Civic Health Month: An Expert’s Advocacy Guide

August is Civic Health Month—a time to ensure that coworkers, colleagues, and patients have an opportunity to participate in the decisions that affect their lives. Being engaged civically and politically is crucial because it gives folks an opportunity to shape the health of their communities. In their recent landmark study about public health and voting, Ehlinger and Nevarez (2021) stated, “More than any other factor, our health is determined by the physical, social, cultural, and economic environments in which we live.” 

The best care is not enough to overcome barriers to good health as “medical care is estimated to account for only 10-20 percent of the modifiable contributors to healthy outcomes for a population.” Evidence finds that health-related behaviors, socioeconomic factors, and environmental factors account for the rest.

Democracy is a government by the people and for the people—and voting is the foundation of democracy. If we want to truly affect the health of our patients and communities, we must strengthen our democracy. 

In recent years, the life expectancy in the US as compared with other high-income nations has been declining. The Covid-19 pandemic served to accelerate that trend, highlighting disparities that have been present in the United States all along. A report from the Lancet Commission of Public Policy linked “shortcomings in US healthcare to the country’s history of racism, economic inequality, and social policy choices that have failed to create a minimally secure safety net for the US population.” 

Furthermore, social determinants of health such as housing, food, and income security, education, and systemic racism help determine our current healthcare deficits. 

Read on to discover how civic engagement can improve public health outcomes.

Voting and Citizen Health

Ehlinger and Nevarez (2021) found that “The 10 least healthy US states have a voting participation rate nearly 10 percentage points lower than the 10 healthiest states.”  Thus one can see the symbiotic relationship between healthcare and political participation. 

Voting impacts health and this is found to be true in international comparisons as well. Kim, Kim, and You (2015) reported that “A study of 44 countries (including the United States) found that voter participation was associated with better self-reported health, even after controlling for individual and country characteristics.” 

Improving the health of people in the US is possible through the democratic process and increasing civic participation. It’s important to note that voting rates are relatively low among marginalized groups—especially low-income folks and people of color. They also are more likely than the average patient population to turn to expensive emergency room services due to a lack of access to routine or preventative care.

The Importance of Immunizations

Getting vaccinated is a form of civic participation and improves public health outcomes.

The US is comparable to other developed nations in vaccination rates for measles, diphtheria, tetanus, and pertussis. There are some communities that are vaccine-avoidant, which creates opportunities for outbreaks. There is also the emergence of new diseases as well as treatment-resistant infections. 

Vaccines are readily available in the US for Covid-19; however, vaccine hesitancy has allowed the spread of the virus and increased opportunities for mutations. More difficult variants such as Delta are challenging hospitals in areas with low vaccination rates such as Springfield, Missouri.

Vaccine hesitancy is a communications issue—one that can be dispelled through a robust public health campaign. Overall, in order to reduce the burden of infectious disease, partnerships must be forged across government, industry, healthcare, academia, and with the public. If we want healthier individuals and communities, we as a society will need to elect people who value and will invest in public health. 

After all, how healthcare is compensated is a political decision. Per capita, the United States has much higher spending as compared to all other Organisation for Economic Co-operation and Development (OECD) countries but has lower life expectancy than the OECD average. A reduction of the barriers to access to high-quality affordable healthcare will not be achieved without significant policy change in the United States. 

Nurse Practitioners and Civic Engagement

Nurse practitioners can facilitate change. Too often we use public health and medical jargon, such as the “social determinants of health,” “health impact pyramids,” and “policy, system, and environmental change strategies.” While useful in some settings, these terms and phrases are too bureaucratic, abstract, and academic to effectively communicate with the general public and advance meaningful change. 

A more productive and effective approach is action-oriented and a good place to begin is with voting. Nurse practitioners and those working in healthcare professions must embrace our civic role by voting and by encouraging all eligible people to register to vote. NPs are uniquely equipped to advocate for their patients and communities to achieve better health outcomes. 

People are interested in voting—especially when encouraged in a healthcare setting. By illustration, Raja, Martin, and Reese (2021)  reported that “89 percent of eligible, unregistered voters were interested in registering at the health center when asked” at a facility in the Bronx, New York. 

Nurse practitioners are accustomed to asking sensitive questions about health and typically have the trust of their patients. Adding voter registration status to a health history can be beneficial, given the connection between civic engagement and health outcomes. Using tools such as VotER’s Healthy Democracy Toolkit can make it quick and easy with their QR code to register to vote and other resources. 

Get Involved in Civic Health Month

This month, challenge yourself to partnering with a voter registration organization and become part of a growing community of healthcare providers working to ensure the health of not only our patients but also US democracy. 

Registering those in your community to vote may be the most powerful tool you give them to improve their health. Brown, Raza, and Pinto (2020) expressed the importance of civic participation in health outcomes: “The causal relationship between voting and health was seen as bidirectional: voting affects health as it shapes who is in power and what policy is made, and individual health can affect voting. Taken together, a cycle can develop of poor health and political disempowerment.”

The bottom line is this: participating in Civic Health Month strengthens our democracy and enhances health by giving people a role in the decisions that affect their lives and that requires voting.

Celeste Williams, MSN, APRN, FNP-BC

Celeste Williams, MSN, APRN, FNP-BC

Writer & Contributing Expert

Celeste Williams is a family nurse practitioner and alumna of Southern Nazarene University and the University of Arkansas for Medical Sciences. Celeste is passionate about healthcare policy, especially its effects on rural and other underserved communities. She believes more nurses belong in all levels of government and places where decisions are made. She is active in her community through her professional organizations, local political organizations, Rotary, and her church. She lives in NW Arkansas with her husband, four children, two cats, a dog, chickens, ducks, turkeys, peacocks, and a bearded dragon.