Connecting health care, voting, and our communities

It has been eight years since I registered patients to vote in the Bronx. I remember the clinic, nestled in a busy commercial neighborhood with its modest windowfront facade. Inside, the flyer was posted everywhere. Among quilts of signs and reminders, it vied for attention with its large block letter logo, “I VOTE, I COUNT.” In the waiting room, our team approached patients to ask, “Are you registered to vote?”.

I was a college intern for the clinic-led voter registration project, spearheaded by physicians. The effort was non-partisan and effective, registering almost 90 percent of eligible voters.

It was an experience that not only sparked my interest in medicine but demonstrated the power of local mobilization. Patients want to vote. But they are besieged by environments that erode opportunities for civic engagement and health. Registering patients to vote in a neighborhood with limited transportation, language barriers, food deserts – a neighborhood in one of the most historically impoverished urban counties in the country – was a small, but tangible way to empower residents.

That summer, I learned that physicians, if they are to achieve patient health, must have meaningful impact beyond the walls of an exam room. Not in a manner that assumes we know best for communities, but through solutions forged in partnership, elevating the patients we serve. Dr. Manisha Sharma, at the time a family medicine resident and leader of the project, would say, “Our communities are capable.”

Although physicians make an enormous sacrifice for patient care in clinics and hospitals, medical care accounts for only a small fraction of the modifiable factors that contribute to health outcomes. The rest lies, by and large, in social determinants.

Voting, and more broadly, civic engagement, is a social determinant of health. Statistics on voting portray glaring, but familiar disparities. Voters tend to be whiter, wealthier, more educated, even healthier than the general population. Unlike other social determinants, such as secure housing or access to foods, universal voter turnout is feasible without massive financial investment or dramatic shifts in policy and structure. Instead, voter turnout in underserved communities is propelled by grassroots efforts. In this space, health professionals have a platform to facilitate outcomes. Our clinics have access to, and the trust of, some of the most electorally under-represented populations. Encouraging patients to vote in these communities, and just as importantly, aligning with patient interests by voting ourselves, is an opportunity to amplify the voices of the electorally disenfranchised.

The impact of community-centered empowerment, as well as the inseparable nature of medicine and the broader social determinants driving health, have only become more apparent throughout my time as a medical student. Fueled by frustration from the limits of traditional medical practice, young physicians and physicians-to-be have pushed community health and systems sciences into central tenets of curriculum. Outside of the classroom and hospital, physicians have evolved into fierce advocates on the issues of gun violence, structural racism, health care reform, and other public health crises.

I have witnessed our activism ricochet back with admonishments to “stay in our lane.” As if tangling with the community somehow weakens our abilities as healers. The COVID-19 pandemic exposes the truth: our role as healers relies on the community.

The pandemic swept through ill-prepared health care infrastructures, uncovering vacuums in leadership and guidance. As physicians met unknown challenges with courage, the community rose alongside them. In my own city, local businesses donated valuable personal protective equipment. Volunteer graduate students collaborated with the health department to provide widespread COVID-19 screening and contact tracing. Schools and charitable organizations facilitated access to basic needs for vulnerable residents and amplified social distancing messaging.  Family, friends, and neighbors created innovative solutions to combat the deleterious effects of social isolation. The COVID-19 pandemic made evident that community organization is not just a powerful tool, but a critical component of health promotion efforts.

Voter registration in clinics will not solve the mammoth injustices faced by our patients, but it is an avenue through which to acknowledge the dynamic relationship between health centers and the broader community. Health centers and professionals are revered in communities. We also lean on them – as demonstrated by local efforts buoying the pandemic battle. And when we fail communities, like when we allow the malignant forces of racism in our society to taint patient care, we are accountable to them.

Eight years ago, I was a college student contemplating a career in medicine. In eight months, I will introduce myself as a doctor. I am going to ask patients if they have registered to vote because it is a small, but actionable way to empower them. Because where systems have failed, communities are capable.

Yumiko Nakamura and Vishnu Muppala are medical students.

Image credit: Shutterstock.com

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