Dr. Alister Martin pictured in front of Mass General Hospital. Martin is a practicing ER physician, a former chief resident at MGH and the co-founder of Vot-ER. He is dually appointed as an assistant professor at Harvard Medical School and as research faculty at the Harvard Kennedy School. (Raychel Casey)

The Vital Links Between My Patients’ Health and American Democracy

If you visited Massachusetts General Hospital in October 2019, you would have been greeted by 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 fast 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 civic health and healthcare-based voter registration has emerged as a viable and new venue for nonpartisan civic engagement.

Many have asked if this is the path of healthcare workers and the institutions in which they work.

They answered with a simple and resounding yes.

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

Our most marginalized communities have lower rates of civic participation, which translates into poorer health outcomes.

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

Nearly one in four eligible citizens is not registered to vote, which represents almost 51 million citizens of voting age who do not make their voice heard at each election. A disproportionate share of them come from black, brown, and other minority communities across America, the same patient communities most marginalized by our healthcare system.

The data also shows what healthcare workers see first-hand every day – there is a link between civic engagement and health outcomes. Several studies show that communities with reduced participation in the democratic process have lower self-reported physical and mental health outcomes. The hypothesis is that it comes from the absence of social capital which comes from having a greater role in elections.

In short, our most marginalized communities have lower rates of civic participation, which translates into poorer health outcomes.

To interrupt this cycle, the health sector has become an essential place for civic engagement.

First, healthcare workers across the country answered 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 make it easy for them to engage their patients in a nonpartisan way. For example, Vot-ER creates and ships Healthy Democracy Kits, which 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 shipped over 50,000 Healthy Democracy Kits to healthcare workers in over 300 healthcare facilities. These collective efforts enabled more than 66,000 people to be helped to register on the electoral lists or obtain their postal ballot.

Next, medical schools begin to explore and implement civic health education in the training of medical students. Medical schools like Stanford and Harvard teach students how they might relate civic health and physical health, and how to incorporate questions about voter registration into the social history of the patient interview. The AAMC, the governing body for the nation’s 154 medical schools, has developed materials that help medical schools communicate and integrate voter registration. Finally, dozens of schools across the country competed in a nationwide voter registration contest, including a contentious rivalry between Duke Medical School and UNC School of Medicine.

Hospitals have also responded to the call to help patients register. For National Voter Registration Day, hospitals across the country, from Topeka, Kansas to Philadelphia, Penn., helped patients through voter registration drives, email communications and posters in their waiting rooms. The American Hospital Association, the largest national organization representing hospitals, has published materials that hospitals can use to help enroll their patients and employees.

The rise of civic health stands out as an inspiring antidote to these troubling times.

With the drive to more meaningfully address health equity and the upstream social determinants of health in the wake of the COVID-19 pandemic, state and federal policymakers on both sides of the aisle began to notice and support the work of voters based on health care registration. In August, Massachusetts Governor Charlie Baker signed a proclamation recognizing August as Civic Health Month, a month dedicated to helping patients and healthcare workers vote in Massachusetts healthcare facilities.

In one of his first acts in office, President Joe Biden signed an executive order calling on all agencies to promote voter registration. As leading healthcare organizations, the Departments of Veterans Affairs and Health and Human Services have released new materials and guidance to help healthcare facilities engage their patients in voter registration for non-partisan manner.

Amid declining trust in government, declining civic participation rates and endemic election denialism, experts say the health of our democracy is beginning to deteriorate. The rise of civic health stands out as an inspiring antidote to these troubling times.

Health workers can help create a healthier democracy. We cannot do it alone. But without us, this cannot happen.

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

Sammer Marzouk is an undergraduate student at Harvard University and a research assistant at A Healthier Democracy, where he explores the intersection of community organizing and how technology can be used to alleviate health inequities.

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