With the November election rapidly approaching and the question of health equity still circulating, it’s hard to ignore both the tie between social determinants of health (SDOH) and voter disenfranchisement.


Social determinants of health are conditions in which people live and work that impact their health outcomes. These can include income, education, location and race. What is important to understand is that these factors can greatly influence voter turnout. 


 A 2019 Annals Family of Medicine journal by Nicholas Yagoda, MD, states, “Overwhelmingly, people of color, people with disabilities, low-income Americans, the uninsured, and young people are those most likely to be unregistered and to experience barriers to voter registration.”¹


Yagoda goes on to say that in the 2016 election, 40 percent of eligible voters did not vote. This could be attributed to “significant gaps in voter participation [that] occurred along racial, educational, and income-level divides, which may largely be attributable to voting restrictions and a sense of alienation from government.”¹


Barriers to Voting


Systemic barriers often further voter disenfranchisement for those facing SDOH. According to the American Civil Liberties Union, this can manifest in multiple ways. 


Voter ID

Some form of identification is often required at polling stations, but IDs are not always easily obtainable depending on the situation. The ACLU says that more than 21 million Americans do not have a form of identification. This is particularly troubling since 36 states require some form of identification at polling stations. For those facing financial difficulties, obtaining an ID might not be the most pressing matter at hand. IDs can be costly to apply for, including the process of obtaining the necessary documents to submit applications. Or, even if an individual has the money, transportation barriers might arise, particularly for those in rural areas or the elderly.²


The U.S. Government Accountability Office estimates that voter ID laws reduce voter turnout by two to three percentage points, which could means thousands of lost votes.²


EXPLORE MORE: See the states with the strictest voter ID laws (Map)


Felony Charges Block Voting

States have different laws regarding whether a convicted felon can vote. Some ban voting during incarceration, some only during parole and probation, while others ban for life. 


Take a look at the imprisonment rates from 2018: 

  • 1,501 black prisoners for every 100,000 black adults
  • 797 Hispanic prisoners for every 100,000 Hispanic adults
  • 268 white prisoners for every 100,000 white adults


It’s important to remember that higher rates of incarceration can be produced from a long withstanding history of lack of access to resources, lowered education and enriching opportunities, which is often the case for minorities in America. 


So, when these high numbers of incarceration translate to lower amounts of voting, often the outcome of the votes is not representative of the entire population. The most vulnerable often get left out of the conversation. 


For example, in Iowa, a felon will never be able to vote after their conviction. Iowa is also the state with the most disproportionate rate of incarceration among black people, which leads to 1 in 4 black men being disenfranchised against voting. Overall, 1 in 13 black Americans are disenfranchised against voting.²


Health and Voting

Poor or complicated health combined with lack of accessibility services can pose additional barriers. According to the U.S. Census Bureau data on the voter makeup in the 2016 election, the third most common reason for not voting was having an illness or disability, which accounted for 2.2. million lost votes.³ 


The ACLU reports that one-third of voters who have a disability report difficulty voting, possibly because only 40 percent of polling locations fully accommodate those with disabilities.²


Dual-eligible beneficiaries face some of the highest rates of chronic disease and disability in the country, and it’s no surprise they’re also highly likely to face SDOH. Without accessibility in place, many voters, such as dual-eligibles, will be discouraged from voting. As stated before, when votes are lost, so are voices. These residents and citizens will not be able to vote for officials and policies that act in the best interest of their health, leaving them in a disparaging cycle. 


With COVID-19 still in full force, many immunocompromised voters will also be discouraged. In states where absentee voting isn’t simple, we can expect to see more disparities as the risk of contracting coronavirus may outweigh the urge to head to the polls. For example, in Texas, fear of coming in contact to COVID-19 while voting in person is not a valid reason to obtain a mail-in ballot.⁴ 


What Health Centers Can Do to Help

With much at stake, health centers can help their patients circumvent some of these issues. Because health centers are so integral to their communities, they can have great influence among their patients, some of which might be these discouraged voters as mentioned above. 


“Nonprofit and private health organizations can educate the community and combat cynicism by providing community-led, culturally competent, nonpartisan health impact assessments of political candidate positions and proposed legislation. In so doing, these health organizations can prepare voters to vote in their best health interest,” The Annals Family Medicine journal states.¹


Although this is by no means saying health center workers can fix every systemic voter suppression issue on their own. However, harping on the relationship between voting and health outcomes can help some patients understand the pivotal impact. 


“The promotion of voter engagement among marginalized communities—people of color, low-income Americans, and people living with disabilities, among others—could increase equitable health policy and mitigate costly and preventable health disparities. By integrating voter engagement as a health equity strategy, nonprofit and private health organizations can help communities leverage health-promoting change through more representative government and more equitable health policy.”¹



¹ Yagoda, Nicholas. “Addressing Health Disparities Through Voter Engagement.” Annals of family medicine vol. 17,5 (2019): 459-461. doi:10.1370/afm.2441

² American Civil Liberties Union. “Block the Vote: Voter Suppression in 2020.” American Civil Liberties Union, 3 Feb. 2020, www.aclu.org/news/civil-liberties/block-the-vote-voter-suppression-in-2020.

³ File, Thom. “Characteristics of Voters in the Presidential Election of 2016.” United States Census Bureau, Sept. 2018, www.census.gov/content/dam/Census/library/publications/2018/demo/P20-582.pdf.

⁴ Pitofsky, Marina. “Appeals Court Rules Texans Cannot Request Mail-in Ballots Over Coronavirus Fears.” TheHill, 5 June 2020, thehill.com/homenews/news/501288-appeals-court-rules-texans-cannot-request-mail-in-ballots-over-coronavirus.