Why would a higher participation rate potentially be detrimental to democracy

Overall Findings: More Voting Access, Better Health Outcomes

States with more inclusive voting policies and greater levels of civic participation are healthier.

Less Voting Access, Worse Health Outcomes

States with exclusionary voting laws and lower levels of civic participation are less healthy.

The Connection: Voting Policy & Public Health

Communities with high voter participation enjoy greater social cohesion and belonging and better health. States that make elections more accessible through policies like automatic and same day registration, non-strict voter ID requirements, felon re-enfranchisement and mail voting options enjoy higher levels of voter participation and stronger public health outcomes

States that have more barriers to voting—and lower rates of voter participation—have worse public health outcomes.

Inclusive Registration Vote at Home Restrictive Voter ID Voting Rights Restoration

Inclusive Registration: Includes automatic voter registration, same day, and election day registration

Vote at Home: Includes all mail elections and states with no-excuse absentee voting

Restrictive Voter ID: States that require additional documentation at the polls, such as photo ID, even after voters have already established their eligibility.

Voting Rights Restoration: Includes states where rights are not lost after a felony conviction or rights are restored post-incarceration.

Healthy People Vote: Voting Takes Time, Focus and Energy

When people feel healthier and more connected to their neighbors they feel valued and are more likely to vote. Being healthy means people can physically vote and have the time and energy to follow voting processes and make voting decisions. Policies that make voting locations more accessible and allow voting from home help people with health challenges cast ballots.

Barriers Harm Health: Low Voter Participation Drives Health Disparities

Communities that face significant barriers to voting suffer from worse health outcomes. A lack of social inclusion, reduced sense of belonging, and less access to health resources are all associated with worse health outcomes, from higher infant mortality rates to greater risk of chronic disease.

These barriers can become self-reinforcing because people who are experiencing poor health are less likely to vote. Further, communities with higher rates of mortality quite literally shrink in electoral influence when people pass away.

Thankfully, higher levels of civic participation can mitigate these disparities. For instance, rates of infant mortality are higher among Black and American Indian communities than white communities, but this disparity shrinks for all racial and ethnic groups in states that have better civic participation.

Looking at the States: Colorado has inclusive policies and strong public health outcomes.

• Automatic voter registration
• Vote by Mail
• Non-restrictive Voter ID
• Voting Rights Restoration

Explore on civic participation and public health.

Looking at the States: Tennessee has exclusive policies and relatively weak public health outcomes.

• Restrictive voter registration
• Restrictive voter ID
• Felon disenfranchisement
• Limited vote by mail

Explore on civic participation and public health.

Policy Action:Closing the Gap

Leaders can close the gap between states with lower and higher levels of civic participation with more inclusive rules, policies, for instance, with automatic voter registration at the DMV, through Medicaid sign-ups and other services.

Explore:

Select a public health metric to see how it correlates to voting access across states.

This is the percentage of adults reporting that their health is good or better when asked “How is your general health?” People who report fair or poor health are less likely to vote, but people who have good or better health are more likely to vote. Higher is better.

See this information in an interactive table.

Explore:

See state-by-state results on civic participation and public health.

See this data in an interactive table.

What We Can Do

These findings underscore the importance of strengthening public health and civic engagement through inclusive policies.

Policymakers can make it easier for voters to register or update their registration through a variety of programs and services. Additionally, policymakers can restore civic participation as one of the goals in the federal Healthy People 2030 initiative, which sets national public health goals for the next decade.

Individuals can promote health in their community, ensure they participate in elections, and help others register to vote and cast ballots.

Institutions can also promote local, state and national health goals, remind people of upcoming elections, and join partnerships and programs to promote civic engagement.

Learn more about our recommended policies.

Conclusion: The Link Between Public Health and Civic Participation

There are many aspects of public health policy that are directly linked to civic participation. For instance, in some states, voters have been able to adopt Medicaid expansion by ballot initiative. At the local level, voters also have significant input on spending and programs for green spaces, schools, public transit and other infrastructure that improves public health.

More broadly, voting is an important way that we build social inclusion and belonging as communities. Elections are the largest public events we hold nationally. Higher rates of community participation and social contact are linked to higher rates of civic participation and better public health outcomes. Similarly, social isolation makes people less likely to vote and is also bad for their health.

Further, laws that make voting accessible make voting easier for people with different abilities. This includes accounting for the location and physical accessibility of polling sites and equipment, language, and assistance with casting a ballot.

For more information, please see Methods for this analysis, including additional references and resources. This data is also available in a detailed, interactive table.

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