(Illustration by iStock/smartboy10)
In early March 2020, VotER felt unstoppable. Interest in our hospital-based voter registration kiosks was taking off: after piloting at Massachusetts General Hospital, we had launched in hospitals across Pennsylvania in January and February, and by mid-March we were seeing interest from more than 50 hospitals around the US. The idea that patients should use their four-hour wait time in the emergency room to register to vote had an intuitive ring to it, often evoking the response “Why didn’t we think of this before?” from our partners.
Even before the pandemic, health care was already one of the most important topics in America. But more than 50 million US citizens were not registered to vote, which meant their voices were missing from policy conversations about health care and on topics that inform health outcomes, like economic stability, education, and affordable housing. As doctors, improving health outcomes is our job. And yet factors beyond the care we give—the kinds of social determinants of health that come out of the political process—can account for as much as 80 or 90 percent of a patient’s health outcomes. And to put salt on this metaphorical wound, physicians vote at lower rates than the general population.
The moment seemed ripe for voter readiness to enter the health care space. And it was, but everything changed when the World Health Organization declared COVID-19 a pandemic. As an emergency room physician, Alister experienced the effects of COVID on the health system directly, especially its disproportionate impact on communities of color. As a civic leader accustomed to serving at the front lines, Aliya wrestled with the moral weight of being told that to keep others safe, the best thing she could do was to stay at home.
Our work took on a heightened sense of urgency, even as it ground to a halt. Hospital leaders were overwhelmed by COVID-19 preparations and went silent; emergency rooms were turned off by the idea of a touchscreen in their waiting rooms, which they feared would transmit the virus; and patients were coming to ERs across the country at lower rates than normal, to avoid the virus. But the pandemic has only spotlighted the flaws and inequities of our health care system, in no small part resulting from a democratic process missing so many voices. Meanwhile, the contagion even makes it perilous to line up at the polls, potentially excluding even more voices.
The big question was how we could press forward with our work? How could we reach out to hospitals whose leaders felt under siege? How could we reach health care providers who felt their own health and lives were at stake? And how could we reach patients who shied away from hospitals out of fear and confusion?
Our questions and conversations in the subsequent weeks led to three major changes in our work.
- We worked to turn our anger and frustration into action. As an ER physician, Alister had to repeatedly turn away patients asking for COVID tests because there were none left to send. He has had to watch Black and Brown patients dying at disproportionately higher rates and colleagues falling ill because of shortfalls in protective equipment. In response to the growing national chorus of health care providers angry at how our health care system had failed us, we created a Healthy Democracy Kit to make it easy for health care providers across the country and across all specialties to help their patients register to vote, effectively creating an outlet for activism that could potentially translate into upstream policy changes. (The Healthy Democracy Kit includes a QR code and a text platform that can help a patient or provider to register to vote or request their absentee ballot, direct from their phone).
- We began reaching out to patients beyond the walls of the hospital. Working with our partners at ideas42, we crafted text messages designed to prompt patients to register to vote or to sign up for their mail-in ballots. Since voting from home has become a major public health priority—the safest way to participate in the upcoming elections—we made it a key part of our digital platform. We piloted the text messaging work with a community health center, and we are now working to extend the service to interested hospitals around the country.
- We helped launch a national campaign, setting our sights on August as an opportunity to focus national attention on the overlap between health care and civic engagement. Following the example of National Voter Registration Day, we are partnering with a range of organizations to celebrate the inaugural Civic Health Month this August. Civic Health Month will include both health care organizations like the American Academy of Pediatrics that have civic engagement initiatives, health care institutions like Massachusetts General Hospital that participate in voter registration activities, and civic engagement organizations like We Can Vote that are working to ensure safe and healthy elections this year.
With these more operational shifts also came new paradigms. Realizing that we needed new voices and perspectives on our team, beyond our initial roots in the behavioral economics space, we brought in community organizers, medical students, social workers, brand strategists, and health policy experts to shape our new work.
With these new perspectives, our work increasingly looks and feels like a movement rather than simply an organization. A day in the life can include debating how we shift the identity of doctors to elevate them from caregivers into leaders who are empowered to impact the broader health system. It might mean medical students commemorating the Black Lives Matter protests by asking their administration to allow them to use the VotER tools without retribution. And it can include connecting department chairs in a large hospital to the American Hospital Association’s legal briefing that gives guidelines to support non-partisan voter registration in health care spaces.
Much remains unknown. Will the 11,000 Healthy Democracy Kits that health care providers have ordered across the country translate into voter registration and more patients taking the opportunity to vote from home? Will patients see their clinic or hospital as an authority not just on their physical health but also their civic health? Will health care institutions that have traditionally felt distanced from policy and advocacy embrace the opportunity to empower their patients?
We don’t know the answers to these questions. But the urgency that came with COVID has given us the humility and courage to step into that unknown. If nothing else, we’ve begun a timely conversation about what it looks like to shift our sights toward a healthier democracy, one where we heal our broken health system, one vote at a time.
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Read more stories by Alister Martin & Aliya Bhatia.