Increasing Voter Participation Through Health Care-Based Voter Registration.

Importance: Young people and historically marginalized racial and ethnic groups are poorly represented in the democratic process. Addressing voting inequities can make policy more responsive to the needs of these communities. Objective: To assess whether leveraging health care settings as venues for voter registration and mobilization is useful, particularly for historically underrepresented populations in elections. Design, Setting, and Participants: In 2020, nonpartisan nonprofit Vot-ER partnered with health care professionals and institutions to register people to vote. This cross-sectional study analyzed the demographics and voting behavior of people mobilized to register to vote in health care settings, including hospitals, community health centers, and medical schools across the US. The age and racial and ethnic identity data of individuals engaged through Vot-ER were compared to 2 national surveys of US adults, including the 2020 Cooperative Election Study (CES) and the 2020 American National Election Study (ANES). Exposure: Health care-based voter registration. Main Outcomes and Measures: The main outcomes were age composition, racial and ethnic composition, and voting history. Results: Of the 12 441 voters contacted in health care settings, 41.9% were aged 18 to 29 years, 15.9% were identified as African American, 9.6% as Asian, 12.7% as Hispanic, and 60.4% as White. This distribution was significantly more diverse than the racial and ethnic distribution of the ANES (N = 5447) and CES (N = 39 014) samples, of which 72.5% and 71.19% self-identified as White, respectively. Voter turnout among health care-based contacts increased from 61.0% in 2016 to 79.8% in 2020, a turnout gain (18.8-percentage point gain) that was 7.7 percentage points higher than that of the ANES sample (11.1-percentage point gain). Demographically, the age distribution of voters contacted in health care settings was significantly different from the ANES and CES samples, with approximately double the proportion of young voters aged 18 to 29 years. Conclusion and Relevance: This cross-sectional study suggests that health care-based voter mobilization reaches a distinctly younger and more racially and ethnically diverse population relative to those who reported contact from political campaigns. This analysis of the largest health care-based voter mobilization effort points to the unique impact that medical professionals may have on voter registration and turnout in the 2024 US elections. In the long term, health equity initiatives should prioritize expanding voting access to address the upstream determinants of health in historically marginalized communities.

Reported Political Participation by Physicians vs Nonphysicians.

This study uses survey data to compare rates of political participation between US physicians and nonphysicians from 2017 to 2021.

The Healthy Democracy Kit: design, implementation, uptake, and impact of a novel voter registration toolkit for healthcare settings.

BACKGROUND: Access to voting is increasingly recognized as a social determinant of health. Health equity could be improved if healthcare workers (HCWs) routinely assessed the voter registration status of patients during clinical encounters and helped direct them towards appropriate resources. However, little consensus exists on how to achieve these tasks efficiently and effectively in healthcare settings. Intuitive and scalable tools that minimize workflow disruptions are needed. The Healthy Democracy Kit (HDK) is a novel voter registration toolkit for healthcare settings, featuring a wearable badge and posters that display quick response (QR) and text codes directing patients to an online hub for voter registration and mail-in ballot requests. The objective of this study was to assess national uptake and impact of the HDK prior to the 2020 United States (US) elections. METHODS: Between 19 May and 3 November 2020, HCWs and institutions could order and use HDKs to help direct patients to resources, free of cost. A descriptive analysis was conducted to summarize the characteristics of participating HCWs and institutions as well as the resultant total persons helped prepare to vote. RESULTS: During the study period, 13,192 HCWs (including 7,554 physicians, 2,209 medical students, and 983 nurses) from 2,407 affiliated institutions across the US ordered 24,031 individual HDKs. Representatives from 604 institutions (including 269 academic medical centers, 111 medical schools, and 141 Federally Qualified Health Centers) ordered 960 institutional HDKs. Collectively, HCWs and institutions from all 50 US states and the District of Columbia used HDKs to help initiate 27,317 voter registrations and 17,216 mail-in ballot requests. CONCLUSIONS: A novel voter registration toolkit had widespread organic uptake and enabled HCWs and institutions to successfully conduct point-of-care civic health advocacy during clinical encounters. This methodology holds promise for future implementation of other types of public health initiatives. Further study is needed to assess downstream voting behaviors from healthcare-based voter registration.

Health system-based housing navigation for patients experiencing homelessness: A new care coordination framework.

Patients experiencing homelessness are among the most disadvantaged in our society, suffering from poor health outcomes and exhibiting disproportionately high hospital utilization and spending. However, to date, hospitals have only scantily devoted time or resources to the housing coordination aspect of homelessness. Implementing better systems to coordinate housing for patients experiencing homelessness may improve health outcomes and reduce health care utilization for this population. This objective is now more important than ever as the economic impact of COVID-19 is expected to exacerbate the homelessness crisis. Ensuring that patients are properly connected to temporary or permanent housing is valuable to patient health, health care system metrics such as excess spending and utilization, and provider performance under Accountable Care Organizations or other risk-bearing payment models. Here, we propose a health systems-based housing coordination framework that may improve care delivery for patients experiencing homelessness. This framework relies on the coordination between dedicated hospital-based housing navigators who can identity patients experiencing homelessness and outpatient housing navigators equipped to coordinate short- and long-term housing specifically for patients experiencing homelessness who frequently interact with the health care system.

The Vot-ER Healthy Democracy Campaign: A National Medical Student Competition to Increase Voting Access.

PROBLEM: Voting affords citizens a direct say in the leaders and policies that affect their health. However, less than 20% of eligible U.S. citizens have been offered the chance to register to vote at a government-funded agency like a hospital or clinic that provides Medicaid or Medicare services. Medical students are well positioned to increase voting access due to their interactions with multiple actors in health care settings, including patients, visitors, colleagues, and others. APPROACH: Vot-ER, a nonpartisan, nonprofit organization that aims to promote civic engagement in health care settings, launched the inaugural Healthy Democracy Campaign from July 20 to October 9, 2020. As part of this national, gamification-based competition, medical student captains were recruited to lead teams of health care trainees and professionals that helped eligible adults start the voter registration and/or mail-in ballot request process before the November 2020 elections. Post competition, medical student captains were surveyed about their motivations for participating and skills and knowledge gained. OUTCOMES: In total, 128 medical student captains at 80 medical schools in 31 states and the District of Columbia formed teams that helped 15,692 adults start the voter registration and/or mail-in ballot request process. Eighty-two (64.1%) captains responded to the post competition survey, representing 56 (70.0%) of the participating schools. The top-ranked motivation for participating in the campaign was the desire to address social and racial inequities (37, 45.1%). Respondents reported gaining skills and knowledge in several aspects of civic engagement, including community organizing (67, 81.7%) and voting rights (63, 76.8%). The majority of respondents planned to incorporate voter registration into their future practice (76, 92.7%). NEXT STEPS: Future Healthy Democracy Campaigns will aim to continue closing the voting access gap and promote the long-term inclusion of hands-on civic engagement in medical education and practice.