Communities, patients, health care executives all play a role in getting out the vote

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Communities with greater levels of civic engagement tend to have better health outcomes than in places where voters stay home on election day.

Meanwhile, patients and health system leaders can have positive reactions when physicians and other clinicians take the lead in helping people get registered to vote.

Alister Martin, MD, MPP, started Vot-ER in 2019 as a hospital pilot program in Massachusetts. Since then, it has grown into a national nonprofit, nonpartisan organization working with more than 50,000 physicians and other clinicians helping their patients register to vote at approximately 700 participating sites, and with more than 400 partnerships.

The organization is gearing up for National Voter Registration Day, one of the busiest Vot-ER days of the year, on Sept. 17. Meanwhile, voters around the nation are preparing for the 2024 presidential election.

Martin, an emergency medicine specialist, sat down with Medical Economics to discuss effects on communities, in examination rooms, and in hospital executive offices when doctors prescribe democracy.

This transcript has been edited for length and clarity.

Medical Economics: In your own words, can you discuss some of the reasons why communities with greater voter turnout tend to have better health outcomes than communities with lower civic engagement?

Alister Martin, MD, MPP
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Alister Martin, MD, MPP: A really good question. There are two schools of thought on this. I find both to be persuasive. The first category is the body of evidence that demonstrates that when communities are voting, they're pulling in resources into those communities. They're pulling in engagement and attention from policymakers to consider the challenges of that community, to consider the questions of that community, to consider the resources that community might need. What we see is, all across this country, not just in urban areas, but we look in rural counties as well, where voting rates are low, health outcomes are low as well, or lower comparatively.

But there's this other piece of it that's very interesting as well, and that's the individual impacts of voting. The data seems to point towards this dynamic that those who vote have a higher sense of self efficacy. And that higher sense of self efficacy means that they feel more empowered to make impactful decisions in their lives. If you're the kind of person who thinks of themselves as a voter, there are a bunch of other downstream decisions and sort of ways of showing up in your community that are going to also make you happier and healthier and more effective as well. So, there are these two different levers that seem to be acting on the individual but also at the community level that tie civic engagement with health outcomes.

One other thing, just to be totally complete about it, to be totally transparent. Politics influences the care that patients receive right? At the end of the day, all of the medications that I have access to, the interventions that I can do, the surgeries, the reductions, all of these things are dictated by the sociopolitical landscape that I practice in as a physician, and if my patients are not involved in that – or, let's shine the spotlight back on physicians and nurses. If we're not involved in the prospect of voting and making our voices heard, then at the end of the day, we are just going to be subject to a system that other folks have decided.

Medical Economics: How has patient response been to Vot-ER? Do they like the assistance, or do they not want to be bothered?

Alister Martin, MD, MPP: I can only speak for me as an individual and my own anecdote is just one part of the puzzle here. And that is that patients are delighted when I talk to them about the importance of this, that the idea that I care enough about them to want them to make their voices heard in elections, is often something that catches them by surprise. They often ask, is this something that the hospital is doing, or is this something that all doctors are doing now? And they wonder are these things that the health care system, more broadly, could or should be doing? I remember one interesting conversation I had recently with a patient. The patient basically was like, yeah, this makes so much sense. Actually, it makes more sense for you to ask me about voter registration than the DMV clerk asking me when I got my license renewed – like, what does voting have to do with driving? And I remember laughing at that. That's just my anecdote, but to add some data to it, the Association of American Medical Colleges did a wonderful study on this actually, and what they found was, for our country's most marginalized patient groups, very interesting, it seems that the act of a health care system or health care provider talking to them about voter registration actually increases trust between that patient and that health care institution. That patient, that marginalized patient, then starts to feel like, oh, this hospital cares about me, or this health center cares about me. I think it's because it's an unusual or atypical message, and so it kind of cuts through. So, that data I found to be very, very compelling.

Medical Economics: A growing number of doctors are employed within hospitals and health systems. How do C-suite leaders respond when physicians and other clinicians begin a campaign to increase voter registration?

Alister Martin, MD, MPP: Let me tell you about the most impactful intervention we can do. You know, if we were to sort of put them all on a scale and say, which of these interventions are leading to the most impact with regard to the amount of effort that we put in? It actually is our CEO messaging program. That is very simple. We organize CEOs of hospitals and health care systems all across this country to do one thing, and that is on National Voter Registration Day, which is in September, to send an email out to their hospitals or health care systems saying something like following: I think it's really important for you to make your voice heard. As the American Medical Association has recently declared, voting is a social determinant of health. Click this blank and check to make sure you are registered to vote. It's kind of like in emergency medicine. We think about our actions as practice changing. What information or data that we get from research would actually change my practice? Because you're constantly bombarded with new information. OK, this is a practice changing intervention for us. The idea of working with CEOs of hospitals, health care systems, that has been such a pleasant surprise. The reaction is generally very, very, very positive. And I would say that when it's not positive, we listen to that feedback, and we try and figure out, how can we make the system more seamless, less cumbersome, less interruptive? And that's really what most of our sort of C-suite feedback has been, is, guys, this is great. We see that you work with TurboVote (a nonpartisan voter registration online platform) and the secretaries of states of all 50 states, plus D.C. We don't have any questions about election security, we don’t have any questions about doing this in a way that's legal. What we have questions about is, how do we adapt this to a health care environment? And that's really where their feedback has been very good for us.