Health Is on the Ballot This Week.
This Tuesday, the US will hold its midterm elections, when voters will choose their representatives in a range of local and national offices. These offices include governorships, seats in the US House of Representatives and Senate, as well as in state legislatures. Some context, for those who may be unfamiliar with how these elections work: During the midterms, one-third of the US Senate and the entirety of the US House of Representatives are up for election. The elections are called “midterms” because they occur near the middle of a president’s four-year term in office. Compared to presidential elections, voter turnout in midterms has typically been low, but there are signs of higher turnout than usual this year, perhaps reflective of the increased political engagement we have seen in the US since the last presidential election.
This is heartening indeed. Voting is core to health. As our Activist Lab Student Engagement Intern Mallory Bersi recently wrote, “Voting and health are inextricably linked…. Political decisions touch nearly every aspect of our daily lives, so having an active voice in these decisions is critical for the betterment of our health, communities, and country.” This note is therefore a call to vote, and a reminder of why doing so matters for health. In writing this, my aim is not to urge anyone to vote for a particular party or candidate. Rather, I will share my perspective on the many ways that voting links to health, and the role the 2018 midterms will play in deciding whether we, as a country, are able to live healthy.
These are difficult times for health, with many of the Trump administration’s policies working against the structures that support health in the US. Health is a product of the social, economic, and environmental conditions that shape our lives. The issues at stake in this election intersect with each of these conditions. Starting with the environment, the Trump administration, in addition to its embrace of the fossil fuel industry and its rush to reduce emissions standards, has been a consistent foe of efforts to address climate change—a growing threat that many deny even exists. This was most clearly on display in Trump’s decision to withdraw the US from the Paris Climate Agreement. These anti-environmental policies come at a bad time. The recent UN Climate Report detailed how far climate change has progressed, and the urgent need to address this challenge. I have written elsewhere that “those who stand in the way of addressing climate change in 2018 have declared themselves friends of disease and foes of health.” By this measure, the current administration has shown itself to be no friend of efforts to mitigate this generation-defining public health threat.
This election also concerns our economy, a core driver of our health. I have written many times about the link between income—and wealth—and health, and how there can be no health without economic justice. Money allows us to access the resources that generate health, like healthy food, safe housing in good neighborhoods, quality education, opportunities for travel and leisure, and the peace of mind that comes with knowing we are not one expensive accident away from insolvency. Widening inequality in the US has only increased the gap between those who can access these resources and those who cannot, a gap which is reflected by the health divide between these groups. Americans at the top of the economic ladder now live 10 to 15 years longer than those at the bottom. We can address this inequality, and the poor health it creates, through progressive taxation and robust investment in the country’s social safety net. Unfortunately, this is not what we have seen in recent years. Far from addressing inequality, Congress passed a $1.5 trillion tax cut which overwhelmingly favors the wealthy. As candidates debate the justice of this tax cut, and US economic policy more broadly, it is important to remember that they are not just talking about money. They are talking about health.
Finally, the vitriol of our current politics, and the daily marginalization of vulnerable groups, have frayed our social fabric, with consequences for health. At the federal level, this has taken the form of the belittlement and exclusion of women, immigrants, people of color, and LGBTQ populations, with the president himself often taking the lead in disparaging these groups. There is ample research on how the physical and mental consequences of such hate can undermine health throughout the lifecourse. But the problem of hate in the political arena is not limited to the harm of hearing hurtful words. It also manifests as policy. By engaging in hate speech, political leaders have the power to normalize it, shifting what is seen as acceptable in the public debate, until acts once deemed unthinkable, such as political violence, begin to enter the realm of possibility, and policies once too cruel to even contemplate, like separating immigrant families at the border, suddenly become daily realities. Yet we have also seen positive developments in recent years. The social movements that have sprung up as a response to Trump’s policies are poised to make progress on a host of issues, from climate change to gun violence. The midterms are a chance for these social movements to truly shift the political power dynamic, and move the country in a healthier direction.
Another key issue in this election—perhaps the key issue for many voters—is health care. A March 2018 Gallup poll found that “the availability and affordability of health care” is at the top of the list of Americans’ concerns. This concern emerged in the context of efforts to repeal the Affordable Care Act, which they have so far been unable to do, in part because of widespread, passionate civil resistance. The efforts to repeal the ACA have created a new opening in the public debate for adopting health as a collective value. We have seen this in the rising support for single payer health care. 51 percent of Americans now support single payer, and many Congressional candidates have endorsed it. As Americans come increasingly to embrace health as a value, the midterms are a window for us to act in accordance with this value—by supporting single payer, yes, but also by supporting the full range of policies that promote health.
I want to be clear that this is not a partisan call to action. Members of any political party can, and should, take positions that promote health, and members of all parties sometimes, unfortunately, take actions that harm health. It was, for example, under the presidency of George W. Bush that we launched PEPFAR, a program that has since gone on to save millions of lives. This note does, however, have a political message. And this is so because public health is politics—the two are indeed inextricably linked. As a school of public health, we have long been engaged with the issues that animate our politics, both nationally and locally. At the national level, our work has informed policies, our words have shaped the public debate, and members of our community have added to the ranks of marchers and officeholders. Locally, our engagement has taken the form of advocacy for the policies that promote health in the state on a range of core issues, from housing, to gun violence, to the opioid crisis. We have been particularly active during this election cycle in opposing efforts that would repeal civil rights protections for transgender people in places of public accommodation in Massachusetts. Through the work of our students, faculty, and staff, and led by our Activist Lab, we have organized in support of voting “yes” on Question 3 to keep civil rights protections in place for the transgender community.
These efforts are core to the mission of our school, and to the work of public health. Yet this work is incomplete if we do not also vote. Political engagement is at the heart of public health; voting is at the heart of political engagement. And, as recent years have shown, choosing to abstain from voting is not a neutral decision. Elections have consequences. If we do not support the policies that promote health, we risk amplifying the power of those whose policies would undermine it. On Tuesday, we have a chance to make progress on a range of issues that matter for health. I hope each of us will take it. As members of our community vote in many different jurisdictions, this means being alert to issues and candidates—both local and national—and being aware of the resources available for transportation to the polls or voting absentee. It also means respecting the conviction that inspires all citizens who go to the polls—regardless of political persuasion—as core to the civic engagement that makes for a healthy society. I am grateful to the many staff, students, faculty, and alumni who have engaged in political discussions in the last two years—our community is richer for having within it a diversity of opinions. And our country is healthier when we express these opinions, collectively, by voting in elections.
I hope everyone has a terrific week. Until next week.
Sandro Galea, MD, DrPH
Dean and Robert A Knox Professor
Boston University School of Public Health
Acknowledgement: I am grateful to Eric DelGizzo for his contributions to this Dean’s Note.
Previous Dean’s Notes are archived at: https://www.bu.edu/sph/tag/deans-note/
Question 1 regarding nurse staffing ratios is also a health-related ballot question. California has already implemented a similar policy. Saturday’s Boston Globe has a balanced look at the issue. People may disagree about the specifics, but it’s clear that nurses are over-stressed and burnout is a real issue. The ballot is a blunt way to deal with this question, but nurses have raised the issue for years but hospitals have ignored them. Personally, I’m voting yes.
Question 2 proposes to set up a commission to study the advisability of proposing a constitutional amendment to overturn the Supreme Court’s decision in Citizens United that defined corporations as “persons” for the purpose of making political donations. It affects health in that the tsunami of private money has helped lead to many of the policies described in the article. While it won’t do much on its own, it’s worth a yes vote as part of the broader effort (including fighting back against gerrymandering and voter suppression) to democratize our elections.