US doctors and hospitals offer a new treatment: voter registrationBMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3895 (Published 12 October 2020) Cite this as: BMJ 2020;371:m3895
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Doctors should espouse politics of 'health is wealth'
The BMJ feature "US doctors and hospitals offer a new treatment: voter registration" is quintessential democracy. It should be an eye opening lesson not only for doctors but every person from developing and middle income countries, for whom USA is a model of democracy.
In this context it becomes extremely relevant for all those, who now are frontline soldiers in the fight against Covid-19 pandemic in their respective countries, and where they have to brave all the odds like shortage of PPE, lack of optimal facilities, and safe environment to discharge their obligations to their patients. It is a reflection of a poor public health system, that has not been addressed for so many years by the respective governments. In a democracy, elections are an opportunity for the citizenry to exercise their right to vote and bring about change in the government. So, what is a vote: an indication of a choice between two or more candidates or courses of action, expressed typically through a ballot or a show of hands. But even if one is eligible to vote, one can't vote unless he/she is a registered voter. Therefore, the conduct of US doctors and hospitals is in sync with what Rudolf Virchow, the great German pathologist and statesman, said: "For if medicine is really to accomplish its great task, it must intervene in political and social life. It must point out the hindrances that impede the normal social functioning of vital processes, and effect their removal".
For the election to be meaningful, it is imperative that citizenry participate in this exercise with conviction and fulfil their obligation and repose their commitment to democracy. The review of voter turn out in the US presidential elections since 1908 suggest that barring a few exceptions it fluctuates between 50 and 60 percent . The natural question arises: 'who are those 50 to 40 percent citizen who don't vote?' Are these people not voting because they don't believe in democracy? This seems unlikely. Other reasons could be lack of understanding of the power of the vote, cynicism, or apathy towards procedural issues involved with the entire process leading up to voting on the day.
So, what about the role of doctors in the political process? American Medical Association policy says physicians have a responsibility to keep themselves informed and "to work for the reform of, and to press for the proper administration of, laws that are related to health care." And hence "It is natural that in fulfilling these political responsibilities, physicians will express their views to patients or their families." the policy says . The Medical organisations have differing views about discussing political advocacy for health with patients. For instance, the Royal College of Physicians and Surgeons of Canada supports advocacy, whereas the Canadian Medical Association doesn’t have policies or motions on the issue .
By all accounts, it is a settled proposition that health is a political issue. It is strongly argued that health and its promotion are profoundly political . However, it has not evoked a uniform but a varied response across the world, from being ignored by the political parties and public alike to surcharged politicisation of health as a key issue in an election. For instance, in the 1945 election, the Labour Party manifesto on health said, "By good food and good homes, much avoidable ill-health can be prevented. In addition the best health services should be available free for all. Money must no longer be the passport to the best treatment" . Similar sentiments were echoed by public health experts in India in 2014 that "Perhaps it is time to remind all parties that are seeking to govern the country that India’s health challenges are perhaps the greatest for any single nation in the world" . In fact in Australia, health policy was considered a vital factor in the outcome of the 2019 federal election . In the current US presidential election, a survey suggests that 79 percent people are of the opinion that economy is first among 12 problematic issues that will decide their votes, whereas health is next at number two with 68 percent . It needs to be underscored that economic crisis and health, in particular the Covid-19 pandemic, are organically linked: as the saying goes 'Health is wealth', and both have to be addressed simultaneously. Hence, the outcome of the US presidential election is going to be impacted by both these issues that has affected every American in some way.
Prof. L R Murmu,
Department of Emergency Medicine,
All-India Institute of Medical Sciences,
New Delhi-29, India
Dr. Sushimta Murmu,
Core Trainee, General Adult Psychiatry,
Pilgrim Hospital, Boston,
Lincolnshire partnership NHS Foundation Trust, UK
 Peeples L. US doctors and hospitals offer a new treatment: voter registration. BMJ 2020;371:m3895. doi: https://doi.org/10.1136/bmj.m3895
 Voter turnout in U.S. presidential elections since 1908. Statista Research Department, Jan 14, 2013 www.statista.com/statistics/262915/voter-turnout
 Arthur Delaney. Politics In The Doctor's Office?. HuffPost. September 27, 2009 https://www.huffpost.com/entry/politics-in-the-doctors-o_n_270513
 Lauren Vogel. Should doctors talk politics with patients? CMAJApril 23, 2018 190 (16) E520-E521; DOI: https://doi.org/10.1503/cmaj.109-5589
 Clare Bambra, Debbie Fox, Alex Scott-Samuel, Towards a politics of health, Health Promotion International, Volume 20, Issue 2, June 2005, Pages 187–193, https://doi.org/10.1093/heapro/dah608
 Health of the Nation and its Children. Labour Party Election Manifesto. www.labour-party.org.uk/manifestos/1945/1945-labour-manifesto.shtml
 Paul Vinod, Reddy K Srinath. For an all-party manifesto on health. The Hindu. March 18, 2014. www.thehindu.com/opinion/op-ed/for-an-allparty-manifesto-on-health/artic...
 Tony Bartone. AMA Federal President. Health Issues for the 2019 Federal Election. April 11, 2019.https://ama.com.au/article/key-health-issues-2019-federal-election.
 Important issues in the 2020 election. August 11, 2020.https://www.pewresearch.org/politics/2020/08/13/important-issues-in-the-...
Competing interests: No competing interests
We commend VotER and other healthcare provider-driven voter registration efforts. Like the authors, we feel strongly that policy often impacts the health of our patients more than the treatments we provide. As unique links to people from all walks of life—especially those who historically have been underrepresented in our democratic process and suffer most from structurally rooted health inequities—health care providers can play a crucial role in empowering our patients and communities to vote.
However, we often overlook our own colleagues. Physician voter turnout has been embarrassingly low in previous elections. An oft-cited paper reports that the physician voting rate was 9 percentage points lower than the general population and 22 percentage points lower than lawyers in 1996-2002 . More recent estimates are unknown but likely similar. Providers and trainees consistently cite lack of time given the demands of their working schedules to vote. Medical students have specifically cited rigid clerkship schedules as a reason why they did not vote in 2016 .
We believe that providers’ lack of civic engagement stems from lack of institutional support from healthcare employers. Hundreds of companies in other industries have pledged to give their employees paid time off to vote in 2020, yet no large physician group or hospital has publicly pledged to do so, to our knowledge .
Our patients’ voices are important, but so are ours. We see the effects of gun violence in our trauma bays, the effects of uninsurance in the emergency department, and the effects of public health underfunding on COVID cases in the ICU. Voting is key to taking care of our patients not only on an individual level but also on a societal level.
We hope that any health care organization leaders reading this letter will strongly consider giving providers and trainees a staggered, two-hour window to vote on or before November 3rd. As providers, we need to be advocates beyond the clinic room. Establishing protected time to vote demonstrates our steadfast commitment to the community we serve.
 Grande and Armstrong (2016). Annals of Internal Medicine https://www.acpjournals.org/doi/10.7326/M16-2470
 Gondi, Kusner, and Berlyand (2018). STAT News. https://www.statnews.com/2018/10/08/doctors-voting-no-shows-election-day/
 See https://www.electionday.org/
Competing interests: No competing interests