Summary

Health departments have a critical role to play to ensure that all communities have a say in the conditions and decisions that impact their lives. Particularly in the 2020 election, as COVID-19 creates unique new challenges that add on to the historic disenfranchisement and related distrust in some communities facing health inequities.

Historically, Black, Indigenous, and people of color, women, immigrants, working class and low income people, and others have been denied the right to vote. Today, many communities experiencing structural oppression continue to experience voter disenfranchisement due to polling site closures, reductions in early voting periods, voter purges, voter intimidation, unsafe and insecure voting machines, voter ID laws, voter registration restrictions, disenfranchisement of people with felonies, misinformation campaigns, and challenges with receipt, delivery, and counting issues with mail-in ballots. These practices disproportionately impact communities of color, and can reinforce policies that further exacerbate health inequity.

Recommendations

1. Leverage your own resources, people, and space

Many states are anticipating a shortage of poll workers as older adults, who represented 58% of poll workers in 2018, are at higher risk of COVID-19 and less likely to volunteer this election year. At the same time, fears of voter intimidation are high, along with fears of COVID-19 transmission from in-person voting. Concrete actions health department leadership can take include:

• Give staff time off or allow flexible time: Give your staff time off to vote and/or to serve as a poll worker. Have November 3rd be a “no-meeting” day for all staff to allow them the flexibility to go vote when they are able.
• Encourage staff to be poll workers: Where possible, encourage all staff who are willing, eligible, and not at high risk of COVID-19 to sign up as poll workers on election day to address the national shortage of poll workers.
• Explore using your health facilities as a ballot drop off location or polling site: Connect with your local election official about using your health facilities, COVID-19 testing sites, clinics, and other sites of service provision to register people to vote and/or as a ballot drop off location or polling site over the coming month.
• Explore registering people to vote in health outreach activities: Particularly if your health team works with individuals who are unhoused, experiencing unstable or limited residential mail access, or who face historic disenfranchisement or are targets of voter suppression or misinformation. Public health service providers can be important sources of information, assistance, and encouragement that every vote is important. See National Coalition for the Homeless’s Unhoused Voting Resources.

Examples in action:

Check out Los Angeles County’s County Employee Election Worker Program and San Bernardino’s Disaster Service Worker County Poll Worker Program

2. Highlight why voting is so important for health and equity

Voting is a public health issue because the policies and candidates we vote for inevitably help determine the conditions in which people can be healthy. The conditions for health are represented in many of the candidates and the issues down the ballot – from affordable housing, to education, climate protections, and employment. Voting also means exercising agency and decision-making power, which directly improve health. All who vote should be thinking about public health when they cast their votes.

Public health departments can play an important role in encouraging all who can to vote, using multiple channels including social media, PSAs, and other forms of public awareness raising . While drawing the connections between voting, health, and equity, health departments can also offer guidance and encouragement for people to vote safely and protect themselves and others from COVID-19. Specific ways health department leadership can draw connections between voting and health include:

• Check out and implement VoteSAFE Public Health’s page and social media section for images and suggested messages.
• Include messages about registering to vote and voting wherever possible in communications, including in email signatures, signs in clinics or offices, in weekly web briefings/updates, via social media, on your health department website’s main landing page, etc.
• Write a blog post or op-ed about the importance of voting for public health. Key values to impart include:
  • Voting is an act of collective care.
  • Voting is a form of power.
  • Voting is a form of belonging.
  • Voting is harm reduction and opens new possibilities for ongoing social justice and movement building.

Examples in action:

Check out this blog post on why public health officials should make voting accessible for all by former Minnesota Commissioner of Health and past-president of ASTHO, Dr. Edward Ehlinger.

3. Disseminate guidance about healthy and safe voting

Voting by mail is the safest option to decrease potential exposure to COVID-19 for voters and election workers. However, some states have complicated processes for requesting mail-in ballots, and/or voters don’t receive their ballots in the mail. And as described above, some voters may be disenfranchised, particularly those with limited access to a residential address. Those who face language barriers or with disabilities may need assisted in-person voting, and others may distrust mail-in voting and prefer to vote in person. Communities already experiencing inequities — who are also hardest hit by COVID-19 — may be at greatest risk of infection and transmission of the virus if they choose to vote in-person. Concrete ways health departments can disseminate guidance about safe and healthy voting include:

• Work with election officials to implement safe practices at polling sites, including designing the voting site to facilitate social distancing, ensuring smoothly functioning processes that avoid long lines, and keep voting transaction times below 15 minutes to decrease possible transmission. Check out recommendations from the Stanford-MIT Healthy Elections Project, CDC, healthyvoting.org, and the Brennan Center-Infectious Disease Society of America.
• Ensure proper COVID-19 safety practices in all election activities and spaces, including wearing masks, social distancing, washing hands, regularly disinfecting surfaces, etc.
• Encourage people to vote early by mailing in their ballots early, or voting at early polling locations.

‍Examples in action:

Check out this helpful guidance on how to protect public health in vote-by-mail and in-person voting described in this open letter to California Election Officials by health professionals in Climate Health Now.

4. Support voting in your local jails

Roughly 555,000 people are currently locked up in jails, the majority of whom have not been convicted or sentenced, and remain incarcerated simply because they cannot afford to pay the set bail amount. And the vast majority of people incarcerated in jail are eligible to vote, as they are not currently serving a sentence for a felony conviction. Yet many are denied access to their ballots.

Because of structural racism, Black and Latinx populations are disproportionately incarcerated in jails, representing 48% of the jailed population nationally, and are thus disproportionately disenfranchised. Some states — including California, Texas, Massachusetts, Colorado, and Arizona — have adopted policies to increase voting access in jails. Within prisons, the right to vote varies significantly by state and the individual’s conviction history. Health departments can take action with local advocates to increase voting access in jails. Specific actions health departments can take to support voting in local jails include:

• Recommend that your local warden support voting in local jails, via in-person voting and/or vote by mail and absentee ballot access.
• Connect with local or national advocates working to end pretrial incarceration and money bail. Check out our recent report on the health impacts of these practices.
• Take action at the systems level to support health instead of punishment by implementing at least one of the five health department actions to help end police violence described in this resource.

‍Examples in action:

Check out these models for voting in jails described by The Sentencing Project in Cook County (IL), Harris County (TX), Denver, Los Angeles, Philadelphia, and Washington, DC.

5. Work to address the root causes of inequities before and after elections

As the government agencies responsible for protecting the public’s health, health departments have an obligation to address health inequities. The root causes of health inequities are the same root causes that create voting inequities across populations: structural racism, class inequity, patriarchy, heteronormativity, ableism, corporate power, and other forms of structural oppression that reinforce power imbalances in our society, including who has the right and access to vote.

Health departments alone cannot tackle the root causes of health inequities. Yet by working in partnership with communities working to build community power, and across government, health departments can work towards collective transformation. Health departments can directly address the social determinants of health — by preventing evictions, increasing wages and paid leave, investing in education and not incarceration, and ensuring food security and health care access for all. And addressing the structural dimensions of health inequities can increase communities’ ability to determine the conditions that impact their lives. Concrete ways health departments can advance equity include:

• Collaborate with community organizers who work with impacted communities to build community power, have a clear strategy and analysis of root causes of inequities, and who can be excellent partners to help advocate for needed systemic and policy change.
• Build your department’s internal capacity to center racial and health equity in its work. Check out HIP’s Capacity Building page for resources, publications, and information about trainings and technical assistance offerings.
• Check out HIP’s Health Equity Guide for ideas of how to get started addressing health inequities in your health department or check out the ideas listed in HIP’s Policy Platform for concrete ideas of how to address housing, economic security, criminal legal system, and health care access inequities.

‍Examples in action:

Check out how King County, WA has worked to embed equity and social justice throughout their entire county government.

The 2020 Election has been called the election of our lifetimes. Recognizing how critical voting is to health, we encourage you to leverage your power and authority as a health department to protect this invaluable right.

To get more involved in our election work, check out Public Health Awakened’s campaign to Defend The Vote for Public Health.

If you or any of the organizations you work with have questions about what’s allowed during election season, call the RoadMap Consulting Technical Information for Power and Security (TIPS) line at 224-818-6468.