Civic participation, including voting in local, state, and federal elections, ensures that all people can advocate for issues that concern them, including education, transportation, and of course, health. The impact of an individual’s right to vote is enormous. Voting specifically allows all American citizens the right to choose who will serve them as local and national leaders and in numerous ballot measures. Ballot measures and the subsequent decisions of those elected leaders can have short-term and long-term implications to the practice of pharmacy and access to health care for individuals living in the United States.
Fifty-six years ago the Voting Rights Act was signed into law by President Lyndon B. Johnson, which was enacted to remove barriers to political participation by racial and ethnic minorities and prohibit any practice that denies the right to vote on account of race. However, in 2013, the Supreme Court case Shelby v. Holder invalidates Section 5 of the Voting Rights Act, which required that counties with a history of discriminatory voting practices obtain congressional approval before making any changes to election policies. Since then, numerous laws have been passed that prohibit many individuals from being able to participate in this fundamental right.
In addition to not reflecting the voices of all of the people, voter suppression can have a significant effect on the health and well-being of those who are silenced. Not only does this impact the over 114,000 pharmacists who are racial minorities, but more importantly it can impact millions of our patients. As healthcare providers, it is important we understand the different elements that influence health and advocate on behalf of our colleagues and patients to ensure overall health and well-being – including opposing the silencing of our community members through voter suppression.
Voter Suppression Efforts
Democracy is described as having four basic elements: a political system for choosing and replacing the government through free and fair elections; the active participation of all people in politics and civic life; protection of the human rights of all citizens; and a rule of law, in which the laws and procedures apply equally to all citizens. Therefore, voter suppression of one or more specific groups of people compromises our democracy.
There are several efforts being made to suppress voting, primarily for minority groups. Voter registration restrictions, including requiring specific identification to register or limiting the times during which individuals can register, may influence voter participation. Voter ID laws create significant barriers, especially in the states that have strict photo ID laws, with over 21 million United States citizens not owning a government-issued photo identification and as many as 13 million citizens not having ready access to the documents required to obtain an ID. Additionally, the cost to obtain an ID or the documents required to obtain an ID leads to additional burden on low-income communities. You can learn more about your state’s voter ID laws here.
More significantly, states have been found to wrongfully purge eligible voters from the voting rolls. Voter purges are often conducted to remove voters who have changed addresses or died. However, if not done appropriately, these purges can prevent eligible voters from being able to cast their ballot. A NYU Brennan Center for Justice report describes error rates in voter purges as high as 17%. Other forms of voter suppression include the various rules for convicted felons in each state, as well as gerrymandering, AKA redistricting states to manipulate the results of an election. This often favors one political party and therefore dilutes the power of the voice and confidence in the vote of the minority group.
Voter Suppression and the Relationship to Health
In “The Right to Vote, the Right to Health: Voter Suppression as a Determinant of Racial Health Disparities”, Anna Hing outlines the various ways in which voter suppression harms health and well-being. Several of these pathways are listed below:
1. Voter suppression creates group-level exclusion. This exclusion primarily reduces voter turnout for racial minorities. Silencing of various groups may result in passing of policies that influence known determinants of health, such as who receives public assistance, how schools are funded, public transportation, and zoning of neighborhoods.
2. Disenfranchisement influences an individual’s social position in society. Disenfranchisement can lead to individuals experiencing loss of control and disempowerment, which not only has a direct impact on well-being, but also can lead to less resources to defend against increased discrimination and subsequent stress.
3. Voter suppression may take place through psychosocial processes which influence health. These psychosocial processes, such as more commonly checking identification for voters of color than for White voters, may lead to consequential effects of discrimination and psychosocial distress. Additionally, negative coping behaviors to overcome this distress, such as substance use, may adversely affect health.
4. Voter suppression may manifest as physical violence, hate crimes, or secondary direct effects on health. If a voter has to wait in line in extreme heat for many hours because other poll sites have been closed, they may be at higher risk for adverse events, such as asthma and COPD exacerbations, or hyperthermia.
5. Health disparities reinforce voting disparities. Those who are ill are less likely to vote. For example, premature death of African Americans translated into one million Black votes lost in the 2004 Presidential Election.
6. Simply put, voter suppression determines who can and cannot vote. This can create stigma for those who cannot vote, which has been associated with internalized racism and subsequently increased metabolic risk, cortisol secretion, and mental health illnesses, including depression.
Many, including The Grassroots Pharmacist team, argue that health is influenced by many policies, outside of those that have a traditional direct tie to health (for example, access to housing and environmental policies). Although the relationship between voter suppression and health is not proven, evidence shows strong associations and as noted above, it is clear how voter suppression can exacerbate racial health disparities and vice versa. One of the overarching goals of Healthy People 2030 is to eliminate health disparities and achieve health equity. The report states “Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.” As such, eliminating barriers to vote and allowing all people to become involved in civic engagement is essential to ensuring health of our communities in the coming years.
A Call to Action: Ensuring All Voices are Heard
This is a critical time for us to advocate for the removal of barriers to voter accessibility and encourage our legislators to pass laws that protect all individual’s rights to vote. The For The People Act of 2021, which passed in the House of Representatives and was introduced in the Senate in March 2021, expands voter registration, including online, automatic, and same-day registration, and voting access, by allowing for vote-by-mail and early voting. Additionally, it limits removing voters from voter rolls and requires states to establish independent redistricting commissions to carry out congressional redistricting. This bill also addresses election security, campaign finance, and ethics in all three branches of government. The John R. Lewis Voting Rights Act, which was originally passed in the 116th House of Representatives but made no progress in the Senate, is also expected to be reintroduced during this Congress. This Act would restore the components of the Voting Rights Act which were invalidated in the Supreme Court Shelby vs. Holder case, thereby requiring pre-approval from the Department of Justice or the US District Court before making legal changes that would affect voting rights.
As healthcare providers, it is our duty to advocate in the best interest of the health and well-being of all of our patients. We the people means all the people, and voting should remain a fundamental right, not a privilege, for all of the people.