Healhy Democracy Healthy People

What We Can Do

There are many immediate and long-term opportunities to bolster health and democracy.

Restore Civic Participation to Our National Health Goals

The national Healthy People initiative is a roadmap for achieving national-level health goals over 10 year spans. Measuring and tracking these goals deeply informs local and state-level health plans, including through governments and hospital systems.

We should restore civic participation as one of Healthy People’s goals. Healthy People 2020 included metrics about voter registration and the portion of people who actually voted, from data found in the U.S. Census but these metrics were dropped in Healthy People 2030. It could be immediately restored.

The National Academies of Sciences, Engineering, and Medicine — the Congressionally chartered experts who advise the government on critical science issues — recommended including voting among 34 Leading Health Indicators.

Several public health organizations have already called on the Department of Health and Human Services and the Biden administration to add these measures back in.

Healthy Democracy Healthy People and coalition partners advocated for the inclusion of voting as an objective of Healthy People 2030. In January 2022, we helped public health organizations and researchers submit 22 public comments on the relationship between health and voting and the importance of including voting metrics in our Healthy People 2030 goals. You can read our public comment letter to the Department of Health and Human Services (HHS) here.

On July 21, the Department of Health and Human Services announced a new research objective and a “high priority public health issue”: “Increase the proportion of the voting-age citizens who vote.” In November 2022 we organized over 50 organizations and public health professionals to submit public comments to HHS in support of transitioning the research objective to a core objective, read our letter to the Department of Health and Human Services (HHS) here.

September 19, 2022: Healthy Democracy Healthy People Coalition Sent Letter to HHS on Promoting Voting

Today, the Healthy Democracy Healthy People coalition, along with leaders across the public health, healthcare, and civic engagement sectors, sent the Biden Administration a set of recommendations to strengthen civic and voter participation through the Department of Health and Human Services (HHS).

The Coalition is unified on the understanding that when more people are engaged in democracy people and communities are healthier. Civic and voter participation is strongly associated with health disparities: states and countries that have more accessible voting policies and higher levels of civic participation are healthier across multiple public health measures. Improving health disparities can only be achieved by fully addressing the social and political determinants of health, including civic and voter participation.

The letter expressed appreciation for the actions HHS has already taken such as, establishing voting metrics as a research objective in Healthy People 2030 and offering guidance for voter registration in Federally Qualified Health Centers (FQHCs). Additionally, we assert there is more that HHS can do to actively support civic engagement, especially as one of the largest federal agencies that directly touches Americans’ lives. The Coalition letter made three recommendations of actions HHS can take to strengthen civic and voter participation and advance health and racial equity. These recommendations include:

To read the full letter, click here.

Strengthen Democratic Systems

Our democratic systems—including voting and public input in policy—currently leave too many Americans behind, erecting barriers that leave millions unable to exercise their right to vote.

As public health practitioners, we can examine the ways voting policies are linked to health outcomes and support policies such as vote-by-mail and early voting, inclusive registration systems and restoring rights for ex-offenders.

The number one reason people cite for not voting is simply not being being registered. We can help people update their voter registration when they sign up for other government services, just like when they renew their driver’s license. This can be expanded to include more services, including health services such as Medicaid.

Specifically, the Centers for Medicare and Medicaid Services can empower states to encourage people update their registration when they enroll in Medicaid.

Public health offices, clinics, and other settings can provide resources to people on participating in upcoming elections, reaching policymakers, and participating in community meetings on issues that impact health.

Health institutions can also identify ways to incorporate civic engagement into strategic plans, health impact assessments, and other guiding documents to address health equity.

Inform Public Policy with Scientific Evidence

We cannot improve what we cannot measure. Given the critical connection between health and voting, we must do more to measure civic engagement as a health goal at all levels.

Promote Health Through Civic Engagement

Learn about the voting policies in your state and how they correlate with different health indicators.

Educate your community about how important civic engagement is to achieving equitable health outcomes by including voter registration in community outreach, ensuring civic engagement is centered in public policy discussions, and help your institutions support voter participation.

Make civic engagement a year-round activity. Promote participation in town halls, public meetings, volunteer activities, and opportunities to educate community members on issues that will shape local policy and strengthen community cohesion.

Support Additional Research on Civic Engagement & Health

Future research should evaluate the individual and community factors that lead to high levels of civic engagement, seek to better understand the causal relationship between civic engagement and health, and explore what these connections mean for health equity.

We should also develop our understanding of how law and policy are determinants of health and monitor where voting laws and policies have changed to assess the relationship between those changes and health outcomes in those communities.