Voting is a social determinant of health

Hugo Balta, Tribune News Service

Approximately 244 million Americans will have the opportunity to vote in the 2024 elections. In the 2020 election, an unprecedented 67 percent of those eligible turned out to vote. If turnout reaches that level again, it will result in over 162 million ballots being cast by November, reports the Bipartisan Policy Center. Over the past two decades, various states have implemented obstacles to voting, such as enforcing strict voter ID requirements, reducing voting hours, limiting registration options, and removing individuals from voter rolls. These initiatives have effectively prevented many eligible voters from participating in elections. While these barriers affect all Americans, they disproportionately impact racial minorities, low-income individuals, and both young and elderly voters.

Voting is often viewed through the lens of civic duty and political engagement, but its implications stretch far beyond the ballot box. Voting plays a crucial role in shaping the social determinants of health (SDOH) — the conditions in which people are born, grow, live, work, and age. Understanding how voting influences health outcomes can help illuminate the pathways through which civic engagement impacts community well-being. The medical community increasingly acknowledges voting as a crucial SDOH, framing it as a significant public health concern. This relationship between voting and health is reciprocal: a person's health can impact their ability to vote, while the act of voting can also impact health outcomes. SDOH encompasses factors such as income, access to nutritious food, reliable transportation, and safe and affordable housing -all critical components of these non-medical determinants that shape healthcare outcomes. Addressing these social factors is essential for improving overall health and ensuring equitable access to health care for all individuals.

Physician’s Weekly groups the SDOH into five domains influencing health: Economic Stability, Education Access and Quality, Healthcare Access and Quality, Neighborhood and Built Environment, and Social and Community Context. In 2022, the American Medical Association made a significant move by passing a resolution recognising voting as a social determinant of health. This acknowledgment highlights the critical intersection between civic engagement and health outcomes, emphasising that access to voting can influence various health determinants and ultimately affect individual and community health. Emory University medical and Ph.D. student Jasmin Eatman was part of the effort to update AMA’s policy. "School children are being murdered by weapons of war. Women are being forced to surrender their very own bodies to the state. In some places, providing water to an individual waiting in line to vote can earn you jail time," said Eatman, speaking on behalf of the Minority Affairs Section, which authored the resolution.

"Despite these undemocratic efforts, we believe that there's still power in the ballot" and that social inequity can be tackled, even "transformed," by voter participation, she stated.

Voting enables individuals to influence policies that directly affect healthcare access, funding for public health initiatives, and regulations that impact the environment. For instance, local elections can determine hospital funding, mental health services, and community health programs. When communities elect representatives who prioritize health, they are more likely to see improvements in health services and resources.

“Fair and constructive policy advancements fundamentally depend on a healthy democracy,” writes Eileen Salinsky, program advisor for Grantmakers In Health. In “ Civic Engagement Is a Social Determinant of Health,” Salinsky determines there are two intersecting and interdependent systems that comprise democracy in the United States:

A political system of representative government, which includes the legislative, executive, and judicial branches at the federal, state, and local levels.

A collective system of self-governance, which includes how individuals interact with each other and their political system through many forms of civic engagement.

Voting is a form of civic engagement that often leads to greater community mobilization. When communities come together to vote, they also tend to organize around health-related issues, advocate for necessary changes, and push for resources to improve overall health. Grassroots movements that emerge from voter engagement can lead to significant health benefits, such as increased access to healthy food, better housing conditions, and improved public safety.

The demographic makeup of voters has direct consequences for health equity. Communities that are underrepresented in the electoral process often face disparities in health outcomes. When marginalised groups — such as racial and ethnic minorities, low-income individuals, and young people — fail to vote, their specific health needs may be overlooked in policy discussions. Ensuring that all voices are heard in the electoral process is essential for addressing health disparities and promoting equity. Participating in elections can foster a sense of belonging and social cohesion within communities. When individuals feel they have a stake in their community's future, they are more likely to engage in collective actions that benefit public health. This sense of community can lead to stronger social networks, which have been shown to improve mental health and overall well-being.

Voting is not just about casting a ballot but also about understanding the issues at stake. Increased civic literacy can empower individuals to advocate for their health needs and rights. When people are informed about the policies that affect their health, they are more likely to engage in discussions, advocate for change, and hold their elected officials accountable.

While voting has the potential to influence health outcomes significantly, several challenges impede equitable participation in the electoral process. Understanding these barriers is crucial for developing strategies to enhance voter engagement, particularly in communities that face health disparities. Many individuals encounter logistical barriers that make voting difficult. This can include:

Physical accessibility: Polling places may not be equipped to accommodate individuals with disabilities, making it challenging for them to cast their votes.

Transportation: Getting to polling locations can be a significant hurdle for people in rural or underserved urban areas, particularly for those without reliable transportation.

Language barriers: Non-English speakers may struggle to understand ballots or the voting process, deterring them from participating.

Voter suppression tactics disproportionately affect marginalized communities and can take several forms. Strict identification requirements can disenfranchise those who lack the necessary documentation, often impacting low-income individuals and people of color. Aggressive purging of voter registration lists can lead to eligible voters being removed, especially in communities with high mobility rates. Insufficient polling hours or reduced access to early voting can hinder participation for those with rigid work schedules or caregiving responsibilities. Economic factors can also play a significant role in voting participation. Individuals working multiple jobs or facing economic pressures may find it challenging to allocate time for voting, especially if they must travel long distances to polling places. Lower levels of education can correlate with decreased civic engagement and awareness of the importance of voting, leading to lower voter turnout.