To advance health equity, public health has a responsibility to promote civic and voter participation.

Our health and the health of our democracy are deeply connected. When people vote they, their families, and their communities are healthier. Communities with high voter participation enjoy greater social cohesion and better health (from self-reported health to premature mortality). Historical experience and research findings make it clear that voting participation matters for health. The Health & Democracy Index demonstrates that states with more inclusive voting policies and higher levels of voter participation enjoy better public health outcomes. To effectively advance health equity we, as public health leaders, must build the public and public and political will for the systems and policies that strengthen civic participation and promote a representative, inclusive democracy. This responsibility is highlighted in the recent article, “Voter Participation is a Path to Health Equity: How Health Departments Can Promote a Healthy Inclusive Democracy.”

Read the Article in JPHMP

Civic and voter participation promote health because people who vote are better represented in policy decisions that have a big impact on their health and the health of their family and neighbors. Pervasive disparities in voter participation mirror persistent health inequities since our health is socially determined through political processes, policies and investments that create (or hinder) health. Representation in these political processes is necessary to assure equitable conditions for health. Individuals and communities that experience the greatest health inequities often face significant barriers to voter participation, excluding their voices from critical policymaking. Disparities in voter participation fuel inequities in representation and mean that some people have less of a chance to contribute to the decisions that affect their communities and their health. Therefore, we have a responsibility to promote inclusive, representative, democratic processes with the aim of creating the opportunity for everyone to be healthy.

Faced with an urgent imperative to protect and promote inclusive voting policies, major public health and civic engagement groups came together in 2020 to form the non-partisan coalition VoteSAFE Public Health, now called Healthy Democracy Healthy People (HDHP). The overall aim of HDHP is to advance health equity by building our collective capacity to strengthen civic and voter participation. We have a clear opportunity to improve health outcomes and decrease health disparities by becoming champions for civic and voter participation. Several public health organizations now recognize voting as an actionable upstream determinant of health. Increasing voter participation is named as a health improvement strategy in Healthy People 2030, County Health Rankings and Roadmaps, and America’s Health Rankings and reinforced by the American College of Physicians, the American Medical Association, the American Public Health Association, and the Society for Public Health Education. This growing recognition serves as a foundation for the health sector to collectively promote voter participation.

The 2024 election will have lasting impacts on the health and wellbeing of our communities. Despite applauded record voter participation, in 2020 a third of U.S. eligible voters did not cast a ballot and more than half of eligible voters did not vote in 2022. In addition, much of the population served by our health systems are among those most likely to face barriers when voting and are underrepresented at the ballot box. Perhaps most surprising and concerning is that healthcare workers themselves, including physicians, nurses, physician assistants, and dentists are 12-23% less likely to vote than the general population. In 2024 HDHP and VotER and Civic Health Alliance are inviting the public health and health care sectors to join the Thrive through Civic Health: We Will Vote (WWV) initiative. The initiative serves as an invitation to public health, health care, philanthropy, non-profit, and community organizations to make organizational and personal commitments to serve as healthy democracy champions and promote voter participation. WWV serves as a call to action for a deepening commitment to the importance of an inclusive democracy for community health and wellbeing.

The article “Voter Participation is a Path to Health Equity: How Health Departments Can Promote a Healthy Inclusive Democracy” provides some practical insight on ways public health agencies and professionals can promote a healthy inclusive democracy. These include using existing touchpoints for education and awareness; incorporating voting participation into health assessments and planning processes; collaborating with local partners to champion voting rights and access; and making organizational and personal commitments to vote, like WWV. We can work through our professional, academic, and community organizations to adopt policies to strengthen civic and voter participation and engage with elected officials about issues that matter to us between election cycles. We can register to vote, vote regularly, encourage family, friends, and colleagues to vote, serve as election workers and support workplace policies encouraging election work.

Finally, remember to VOTE like our health depends on it because it does!

Jeanne F. Ayers, RN, MPH, leads Healthy Democracy Healthy People, a coalition of 11 public health organizations committed to advancing health and racial equity by strengthening civic and voter participation and ensuring access to the ballot for all eligible voters. Prior to establishing this coalition in 2020, Ayers held leadership roles in state governmental public health for over nine years. She served as the Wisconsin State Health Officer and Assistant Commissioner and Chief Health Equity Strategist for the Minnesota Department of Health.

Gnora RG Mahs, MPH DrPH(c), is the Partnerships Director for Healthy Democracy Healthy People. Gnora’s background is rooted in community organizing. Alongside her professional endeavors, Gnora is pursuing a Doctorate of Public Health at George Washington University and her research is focused on the relationship between voter participation and community health.