We know that many things influence people’s health, including genetics, behavior, environmental exposure, and socioeconomic factors. One contributor, however, often goes unappreciated: civic participation.
The two can at first seem unlikely companions. Why, for instance, would people who get involved in their communities or participate in the political process be shown to enjoy lower rates of heart disease, cancer, and depression?
But further exploration reveals essential connections between civic engagement and health.
Government laws and funding influence health and health care, from childhood nutrition programs to Medicaid reimbursement policies. The well-being of individuals and communities thus rides not only on social but also political determinants of health.
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Studies such as a 2020 review in Public Health Reviews have documented that people with better health are more likely to vote, while those who are less well tend not to vote. That can skew which populations get represented at the polls and what health-related policies are put into place.
To expand their ability to help their patients experience better care and outcomes, Harvard Medical School physicians and students are engaging in civics and policymaking.
Mobilizing voters
Voting is so consequential to health that the Department of Health and Human Services’ Healthy People 2030 initiative set an objective to increase the proportion of U.S. citizens who vote from 52.2 percent in 2022 to 58.4 percent by 2030.
Under the National Voter Registration Act of 1993, health care facilities can support nonpartisan voter registration activities. The Association of American Medical Colleges published a fact sheet about such registration with guidance on activities that are allowed, such as asking people about their voter registration status and helping them register, and not allowed, such as indicating preferences for parties or candidates.
Alister Martin, HMS assistant professor of emergency medicine at Massachusetts General Hospital, founded the nonpartisan organization Vot-ER to encourage voter registration during routine health care visits. The program educates individuals across the political spectrum who are legally eligible to vote about the process.
Vot-ER participants — doctors, nurses, social workers, medical students, and technologists — wear badges with QR codes that link patients to a website where they can check their voter registration status, register to vote, and request mail-in ballots. Since 2019, the organization has distributed more than 60,000 badges to approximately 700 clinics and hospitals across the United States.
Now, along with the usual social history questions such as tobacco and alcohol use, Vot-ER participants ask patients whether they’re registered to vote. The organization offers scripts so that health care workers remain nonpartisan and comply with voter registration laws.
Health care providers have a unique opportunity to reach people, said Martin.
“Physicians are trusted voices in the community, and they can make a simple, quick case to their patients that voting is important for their health,” he said.
Getting physicians involved
It’s not only patients who could use encouragement to vote and otherwise participate in civic life. Martin is among those who would like to see physicians, too, become more civically involved.
He pointed out that doctors vote at lower rates than the general population and tend to be reluctant to get involved in policymaking, even though politics “influences the care we can give our patients, the medications and procedures we can provide, and whether and how our patients can access the health care system.”
The American Medical Association holds events for physicians to learn how to advocate for patients on state and national levels. The American College of Surgeons has a primer for getting involved in advocacy and policymaking. Many professional organizations, such as the Society for General Internal Medicine, offer policy training with visits to Congress so health care providers can provide expert testimony and tell firsthand stories to lawmakers about issues their patients are experiencing, said Sharon Inouye, HMS professor of medicine at Hebrew SeniorLife.
Inouye also thinks it’s important for doctors to vote. She understands that some don’t because they lack the time.
“Residents and trainees work long hours and cannot get to the polls because of their schedules,” she said. “I do think it’s a big problem, and I’m hoping we can raise the number of those who vote.”
As editor in chief of JAMA Internal Medicine, Inouye supported the publication of an article in the journal about an effort to motivate residents to register to vote. With her own trainees, she encourages them to register to vote and urges them to vote by mail.
Influencing policy
Doing health policy work outside the clinic is one way Inouye, who is a geriatrician and director of the Aging Brain Center at Hebrew SeniorLife, believes physicians can improve their patients’ health and health care.
During the height of the COVID pandemic, Inouye could not serve on the front lines in the hospital due to health vulnerabilities in her immediate family. Instead she published research on the lack of older adults in COVID vaccine clinical trials and provided expert guidance about the issues older adults faced by interviewing with the press, writing opinion pieces, and participating in panels for the National Academy of Medicine and the American Public Health Association on issues such as vaccine eligibility, ventilator rationing, and mask wearing.
Turning to local or national media is an important step in making sure that physician-investigators’ evidence-based results reach policymakers, Inouye said.
Inouye participated in the Health and Aging Policy Fellows Program to understand how to improve care for older patients through sustained, system-wide policy change. Almost 10 years later, she feels remotivated to take the time to be involved as a citizen.
While she delved into policy later in her career, she encourages others to check out opportunities earlier so they can make the most of their time in the profession advocating for their patients.
Advocating for patients
HMS students such as Maryann Zhao, a fourth-year MD student in the Harvard-MIT Health Sciences and Technology Program, have begun exploring early, learning about becoming physician advocates during their medical school training.
For them, Zhao said, it’s not about the politics but about working to change policies and practices to improve patient care.
“Honestly, it’s all about the patients,” Zhao said. “They deserve to get the best care and access to care. And we have to be the ones to help them because we see the negative consequences on their health from certain policies and the way the health care system runs.”
Zhao and classmates began the HMS Future Doctors for Progress Student Advocacy Group to empower medical students by equipping them with the skills to enact policy change that benefits their future patients and communities. The group has hosted events such as workshops on how to write an op-ed and talks from physicians about providing expert testimony to legislators.
There are many degrees of involvement, from just learning about governmental policy and politics to taking on a governmental or legislative role.
Martin agrees that physicians have a unique vantage point as potential policy shapers; they can diagnose and propose fixes to health policy because they know well the problems their patients face.
Involvement in advocacy and legislation offers an opportunity to improve health on a broader scale than individual patient care, Zhao said. “Bigger issues in health care can’t be changed unless there’s a more concerted effort at the state or national level,” she said.
And yes, she plans to vote in November and has updated her voter registration this fall.
