Voting for health: Helping patients engage in democracy

Sep 23, 2020

With elections approaching across Canada and the United States, experts at the University of Toronto have been exploring the interplay between voting and health. Their findings suggest that healthcare organizations could help patients engage in the election process, and shape the services they rely on.

“When we vote, we have the opportunity to shape public policy,” explains co-author Dr. Danyaal Raza, an Assistant Professor in the Department of Family and Community Medicine (DFCM) and a family physician at St. Michael’s Hospital. “These policies in turn shape our healthcare system and influence the social determinants of health, whether that’s affordable housing, employment opportunities or education. But if large groups of citizens don’t vote, then public policy is less likely to reflect their needs.”

To understand more, Dr. Raza and fellow faculty member Dr. Andrew Pinto, alongside medical student Chloe Brown, carried out a scoping review to examine the existing research on health and voter participation.

The search confirmed a consistent positive association between health and voting. In Canadian federal and municipal elections, those with higher self-rated health (and mental health) were more likely to vote. In contrast, those with health issues such as depression, addiction and dementia were less likely to vote. This is not just a Canadian phenomenon, the researchers identified similar trends in Europe and the USA.

Race also plays a role, with multiple studies highlighting a connection to racial health disparities in the USA, and a voting gap in elderly black communities. While these disparities have consequences at the political level, research suggests that interventions in healthcare environments can increase voter participation.

“We wanted to understand more about the relationship between health and voting, and look for opportunities to encourage democratic engagement among some of the most vulnerable people in our society,” explains Brown. “We found some really promising ideas.”

These ideas include reducing barriers to voting by hosting polling booths in clinics or hospitals, supporting voter registration, and providing non-partisan education about voting by proxy or mail.

This intersection of physical, mental and civic health is not new. Teams across Canada and the US are working hard to increase the participation of communities under-represented in the electoral process. But more research is needed on the long-term effects of voting on health, and the role healthcare organizations can play, particularly among marginalized groups.

“As family physicians, we see the economic and social consequences of poor health in our patients,” says Dr. Pinto, the founder and director of the Upstream Lab, which focuses on tackling social factors that impact health. He is also a public health and preventive medicine specialist and family physician at St. Michael’s Hospital, and an Associate Professor at DFCM. “If we can remove some barriers to voting, this means people who have not been part of the democratic process can engage. Power and resources shape our social determinants, and by significantly increasing voter participation this can change who is in power and their priorities."

This study was published in Public Health Reviews with commentary in Canadian Family Physician.