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Source: Healthy Democracy Healthy People
When communities vote they influence policy decisions that have a big effect on their health.
This analysis compares 12 public health indicators and voter turnout to the restrictiveness of voting policies in each state.
OVERALL FINDINGS:
More Voting Access, Better Health Outcomes
States with more inclusive voting policies and greater levels of civic participation are healthier.
Less Voting Access, Worse Health Outcomes
States with exclusionary voting laws and lower levels of civic participation are less healthy.
WHAT CHANGED?
After 2020, in general, public health indicators showed improvement across the board.
Most notably, every single state showed an improvement in Self-Rated Health, and a majority of states (32) showed an improvement in Mental Health. All but one state showed a decline in the percent uninsured.
THE CONNECTION:
Voting Policy & Public Health
Voting policies shape our ability to participate in elections and be represented on decisions important to us as individuals and communities. States that make elections more accessible through policies like automatic and same day registration, non-strict voter ID requirements, felon re-enfranchisement and mail voting options enjoy higher levels of voter participation and stronger public health outcomes. States that have more barriers to voting—and lower rates of voter participation—have worse public health outcomes.
Why this matters: communities with more inclusive voting policies enjoy greater social cohesion, improved community conditions, and better health.
Inclusive Registration: Includes automatic voter registration, same day, and election day registration
Vote at Home: Includes all mail elections and states with no-excuse absentee voting
Restrictive Voter ID: States that require additional documentation at the polls, such as photo ID, even after voters have already established their eligibility.
Voting Rights Restoration: Includes states where rights are not lost after a felony conviction or rights are restored post-incarceration.
HEALTHY PEOPLE VOTE:
Voting Takes Time, Focus and Energy
When people feel healthier and more connected to their neighbors they feel valued and are more likely to vote and engage in other aspects of community life. Being healthy means people can physically vote and have the time and energy to follow voting processes and make voting decisions. Policies that make voting locations more accessible and allow voting from home help people with health challenges cast ballots.
BARRIERS HARM HEALTH:
Voting Disparities and Health Disparities are Linked
Some of the same barriers to health are barriers to voting, including structural inequities in transportation, language access, broadband access, and accessible spaces. Communities that face these barriers may have a lack of social inclusion, reduced sense of belonging, and less access to health resources, which are all associated with worse health outcomes, from higher infant mortality rates to greater risk of chronic disease.
These barriers can become a self-reinforcing feedback loop: people who are experiencing poor health are less likely to vote, and people who don’t vote are more likely to report that they have poor health. This tends to impact people with low incomes and lower education levels, and people of color more than other population groups. The practical result is an underrepresentation of these communities in important policy decisions that shape health and wellbeing.
Thankfully, higher levels of civic participation can mitigate these disparities. For instance, rates of infant mortality are higher among Black and American Indian communities than white communities, but this disparity shrinks for all racial and ethnic groups in states that have better civic health and voter participation.
LOOKING AT THE STATES:
Colorado has inclusive policies and strong public health outcomes.
Automatic voter registration
Vote by Mail
Non-restrictive Voter ID
Voting Rights Restoration
Explore state-by-state results on civic participation and public health.
LOOKING AT THE STATES:
Tennessee has exclusive policies and relatively weak public health outcomes.
Restrictive voter registration
Restrictive voter ID
Felon disenfranchisement
Limited vote by mail
Explore state-by-state results on civic participation and public health.
POLICY ACTION:
Closing the Gap
Leaders can close the civic participation with more inclusive rules and policies, for instance, with automatic voter registration at the DMV, through Medicaid sign-ups and other services. There is a growing commitment to strengthen civic health and voter participation as evidenced by recent positions taken by multiple public health organizations:
American Medical Association: Support for Safe and Equitable Access to Voting
American Public Health Association: Advancing Health Equity through Protecting and Promoting Access to Voting
Society for Public Health Education: Voter Registration and Participation Resolution
County Health Rankings & Roadmaps: 2023 National Findings Report Cultivating Civic Infrastructure and Participation for Healthier Communities
Healthy People 2030: Increase the proportion of the voting-age citizens who vote — SDOH‑07
EXPLORE:
This is the percentage of adults reporting that their health is good or better when asked “How is your general health?” People who report fair or poor health are less likely to vote, but people who have good or better health are more likely to vote. Higher is better.
See this information in an interactive table.
EXPLORE:
See state-by-state results on civic participation and public health.
More Voting Access, Better Health
California
Voting Access
Inclusive Registration - Yes Includes automatic voter registration, same day, and election day registration
Restrictive Voter ID - No States that require additional documentation at the polls, such as photo ID, even after voters have already established their eligibility.
Vote at Home - Yes Includes all mail elections and states with no-excuse absentee voting
Voting Rights Restoration - Yes Includes states where rights are not lost after a felony conviction or rights are restored post-incarceration.
Health Outcomes
Self-Rated Health Good or Better - 84% This is the percentage of adults reporting that their health is good or better when asked “How is your general health?” People who report fair or poor health are less likely to vote, but people who have good or better health are more likely to vote. Higher is better.
Poor Mental Health Days - 4.4 This is the average number of poor mental health days reported in the last 30 days. People with poor mental health are less likely to vote. Lower is better.
Adults Receiving Disability Benefits - 2.5% This is the percentage of adults 18-64 receiving Social Security Disability Insurance (SSDI) payments. This tells us about economic stability for workers with disabilities and also helps us understand labor force participation rates in each state. People with disabilities tend to vote at lower rates than people without disabilities. Lower is better.
Uninsured - 7.7% This is the percentage of people reporting not having health insurance coverage. Lack of coverage is associated with increased risk of chronic disease and mortality and delayed access to care. Lower is better.
Active Physicians - 287.8 This is the total number of active physicians of all types per 100,000 population. It tells us about access to health care in a population. People who are healthier are more likely to vote, and access to care is one way that people can obtain and maintain good health. Higher is better.
Infant Mortality - 3.9 This is the rate of infants dying within the first year of life. It is a common measure of public health worldwide, and tells us about access to and quality of healthcare in a community. Lower is better.
Premature Mortality - 1 This analysis uses a state ranking based on years of potential life lost (YPLL) before age 75. Many premature deaths are preventable. People of color are at higher risk for premature death, and there is some evidence linking this to lost votes over time resulting in significant voting disparities. Lower is better (1 is the best, 50 is the worst).
Connecticut
Hawaii
Less Voting Access, Worse Health
Mississippi
Voting Access
Inclusive Registration - No Includes automatic voter registration, same day, and election day registration
Restrictive Voter ID - Yes States that require additional documentation at the polls, such as photo ID, even after voters have already established their eligibility.
Vote at Home - No Includes all mail elections and states with no-excuse absentee voting
Voting Rights Restoration - No Includes states where rights are not lost after a felony conviction or rights are restored post-incarceration.
Health Outcomes
Self-Rated Health Good or Better - 79% This is the percentage of adults reporting that their health is good or better when asked “How is your general health?” People who report fair or poor health are less likely to vote, but people who have good or better health are more likely to vote. Higher is better.
Poor Mental Health Days - 4.2 This is the average number of poor mental health days reported in the last 30 days. People with poor mental health are less likely to vote. Lower is better.
Adults Receiving Disability Benefits - 7% This is the percentage of adults 18-64 receiving Social Security Disability Insurance (SSDI) payments. This tells us about economic stability for workers with disabilities and also helps us understand labor force participation rates in each state. People with disabilities tend to vote at lower rates than people without disabilities. Lower is better.
Uninsured - 13% This is the percentage of people reporting not having health insurance coverage. Lack of coverage is associated with increased risk of chronic disease and mortality and delayed access to care. Lower is better.
Active Physicians - 196.8 This is the total number of active physicians of all types per 100,000 population. It tells us about access to health care in a population. People who are healthier are more likely to vote, and access to care is one way that people can obtain and maintain good health. Higher is better.
Infant Mortality - 8.1 This is the rate of infants dying within the first year of life. It is a common measure of public health worldwide, and tells us about access to and quality of healthcare in a community. Lower is better.
Premature Mortality - 49 This analysis uses a state ranking based on years of potential life lost (YPLL) before age 75. Many premature deaths are preventable. People of color are at higher risk for premature death, and there is some evidence linking this to lost votes over time resulting in significant voting disparities. Lower is better (1 is the best, 50 is the worst).
Louisiana
Alabama
See this data in an interactive table.
What We Can Do
These findings underscore the importance of promoting a healthy and inclusive democracy to assure the conditions for all people to be healthy.
Policymakers can promote health and wellbeing by making it easier for voters to register or update their registration through a variety of programs and services. Additionally, building upon the adoption of voter participation as a core objective in Healthy People 2030, state and local health departments can include civic and voter participation in their health improvement plans and in their health education and outreach campaigns.
Individuals can promote health in their community by ensuring they participate in every election, and help others register to vote and cast ballots.
Institutions can also promote local, state and national health goals, remind people of upcoming elections, promote the relationship between health and voting, and join partnerships and programs to promote civic participation.
Learn more about recommended policies.
CONCLUSION:
The Link Between Public Health and Civic Participation
There are many aspects of public health policy that are directly linked to civic participation. For instance, in some states, voters have been able to adopt Medicaid expansion by ballot initiative. At the local level, voters also have significant input on spending and programs for green spaces, schools, public transit and other infrastructure that improves public health.
More broadly, voting is an important way that we build social inclusion and belonging as communities. Elections are the largest public events we hold nationally. Higher rates of community participation and social contact are linked to higher rates of civic participation and better public health outcomes.
Further, laws that make voting accessible make voting easier for people with different abilities. This includes accounting for the location and physical accessibility of polling sites and equipment, language, and assistance with casting a ballot.
For more information, please see Methods for this analysis, including additional references and resources. This data is also available in a detailed, interactive table.
Sources: