As a pediatrician, in every well-child visit besides the standard inquiries about illnesses, vaccinations, diet, and behavior, I would always ask the parents of my patients four additional questions: does your child know how to swim, does your child have a library card, have you taken your child to visit the state Capitol, and are you registered to vote? Parents intuitively understood that swimming was a life-saving skill and quickly grasped the link between reading and educational success and health. But they were usually perplexed and intrigued by the last two questions. They were surprised to discover that the policy decisions made at all levels of government had a bigger impact on their child’s health than the medical care they received, and that voting was the best way to influence those decisions. I always made information on how to register to vote available to parents as part of the “anticipatory guidance” portion of the clinic visit.
As a public health professional, I have continued similar discussions about what determines health. Most people are surprised to learn that medical care accounts for only about 10% of society’s overall health while at least 50% of health is determined by the social, economic, and environmental conditions in the communities where they live – conditions that are influenced by policy decisions at all levels of government. Once people recognize that fact, they better understand why voting is a public health issue.
When voting participation is high, a population’s health is better
Multiple studies confirm the health consequences of voting. When voting participation is high, a population’s health is better. The 10 least healthy states in America have a voting participation rate nearly 10 percentage points lower than the 10 healthiest states.
History demonstrates the impact of voting on health – particularly the health of mothers and babies. After women gained the right to vote in 1920, maternal and infant mortality rates dropped precipitously. Similarly, when the Voting Rights Act of 1965 passed, infant mortality rates again dropped and the Black/white disparity in those rates narrowed. In both situations, policymakers began better serving the needs of previously disenfranchised people only after they were able to express their will by voting.
The COVID-19 pandemic adds unprecedented health risks to voting. Knowing that large gatherings pose a risk for spreading the SARS-CoV-2 virus and that elections are among the largest public events in America, we must work to assure that voting is safe. A public health strategy is to embrace voting by mail, which minimizes contact and reduces viral spread. Additional options including early voting and ballot drop boxes would supplement the mail-in efforts. Voters need to be assured that the U.S. Postal Service will promptly deliver all ballots and that state officials will include all early and mailed ballots for accurate tallies.
This election year, our country is in the midst of cascading and interconnected crises: an infectious disease pandemic, nationwide protests against racial injustice, and catastrophic economic strain for millions of people. Each of these crises reveals the deficiencies and inadequacies of our health, social, and economic systems, and the urgent need for significant policy changes to address the flaws. Officials elected in November will be the people with the opportunity to craft policy changes to address these needs. Thus, it is more important than ever that all our citizens have their voices heard – particularly those who have been disenfranchised in the past. The lessons of 1920 and 1965 teach us that universal suffrage is essential not just for the health of our democracy, but for the health of individuals and communities.
Raising a healthy child is one of the most important and difficult tasks of being a parent and no parent can do it alone. It is a tired and overused cliché that “it takes a village to raise a child.” But what is not well recognized is that part of that village’s role is to have every adult vote. A village of voters is necessary to create the conditions in which every child has the opportunity to be healthy and thrive.
With only a few weeks to go until the November election, now is the time for everyone in every village to step forward and vote in a safe way. It is the most powerful thing we can do for the health and well-being of our children and our community.
Edward P. Ehlinger, M.D., MSPH, is a past president and current board member of the Association of State and Territorial Health Officials and a board member of the Jacob and Valeria Langeloth Foundation. He also previously served as commissioner of the Minnesota Department of Health under Gov. Mark Dayton.
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