What We Can Do

There are many immediate and long-term opportunities to bolster health and democracy.

Restore Civic Participation to Our National Health Goals

The national Healthy People initiative is a roadmap for achieving national-level health goals over 10 year spans. Measuring and tracking these goals deeply informs local and state-level health plans, including through governments and hospital systems. HDHP’s efforts to reinstate voting as a core objective of Healthy People 2030 were successful, and the change was approved by HHS and published today on HealthyPeople.gov.

Why It Matters

Recognizing voting as a core objective in Healthy People 2030, paves the way for health authorities to establish similar objectives in state and local health assessments and drive action and resources towards increasing voter participation.

How Did We Do It?

Healthy Democracy Healthy People coalition and our allies took a number of actions to advocate for this change:

The coalition’s efforts began when members and allies sent a sign-on letter in April 2021 advocating for the inclusion of voting metrics in Healthy People 2030;
HDHP launched The Health & Democracy Index in August 2021 which supported the analysis and the coalition’s effort to expand public understanding of the relationship between civic and voter participation and health;
The coalition and community partners submitted public comments in response to a Request for Information in January 2022 which solidified the evidence and arguments in support of this new objective;
HDHP hosted numerous efforts in dissemination promoting the importance of civic and voter participation for health equity including presentations and publications.
In September 2022 the coalition sent another letter to the Biden Administration applauding the addition of voting as a new research objective and urging the administration to elevate the objective to a core objective; and
In November 2022, the coalition and a wide range of community partners responded to a new call for public comments focused on promoting voter participation to a core objective.

Where to Learn More:

On August 16, 2023 Healthy Democracy Healthy People and the National Academies of Science Engineering and Medicine’s Roundtable on Population Health Improvement will be hosting a virtual session “Practical Approaches to Strengthen Civic and Voter Participation Through Public Health” featuring a presentation from Carter Blakey, Deputy Director of the Office of Disease Prevention and Health Promotion, who will discuss the impact of adding Voter Participation as a core objective in Healthy People 2030. Blakey will be joined by state and local public health leaders including representatives from County Health Rankings & Roadmaps.

Strengthen Democratic Systems

Our democratic systems—including voting and public input in policy—currently leave too many Americans behind, erecting barriers that leave millions unable to exercise their right to vote.

As public health practitioners, we can examine the ways voting policies are linked to health outcomes and support policies such as vote-by-mail and early voting, inclusive registration systems and restoring rights for ex-offenders.

The number one reason people cite for not voting is simply not being being registered. We can help people update their voter registration when they sign up for other government services, just like when they renew their driver’s license. This can be expanded to include more services, including health services such as Medicaid.

Specifically, the Centers for Medicare and Medicaid Services can empower states to encourage people update their registration when they enroll in Medicaid.

73 million people are enrolled in Medicaid.
Enrollment happens every year, which means voters can easily keep their info up to date.
Health offices already verify relevant information for voting, including people’s address, so this makes our elections more secure and helps election offices keep their voter registration information up to date in a reliable, efficient way.

Public health offices, clinics, and other settings can provide resources to people on participating in upcoming elections, reaching policymakers, and participating in community meetings on issues that impact health.

Health institutions can also identify ways to incorporate civic engagement into strategic plans, health impact assessments, and other guiding documents to address health equity.

Inform Public Policy with Scientific Evidence

Given the critical connection between health and voting, we must do more to promote the understanding of how democracy and health are interconnected at all levels of community.

Future research should evaluate the individual and community factors that lead to high levels of civic engagement, seek to better understand the causal relationship between civic engagement and health, and explore what these connections mean for health equity.

We should also develop our understanding of how law and policy are determinants of health and monitor where voting laws and policies have changed to assess the relationship between those changes and health outcomes in those communities.

Promote Health Through Civic Engagement

Learn about the voting policies in your state and how they correlate with different health indicators.

Educate your community about how important civic engagement is to achieving equitable health outcomes by including voter registration in community outreach, ensuring civic engagement is centered in public policy discussions, and help your institutions support voter participation.

Make civic engagement a year-round activity. Promote participation in town halls, public meetings, volunteer activities, and opportunities to educate community members on issues that will shape local policy and strengthen community cohesion.

HDHP piloted a state-level organizing approach in two states, Minnesota and Michigan engaging health leaders in local efforts to educate stakeholders and policy-makers on the health benefits of inclusive voting policies. The Minnesota- HDHP Team partnered with We Choose Us to share health data on the benefits of expanding and protecting democracy. Minnesota public health leaders shared the data on the relationship between health and inclusive voter participation in testimony, letters to legislators and communications with the public. Examples and excerpts from the Minnesota- HDHP Team are included below:

"... Inclusive, robust democratic processes are vital to creating the opportunity for everyone to be healthy. As a medical student, I want my future patients and community to be able to see their priorities represented in the decisions of their elected officials. The more participants in our democracy, the better it works for everyone–especially those whose voices have been historically silenced." Vineet Raman, second year medical student and fellow for Advocates for Better Health testified in support of the Democracy for the People Act (HF3/SF3). You can watch his full testimony, linked here.
“... there is a cost to voting. One tool to measure how hard or easy it is for people to vote is The Cost of Voting Index which refers to the time and effort it takes a person to vote. Minnesota is ranked 15th of all states, so while we are doing better compared to some states, there is more we can do to protect and expand democracy. It is important to promote and protect inclusive policies including the ones in HF3. Including AVR within DHS would dramatically improve voter registration for low-income Minnesotans and increase opportunities for improved health and well-being.” Catherine Harrison, public health professional and member of the Minnesota Public Health Association. You can watch her full testimony, linked here.
“Ensuring representative democratic decision making and holding systems of accountability in place are necessary means to health equity." Lauren Witt, Advocacy Chair of Minnesota Society for Public Health Education testified in support of SF3. Watch the full video of her testimony, linked here.

The Michigan HDHP Team is organizing health sector leaders including faculty at Central Michigan University, the Michigan Organization on Adolescent Sexual Health, and retired local public health officers to launch a state HDHP Team in partnership with Promote the Vote to support inclusive voting legislative priorities.

To support these efforts, HDHP created multiple materials and templates. Examples of these resources are included below:

Want to explore the possibilities for strengthening democracy and promoting civic and voter participation in your community? Email info@hdhp.us to connect!

Healhy Democracy Healthy People