Ep. 99: Ballots & Wellness: Talking Civic Health with Aliya Bhatia of Vot-ER

The American Medical Association, the American College of Physicians, and the U.S. Department of Health and Human Services all recognize voting as a social determinant of health. In a year when more than 60 nations have or will hold elections (including the United States), the Well Beyond Medicine podcast examines the concepts of civic engagement and voting as ways to improve health.

On this episode, we’re joined by Aliya Bhatia, Executive Director of Vot-ER, a nonpartisan, nonprofit organization working to integrate civic engagement into health care.

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Guest:
Aliya Bhatia, Executive Director, Vot-ER

Host/Producer: Carol Vassar

Views expressed by guests do not necessarily reflect the views of the host or management.

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Transcript

Announcer:

Welcome to Well Beyond Medicine, the world's top-ranked children's health podcast produced by Nemours Children's Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.

Carol Vassar, podcast host/producer:

Each week, we're joined by innovators and experts from around the world, exploring anything and everything related to the 80% of child health impacts that occur outside the doctor's office. I'm your host, Carol Vassar, and now that you're here, let's go.

Hi everyone. You know, the American Medical Association, the American College of Physicians, and the US Department of Health and Human Services all recognize voting as a social determinant of health. In a year when more than 60 nations have or will hold elections, including, of course, the United States, let's explore the idea of civic engagement as a way of improving health. With me to discuss the nonpartisan civic health movement is Aliya Bhatia, Executive Director of Vot-ER, which is working to integrate civic engagement into health care. Aliya, let's start by making that connection for our listeners between healthcare and civic engagement. What is that relationship? Why is it so important?

Aliya Bhatia, Vot-ER:

Carol, I'll start here with a bit of a personal story and my journey to this work. I'm from the Metro Atlanta area, and part of the things that we try and do in our community is make sure that leaders in Atlanta are really well-equipped to understand the broader community and the challenges it faces.

As part of that, I was in a leadership program where part of what they had you do was go on a ride-along with your emergency medical services at your hospital. So I showed up at Grady Hospital in the dead of winter in 2019 and knocked on the door of the manager, and he started taking me around town to see the different ways that his EMTs and ambulances were responding to the community and supporting them with their health needs. What immediately jumped out to me, and I'm sure that you know this from Nemours, is so much of what his team was responding to was not health-related.

There were elements where his team was responding to homelessness, they were responding to food insecurity, they were responding to moments where a person's change in their health insurance might impact access to a life-saving medication. And so, at the end of this ride-along, when I'm talking to this manager of the emergency medical services from Grady Hospital, I said, "What happens if I give you this magic wand? Because this is an overwhelming problem. It seems like your team is being asked to respond to things far beyond the scope of the emergency medical system. What's the one thing you would change?" And his answer surprised me. He said, "Aliya, if I could only change one thing, I wish all my patients would vote because if all my patients voted, local elected officials would invest in affordable housing, they'd put good schools in every neighborhood, there'll be a grocery store in every neighborhood, and when I have to get somebody an ambulance, I would have the money to get them one on time."

It wasn't too much later that I heard about Vot-ER and the work that our founder, Dr. Alister Martin, was doing, and also about the fact that there is global, national, state, and local research naming exactly this connection that the emergency medical services manager pointed me to. There is research at the global level, national, state, and local, showing that there's a relationship between voting and health. And I'm not an international politics major, but for my undergrad, and my favorite story around this is the research that's been done in Brazil, specifically in Brazil. Carol, you used to have to write out the name of the person who you were voting for. So it was a paper ballot. They have hundreds of candidates, often in their state and national elections. I bet you can imagine what type of person was not able to accurately cast a ballot in an election like that.

Often, folks on the margins of our society were the ones who wrote in ways that were ineligible, and so their ballots were cast out because they couldn't be read. Well, Brazil decides that it's going to make a national voting system that is a digital voting system, and they start moving people over, but they can't move everybody at once. So, this experimenter from Princeton decides to look closely at the places that get this new voting technology first. What happens in the places where voting becomes more accessible first?

In this new system, you just have to put in the number of the candidate you're voting for. It shows you a picture, and you hit enter, and you vote, so ballots are not going to get cast out. In the communities that get this technology first, they're about 10% more votes that are counted as valid. And in response to that, probably the same set of people get elected, but they're starting to pay attention to a group of folks who they weren't paying attention to before, those who are on the margins of society.

And a ton changes almost immediately. About a third in additional funding goes towards public health services in Brazil in those regions. And then in addition to that, you see a reduction in low-birth weight childbirth. So I think that example in Brazil just shows the power of voting, and in the power of more people voting, so that we can have high-quality healthcare and health systems. And I think that we can apply that here in the US and make it so that families of young children, in particular, are ensured that they're having access to high-quality care.

Carol Vassar, podcast host/producer:

How could we go about changing that here in the US?

Aliya Bhatia, Vot-ER:

Yeah. At Vot-ER, we focus primarily on what is the role of the health system in supporting that. And to share a little bit about that, a number of our advisors are secretaries of state, former secretaries of state. So there's a former Secretary of State, Republican Trey Grayson from Kentucky. When he was the Secretary of State, one thing he really struggled with was how to keep people's addresses up to date. How do I make sure I'm getting them the right ballot, that they're receiving their ballot, and that they're voting in a way that I can count and make sure that their voices are heard? Because as you know, with, Carol, us young folks, we're moving often. And so, sometimes the address that we're kind of like our parents are at or whatnot is an address that we might use often, but it's not actually the address where we're living.

We haven't updated our voter registration, for example. And so what he named for us, as we were getting started in this work, in his original advising of Vot-ER, is that when you see a health professional, you have this trusted relationship with them and you're seeing them far more often than you're seeing your Department of Motor Vehicles, for example, or your post office and your health professional can help you update your voter registration and make sure it is up-to-date.

The other exciting thing that a health professional can do, particularly in the children's context, is that when you turn 18, there's this automatic opportunity to say, "Hey, you're 18 now. We have a new question for you. Are you registered to vote?" So those are a few of the ways that at Vot-ER we collaborate with our partners to help make sure that there's access to the vote for as many people as possible.

Carol Vassar, podcast host/producer:

It's interesting what you bring up—that question, that possibility of a question when a young person goes into the doctor's office and says, "Hey, I'm 18 now. What do I need to know?" And the doctor responds by saying, "Are you registered to vote?" Is that happening in doctor's offices across the nation?

Aliya Bhatia, Vot-ER:

Yeah. Actually, when we look at the folks who are Vot-ER participants, we find that the biggest community of those are pediatricians. What Vot-ER does in our work is we provide Vot-ER badges and lanyards to our community of health professionals. And on these lanyards, there is a QR code that takes you to a nonpartisan resources page that helps you update your voter registration or register to vote for the first time, request a mail-in ballot, get information about what's coming up on your elections.

And then if you need help, we never want to put a health professional having to become a voting rights expert, there's a helpline directly connected to our resources that helps you find out information to make sure that you can register to vote. And so, pediatricians who we work with, there's two types of folks who they'll talk with. There are young voters who have just turned 18, and we're finding that there's a huge number of people who have recently turned 18.

So I think since the 2022 midterms, over 8 million youth have become eligible to vote, which is a part of the growing community of Gen Z who are eligible to vote, I believe 41 million members of Gen Z who are eligible in the upcoming November election. So pediatricians have the opportunity to ask, "Oh, hey, I've noticed that I haven't seen you since before you turned 18. Let's make sure and check that you're registered to vote." And what we know is that there are barriers to knowing about elections, how to cast your ballot, how to register to vote amongst this younger population, and that it's really important that we help address those. But Carol, there's another group of people who we're also touching through this, which is parents of young kids. The research actually shows that mothers of young children vote at lower rates than the rest of the public because they're so busy.

And so, what our resources help do is both remind people the importance of their vote in service of their child's health and wellbeing, but then in addition, because we offer resources like finding your polling location or getting your mail-in ballot or planning your early vote, we're making sure that we're providing options that can work for extremely busy family of young children. And that's something that the health community can continue to do to support parents, in particular, to make sure that they can vote. One personal story from me, my first presidential election, I was studying abroad. I received my ballot, I did not get it back in time. And it's one of the things that I think about, personally, as we're thinking about young folks, is making sure that, especially if you're in a city that is different from your home state, making sure that we're empowering people to be able to make sure that they're able to vote and cast their ballot and do all of that in time for the upcoming elections.

Carol Vassar, podcast host/producer:

Let's talk a little bit more about the younger demographic—I'm talking 18 to 35, if we're including young parents. Traditionally, they don't register or vote. Is this helping with getting that group of citizens on the rolls and to the polls?

Aliya Bhatia, Vot-ER:

There are several different reasons that young folks vote at lower rates. One of those reasons is an information gap. So when we poll young voters and take a look at that, CIRCLE at Tufts University has done some good work on this. When we poll young voters and look at the reasons they're not voting, often, information, lack of access to voter registration, not knowing how to vote are a big part of that. I think that piece, we've already mentioned how our health professionals can help be a part of addressing that. I think there's also another element of what's in it for me. How does this impact me? How does this relate to me? And so what we do as part of our work at Vot-ER is we provide nonpartisan voting scripts to help health professionals talk with their patients about the importance of their vote and why it matters.

And I think that there's two big things that I would want a young person thinking about today, as somebody who was very recently within that age range. I think that the first reason is that so much of what we see around health and health outcomes happens at the local level. Whether your water is clean to drink versus having lead in the water, whether you have green parks in your neighborhood, how high paying the jobs are in your community, and whether you've attracted businesses that pay high-paying wages, those social determinants of health happen at such a hyperlocal level. And oftentimes, we're so fixated on the media that's focused on the national election that we forget these nonpartisan local elections where a very small handful of votes can often tip those elections in ways that significantly impact health and health outcomes. And so, I think that's one really important piece there.

But the second piece is that young folks today, including myself, have really high expectations of what our elected leaders do and the types of policies that they implement. It is so important to us not to compromise on some of those values. I think an important aspect of voting is that by voting, you're not just selecting a person; you have to choose when you vote.

Sometimes, you're choosing someone where you may not agree with everything that they're thinking, but the other thing that you're doing that's super important when you vote is creating accountability. You become the person that that elected official is going to reach out to before their next reelection because they want to know what matters to you. If you don't vote, you're not on that list of people who that elected official is going to care about, and therefore, if you don't vote, others are going to decide for you.

It turns out that while voting is not our panacea, it's not going to solve everything. Without voting, it's really hard to get anything else done. So, it's a really important starting point. I think it's important for folks to recognize that they have the power to select their school committee member, their city councilor, their town clerk, all these folks who directly impact their lives. So those are a couple of thoughts.

Carol Vassar, podcast host/producer:

That's a thread I want to continue to pull on just a little bit. This is a presidential election year, but I know where I live, in Connecticut, it seems like we're always having some sort of election or a decision that needs to be made. How does an effort like this help with our down-ballot candidates and also with local elections, school referendums, and deciding whether or not there's going to be a new pool in town? Talk about the importance of that.

Aliya Bhatia, Vot-ER:

At Vot-ER, we partner and have a national partnerships with the National League of Women Voters, a very long-standing and early partner of Vot-ER. And what the League of Women Voters does is they collect everything that's going to be on your ballot, and close to when early voting starts in your state, you can put in your address and get a pretty good sense of what's going to be on your ballot to help you decide who you're going to vote for. Think about that ahead of time, request your ballot, for example, if you're someone like me, who likes to think a little bit more about that and process it a little more, for example. And so that gives you the opportunity to really dig into what are these different pieces? How do I make sure that I am voting in a thoughtful way? So I think that's one important example.

But then the second piece is if you register to vote through Vot-ER, our partners at TurboVote, which are Google's official partners for voter information, they will remind you before every election, and I get election reminders for tiny hyperlocal elections through TurboVote, but I also get them for the big national ones. And I think that TurboVote has done a really excellent job along with some of our other partners in this space, making sure that you make voting into a habit and have the resources to know when those are coming up and what they're going to impact. And I can tell you my dad, there were a number of elections that were happening in Brookhaven, Georgia, where he lives, there were a number of elections coming up he didn't know about. And because of those texts, he said, "I'm going to go make sure that I vote." He knew that it was coming up because he was getting that reminder. So our resources help create ongoing reminders work.

Carol Vassar, podcast host/producer:

Is it true that people who participate in the democratic process by voting, and you have to register in order to vote, report feeling healthier?

Aliya Bhatia, Vot-ER:

Yeah. So, we see this data reported at the individual level as well as the community level. So, at the individual level, a study of 44 countries demonstrated higher self-reported health amongst those who vote. And our best sense is that this is connected to the personal agency that comes along with that process and the importance of that self-agency to feeling at home and feeling fully in their well-being. But then if you zoom out to the community level, I mentioned Brazil, but you can actually see that same dynamic here in the US. At the community level, there's a researcher at the University of California San Diego who really dug into local elections. And what he found is that when you vote, if a really narrow group of people voting, there's less money invested into some of these public resources, such as affordable housing, such as education, such as public health.

But when renters and folks of color and people all across our society are involved in voting and when they vote at those local, often non-partisan races, you see about a third more investment in these public resources in your community, which creates the foundation, financially, for us to be able to address those social determinants of health. So, we do see that connection both at the individual level and at the community level. And in zooming out to the national level, if you plot every state's access to the vote across its health outcomes, you see a correlation between how easy is it to vote in my state and what are the health outcomes in my state? So we see that at all different levels from global all the way down to individual.

Carol Vassar, podcast host/producer:

I'm curious, how does Vot-ER address issues of voter registration among some of the historically marginalized communities? Can this be a means of addressing health disparities, ultimately?

Aliya Bhatia, Vot-ER:

I think about this from two angles because we never want to make health professionals, who are already carrying so much on their shoulders, the only people driving this forward. One of the ways that our founder puts this, Dr. Alister Martin, says, "The health sector cannot do this alone, but without health, it cannot be done." I think young folks very much fit under that historically marginalized group. They were late to get access to the vote, to be able to vote, so we definitely view them as a critical demographic.

But another one that I want to talk about very specifically, as we think about this fall's elections, are rural voters. A lot of folks in rural communities, right now, are facing challenges of hospital closures, they're experiencing directly, within their community, experiences of opioid overdoses. And what we know is that so many of these decisions about resourcing of local rural hospitals are being made by people who are elected nationally or at the state level.

But then, additionally, the other thing that we know is that the opioid settlement money that has been coming down that is all going to be determined by your local elections. Local elected officials are the ones with the power to determine what do we use that money towards. How do we use this money to prevent opioid overdoses? Do we think about this money as part of an existing budget, or is there a way of funding that we can use to prevent and reduce opioid overdoses?

Those decisions are all being made at the local level, and it's really, really important that folks in rural communities have access to the vote. And that's why Vot-ER works really hard to make sure that we're doing our work across all 50 states in urban and rural communities. Our rural-urban mix is about the same as the country is in terms of who you reach, so we can make sure to empower those voices as well. So those are just a couple of examples from our work.

Carol Vassar, podcast host/producer:

I want to circle back to how voting directly impacts health. I believe there was something happening in Oklahoma that actually was to that point. Talk about that.

Aliya Bhatia, Vot-ER:

Yeah, absolutely. So, in Oklahoma, they recently passed Medicaid expansion, and it was a very tiny percentage of votes. I believe it was 6,000 votes that made the difference between Medicaid expansion passing and not passing. And so, you can imagine that so many folks who are looking to have access to insurance are going to be directly impacted by that vote and by such a tiny margin of society.

And I think that just goes to demonstrate every vote does truly count, every vote does make a difference. Sometimes, it's not on the issue that's going to get the most press, and it's not on the thing that you're going to see in the national news, but if you look at your local press and look at the League of Women Voters and their guide on your local election, you will see issues that are going to directly impact your family and your family's well-being on that ballot. And a small number of votes can tip the result, as we saw in Oklahoma.

Carol Vassar, podcast host/producer:

I want to ask about absentee ballots. You have to be registered, and then you have to apply in most, if not all, states for that absentee ballot. How important is it, especially amongst young voters and perhaps amongst the baby boomers, who maybe find family or friends are in assisted living, to make sure that that application takes place?

Aliya Bhatia, Vot-ER:

Yeah. I'll speak to this broadly, and then I'll talk about it from the healthcare perspective, specifically. There are several really important deadlines coming up. Depending which states you're in, your voter registration deadline and your online voter registration deadline could be coming up as soon as October 5th. So encouraging your patients, your staff, your community to make sure that they're registered at their current address is the first critical step around mail-in voting and early voting voting.

The second piece is every state, and sometimes, even down at the county level, different counties have different rules around when you need to request a mail-in ballot, how soon you need to get it back to your county, and then, in addition, your opportunities to show up early and to vote early. Some people have different preferences around this. If you are somebody where you prefer to vote by mail or it's because you're out of state, we request that you get that application in for your mail-in ballot as soon as possible so that you have time to return it.

Getting close to the election, there will just be a lot of mail going on. And so, while everyone at the post office is doing their very best, it's important to try and get that turned in as soon as you can and early as possible. So, request your ballot early. I'm from Georgia, originally, and I know that I just saw our Secretary of State's office has already gotten ballots out to military who are overseas to make sure that they can vote. So that's, I think, one important piece of this is make your plan early. And then if you're somebody where you're like, I really want to see my ballot counted, then probably early voting might be the best thing for you, or returning your mail-in ballot straight to a drop box in your county, for example. And so, I think, really, there's a preference there and also a timing there.

If you're thinking about a mail-in ballot and you're like the day before the election, personally, I would go take that straight to a drop box rather than put it in the mail. That would be my recommendation. The Center for Medicare and Medicaid Services has put out guidance that specifically names the importance of assisting folks in assisted living and making sure they have access to the vote. So I just want to name that it is a right of patients who are, whether in assisted living or people who are in ... they go into early labor right before an election. It is a right to be able to vote, and we need to make sure that our hospitals and clinics, as well as assisted living communities, are supporting people to cast their ballot.

Carol Vassar, podcast host/producer:

As we are talking about voting, I want to know from you, in addition to voting, what can people listening do to ensure a healthier democracy?

Aliya Bhatia, Vot-ER:

I was thinking about this. I think I'd give you a different answer if the time was different, but I think, right now, I'd say, if you have already got yourself in place to be able to vote, the next most important thing to do is to get people in your family and your community prepared to vote. They're going to listen to you more than they're going to listen to a political campaign. You get a text message from someone random you don't know claiming to be some big-shot politician. You don't know that person and you know they've just bought your phone number for the purpose of trying to get you to turn out. But if you speak to the people in your family, in your community and help them vote, that is a different effect. It's a different level of trust that you have with them.

The number one thing I would say, right now, is make sure people in your family, in your community have the resources to vote, that they know about how to get their early vote or in or their absentee mail ballot in, that they have a plan to vote, they have a ride to the polls. That's what I would say, right now.

I think if we're not in the middle of coming up to a national election, then what I would say is making sure that you're engaged in your community as best as you can be, and for every person that looks different. I used to work in public schools in Atlanta, and one of my mentors used to have this expression of, "I want for parents of kids to be able to drop their kid off on time, pick them up on time, and the most important way they can participate is by making sure that that child is present and that they are earning a good living and making sure they're taking care of that child at home." I think participation really varies for us, depending on what segment of society that we're in or what we're experiencing in our life. And the most important thing is do whatever you can do to be able to participate.

Carol Vassar, podcast host/producer:

There's a segment of people who believe their vote doesn't matter. What would you say to them to get them to register, to get them to the polls?

Aliya Bhatia, Vot-ER:

The first thing to do is empathize with those folks. I think naming that we all get frustrated, we all look at that ballot and say, gosh, I really want voting to be this magic thing that fixes everything. And I just know it's not that. What you can do, if you hear that from somebody, you start by sharing why you vote. Is there a time that your vote was something that made a really big difference to you? And then name that voting isn't the only way to make a positive change. It's an easy way to get started, and that without voting, it's hard to get anything else done. There are so many things we want to get done, but without first selecting and holding accountable our politicians, we can't do the rest of that work. And the reality is that if you don't vote, others are going to decide for you, and we don't like our power to be taken away from us.

We want to emphasize that step into the power that you have. And then, a second piece is I would point out the importance of these local nonpartisan elections. I think that too often when people are saying, my vote doesn't matter, they're thinking about a major national election, for example. And I think it's important, first, that they cast a ballot in that because we want them to be at the table for that. But also that they're looking at these nonpartisan local elections that are going to directly impact their lives, day in and day out, choosing their school committee member, their city councilor, their town clerk, and emphasizing that for them as well. The final thing, and I think this is a really important aspect of Vot-ER, all of our resources at Vot-ER are nonpartisan.

Our goal is to give people the information to make their choices and not to influence the way they are voting. I think too often when people say, "Hey, are you voting?" You assume that they have an intent about which way that they want you to vote, right? They want you to vote for the magenta party. When you have that assumption built into it, it's a lot harder to build trust around the importance of a vote. And there's real power in naming I don't care who you vote for, I just care that you show up and vote. There's a deep power in giving people that agency to make that choice for themselves.

Carol Vassar, podcast host/producer:

Aliya, what do you want people to know most about the upcoming election?

Aliya Bhatia, Vot-ER:

Carol, in 2020, there was a so-called record turnout. We hadn't seen that type of turnout in 2020 in over a century, but still, even with record turnout, one in three eligible Americans didn't vote. I'm a former school teacher. When one in three eligible people don't vote, that's a 66%, that's a D or an F in most schools. So we really have a lot of work to do to try and get up to a record that truly feels like a celebratory number in terms of the amount of Americans who are able to cast their ballots successfully and to vote.

So I would ask that you ensure that everyone in your community and your family is voting because we have a lot to do to make sure that the foundation of our democracy is strong and that we're setting new records where people voting becomes the norm and not an aberration or something out of the ordinary. I really think that this is one of the most important things for me to stress about this upcoming election, is making sure that everyone's voice is heard is one of the most critical things that we can do.

Carol Vassar, podcast host/producer:

Aliya Bhatia, Executive Director of Vot-ER, thanks for joining us.

Aliya Bhatia, Vot-ER:

Thank you, Carol.

Carol Vassar, podcast host/producer:

And thanks to you for listening. If you're not currently registered to vote, we'll put a link in the show notes so you can register for future federal, state, and local elections. The Well Beyond Medicine Podcast is taking your ideas for future episodes and your comments on the podcast, too. Email us at producer@nemourswellbeyond.org, that's producer@nemourswellbeyond.org. Or you can leave a voicemail on our website, nemourswellbeyond.org. Our podcast team for this episode includes Cheryl Munn, Susan Masucci, and Lauren Teta. I'm Carol Vassar. Until next time, remember, we can change children's health for good, well beyond medicine.