Social determinants of health (SDOH) impacting 80% of health outcomes in the U.S. continues to be the norm(1). Healthcare professionals often feel limited when it comes to addressing SDOH, but there is a way to impact change at the system level. Beyond traditional treatment interventions, integrating civic health—active participation in democratic processes and community activities—can significantly enhance health outcomes.
The Healthy People 2030 Framework, which aims to improve the health and well-being of all people, includes a focus on voting and civic engagement. It notes that voting allows people to influence the decisions and policies that affect their communities and impact their health and well-being.
The Federal Plan for Equitable Long-Term Recovery and Resilience, which leverages the Vital Conditions for Health and Well-Being as the guiding framework, also points to civic engagement as an important factor. Belonging and Civic Muscle is one of the vital conditions and emphasizes the importance of social connections and civic engagement in building resilient communities. It highlights how strong social supports and civic participation can help communities respond effectively to crises, address inequities, and foster inclusive belonging.
And according to the Health & Democracy Index, “some of the same barriers to health are barriers to voting, including structural inequities in transportation, language access, broadband access, and accessible spaces. Communities that face these barriers may have a lack of social inclusion, reduced sense of belonging, and less access to health resources, which are all associated with worse health outcomes, particularly in marginalized communities”. Fortunately, there is data showing that higher levels of civic participation can mitigate disparities.
With civic engagement being increasingly recognized as a critical component of health, there are direct implications for substance use treatment organizations and professionals to play a part in efforts to expand access. For individuals in recovery, the benefits of being more civically engaged in their communities are particularly impactful, as this can enhance one’s sense of purpose and belonging that is critical to sustained recovery.
Dr. Leigh Beck, a licensed clinical social worker with a micro and macro expertise in substance use, points out that, “As a social worker, you have a responsibility to provide the best, most effective interventions to the people you serve. And if you commit to that, you have to include civic engagement”. The NASW Code of Ethics states explicitly that social workers should be promoting the general welfare of society through social and political action along with facilitating informed participation by the public in shaping social policies and institutions(2). However, according to recent reports by Nonprofit VOTE(3), despite data showing that 7 in 10 voters believe nonprofits should offer voting services, in 2020, only 20% of nonprofits reported doing any voter engagement activities.
Community-serving nonprofits employ more than social workers, of course, and other helping professions are beginning to act on the importance of integrating civic health into their regular practices. For example, a 2022 policy statement from the American Public Health Association noted, “Achieving health equity requires ensuring that all people have a voice in the political process. Actions include supporting inclusion of voting and civic participation objectives in the Healthy People initiative, adopting policies to advance civic participation and public health, and integrating voter registration and civic engagement into public health work”(4). In the same year, the American Medical Association also endorsed a policy which declared voting as a social determinant of health(5).
Aliya Bhatia, Executive Director of Vot-ER, a nonpartisan nonprofit organization founded by an ER doctor that equips healthcare providers with tools to help patients register to vote and get involved in civic activities, notes the connection between voting and access to funding for treatment and prevention services. She explains that “as more than $50 billion in opioid settlement payouts continues to flow through state and local governments in the coming years, the officials we elect will be part of the decision-making process on how to spend the funds”.
According to Dr. Beck, “the attorney generals that are being elected play a major role in spending this money. So, if you care about the opioid crisis, you should care about who that attorney general is going to be”. Bhatia adds that “supporting our communities to show up to the polls is crucial to ensuring that our health needs — including support for SUD prevention, treatment, and recovery — will be reflected in those choices”.
As healthcare professionals of all types, we have the power to enhance the recovery journey of the individuals and communities we serve by integrating civic health into our organizations and our own daily practices. By utilizing resources from nonpartisan nonprofits like Vot-ER and Nonprofit VOTE, we can empower eligible citizens to become active participants in their communities, which in turn supports their long-term health and well-being.
Here are a few ways to get started:
Don’t forget to apply the same practices to your own civic health. Check your voter registration status and talk to your friends and family and encourage them to do the same. Next, make a plan to vote and be sure to look up who/what’s on the ballot. Then, exercise that civic muscle by casting your vote by mail or in-person! Remember, the future of health and recovery depends on the actions we take today.
Equitable Long-Term Recovery and Resilience The People & Places Thriving Approach
Opioid Settlement Tracker https://www.opioidsettlementtracker.com/
Staying Nonpartisan: Permissible Election Activities Checklist for 501c3 Organizations
The opinions expressed herein are the views of the authors and do not reflect the official position of the Department of Health and Human Services (DHHS), SAMHSA, CSAT or the ATTC Network. No official support or endorsement of DHHS, SAMHSA, or CSAT for the opinions of authors presented in this e-publication is intended or should be inferred.