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The medical community recognizes voting as a social determinant of health, noting its mutual influence: health affects voting ability, and voting impacts health.

The medical community increasingly recognizes voting as one of several social determinants of health (SDOH) and emphasizes that this is a public health issue. This connection between voting and health works both ways: health influences the ability to vote, and voting also influences health. As such, physicians need to get involved in voting advocacy.

What is an SDOH?

SDOH are social needs and environments that contribute to health. Healthy People 2030 describes SDOH as “conditions in the environments where people are born, live, learn, work, play, worship, and age that affects a wide range of health, functioning, and quality of life outcomes and risks.” Many significant healthcare outcomes are determined by these non-medical factors such as income, access to healthy food, transportation, and affordable and safe housing.

SDOH can be grouped into five domains that influence health:

1. Economic Stability:
   1. Employment
   2. Food Insecurity
   3. Housing Instability
   4. Poverty
2. Education Access and Quality:
   1. Early Childhood Development and Education
   2. Enrollment in Higher Education
   3. High School Graduation
   4. Language and Literacy
3. Healthcare Access and Quality:
   1. Access to Health Services
   2. Access to Primary Care
   3. Health Literacy
4. Neighborhood and Built Environment:
   1. Access to Foods That Support Healthy Dietary Patterns
   2. Crime and Violence
   3. Environmental Conditions
   4. Quality of Housing
5. Social and Community Context:
   1. Civic Participation
   2. Discrimination
   3. Incarceration
   4. Social Cohesion

SDOH may account for 30% to 50% of health outcomes. As such, SDOH significantly impacts people’s health and physical and mental well-being.

In 2022, the American Medical Association passed a resolution declaring voting a social determinant of health.

What’s the Connection Between Health and Voting?

Recent research shows a consistent association between voting and health. People who vote tend to report better health compared with those who do not vote. Voters show better future mental and physical health than non-voters, even after adjustment for a range of other factors, including age.

Voting can influence health policies, foster community empowerment, and improve civic engagement and social capital.

Health Policies:

1. Elected officials make decisions about policies and budgets that directly affect health.
   1. Local officials like Governors have broad powers over state expenditures, including healthcare, Medicaid coverage, prescription drug policies, efforts to fight chronic and infectious diseases, and mental health.
2. Voting allows people to influence who makes these decisions and prioritize issues like healthcare access, education, and environmental quality, which impacts health outcomes.
   1. The top issues in the 2020 U.S. Presidential Election included:
      1. Economy and jobs ranked first (38% of voters).
      2. National security and terrorism ranked second (28%).
      3. Healthcare ranked third (11%), followed by immigration (7%).

Community Empowerment:

1. Voting can empower communities to advocate for their needs and hold elected officials accountable for addressing health disparities.

Civic Engagement and Social Capital:

1. Voting and participating in the democratic process can foster a sense of civic engagement and social connection within communities.
2. Strong social capital is associated with better health outcomes.

Studies have shown that voting and health outcomes are connected on several different levels:

Voter Turnout:

1. Higher voter turnout is correlated with better health outcomes in communities, such as lower infant mortality rates and improved access to healthcare.
2. Lower voter participation is often linked to marginalized/socio-economically disadvantaged communities and patients with chronic diseases.

Access to Voting:

1. Decreased access to voting leads to worse health outcomes.
2. Patients with chronic diseases have reduced access to voting.
3. Marginalized communities also have decreased access to voting.

The connection between voting and health is clear. A cycle of poor health leads to decreased access to voting, resulting in worse health outcomes.

That, in turn, decreases political capital and leads to health policies that de-prioritize the needs of patients who are sick or marginalized.

Addressing SDOH can create a more equitable and healthier society. This requires collaboration between public health, government sectors like education and housing, and community organizations.

One way to improve access to voting in marginalized communities and patients who have no or limited access to voting is to increase access to voting in healthcare spaces.

There are efforts in healthcare systems to increase voter registration and education in clinical environments.

There are efforts underway to integrate voter registration and education into healthcare delivery.

When we empower patients to vote, they engage in the process that ultimately affects health policies and outcomes. Here are some of the organizations involved in these efforts:

• Vot-ER: works on integrating civic engagement into a healthcare system. That includes increasing voter registration and participation among patients, especially those who might face barriers to voting.
• Civic Health Alliance is a coalition of health and civic leaders working to improve America’s health through civic engagement in healthcare settings and communities. They curate resources, build partnerships, and raise awareness about the connection between civic engagement and health.
• Patient Voting is a Vot-ER program that aims to “increase voter turnaround among registered voters who are unexpectedly hospitalized in the days and weeks before elections.”
• Healthy Democracy Healthy People is a nonpartisan coalition that works to strengthen civic engagement and public health. Some of these efforts include advocating for policies that make voting more accessible, like same-day registration and mail-in voting options. They also encourage civic participation, such as attending public meetings, contacting elected officials, and volunteering.
• Indelible Learning aims to increase education about the electoral process and decrease cognitive bias in how we elect U.S. Presidents. I am a Principal Investigator on a project funded by the Department of Education, Institute of Education Sciences, to create Election Lab Games. The main goal of this project is to enhance overall electoral college education.
• Election Lab is a collection of authentic games that combine history with data science. These games place voters in the role of campaign strategists. Moreover, with a multidisciplinary approach (ie, combining Math, Statistics, and Civics), these Election Lab games increase data literacy. Election Lab Games beautifully elucidate the complex process of winning the highest office in the United States. Through immersive, hands-on experience, these games turn U.S. Presidential Elections into fun, engaging, motivating, and easier-to-understand processes. After playing the 2016 Election Game, one superintendent exclaimed, “This game is insanely brilliant! It takes a highly charged emotional issue and takes the emotion right out of it. Great visuals! Easy to understand. Beautiful!”

And who does not want to replace highly charged emotions with increased critical thinking, acceptance, negotiation, and tolerance?

It is only with a multiprong approach to increasing civic education and voting participation that we can make a dent in increasing voters’ engagement in the electoral process.

We aim to increase critical thinking and data literacy by building innovative educational technology. We also aim to increase voting engagement, particularly youth voting. We believe that voting is a habit. The more educated people are about voting, the more durable their voting habits will develop as adults.

At the end of the day, all these skills—increased critical thinking, decreased cognitive bias, increased data literacy, increased civics participation, and increased voting habits—will ultimately result in improved health, improved health outcomes, and improved overall quality of life.