PW board member Dr. Alex McDonald speaks with Dr. Ilan Shapiro about the upcoming election and the importance of making sure patients are registered to vote.

Dr. McDonald: Hello, podcast listeners. Happy whatever day you might be listening to this, but hopefully you’re listening to it sometime in October 2024, maybe early November 2024, because it is very timely. We are going to be talking with my good friend and colleague, Dr. Ilan Shapiro, about civic engagement, voting, and why physicians should help encourage patients to vote and be involved in civic engagement in and of themselves.

Let’s just jump right in. Dr. Shapiro, thank you so much for joining us. Tell us who you are and what you do.

Dr. Shapiro: First of all, doctor, thank you so much for the opportunity. It’s a moment that we can get on the week to talk about life and good stuff with a friend. Thank you so much for this space.

I was born and raised in Mexico City; did my MD over there; work as the liaison between Mexico and the WHO. Love the national policy, by nationality, the complications between—I trained in little pueblitos, little towns, to going to Geneva and talking with other ministers on how we can improve the health of everyone. I did my pediatric training at Mount Sinai Hospital in Chicago. Loved it. Have been working with federally qualified health centers in Fort Myers, Florida. Loved it. I currently serve as a senior vice president, as chief health correspondent and medical affairs officer for a federally qualified health center called AltaMed. We serve around 500,000 patients.

You probably will ask if I’m still practicing. Yes, I’m a practicing pediatrician, and I’m loving it.

Dr. McDonald: Wonderful. You are exceptionally qualified, given your diverse background and experience both within the health’s policy world as well as actual clinical experience in seeing patients. So let’s just take a step back. Why is voting important? That may seem like a simple question, but why is voting important, and why is it important for physicians and healthcare workers to vote?

Dr. Shapiro: I’m laughing right now because the first time that they told me, “Dr. Shapiro, we have this project and we think that we should start talking about civic engagement at the clinics.” And I was like, hell no. Hell no, no, no, no. I’m a physician. I save lives, I give vaccines, I do a lot of things, but that’s not part of how I want to serve my community. And, oh boy, I was mistaken.

A lot of the frustrations that we have inside of the clinic—anybody, if you’re a surgeon or you’re a family practitioner in child medicine, it doesn’t matter. You have the same frustration, that you can give all the insulin in the world, all the preventive educational messaging that you want, all the technology that we have, but we can only move 20% of the health of our patients. That’s a reality, and we have that every day.

We are maxing out on this medication and your sugars are still not getting improved. I’m giving all the medications that I have in the world for my kids with asthma, and they continue going to the ER. It’s more than the medications, it’s more than our clinics and healthcare systems. It’s actually those social drivers of health that affect 80% of their health, that I was extremely frustrated that I couldn’t touch.

Dr. McDonald: I’ve heard some studies say social drivers account for as much as 90% of somebody’s health. So somewhere in that 80% to 90% of health is totally unrelated to what we do as physicians and the care we provide.

I have a really great example that I think will highlight what you’ve been saying here. I had a patient whose average blood sugar was poorly controlled. He was getting all kinds of complications from diabetes. I kept preaching, diet, sleep, exercise, medication, all those pieces, and then finally, it turned out that he didn’t live in a safe neighborhood or have anywhere he could go to exercise or afford a gym. It took me reframing my brain to understand all these impacts that are limiting or helping patients achieve health. We have no control over them whatsoever. So those social factors are so important.

Dr. Shapiro: Completely, and we’re never trained on how to address those. We were never trained to recognize those and rarely put the value on that part. You give a great example of what was happening with your patient.

The other thought that I had, apart from “hell no” at the beginning and the frustration, was how can I talk about registering to vote or elections inside of the clinic? Then afterwards I had a second thought: I’m asking my patient if he or she feels safe at home, I’m asking them about their sexual preference to understand where they’re coming from, I’m asking if they plan to hurt themselves or others. I’m asking very deep and hard personal questions. Can I ask, “Are you registered to vote? Do you know what’s going to happen in the election? Do you have a plan?” Of course I can! Those are easy questions.

Compared to absolutely everything that we have around us, we have the opportunity to engage our community. By the way, Dr. Alex, it’s not that they need to go and vote for the tree party or the purple party, it doesn’t matter. We need to be there and engaging in order to raise our voice. If we’re quiet and we’re in the corner, it doesn’t work.

Dr. McDonald: Yeah, I think we’re somewhat afraid and tiptoe around some of these issues, whether you’re talking about being partisan or nonpartisan. Everyone freaks out and gets very scared, but really, like you said, it’s about civic engagement. It’s not about voting for a Republican or a Democrat or an independent, it’s about just voting. Because when people vote, when they have more engagement in the civic process and are electing people who support policies which are going to directly impact them, that’s the most powerful tool we have. More than any injection, antibiotic, prescription surgery, you name it.

Dr. Shapiro: Completely, and a lot of the times we go, my vote doesn’t count on those big elections. But most of the important things—parks, streets, police officers, community clinics—are managed at the local level. Most of the time, the win or lose margin is a couple of votes. Imagine if we all are talking about the things that we want to change and participating in this civic engagement exercise. I call it civic health because our civic health, same as our mental health and our physical health, needs to be accounted for.

The best example that I give to my patients is, imagine that you have a gym in the corner of your house, and they give you a free membership, and you’re not using it. That’s actually being able to vote and not voting. You have what you want to have, but you’re just not moving forward and doing your part to be represented.

Dr. McDonald: Yeah, I love that analogy, having a gym with a free membership right on your block, but you don’t use it and it’s a lost opportunity. I think we’ve established for listeners that voting and encouraging people to engage in the civic process is well within the physician’s wheelhouse, so how do we now go about doing that? What can physicians do to help encourage patients to vote. Are there certain individual tactics? Are there clinic-based tactics? Are there organization-based tactics that you recommend or that have or have not worked in your experience?

Dr. Shapiro: For the six questions? Yes, yes, yes, yes, yes and yes.

Dr. McDonald: I don’t remember what I asked in what order, but that’s okay.

Dr. Shapiro: The first part is starting with us. We need to recognize how our civic health is as physicians. There has been a lot of research that we, as physicians, are amazing, doing a lot of things, but voting is not one of our fortes. We need to make sure that we are already registered and ready to vote. We have a plan and move it forward. It’s the same way that whoever has kids or grandkids, kids actually learn by example, not with the words that we say. Make sure that you preach and be the example. That’s the first part.

The second one is that everybody goes, oh my god, how can I start? It doesn’t need to take a lot of time. There are interventions that last one or two minutes and you don’t need to do absolutely anything else. We have a running joke where you have the Diet Coke part of it, the diluted one, or you have the champagne package. Let me start with the champagne package, the best thing that anybody can do. Community clinics, clinics and hospitals, are a beautiful place where trusted sources of information live. That’s you, doctor, that’s me, that’s our amazing nurses, our amazing staff. Have at least a poster regarding, do you have a plan to vote? You register to vote, and you can start scaling that from the visual part.

Also, have that conversation and training with our community, with our staff and our healthcare providers, meaning absolutely everybody that touches a patient. We start creating the movement. At the end of the conversation with a patient, when we already talked about vaccines, preventions, therapy, anything, it takes one or two minutes and it goes like this: By the way, do you know what’s happening right now, on November 5th? Yes, no. Yes. Are you registered to vote? You maybe hear yes and no, or I don’t believe in this. Whatever the answer is, just put that forward.

We are working with My Vote, My Health. It’s California-based. Right now we are collaborating a lot with the National Association of Community Health Clinics, where we are putting resources around our community. One of the most important things is that we open the door to have a conversation with everybody willing to have that conversation, and the engagement part is one or two minutes.

We also work together with Vot-ER. They have a beautiful badge with a QR code that is local with your zip code. That way if you need to register in your state earlier or later, then you start having all this information and possibilities that are important for you and that will help that conversation.

Dr. McDonald: I think your points are so well taken. It can be as simple as a poster on the wall. I have the Vot-ER QR code on my badge. Again, this is not a partisan issue. This is about just getting people to vote.

I have some sobering statistics that I looked up. I think it will highlight this point. If you look at the United States population, about 94% of the US population is registered to vote, but turnout rates are around the low 60%, 62%. Physicians and healthcare workers are 12% to 23% less likely to vote than the population. Looking at other industrialized nations, the difference between the percentage of population who are registered to vote compared to those who actually do vote is a much smaller gap between, 5% to 10%.

I think, in this country, we have expanded access to voter registration. We’ve made it easy to register to vote. But when it comes to actually getting people to vote and our voter turnout rate, that is one of our biggest challenges. Like you said, it starts with us. It starts with leading by example. I always vote every year. I’ve voted ever since I was 18 and even in midterm elections where nobody seems to care. Taking a picture of my ballot and posting it online and publicly sharing that information, I think, is really valuable, and I hope other physicians will do the same.

I wanted to touch on what you commented about local engagement. I think that’s something that people really forget about and miss out on. Everyone pays attention to the big shiny presidential elections and the national elections, but so much of local city and school board elections have much more impact on their direct and daily lives. Can you expand more on that?

Dr. Shapiro: The people that live around you, they know you. If you’re allergic to peanuts, they will know to avoid bringing peanuts to you. The same thing happens with the elected officials around you. If you’re participating in electing people that know you, know your preference—it will not be perfect all the time, but at least they’re trying to make sure that you’re taken care of. That’s your local elections, those are your local people, that’s your city, that’s your counselor, that’s your council member.

They can swiftly change a street. They can improve a school. They can improve—I’m going to say the T word—taxes, the local taxes. They can actually do a lot of things. It’s not the federal people, it’s the local stuff that starts accumulating.

Dr. McDonald: I guess I should give a full disclosure here that I’m actually on my elected local schoolboard. I was advocating for these issues and thinking how important it was, and so I decided rather than advocate towards my local elected officials or state officials, I would just run for office myself. That’s a bit of a non-sequitur, but I feel like I should share that information with our listeners in the spirit of full disclosure.

You’re absolutely right. They were trying to put a bike lane in one of the streets by one of our schools, and they came and presented to the schoolboard about the importance of physical activity and safe, walkable neighborhoods for children to walk to school. That is not something that the president of the United States decides, but it is probably far more impactful to my local neighborhood than anything the president could do, honestly. That’s just one example. How do we encourage patients or help patients understand that local elections really matter, probably more so than the national elections?

Dr. Shapiro: It’s extremely important to understand that things around us give us help, they give us a better improvement of QOL, and a better future for our kids. The first thing that we always say to our patients no matter what is, make sure that you’re eating well. Make sure that you’re doing movement. Do sports and, of course, try to make sure that you have a healthier lifestyle. They say, yes, Dr. Shapiro, I’m going out there. Yes, I know about the vegetables, the green stuff. I want to have a Mediterranean diet.

They go to the supermarket, and they need to fight hunger. The choices are not as simple as we think they are. The other thing is, yes, Dr. Shapiro, I’m going to start training to do a 5K. I’m going to do that part. And the first thing that they do is they pick up their phone and look for a park. Maybe there’s not a park, there’s not a green space around them.

In the community that I serve, the safest place is the cemetery. They actually jog around the cemetery because gangs do not touch that area of the city. Then when we start thinking about the reality of, yes, I want to do sports, I want to bring my kids—is there a space? Is there a safe space?

All of these things can change at the moment that we’re voicing it to our local electives. The same thing with our schools, our police officers, all of them. Everybody wants to do the good thing, but if we are not there as a community member and we do not measure our civic health, we are just going to be lacking and doing treatments instead of prevention.

Dr. McDonald: Yeah. Those local elected officials have far more control over those barriers to healthy lifestyle and social determinants than any national or even state elected officials sometimes, so get patients involved, connected, and engaged.

I also think that some of my patients who have become more civically engaged feel more connected to the community. They build more relationships, they have more of a stake in their community, and they have more of a stake in their health. There’s a positive upward physical-psychological spiral, I think, when you get connected to your community. Different cultures and ethnic groups have different connections to their community. Find out however people like to get connected and feel engaged. We know that social connections are so valuable to our mental and physical health.

This is a phenomenal conversation. You and I could probably go preaching all day long if we want, but give us a couple of places where can physicians learn more about how to get more engaged in civic engagement and how to help their patients engage. Give us a couple of resources.

Dr. Shapiro: I’m going to start with a champagne package. I will bring the caviar, or whatever is your best food that you can imagine. It’s called My Vote, My Health. https://www.myvotemyhealth.org/. It’s everything that I’m telling you about, involving our healthcare system, our leaders in our clinics, or our hospitals, and actually making that move. They have all the tools and information on how to engage our community members in order to make change. That’s the first one.

My second one that we work very closely is Vot-ER. They have this amazing badge where you, as a doctor at the end of your conversation, can go, oh, by the way, these are the best resources that you can find. It’s nonpartisan. It has a zip code. You put your zip code and it gives you specific information of your locality in order to be civically healthy and engaged.

Those are the ones that I want everybody to remember. My Vote, My Health, and Vot-ER.

Dr. McDonald: It’s https://vot-er.org/. Well, this has been such a great conversation. I really appreciate your insights and your time. Last question, I always end with this question. What makes you most proud to be a physician?

Dr. Shapiro:

The opportunity to wake up every day, have joy, be present, and call it work. That’s one of the beautiful things that I have been cherishing for almost two decades. I can fulfill my mission. Sometimes it’s harder, sometimes it’s easier. There are a lot of scars. But I’m making sure that I’m doing something better for my community, for me and my family.

Dr. McDonald:

Wonderful. Dr. Shapiro, thank you so much for joining us. Thank you to all of you out there for listening. Make sure you like, subscribe, however you want to get your podcast, and we’ll keep the conversation going with all these fantastic conversations with the PW podcast. Thanks all.

Thanks for listening. Stay tuned for next week’s episode. To hear more, follow PeerPOV: The Pulse on Medicine on Apple Podcasts, Spotify, or Amazon Music.

This transcript has been edited for readability.