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Despite a worldwide pandemic that had profound effects on every single American household, voter turnout increased by seven percentage points since the 2016 election with more than two-thirds of US citizens having cast their ballots in 2020 (1); this made the 2020 election the highest voter turnout in the 21st century (2). Notably, communities of color experienced increased turnouts with 6 percentage point increases among Asian Americans and Latino/Hispanics from 2016 to 2020. While not as high as the 2008 and 2012 elections, turnout among Black voters was considered “high” at 63 percent (3) by prominent news outlets.
In the last year, there have been efforts to restrict voting access through the introduction of various pieces of legislation across 47 states (4); examples include shortening early voting times, removing same-day voter registration, limiting mail-in voting, and tightening voter identification laws (4). Legislators of the Republican Party say that these laws are necessary to prevent voter fraud while legislators from the Democratic Party allege that the efforts to restrict voter access is voter suppression and it places an undue burden on people of color (5). In recent news, there has been a great deal of chatter over two federal bills: For the People Act (HR1) and the John Lewis Voting Rights Act. The former bill included the creation of a national automatic system for registering voters with national voting standards (6); the bill was blocked by a filibuster in June 2021. The latter bill is yet to be introduced, however, based on the 2019 version, it is expected that the bill will create a buffer for any newly passed voting laws to allow for time before implementation (particularly related to voter suppression laws) and create a pathway for citizens to challenge voter laws in court (7).
The health of a democracy is intricately tied to the health of the community and voting rights must be viewed as a public health issue. Since 1988, the National Academy of Medicine (formerly known as the Institute of Medicine), has called upon public health professionals to advocate for conditions that directly affect the health of people, including voting (8). Voting is a tool that impacts policies which affect social determinants of health as the results of the votes shape the formation and enactment of such policies. Moreover, voting also helps decide leadership; as more votes are cast and counted, political leadership and therefore, policies, become more representative. Dr. Barry Burden, Director of the Elections Research Center at UW-Madison stated, “as you move down the list of offices on the ballot, the effects on your daily life become more and more immediate (9).” Dr. Burden was shedding light on the impact of local elections on day-to-day life, specifically as they relate to city planning and health regulations. Finally, multiple studies have shown that the act of voting itself has direct impacts on self-perceived health. Expansion of voting, such as the passage of women’s rights to vote in 1920, or the Voting rights Act of 1965, were linked to improvements in maternal and infant mortality rates and decreases in black-caucasian health disparities (10). Likewise, research has indicated that barriers to voting are associated with health disparities (11).
Voting restriction laws place an undue burden on communities of color, underserved populations, and people with disabilities- populations that already face severe health disparities and inequity. Throughout the last year, multiple cities and states declared racism as a public health crisis. Voter restriction laws that actively seek to suppress votes from BIPOC communities (Black and Indigenous People of Color) are only perpetuating the systemic inequality that creeps within American society, concentrating power and influence within predominantly caucasian and wealthy communities. The issue of voter suppression must be viewed through the lens of public health.
The next few years are crucial election years as the fate of our healthcare system balances on a thread. The pandemic has unveiled the inadequacies of our frail public health system- a system that has been consistently underfunded and, arguably, undervalued. Therefore, voters will have the power to steer health policies to address these gaps that were made evident to everyone, including those who work outside of the field of health. Moreover, we must address systemic inequities through the lens of public health. Voter suppression can disenfranchise vulnerable communities and will directly impact health and wellbeing.
Therefore, it is crucial that healthcare leaders and organizations begin taking a stance on this issue to ensure that voting access is expanded and that the method of mail-in ballots is preserved. Leaders can also work with non-partisan organizations to increase voter registration and improve voter turnout. We must reimagine hospitals as mini Democracy centers- safe places where voter registration forms and information about voting can be made available to patients and their families. Whatever the method, it is clear that healthcare leaders must act diligently on this issue. Voting is a public health matter!
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