The Right to Vote, The Right to Health: Voter Suppression as a Determinant of Racial Health Disparities

48 The Right to Vote, The Right to Health: Voter Suppression as a Determinant of Racial Health Disparities Hing Journal of Health Disparities Research and Practice Volume 12, Issue 6, Winter 2019, pp. 48-62 © 2011 Center for Health Disparities Research School of Community Health Sciences University of Nevada, Las Vegas The Right to Vote, The Right to Health: Voter Suppression as a Determinant of Racial Health Disparities Anna K. Hing, MPH UCLA Corresponding Author: Anna K. Hing, ABSTRACT Civic participation is beneficial to one’s health. Conversely, being unable to participate, such as being unable to vote, may be detrimental for health. Barriers that prevent voting and civic participation, which constitute voter suppression, disproportionately impact people of color. Therefore, voter suppression may explain intractable racial health disparities. However, few studies have examined the connection between voter suppression and health. In consideration of the frequent, and increasing, reports of voter suppression in recent elections, including the rise in voter identification laws, the reduction in early voting opportunities, and the closing of polling places, the field of public health should address voter suppression as a significant determinant of health inequities. This paper suggests a framework for how voter suppression may operate to negatively impact health and well-being, especially for people of color. Lastly, directions for future research are recommended to begin to disentangle the complex relationship between civic participation and health. Keywords: voter suppression; racism; health disparities INTRODUCTION Healthy People 2020 identified civic participation as a social determinant of health (Office of Disease Promotion and Health Prevention, 2019). Internationally, the Organization for Economic Cooperation and Development (OECD) proposed a framework arguing for civic engagement as an indicator of overall well-being (Organization for Economic Cooperation and Development, 2019). Both suggest that civic participation contributes to improved physical and mental health. In the United States (U.S.), the expansion of civil rights in the 1960s included the passing of the Voting Rights Act (VRA), the Civil Rights Act, and the Fair Housing Act. These three Acts sought to remedy discrimination within institutions and to promote social equality; they were followed by a reduction in racial health disparities, such as decreased mortality for African Americans (Chay & Greenstone, 2000). In the five years following the Civil Rights Act, Black infant mortality, which had been stable from 1961-1965, fell by 30% (Chay & Greenstone, 2000). Other analyses show that, from 1960-1964, living in an area with Jim Crow legislation, which Journal of Health Disparities Research and Practice Volume 12, Issue 6, Winter 2019 http://digitalscholarship.unlv.edu/jhdrp/ Follow on Facebook: Health.Disparities.Journal Follow on Twitter: @jhdrp 49 The Right to Vote, The Right to Health: Voter Suppression as a Determinant of Racial Health Disparities Hing prevented equal rights for African Americans, was associated with 1.19 times the odds of Black infant mortality compared to those living in a non-Jim Crow area (Krieger, Chen, Coull, Waterman, & Beckfield, 2013). Upon the abolition of Jim Crow, the odds of infant mortality converged between these two areas (Krieger et al., 2013). Further, using U.S. data from 1980, LaVeist showed that an increase in African Americans’ share of relative political power at the citylevel was associated with a significant decrease in infant mortality rates for African Americans, even after controlling for city-level poverty rates, segregation, unwed birthrate, low birth-weight rate, Black and White education levels, geographic region, and African American percent of population (LaVeist, 1992). With data from the 1990s, researchers found that living in a state with the highest voting inequality was associated with 1.54 times the odds of having poor or fair selfrated health compared to individuals in a state with the lowest voting inequality (Blakely, Kennedy, & Kawachi, 2001). More recently, policies that expanded protection against institutional discrimination for lesbian, gay, bisexual, and transgender individuals were associated with better mental health outcomes (Hatzenbuehler, 2009). These findings suggest that improvements in social equality and political representation may result in improved health. Across these examples, two mechanisms are in operation (Hanh, Truman, & Williams, 2018). First, voting possesses symbolic significance that may impact health; the right to vote connotes social standing and inclusion and provides one with dignity and self-confidence (Manza & Uggen, 2004). One’s inclusion in society and feelings of collectivity, demonstrated through civic participation and civic protection, may bolster one’s social and human capital, benefiting their overall well-being (Kawachi & Berkman, 2000). Second, the right to participate in society, such as through voting, allows the individual to influence policies and laws that shape wellbeing and known social determinants of health (Woolf & Braveman, 2011). Therefore, the expansion of civil rights and the ability to participate fully in such rights through voting may reduce health inequities. This commentary provides a framework which argues that voter suppression in the United States disparately impacts people by race, that this differential impact is due to voter suppression’s roots in racism and White Supremacy, and that voter suppression exacerbates racial health disparities through three primary mechanisms of structural exclusion from the electoral process, unequal allocation of resources and capital, and stress. Additionally, calls to action are provided which outline directives for future research on voter suppression and health. Framework: Voter Suppression as a Determinant of Health and Well-being Voter suppression, a form of structural racism, likely exacerbates racial health disparities. Harrell defines racism, structurally, as “a system of dominance, power, and privilege based on racial designations, rooted in the historical oppression of a group…and occurring in circumstances where members of the dominant group create or accept their societal privilege by maintaining structures, ideology, values, and behavior that have the intent or effect of leaving non-dominantgroup members relatively excluded from power, esteem, status, and/or equal access to societal resources” (Harrell, 2000, p. 43). Harrell’s definition harkens to the disenfranchisement created and maintained by structural racism. With voter suppression policies, one can begin to understand how power is stratified and, subsequently, how voting becomes a privilege, instead of a right, possessed only by the dominant racial group. Thus, voter suppression should be considered a form of structural racism in that it manifests through insti (...truncated)