The birth of an idea
As medical students at Emory, we spent our first six months building a firm conception of what it means to be healthy. It did not take long to appreciate how much of our patients’ health would be determined by their social context before they ever walk into our clinics and hospitals. The importance of adequate and healthy nutrition, safe housing and manageable stress is clearly linked to patient outcomes. We can see these issues on the ballot in every election. In this sense, voting is healthy.
The idea that voting is healthy resonated with us, especially in a year of historic election anticipation and high stakes for our state and country. We launched our “Voting is Healthy” campaign in August 2020, marking the beginning of a multifaceted effort to mobilize our medical school — and any patients, providers or community members we engaged with — to the polls. We feared the COVID-19 pandemic would cause outsized confusion and apprehension around voting, but we had no idea then that the results of Georgia’s election would be in the national spotlight.
This campaign was intended to create a culture that encourages medical students to advocate on behalf of patients and to help them access the right to vote. We believe our efforts provide a roadmap for other medical students and health care professionals on how to partner with stakeholders and meet the needs of their communities during an election.
Barriers to student voting are plentiful and well-documented: the need to update voter registrations ahead of deadlines, limited time given classes and exams, lack of transportation to off-campus voting sites and incomplete knowledge of an electoral system that may be unfamiliar. Pre-pandemic, we may have scheduled school-wide voter registration drives or stationed volunteers on campus to catch students between classes, but the COVID-19 pandemic shifted a majority of coursework online. We needed a new playbook.
One challenge we faced was that voting is not an intrinsic part of medical education. Despite the direct impact that social determinants of health have on patients and the community, physicians consistently vote at lower rates than the general population. We needed to persuade peers that voting and voter engagement are extensions of the obligations we have to our patients and their health. As students, interacting with other students, providers, and patients regularly, we were well-positioned to mobilize.
Outside the walls of Emory, the greater Atlanta community had its own needs. The electoral system in Georgia has historically been fraught with voter suppression. From 2010-2018, 1.6 million voters were purged from the voter rolls and left ineligible to vote. People of color and people who are uninsured are the most likely to be unregistered and experience barriers to voter registration. The COVID-19 pandemic exacerbated all these dynamics by shutting down polling centers and making absentee ballots more likely to be rejected due to missing information or late arrival.
In the fall of 2020, medical students in Georgia faced the reality of multiple intertwining forces: student barriers to voting, a health care culture that was not civically engaged, widespread voter suppression, the rising number of COVID-19 cases and an upcoming presidential election. This was the environment that bred our voter engagement campaign at Emory University School of Medicine.
A mobilization campaign
We began our campaign three months prior to the election with an effort to convince students that voting and voter engagement were essential. We asked faculty to serve as ambassadors for our message. Our professors and deans were generous with their time, excited to participate in the historic elections. They wrote emails encouraging voter registration, recorded videos with their “I voted” stickers and even forfeited class time to help spread our message.
Our professors started to incorporate infographics on voting deadlines and details into their lectures while discussing their own motivations to engage in the electoral process. Some shared powerful personal anecdotes on how their identity shapes their relationship to civic engagement; others connected voting to their roles as physician-advocates. They demonstrated that civic engagement is a part of medicine. We had a variety of messengers deliver the same message, hoping that it would resonate with our classmates.
Some of our classmates were also key champions of our message. Each week, we asked students to contact three potential voters they knew to ask if they were registered and had a plan to vote. Slowly, we built a network in which each person held those around them accountable. This strategy was modeled on the concept of relational organizing, based on research that an individual contacting their closest associates, such as friends, family and coworkers, had a larger impact on mobilizing participation than every other method of increasing turnout, including canvassing, phone-banking, video or text advertising and mailers.
Once students were engaged in conversations about voting, we sought to turn intention into action: during a mandatory lecture, we asked students eligible to vote to formulate vote plans. Vote plans are a style of persuasion largely similar to motivational interviewing and involve asking a potential voter to consider why they would vote, when they will go to vote and what they need in order to follow through on their intention. Evidence from over 287,000 interactions suggests that vote plans lead to a 9.1% increase in turnout compared to other styles of persuasion. In our case, we encouraged voters to partner with a classmate who would hold them accountable to go to the polls.
Partnering with the community
With the momentum of our work on campus, we turned outward to contribute to broader Atlanta community efforts to combat voter suppression.
We engaged with Grady Memorial Hospital by assisting in their efforts to mobilize both employees and patients to the polls. At Grady, health care professionals, trainees and staff had begun incorporating voting-related questions during patient visits, relaying application deadlines and helping patients register and request absentee ballots. We encouraged students to follow physicians’ leads and ask about voter registration and absentee ballots when talking with patients.
Some medical students worked with Grady staff and the non-partisan organization Georgia Equality to create a website and promotional materials for voter engagement. This interprofessional team established a voter registration hotline for Grady patients and staff, as well as badges for Grady faculty to wear and discharge text messaging to encourage voting. Other students collaborated with Grady staff and county officials to authorize emergency absentee ballots for hospitalized patients on Election Day.
Outside our health system, we partnered with local voting rights organizations like the New Georgia Project and other Emory University graduate programs to advertise non-partisan activities in the weeks leading up to Election Day. These activities included hour-long phone banking or text-banking sessions, voter registration drives, poll watching during early voting and personal protective equipment distribution events.
Taking action and casting votes
Throughout the election cycle, we hosted a school-wide voting competition to incentivize students to volunteer and to measure the impact of our efforts. Over half of the School of Medicine participated in the voting competition. Our students worked as poll workers, poll watchers, technicians and line warmers at as many precincts as we could staff. In the end, in a student body of over 500, 44 students volunteered for half the day on Election Day, 41 other students volunteered for the full day, and 195 students participated in phone-banking, text-banking, and other volunteer efforts in the weeks leading up to the November election.
While it is hard to correlate specific actions we took to increased turnout, we have some hints that our strategies worked. In 2018, just 50% of students in health professional schools at Emory voted in the 2018 gubernatorial election. In 2020, we observed a 56% overall turnout among medical students. Though these values cannot be compared head-to-head, we knew we now had a strong foundational strategy to build on during future elections.
Every election is an opportunity
A few days after a contentious presidential election that placed Georgia — and specifically DeKalb and Fulton counties, where most of the Emory School of Medicine students live — in the spotlight, we were informed that the balance of power in the United States Senate would be decided in our state, all in the midst of the on-going pandemic.
Our “Voting is Healthy” campaign did not end in November. Pivoting from one election to another, we relied heavily on the scaffolding from our first round of efforts. We launched the same initiatives again — made easier by existing relationships with community organizations, faculty and administration. The run-off election for two seats in the U.S. Senate was a true test of our team’s strength and approach and the ability for these initiatives to be reapplied from election to election. Our enthusiasm was sustained: over a quarter of the medical school volunteered in the days leading up to the election.
Our work in Georgia can be replicated in any state. We integrated into an existing ecosystem of organizers who laid the voter engagement groundwork in our communities and extended their efforts into our own health system. We capitalized on a moment — a confluence of multiple historic events.
However, the opportunity to interlink health care advocacy with civic engagement is neither limited to a single moment nor unique to Georgia. We encourage professional students in health care at other institutions to find the key stakeholders in their communities, launch their own “Voting is Healthy” campaigns and meet their next elections with the energy and effort they require.
We believe that voting is a key component of enacting systemic change in our local and national communities. Casting ballots is an instrumental means of empowering our patients and providers and it is a core component of being healthy. In the future, we will host voter registration drives on campus, provide materials that demystify our state’s changing election laws and implement a feedback system to evaluate and update our initiative. We hope to harness the energy and infrastructure we have built to continue to motivate health professional and patient turnout in future elections.