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Why the Conventional Social Determinants of Health Must Include Racism (Part 3: Voting and Civic Engagement)

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Vanessa Lopez-Littleton and Carla Jackie Sampson
November 6, 2020

The 2020 election may be the most consequential of our lifetime. The progress we have made towards a more just and liberated society now hinges on voter turnout and ongoing civic engagement. This election was a clarion call about the future of United States democracy and our ability to combat efforts to influence and delegitimize election outcomes. Moving forward, our success will depend on our willingness to overcome deep partisan divides, election interference and racial and social injustices. If we are to move the United States forward, we must push for systemic change in a society with longstanding racial and social problems.

In many states, voter suppression, voting laws and gerrymandering have harmed individuals and communities of color. Their inability to participate fully in our system of government has implications for the social determinants of health, which are influenced by the policy decisions (e.g., Medicaid expansion, the Affordable Care Act, judicial appointments) made by elected officials. Health, and access to healthcare, is just one aspect of American life under threat this election. There is an urgent need for all Americans to actively participate in this and future elections, as every election has far reaching consequences.

In the United States, various groups have differing levels of access to goods, services and opportunities. Disadvantaged groups experience greater health risks and consequences that are evidenced by disparate outcomes. While some argue that every American has the same rights and access, some oppressed groups in the United States are continually fighting for equity, equality and justice. Black Americans and women had to fight for the right to vote. Same-sex couples had to fight for marriage equality. Women are still fighting for pay equality. Black, Latino and Indigenous groups are still fighting for an end to police violence. These examples demonstrate that every American is not endowed with the same set of inalienable rights. 

One of the greatest threats to racial and social justice are the implications undergirding the Executive Order (EO) on Combatting Race and Sex Stereotyping signed by President Trump in September 2020. This directive seeks to overturn decades of progress towards reducing bias, improving organizational culture and increasing equality of opportunity for individuals and groups from divested communities. Decades of advances in racial and social justice work have translated into more inclusive and supportive workplace cultures for women as well as Black, Latino, Native American, LGBTQ+ and other individuals. In this way, this EO is antithetical to the work needed to become a more just and liberated society. 

The premise of this EO contends counternarratives that challenge the dominant paradigm are destructive ideologies. But, it is this perspective that attempts to protect failed policies and practices that perpetuate disparities. In contrast to language in this EO, the racial and social justice movement seeks to level the playing field, not posit that any group is better than any other group. The movement asserts that real change recognizes that the history of the United States is far from perfect and intentional efforts to unite the country are necessary and proper. This EO is a manifestation of fear, by those in power, of losing some degree of power or control. However, democracy is about the will of the people and not just those who are in power.

In past decades, the United States has been unable to develop or sustain a national strategy that moves us closer towards a more just and liberated society. Instead, our current leaders denounce systemic racism in an attempt to delegitimize decades of work. Black Lives Matter (BLM) has become a dog whistle for those who argue the movement prioritizes the lives of Black people over others. In fact, BLM is merely a plea to save Black lives from the real threat of bodily harm from police violence. These distractions and misrepresentations create further divisions. 

While we may have moved beyond the literacy tests and poll taxes that kept people of color away from the ballot box, other systematic efforts to silence the collective efficacy of people of color remain. Voting and civic engagement have become the counteroffensive for advancing racial and social justice. Using your voice and your vote to say that all Americans deserve access to all the freedoms and opportunities is a powerful message to declare. Voting is a mechanism that citizens can use to challenge a system that has failed far too many Americans for far too long. 

Health disparities, including COVID-19 morbidity and mortality rates, exemplify the oppression of racial and ethnic groups in the United States. Addressing these inequities must include expanding the social determinants of health to include racism, a known threat to the health of oppressed groups. In order to drive systemic change, we must be willing to amplify our voices by becoming more involved in our civic duties and actively supporting candidates who understand the real and mounting threat to our democracy. As a society, we must be willing to name systemic racism and demand a national strategy to dismantle all forms of oppression in the pursuit of a more just and liberated society. 


Vanessa Lopez-Littleton, Ph.D., RN, is an Associate Professor at California State University, Monterey Bay and Chair of the Health, Human Services, and Public Policy Department. Her research interests include social determinants of health, racial equity, and organizational behavior. She may be reached at [email protected], DrVLoLil.Com or @DrVLoLil

Carla Jackie Sampson, Ph.D., MBA, FACHE, is a Clinical Associate Professor and Director of the Health Policy and Management Program and online Master of Health Administration Program at NYU’s Robert F. Wagner Graduate School of Public Service. Her research interests include healthcare workforce policy and management, social determinants of health, and anchor mission strategy development. She may be reached at [email protected] or @ProfessorSamps1

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2 Responses to Why the Conventional Social Determinants of Health Must Include Racism (Part 3: Voting and Civic Engagement)

  1. Dr. William Clements Reply

    November 6, 2020 at 3:54 pm

    Great post! Id love to speak with you about a possible study observing the intersectionality of race, health, voting, and outcomes.

  2. Darrell Moore Reply

    November 6, 2020 at 2:52 pm

    I am always encouraged and excited when I see fellow Americans address systemic racism as one of the direct social determinants to health and wellness in this country. When low life expectancy, high infant mortality and and a plethora of debilitating illnesses display disproportionate numbers among people of color in this country, there has to be some association to racist policies that cause these disparities. As a nation, we must do better. In my opinion, this has been an ongoing lively discussion in our society since the Civil Rights Act was passed over 50 years ago and must continue until we start seeing the gaps closed. And even on that wonderful day when the gaps do close, we must teach future generations to not turn back, but to keep moving forward.

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