Opinion
June 8, 2026
Voting is Paramount for a Healthy Population
By Mary K. Canales
When you see something that is not right, you must say something. You must do something. Democracy is not a state. It is an act, and each generation must do its part. John Lewis (2020)
We must heed John Lewis’ call to action if current and future generations’ right to vote are to be protected. As we approach Juneteenth, the federal holiday celebrating the end of slavery and the hope for a more racially just America, we need to recognize the intricate relationship between voting and health. Mounting evidence demonstrates that communities with strong voting protections have better health outcomes. According to researchers at the T.H. Chan School of Public Health, in Boston, MA “elections, political ideology, and concentrations of political power matter for population health.”
On June 17, 2021, President Biden signed legislation to make Juneteenth a federal holiday. The historical legacy of Juneteenth shows the value of never giving up hope in uncertain times and provides guidance for future voting rights efforts.
We certainly need that guidance now. With the recent Supreme Court’s Louisiana v. Callais ruling, gutting Section 2 of the 1965 Voting Rights Act (VRA), and the subsequent rush to gerrymander Southern states to eliminate predominately Black voting districts, some days it is difficult to remember that the year is 2026 and not 1956, when John Lewis was battling for the right to vote for Black Americans, or 1826, when the idea of the U.S. Black population voting was barely a dream. While 1826 saw major advances, including the first chartered railway and the invention of the internal combustion engine, it was also a time of horror, as slavery hardened in the South and industrialization created harsh working conditions in the North.
Yet less than 40 years later, in 1863, President Lincoln issued the Emancipation Proclamation, ending slavery. Then in June 1865, the 13th Amendment to the Constitution, enshrining emancipation as national policy, was ratified.
It was not, however, until June 19, 1865, referred to as Juneteenth, that the last enslaved people living in Galveston, Texas, the westernmost Confederate state, were officially freed. On this day, Union General Gordon Granger arrived with his troops to announce to the remaining enslaved people that they were finally free. Today, the accomplishments achieved in 1865 through the tireless efforts of those committed to a more equitable and just society are again in danger but also provide hope for overcoming the challenges we face.
To start, we must strengthen voting rights for all. Because the U.S. Constitution did not originally enshrine the right to vote, mass struggle has been necessary to gain and codify the franchise, beginning with the 15th Amendment (1870), prohibiting the denial of the right to vote based on race, color, or previous condition of servitude; the 19th amendment (1921) prohibiting the denial of the right to vote based on sex; and the 24th Amendment (1964) removing barriers to voting by prohibiting a poll tax. Both the 14th and 15th Amendments empower Congress to enforce voting protections through legislation, including the Voting Rights Act of 1965. These amendments and laws have been instrumental in ensuring that all can freely participate in our representative government. These legal gains have, in turn, improved health outcomes especially in former Jim Crow Southern states.
For example, a study published in the American Journal of Public Health found that “passage of the VRA led to pronounced reductions in Black infant deaths in Southern counties subject to government intervention.” Among Black Americans, the infant death rate in 1959 to 1965 was 51.9 per 1000 population in VRA-covered counties; by 2017 to 2021, these rates dropped to one fifth the 1959–1965 rates. Truly a stunning improvement in population health!
A great deal of data links voting rights to healthier communities. For example, a piece published by The Network for Public Health Law explains 25 years of evidence demonstrating the clear connection between voting and health, including fewer people without insurance and lower death rates for working-age adults. The Health & Democracy Index, created by the Institute for Responsive Government, has catalogued this relationship across the states for 12 public health indicators. This interactive tool visually reinforces that some of the same barriers that negatively affect health also limit voting and when combined, reduce democratic participation. This vicious cycle, however, can be broken. Like the improvements gained through legislation supporting public health, the passage of legislation supporting civic health can reverse negative trends and reinvigorate voter participation.
For example, researchers writing in Health Affairs reported that of the 10 healthiest states, eight restore voting rights to those convicted of a felony. By contrast, of the 10 least healthy states, only one allows for such restoration. Similarly, the 10 healthiest states all have programs that make it easy for eligible voters to register, such as same-day or automatic registration. Of the 10 least healthiest states, only two have such programs. The Health & Democracy Index and other similar tools provide Defend Public Health members and other health advocates with easily accessible evidence to educate health professionals and the general public that voting matters for health and vice versa.
Yet voting rights, and the health improvements they ushered in, are clearly threatened in the aftermath of Callais. As legal scholars, historians, and legislators examine the past, present, and future of voting rights, health professionals, especially those engaged in public health, must also join these efforts. Although national organizations, including the American Public Health Association and American Medical Association, support the importance of voting, and voter participation was included as a core Healthy People 2030 objective, designating it a high-priority public health issue, health professionals themselves are less likely to vote; physicians, nurses, physician assistants and dentists are 12-23 percent less likely to vote than the general population. Health professionals need to educate themselves – and do better.
Health and voting are intricately connected; we cannot have one without the other. This is the time for us to heed the words of John Lewis: “Ordinary people with extraordinary vision can redeem the soul of America by getting in what I call good trouble, necessary trouble.” The “ordinary” members of DPH are getting into some “good trouble”, so let’s redouble our efforts and get to work!
Mary K. Canales, PhD, RN is professor emeriti from the University of Wisconsin-Eau Claire, where she concluded 30+ years of teaching community/public health nursing and health policy. She is a member of DPH’s Communications Committee; a core member and secretary for Nurses for America (NFA); and a member of Chippewa Valley Indivisible, Eau Claire, WI.
