On Wednesday October 20, Dr. Rishi Manchanda addressed “Innovations at the Intersection of Health Care, Democracy, and Civic Engagement” as part of the Kennedy School’s Democracy Seminar Series. Dr. Manchanda is the founder and chair of Rx Democracy, an organization that represents “a nonpartisan network of America’s best clinicians, health professionals and students helping our patients to improve their health by participating in community and civic life.”

Why pair democracy and health care? For starters, in 2008, 2.3 million registered voters did not vote due to illness or disability (14% of the 16 million registered voters who didn’t vote). Furthermore, states with lower voter turnout also have poor self-reported health (which in the world of self-reported statistics, is actually reliable). Dr. Manchanda showed that health disparities tend to mirror and drive widening civic participation gaps, but acknowledged that less is known about how poor health outcomes and health disparities are influenced by a lack of power and political efficacy. However, we do know that health often begins with where and how we live, work, learn and play. In turn, those environments and experiences are linked to our ability to access information and advocate for ourselves.

Dr. Manchanda called health care the “predominant institution of our time” (it represents roughly one-sixth of the U.S. economy), but lamented the fact that the field has not become a better advocate for civic participation. Rx Democracy was founded, in part, to address that concern, and has done so with success: In 2008, clinics and offices that partnered with Rx Democracy registered 26,000 voters. Dr. Manchanda sees civic engagement as yet another health intervention–increased civic engagement can lead to better health and healthier people participate more. Additionally, increased interest in the social determinants of health has made it easier to incorporate civic participation into the ongoing dialogue around patient care beyond the exam room.

Still, Dr. Manchanda noted that it can sometimes be difficult to convince practitioners that civic participation is a critical part of their mission and that “politics” isn’t a “dirty” word. However, incorporating civic engagement into the clinical setting can be as simple as asking a patient at intake, “Are you eligible and interested in registering to vote?” making registration forms available, or putting up a get-out-the-vote poster.

Rx Democracy is not alone in recognizing the links between health and democracy. Vote and Vax is an initiative that uses Election Day to safely and conveniently administer flu vaccinations. Vote and Vax works with local public health providers to assist them in holding vaccination clinics at or near polling places across the country. Vote & Vax launched its first multi-state program in 2004, but significantly expanded its efforts in 2008, ultimately delivering 21,434 flu vaccinations at 331 locations in 42 states and the District of Columbia in November 2008. Of those vaccinated through the project, 47.7% were “new” recipients, meaning they had either not received a flu shot in the preceding year or would not have otherwise been vaccinated.

Like nonprofit organizations, there is a great deal the health care field can do to promote civic participation. It’s relatively easy, too, because of the established and trusting relationships doctors, nurses, and other providers have with their clients. So take your doctor’s advice: exercise more, watch what you eat, and vote!



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