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Addressing Health Disparities Through Voter Engagement: A Social Worker’s Point of View

Our health is a product of our environment. Therefore, a healthy community should be one in which all residents have access to quality education, safe and healthy homes, adequate employment, transportation, nutrition, and quality health care. Right? Sadly, the dominant public narrative blames individuals for their poor health and renders the social determinants of health inequity invisible, despite a large body of research documenting racial and class disparities in health. When it comes to flipping the narrative to focus on the upstream determinants of those disparities, social workers bring a valuable perspective. The social work profession has roots in structural change efforts and is committed to navigating the various dimensions that influence health, such as work, family, and neighborhood.  

As a graduate student at Boston University’s School of Social Work, I’ve been learning about racial justice and cultural oppression. My interest in macro social work led me to an internship placement with Vot-ER, a nonprofit nonpartisan voter registration organization. It sounds simple. But here’s what you might not have taken away from that sentence: Vot-ER was founded by an Emergency Medicine Doctor in Boston after he was inspired by a social worker. Yes, you heard that correctly. A social worker! Social workers are essential; they make a difference in addressing inequities within our various systems. 

As a part of the Vot-ER Social Work team, I have quickly learned this organization is more than a simple voter registration organization. Vot-ER is advancing the public narrative for health equity and social justice. Vot-ER has not only been working diligently to register patients to vote, but also has been helping make social injustice more visible, specifically within the healthcare system. Vot-ER has helped me understand the relationship between voting and its effects on the social determinants of health. 

One of Vot-ER’s core beliefs is that “by voting for our health, we can preserve what works or demand change for the things that don’t.” The power of this belief comes from the affirmation that when a system or policy does not work for us, for our families, and for our community, we have the power to demand changes to that policy or system through our vote. Through Vot-ER’s work and vision, I have become a firm believer that we can address health disparities through voter engagement. 

We need to understand that access to healthcare, adequate transportation, safe homes, and quality education are components of healthy communities. However, we also need to be mindful that there are many barriers for many people to receive these services. Yagoda (2019) stated that people of color, low-income Americans, the uninsured, and young people are the most likely to be unregistered and to experience barriers to voter registration. Let’s take a look at lack of transportation as a barrier to civic engagement. Adequate transportation is often a prerequisite for accessing healthcare, employment, grocery stores, and other public services. Nevertheless, according to the American Public Health Association (2011), low-income persons, people with disabilities, racial and ethnic minorities and people with limited English proficiency experience a transportation disadvantage.

You might be asking yourself, how do we build healthy communities? How do we break these barriers? As social workers, it is time for us to get involved in the work Vot-ER is doing. We need to start registering clients to vote in all settings whether it’s a hospital, a clinic, or a university. It is time for us to be a part of this nonpartisan process and help create a more inclusive and just democracy.

An Odd Year Like No Other

The day after Christmas, I drove an elder to vote early in the Georgia runoffs. I asked her why she was voting. She responded that she wanted to elect leaders who put people over money. She was voting for democracy. 

The vision of democracy that she treasures remains in peril: Almost every state legislature is revisiting their voting laws - some for better, but too often for worse. 

In the US, we often fall into a cycle where we pay close attention to the health of our democracy every 4 years. When we are lucky, we may get closer to an even-year cycle where our interest peaks for midterms, governor’s races, and other major milestones. 

But as our advisor Miles Rapoport has shared with us, this year is an odd year like no other - and it deserves both our immediate attention and our commitment to sustain our interest even when it isn’t clear who or what is directly on the ballot. 

In a conversation with the Brennan Center last week, they commented that while COVID-19 forced the hands of state and local governments across the country, that many saw this as a necessity because of COVID - not because of democracy. So far, the heightened access to the ballot in a year otherwise marked by the restrictions of a pandemic is currently playing out as an ironic fluke in peril of being undone, not as a model that should permeate both our democratic infrastructure specifically and our approach to designing policy generally. 

Even in the context of a race where our elections leadership worked around the clock and persisted through both time pressures and death threats, the final day of the Georgia runoff shows why expanded access is so critical. On that day, I drove three women to the polls. One had requested an absentee ballot that never showed up. Her car had broken down so she needed help getting to the polls on election day. Another - a visually impaired woman - had gone with a friend to vote early, but had landed up at the wrong location. Yet another had tried to go in the morning before her shift at Goodwill, but the line was too long. She took her “lunch break” to go vote. All three of these women embody the human stories that build our democracy, along with the social and economic landmines hidden on the path to the ballot box. 

When the best intentioned people try to vote early and the best intentioned elections officials try to make that possible, and when it is still hard to vote, the last thing we should be doing is making it any harder than it already is. 

It does not have to be this way. And it isn’t this way everywhere. 

There are 700 bills introduced in state legislatures around the US to expand access to the ballot. Many of these are in unlikely places - Texas, Mississippi, and Missouri (I have worked in two of three of those states - I say “unlikely” with the love of a Southern neighbor). The authors of these bills see something that is now also echoed in the recent COVID relief package - that we have an imperative to design policy to support our most vulnerable, not to appease our most skeptical. 

If we take this odd year as one that is truly odd in multiple ways - not just the final digit of 2021 but in its unique position following upon a disruptive year - then we find ourselves in an odd year like no other. It is not simply the year after a Presidential election. It is a year when we are defining our new normal. 

That new normal can be remarkable or regressive. We each play some part in pushing for the remarkable.

Building a Bottom-Up Path to Health Equity

In 2019, the National Academies of Sciences, Engineering, and Medicine outlined a strategy grounded in advocacy to guide healthcare institutions in addressing the social determinants of health. In November 2020, the American Medical Association formally adopted a policy that recognized racism as a public health threat and promised to fight racist policies and practices in healthcare. Both examples underscore the healthcare system’s growing shift from prioritizing awareness about systemic racial and social inequities in our communities to engaging in meaningful action aimed at addressing their root causes.

In addition to these and other top-down approaches to increasing health equity and access, we have the opportunity to empower individual patients and healthcare providers to take action from the bottom-up. Voting—and civic engagement more broadly—are viable pathways for patients and providers alike to have a voice in shaping the policies that drive inequities and create disparities in health outcomes. 

As a central and often trusted community touchpoint, healthcare settings are a powerful place to promote access to the ballot box. It is imperative that healthcare institutions and providers engage in concrete and sustained efforts to increase civic participation as a means of empowerment and better health. 

Recognizing the Relationship Between Voting and Health Outcomes

Racial and social inequities at the neighborhood level often correlate with both low voter turnout and poorer health outcomes. In the 2018 New York City mayoral election, voter turnout in East Harlem was 35% lower than the citywide rate. In that same year, life expectancy in East Harlem was decades lower than neighboring voting precincts. In Michigan, over 19 of the 100 lowest-turnout voting precincts in the state are located in Southwest Detroit. Home to more than 24 industrial sites, Southwest Detroit has asthma hospitalization rates that are twice the statewide rate and five times the nationwide rate, in addition to a life expectancy seven years below the U.S. average. Both East Harlem and Southwest Detroit are overwhelmingly Black and Latino neighborhoods with poverty levels higher than their respective city averages. 

While the act of voting alone cannot instantly lengthen life spans and reduce asthma, increasing voter turnout in areas like Harlem and Southwest Detroit empowers community members to have a voice in shaping the policies that drive inequities and affect health outcomes.. To make this happen, we must expand opportunities for voter engagement at institutions that are frequently visited by unregistered or low-turnout voters. The DMV, for instance, can serve as one potential place for this because it provides services to individuals who are unregistered to vote, such as 18-year-olds receiving their first drivers license. In a similar way, the healthcare system often interfaces with unregistered voters: those same newly minted 18-year-olds from the DMV may head to the optometrist for their DMV-required vision test or the pediatrician for their yearly physical. 

More broadly, there is strong demographic overlap between the patients most marginalized by our healthcare system and unregistered eligible voters: the young, the lower income, and people of color. These three groups have previously been found to have the largest increases in voter turnout when engaged by the nonprofit they receive services from. As service-providing institutions, healthcare settings are equally well positioned to make this kind of  impact on the traditionally underrepresented communities that walk through their doors by promoting voter engagement in their patient population. 

Promoting Health Through Civic Engagement 

Geographic overlap between voter turnout and racial, social, and health inequities is more than a coincidence: it is the manifestation of the ways in which civic participation is deeply connected to the health of our communities. We know that factors beyond hospital or clinic walls, called the social determinants of health, are responsible for up to 80% of health outcomes. Everything from education quality, to housing safety, to economic opportunity plays a role in an individual’s physical and mental wellbeing. Working to reduce inequities in these areas is a key way for healthcare institutions and providers to advocate for their patients. 

Because the social determinants of health are shaped by policies at the federal, state, and local level, participation in our elections gives us representation in the decisions being made that will ultimately affect our health. Candidates run on platforms that aim to attract as many supporters as possible. When our most marginalized patients vote consistently, campaigns label them as likely voters and start to contact them, which provides more opportunities for patients to voice their needs and have them addressed. This extends to local officials as well because they must also be responsive to the needs of their constituents. One example of this is government spending. When voter turnout increases, the electorate becomes less skewed by factors such as race and income, which could result in governments raising the amount of funding allocated towards redistributive programs by 30%. These programs include education, public housing, and welfare—all social determinants of health. 

Furthermore, healthcare providers—as a duty to both themselves and their patients—should have a seat at the table when decisions are being made about our country’s health policies. This starts by making sure providers participate in our elections. For example, the voting rate for doctors has decreased over the past few decades: eligible physicians voted at roughly 9 percentage points less than the general population between 1996-2002, and 14 percentage points less between 2006-2018. Healthcare providers, therefore, are another demographic of underrepresented voters who are present in healthcare settings and can be engaged to increase their participation in elections. 

Caring for Our Democracy and Our Health

The importance of civic engagement for health outcomes and in healthcare settings has become increasingly clear over the past year. Over 300 hospitals, clinics, and health centers, along with more than 100 medical associations and organizations, have already stepped up to help their patients, members, and staff vote in local, state, and federal elections. This is reflective of the sector’s response to an awakening happening in all corners of the country: optical allyship—or allyship that makes a surface-level statement but does not actually try to break away from oppressive systems of power—is not enough. True allyship requires action. Empowering patients and colleagues to vote is a concrete action that healthcare institutions and providers can and should take in order to better advocate for their patients and reduce racial and social inequities. 

In continuing to build true allyship with those most marginalized by both the healthcare system and society, we must recognize that this is not a one-time commitment. Our democracy can only be strengthened through persistent and intentional efforts to exercise our collective voice while also empowering new voices to join us. 

The 2020 presidential election may be over, but participation in state and local elections in 2021 and beyond will continue to shape the factors that impact the health of our communities. In other words, the strength of our democracy is tied to the state of our health, and it’s up to us to care for them both. 

Dr. Karen Smith Helps Rural North Carolina Get Registered

Family physician Dr. Karen Smith has been helping patients register to vote while administering COVID-19 tests at her clinic in Raeford, a rural town in Hoke County, North Carolina.

Smith’s voter registration efforts stretch back to the beginning of the coronavirus pandemic. Though COVID-19 testing and treatment has strained community health centers across the nation, Smith has maintained a steadfast commitment to civic health over the past few months. Smith said she believes voting is important because she sees a direct connection between government action and community health.

“I personally feel like voting matters because there are so many decisions that are made — even from the local government side all the way to our state [and] federal side — and those decisions have an impact on every person that lives in this community,” she said.

Smith’s clinic serves around 3,500 patients in Hoke County and neighboring counties outside the Fayetteville, North Carolina metro area. The regional economy relies heavily on poultry processing, hog farming, cotton, corn, and textiles, so environmental issues are of paramount importance. Smith says soil contamination in rural North Carolina has been exacerbated by climate change, and the consequences of contamination trickle from the farmlands to the food on the table. Environmental degradation and pollution is associated with high blood pressure and impaired kidney function, in turn putting rural North Carolinians at higher risk for heart disease and stroke.

Effective leadership is key to addressing these issues, Smith said.

“People need to be able to voice their concerns,” she said. “They need to vote and get leaders who take time to understand and know how these issues have impact.”

Smith said that the biggest challenge for her community is that of access to healthcare. High rates of unemployment and lack of health insurance prevent some people from seeking care. Those who are employed mostly work in the agricultural industry and receive relatively low wages, making cost a barrier.

In addition to bolstering the local economy, Smith said that expansion of telehealth services could significantly improve health outcomes. Many people in Raeford lack reliable broadband, which is crucial for everyday telehealth services and emergency support. Before Hurricane Sally hit North Carolina last week, Smith predicted that her community would lose internet access and thus be left more vulnerable to disaster.

“We’re going to lose connectivity, but there are going to be other areas in the county where — if we have broadband and we have digital technology — we could be able to reach out, we could continue to have care for these individuals, we could check on them in their homes.”

By using VotER materials and engaging her patients in conversation about civic engagement, Karen is working to address the issues she sees firsthand and catalyze positive change in her rural community.

Holding hands with strangers

George Zimmerman’s acquittal in 2013 took me to my first protest. At the time, I was one of few non-black participants, marching through downtown Atlanta, demanding justice for Trayvon Martin. Introverted at heart, I treasure quiet and restful weekends, but I knew that day that I had to march.

As a former 11th grade teacher, my students used to walk home in their hoodies, bought Skittles and Arizona Iced Tea at the corner store, and to this day remain some of the most inspiring people in my life. Back then, they taught me about resilience, about teamwork, and about compassion. These days, they still teach me — about everything from discipline to branding, from mindfulness to patent law.

You can probably tell without me even saying it that almost all of my students happen to be black. It’s not an accident, but it’s also not inevitable.

So it was clear to me that the protest was my only possible response. Standing side-by-side with strangers, holding hands in solidarity, I saw a woman walking through the crowd, waving a clipboard over her head. She was handing out voter registration forms, and I had recently moved states, so I took one and completed it. In the darkness of that moment, what I desperately needed was to know that there was something I could do about it — and that piece of paper helped me see a path to hope.

Today, on the anniversary of the March on Washington for Jobs and Freedom, I think about the hope that protest gave me. Today the context is completely different, and yet it is exactly the same. COVID’s disproportionate impact on America is a byproduct of our nation’s persistent inequality. Violence against unarmed black men remains frequent, heartbreaking, and intractable. And the need to march (virtually or physically) while also exercising our democratic voice as a crucial form of expression is clear as day.

I miss the days when we could hold hands with strangers. I’m proud of all the work that has gone into creating collective action and power in the isolation of a pandemic. And I am excited to see how it crescendos in the coming months and years as we combine the light from our protests with the accountability of our votes.

Health Problems Our Doctors Can’t Fix Alone: The Social Determinants of Health

When we are healthy, it is easy to take health for granted. We fail to notice non-events, the calamities we’ve narrowly avoided. Being able to breathe without struggle is a given until it isn’t.

This year, for five months and who knows how many more to come, we’ve gotten to experience our health in peril from up close. In the wake of this pandemic, we see how our health and the health of our communities are intertwined with education, employment, housing, income, and other non-biomedical factors, collectively known as the social determinants of healthIf you’ve never had to worry about how you’ll get your next meal, whether you can make rent next month, feared for your life when stopped by the police, or wondered if you can afford your life-saving prescription, it can be easy to let the social determinants of health go unnoticed. Health can just seem like going to the doctor every now and then, exercising, eating healthy, getting enough rest, all things you can just do on your own. Now, in this pandemic, the interconnectedness of it all is evident. No one’s health exists in isolation, and health is often about what happens outside of the hospital even more than what happens inside.

What do politics have to do with health care? Politicians determine who gets health insurance, and subsequently access to health care. Nearly 1 in 4 Americans reported putting off treatment for a serious medical condition in the past year because of cost. But seeking treatment later may result in seeking treatment when it’s too late or more serious measures are required.

A lot of time is spent in politics talking about creating and saving jobs, yet we often forget the important fact that in the US, employment is tied to health insurance and 50% of Americans are covered by their employer. This means that when someone loses their job because they’re laid off, or unable to work due to injury or illness, they face multiple layers of crisis. People are left struggling to pay rent, provide for their families, and receive appropriate medical care. 1.1 million Americans filed new claims for state unemployment last week. What your doctor could do for you doesn’t mean very much when you can’t afford to go see them because you don’t have health insurance.

The burdens of the pandemic fall disproportionately on already marginalized communities. Being told you should stay at home to stop the spread hits differently when you are homeless, or one of the millions of Americans on the brink of being evicted from their homes. The Aspen Institute estimates that 30–40 million Americans will face eviction by the end of 2020. Black and Latinx Americans constitute nearly 80% of those potential evictions. A study published in 2018 by the American Academy of Pediatrics found that families experiencing housing instability experienced worse health outcomes for caregivers and children. Housing isn’t considered a medical issue, and a house is not something your doctor can prescribe for you, but having a safe, warm place to live is essential to your health. As protest signs in New Orleans read, “You can’t wash your hands if you don’t have a sink.”

Civic Health Month is about recognizing these underlying causes for illness and disease — such as racism, sexism, homelessness and housing insecurity, income inequality, and food insecurity — as issues that no individual doctor or hospital or health system can solve. We’ve got to do this together, and that’s why we’ve partnered with hospitals and civic engagement organizations all over the country to highlight the importance of the social determinants of health, and how improving our civic health addresses these determinants.

Our healthcare workers have been referred to as the frontline; they are also often the last defense. Too often, they’re seeing patients when it has reached the worst case scenario of diabetic coma after months of rationing insulin, or being put on dialysis because they couldn’t afford medication in the earlier stages of kidney failure.

It takes physicians and allied health professions advocating for their patients’ health beyond what can be done in a medical context. It will take giving everyone a voice in our democracy and getting people registered to vote, but it will not stop there. It takes mutual aid, organizing, advocacy, protesting, donating.

Just like how our physical and mental health is shaped by numerous factors, so too is our civic health. We wear masks for our own wellbeing and to keep others healthy, especially the most vulnerable populations. Similarly, we are casting our votes not just for our own benefit, but for the most vulnerable in our communities and for the collective good of our nation.

What 26 Million New Voices Meant for Health in America

1920 was a big year for being in the 26-million range.

In November’s Presidential Election, 26,368,528 total votes were counted, and Warren G. Harding emerged as the winner. But democracy’s biggest victory of the year had occurred about two and a half months prior, on this day 100 years ago.

When over 26 million women were granted the right to vote.

26 million voices formally invited into the democratic process, after decades spent fiercely demanding their rights through seemingly every means for change the American Constitution provides, excluding the ballot box. And with the calls for women’s suffrage reverberating so loudly across the country, how could they be ignored?

They couldn’t. The 19th Amendment was ratified, and with it came a reckoning for many politicians who wrestled with a big question: what did it mean for an entirely new demographic of eligible voters to enter the playing field, especially all at once?

Strategies were quickly recalculated, with 26 million additional voices factored in. Realistically, not every woman would vote in every election, but it was nevertheless a shock to what was a traditionally male-dominated sphere. Many anticipated that women would consolidate an enormous voting bloc, and while it later turned out that this was not the case — women were actually represented across the ideological spectrum — in the moment politicians scrambled to take a stance that they believed would best align with a demographic 26 million strong. Either way, the right to vote became a newfound source of power and influence for women: lawmakers could either listen or risk losing their seats.

Many chose to listen, and listened particularly well when it came to health issues. Just a year after the 19th Amendment was ratified, the Sheppard-Towner Maternity and Infancy Act passed, allocating $1 million in federal funding per year to support states running programs for mothers and infants, including prenatal clinics and health education efforts. Local public health spending also increased by 35%, enabling door-to-door hygiene campaigns to take place across the country that ultimately reduced child mortality by 8–15%.

The presence and efforts of women voters also transformed reproductive healthcare policies. In the wake of the 19th Amendment, birth control was made more accessible and affordable, and state Medicaid programs were mandated to include services and supplies for family planning.

Through all of these changes, an important commonality exists: 26 million women were granted the right to vote, and many of them acted on it. Many of them continued to be activists for the issues that mattered to them, including but in no way limited to their health and the health of their children. Their voices were heard in every corner of America, taken seriously by legislators in Congress, and backed at the ballot box at last.

August 18th, 1920 was indeed a big win for democracy.

A win for America’s founding ideals.

A win for women.

And 100 years later, that win continues to be honored and celebrated as we bear witness to its effects in not just health care but every aspect of society.

A spirit who lives on in all of us

When Congressman John Lewis visited Harvard in 2017, he left us autographed copies of his graphic novel March. I knew exactly what to do with my copy. Putting it in the mail, I sent it to one of my former students Khoryel for her son Khobie. As a family, they are one of the bright lights of my life, and as an educator, I hold a deep conviction that “good trouble” should be at the heart of how we teach and parent in America.

Khoryel sent me back a video of Khobie jumping up and down when he opened the present. In that video, she captured a feeling so many of us have about Congressman Lewis: he is there at precisely the moments we need him, inspiring delight through his accessibility.

Today, on the anniversary of the Voting Rights Act of 1965, there are many reasons to feel concerned and even afraid. We have lost Congressman Lewis and other giants like Reverend C. T. Vivian at a vital time in our country’s political evolution. We are navigating questions of how to ensure equity and integrity in our elections in the midst of a global pandemic. We face an incomprehensible flurry of state-level laws, administrative choices, and resourcing decisions that make it challenging to uphold the intent of the Voting Rights Act.

But Congressman Lewis modeled the antidote to the darkness we now face. In his constant presence, his humility, and his insistence on fairness in the personal and legislative realms, he taught us that this work becomes powerful and even joyful when we do it all together.

Across race.

Across generations.

Across geography.

Not simply in the halls of Congress or in the formality of the voting booth, but also in the organizations we lead and the ways we create opportunities for others in our individual actions and choices.

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If every person who has taken a selfie with John Lewis — every person with a copy of March — every person who read his final written words in the New York Times with grief and wonder — if all of us do our part, we can go beyond simply honoring the Voting Rights Act of 1965. We can eclipse it with norms, laws, and enforcement that prove that democracy and diversity are not simply compatible but inextricable.

Congressman Lewis is a spirit who lives on in all of us. In his words, actions, and even ubiquitous selfies, he never claimed that this was a task for any one person alone.

It is a task for all of us.

Today, on the anniversary of the Voting Rights Act of 1965, let’s honor John Lewis by giving him a voice in each of our hearts as we march on towards November.

Have You Checked on Your Civic Health Lately?

You see your primary care doctor every year, try to eat healthy each meal (okay fine, most meals), and get a half hour of exercise each day. Those fitness tracker stats are looking great.

Physical health…check.

Maybe you do some morning meditation, talk to your therapist weekly, or take an hour a day to just focus on you. A little self care goes a long way.

Mental health…check.

But have you registered to vote? Do you trust the public institutions in your community? Have you volunteered to help your neighbors recently?

Civic health…wait what?

Yes, that’s right. Your civic health. It’s just as important as your physical and mental health, but chances are no one ever told you that. Don’t worry though — that’s what Civic Health Month is here for. Our nationwide coalition of partnering organizations, hospitals, and healthcare providers is committed to making sure you’re checking on your civic health moving forward.

Curious to learn more? Let’s get started.

Your civic health describes how well you and your community are able to participate in activities that require you to come together, solve problems, and make decisions that affect everyone. Almost anything you can think of that is considered a public issue and needs collective input or action is related to how healthy you and your community are civically.

Ready for some examples? If they were scored, any of the following scenarios would create a positive effect on your civic health, represented as a +1:

You vote in every election for the candidates and issues you care about: +1.

You’ve been to a neighborhood meeting before, such as a Town Hall: +1.

A snowstorm last winter left huge potholes in the streets that still haven’t been fixed. You call your government representatives to get them involved: +1.

You’re angry that your child’s school is underfunded. A group of parents has created a petition to send to the School Board, so you read it and sign it: +1.

Your city’s Department of Housing and Urban Development is an institution you can trust to address you and your neighbors’ concerns about lead paint in your apartment building: +1.

Almost every eligible person in your district is registered to vote because your community is committed to holding frequent voter registration events: +1.

Hopefully you’re getting the hang of it now. Civic health is vital to your own well-being and the well-being of your entire community. As members of a democracy, we are empowered to use the tools available to us — like voting, signing petitions, talking to our representatives, and taking action together — as we fight for what we believe can be better. The same way you look after your physical and mental health, you should be taking care of your civic health to make sure you are in the best position you can to do this.

Now that you know, take a second to think about the way that you engage in your community and how this affects your civic health. I’ll bet you have lots of +1’s on your list. But I doubt any of us has perfect civic health just yet, so it’s okay if you came up with some -1’s too. We’ve all got some work to do together, and today’s a great day to begin.

Why go to the DMV to register to vote when you can just ask your doctor?

An apple a day keeps the doctor away, and don’t we all wish there was a magical voting fruit we could eat to avoid a trip to the DMV? I mean, imagine a world where eating an orange boosted your Vitamin D levels and autofilled your voter registration application. Peak multitasking if you ask me, but here we are, stuck in a world with plain old oranges, some extra Vitamin D, and a blank application.

(Not to make it worse, but the apple thing is sadly also a myth.)

However, you can still get a nice 2-for-1 deal by asking your doctor this simple question:

“Hey Doc, can you help me get ready to vote?”

Now, you may be thinking I actually am comparing apples and oranges here. Hard to imagine a world where doctors and voting go hand in hand? Maybe at first, but it turns out that world is actually our world this time around. Don’t believe me? Ask the 18,000+ healthcare providers across the United States who are currently helping thousands of patients just like you register to vote or request their mail-in ballots for November 3rd.

Are providers really allowed to be doing that? They sure are. The very same law that lets you register to vote at the DMV — the National Voter Registration Act of 1993 — also lets you do it in the hospital setting, as long as it’s nonpartisan. In fact, over 130 hospitals are engaging in voter registration efforts right now because of this.

So, we’ve established that having your doctor to help you get ready to vote is an increasingly popular thing and also not breaking the law. But why would your doctor even care if you are registered to vote or have requested your absentee ballot? For several reasons.

The first is that up to 80% of your health outcomes are determined by factors outside the hospital walls. They’re called the social determinants of health, and many of them aren’t biological. Think of air pollution, difficulty accessing healthy food or clean water, housing instability, or poor working conditions. Your health is impacted by all of them, and many of them are controlled by the policies our elected officials make. Your doctors obviously care about these factors, and since policies are impacted by the voices of voters, by default making sure their patients can vote is something providers should and often do care about too.

Also, people who are civically engaged tend to have better self reported health. In fact, civic engagement is recognized as another social determinant of health, so tons of doctors have started to make sure their patients are getting a healthy dose of such activities, especially voting. In other words, providers are now looking out for your civic health (which describes how well you and your community are able to participate in activities that require you to come together, solve problems, and make decisions that affect everyone) in addition to your physical and mental health. All that said, here’s an easy way to think about it:

Whenever you see your doctor, they ask you lots of things about your health, and you probably ask some questions of your own in return. Asking a healthcare provider if they can help you register to vote or request your mail-in ballot is literally asking them to help you look out for your health, which is most definitely within their job description.

So next time you find yourself at the doctor’s office, don’t hesitate to ask about it. A “Hey Doc, can you help me get ready to vote?” is all it takes.

If they can, you’ll have better civic health because you are empowered to impact the policies that shape the non-biological factors affecting your physical health. Not to mention one less trip to the DMV.

If they can’t, it’s an opportunity to teach your doctor something new by letting them know that thousands of their peers are already doing it. Chances are they will see what they’re missing out on and get involved. You’ll have better civic health in this case too because you are being proactive about increasing voter registration access in your community. Not only will future patients be very grateful for the DMV trip they avoided because of you, but more importantly they will be ready to vote, and you’ll all be healthier for it.

Come November 3rd, your daily apple might not pay off the way you wanted, but asking that one question most definitely will.