When I started working at the Community Health Center, I connected with people at the National Association of Community Health Centers (NACHC)and starting learning about their programs.

One program that caught my attention was the Community Health Vote Campaign.

NACHC has initiated the Community Health Vote Campaign to encourage and assist Health Centers in developing and implementing local programs to educate their patients and their families about public policy issues affecting their access to health care and to increase significantly voter registration and participation in the nearly 7000 communities in which Health Centers are located.

Since my wife works for Common Cause, it seemed like an interesting way we could tie our work together. I suggested that my wife do a voter registration drive and the one of the health centers and suggested to people at NACHC that they might want to connect with Common Cause nationally. I met some resistance, and it took me a while to get a sense of the concern.

It boils down to this. Voter registration should be some special drive done every once in a while at a community health center, it should be a normal part of way the health center works. Essentially, the intake and screening of patients should include a question, are you registered to vote? Those patients that are eligible to vote should be encouraged to register and vote, and where possible, registration forms should be part of the stack of forms a new patient fills out, no different than filling out an insurance or HIPAA form.

Thinking about it, it makes a lot of sense. An important part of successful primary care is to empower patients to take better care of themselves. This may include quitting smoking, losing weight, or working on developing a better self image. Voting is part of this. It is a way to take a little more control of ones life.

This led me to an interesting thought. Is voting a social determinant of health? There are various factors that determine health outcomes for various populations. How easy is it to get health food? What opportunities are there in the community to get exercise? These are often related to racial and economic disparities in health.

Thinking it through, it seemed like there should be a correlation. There is correlation between poverty and poor health outcomes. There is a correlation between poverty and low voter turnout. So, is there a correlation between low voter turnout and poor health outcomes?

The topic came up in a Tweetchat today, so I finally decided to try and find some data that would help me answer this question. I went to the website, County Health Rankings. From this site, you can download health data on a county by county basis for any state.

I then did a bit of searching to find voter turnout records and found Wisconsin Voter Turnout By County. Combining all of this into Excel, I could do a little analysis.

First, some caveats. I looked at correlation. Remember, correlation does not necessarily imply causation. One could argue that low voter turnout causes poor health outcomes, that poor health outcomes causes low voter turnout, or that while the two are related, there is no causation one way or another.

The data I have is limited. In this case, I’m looking at 72 counties in Wisconsin. It would be great to look at this on a much broader basis. Also, there are time issues. The voter turnout is for the 2010 election, yet different parts of the health data comes from different time periods.

Nonetheless, I was struck by some of the results. The correlation between health outcome rank and voter turnout rank was .34. The correlation is even stronger, when you compare percentage turnout to the standardize health scores, in this case -.45 (where the lower the score, the higher the ranking).

Looking at health factors, it became even more pronounced with a -.56 correlation factor. Digging deeper, certain underlying factors jumped out. Health factors had a -.52 correlation, social and economic factors had a -.47 correlation. My understanding is that there is other research supporting the correlations between social and economic factors and voting turnout, so this was not a surprise. The bigger surprise is that mortality rates where correlated to voter turnout at -.45, while morbidity was only correlated at -.33

Digging further into the factors, the correlation between unprotected sex and voter turnout was -.58. Income was -.46, smoking -.36, diet and exercise -.32, and alcohol use -.25.

What was also particularly striking was access and quality of care metrics. There was no correlation between access to care and voter turnout (0.01). Yet when you look at the quality of care, there was a strong correlation, or -.46. That is, if you live in an area with higher voter turnout, you live in an area with a higher quality of care.

There is plenty more data that can be dug into and it looks like it may well be worth the effort. Here in Connecticut, it might be possible to get a larger set based on towns. It might also be interesting to look at this on the international level in terms of health outcomes and voter turnout.

While the data may not be definitive, it does reinforce my belief that voter participation is a social determinant of health that needs to be investigated, and while it is being investigated, it seems like medical providers should be encouraging all their patients to become civically engaged, for the sake of democracy, and perhaps for the sake of their own health.