Go Vote!

In my previous article “Wealth Divides Health,” I discuss the topic of Social Determinants of Health as “non-medical factors that affect healthcare outcomes.” (1) Common social determinants such as education, income, neighborhood, and access to food do have a direct effect on health; however, in this article, I hope to introduce voting as a new social determinant. 

Municipal elections in North Carolina have recently concluded and I have just started engaging with the time-old question “does my vote matter.” 

One of my main goals with this journal is to foster public interest in politics and a desire to improve politics to facilitate better health outcomes. Low voter participation and turnout is a complex issue. Income is one of the most relevant determinants of voter turnout; I believe that through health education and by actively including individuals of varying socioeconomic status in the legislative process, we might improve voter turnout and create policy in the best interest of the majority, an ideal we strive for in a democratic nation. (2)

In a sociology course, I was presented a 2014 study by the American Political Science Association (3). In this paper, the authors Gilens and Page argue:

The argument Gilens and Page make is that the U.S. political system is built around preserving the present and thus, even when individuals congregate together to push for change, they face severe structural barriers. Furthermore, they argue that individuals with immense political and economic power and large interest groups hold greater power than the average citizen in determining policy and creating political agendas. All in all, the study paints a grim image of voting as it depicts the American system as fairly non-democratic. Do we as individuals hold any power in determining the future of the nation? And if so, how do we maximize that power to make decisions in our collective best-interest, particularly related to health? 

I argue that collective mass action has the most promise in maximizing individual-level political power. By participating in collective mass action, individual voters group together, forming groups of people with similar policy interests and beliefs regarding a specific issue. Organizations that aim to raise awareness of particular issues amongst the public and grassroots campaign organizations both attempt to facilitate collective mass action. The question is: does this really work?

One of the most notable election outcomes from 2023 was Ohio’s legalization of recreational marijuana and of a woman’s right to access an abortion. Regardless of what your opinions are of these two issues, these policy changes reflect the importance of individual voters and collective mass action and their impacts on state-level policy decisions. 

• Ohio’s State Issue 1 was a proposed amendment establishing a constitutional right to access an abortion. (4) Prior to the election, a study at Ohio Northern University found that 52% of individuals were in support and 36% were against State Issue 1. (5) Ultimately, 57% supported the issue and 40% opposed it on election day when surveying all likely voters.

• Ohio’s State Issue 2 was a proposed law allowing adults to purchase and maintain recreational marijuana. A survey of likely voters found 61% in support and 34% in opposition.

Ohio State Issue 1 and 2 are highly partisan, but health policy in general is not necessarily partisan from a voter perspective. By that, I mean that individual voters are often willing to cross party lines in support of perceived better health policies. One of the main issues right now with the American health system is cost; with or without insurance, many Americans feel that they are spending too much out-of-pocket when it comes to healthcare. Furthermore, the idea of universal healthcare or healthcare as a right, enshrined in the laws of other nations, has garnered increasing interest in the US. Thus, it comes as no surprise that many Americans seem willing to vote for a candidate from a competing political party if that candidate promises to reduce healthcare costs. (6)

Now, let me conclude this article by returning to the question “Is voting a social determinant of health?”. While voting on health-related issues may improve health outcomes and reduce disparities, data shows another interesting phenomenon connecting voting and civic participation to better health outcomes. 

Individuals who vote typically feel more connected to their communities and develop a greater sense of agency and belonging when able to play a role in legislative decisions. This sense of agency has long-term health impacts even when adjusting for possible confounding factors as a 2008 study finds that abstaining from voting is associated with a 1.3 times greater likelihood of reporting poor health after two years. (7) This correlation between civic participation and long-term health contributes to a structural health disparity between communities; communities where individuals suffer from a lack of voting access or barriers that prevent voting may have poorer long-term health outcomes when compared to communities that provide individuals with opportunities to vote and participate in the legislative process. (8)

As I conclude this article, I can only think of one statement -- Go Vote! Individual level voting and collective mass action not only ensure policies meet the needs of those they are designed to serve but also affect the health of those who participate. When more and more people believe that their vote doesn’t matter, corporations and interest groups gain more power in deciding policy, resulting in legislation that might be less in favor of American individuals. Voting is the cornerstone of American democracy; regardless of partisan politics, civic participation holds the promise of improving health and policy.