The Civics Prescription: How Voting Shapes Your Health

Root Causes is our policy analysis series, grounded in rigorous, nonpartisan research, and written by Rachel Bouzis, the Trust’s Director of Policy & Learning. Each installment examines the systems, data, and decisions that shape the health and well-being of Natrona County residents by going beyond the headlines to understand why things are the way they are, and what it means for the people who live here. We believe an informed community is a healthier one.

The hidden barriers to health

According to the State Democracy Index, American democracy is under strain and has been backsliding since 2000. The reasons are as complicated as today’s politics. Judicial decisions like unwinding the Voting Rights Act in 2013 and Citizens United that removed spending limits from corporations and special interest groups¹ have changed how Americans vote and who can influence that vote. These changes coupled with deep national polarization and distrust have resulted in enormous state-by-state disparity across voter access as well as gerrymandering.² It’s hidden barriers like these that are root causes of health inequities. Voting isn’t as obviously health-related as policies like Medicaid expansion or tobacco taxes. But just as economics and housing shape health, so does voting.

Charting health and democracy

The Health & Democracy Index charts health outcomes with voting access across all 50 states. It measures four indicators of voting restrictiveness, inclusive registration, restrictive voter ID, vote at home access, and voting rights restoration, and compares them to 12 public health indicators, including uninsured rates, active physicians, premature mortality, and poverty, along with voter registration and turnout. The visual is compelling; the positive linear relationship makes clear that the more access to voting a state has, the better its health outcomes. Wyoming, disappointingly, splits the axes, middling across both metrics.

Correlation, causation, and consequences

The authors of the index acknowledge that the data is correlative, not causal. Establishing causality is a challenge across this field of study. It is established, though, that democratic institutions are critical for population health. A 2022 study examined the correlation between state-level democratic institutions and population-level health outcomes from 1975 to 2016. It concluded that political accountability, like campaign finance regulations, term limits, and ballot initiatives predicted lower infant mortality. A strong system of checks and balances, like veto overrides, predicted longer life expectancy.³

Similarly, another study examined the relationship between higher mortality rates among working age people and states with observable democratic backsliding. The findings were stark. States with a high level of electoral democracy have an estimated 3.2% and 2.7% lower mortality rates for men and women, respectively, than states with a moderate level of electoral democracy. Incredibly, the study estimated that if all states scored at the SDI’s high level of democracy, there could have been 20,408 fewer deaths in the national working-age population in 2019 alone, mostly due to reductions in deaths from drug poisoning and infectious diseases followed by reductions in homicides and suicides.⁴

The cycle of health and voting

These policy-heavy correlation versus causation questions are part of a larger discussion on the reinforcing, vicious cycle of voting and health. Healthy populations vote and elect policies that favor them, while sick and marginalized populations face barriers to voting. They’re left out of policymaking as a result, and their health declines further.⁵ This is chief among reasons voter access should be expanded. There’s also scholarship, though, that indicates that the act of voting could improve health.

The American Medical Association declared voting a social determinant of health in 2022. The federal Healthy People 2030 program explains why.

Voting offers a chance for people to contribute to decisions that can affect their communities and directly or indirectly impact their health and well-being. Voting can also help people develop a sense of purpose and help them feel connected to their community.⁶

Similar to volunteering, civic engagement is connected to altruism, agency, and belonging to a community, all of which contribute to improved health.⁷ But a new study reveals that benefits of voting go beyond just warm, fuzzy feelings.

What the data says about voters

In 1957, 10,317 Wisconsin high school graduates agreed to participate in a study to measure various outcomes over time, including health. Researchers matched 4,078 of these individuals on voting records and similar characteristics, including socioeconomic status and health conditions such as smoking and alcohol use. In fully adjusted models, older adults who voted in the 2008 election had a 45%, 37%, and 29% lower mortality risk relative to nonvoters, after 5, 10, and 15 years, respectively. The findings held across both in-person and remote voting.⁸

These health benefits weren’t a function of higher income or wealth. The association between voting and lower mortality was consistent across income levels and, notably, across the political spectrum.⁹ I guess health isn’t political, after all.

What’s at stake in Wyoming

There’s a seismic election happening in Wyoming right now. A new senator and representative will head to Washington. The top five elected state officials are all up for election, meaning that the all-important State Loan and Investment Board will have a very different makeup in January. Half of the state Senate and every House seat need filled. But these aren’t November decisions. Nearly all of these races will be decided by early morning August 19. These are the people who will move Wyoming either up or down the Health & Democracy Index.

In case that’s not enough, the study of Wisconsin voters revealed something else significant. Income and party didn’t reduce the impact of voting on mortality risk. Underlying health actually did, but not in the way you might think. People who started out in worse health when they voted in 2008 actually saw a larger mortality-risk reduction than healthier individuals. Voting mattered more, not less, for people who were already sicker.¹⁰

Learn who will best represent your health with the Oil City voter guide. Take it to the polls with you. Vote. Vote smart. Vote like your health depends on it.

Sources

1. Electoral Democracy and Working-Age Mortality ↩
2. State Democracy Index 2.0 Report ↩
3. The Link between Democratic Institutions and Population Health in the American States ↩
4. Electoral Democracy and Working-Age Mortality ↩
5. Voting, health and interventions in healthcare settings: a scoping review ↩
6. Voting behavior and mortality risk in older adults: Evidence from the Wisconsin Longitudinal Study ↩
7. What Motivates People to Vote? The Role of Selfishness, Duty, and Social Motives When Voting ↩
8. Voting behavior and mortality risk in older adults: Evidence from the Wisconsin Longitudinal Study ↩
9. Ibid ↩
10. Ibid ↩