The 2018 Midterms: A Public Health Takeaway.
In my last Dean’s Note, I argued that health was on the ballot in the 2018 midterm elections. This week, health won. From climate change, to gun control, to health care, the issues that shape health were at the heart of campaigns across the country. Soaring voter turnout showed the power of these issues to mobilize millions of people in pursuit of a healthier world. Even more encouraging is how many candidates won on platforms that are good for health—from commonsense gun safety reform, to universal health care, to a willingness to address climate change. Arkansas approved a ballot measure raising the minimum wage by 29 percent over three years, a move which will help about 300,000 workers in the state access the resources they need to be healthy. Washington state approved a ballot measure to raise the legal age for buying assault rifles. Florida approved a ballot measure restoring the right to vote to more than 1 million former felons, allowing them to participate in the political process that shapes their health and the health of all. These are just a few of the changes ushered in by the election, changes with positive implications for health.
Politics, as I have often written, is inseparable from health. For this reason alone, the political engagement we saw Tuesday bodes well for health in the US. But the high numbers of women, people of color, and LGBTQ people who participated in the election, both as voters and as candidates, add a deeper meaning to this engagement. Their participation echoes a central aim of public heath—to shine a light on vulnerable populations and ensure no one is excluded from the conditions that make people healthy. This means ensuring that all have a say in the political process. The more inclusive our politics, the healthier we will be. At a time when marginalized groups are often threatened by those with political power, the midterm election was a significant, and welcome, step toward greater political inclusion.
Three additional takeaways from the election:
Values are core to the political change that creates better health.
In the US, we spend more on health care than any other country in the world, yet we have been slow to decide whether we truly value health. When the Affordable Care Act became law in 2010, it encountered strong opposition, culminating in Republican attempts to repeal the law under President Trump. These efforts helped galvanize a movement against repeal, which has since evolved into a movement for health. This movement both reflects and informs changes in how we as a country think about health. For example, single payer health care—an idea long regarded as radical in the US—is now widely accepted as mainstream. At the same time, we have begun, more and more, to think of challenges like climate change, economic injustice, and gun violence as public health issues. Gun violence, in particular, has been a powerful motivator for political action, as we have seen in the voter registration efforts of the Parkland activists. These changes would not be possible without first adopting health as a value worth promoting in the political arena.
Civic engagement is more important than ever.
Despite clear gains for a vision of politics that promotes health, last night’s result was also, in many ways, ambiguous. Democrats took control of the House of Representatives, while Republicans expanded their majority in the Senate. It would be easy to interpret this as another cause for frustration with the political process, just as legislative gridlock on the issues that matter for health can be a source of frustration that can chill deeper political engagement. But this would be wrong. In fact, civic engagement has rarely been more important for promoting health in the US, or better poised to do so. Consider Question 3, which asked whether to preserve civil rights protections for transgender people in Massachusetts. Had the protections been repealed, it would not only have left a vulnerable population open to harassment and attack, but it also would have served as a model for the rest of the country for how such measures could be taken elsewhere. The fact that voters chose to keep these protections—that they did so, in fact, by a nearly 70-30 margin—shows just how necessary it is for everyone to participate in the political process. That state voters chose to engage politically on this issue, guided by the values of tolerance and inclusivity, means transgender people were able to leave their homes today knowing they are recognized, and protected, by the law. This is good for health, and shows the true value of civic engagement.
Our school must continue to lead on the issues that matter for health.
One of the most inspiring elements of the 2018 midterms was our school’s work to push a “yes” vote on Question 3. Led by our Activist Lab, SPH students, faculty, staff, and alumni rallied in defense of the transgender population. These efforts were part of our broader work on the core issues of the last campaign—from guns, to climate change, to economic inequality. Through our scholarship, practice, events, and engagement with the media, we participate in the day-to-day political process, even as we help to inform deeper shifts in our country’s politics by changing how we think and talk about health. This remains core to our mission as we enter this new phase of the Trump era, and will continue to guide our work as a school when the politics of today are a distant memory. Ultimately, the progress we have seen during these years is a result of these foundational shifts, of slowly moving the needle in the direction of better health. The election confirms that, even during these tumultuous times, the fundamentals of creating a better world still apply: Values lead to action, politics is what we collectively make of it, and there can be no health without sustained engagement in the political process. We should continue to apply these principles, as we build on the progress we have made.
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 Catherine Ettman and to Eric DelGizzo for their contributions to this Dean’s Note.
Previous Dean’s Notes are archived at: https://www.bu.edu/sph/tag/deans-note/
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