The midterms are coming, and their approach bombards us daily in seemingly every space — except the clinic. Political commentary pours in from our news programs and social media feeds. Candidates’ ads fill our mailboxes and pepper our commutes to work.
Then we arrive at the clinic or the office, and the buzz seems to fade to background as we focus on the healthcare needs at hand. That silence is an illusion.
The truth is, politics is present with us every moment in the exam room, exerting an influence at least as powerful as any prescription we can write. I know this from the patients I’ve served: from asthmatic children who suffer from disproportionate pollution to veterans left destitute by employment policies that don’t recognize their needs. I am especially aware of it today, as I travel to Flint, Michigan, to meet with the Greater Flint Health Coalition, which includes many institutions on the front lines of the city’s lead crisis.
Politics itself is a social determinant of health. If we want to move upstream we have to address not only the social conditions that influence health — the unequal access to healthy food and housing, the uneven distribution of reliable employment and transportation — but also the policies that shape those conditions in the first place.
In other words: Civic engagement is a form of healthcare. And that is actually good news! Because it means we can, and must, do more to support it.
We’ve been trained, rightly, to remove partisan politics from our healthcare practice. But there is lots of essential nonpartisan work we can do, and not only after hours. Here are three places to start:
1) Speak out publicly and vote, especially on issues relevant to the populations we serve.
This election season is rife with political issues affecting health, but two recent ones come especially to mind. One, the proposed new federal “public charge” policy that would deny green cards to some immigrants who have received certain public benefits, such as food stamps or Medicaid. Now is the time for us in healthcare to add our essential perspective, with the proposal open for public comment until Dec. 10. And two, the Trump Administration’s indication that it may move to redefine gender as fixed at birth, another change that would erase entire populations within our communities and erect political barriers to health.
As healthcare experts, it is our role to inform the public discourse about how and why such policies affect health.
2) Enable patients and staff to participate in our political process. Know the deadline to register to vote in your state, and make sure your staff and colleagues have time to register in advance and plans to vote absentee or in-person on election day.
Voter registration via the clinic is also critical for patients. In 2008, my clinic in South Central Los Angeles started supplying nonpartisan voter registration forms in our waiting room. I have also written about how hospitals can help counter voter suppression and get out the vote. Now a spate of new regulations in many states would make it harder for low-income, underserved citizens to vote. Several national initiatives, such as Rx Democracy, Med Out the Vote, and On Call for Democracy, provide resources to help any healthcare organization support registration and foster civic engagement among patients. (Dr. Danielle Ofri eloquently calls for this work in her recent op-ed advocating a prescription for democracy.)
It should be as easy to register to vote in a doctor’s office as it is in a DMV. In fact, a law on the federal books requires this service of any agency that receives federal funds. This way, we help to give our communities a voice and a chance to view civics as healthcare.
3) Start and amplify conversations that foster the understanding that political voice is a health-related social need. As Upstreamists, we are evolving the focus on social determinants of health to a broader view of social determinants of health equity. It’s clear that the distribution of the social determinants is unequal. And that means that health ultimately hinges on power, politics, and privilege.
There is a small but mighty group of advocates in healthcare organizations who are already working to make civic engagement integral to our practice and our mission as caregivers. Let us all seize the opportunity of the midterm elections to join them, now and into the future.