Voting As a Social Determinant of Health: Leveraging Health Systems to Increase Access to Voting

There has been recent interest in the upstream power structures that manifest as social determinants of health. Such structural inequities are relevant to what we now recognize as political determinants of health, the policy drivers that result in unmet social needs that affect the manifestation of disease and access to health care. One such key political determinant of health is voting. The relationship between voting and health outcomes is multifactorial: people from marginalized backgrounds are more likely to be affected by poor health, and decreased access to voting has been associated with worse health outcomes, ultimately leading to decreased representation of the interests of the marginalized and those struggling with chronic disease. These relationships beget a cycle of poor health, decreased voting, decreased political capital, and policies that deprioritize the needs of the sick and marginalized. In 2022, the American Medical Association passed a policy resolution declaring voting a social determinant of health. To meet voting as a social need for patients, health systems must understand how voting as a political determinant affects downstream social determinants and consider ways to increase access to voting in health care spaces. Here, the authors review some previous efforts to increase voter registration and education in clinical environments and discuss preliminary efforts at Parkland Health to increase access to voting for a large, urban safety-net population in Dallas County, Texas. The authors also discuss future plans to fully integrate voter registration and education into processes of health care delivery, recognizing that meeting voting as a social need is an imperative of the health system. Addressing the social determinant of health of voting is uniquely impactful in that increasing access to voting builds political and social capital for the disenfranchised and underserved, leading to downstream impact on other social needs.