Through the Lens of Public Health: Voter Suppression and COVID-19

A National Guardsman, activated to assist as a poll worker, processes absentee ballots in Wisconsin’s April election. Wisconsin’s decision to go ahead with its election was widely criticized, in part because the risks of both infection and disenfranchisement disproportionately impacted minority voters. Wisconsin National Guard photo by Specialist Anya Hanson.

COVID-19 is new. Our bodies have neither inherent resistance nor immunity to it, and it is hard to tell what full recovery looks like. Voter suppression isn’t. Rooted in elitist ideology, racism, and discriminatory beliefs about who ought to have a say in the elected officials who run this country, it is as old and pervasive as the practice of voting itself, impacting all levels of government from municipal to federal. America has reached a point at which voter suppression is cresting a peak—just like this novel coronavirus. It is cyclical, like a virus, in that it surges when conditions are ripe for its growth, attacking the most vulnerable. Widely dismissed and ignored by politicians and laypeople alike for whom it is of less importance and perhaps even beneficial, reports of voter suppression are coined a “hoax” elaborately crafted by liberals seeking electoral gains in upcoming elections. Most critically, both the COVID-19 pandemic and voter suppression are particularly and disproportionately fatal to minority and at-risk populations in ways that have gone largely unnoticed and unaddressed. They are seldom discussed in the same sentence or news segment. COVID-19 is a public health crisis. Voter suppression is political. Both are usually seen as entirely disparate crises with little overlap, rooted in different societal conversations around agency and power.

But what if you looked at both through the same lens?

Let us consider, for a moment, the crisis of voter suppression from an epidemiological standpoint. And let me be clear: voter suppression is an epidemic. It is widespread. Governors and elected officials in both conservative and liberal-leaning states have deployed initiatives like gerrymandering, proof of citizenship, and inactive voter purging in an effort to restrict all eligible voters from casting their ballots come election day. Voter suppression destabilizes particularly vulnerable populations—low-income people of color most of all—and will not simply disappear with benign neglect or wishful thinking. The ways in which leaders have addressed—or ignored—it have been both passively and actively malicious. 

Voter suppression and COVID-19 are not two individual catastrophes. Their combination compounds the effect of each: this is a syndemic. Coined by anthropologist Merrill Singer in response to the H.I.V./AIDS epidemic amidst the concurrent emergence of other public health crises, a syndemic refers to the occurence of multiple epidemics that simultaneously exacerbate each other. Consequently, syndemics must be approached as a collective issue. You cannot simply solve for one public health crisis without confronting the other—it is a futile effort to do so. Viewing COVID-19 and voter suppression as a syndemic thus necessitates an approach that addresses both issues simultaneously. One of the key facets of disease management is the identification of a vulnerable population. For COVID-19 and voter suppression, this subset of people is largely the same—African Americans. 

Black voters are the backbone of the Democratic Party. Although only categorically having had the right to vote for 55 years, they are perhaps the most consistent population of liberal voters in modern American history. In each presidential election since 1964, the results have been staggering—turnout has been consistently between 50 and 60 percent among black voters. While this statistic is nearly identical for their white counterparts, it should be noted that the percentage of black voters would likely be higher in the absence of stringent voter suppression initiatives intended to suppress the minority vote. Moreover, black people have identified as Democratic or liberal between 70 to 95 percent in each election. These numbers differ significantly from white voters, who are generally evenly split amongst liberal and conservative support. When high turnout and astronomical support for the Democratic Party occur simultaneously, liberal candidates in areas with high populations of African Americans nearly always emerge victorious. 

Conservative politicians only have one effective tool in their wheelhouse to curb this liberal success: voter suppression. It appears now that they have another tactic to add to that arsenal—avoiding the gravity of the coronavirus pandemic within communities of color. Republicans have generally been hostile to sweeping public health measures and access to equal health outcomes. This is not to say that they universally wish poor health upon black people in America. It is, however, a reflection of the fact that the G.O.P. does not view health among minority populations as a critical issue requiring urgent attention. It is both a manifestation of limited government and an intentional avoidance of issues that disproportionately affect people of color—voters who likely will cast their ballots for their liberal opponents. Conservative politicians in the past few weeks have sought to pin the blame on black communities, claiming that increased rates of heart disease, diabetes, and obesity are circumstantial and reflective of their own personal decisions. Moreover, they pay little attention to the fact that for autoimmune disorders and diseases that have little to do with life choices and a lot more to do with systemic racism, the rates among black people in America are astronomically and disturbingly high. 

A list of pertinent statistics would easily triple the word length of this piece. A few, however,  best highlight the gravity of racial health disparities. Notably, black children are 500% more likely to contract asthma than white children. Women of color are between two and three times more likely to develop lupus. Sickle cell anemia, which is a considerable comorbidity for COVID-19, is a disease to which African Americans are genetically predisposed by no fault of their own. It is consequently a combination of embedded health disparities as well as social determinants that have little to do with choice and are instead reflective of racially discriminatory policies and practices that limit access to healthcare and opportunity for black people. Poor quality of air and lack of adequate air quality regulation induces asthma. Food deserts in marginalized communities eliminate the possibility of healthy eating. Low wage and essential jobs often lack basic healthcare benefits and reasonable hours, requiring employees to work themselves into exhaustion. Many cannot afford the expense of a baseline yearly physical, nor simple procedures and operations that might help to mitigate future comorbidities like heart disease, hypertension, and diabetes. Astronomically high housing values in major cities like New York and San Francisco have left many lower-income residents—especially those of color—with no choice but to overcrowd themselves into small spaces for the sake of affording rent. Simply put, the confluence of these factors facilitates an environment in which poor health outcomes among majority-black populations are simply inevitable. Any effort to discuss health disparities without considering the aforementioned conditions that together comprise the fabric of systemic racism will only exacerbate the problem itself. 

Herein lies another critical similarity between the COVID-19 pandemic and voter suppression in America: black Americans hold no culpability for either issue. The social determinants into which they are born and live dictate the circumstances of their lives. Zip codes that are gerrymandered in ways that benefit conservative candidates are often the same communities with food deserts, high unemployment rates, and few hospitals or healthcare facilities. Voting access and health care disparities—as well as the adverse outcomes they precipitate—are inexorably linked.

Executives, college students, and corporate employees can teleconference all day. Postal workers, grocery clerks, and sanitation employees, who perform essential functions for those who remain at home, cannot. Single-family homes proffer space to effectively distance from each other. It is difficult to safely keep distance in small homes or apartments with large or multiple family units cohabiting. Most people of color do not have the luxury of staying at home to avoid this pathogen despite increased risk to lethally contract COVID-19. Most of these essential workers, notwithstanding this virus, are already perilously close to the poverty line. One missed paycheck can send their finances into a tailspin. The inevitable interactions between essential workers, many of whom are crowded into warehouses and small stores, are likely the primary source of infection. Meat processing plants—take the Tyson Foods warehouse in Waterloo, Iowa, for example—have been forced to close as the virus has knocked their workforce on its knees. First responders and nurses, exposed to the virus daily, risk taking the virus home to their families—often with tragic consequences. The great irony is that their jobs aren’t just critical to their own survival, but all of ours as well. Essential workers are the foundation of our communities—bagging our groceries, collecting our waste, keeping our hospitals clean and trains running. They are on the frontlines of this pandemic. They are our lifeline in this crisis. Like a syndemic, their civil liberties and health are bound tightly to each other. Holding an essential job already poses a difficulty to voting on a Tuesday. Taking time off from driving a bus or bagging groceries isn’t particularly feasible. Showing up to work, day after day, in the midst of this crisis endangers one’s right to a clean bill of health. 

The inequity exists even deeper within the healthcare system. Black patients are typically expected to have a higher threshold for pain, as well as a propensity to mischaracterize or exaggerate how they are feeling. Doctors ignore and minimally treat many black patients, even when they demonstrate life-threatening symptoms. Black people are, consequently, deeply skeptical and fearful of medical professionals, believing that they are likely to be worse off if not wholly ignored if they seek medical assistance. On top of this, the healthcare conundrum in this country exists in a way that makes it nearly impossible for many low-income people of color to obtain reliable health insurance. A simple trip to the doctor’s office can result in a bill worth a couple thousand dollars. This is a steep disincentive to seeking medical attention for potential symptoms, as a negative test will confer a bill that is likely insurmountable for many essential workers. and low-wage earners. Going to the hospital for many simply isn’t an option. But dying shouldn’t be either. 

The novel coronavirus is not the first pathogen to run rampant through black communities. It likely will not be the last. In just the same way, we are likely to witness future waves of voter suppression. Only now does the gravity of this pandemic fully bring to light the intense disparities that predate this pandemic, inspiring difficult conversations and fierce advocacy that has been long overdue. America writ large is now starting to see these disparities manifest themselves in black communities across America. particularly in those that will likely determine the outcome of the 2020 general election. States like Michigan, Illinois, and Wisconsin have highly concentrated black populations that all but determine to whom the electoral votes go—Democrat or Republican. In Milwaukee, for example, black people make up 70 percent of those who have perished from COVID-19, but comprise just below 30 percent of the population. The virus itself started in a wealthy, minority white population but quickly took hold in poorer black communities. Even more disturbingly, blacks in Detroit make up 40 percent of those who have died from COVID-19, but represent just under 15 percent of the population in Michigan’s largest city. In the entire state itself, black people have died eight times more often than their white counterparts from this disease. Compounding this, restrictive laws around voter ID registration, early poll closing times, deliberately confusing requisites on Election Day, and lower concentrations of polling places in majority black communities have historically worked in suppressing the black vote. The few polling places that will open on Election Day, if any, will likely see long lines if mail-in ballots are not made ubiquitous. The consequences on a public health scale will be dire—we need not look any further than Wisconsin’s recent primary election. 

Democrats and Republicans alike acknowledge the value black voters hold in elections. They propelled Barack Obama through the democratic primary and, eventually, to the presidency in 2008 and 2012. They voted Doug Jones, a Democrat, into office in deep-red Alabama in 2018. They single handedly revitalized Joe Biden’s presidential campaign with a formidable showing in South Carolina. This trend will continue, but only if black voters can turn out and vote as they historically have. 

Demonstrators march against voter suppression in 2011. Photo by Michael Fleshman.

Identifying the concurrence of COVID-19 and voter suppression as syndemic is a critical step in the right direction. The real work, however, begins with developing a roadmap to recovery. I propose four critical tasks in an effort to neutralize the adverse effects on communities of color: Firstly, public health experts and community leaders must identify at-risk populations and their associated comorbidities. Which majority-black zip codes have the highest concentration of heart disease patients, high density, and few polling locations? What is the data around heart disease, lupus and sickle cell anemia? Secondly, I propose a widespread effort to establish trust in healthcare professionals and election officials. Perceived prejudices within the medical community prevent many black people from seeking treatment. Addressing COVID-19 cases must be a two-way street in which healthcare practitioners and potential patients are eager to seek one another out if necessary. Efforts to ensure safe voting practices must also take place so voters who might ultimately face the task of voting in person will feel as though they will not have to risk their lives to cast a ballot. Thirdly, protective equipment and testing must be rapidly and widely deployed. It does not take a public health professional to understand the urgency of this goal. Without gloves and masks, the pathogen is easily transferred between unsuspecting hosts. Without testing, we know little about just how pervasive this virus might be. Say, for example, whether or not it has ravaged an entire grocery store staff, or half of a sanitation department. Finally, lawmakers and activists alike must undertake a strong, unified effort to offer alternatives to voting in person. For those for whom voting by mail will prove difficult, city and state governments must work to ensure that in-person polling places are sanitized and organized in accordance with public health guidelines to prevent anyone from contracting the disease waiting in line, filling out a ballot, or utilizing a machine. 

The syndemic of voter suppression and COVID-19 requires a response that specifically targets health disparities amongst black communities in America by providing the necessary resources to combat this disease and its comorbidities in low-income and minority neighborhoods and expands the existing voter framework to accommodate those who may legitimately fear the act of in-person voting over the next few months, or will be unable to do so in the event they fall ill. If we allow this virus to continue its devastating course through minority populations, the task of constructing this framework will be insurmountably demanding and perhaps impossible. Conversely, a significant voter turnout effort will be rendered needless if the voters it is designed to prioritize have perished. Subjective social determinants are critical to understand and account for. Objective empirical data, however, will prove to be a critical infrastructure upon which to build a strategy to save lives and ensure high, legitimate voter turnout from now on.

Aja Johnson is a junior at Columbia College studying History and African American Studies. She has a keen interest in unearthing, mitigating, and solving public health inequities, especially for black women in America. She is from Washington, D.C. and enjoys English breakfast tea, music documentaries, and keeping an eye out for the newest Jordan Brand shoe release.

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