The vital connections between my patients’ health and American democracy

If you visited Massachusetts General Hospital in October 2019, you would have been greeted with a sight that didn’t exist at any other hospital in the country: a voter registration kiosk. Three years later, with the 2022 midterm elections approaching, more than 700 hospitals, clinics and medical schools across the country have the capacity to help patients register to vote. (The Globe recently covered this story.)

Over the past three years, an explosion of action and momentum around the concept of citizen health and health-based voter registration has emerged as a viable and new venue for nonpartisan civic engagement.

Many question whether this is the path of healthcare workers and the institutions in which they work.

They have answered with a simple and emphatic yes.

Why? Simply put, politics affects the care we can provide to our patients.

Our most marginalized communities have lower levels of civic participation, which leads to poorer health outcomes.

We see the vital connections between our patients’ physical health and their civic health. While we may not be able to address all the ways our democracy has faltered, we can start with a simple and basic building block of civic engagement by making it easier for our patients to register to vote.

Almost 1 in 4 eligible citizens are not registered to vote, which equates to nearly 51 million voting-age citizens whose voices are not heard in every election. A disproportionate number of them come from black, brown and other minority communities across America, the same patient communities that are most marginalized by our health care system.

The data also demonstrate what health care workers see firsthand every day—there is a link between civic engagement and health outcomes. Several studies have shown that communities with reduced participation in the democratic process have lower self-rated physical and mental health scores. The hypothesis is that this comes from the lack of social capital that comes from a greater role in elections.

In short, our most marginalized communities have lower levels of civic participation, which leads to poorer health outcomes.

To break this cycle, the health sector has become a critical site for civic engagement.

First, individual healthcare workers across the country responded to the call to help their patients vote as if their health depended on it. Organizations like Vot-ER, Med Out The Vote, and Vote Health facilitate patient engagement in a nonpartisan way. For example, Vot-ER creates and supplies Healthy Democracy Kits that include a badge and lanyard that doctors and hospital staff can wear to help their patients and colleagues vote. Since 2019, Vot-ER has created and sent over 50,000 Healthy Democracy Kits to healthcare workers in over 300 healthcare institutions. This collective effort resulted in more than 66,000 people being assisted with voter registration or receiving a mail-in ballot.

Medical schools then began to explore and implement civic health education in the training of medical students. Medical schools like Stanford and Harvard teach students how they can connect civic health and physical health and how to integrate voter registration questions into the patient’s social history interview. The AAMC, the governing body of the nation’s 154 medical schools, has developed materials to help medical schools communicate and integrate voter registration. Finally, dozens of schools across the country competed against each other in a national voter registration contest, including the hotly contested rivalry between Duke School of Medicine and UNC School of Medicine.

Hospitals have also been called upon to help patients register. For National Voter Registration Day, hospitals across the country, from Topeka, Kansas to Philadelphia, Pennsylvania, helped patients through voter registration campaigns, email communications and posters in their waiting rooms. The American Hospital Association, the largest national organization representing hospitals, has released materials that hospitals can use to help their patients and employees sign up.

The growing momentum around public health is emerging as an inspiring antidote to these troubling times.

With the push to more meaningfully address health equity and the social determinants of health upstream in the wake of the COVID-19 pandemic, state and federal policymakers on both sides of the aisle have begun to pay attention to and support the work of health-based constituents. . In August, Massachusetts Governor Charlie Baker signed a proclamation recognizing August as Civic Health Month, a month dedicated to helping patients and health care workers vote in health care settings in Massachusetts.

As one of his first acts in office, President Joe Biden signed an executive order calling on all agencies to promote voter registration. As agencies focused on primary care, both the Departments of Veterans Affairs and the Departments of Health and Human Services have released new materials and guidance as a way to help health care facilities engage their patients in voter registration in a nonpartisan manner.

Amid declining trust in government, declining levels of civic participation and rampant voter turnout, experts say the health of our democracy is beginning to fail. The growing momentum around public health is emerging as an inspiring antidote to these troubling times.

Health workers can help create a healthier democracy. We can’t do it alone. But it cannot be done without us.

Alistair MartinMD, MPP is CEO of A Healthier Democracy and an emergency physician in Boston who writes about the intersection of medicine, public policy, and behavioral economics.

Samer Marzouk is a graduate student at Harvard University and a research fellow at A Healthier Democracy, where he explores the intersection of community organizing and how technology can be used to alleviate health disparities.

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