Rates of electoral participation in the United States continue to rank in the bottom quartile among developed nations.¹ Resulting from a number of factors, poor voter turnout has characterized our democracy for decades.² Can emergency departments help? It might seem like an oddly arranged marriage, but it isn’t.

A majority of U.S. voters consistently rank health care as their top policy priority. Simultaneously, voter rolls are shrinking. This suggests that a smaller and smaller group of people are having their voices heard on the direction of health policy.^3,4 This is especially troubling for communities of color, those living in poverty, and the young, who are often among the least politically active. COVID-19 has led to the closure of motor vehicle registration offices and other traditional voter registration venues, resulting in plummeting rates of voter registration nationwide. We know that these marginalized patient populations use emergency departments at disproportionately higher rates than the average population because of a lack of access to traditional forms of health care.⁵ The discrepancies in ED use along the lines of age, race, and socioeconomic demographics represent both a challenge and an opportunity for health care workers as the needs of these populations often extend beyond traditional health care boundaries.

Rising to the Challenge

Many health care professionals have risen to this challenge by broadening their scope of care, engaging more deeply with the social determinants of health, and administering programs that address larger societal issues affecting their patients such as housing, food insecurity, and opioid addiction.^6,7 Marginalized patient populations benefit most from these and larger structural changes needed to improve health care delivery systems. But they also have the lowest rates of voter registration.

For example, a disproportionately large share of eligible Americans who were not registered in the 2016 presidential election were low-income citizens and people of color.⁸ Among eligible voters, 31 percent of African Americans, 43 percent of Hispanics, and just over 43 percent of low-income Americans were not registered to vote in that election.⁹ Rates among the nation’s young voters are not much better: Only 50 percent of millennials voted in the 2016 election compared to 69 percent of baby boomers and 63 percent of generation X.¹⁰

Regardless of party affiliation, policy endorsement, or stance on a given issue, we can all agree that to be pro-democracy we must be pro-participation. Further, most can agree that without claiming their role in our democracy, these groups will never achieve true equity in and risk being politically voiceless.