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Lisa Schavrien worked as a nurse for more than a decade before considering the link between voting and health. But the night before Election Day in 2016, a pregnant patient arrived at Lenox Hill Hospital in Manhattan. Her water had broken a month early.
“She said to her nurse, ‘What am I going to do? How am I going to vote today?’” Schavrien recalled.
The hospital’s obstetric nurse navigator, Schavrien made it her mission to ensure that the patient could cast her ballot. She had missed the deadline for an absentee ballot application. But through consultations with the NYC Board of Elections and a court order from a Staten Island judge, Schavrien was able to secure her ballot.
By the 2018 midterm elections, Schavrien and her colleague Erin Ainslie Smith had launched a hospital-wide effort to help patients register to vote or cast ballots if they were unexpectedly hospitalized on Election Day. Today, their project has expanded to nearly 20 Northwell Health sites, and they are preparing to assist patients again as Tuesday’s election approaches.
“This is not political,” Schavrien said. “This is patient advocacy. This is civic engagement.”
Their efforts reflect a growing recognition among health care workers and public health leaders that voting and health are intertwined. The American Medical Association recognizes voting as a social determinant of health — and says gerrymandering negatively impacts health outcomes and restricts health care access. Researchers have also found a link between voting and health, noting that a vicious cycle can develop where poor health can reduce voter turnout, which can result in electoral outcomes and policies that worsen health inequities.
Last year, increasing the proportion of voting-age citizens who vote became part of Healthy People 2030, a set of nationwide health and disease prevention goals set by the U.S. Department of Health and Human Services.
Voter registration and turnout efforts have emerged in health care settings across the country. In 2019, Dr. Alister Martin launched a pilot program in the waiting room of the emergency department at Massachusetts General Hospital in Boston, with iPads where patients could register to vote. His work has expanded into Vot-ER, a nonpartisan civic engagement nonprofit, which now works with hundreds of institutions and 50,000 health care workers to help patients register to vote and vote while hospitalized, through emergency absentee ballot processes.
Motor vehicle departments help people sign up to vote — and health care institutions may have even greater reach, since the vast majority of Americans visit a doctor or health care provider each year, Aliya Bhatia, Vot-ER’s executive director, said in a statement.
Election outcomes also directly impact residents’ health, said Elizabeth Cohn, vice president of health equity research at the Institute of Health System Science at the Feinstein Institutes for Medical Research at Northwell Health. For Cohn, decades of work at patients’ bedsides made that link clear. Zoning decisions about where garbage dumps are built, or how highways cut through neighborhoods, affect local pollution levels — and residents’ rates of asthma, she said.
“Health is driven by more than just the medical treatment that you’re getting,” said Cohn, who is on the advisory board of Vot-ER. “One of the best ways to affect that is through civic engagement, and more specifically, through voting.”
In the Bronx, Sandra Pimentel has drawn from Vot-ER’s resources to encourage civic engagement at Montefiore Medical Center and the Albert Einstein College of Medicine, where she is the chief of child and adolescent psychology and an associate professor in the psychiatry and behavioral sciences department.
Casting a ballot can be an important expression of personal values, Pimentel said. But it can also help forge connections with a broader community, stave off loneliness and be an indicator of resilience.
“There’s a sense of hopefulness that’s built into voting,” she said. “It’s inherently future-oriented.”
At Lenox Hill, in the lead-up to the 2018 election, Schavrien and Smith rounded on the hospital’s roughly 400 beds, asking patients if they were registered to vote, if they had already voted, and if they wanted to vote through an absentee ballot. They helped about two dozen patients vote — one of whom was about to undergo surgery for a brain tumor.
“She was having a resection of her brain on Tuesday and she told them that she wouldn’t let them do that until she voted,” Schavrien recalled.
Smith, the clinical program manager for the Lenox Hill Center for Family Education, stressed that their work is purely informative and nonpartisan.
“There were definitely patients who were like, ‘No, I’m not interested,’” she said. “But there were so many stories of people who were so excited that we were there.”
Early voting, which began in New York in 2019, has reduced some of the stress of patients who are hospitalized on Election Day, according to Schavrien and Smith. Still, during the 2020 election, their initiative helped about 250 patients at multiple Northwell Health sites vote.
For Cohn, the health benefits of voting are multilayered. Casting a ballot can confer a sense of individual agency, an understanding of community issues, and a feeling of national engagement.
“Especially from a nursing perspective, we treat the whole patient,” she said. “This is more and more becoming part of the treatment of the whole patient.”
Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.
