Along with our co-authors, we recently published an article, “Restrictive State Electoral Environments and the Health of Black Americans,” in Social Science Quarterly showing that restrictive voting environments are associated with worse health outcomes for all people, but the relationship is stronger for Black Americans. The study adds to growing evidence and recognition that inclusive civic participation and better health outcomes go hand in hand. It also builds on critical research that started in 2021 and led to the creation of the Health & Democracy Index, a visualization of the relationship between access to the ballot and health outcomes.

Our study looks at how state voting rules affect people’s health. We used national survey data and found that even after controlling for other factors known to be associated with health outcomes like education, income, health insurance, age, gender, employment status, obesity, and exercise habits, people living in states with more restrictive voting rules were more likely to report being in fair or poor health. 

The effect is especially strong for Black Americans. In states with restrictive voting environments, Black Americans report worse health than non-Black Americans. However, in states with less restrictive voting rules, there is no meaningful difference  in self-reported health outcomes between the two groups.

These findings suggest that reducing barriers to civic participation and strengthening democracy could support individual and community health, particularly for Black Americans.  While the study does not prove that restrictive voting laws directly cause poor health, it shows they are part of the conditions that make it harder for some communities—especially Black Americans—to thrive. One causal mechanism explored in the study is that of legislative representation. States with less restrictive electoral environments also have legislative bodies that are more representative of the state’s Black population. When electoral policies are more inclusive it allows communities to vote in support of legislators that represent shared interests who in turn make investments in health resources essential to the health of Black Americans. It is also likely that this relationship is bidirectional, poor health among Black Americans can reduce political participation which in turn limits their ability to elect lawmakers who support voting reforms. This underrepresentation creates a reinforcing cycle of political and health inequities. Removing barriers to voting is a crucial step toward building a system where people can influence decisions that affect their health and well-being.

These findings come at a critical time for American democracy. Between 2021 and 2024 states introduced over 300 bills and passed 79 new laws making it harder for eligible voters to cast a ballot.  Our research reinforces that making elections more accessible not only builds a fairer democracy, but also improves health outcomes for everyone.