Why Public Health Officials Should Make Voting Accessible for Everybody

July 15, 2020|12:12 p.m.| Edward P. Ehlinger, MD, MSPH, Past-President of ASTHO

Edward P. Ehlinger, MD, MSPHThe 2020 election will be here before we know it, and our country is in the midst of cascading and interconnected crises: an infectious disease pandemic, nationwide protests against racial injustice, and catastrophic economic strain for millions out of work.

COVID-19 and the protests for racial justice have revealed the deficiencies and inadequacies in our health, social, and economic systems—along with the need for significant policy changes. With a major election less than four months away, now, more than ever, our communities and citizens need to have their voices heard. Not just for the health of our democracy, but for the health of individuals and communities.

A landmark 1988 report from the Institute of Medicine entitled, The Future of Public Health acknowledges that voting is a public health issue because it helps shape "the conditions in which people can be healthy." That still holds true, so we must support activities that promote civic engagement in every community.

Public health officials are in a unique position to leverage their influence to enhance civic engagement in a non-partisan way that enhances health and builds democracy. The research is clear—voting and healthy communities go together, and part of the job of a public health official is to make that case.

Here are three reasons why health officials should encourage voting, and how they can make it easier for their communities.

Voting Directly Impacts Health
During my time Minnesota’s Health Commissioner and ASTHO president, my "President’s Challenge" to all state health officials was to advance health equity and optimal health for all. A key element of that work was to encourage public health officials to expand their understanding of the community social factors that contribute to healthier individuals. Research conducted in 44 countries showed that civic participation, specifically voter participation, was associated with better self-reported health—while another study showed that those who did not vote reported poorer health outcomes. Historically, we can see this trend play out via suffrage and voting rights. While other factors were of course at play, it was after women got the right to vote in 1920 that the maternal and infant mortality rates dropped dramatically. This can be attributed to the passage of the Sheppard Towner Act of 1921, which set up maternal and child health units in every state health department, expanded collection of birth and death data, and began federal funding of state health programs. Similarly, when the Voting Rights Act of 1965 passed, infant mortality rates dropped and the Black/white disparity in those rates narrowed, again because of legislation that was passed in response to new voter enfranchisement.

Infant Mortality Rates by Race and Black/White Ratio US, 1935-2007

Maternal and Infant Mortality Rates Post Women’s Suffrage

 

Voting Safely Is Particularly Important This Year
This year, when gatherings pose a risk to health the public health work around voting is two-fold: There should be assurance that voting can be done safely, while also making sure that everyone that can vote, does. And make no mistake, there is significant work to ensure that voting is as healthy and safe as possible. ASTHO CEO Mike Fraser and I have recently joined the advisory board of a nonpartisan coalition called We Can Vote. In May they launched HealthyVoting.org, a state-specific guide that helps voters discover their healthy voting options during COVID-19—things like voting by mail, voting early, and observing social distancing measures when voting in person. I urge all public health officials to review the options available in your state, publicize the information to the public, and consider what influence you can use to promote healthy voting. I also urge health officials to consider how to be more involved in not only making the act of voting safe, but increasing access to voting information for all communities in your state. Studies show that social, economic, and health inequities have a large effect on electoral outcomes. As public health officials, it is well within your purview to advocate for the right of all citizens to vote for the sake of their own health and the health of their communities. Voting is one of the most effective ways of advancing health equity.

Enhancing Voting Safety and Participation Should Be Part of Your Public Health Portfolio
While this might feel like a daunting task, you don’t have to do this alone—there are already a range of initiatives promoting voting and strengthening democracy in all states. For example, the organization VotER—which brings together a team of physicians, designers, and behavioral scientists—is offering patients the chance to register to vote while with a provider in a nonpartisan, non-interruptive, and completely optional way.

The non-partisan State Infrastructure Fund and Heartland Fund recently received several million dollars from the Jacob and Valeria Langeloth Foundation to support civic engagement efforts. These intermediaries support a network of on-the-ground voter engagement and civic participation organizations in almost every state. With traditional voter engagement activities upended by the COVID-19 pandemic, they have supported organizations that now have to pivot to remote and digital organizing strategies and tactics.

State-level organizations are also stepping up to the challenge with a range of innovative adaptations. In the lead up to the Pennsylvania’s June elections, Pennsylvania Voice engaged in census-outreach to ensure that individuals updated their registrations and encouraged vote-by-mail (VBM). It worked: 19.3 percent of contacted voters applied for a VBM ballot, compared to the statewide average of 11.3 percent among people of color voters. In Mississippi, Mississippi Votes has held a host of virtual events and is developing a new text organizing program around the census, voter registration, and voter mobilization. The organization is continuing to hold conversations both nationally and locally about how to address some of the obstacles for VBM in the rural parts of Mississippi and among college students. Leaders Igniting Transformation in Wisconsin is pivoting to a digital-first organization. Among their innovative initiatives to promote civic participation people included their online version of Black Hogwarts: Digital Action, Organizing, and Training catered to young people of color. And in Montana, Montana Women Vote has been keeping voters educated and up to date on their social media and voter registration portal on the changing rules for this upcoming election cycle.

Please visit State Infrastructure Fund and the Heartland Fund for a directory of organizations working on the ground in your state and for contact information.

With just around 100 days to go until the November election, there is no time to lose. We need all hands-on deck. ASTHO is partnering with We Can Vote to elevate voting as a public health issue. I encourage you to become part of the broad-based public health effort to get out the vote.


Edward P. Ehlinger, MD, MSPH, is a member of the ASTHO board and former health commissioner for the Minnesota Department of Health.