Prescription for a healthy future—vote!

We’re re-featuring this piece as Election Day 2024 in the U.S. approaches.

As pediatric intensivists from across the country, we care for the most severely ill and injured children. Every day we see children recover from devastating disease or benefit from new and emerging treatments or technologies. But as Dr. Paul Wise said, as pediatricians, we’re also “the ultimate witnesses to failed social policy.” From our nearly 60 combined years of practice at academic and community hospitals across the country we have hundreds of stories and tragedies to illustrate that policy can be life and death for children: a child who committed suicide with an unsafely stored firearm, a child experiencing homelessness due to economic losses during the COVID-19 pandemic, an adolescent who committed suicide with the pink handgun given to her as a gift, a child from an immigrant family lacking access to healthcare who suffered a delayed serious diagnosis. Policies matter for our patients.

There’s significant and growing health disparity and inequity for children in the U.S. As clinicians who bear witness to those widening disparities and inequities, we have a responsibility to advocate for policies that can improve the health of all children. Gun violence is the second leading cause of death in the United States and is associated with increasing critical care resource use, yet we do not have adequate funding for research about firearm safety and injury prevention. Poverty is a major social determinant of health for children and increases the utilization of pediatric critical care. Black children have an increased risk of complications and mortality following surgery, even if they were healthy prior to the procedure. Our patients under the age of 18 can’t vote—we can. As pediatric intensivists, we have a responsibility to ask candidates who are campaigning for office what they’ll do to improve the health of children. Then we must vote. And we must hold those elected officials to the same standard of excellence that we demand of ourselves in the intensive care unit—because children’s lives depend on it.

The results of the upcoming election will determine how our country approaches the SARS-CoV-2 pandemic, racism, immigrant child health, e-cigarette use, climate change, access to health care, LGBTQ rights, gun violence prevention, graduate medical education, health insurance coverage, public education, access to housing and nutrition assistance, and myriad other issues affecting child health and well-being. In recent years, we have seen repeated attacks on Supplemental Nutrition Assistance Program (SNAP) and Children’s Health Insurance Program and a failure to address the factors that make these programs necessary. The substantial costs associated with pediatric critical care further burden families who are already financially strained, particularly as Medicaid and CHIP enrollment rates have declined leaving more children uninsured. Race, class, and gender shouldn’t make access to health care more difficult or increase mortality.

While many physicians see their work as having social purpose and even as a service to their communities, the data suggest that physicians are disengaged from civic life. Physicians are significantly less likely to vote than the general population and less than their socioeconomic position would predict and they are half as likely to have engaged in community volunteerism. Voting is a basic metric for civic engagement. While some professional organizations and institutions discourage or even prohibit influencing legislation and participating in political campaigns, most view civic engagement as a key aspect of medical professionalism. Indeed, one of the ways we can help all children (not just our patients), is through our civic engagement. Recent years have seen increasing interest in advocacy among pediatric trainees and the addition of advocacy education to standard curricula. More healthcare workers are adopting the narrative that good patient care requires advocacy for good social policy (#ThisIsOurLane #VoteKids). The American Academy of Pediatrics (AAP) has spearheaded a non-partisan “Get Out the Vote” campaign based on connecting health equity and voting. The AAP is collaborating with VotER to enhance voter registration among parents and teenagers. With this system, participants can securely and safely register to vote or request a mailed ballot from their smartphone in just a few minutes.

We must take our civic responsibility seriously. All healthcare professionals need to register to vote, verify their registration, get election reminders, and locate their polling places. We should make voting plans for ourselves, our colleagues, and our trainees, particularly with the complications expected due to the pandemic.

As pediatric critical care teams, we could write the “worst case scenario survival guide” for children. A key part of the survival of our future is civic engagement. This is a call to action for all medical teams to vote and facilitate voting for your trainees, your partners, and your patients. Call the candidates and ask questions. Once elected, call officials and advocate for issues that are important. Get involved in legislative advocacy. Testify, share the data and the stories that drive us. As Martin Luther King, Jr reminds us in his “Letter from a Birmingham Jail,” “We will have to repent in this generation not merely for the hateful words and actions of the bad people but for the appalling silence of the good people.” We are experts in health, voices for the voiceless, and it’s time for us to be heard.

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.