The struggle in the US to manage the covid-19 pandemic has made it clear that public leaders at all levels of government wield great influence over our health. Beyond the risks of voting during a pandemic, we are well aware that the upcoming US Presidential elections in November will have major public health implications. This context highlights a deeper truth that predates the covid-19 pandemic and has long been neglected by the healthcare community: voting matters profoundly for our health. Accordingly, in our view, it is time for health professionals to recognize voting as a dimension of healthcare and offer much-needed resources to support voter enfranchisement and safe voting.

A body of evidence has found that when a more diverse array of American citizens vote, policymaking becomes more inclusive of the poor and vulnerable. For example, one study found that states with higher turnout among low-income voters implemented more generous welfare systems. Another study found that states with more equal voter turnout—meaning people from wealthy and poorer backgrounds voted at more comparable rates—were more likely to expand health insurance for low-income children and to adopt higher minimum wages.

Our current healthcare system fails to meet the needs of many populations. Such policies help fill major healthcare gaps by addressing socioeconomic disadvantage, which is widely considered to be a primary cause of health inequities. These policies focus on improving how people “live, work, learn, and play,” which we know is where good health begins. 

Beyond improving economic and healthcare support for low income individuals, voter turnout has also been directly linked to community-level health outcomes. For example, one widely-cited study found that states with more equal voter turnout rates had better average self-reported health among residents. Another found that the surge of female voters following women’s suffrage laws increased government spending on health, which cut child mortality by 8-15 percent between 1900 and 1930.

These studies reveal a common theme: enfranchising the disenfranchised results in policies that benefit those with the worst health outcomes. How does that happen?

Part of the explanation comes from voter choice at the polls. Surveys show that unregistered voters and people who vote less frequently tend to support policies focused on equity, like increased spending on healthcare and education.

Further, policymakers are more responsive to voters than non-voters. Since they depend on voters for re-election, it is only natural that when non-voters become voters, their needs are more likely to be addressed. That’s why when voter-suppressed groups, like people from ethnic minorities and low-income individuals, turn out to vote in higher numbers, officials direct more funding and resources toward these underserved communities—they can no longer ignore those communities and expect to be re-elected.

And when the electorate does not include the voices of historically disenfranchised voters, their needs fall on deaf ears. For example, two-thirds of the Alabamans who would benefit from the expansion of Medicaid were not registered to vote. It’s no surprise Alabama has not expanded Medicaid under the Affordable Care Act.  

There is a vicious cycle at play: poor health is also associated with decreased voter turnout. Therefore, without outside intervention, these individuals remain sick in a system that was not designed for them and voiceless to call for change. Once enfranchised, we could see a new cycle emerge, one in which our healthcare system improves for these individuals, empowering them to vote at higher rates. With this understanding, voter registration behaves on a systems level very similarly to how blood pressure medication acts at the individual level. When administered consistently, these interventions act to improve health and protect against factors that are known to cause disease.

For those who have dedicated their lives to healing others, it is time to recognize that breaking down barriers to voting is a dimension of healthcare. Many health professionals have taken up this charge. Throughout the United States, over twenty thousand doctors, medical students, and other health professionals have chosen to participate in non-partisan voter registration. They are not expected to become voter registration experts. Instead, their energies are best used by directing colleagues and patients to high-quality non-partisan voter registration resources and continuing on to care for their next patient. The resources will take care of the rest.

If we fail to invite voiceless communities into the democratic process, we will continue to treat the symptoms of our broken system while ignoring the perspectives of those with the greatest insight into how our system must change.

Charlotte O’Herron is a candidate for a Master in Public Policy at the Harvard Kennedy School. Previously, she was a fellow at VotER, a nonprofit that advances healthcare-based voter registration. She also worked as a Research Analyst at MDRC, a nonprofit social policy research organization in NYC. 

Jon Kusner is a fourth year medical student at Harvard Medical School. He serves a co-chair of the AMSA National MedOutTheVote campaign that seeks to engage healthcare professionals and trainees in improving the health of our democracy.

Competing interests: None further declared.