The benefits of voting are ample: having a say in the political process, strengthening civic engagement, asserting one’s personal agency and values, fostering social connection, and, not least, protecting democracy. But how many of us think of voting as a health behavior?
The most common behaviors influencing people’s health are typically characterized as tobacco use, diet and exercise, alcohol and drug use, and sexual activity. But these health behaviors account for just 30 percent of health outcomes, while 50 percent of our health outcomes are determined by our physical environment along with social and economic factors. And these are most influenced by voting.
As we reflect on this year’s mid-term elections and the roughly 5.7 million New Yorkers who went to the polls statewide, about 1.7 million of them in New York City, it behooves us to consider voting not only as an individual health behavior, but one that has health implications at the community and systemic levels.
First, the literature on the intersection between health and voting is limited, and we need more scholarship in this area. That said, consider three interesting findings from across the country:
- Poor people in poor health are less likely to vote as compared to high-income people in poor health who are just as likely to vote as their well and well-off counterparts.
- On average, rural areas in the United States are less educated, less wealthy, and less healthy than their non-rural counterparts, yet they are no less likely to vote.
- Individuals with chronic disease who are most likely to vote because of their illness are people with cancer because they are more likely to be in support groups which not only support the act of voting, but also help members better understand the political process which then leads to higher voter participation.
As with most health behaviors, the earlier someone starts voting, the more likely they are to be a consistent life-long voter. An interesting study by Ballard, Hoyt, and Pachucki looked at longitudinal data that followed late adolescents and early adults into later adulthood and found that voting was positively associated with better mental health and health behaviors over time, along with improved income and education level.
Beyond individual considerations, it is important to note that having social networks who vote and talk about voting can reinforce voting patterns within communities.
PREMATURE DEATHS AND VOTING POWER
The health equity work UHF champions moves us from focusing solely on individuals to grappling with community-level inequities. Two studies focusing on the impact of high rates of aggregate premature mortality on community voting power stand out for me. The first looks at differential mortality and racial composition of the U.S. electorate, comparing 1970 to 2004. The authors calculated excess deaths among Black people (2.7 million) and then estimated how many of the hypothetical survivors would have voted in 2004. They estimate that an additional one million Black voters would have participated in the 2004 elections were it not for unacceptably high premature mortality rates. The authors rightfully reflect that “Systematic disenfranchisement by population group yields an electorate that is unrepresentative of the full interests of the citizenry and affects the chance that elected officials have mandates to eliminate health inequality.”
The second study looks at differences in socioeconomic status and premature mortality and the potential broader impact on shaping the social determinants of health through voting. What they found was that “health differences between survivors and non-survivors explain 56 percent of their differences in voting.” They hypothesize that increased rates of premature mortality seen in those with low-socioeconomic status denies their communities of votes, thereby magnifying the impact of votes cast by high-socioeconomic status community members and further perpetuating inequality in the status quo. This translates into increased rates of premature mortality among poor people, likely disproportionately affecting their collective ability to influence electoral outcomes and their impact on public health through shaping the social determinants of health.
During this time when health and public health have been so politicized and polarized, it’s interesting to think about the intersection of health and voting. One thing is clear: We cannot take for granted that we live in a New York State health bubble. The gains in health outcomes achieved over the last few decades through policy could easily become victim to changing demographics accelerated by increasing rates of premature mortality disproportionately affecting communities of color.
WAYS FORWARD
There are remedies addressing voter registration and voter activation we can implement before the next election cycle that can help sustain equity gains in our state. Implementing, as quickly as possible, automatic voter registration through the Medicaid and other public benefits application processes similar to what many other states currently do is a structural remedy that could help offset loss of voters in poor communities and communities of color. Another approach is broadly engaging the health and social services sectors to utilize non-partisan tools such as Vot-ER to promote voter registration among their patients, as well as motivating them to vote. Lastly, incorporating civic engagement into chronic disease management models can help normalize conversations about exercising democratic rights in contexts that foreground historical challenges rooted in systemic racism that have been generational barriers to better health outcomes.
As we work to advance health equity, we can’t forget that voting is a measurable health behavior. There’s what you see when election boards report on numbers and percentages of registered voters who exercised their civic right and obligation. There’s also what you don’t see, because the numbers are so big and relatively slow moving, but that nonetheless alters the health trajectory of generations of people. And that’s the choke hold racial inequities in premature mortality have had on communities for decades.
The intersection of health and voting now and for election cycles to come must remain high on our collective to-do list.