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The American Medical Association (AMA) endorsed a policy declaring that voting is a social determinant of health at its AMA House of Delegates meeting on Monday.

The house also recognized that gerrymandering -- or manipulating the boundaries of an electoral constituency to one party's advantage -- limits access to healthcare and negatively impacts health outcomes.

"School children are being murdered by weapons of war. Women are being forced to surrender their very own bodies to the state. In some places, providing water to an individual waiting in line to vote can earn you jail time," said Jasmin Eatman, a medical student and PhD candidate, speaking on behalf of the Minority Affairs Section (MAS), at a weekend discussion of the policy. The MAS authored the resolution. "Despite these undemocratic efforts, we believe that there's still power in the ballot," and that social inequity can be tackled, even "transformed," by voter participation, she stated.

Eatman also submitted amendments on behalf of the MAS that highlighted civic participation and recognized gerrymandering as a tool that impedes health equity.

"It is time for the AMA to recognize voting as a social determinant of health," she told attendees to appreciative hoots and applause.

Dionne Hart, MD, speaking on behalf of the American Psychiatric Association, noted that "Differences in voter participation due to social economic and health inequities have been shown to have large effects on electoral outcomes. Physicians are one of the most trusted professions in the country and are well suited to educate our patients on the interface between voting and health access and outcomes."

Emily Cleveland Manchanda, MD, MPH, an alternate delegate from Massachusetts who spoke on behalf of the New England delegation, explained that as an emergency department physician in a safety net hospital, she's helped hundreds of patients register to vote and complete absentee ballots during the last several elections.

"If I can make time to do this in my busy practice, this can and should be done in our clinics and in our healthcare systems across the country," she said, calling on her colleagues to support the proposed policy.

However, Mary Campagnolo, MD, MBA, speaking on behalf of the New Jersey delegation, stated that "voting itself is more of a right and not necessarily meeting of the definition of a social determinant of health." She stressed that her group was sympathetic to the proposed policy, and collaborated on shaping the provisions related to the relationship between voter participation and health outcomes, but called instead for the AMA to acknowledge "access to voting" as a social determinant.

She added that gerrymandering is "a partisan effort and probably [has] never been a good thing," but "it never has really been shown to directly function as ... limiting healthcare." Campagnolo recommended that a portion of the resolution be removed or reworded.

Albert "Al" Osbahr III, MD, a delegate for the American College of Occupational and Environmental Medicine, who spoke on his own behalf, questioned the view of voting as a "social determinant measure," and whether "access to voting" is the real issue. He said he also was uncertain about links between health and gerrymandering, and recommended referral.

In response to the comments about gerrymandering, Hart noted on her own behalf that the " has studied and recognized the social political determinants of health involved in the process of structuring relationships, distributing resources, and administering health... in ways that mutually reinforce and influence one another to shape opportunities that advance health equity or exacerbate health inequity. Efforts to manipulate boundaries to support one political party or another have a direct [influence] on health outcomes and exacerbate health disparities."

"Many of the patients most negatively impacted by gerrymandering had a limited understanding of these impacts on their health," Hart added.

Eatman strongly opposed referral of the draft resolution and pointed out that gerrymandering "disproportionately affects people who are already disenfranchised ... and to add an allowance for embracing this process of gerrymandering is quite frankly unacceptable."

Leonard "Len" Lichtenfeld, MD, a delegate for the American College of Physicians, spoke on his own behalf in favor of the resolution and against referral.

"This is an urgent matter. Voting is a social determinant," he said. "I come from Georgia, and I will tell you to to repress the votes of people in the Black and Brown community -- so that they won't vote for their own welfare, their own health, their own status. [It] is absolutely reprehensible and inexcusable, and there's no excuse for what's going on."

"[Voter] intimidation is rampant," he added. "It is ramping up, and we have to stand strongly to say that 'This is not acceptable,' and if we can't say that intimidation doesn't affect social determinants, then shame on us."

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