To the Editor:
As health care providers, we should help our patients register to vote.
Voter turnout in the United States remains a serious problem. Driven by low rates of registration, participation in U.S. elections is lower than in most other developed nations. Despite unprecedented public interest, the 2016 election drew fewer than 60% of eligible voters to the polls.
The weight of this problem is not borne equally. In 2012, Asian and Latino Americans voted at a rate 20% lower than whites or blacks. Poorer and less-educated citizens turned out at half the rate of their more affluent peers.1 Despite talk of a groundswell of poorly educated white voters in the most recent election, the results from 2016 will likely show a familiar trend.
The people least likely to vote are also those with the poorest health in our society. Failing to vote, of course, does not lead to poor health, but the two issues are inextricably tied. A 2001 study found a striking connection between voter participation and self-reported health. In states with the greatest disparities in voter participation between rich and poor, citizens tended to rate their health poorly. On the other hand, citizens of more egalitarian states rated their health better.2 This phenomenon seems peculiar, but a growing body of literature suggests an explanation. Among nations and states, electorates that contain fewer low-income voters tend to have less generous social welfare systems. Administrations enact legislation that favors their electoral coalitions, and higher-class interests—overrepresented in such blocs—are often at odds with policies benefiting the poor. Thus, by failing to vote, society’s most disenfranchised citizens are foregoing a powerful opportunity to influence their elected officials and improve their conditions.
Clinical duties demand the primary attention of all health care providers, but we believe that helping patients register to vote is a meaningful professional aspiration. While it would be inappropriate for physicians to coerce their patients to adopt specific political views, recent experiences have proven that voter registration drives in clinics can be performed easily, ethically, and without tarnishing the patient–doctor relationship.3
By empowering our patients from every socioeconomic and ethnic background to vote, we can help them strive, in a small but absolute manner, for the rights that they believe in, for health care and beyond.
Michael Milligan
Fourth-year medical student, Harvard Medical School, Boston, Massachusetts; [email protected]; ORCID: http://orcid.org/0000-0002-9101-9262.
David Jones, MD, PhD
A. Bernard Ackerman Professor of the Culture of Medicine, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0003-0039-7784.
References
1. Perez V. Representational Bias in the 2012 Electorate. January 2015. Washington, DC: Project Vote;
http://www.projectvote.org/wp-content/uploads/2015/06/Representational-Bias-in-the-2012-Electorate.pdf. Accessed May 24, 2017.
2. Blakely TA, Kennedy BP, Kawachi I. Socioeconomic inequality in voting participation and self-rated health. Am J Public Health. 2001;91:99104.
3. Liggett A, Sharma M, Nakamura Y, Villar R, Selwyn P. Results of a voter registration project at 2 family medicine residency clinics in the Bronx, New York. Ann Fam Med. 2014;12:466469.
