New policy brief emphasizes the influence of elected officials in advancing health equity
Jan. 26, 2024 (ACP) -- Whether running at the local, state or federal level, winning political candidates often make crucial decisions about who gets access to medical care -- and who does not. Ballot measures play an important role, too. That is why the American College of Physicians is taking a stand in favor of safe and equitable access to the ballot box.
In a new policy brief titled “Ensuring Equitable Access to Participation in the Electoral Process,” published Dec. 26 in the Annals of Internal Medicine, ACP urges support for electoral protections to advance health equity.
“Unfair election practices penalize people -- especially those from disadvantaged communities -- in the process of voting,” said Dr. Omar T. Atiq, president of ACP. “Those who represent them determine policies that impact all facets of their lives. ACP supports efforts to make access to voting and other electoral processes more equitable and responsive to the needs of all individuals and communities.”
As the paper notes, voter participation in the United States is low, with a third of eligible voters not taking part in the 2020 presidential election. Nearly a quarter of eligible people are not registered to vote, and about one in eight voter registration records has problems that may prevent voting.
“Low voter turnout rates and skewed electoral institutions can substantially affect policy trajectory at the local, state and federal levels, undermining the principles of representative democracy and shifting policy toward the preferences of a smaller group of persons,” the authors note in the policy brief. “Mitigating the costs of casting a vote through advocating for more accessible and equitable elections allows more persons to take part in the political processes that shape their social drivers of health and, in many cases, direct access to health care services.”
ACP's paper provides five recommendations:
ACP recognizes that voting impacts health and health care.
Voting can have direct positive effects on underrepresented groups, noted Dr. David R. Hilden, chair of the ACP Health and Public Policy Committee and co-author of the paper. “One example is Medicaid expansion. When put to a general vote, many states -- Maine, Missouri, Nebraska and Oklahoma -- have adopted Medicaid expansion.”
In contrast, several states continue to reject Medicaid expansion because voters have elected leaders who oppose it.
ACP supports policies that ensure safe and equitable access to voting and opposes the institution of barriers to both the process of voter registration and the act of casting a vote.
“There is an indirect health benefit to engagement in the electoral process,” Hilden said. “Civic engagement can lead to networks, norms and trust in social structures that lead to health and well-being. There is even some evidence that skewed electoral systems could be associated with lower life expectancy.”
ACP supports the drawing of fair, representative and nonpartisan electoral districts. ACP recognizes that partisan gerrymandering may exacerbate health inequities through the disenfranchisement of vulnerable communities and supports efforts to end the practice of partisan gerrymandering.
“Gerrymandering is not the tactic solely of one party, and we acknowledge that the drawing of maps is necessarily rather messy,” Hilden said. “In the end, what is objectively measurable is that gerrymandering is about maintenance of power in government. When that interferes with health, as we are convinced that it does, then we have a problem that must be removed.”
ACP encourages medical students, residents, physicians and other health care professionals to vote and supports efforts to eliminate barriers to their participation in the electoral process.
“Sadly, physicians vote in lesser numbers than the general population,” Hilden said. Data from a 2022 analysis published in JAMA Network Open revealed that an average rate of 57.4 percent of physicians voted between 2000 and 2020 compared with 63.4 percent of the public.
“This may be due to time constraints, lack of trust that it matters or not being registered where they practice,” he explained. “There are probably lots of reasons. But internal medicine physicians are uniquely cognizant of the effects of health care policies that do not always align with what they see as necessary for their patients.”
ACP encourages nonpartisan health care-sponsored voter engagement as a strategy to increase health equity for patients and health care professionals.
“For many patients, the trip to the doctor's office is their most consistent encounter with the societal systems. Their doctor's office is likely a place in which they have some degree of trust. So, this is a great place to assist patients to have their voices heard in the voting process,” Hilden said. “Interventions include nonpartisan voter engagement methods, such as a pin on the white coat or a sticker on the doctor's ID badge that encourages people to vote.”
Hilden added that physicians can also advocate in their own health care systems for policies that give flexibility to employees who want to vote. “We can also help our patients who are in the hospital to vote,” he said. “And we can go to our state's physician ‘Day at the Capitol’ and advocate for not only reimbursements, student loan relief and practice reform, but also for removing barriers to voting for our patients.”
“ACP represents the best of internal medicine doctors, and the College has a long commitment to advocacy for policies that benefit our patients,” Hilden said. “Even though historically, doctors may have considered their voice to be only appropriate in the exam room, ACP will continue to pursue policies and support efforts to enable our patients to exercise their right to make their voices heard. We as physicians ought to be clamoring to remove barriers to participation in the electoral process for all people without exception. The health of our communities demands we do this.”
“Ensuring Equitable Access to Participation in the Electoral Process,” is available on the Annals of Internal Medicine website.