The prescription for a healthier democracy: Physicians' role in political inclusion

When we're sick, the first step on the road to recovery is a visit to the doctor's office.

It turns out the same may also be true for breathing life into America's democracy.

A Rutgers University–New Brunswick study published in the journal JAMA Health Forum finds that physicians can play a crucial role in strengthening political inclusion of marginalized groups by aiding patients in voter registration.

"Hospitals aren't the first place we think of when it comes to voter registration," said Katherine McCabe, an associate professor of American politics at Rutgers University-New Brunswick and lead author of the paper. "But our study finds that by bringing voting registration resources into health care institutions, health care professionals have the potential to reach a type of voter that otherwise might be left out of the political process."

In the United States, 72 million eligible voters aren't registered, nearly a quarter of the voting-age population. Three decades ago, lawmakers seeking to expand voting access passed the National Voter Registration Act, which mandated that government facilities—including state motor vehicle agencies and federal assistance offices—provide voter registration support. Hospitals and health care settings weren't included in the law.

To gauge whether mobilizing people to vote in health care settings could help close the voting gap and encourage lower-propensity voters to register, McCabe analyzed data from Vot-ER, a nonprofit organization that integrates civic engagement into health care.

Emergency departments disproportionately care for low-income, minority and uninsured individuals, populations that are also less likely to vote. In 2019, alumni Alister Martin, RC '10, an emergency medical specialist at Massachusetts General Hospital, founded Vot-ER to engage these potential voters.

Working with Martin and Vot-ER, McCabe conducted a cross-sectional study to analyze the demographics and voting behavior of people reached by the nonprofit.

By comparing age, race and ethnic identity data from Vot-ER outreach during the 2020 election cycle with data from the Cooperative Election Study (CES) and the American National Election Study (ANES), which survey US adults, McCabe found that voters contacted in health care settings tended to be more racially and ethnically diverse, and younger, than registration efforts in non-health-care settings.

"Of the 12,441 health care-based contacts reported by Vot-ER, a significantly larger proportion were young (41.9%) and racial and ethnic minority individuals (39.6%) relative to the nationally representative data," McCabe wrote.

Martin, who co-authored the paper, said these findings could have profound implications for voter turnout in national elections, including the presidential election this fall.

"Health care-based voter mobilization reaches a distinctly younger and more diverse population than those contacted only by political campaigns," he said. "Rutgers' analysis of our work points to the unique impact that medical professionals may have on voter registration and turnout in US elections—including the one fast approaching in November."