Dr. Stella Safo, Dr. Christine Petrin, and Olivia S. Morris: Health is political, and it’s always on the ballot
By Dr. Stella Safo, Dr. Christine Petrin, and Olivia S. Morris
Over the past decade, voters across the country have passed more than 500 state ballot initiatives, 63.5% of which address issues concerning public health — ranging from tobacco taxes to health insurance to reproductive care to food security.
As physicians and public health professionals, this trend is no surprise. We know that at least 80% of health outcomes are driven not by medical care, but by the social determinants of health– non-medical factors that shape the conditions where we live, work, and play. Public policy plays a major role in shaping the social determinants of health, whether it’s housing safety, clean air regulations, or access to green space. When voters have the power to impact health policies by directly voting for ballot initiatives, it is perhaps the most compelling example of how participating in our democracy impacts our well-being. But it is far from the only way.
In every election, and especially in local ones, we choose leaders whose decisions shape and reshape what our communities look like, how safe they are, and which resources are available to us. Our elected officials influence the kind of care patients can receive and how much life-saving medications will cost. Elected officials set agendas and approve budgets that can transform the landscape of healthcare availability and delivery.
Just in the past few years, we have seen this process play out at every level of politics. Access to reproductive health care has been influenced by the rulings of judges, the actions and budget requests of governors, and the laws passed by legislatures. Abortion-related ballot initiatives have appeared in six states since 2022, and citizen-initiated constitutional amendment proposals will be on the ballot in an additional eight states this November. Importantly, no matter the level, these processes all involve the power of voters. Whether it’s who we elect or the ballot initiatives we pass, showing up to the polls is vital to our health.
Recently, the healthiest states in the country have had voter turnout rates 10 percentage points higher than those with the poorest health. When we have a more inclusive electorate, we also see health outcomes improve. Historically, women’s suffrage was associated with an 8 to 15% decrease in child mortality. The Voting Rights Act of 1965 was associated with a greater decrease in Black infant mortality in states with Jim Crow laws, helping to reduce inequities. And today, research from the Health and Democracy Index has shown that states with more inclusive voting policies also have better outcomes across 12 different public health indicators, including infant mortality and chronic disease management.
When more people show up at the ballot box, our elected officials become more responsive to our needs and increase funding for safe, healthy, and well-resourced communities. Health is political, and voting is a powerful path to demanding healthy neighborhoods and communities from our elected officials. With the 2024 general election already upon us, health is once again on the ballot. Don’t miss the opportunity this year to care for your health and the health of your communities by casting your vote.
Stella Safo, MD, MPH is an HIV internist and primary care physician and the Co-Founder of Civic Health Alliance.
Christine Petrin, MD, MPH is a primary care physician in East Harlem, NY, and Board Chair of Doctors for America.
Olivia S. Morris is an MPH student in the Department of Social and Behavioral Sciences at the NYU School of Global Public Health.
