This Is How Racial Health Inequities Undermine Democracy

This article was originally published by the National Center for Institutional Diversity (NCID) at the University of Michigan.

Photo by  Maatla Seetelo  on  Unsplash

The United States touts a “free and fair” democracy, yet health inequities that stem from deeply entrenched systems of racialized oppression suppress the vote of millions of people of color at polls throughout the US. The United States is predicated on racial capitalism, a term coined by Black studies scholar and political scientist Cedric Robinson, in which white individuals and institutions have exploited non-white populations to acquire wealth and resources for centuries. Mechanisms of exploitation include slavery, state-sanctioned surveillance and violence, imperialism, and genocide. These systems have resulted in the poorer health of Black US citizens through a constellation of inter-locking means, including residential segregation, systemic discrimination, poverty, and other ways of reducing access to economic, social, and political capital. In this piece, I describe how these systems undermine Black people’s collective enfranchisement by systematically degrading their health.

Black Health Inequities

In the US, Black people have drastically higher rates of sickness and death compared to most racial and ethnic groups. This disturbing trend has endured since documented in WEB DuBois’s pioneering work The Philadelphia Negro: A Social Study (1899), in which he attributes the poorer health of Black people to their social conditions. According to a 2017 report from the Centers for Disease Control and Prevention (CDC), Black people under the age of 65 years had higher levels of chronic disease morbidity and mortality compared to their white contemporaries. Further, chronic diseases, like cancer, heart disease, and diabetes, are commonly found among people much older, hence Black people are sicker and more likely to die at younger ages than their white counterparts. Rigorous studies and extant scholarship spanning the last twenty to thirty years have consistently linked the poorer health of Black people in the United States to structural inequities based on racism and poverty, such as residential segregation, mass incarceration, and systemic racial discrimination and bias. This premature death due to excess illness and disability — as well as homicide, state-sanctioned police killings, and mass incarceration — weaken Black political power simply by reducing the number of Black votes.

Researchers have linked the early mortality of Black people to the loss of Black voting power. A 2011 Washington Post article, based on a study by the same authors, highlights that nearly 3.9 million Black votes are missing due to excess mortality and mass incarceration combined. The authors argue, “Disproportionately high rates of early death and incarceration mean more blacks go ‘missing’ from the electorate, and these people cannot make their voices heard in politics.” The authors found a national disenfranchisement rate of 13.2%, with missing votes concentrated in the Southeast states of Alabama, Florida, Kentucky, Tennessee, and Virginia. These states have Black disenfranchisement rates between 20.7 and 24.3%. The fact that the states that have the highest disenfranchisement rates due to excess Black death also share a history of suppressing the Black vote through more explicit means is not coincidence — the two mechanisms work in lock-step.

Photo by  Jakob Owens  on  Unsplash

Photo by Jakob Owens on Unsplash

Disenfranchising the Black vote

The history of rigging elections to suppress the Black vote in the Southern states goes back to the aftermath of the 13th, 14th, and 15th amendments, which freed enslaved Black people and granted them citizenship and protection of their rights, including the right to vote. In One Person, No Vote, Black studies scholar Carol Anderson discusses the history of suppressing the Black vote by white supremacist power structures in the South. She writes that the Mississippi Plan of 1890, which would later be adopted and refitted across many states, was an “intentionally racially discriminatory plan” devised to strip away Black people’s right to vote through the use of “a dizzying array of poll taxes, literacy tests, understanding clauses, newfangled voter registration rules, and ‘good character’ clauses.” These coordinated efforts followed the rise of Black political power during Reconstruction in the Southern states and complemented the systematic neglect of Black people and their institutions. For example, the systematic underfunding of schools produced populations of Black people who could not pass the discriminatory literacy tests in order to vote.

Today, there is no shortage of policies that disenfranchise a range of members of Black communities, whether overtly through policy requirements or covertly through thinly veiled efforts to prevent “voter fraud.” Contemporary methods of voter suppression, like voter ID laws and voter registration policies, make casting a ballot confusing, difficult, and inconvenient. Voting is anything but “free and fair” when populations that are already burdened with disability, illness, and poverty must wait in longer linestravel farther distances, and contend with hassles before reaching the ballot box. According to one analysis of state elections from 1996 to 2016, the time an individual must spend to cast a vote was higher in eight of the ten states with the highest percentage of Black residents. In the United States, where a great proportion of Americans, particularly Black Americans, are impoverished, lack access to safe and affordable housing, healthy food, adequate transportation, and affordable health care, voter suppression laws are demoralizing and make the cost of voting burdensomely high.

Health Inequity and Voter Suppression go Hand-in-Hand

The United States — with its vast amount of wealth, power, and resources — can address and eliminate the health inequities that undermine its democracy, yet it continually fails to do so. Perhaps this failure is due to the fact that the systematic disenfranchisement of Black people has been present since the inception of the United States and has served as its source of wealth and power. That is, Black disenfranchisement is woven into the collective consciousness of even those individuals and institutions who mean well, both through policies that limit voting access and policies that shorten lives. There can be no true democratic system in the US when preventable illness and death keeps millions of Black voters from exercising their rights to vote and voter suppression is a blatant occurrence. In order to be a true democracy, the United States should reckon with its past and relinquish the racist and capitalist systems that fuel health inequities.


Akilah Wise is a writer and postdoctoral research fellow at Emory University Rollins School of Public Health, where she studies place-based correlates of HIV risk-related behaviors among people who inject drugs. She is also a member of the Diversity Scholars Network at the National Center for Institutional Diversity.