Voting is Not Only Good for the Public’s Health but for Public Health, Too
September 17, 2024
Overview
A growing body of evidence shows a consistent 25-year relationship between an inclusive, representative democracy, and community health. When we’re healthier, we’re more likely to vote, and communities that vote experience better health. This evidence bolsters the expanding number of leading health organizations and institutions that recognize voter access as a pathway for advancing health equity.
Did you know that the health sector—one of the largest U.S. workforces— is less likely to vote than the general population? It’s one of many reasons why the Network for Public Health Law (the Network) and Healthy Democracy Healthy People are celebrating National Voter Registration Day, a nonpartisan civic holiday celebrated on September 17 this year. We invite you to join us by checking your voter registration status.
The Network is also a proud organizational champion of the Thrive Through Civic Health: We Will Vote initiative led by Civic Health Alliance, Healthy Democracy Healthy People, and Vot-ER. The initiative is designed to improve population health by strengthening civic and voter participation across the health sector, including with our colleagues, organizations, and the communities we serve.
The deep connections between voting and the health of individuals, communities, and the legal powers of governmental institutions and private actors to take actions that impact our health are among the other important reasons the Network has partnered with Healthy Democracy Health People. As one example of our work together, the Health & Democracy Index shows that states with more inclusive voting policies and greater levels of civic participation are healthier. Conversely, states that make voting more difficult and have lower levels of voter participation also have worse public health outcomes. The barriers to health and voting can become a self-reinforcing feedback loop because many of them are the same. A few examples include structural inequities related to broadband and language access as well as transportation. Increasing civic participation is thus an important—but underutilized —public health and public health law strategy to improve public health authority, its uses, and as a result, the public’s health.
Good for the Public’s Health
A growing body of evidence shows a consistent 25-year relationship between an inclusive, representative democracy, and community health. For example, jurisdictions with more inclusive voting policies were found to have fewer adults who are uninsured and lower COVID-19 case and mortality rates. They were also estimated to have lower rates of death among working-age adults. Said another way, structural inequities, including greater barriers to voting, have been associated with both higher rates of being uninsured, especially among people with less income, young people, and communities of color; higher COVID-19 case and mortality rates; and working-age mortality. What does this all mean? When we’re healthier, we’re more likely to vote, and communities that vote experience better health.
This evidence bolsters the expanding number of leading health organizations and institutions, including Healthy People 2030, the American Public Health Association, the American Medical Association, the Society for Public Health Education, and County Health Rankings & Roadmaps that recognize voter access as a pathway for advancing health equity. Healthy Democracy Healthy People has compiled evidence-based strategies to promote civic and voter participation, which can improve not only the public’s health but the health of the public health system, too.
Good for the health of the public health system
An inclusive and representative democracy is key to protecting and improving systems that impact the public’s health. The strengths and weaknesses of the public health system in particular were laid bare when the COVID-19 pandemic hit. While there were successes such as an all-hands-on-deck vaccination effort that prevented millions of hospitalizations and deaths, the demands of understanding the spread of, and predicting the efficacy of potential mitigation measures to contain the novel virus was met with the realities of a chronically underfunded system that lacked the necessary infrastructure and political support to mount a timely and effective response. This reality chipped away at the trust communities may have had in the system’s ability to inform and protect them, resulting in a tidal wave of political backlash to government officials and public health authority overall.
The outcome was that more than half of states adopted legislation limiting public health authority. Key losses in the courts regarding religious liberty and the exercise of statutory powers by health officials now make up part of the arsenal of court decisions overtly hostile to public health, especially at the highest level. And while many states and local jurisdictions have found innovative ways to advance concepts of more equitable and effective public health authority, the field is just beginning to acknowledge and internalize that public health is political.
Bipartisan support for a modernized public health system is possible, though. The largely decentralized nature of the U.S. public health and legal systems also means that state and local context—and its relation to the federal system—matter a lot. State and local health departments are executive branch agencies created by state statute, and they are governed by a myriad of sources of law created by legislative bodies, other executive branch actors, courts, and even citizens themselves. Ballot initiatives and elected officials across, and at every level of, government shape what health departments, other governmental institutions, and private actors can (or cannot) do; the resources with which they may operate; the processes they must undergo to take actions; and even who makes what decisions and who must be involved in decision-making processes. This is why inclusive, representative civic participation and voter access influence the health of the public health system, too.
Understanding the unique legal governance and politics of public health decision making within your state and local context is a necessary first step to identifying changes to improve the system. The Network and our Act for Public Health partners can help you with that. For example, we can help you identify who appoints key public health decision makers and advisors in your community and connect that information to the larger policy context.
Brief descriptions of some of the major elected state and local offices that impact the public’s health can be found in this guide to local elections by the Thurgood Marshall Institute. And when you lay that over what’s at stake in the 2024 elections, you find there are 13 gubernatorial elections, ten attorney general elections, and seven secretary of state elections to be decided in November. Hundreds of other state executive seats will be determined across 30 states, and almost 80 percent of state legislative seats and over 300 state appellate court seats across the country are also open. Thousands of local government officials at the municipal and county level will also be elected this year. In fact, many of these races may be determined by a handful of votes, and even some may be decided on a coin-toss. This means your vote matters in so many ways for the health of your community.
As public health professionals, we seek to make the places we live, learn, work, play, and worship better for everyone. Increasing voter participation is yet another way we can do our work. For more information about how the Network can be of assistance, please contact Darlene Huang Briggs.
This post was written by Gnora Mahs, Partnerships Director, Healthy Democracy Healthy People and Darlene Huang Briggs, Deputy Director, Special Projects, Network for Public Health Law.
The Network promotes public health and health equity through non-partisan educational resources and technical assistance. These materials provided are provided solely for educational purposes and do not constitute legal advice. The Network’s provision of these materials does not create an attorney-client relationship with you or any other person and is subject to the Network’s Disclaimer.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.