequence of this is that those with poor health but the ability to afford quality health care (and are thus less likely to empathize with the need to expand health care access) are more likely to be able to vote, while those with poor health who are unable to access care are less likely to surmount this double barrier, leading to the perpetuation of policies that disfavor health equity.
This association between poor health and low voter turnout naturally begs the question: Does poor health prevent voter participation, or does low voter participation lead to poor health? The answer is likely both. It’s both logical and evidence-based that those with serious illness are less likely to be able to meet the demands of voting. However, voter participation has also been shown to be associated with better health, even when controlling for race, income, education, home ownership, housing quality, and population density. In older adults, voters have been found to have lower mortality risks at 5-, 10-, and 15-year study points. Analysis mapping the cost-of-voting index (a tool that measures time and effort required to cast a vote) against state-level health outcomes has even shown that states with lower cost-of-voting scores consistently have better health outcomes, and vice versa. Whereas not voting may lead to worse health equity, leading to worse health, which then leads to reduced voter participation in a vicious cycle, the converse is also likely true: Voting may lead to improved health equity, leading to improved voter participation, which then promotes even greater health equity, in an opposite, virtuous cycle.
It shouldn’t be surprising then that the American Medical Association considers voting a social determinant of health, and encourages voter participation as a harm reduction strategy. Or that the American Public Health Association specifically advocates for adopting policies to advance civic participation, voter registration, and civic engagement. Or that the American College of Physicians supports voting access, encourages nonpartisan health care-sponsored voter engagement strategies, and specifically rejects partisan gerrymandering. The American College of Preventive Medicine has even gone so far as to endorse the position that “Voting is public health.”
As physicians and health care professionals, it is therefore our duty not only to vote, but to support policies that improve voter accessibility, such as automatic and same-day registration, mail-in or at-home voting options, nonrestrictive voter ID requirements, nonpartisan health care-based voter registration initiatives, equitable distribution of voting locations, voting rights restoration, and other initiatives that promote democratic representation such as open primary elections and ranked-choice voting. Health care workers historically have lower rates of voter participation, but this is the primary, transformative step needed to break the vicious cycle of poor health and poor voter participation and trade it for a cycle of improved health equity. Come election time, help give a voice to the voiceless and improve the health of your patients not only in the clinic or hospital, but in the voting booths as well.
Jacob Player is a family medicine resident.
