Public Health on the Ballot: A Review of Local Initiatives

By Catherine D. Patterson, MPP

I love to vote. I remember going to vote with my mom as a kid. We’d wait in line, get her ballot, and then cram into one of those make-shift booths behind a flimsy curtain. I’d watch her fill in each oval, curious about the hushed tone that lay over the entire room (usually a school gym). Once finished, she’d let me hand her ballot to the local poll worker, and then I’d proudly stick out my chest for a coveted “I voted” sticker. I still get a ridiculous amount of satisfaction when I get one of those stickers.

At the de Beaumont Foundation, we believe that the community conditions in which people live impact health. CityHealth, an initiative of the de Beaumont Foundation and Kaiser Permanente, provides cities with a curated list of policies that are proven to make cities healthier places to live, work, and do business. CityHealth rates the performance of each of the 40 largest cities on the following nine policy recommendations: access to high quality pre-K, paid sick leave, safe streets, affordable housing, Tobacco 21, alcohol sales control, restaurant grading, healthy food procurement, and smoke-free environments.

Given what we now know about what actually contributes to overall health, choices about local policies become an opportunity for residents to vote for better health. While access to healthcare is important, it is not sufficient. For the upcoming election, I reviewed ballot measures in the nation’s 40 largest cities. What are city residents being asked to consider? And which measures will affect public health? Here’s what I found.

Four cities (Austin, Baltimore, Charlotte, and San Francisco) have housing measures on the ballot. Most of these are bond initiatives attempting to make housing more affordable. San Francisco’s Measure C is proposing to tax local businesses in order to provide the funding to house the city’s homeless residents.

These local measures could have a major impact on community health. Affordable housing has been shown to be associated with improved health outcomes, and having access to quality, stable housing reduces exposure to environmental toxins and has positive benefits for mental health.

At least four cities have education initiatives (Dallas, Indianapolis, San Diego, and Seattle). Dallas voters are deciding whether to increase taxes to pay for certain programs, such as early childhood education. Done right, pre-K can have significant effects on kids.  Pre-K participants have shown increased rates of immunizations and screenings, regular visits to the doctor, and routine dental care. Long term, children who attend high quality pre-K programs show increased high-school graduation rates, complete more years of education, have higher earnings, and show reduced rates of crime and teen pregnancy.

Denver has a local tax initiative that would provide fresh, healthy food to low-income children. The tie to health here is very clear, and this effort complements a recent executive order from Mayor Hancock to adopt a healthy food procurement policy for vending machines on city property.

Chicago voters are being asked to consider both earned sick leave and raising the minimum wage (both of which have been shown to improve health outcomes). However, these measures are nonbinding and are purely being used to gauge public opinion about the issues.

Local decisions can have an outsized impact on communities. The choices that voters will make on Nov. 6 will have an effect on the health and well-being of our nation’s communities. While some of these local ballot initiatives may not look like a traditional public health interventions, there is no doubt that evidence-based policies are essential for achieving better health for all.

I look forward to reporting back after the election to let you know the voting results for these and other issues.

Catherine Patterson is Managing Director of Urban Health and Policy at the de Beaumont Foundation.