Advancing voter and civic engagement within health care to address health disparities

Background: In 2008, over 59 million eligible Americans did not register to vote. The demographics of these nonvoters, and of infrequent voters in general, tends to mirror those of the sickest Americans. Low-income, minority, and uninsured Americans, for instance, have disproportionately low levels of electoral participation. Low-income families often vote half as often and are up to six times less politically active compared with higher-income families. These same groups bear an unequal burden of disease, which exacerbates civic disparities. In 2008, for instance, illness or disability prevented 1 in 5 low-income eligible voters from voting, compared to 1 in 14 higher-income eligible voters.

Health disparities are not only caused by unhealthy living and working conditions and limited access to prevention and quality care but also by a relative lack of civic agency and political efficacy, which are significant yet relatively unexamined determinants of health. As civic enterprises, the public health and health care systems have been underutilized as a means of increasing democratic participation and civic agency, particularly among traditionally marginalized communities. Few public health models for fostering civic engagement to address health disparities have been developed.

Methods: In 2008, a nonpartisan coalition of national physician and public health organizations was formed to address health disparities by increasing civic participation, particularly among marginalized communities. This coalition, named the “Rx Vote Campaign”, developed specific tools to increase access to nonpartisan voter registration services in health care settings, including doctor's offices, community health centers, and hospitals. Providers and patients were educated about the importance of civic participation. Innovative approaches and challenges were shared among coalition partners.

Results: Within four months, a coalition effort of eleven national organizations helped register over 26,000 voters in over 200 sites nationwide in 2008. An assessment of the campaign's efforts after the 2008 election revealed strengths and inherent limitations of a model that relied heavily on physicians to spearhead the coordination of voter registration tasks. An alternate process was developed.

Conclusions: This approach represents a novel method to dramatically increase civic engagement and democratic participation through the health care system and address health disparities.