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The vital connections between my patients' health — and American democracy

Dr. Alister Martin, in front of Mass General Hospital. Martin is a practicing ER physician, a former chief resident at MGH and the founder of Vot-ER. (Courtesy Raychel Casey)
Dr. Alister Martin, in front of Mass General Hospital. Martin is a practicing ER physician, a former chief resident at MGH and the founder of Vot-ER. (Courtesy Raychel Casey)

If you visited Massachusetts General Hospital in October 2019, you would’ve been greeted with a sight that existed in no 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.)

In the last 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 novel venue for nonpartisan civic engagement.

Many have asked whether this is the lane of healthcare workers and the institutions they work in.

They have answered with a simple and resounding yes.

Why? Put simply, politics influences the care we can give our patients.

Our most marginalized communities have lower civic participation rates, resulting in worse health outcomes.

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

Nearly 1 in 4 eligible citizens is not registered to vote, which amounts to nearly 51 million voting-age citizens who do not make their voices heard in each election. A disproportionate share of them come from Black, Brown and other minority communities across America, the very same communities of patients most marginalized by our healthcare system.

The data also demonstrates what healthcare workers see firsthand everyday — there is a link between civic participation and health outcomes. Several studies show that communities with decreased participation in the democratic process have lower self-reported physical and mental health outcomes. The hypothesis is that this comes from the absence of the social capital that comes from having a greater role in elections.

In short, our most marginalized communities have lower civic participation rates, resulting in worse health outcomes.

To interrupt this cycle, the healthcare sector has emerged as a critical venue for civic engagement.

First, individual health care workers across the country have answered the call to help their patients vote like their health depends 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 health care workers in over 300 health care institutions. These collective efforts have resulted in more than 66,000 people who have been helped with voter registration or obtaining their vote-by-mail ballot.

Next, medical schools are beginning to explore and implement education about civic health in the training of medical students. Medical schools like Stanford and Harvard are teaching students how they might connect civic health and physical health, and how to integrate questions about voter registration into the social history of the patient interview. The AAMC, the governing body of the nation’s 154 medical schools, has developed materials that help medical schools communicate about and integrate voter registration. Lastly, dozens of schools across the country have competed against each other in a nationwide voter registration competition, including a contentious Duke Medical School vs. UNC School of Medicine rivalry.

Hospitals have also taken up 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 nation’s largest organization representing hospitals, released materials that hospitals can use to help their patients and employees get registered.

The surge in momentum around civic health is emerging as one inspiring antidote to these troubling times.

With the push 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 have begun to take notice and support the work of healthcare-based voter registration. In August, Massachusetts Gov. Charlie Baker signed a proclamation recognizing August as Civic Health Month, a month devoted to helping patients and healthcare workers vote in healthcare settings across Massachusetts.

As one of his first acts in office, President Joe Biden signed an executive order calling on all agencies to promote voter registration. As the primary health care-facing agencies, both the Departments of Veterans Affairs and Health and Human Services have released new materials and guidance, as a way to help health facilities engage their patients in voter registration in a nonpartisan way.

Amid declining trust in government, decreasing rates of civic participation and rampant election denialism, experts argue that the health of our democracy is beginning to fail. The surge in momentum around civic health is emerging as one inspiring antidote to these troubling times.

Healthcare workers can help create a healthier democracy. We cannot do it alone. But without us, it cannot be done.

Alister Martin, MD, 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 healthcare inequities.

Follow Cognoscenti on Facebook and Twitter.

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