From the Polls to Politics and Public Health

More than 155 million votes were counted in the United States presidential election of 2020. That is roughly 62% of the eligible voting population in the U.S., making it the election with the highest voter turnout in this country in over 50 years. Although turnout on November 3 was record-breaking, the U.S. ranks in the bottom third among OECD (Organization for Economic Co-operation and Development) countries for overall voter turnout. Without a fair and efficient voting system nationwide, the status quo will remain. The way to raise the bar and America’s ranking for voter participation is by reducing inequalities through the passage of progressive health policies and by electing candidates who support better health outcomes. 

From 2017 to 2020, I led efforts at Drum Major Institute, a nonprofit committed to continuing the legacy of its founder Dr. Martin Luther King, Jr., to identify common-sense solutions to pressing social issues such as voter turnout and gun violence. As I worked to dismantle many of the purposeful barriers put in place that prevent everyone from voting, I was inspired to commit to public health, as those are some of the same barriers preventing equal access to healthcare. Ensuring individuals are heard, regardless of their age, sex, gender, race, or health status is at the root of advancing the lives of individuals impacted by society’s deepest inequalities.  

A report published in 1988 titled "The Future of Public Health" states that voter engagement is a public health issue because it molds the ways in which individuals and communities can participate in and have access to healthy behaviors. 32 years later, its premise is validated: voting directly impacts health. Those who are more likely to vote in elections tend to be healthier and are less concerned about the state of healthcare, making the implications during each election biased. It is a perpetual feedback loop and one where the ultimate tool is ensuring access to the ballot box. Another study in 2015 found that voter participation was associated with better self-reported health in 44 countries, including the United States, while another found that individuals who did not vote reported poorer health in the following years. Voting abstention, often an indicator of low social capital, has negative health effects throughout a lifetime. Historically speaking, after the Voting Rights Act of 1965 passed, infant mortality rates dropped among Black Americans, which can be traced back to observed associations between public health efforts, such as inclusive voting, and positive health outcomes.  

One of the main barriers to accessible voting is clear. In 2005, Ambassador Andrew Young, Senator Bill Bradley, and Congressman Jack Kemp came together to ask a simple question: why do we vote on Tuesday? An 1845 law mandated that we vote on Tuesday to observe the Sabbath and because of travel time on horse and buggy. From 2019 to 2020, I worked as the Executive Director of Why Tuesday?, a non-partisan organization that raises awareness about how low voter turnout impacts our voting system, to craft policies advocating for weekend, early, and day-of voting. By ensuring that voting is not only a right for all citizens, but an action that will be encouraged and easily accessed will ultimately increase voter engagement and provide an opportunity for those bearing the burden of poverty and invisibility to be heard. Today, 39 states offer alternatives such as early voting, absentee voting without restrictions, and mail-in voting. While opponents opine that these “easier” options increase chances of voter fraud, those myths mask voter suppression among marginalized communities — the very communities with the greatest need for public healthcare. 

Not only will increasing access to voting improve the long-term health outcomes of those who participate, but it will also protect us in more acute and sustainable ways. In a phone interview, Dr. Norman Ornstein, a Why Tuesday? board member and a resident scholar at the American Enterprise Institute specializing in accessible voting, noted that “the pandemic, which will not be the last, has made it clear that there will be many occasions when voting in person, amidst large crowds, will be a major public health hazard. Finding ways to make voting easier and safer, avoiding ‘rush hour’ periods that have long lines, should be a major priority in our democracy. Expanded vote by mail, days of early voting, weekend voting, all could make a difference.” 

One policy that best illustrates what happens without accessible voting is affordable healthcare for all. A 2016 American National Election Survey showed that the 2016 presidential election turnout rate among uninsured Americans was 34%, in contrast to a 63% turnout rate among those who were insured. Individuals without health insurance are likely to be more supportive of government healthcare programs but are less likely to be able to vote on that issue. 

With a more inclusive voter system that increases voter participation, we will have more equitable policies that address the gaps in health outcomes. 

Voter suppression takes shape in laws, policies, and practices nationwide, as evidenced by strict voter ID laws that continue to complicate voter registration requirements, resulting in voter purges and gerrymandering, a practice intended to establish an unfair political advantage for a particular group by manipulating district boundaries. Such policies manipulate political outcomes at local, state, and national levels, further perpetuating a state of democracy that does not reflect the essential needs of its people. Individuals who have easy and legitimate access to the polls will ultimately impact a wide range of health policies ranging from firearm safety to LGBTQ access. 

The cornerstone of our democracy is the right to vote. It is an essential public health duty to ensure that this right is not stolen, infringed upon, or abused. We are overdue in dismantling the negative feedback loop of health disparities that generate poor voter participation and further reinforce insufficient health policies. By addressing these disparities through voter engagement, we will tackle systemic issues tied to race, educational access, and economic divides. Increasing voter turnout makes room for the growth of a healthier society. Deciding whose voices are heard in the political system has serious implications for healthcare coverage, health policies, and overall wellbeing. Like good nutrition and consistent exercise, voting is vital for your health.

Zoe Siegel is a 2022 MPH candidate in the Department of Health Policy and Management. She received her Bachelor of Science in Applied Psychology and Global Public Health from New York University.