When we care for patients in the privacy of exam rooms, we are not actually alone. A host of other forces are present there with us, intersecting each other and fueling the ailments and inequities we treat. They include economics, education, employment, transportation, and racism. Plus one that looms silently but underpins it all: politics.

Politics may seem far afield from health care, but now more than ever as we strive to improve the health of communities, we need to protect the health of our democracy.

At HealthBegins, we’ve always understood that moving upstream means moving at all three levels: from individual social needs to community-level social determinants of health to society-level structural determinants of health inequity. Politics occupy that third level — they shape how power and resources are distributed and heavily influence the levels downstream.

We and our partners, like those in the VoteHealth 2020 coalition, are working to improve these political determinants of health. As we do so we are looking hard at the fundamental role of power. A crucial part of moving upstream is understanding the sources of power, how it works, how to build it, how to share it — and, of course, how it’s linked to health.

Did you know that in the 2016 election, more than 1 in 9 of the registered voters who did not end up voting cited illness or disability as the reason? Because of their poor health and equity, they couldn’t cast their ballots on candidates and policies that affect their health and equity. This reflects something I wrote about more than ten years ago —  the vicious cycle that links civic and health disparities.

But we can help turn that vicious cycle into a virtuous one, where equity in civic engagement fuels health equity — and vice versa. There are many ways to help shape political determinants: by organizing and supporting protests, petitions, and strikes; by filling out the census and encouraging others to do so; and through many other actions. One timely way of thinking and acting is through the vote.

Many health professionals are already taking up such initiatives. On Sept. 14, at 9 a.m. PT / 12 p.m. ET, we invite you to learn about these in a national VoteHealth 2020 webinar, proudly co-sponsored by HealthBegins, hosted by Donald Berwick and Dr. Mona Hanna-Attisha. We’ll hear concrete examples from vanguard health systems that are working to increase voter turnout. Please save the date and watch your email for an invite.

Meanwhile, here are concrete steps you can take on your own today:

• Check your own registration and make a safe voting plan by asking questions such as: When will you vote? How will you submit your ballot? How will you get to your polling location or post office? The VoteHealth 2020 website provides helpful tools, resources, and 5 ways to #votehealth2020.
• Consider offering voter registration and vote-by-mail support in your clinic or hospital. The Vot-ER website offers a Healthy Democracy Kit for care providers, teams, and institutions to do this. Ask: Are your colleagues registered? What about your patients? Health care reaches so many people that a little effort here can make a real difference. An effort I co-founded in 2008 registered over 26,000 voters in healthcare settings — and that was just a pilot program.
• Think about the broader civic role of your institution. Hospitals and medical offices can serve as polling places, and teams can adopt a block to support voter turnout or help patients create a safe voting plan. More broadly, they can shape the dynamics of power by becoming anchor institutions (or, on a more basic level, can just stop suing patients).

Power and resources — the way they are structured, distributed, wielded, and shared — shape health and equity. That’s why this and all elections matter. That’s why healthcare professionals and institutions, like all members of a civil society, are doing more to share our power and provide opportunities for our patients, employees, and neighbors to exercise theirs.

Join us. It’s time we all recognized that voting is vital.

Best,

Rishi Manchanda