Voter Suppression on the March: A Public Health Issue

A Center for Community Resilience ‘Emerging Voices in Public Health’ guest blog by Elizabeth Mason, MPH ’22, George Washington University Milken Institute School of Public Health

Voting laws that strip any group of its collective power at the ballot box ensure the needs of those silenced go unaddressed in the development of law and public health policy, which further perpetuates health disparities in America. Throughout this nation’s history, the expansion of voting rights has been followed by a wave of voter suppression bills, either subtle or blatant in their aim to limit voting access for communities of color. Voter suppression laws threaten to disenfranchise millions of voters of color. Following the 2020 election — which had record high voter turnout across all racial groups — Republican lawmakers in state legislatures across the country produced hundreds of bills with the sole purpose of making it harder for Americans to vote. As of October 2021, thirty-three laws in nineteen states had been enacted that restrict voting rights.

In March 2021, following Georgia’s historic Democratic victories for both U.S. Senate seats as well as the Presidency, state legislators passed a voting law designed to restrict access through various mechanisms. Provisions include targeting communities of color, through onerous voter ID requirements; restricting or limiting mail-in voting. The effect is chilling. In Atlanta — a Democratic and largely Black stronghold — voting drop box locations have been reduced from 94 to 23.

In July 2021, the Supreme Court ruled that Arizona’s restrictive voting laws do not violate the Voting Rights Act (VRA) despite lower federal courts finding evidence that these laws make voting harder for people of color. The decision will make it harder, if not impossible, to challenge the myriad voting restriction laws being instituted across the United States — including the one in Georgia — guaranteeing their longevity without additional federal voting protections.

Voting: A Tool for Improving Community Health, Well-being & Equity

Voter suppression is not merely a civil rights issue, it is a public health issue, as candidates, policy and provisions voted on by the populace directly affect services, systems, and environments that serve every community.

Casting a ballot is connected to community and health outcomes because the act of voting gives equal opportunity for citizens to advocate for their needs through public policy and representation.

It is therefore imperative to both challenge these voter suppression laws and ensure large scale civic participation.

Increasing civic participation is critical to advancing equity in our country and improving health. It was only after women won the right to vote in 1920 that maternal and child mortality rates saw their biggest decline. Even though additional factors played a role, this reduction in infant mortality can be partially attributed to the Sheppard-Towner Maternity and Infancy Act of 1921, which created maternal and child health units in every state health department. The female vote was instrumental in the passage of this act and had a direct and positive impact on women and children’s health and well-being and by extension, the nation’s health. The Sheppard-Towner Act funded home-visitation initiatives, allocated federal funds to support state health programs, and increased the collection of birth and death data.

While it is impossible to attribute improvements in maternal and infant mortality solely to the increase in voter enfranchisement, compared to the public health advancements in the wake of women’s suffrage in the 1920s, we can see a similar trend in the public health gains following landmark civil and voting rights legislation in the 1960s. On the heels of the passage of the Civil Rights Act of 1964 and the VRA of 1965, infant mortality rates declined yet again. Various institutional, political, economic and technological forces, many rooted in civil rights legislation, contributed to narrowing the gap between the Black-White infant mortality disparity in the late 1960s.

These include the desegregation of hospitals in response to the federal government’s threat to withhold Medicare funding from hospitals not in compliance with Title VI of the Civil Rights Act; implementation of the Medicaid program in 1966, which allocated funds to support medical care for low-income families, in particular women and children; and the institution of modern neonatal intensive care units (NICUs).

One thing is certain, the right to vote is a citizen’s opportunity to express their support or dissent for policies that directly influence the social determinants of health. Until all citizens can be assured equal and equitable opportunity to vote, public policy will not have a chance to accurately reflect the will or needs of the people, and instead, further perpetuate health disparities.

The Durability of Structural Racism

Structural racism is foundational to American systems and has endured since our nation’s inception. It should come as no surprise that throughout the fight for its passage, the VRA was adamantly contested. As evidence of the durability of structural racism, the necessary reauthorization of the VRA is routinely met with legal challenges. The most significant blow to the VRA came in 2013 in the Shelby County v. Holder case when the Supreme Court ruled in a 5–4 decision that one of the most powerful protections of the VRA was unconstitutional. Section 4 had previously required nine states, mostly in the South, and scores of counties and municipalities in other states, to obtain advanced federal approval before changing their election laws, referred to as “preclearance.” In the majority opinion, Chief Justice John Roberts insinuated that racial minorities no longer face barriers to voting in states with a history of discrimination.

With the removal of voting protections, an onslaught of voter suppression laws employed by the states no longer subject to preclearance were unleashed. These states saw a monumental increase in voter ID laws, purged voter rolls, gerrymandering to diminish the collective power of the minority vote and the strategic relocating or shuttering polling places. In her book, One Person, No Vote, Carol Anderson demonstrates how these voter suppression tactics reshaped the voting landscape prior to the 2016 election. By the time the 2016 election was held, millions of Americans had been purged from the voter rolls in the name of “voter roll maintenance.” There were 868 fewer polling places available in previous VRA preclearance counties and Black voter turnout fell for the first time in 20 years. Not only do these voter suppression tactics successfully block minority participation in society, they disenfranchise Americans who were not originally protected under the VRA.

An Inextricable Link: Voting Rights & Public Health

The right to vote enables citizens to have agency over community representation and public policy; a voice that will be heard not silenced, an ability to act independently, to make free choices, are all integral to the Constitutional right to life, liberty and the pursuit of happiness. To improve the capacity of public health policy and work towards the elimination of health disparities in America, it is essential to harness the collective power communities hold at the ballot box. Until voter suppression laws are abolished making universal suffrage easily accessible, the public health needs of all Americans will not be guaranteed.

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Center for Community Resilience

A Milken Institute School of Public Health collaborative seeking to address the root causes of childhood & community adversity.