Civic participation and public representation have strong, though indirect, connections to health. The recommendations in this Policy Action Area are tied to initiatives that can help improve public participation in democratic institutions and help build social trust and power.

Everyone should be able to contribute their voice to the political process and to participate in their communities. Voter participation is an indicator of both social power and social cohesion.

Communities with higher rates of voter participation typically have more social and political power than other communities and are often better positioned to successfully influence the local conditions that shape health.

 For instance, communities may advocate for beneficial social programs and education, or against the location of toxic facilities in their neighborhood. Voting is one important way in which social power is exercised in California, but far from the only one. Economic or institutional influence and community organizing can also influence community conditions. Yet there are few data sources, and none at the census tract level for the entire state, that measure these other mechanisms, leaving voter participation as an imperfect but necessary proxy.

Voting can also be an indicator of social cohesion, or the trust, relationships, social support and participation in a community or society. A number of studies, including several in California, have drawn connections between social cohesion and health.

 Social cohesion has also been found to be health protective during climate events and other disasters, helping people and communities respond and recover.

 Like social power, there are currently few data sources, and none at the census tract level for the entire state, that provide an adequate picture of social cohesion.

A longitudinal study of over 9,000 youth released in 2018 found a positive association between civic engagement (defined as voting, volunteering and activism) and income and education levels later in adulthood

; both are factors that can influence one’s health. In California, voter participation rates are inequitably distributed, with Latinos and Asians voting at much lower rates than other racial and ethnic groups, due to gaps in citizenship, voter registration and voter turnout. Other measures of political participation, such as engagement with elected officials, and participation in campaigns, meetings, protests, or consumer activism show similar patterns, reflecting broader inequities in political power.

Voting

Everyone should be able to contribute their voice to the political process and to participate in their communities. Census participation is an indicator of both social power and social cohesion.

The United States’ system of electoral representation has been rooted partially in the Decennial Census. The Constitution formally established population as the basis for sharing political power rather than wealth or land.

 The allocation of the 435 seats of the U.S. House of Representatives is based on the population of people in each state. Within each state, electoral districts are redrawn based on where the population is distributed within each state. The implementation of the Decennial Census has – like much of the institutions in the United States has evolved from its original implementation. Throughout much of history in the United States, the Census was applied to protect the status, power, and wealth of White landowners. The activism of the Civil Rights movement was a catalyst for the Census to 

 as being utilized as a tool for racial inclusion rather than exclusion. 

For the Decennial Census to be most effective for distributing federal power, communities must participate to the greatest extent possible to receive fair representation. With proper representation comes the social and political power to influence vital community conditions that affect health.

Not only does the Census help determine political power, but its results also help determine how hundreds of billions of dollars of federal funding are allocated by Census tract for the next decade. This money is used for schools, hospitals, roads, and public works, all of which are essential determinants for individual and community health outcomes.

 If a community has been undercounted in the Census, it will not receive its equitable share of federal, state, and local funding.

Census participation has also been shown to be an indicator of social capital – or how residents of communities cooperate with one another to collectively solve problems and build their community.

Numerous studies have shown a positive association between population health and social capital.

 While researchers do not fully understand whether Census participation is caused by social capital or vice versa,

 policies on the local level that are designed to increase either social capital or Census response rate will likely have a strong influence on each other.

Not only does the Census help obtain funding for local communities, but it is also a critical tool for local planners and decision-makers to understand the social, economic, and demographic conditions within their communities.

Without an accurate understanding of community conditions, policy decisions may not be appropriate to meet the needs of residents.