A child joins his father as residents receive food at...

A child joins his father as residents receive food at the St. Helena Pantry in the Bronx on Sept. 28. Credit: Getty Images/Spencer Platt

The midterm election is just days away. One of the most important issues on the ballot is health equity.

As pediatricians, we cannot treat children equitably unless we fight to dismantle the systems of oppression and systemic racism that lead to disparities. The policies that govern our communities and health care system often make it impossible to provide the care that our patients deserve. On Nov. 8, we have the power to move our communities closer to health equity or continue to widen the gap.

As pediatricians, we have a unique view of how health inequities affect children’s lives. If society intervenes and invests in children, we can improve their physical and mental health and increase their chances of finishing school, getting a stable job, and becoming happy and productive adults. The way we vote affects whether or not a child gets the opportunity to reach their full potential.

Health disparities start during pregnancy and early infancy. Black women are significantly more likely than white women to die from a pregnancy-related complication. Black, Native Hawaiian and other Pacific Islander babies are twice as likely to die as infants of white women, according to the CDC.

If a child experiences homelessness due to failed social policies, they can experience developmental delays, physical illnesses, emotional problems and attachment disorders. As a society, we can choose to mitigate these risks by prioritizing children and families in public housing policy and improving access to early interventions. These steps can improve educational attainment and health outcomes and strengthen family and community bonds.

Similarly, there are profound impacts of poor nutrition when children are living in poverty. Children cannot learn or grow when they are hungry. We celebrate when children gain access to evidence-based programs like the Supplemental Nutrition Assistance Program.

We know there is a mental health crisis in children and adolescents, especially in historically marginalized groups. Research shows that children who live in communities with high rates of gun violence experience trauma from the constant stress of their environment. The 2022 Bipartisan Safer Communities Act, the most significant piece of anti-gun violence legislation in decades, included provisions for trauma informed care for vulnerable populations.

These are just a few examples of how policies enacted by elected officials have a direct impact on the health and well-being of children.

Policy matters at all levels. While national elections are important, many policies that directly affect children are enacted on the state level. Illinois has some of the strongest gun laws in the country, yet children in Illinois die every day from guns trafficked from neighboring states. There are still 12 states that have declined to adopt Medicaid expansion. Medicaid expansion in those states would help lessen disparities in health care coverage for people of color. Without Medicaid expansion, people who live in Kansas simply do not have the same access to care as people in the neighboring states of Missouri and Colorado.

These policies are drafted, voted on and enacted by legislators. And yet, many Americans don't vote. The presidential election of 2020 had the highest turnout in the 21st century, yet nearly a third of eligible citizens did not make it to the polls. Midterm elections historically have lower turnout. In 2018, nearly half (47%) of eligible Americans did not vote. Beyond this, “undervoting,” or voting in a few races and leaving the rest of the ballot blank, means that many of our local leaders are chosen by an even smaller percentage of our communities and may not reflect the actual population.

Why don’t people vote? There are numerous barriers to voting, and many of them vary widely from state to state. Some states suppress voter turnout through voter roll purges, voter ID requirements, under-resourced polling locations, reduced voter hours, and reduced or difficult early voting or voting by mail. The impacts of voter suppression cannot be understated. Finally, an NPR commissioned study cited a host of reasons, but ultimately concluded that a sense of alienation and apathy was a major factor behind the dismal turnout so common in the United States.

We have to change this conversation. Election outcomes are critical to achieving health equity. Everything from income to environment impacts health, but public health has become politicized in a way that is proving deadly.

The Health and Democracy Index analyzed 12 public health indicators in relationship to state voting policies. They demonstrated a clear relationship between inclusive voting policies and better health outcomes. The American Medical Association recognizes that voting is a social determinant of health.

We must all promote free and fair elections. Democracy works best when everyone who is eligible votes. What can you do?

  • Check your voter registration status at Vote.org.
  • Familiarize yourself with your state’s deadlines and rules.
  • Vote by mail, vote early or take time off to vote, if you can.
  • Research your ballot to find candidates who align with your values.
  • Talk to family members, friends and colleagues and encourage them to vote.

Just as we actively and aggressively work to dismantle the other systemic inequalities of our health care system, we must work on this one. We will never have health equity without voting equity.

Dr. Lauren Gambill is a hospital-based pediatrician in Austin, Texas. Dr. Deanna Behrens is a pediatric critical care physician in Chicago.