Journal Article

Safeguarding Infant Lives: The Unappreciated Effects of Voting Rights Enforcement

Rhodes, Jesse H.

2024

Overview

There is mounting evidence that increased voting and political participation are associated with improved public health, and the erection of barriers to voting can have deleterious public health consequences.1,2 Yet over the past two decades, access to the ballot has become a contentious issue with strong partisan and racial overtones. Claiming (without evidence) that US elections are marred by widespread voter fraud, many Republicans, including former president Donald Trump, call for \"election security\" measures, such as voter ID laws, that make registration and voting more difficult.3 Meanwhile, many Democrats contend that such measures alm to suppress the legitimate votes of people of color and advocate instead for policies like same-day registration and all-mail voting that expand ballot access.4 This ideological divide has manifested at the state level, with Republican-controlled states imposing new barriers to voting and Democrat-controlled states adopting policies that enhance access to the ballot.5 Recent research suggests that state partisan polarization in ballot accessibility may have contributed to interstate inequalities in public health outcomes in critical areas such as COVID-19 case and mortality rates.6Partisan and geographic polarization in ballot access has been exacerbated by a conservative retrenchment in voting rights jurisprudence on the US Supreme Court. Since the 1970s, and accelerating between the 2000s and 2020s, the court's decisions have gradually eroded the Voting Rights Act (VRA), the most important federal voting rights law.7 In Its landmark decision in Shelby County v Holder (2013), the court invalidated a crucial provision requiringjurisdictions with histories of racial discrimination in voting to seek federal approval for proposed changes in their election laws.8 The elimination of this preclearance requirement has made it easier for Republican governments in previously covered states to erect new barriers to voting that may disproportionately burden voters of color.9Scholars are just beginning to grapple with the public health implications of the erosion of the federal government's capacity to enforce voting rights for communities of color. In this issue of AJPH, Rushovich et al. (p.300) shed light on this matter by appraising the historical impact of preclearance on infant mortality among African Americans and White Americans. Using data from 1959 to 1980, they applied differencein-difference methods to examine preto post-VRA changes in deaths both in counties that were required to submit proposed changes in election laws and in comparable counties that were not subject to this requirement. What difference did preclearance have on infant mortality?According to the authors, preclearance made the difference between life and death for thousands of African American infants between 1965 and 1980. African American infant deaths in preclearance-exposed counties decreased by 11.2 additional deaths per 1000 population of individuals younger than one year beyond the decrease experienced by unexposed counties between the pre-VRA period (1959-1965) and the immediate post-VRA period (1966-1970). This translates to 17.3% fewer African American infant deaths during this period than would have occurred in the absence of the federal preclearance requirement. The authors also reveal the longer-term impacts of preclearance by showing that African American infant deaths per 1000 population younger than one year in preclearance-exposed counties continued to decrease more swiftly relative to unexposed counties between 1971 and 1980. Notably, the beneficial effect of preclearance on infant survival was concentrated among African American infants, with no significant differences among Whites or the total population.

• Publisher: American Public Health Association
• Subject: Access / African Americans / Babies / Ballots / Barriers / Changes / Civil Rights / Counties / COVID-19 / Deaths / Election law / Elections / Elimination / Enforcement / Erection / Fatalities / Federal government / Fraud / Health disparities / Health status / Humans / Inequality / Infant mortality / Infants / Jurisprudence / Mortality rates / Partisanship / Polarization / Policies / Political activism / Political participation / Political parties / Political power / Politics / Presidents / Public health / Public participation / Racial discrimination / Racism / Registration / Supreme courts / Voter fraud / Voter registration / Voters / Voting / Voting rights / Voting Rights Act