Voter suppression is a structural determinant of health, psychiatrist argues

Voter suppression should be treated as a structural determinant of health, according to a perspective article published in JAMA Health Forum by Ruth Shim, a professor in the UC Davis Department of Psychiatry and Behavioral Sciences. Shim, a psychiatrist at UC Davis Health, argues that the ability to vote shapes the conditions in which people live, and that policies restricting ballot access therefore belong alongside better-known structural forces such as redlining in public health research and practice.

Public health researchers have long examined how societal forces shape health outcomes. Decades after redlining was outlawed, researchers continue to document its lasting effects on life expectancy, chronic disease and access to healthcare resources in many communities. Shim suggests that voter suppression deserves the same scrutiny, asserting that voting is a social determinant of health and that voter suppression is a structural determinant of health, one of the policies and practices that shape who has access to the conditions for good health.

“We have spent two decades bringing the social determinants of health into clinical practice, but we have paid far less attention to the structures that create them,” Shim said in the university’s announcement of the article. “Voter suppression is one of those structures, and it can be changed.”

Shim notes that U.S. voter turnout lags behind many other countries, in part because states administer elections and set their own registration rules. She also points to the Supreme Court’s 2013 decision in Shelby County v. Holder, which was followed by polling place closures that reduced voting access in communities of color, lower-income communities and rural areas.

The article highlights studies showing links between voter participation and population health. Research has found that states with lower voter turnout have worse health outcomes, while people in poor health are less likely to vote.

Some of the most striking evidence comes from historical analyses. One study cited by Shim found that passage of the Voting Rights Act of 1965 was associated with significant reductions in Black infant deaths in Jim Crow states, suggesting that expanded federal protection of voting rights had measurable consequences for infant survival.

Other studies have examined the health consequences of voting restrictions directly. Shim points to research linking felony disenfranchisement laws with increased depressive symptoms among Black people, but not among White people, an association that underscores how the burden of voting restrictions falls unevenly across racial groups.

Shim notes that health professionals, who are trusted messengers in the communities affected by health disparities, can support voter registration in health care settings. She points to nonpartisan resources such as Vot-ER and the Civic Health Alliance, both of which advance public understanding of the relationship between voter access and health.

“These inequities are not accidental,” Shim said. “When people are blocked from voting, they lose a voice in the decisions that shape their health. Protecting the right to vote is a public health intervention.”

The article, published in JAMA Health Forum on 22 October 2026, is a literature review and perspective rather than a new empirical study, so its claims rest on the accumulated findings it synthesizes. Shim’s argument is that the evidence base is now sufficient to justify treating ballot access as a matter of public health, and that because voter suppression is a policy choice rather than a fixed condition, it is one of the structural determinants that can be changed.

Subject of Research: The role of voter suppression as a structural determinant of health

Article Title: What does voter suppression have to do with health?

Article References: What does voter suppression have to do with health?. Original publication (Bibliographic details unavailable.)

Image Credits: AI Generated

DOI: Not provided

Keywords: voter suppression, social determinants of health, health equity, Voting Rights Act, felony disenfranchisement, JAMA Health Forum, UC Davis, voter turnout, public health, Shelby County v. Holder, infant mortality, civic health