Voting as a Social Determinant of Health

By Ashley Shelton, Executive Director, Power Coalition for Equity and Justice

 


 

If our new Covid-19 reality has taught us anything, it’s that Louisiana–and the United States–ignores the importance of public health at its own peril.

The immediate needs for our health systems are well-known: More tests, more masks and other personal protective equipment, and more ventilators. But beyond that, this pandemic should show us what happens when we diminish the importance of public health until it’s too late.

As Louisiana begins to move forward in the weeks and months ahead, the pandemic should serve as a lesson and opportunity to do better by our most vulnerable citizens. That will require thinking of public health from a holistic perspective, not just in terms of reacting to the crisis at hand. If we want to avoid or minimize future events of this nature, and more effectively deal with the current one, we have to think of public health as being intertwined with every aspect of our lives.

A holistic approach means thinking about health care not just as something that takes place in a hospital or doctor’s office, but looking at “social determinants of health.” These determinants include everything from diet and exercise to economic security, the block where you grew up, the schools you attended, and the occupation you choose. All of these things affect a person’s health, and the health of the community where they live.

Addressing the social determinants of health means looking at the root causes of why some groups lead shorter, less healthy lives than others: poverty, violence, poor educational outcomes, structural racism, and a lack of access to healthy food, among others.

In response to the coronavirus crisis, Congress has moved swiftly to send relief to families and communities. Millions of households will get checks from the government, while people who become unemployed because of the pandemic will get up to $600 a week more through July. There will be money flowing to hospitals and universities to help them survive these difficult times, and money to shore up the state budget.

But having led recovery work in Louisiana after four major hurricanes and the BP oil spill, I have seen first-hand how hard it is to get recovery dollars to the people on the ground who need it most. Systems in America have often failed Black people, and those racial inequities can be further exacerbated during times of crisis. I’ve also seen how quickly the safety net can be pulled away from vulnerable communities as soon as a crisis fades from the headlines.

Which brings me to another important social determinant of health: Voting.

In 2015, Louisiana elected Gov. John Bel Edwards, who had campaigned on expanding Medicaid. This simple decision has had a profound impact on public health in our state, allowing more than 480,000 Louisianans to gain health insurance. As thousands of our fellow citizens lose their jobs due to the pandemic, the Medicaid program will be there to ensure their health care expenses are covered.

Medicaid expansion has already helped reduce racial inequities in our state’s healthcare system. The Commonwealth Fund reports that the uninsured rate among Black Louisianans fell from 17.3% in 2016 to 11.3% in 2018. The Kaiser Family Foundation notes that states that expanded Medicaid saw notable improvements in measures of self-reported health. 

But while many elected leaders strive to do the right thing by their constituents, others continue to put politics and profits above public health. Instead of working to expand health coverage, raise wages and make housing more affordable, they put new hurdles in front of people through ineffective work reporting requirements to Medicaid and SNAP (food stamp) benefits.

Groups like the one I lead, the Power Coalition for Equity and Justice, have worked for years to center people in policy. But we’ve often met strong resistance from elected officials, even though polling shows overwhelming support for progressive policies like a higher minimum wage, paid leave, and access to health care.

Hopefully this pandemic has created a moment that transcends partisan politics. The short-term remedies that are being discussed right now could easily be implemented long-term. That will require political will, and political will is determined by our votes. Your voice and your vote are the greatest tools you have to protect your health and the health of your loved ones.

Voting can be the most powerful social determinant of health.