Context for using this document
Vision:
The vision of Vot-ER and Civic Health month is “healthy communities powered by an inclusive democracy.”
Context and Use:
Vot-ER and Civic Health Month created this document for the December 2020 Look Ahead convening. This document is intended to support healthcare professionals, social workers, public health leaders, and others in their presentations around the link between health, voting, the social determinants of health, and the structural determinants of health.
Feel free to use specific slides or segments that support our collective vision in your efforts. To edit slides, please make a copy of this document first. You can find a PDF version of these slides (as of December 2020) here. A video of Dr. Alister Martin presenting these slides is here.
Tag Us on Social Media:
If you give a presentation using these slides, take a photo and tag us at @vot_er_org
Contribute to the Living Document and Appendix:
Please feel free to send potential additions to this document to Vot-ER Executive Director aliya@vot-er.org. She will incorporate relevant changes into this document. Examples of additions could include:
Civic Engagement and Health
www.vot-er.org
July 2022
@vot_er_org
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Indirect benefits of voting on health
www.vot-er.org
@vot_er_org
Terms | Definition | Populations targeted | Level of change |
Social needs/health-related social needs (HRSNs) | “The effects of the causes”��Individual material and psychosocial circumstances | Specific individuals or defined populations | Micro |
Social determinants of health (SDH) | "The causes of poor health"� Underlying community-wide social, economic, and physical conditions | Defined communities or regions | Meso |
Structural determinants/ SDH inequities | "The causes of the causes" �The climate, socioeconomic political context, and the structural mechanisms that shape social hierarchy | Cities, states, nations, or the world | Macro |
Voting
Structural determinants of health
The upstream causes of the causes
Social determinants of health
The causes of poor health
Health-related social needs
Effects of the causes
Voting is arguably the most important aspect of the political determinants [of health]”
Daniel Dawes
Morehouse School of Medicine
Demographic Overlap
Unregistered eligible voters
Patients most marginalized by our current health system
young,
low-income,
patients of color
When our patients don’t vote, campaigns are less likely to address their needs resulting in negative health impacts.
Our patients who don’t show up at the polls are labeled as “unlikely voters” and are not contacted by campaigns about voting.
Voting, the social determinants of health, and community outcomes have a complex relationship.
What follows are maps of observational data around voting and health.
East Harlem: Voter Turnout 2018
Source: Gothamist
East Harlem had a 35% lower voter turnout rate compared to citywide turnout in the 2018 mayoral election.
East Harlem: Life Expectancy 2018
Source: Quartz
East Harlem had a life expectancy rate that was decades lower than surrounding voting precincts in 2018.
Southwest Detroit
Source: Bloomberg, “Covid Plus Decades of Pollution Are a Nasty Combo for Detroit”
24+ industrial sites
Residents live 7 years less than the US as a whole
Asthma hospitalization is 2x MI and 5x US
Of those, 19+ precincts are in Southwest Detroit
41 of the 100 lowest-turnout precincts in Michigan are in Detroit
About 4,800 election precincts in Michigan
Source: Michigan Secretary of State Voting Matters Report, a list of 100 lowest turnout precincts in Michigan, data is through 2018
*Note: Definition of Southwest Detroit varies, this analysis focuses on zip code 48217 and immediate surroundings
We also see this relationship nationally with the Health & Democracy Index
The American Medical Association recognizes this link
In June 2022, the American Medical Association formally recognized voting as a social determinant of health
The 2022 elections will have an important impact on the health of our patients and communities
When our patients vote, campaigns are more likely to address their needs.
As our patients vote more often, they are labeled as likely voters and campaigns start contacting them, at which point a positive feedback loop begins to take shape.
Promising Indicators of Success: Income
Source: Engaging New Voters 2018, ‘If Nonprofits Don’t, Who Will?’, Nonprofit Vote Executive Summary.
Lower income clients and patients who were encouraged to vote by the nonprofit institution they received services from had the largest turnout advantage.
Promising Indicators of Success: Race
Source: Engaging New Voters 2018, ‘If Nonprofits Don’t, Who Will?’, Nonprofit Vote Executive Summary.
Clients and patients of color who were encouraged to vote by the nonprofit institution they received services from had the largest turnout advantage.
Promising Indicators of Success: Age
Source: Engaging New Voters 2018, ‘If Nonprofits Don’t, Who Will?’, Nonprofit Vote Executive Summary.
Young clients and patients who were encouraged to vote by the nonprofit institution they received services from had the largest turnout advantage.
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Direct benefits of voting on health
People are more likely to self-report “fair” or “poor” health in states where there’s below-average voter turnout.
Source: Blakely TA, Kennedy BP, Kawachi I. Socioeconomic inequality in voting participation and self-rated health. Am J Public Health. 2001;91(1):99-104. doi:10.2105/ajph.91.1.99
“...voter turnout is associated with poor self-rated health, independently of both income inequality and state median household income.”
“Voting among adolescents was associated with less risky health-related behaviors and fewer depressive symptoms in young adulthood.”
Source: Ballard, Parissa J, Hoyt, Lindsay T, & Pachucki, Mark C. (2019). Impacts of Adolescent and Young Adult Civic Engagement on Health and Socioeconomic Status in Adulthood. Child Development, 90(4), 1138-1154.
“From a theoretical standpoint, voting presents an opportunity to exert voice, perhaps establishing a path to health through empowerment.”
“Statistical analyses showed that after controlling for demographic factors like age, race, political orientation, and education, study participants who scored higher in political activism also reported higher levels of personal well-being.”
Source: Benefits of Being an Activist: Measuring Activism and Its Role in Psychological Well‐Being Malte Klar Tim Kasser First published: 09 September 2009 https://doi.org/10.1111/j.1467-9221.2009.00724.
“A study of 44 countries (including the United States) found that voter participation was associated with better self-reported health, even after controlling for individual and country characteristics.”
Source: Kim S, Kim CY, You MS. Civic participation and self-rated health: a cross-national multi-level analysis using the world value survey. J Prev Med Public Health. 2015;48(1):18–27.
Registered voters tend to have higher levels of social connection
The Benefits of Social Connection
Source: Social relationships and health BY JS HOUSE, KR LANDIS, D UMBERSON SCIENCE29 JUL 1988 : 540-545
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Latham Thomas
Optical allyship is defined as allyship that only serves at the surface level to platform the 'ally,' it makes a statement but doesn’t go beneath the surface and is not aimed at breaking away from the systems of power that oppress.”
The National Academies of Sciences, Engineering, and Medicine 2019 report outlines the "5As" strategies and urged health institutions to move from awareness towards concrete initiative rooted in advocacy to address SDOHs in the communities they serve.
Allyship requires action.
Helping patients vote is one concrete action institutions can and should engage in to advocate for their patients and address upstream social and racial inequities.
Office of the CEO: Hospital Advocacy Through Encouraging Voting
Over 500 Hospitals, Clinics, and Health Centers are helping their patients vote as a partner of Vot-ER.
Massachusetts General Hospital
University of Cincinnati
M Health Fairview
Groups: Organizational Advocacy Through Encouraging Voting
Over 100 medical associations and organizations work with Vot-ER to help their members and staff vote.
SNMA
American Academy of Pediatrics
State Hospital Associations
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From 1996 to 2002, eligible physicians voted approximately 9% less than the general population.
Surely we’ve fixed this since then, right?
From 2006 to 2018, eligible physicians voted approximately 14% less than the general population.
We owe it to our patients to be at the table when it comes to deciding our nation’s health policies.
In the 2020 election, health care providers helped 47,000+ colleagues and patients get ready to vote!
Source: vot-er.org
Civic Health Month
Through Vot-ER’s national program Civic Health Month, we partner with over 200 organizations and associations.
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Keep the Pulse Going in 3 Steps
1. Make sure you are registered to vote
Take 60 seconds and make sure that you are registered to vote.
https://vot-er.org/pulsecheck/
https://vot-er.org/kit/
2. Get a kit to help others vote
Join thousands of other clinicians who use their free healthy democracy kit to help patients, family, and friends vote.
https://vot-er.org/site-based-setup/
Help your clinical site
Get posters, discharge paperwork, and materials that can help patients ensure they are ready to vote.
Thank you
www.vot-er.org
@vot_er_org
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Appendix
Additional materials you can incorporate as needed plus maps of additional communities across the US
“Pediatricians have historically used their knowledge and experience to advocate for children and families in a number of forums, including authoring opinion pieces and editorials, participating in interviews with the media, and meeting with policy makers. Although these forms of advocacy are important, they lack a key characteristic: enhancing the agency of our patients and families.”
Official Journal of the American Academy of Pediatrics
“Building Political Capital: Engaging Families in Child Health Policy,”
We encourage all pediatricians to broaden their definition of advocacy to include facilitating patients’ and families’ political engagement.”
Who votes seems to substantially affect how governments raise and spend their money. When fewer people vote and turnout is presumably more skewed by race, income, and other factors, governments appear to behave differently than when turnout is higher and less skewed …
America's Uneven Democracy : Race, Turnout, and Representation in City Politics
... This suggests that when disadvantaged groups fail to vote, local officials are more likely to be unresponsive to their concerns. Moreover, the effects are substantial. Expanded turnout could increase the amount of money going to redistributive programs by a third.
America's Uneven Democracy : Race, Turnout, and Representation in City Politics
Redistributive programs include health services, education, public housing, welfare
As many places in the US have declared racism a public health crisis, the erosion of voting rights must be understood as manifestations of structural and cultural racism and thus, prioritized for action. When democracy is weakened, social cohesion and public health suffer.”
Incorporating Voting into Healthcare Works
For every one percent of total voters in a precinct that AltaMed contacted, the percent change in turnout from 2014 to 2018 increased by 8.3 percentage points.”
—Center for Social Innovation at University of California Riverside. “Evaluating AltaMed Voter Mobilization in Southern California, November 2018”
Detroit
Chaldean Town, Detroit
Source: Detroit Free Press, “The Last Days of Detroit’s Chaldean Town”
“The neighborhood kept deteriorating, the schools were getting more dangerous.”
Chaldean Town: Voter Turnout 2013
Source: Gothamist
Chaldean Town had a 14% lower voter turnout rate compared to citywide turnout in the 2013 mayoral election.
% Citizens Voting Age Population Turnout Rate
Source: Who Votes for Mayor? (Project of Portland State University)
Chaldean Town: Life Expectancy 2015
Source: CDC’s National Center for Health Statistics
Chaldean Town had a life expectancy rate that was 6 years lower than the state average in 2015.
Philadelphia
Kensington, Philadelphia
Source: Community Health Profile: Kensington, Philadelphia, PA, Drexel University Urban Health Collaborative
High poverty rate
High rate of languages other than English spoken
Large population of young people
Kensington: Voter Turnout 2015
Source: Who Votes for Mayor? (Project of Portland State University)
Areas of Kensington had a 15% lower voter turnout rate compared to citywide turnout in the 2015 mayoral election.
Kensington: Life Expectancy 2015
Source: CDC’s National Center for Health Statistics
Areas of Kensington had a life expectancy rate that was a decade lower than the state average in 2015.
Ohio
The LOCAL Level
…we found that census tracts with greater voter participation rates had lower all-cause child inpatient bed-day rates, even after adjusting for socioeconomic deprivation.
For every 10% increase in voter participation, there is an approximately 10% reduction in the number of days children spend hospitalized.”
“Voter Participation is Associated with Child Health Outcomes at the Population Level”
The Journal of Pediatrics, 2021
Arizona
The LOCAL Level
Alhambra, Phoenix
Source: City of Phoenix Planning & Development Research Team
40%+ Hispanic
< 20% of the population has a college degree
23% of families living in poverty
Alhambra: Voter Turnout 2015
Source: Who Votes for Mayor? (Project of Portland State University)
Parts of Alhambra had a 15% lower voter turnout rate compared to neighboring areas in the 2015 mayoral primary election.
Alhambra: Physical Health 2018
Source: CDC’s PLACES: Local Data for Better Health
Residents in parts of Alhambra reported poor physical health at a rate 10% higher compared to neighboring areas in 2018.
Boston
Mattapan, Boston
Source: Boston.gov
Large Black and Caribbean population
Many immigrant-owned businesses
Mattapan: Voter Turnout 2013
Source: Who Votes for Mayor? (Project of Portland State University)
Mattapan had a 24% lower voter turnout rate compared to West Roxbury in the 2013 mayoral election.
Mattapan: Life Expectancy 2015
Source: National Center for Health Statistics
Areas in Mattapan had a life expectancy rate that was five years lower than the state average in 2015.
New York City
East Harlem
Source: NYU Furman Center
Large Hispanic and Black population
Poverty rate 13% higher than citywide average
East Harlem: Voter Turnout 2013
Source: Who Votes for Mayor? (Project of Portland State University)
One area in East Harlem had a 12% lower voter turnout rate compared to neighboring areas in the 2013 mayoral election.
East Harlem: Diabetes Rates 2018
Source: CDC’s PLACES: Local Data for Better Health
One area in East Harlem had a diabetes rate 13% higher than surrounding neighborhoods 2018.
Voting is critical for living long and healthy lives
“From midtown Manhattan to the South Bronx in New York City, life expectancy declines by 10 years: 6 months for every minute on the subway.”
— Dr. Donald Berwick,
The Moral Determinants of Health
Data: 2018 Community Health Profiles; NYC Votes
Political Determinants - Environmental Health
Policy:
Voting & Health:
Increasing voter turnout in BIPOC communities can help drive an equitable approach to urban planning and other policies that impact health.
Data: 2018 Community Health Profiles; NYC Votes
Political Determinants - Reproductive and Maternal Health
Policies:
Voting & Health:
Empowering underrepresented voters can help keep local officials accountable in advocating for communities’ health needs.
Data: 2018 Community Health Profiles; NYC Votes
Jacksonville
Woodland Acres, Jacksonville
Source: Google Maps
Bordered by Route 115, Atlantic Blvd, and the Arlington River
Woodland Acres: Voter Turnout 2015
Source: Who Votes for Mayor? (Project of Portland State University)
Part of Woodland Acres had an 18% lower voter turnout rate compared to citywide turnout in the 2015 mayoral election.
Woodland Acres: Life Expectancy 2015
Source: CDC’s National Center for Health Statistics
Part of Woodland Acres had a life expectancy rate that was 6 years lower than the state average in 2015.