Voting, Gerrymandering, & Social Determinants of Health
This weekend is a reminder that voting rights in America were and continue to be an important aspect of equity, justice, and health. Why? Here is a brief primer.
I am marking Dr. Martin Luther King Jr. day by watching a documentary on this incredible icon. I have come to the stark realization that voting in America is complex, a struggle to understand, and a battle with many fronts. As I watch this Dr. King documentary, my great appreciation for civil rights leaders in America’s past only rises further, and I find myself thinking of today’s civil rights leaders as they continue to fight this battle.
The stories of voting rights, Dr. King, gerrymandering, and social determinants of health are closely intertwined. This weekend is a reminder that voting rights in America were and continue to be an important aspect of equity, justice, and health. Let us unpack this!
What did the Voting Rights Act of 1965 do?
Voting Rights Act of 1965 was a landmark bill advocated by Civil Rights leaders (including Dr. Martin Luther King, Jr.) and passed into law by then President Lyndon Johnson.
It outlawed the discriminatory voting practices adopted in many southern states after the Civil War, including literacy tests as a prerequisite to voting. (National Archives)
Prior to the Voting Rights Act of 1965, African Americans faced significant barriers in registering to vote - ranging from harassment, literacy tests, and poll taxes, to physical violence (and death).
What is the current State of Voting Rights Act of 1965?
Today, changes in legislation have allowed the creation of barriers by state governments (such as strict voter ID laws, cutting voting times, restricting registration, limiting voting-by-mail and early voting, and purging voter rolls) thus restricting citizens voting rights. (Ohio Photo ID Requirement example)
What is gerrymandering?
Gerrymandering is the “political manipulation of electoral district boundaries with the intent to create undue advantage for a party, group, or socioeconomic class within the constituency.” Or as I like to explain: take a crayon and draw your district based on where your supporters are. (Great article by Chris Ingram explaining gerrymandering)
Under the Voting Rights Act of 1965, gerrymandering based on race was prohibited.
Gerrymandering creates injustice for many reasons as Christopher Ingram describes in his article.
To describe one of the most straightforward injustices of gerrymandering, I give you the example of Eliza (a fictitious character). Eliza is a factory worker, and a single mother of 2 kids aged 8 & 10 years old - both have asthma and frequent exacerbations. She is a resident of a newly redrawn district and her new polling place (voting place) is 2 hours away by bus. Her state does not allow early voting. This year she is determined to vote because on the ballot is a measure that would affect the public funding for the local medical clinic for her and her children. She wants to ensure her (and her family’s) voice is counted in this ballot measure vote. Her factory shift manager does not approve of her taking a half-a-day or leaving work early to go vote because no one can cover her shift. The polling place is open from 8AM to 6PM but her shift is from 9AM to 5 PM. It would take her 2 hours to travel by bus to reach the polling place and 2 hours to return home. She has to make a choice between voting in person or losing a day on her job.
What are social determinants of health?
Social determinants of health (SDOH) are recognized as “the forces shaping a person’s daily life and influencing health outcomes, including economic policies and systems, development agendas, social norms, social policies and political systems.” (WHO)
In simpler terms, SDOH are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” (Healthy People 2030)
In my terms, SDOH are the explicit and implicit, internal & external forces that are working in the background (or foreground!) as you go about your day. And in many ways they influence the trajectory of your health - the quality of nutrition available locally, safe places to walk, availability of lifeguards at the local beach or pool, chronic stress (mental, emotional, financial), noise & air pollution, quality of public education, insurance coverage, public transportation availability, access to higher learning, and much much more.
How are voting, social determinants of health, and gerrymandering related?
WHO has shown in many ways that inequitable distribution of resources leads to disproportionate negative health outcomes. Studies noted in Healthy People 2030 illustrate that access to voting rights and increased civic participation improves the likelihood of closing the equity gap in SDOH due to the creation of social cohesion, trust, and networks within a given generation, group, and community.
On an individual basis, empowering patients to vote increases their agency to improve their health, address underlying political and social determinants of health, and impact long-standing, systemic inequities and discrimination in medicine. (Healthy People 2030)
Furthermore, professional societies such as the American College of Physicians have continued to note that “policymakers [must] address the effect of social drivers of health, like poverty, on the health and health care of those affected” and “physicians and other clinicians must make it a priority to meet the cultural, informational, and linguistic needs of their patients”.
The ability for an individual to vote and make their voice heard is imperative for justice, equity, and health. And this ability can be affected by circumstances dictated by gerrymandering, thus increasing the burden of SDOH on a specific group or community, and having implications for their health.
In the example of Eliza - gerrymandering and SDOH have asked her to choose between voting to secure healthcare access or working the factory shift to put food on the dinner table. In this case, Eliza’s right to vote is available but not protected.
Final thought
Voting restrictions (such as gerrymandering) directly affect the ability of a community to advocate for itself, be civically engaged, and partner in the improvement of local access to programs and funds. This availability and access to improving local conditions directly influence the likelihood that we will improve SDOH for vulnerable populations - the current generation and future generations.
Said another way, the ability to exercise your vote, in itself, is a social determinant of health.
As clinicians, we must choose to advocate for the preservation of voting rights, the elimination of gerrymandering, and ensure eligible patients are registered to vote. For if we fail, we too are responsible for limiting voting rights and the promise of a better future - a grave injustice.
“Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly.” - Dr. Martin Luther King, Jr.
To learn more about voting & health check out these resources:
VOT-ER: helping clinicians and patients talk about voting!
Civic Health Alliance: helping clinicians identify resources for civic engagement!
Voice Project at UCSF: youth voting and health care improvement