Doctor Says Ballot Access May Affect Who Stays Healthy

Doctor Argues Voting Barriers Are a Public Health Problem

A law written to protect ballots may have protected babies, too. A new commentary in JAMA Health Forum points to research linking the Voting Rights Act of 1965 to a measurable drop in Black infant deaths in states that had enforced Jim Crow segregation laws.

That research anchors a bigger argument from Dr. Ruth S. Shim of the psychiatry department at the University of California, Davis. Voter suppression, she writes, is a structural determinant of health. In plain terms, the rules and institutions that decide who holds power also help decide who gets better health outcomes.

Her argument arrives as the 2026 midterm elections approach. It is a commentary rather than a new study, so it presents no new data. Shim instead interprets earlier research, tracing a line from barriers such as poll closures and restrictive voter ID laws to poorer health in the communities hit hardest by them.

Voter Suppression and Poor Health Feed Each Other

In 2022, the American Medical Association passed a policy resolution declaring voting a social determinant of health, one of the everyday conditions that affect well-being. Shim notes that U.S. turnout reached 66.2% in the 2020 general election and 63.7% in 2024, far behind Australia at 90.7% and Sweden at 84.2%.

Many countries register citizens automatically, while U.S. residents must register themselves under rules each state sets. According to Shim, many states create barriers that make voting harder for racial and ethnic minority groups and people with lower socioeconomic status, and states with higher minority voter turnout also have more suppressive voting policies.

Low voter engagement is linked to poor health, and states with lower turnout have worse health outcomes than states where more people vote. People in poor health are also less likely to vote, which Shim describes as a vicious cycle.

2013 Court Ruling Disabled Federal Voting Oversight

Shim traces a history from the 15th Amendment, which gave Black men the right to vote, through the 19th, which gave women the same right, to the Voting Rights Act of 1965. Part of that law required states and localities with histories of voting discrimination to submit any election rule changes to the federal government for review in advance.

That protection was effectively disabled in 2013, when the Supreme Court’s ruling in Shelby County v. Holder invalidated the formula used to decide which places needed review, leaving the requirement inoperative. The ruling reduced voter access, the commentary states, often through poll closures, particularly in communities with large minority populations, lower-income residents, people with disabilities, transgender people, and rural residents.

Voter suppression also limits citizens’ say in health policy, Shim argues, because the presidents they elect nominate Supreme Court justices. She cites the Court’s decision to overturn the mandate requiring states to expand Medicaid under the Affordable Care Act and its ruling in Dobbs v. Jackson Women’s Health Organization that abortion is not a constitutional right, which she says widened health inequities over time.

Voter Suppression Tied to Worse Health Among Black Americans

Felony disenfranchisement laws, which restrict people convicted of felonies from voting, have been associated with more depressive symptoms among Black people, but not among white people. For the infant death finding, Shim cites a 2024 study in the American Journal of Public Health. She writes that passage of the Voting Rights Act was associated with significant reductions in Black infant deaths in Jim Crow states, which she takes as support for the health benefits of laws that protect people from voter suppression.

Doctors Urged to Fight Voter Suppression to Improve Health

Because the conditions that affect health can be changed through public policy, Shim says health professionals are well placed to act, since they are trusted messengers who connect with the people most affected. She points to Vot-ER and the Civic Health Alliance, groups that encourage voter registration in health care settings. She also calls for removing restrictive voter ID laws and limits on voting by mail, naming the John R. Lewis Voting Rights Advancement Act as legislation that could help.

Gerrymandering, the manipulation of district boundaries to benefit a specific party, occurs on both ends of the political spectrum, the commentary notes. Recent redistricting battles have changed congressional districts in ways affecting approximately 35 million U.S. adults. Her short-term goals are independent commissions to draw district lines and the National Popular Vote Interstate Compact, an agreement among states to award electoral votes to the national popular vote winner.

Shim ends with John Lewis, the civil rights activist and later congressman, who needed medical care in 1965 after Alabama state troopers fractured his skull during a Selma voting rights campaign. Between that injury and his death from pancreatic cancer in 2020, she writes, he championed greater access to voting for all U.S. citizens.

Voting rights and public health can seem like separate conversations. An association between the 1965 law and fewer Black infant deaths cannot prove that ballots save lives, and Shim herself says more research is needed on how voting policies affect health. Still, the evidence she cites is enough to make voting restrictions a public health question worth testing, alongside the political one.

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Disclaimer: This article is for informational purposes only and is not medical advice. Consult a qualified health professional about personal health concerns.

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