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Civic Engagement: A Vital Sign of Health and Democracy

By Philip M. Alberti, PhD, Founding Director; Carla S. Alvarado, PhD, MPH, Director of Research; and Heather H. Pierce, JD, MPH
Sept. 26, 2022
Policy Matters

Civic engagement has been shown to have a positive impact on the health of people and communities, providing health care institutions with opportunities to help people become more civically engaged.

  • Trusted institutions like hospitals can increase voter registration by acting as a registration site and by implementing policies that encourage employees, trainees, patients, and community members to be engaged, including employer-sponsored time off for volunteering or community service.1

  • For those people who feel unengaged or do not believe that voting makes a difference, effective civic education tools include experiential opportunities like community service, debate, and other simulations of the democratic process to reinforce text-based learning.2

  • Results of a new poll indicated that making voting easier would make more people vote. State-based policies such as offering voting by mail, maintaining or increasing the number of polling sites, and allowing longer periods for early voting can improve accessibility and voter turnout. 

  • Engaging communities by ensuring that voter and volunteering information is available in languages other than English can increase access to civic engagement opportunities.3

Civic engagement means promoting the quality of life in a community4 through activities both political (e.g., voting, organizing) and non-political (e.g., local team sports, volunteerism). In the U.S. and across the world, people who are civically engaged derive direct mental and physical health benefits5,6,7,8and collectively, civically engaged communities enjoy higher degrees of social trust, social cohesion, and resource sharing — all feeding a virtuous cycle that generates even more civic participation.9 There is broad agreement that civic engagement improves individual and population health and it is acknowledged and operationalized in frameworks such as The Seven Vital Conditions for Health and Well-Being and the U.S. Department of Health and Human Services’ Healthy People 2030

Despite these benefits, according to an August 2022 AAMC Center for Health Justice poll,10 only 56% of U.S. adults consider themselves somewhat or very civically engaged. Adults with high income (≥$100k) and with a bachelor’s degree or higher are more likely than members of other groups to report being civically engaged.

Civic Engagement is more commonly reported by the highly-educated and the affluent.
Figure 1

We asked about civic engagement across an array of civic activities, including voting, donating money, and contacting an elected official. Voting was the most reported activity by those polled.

In the past two years, respondents were most likely to vote compared to other civic engagement activities.
Figure 2

 The 44% of U.S. adults who self-identified as “disengaged” reported that they would be more likely to engage if they had the time (21%), held strong beliefs about something (21%), or, most crucially, knew their participation would make a difference (41%). For the 19% of adults in our sample who did not vote in the 2020 presidential election, top responses to what would increase their likelihood of voting in future elections were if they liked the candidates (28%), if they could vote by mail (18%), or if voting locations were closer to where they worked or lived (11%). Still, a very frequent response was the choice, nothing would make me more likely to vote (27%). These responses point to policy solutions like civics education11 and paid time off to volunteer or vote, for example, that would facilitate and encourage (re)engagement in civic life [See Policy Matters above].

76% of U.S. adults polled say that voting can have an impact on their communities.

More than a quarter of adults who did  not vote in the 2020 election said there's nothing that would make them more likely to vote.
Figure 3

Nonpartisan campaigns, initiatives, coalitions, and organizations like the Civic Health AllianceHealthy Democracy Healthy People, VoteHealth, and Vot-ER have recently emerged to work with health and health care organizations to educate staff, providers, and patients alike about voting registration with the aim to foster an inclusive democracy. Vot-ER, for example, has expanded its reach to initiate the voter registration process for 46,000 individuals at 715 sites across the country, including members of historically underrepresented groups such as Black and Hispanic/Latino/a/x adults and younger voters.12

Despite these evolving efforts and the high level of community trust in health care organizations like hospitals and pharmacies, only 37% and 38%, respectively, of U.S. adults perceived such organizations as appropriate facilitators of voter registration and a considerable portion (16%) said they did not know or had no opinion. Poll respondents were more comfortable with libraries (77%), universities (69%), and fire stations (61%) — institutions with long traditions of supporting civic engagement — facilitating voter registration. These findings point to the opportunity to educate communities about the role that health care organizations can play in civic engagement.

Libraries, universities, and fire stations were most viewed as appropriate locations to offer voter-registration services.
Figure 4

While many U.S. adults do not yet see the health care sector playing a role in civic engagement activities like voting registration, such efforts would not negatively impact adults’ trust in health care organizations: a full 69% said there would be no change in their trust should hospitals work to promote voter registration, and 15% said their trust would increase. In fact, 28% of Black respondents and 22% of younger adults (ages 18-44), members of communities that often report the least amount of trust in health care institutions,13 said their trust in hospitals would increase if they offered voter registration services, pointing to health care action in civic engagement as an important strategy to demonstrate trustworthiness and promote health equity.

Black, younger, and urban-dwelling adults were more likely to say their trust would increase if hospitals or pharmacies would provide voter-registration services.
Figure 5

 To build an inclusive democracy, civic engagement must be inclusive too. Given the beneficial impact of civic engagement on the health of individuals and communities, health care organizations have the opportunity to increase health and wellbeing — and to prove trustworthiness to their communities — by encouraging and facilitating participation in these activities. Learn more about encouraging civic engagement with the resources below.

Download the One Page Summary

1Only 26% of employers in the U.S. currently grant time off for employee volunteering or community service. See the Society for Human Resource Management. Employee Benefits Summary 2019. https://www.shrm.org/hr-today/trends-and-forecasting/research-and-surveys/documents/shrm%20employee%20benefits%202019%20executive%20summary.pdf.  
2For more information, see the National Education Association, Forgotten Purpose: Civics Education in Public Schools. https://www.nea.org/advocating-for-change/new-from-nea/forgotten-purpose-civics-education-public-schools.
3United States Department of Justice. About Language Minority Voting Rights. https://www.justice.gov/crt/about-language-minority-voting-rights.
4New York Times. The American Democracy Project. The Definition of Civic Engagement.  https://archive.nytimes.com/www.nytimes.com/ref/college/collegespecial2/coll_aascu_defi.html?scp=2&sq=The%2520Engagement&st=cse.
5Nelson C, Sloan J, Chandra, A. Examining Civic Engagement Links to Health: Findings from the Literature and Implications for a Culture of Health. Santa Monica, CA: RAND Corporation;  2019. https://www.rand.org/pubs/research_reports/RR3163.html.
6Brown CL, Raza D. Pinto AD. Voting, Health and Interventions in Healthcare Settings: A Scoping Review. Public Health Rev; 41(16). https://doi.org/10.1186/s40985-020-00133-6.
7Abbott S. Social Capital and Health: The Role of Participation. Social Theory & Health. 2010;8(1):51-65.
8Kim S, Kim CY, You MS. Civic Participation and Self-Rated Health: A Cross-National Multi-Level Analysis Using the World Value Survey. J Prev Med Public Health. 2015;48(1):18.
9National Research Council. 2014. Civic Engagement and Social Cohesion: Measuring Dimensions of Social Capital to Inform Policy. Washington, DC: The National Academies Press. https://doi.org/10.17226/18831.
10A nationally representative sample of 2210 adults were polled on August 6-7, 2022, by Morning Consult.
11Brookings Institution. The Brown Center Chalkboard. https://www.brookings.edu/blog/brown-center-chalkboard/2018/07/23/what-does-civics-education-look-like-in-america/.
12Vot-ER Impact Report (shared with the AAMC Center for Health Justice).
13Center for American Progress. Why Young, Minority, and Low-Income Citizens Don’t Vote. https://www.americanprogress.org/article/why-young-minority-and-low-income-citizens-dont-vote/