AAP Voices Blog

As a pediatric emergency medicine physician, I love my job.  But most tragic is when an infant presents in prolonged cardiac arrest.  Often, this happens early in the morning when a family wakes up to find their infant lifeless, apneic, and cold.  Emergency Medical Services is called. CPR is started. Epinephrine is given. The infant arrives in the emergency department. And sometimes, despite our best efforts, that infant dies.  

As a clinician, I’m helpless at this moment to get this child back. But as a voter, I know there’s more I can do to keep fighting for them.

"What’s needed is the political will to implement and increase funding for high-impact policies already proven to enhance child well-being.  Voting is arguably the most fundamental action we can take to generate this political will."

Why does voting matter for this type of catastrophic patient scenario? There are population-level, policy-level solutions that we already know work to reduce our country’s unacceptably high infant mortality rate. The United States has an infant mortality rate higher than that of any other wealthy nation, and non-Hispanic Black infants die at over twice the rate of non-Hispanic white infants. But policies such as the earned income tax credit are associated with both reduced infant mortality and improved racial equity.  What’s needed is the political will to implement and increase funding for high-impact policies already proven to enhance child well-being. Voting is arguably the most fundamental action we can take to generate this political will.  

Getting out the vote is particularly important among minority communities who face racism, inequitable health outcomes, and disenfranchisement. The American Academy of Pediatrics has described racism as “a core social determinant of health” that drives health inequities through multiple mechanisms. Racial discrimination is a well-documented risk factor for numerous adverse health outcomes, including depression and obesity.  

Racism acts not only between individuals, but also through institutions. For instance, redlining is a practice dating back to the 1930s whereby the federally funded Home Owners’ Loan Corporation created maps that color-coded communities based on credit risk. Neighborhoods with higher proportions of Black, immigrant, or low-income families were systematically more likely to be classified as “red” (ie, “hazardous”). Redlining has contributed to decreased access to home loans, decreased neighborhood investment, and decreased neighborhood-level opportunity, particularly for Black children. This decreased opportunity persists even today and is associated with numerous adverse health outcomes including increased mortality and shorter life expectancy.

These health inequities are compounded by long-standing voting inequities. In 1870, 81 years after the country’s first presidential election, the 15th amendment to the U.S. Constitution granted men of any race the right to vote. Unfortunately, this amendment was inadequately enforced. Thus, cost-prohibitive voting taxes, “Kafkaesque” literacy tests, and violent intimidation were used to prevent many Black Americans from voting through the 1960s. The Voting Rights Act of 1965 took major steps to enforce the 15th amendment, thereby helping significantly increase voting among Black Americans. Section 5 of the act - considered by many to be the “heart” of the legislation - required states and localities engaged in voter discrimination to obtain federal government approval before changing voting rules. However, in 2013, the U.S. Supreme Court ruled to end Section 5 of the Voting Rights Act until the U.S. Congress revised its voting discrimination criteria. In the 10 years since this ruling, states passed 94 laws restricting access to voting. These included laws that likely disproportionately burden Black and Hispanic voters by creating stricter voter ID requirements, reducing polling location availability, and increasing erroneous removal of individuals from government voter lists.

As a result, voting rates are disproportionately low among Black and Hispanic populations. Young adults, lower-income people, and people with disabilities also vote at lower rates.  This matters for the children we serve. A growing body of research supports an association between adult voting and child health. When women were enfranchised, child mortality decreased. When the Voting Rights Act passed, Black infant mortality decreased. Even today, increased population-level voting rates were found in one study to be associated with decreased pediatric inpatient bed-day rates. Given this evidence, I see getting out the vote as one of the most important things I can do for my patients.

Many of us have made personal commitments to address health inequities. Now is the time to make good on those commitments. No matter whether or not you’re in a swing state. No matter what issue you care about. There’s so much at stake this election, particularly for disadvantaged patients who face racism, poverty, poor health outcomes, and barriers to voting that persist to this day.

We must never underestimate our power as individual pediatricians and citizens. We can vote. We can encourage our family, friends, and colleagues to vote. We can use American Academy of Pediatrics resources to educate patients and their families about the importance of voting. We can volunteer with non-profit organizations to register voters and increase election turnout. And we can advocate for legislation to help ensure equitable access to voting for everyone. Even just a few minutes - even just one vote - can make a meaningful difference.