A polling place in a space that appears to be a gymnasium. (A large Nike "whoosh" banner hangs high on the wall.) There are two curtained voting booths on wheels, and the lower legs and feet of a voter can be seen behind one of the curtains. The second booth is partly hidden, but a woman in jeans and a blouse is standing in front of it. She may be a voter or a poll worker. A volunteer poll worker seated at a folding table is signing in a voter, and two other people wait in line to sign in.


Did America Vote to Tackle Race and Health Inequities?

The ushering in of a new administration is a good time to reflect on some key 2020 ballot measures that have either advanced or hurt racial and health equity.

Photo by Flickr user Brooke-Lynn, CC BY-NC 2.0 Deed


A polling place in a space that appears to be a gymnasium. (A large Nike "whoosh" banner hangs high on the wall.) There are two curtained voting booths on wheels, and the lower legs and feet of a voter can be seen behind one of the curtains. The second booth is partly hidden, but a woman in jeans and a blouse is standing in front of it. She may be a voter or a poll worker. A volunteer poll worker seated at a folding table is signing in a voter, and two people wait in line to sign in.

Photo by Flickr user Brooke-Lynn, CC BY-NC 2.0 Deed

While the spotlight was on the presidential and congressional races in November 2020, voters also decided on 120 ballot measures across the country, 88 of which passed. Many of these ballot measures had important implications for health equity, economic justice, racial equity, and climate change. Some would advance equity (e.g., paid family and medical leave), and others represent a step backward (e.g., narrowing voter rights).

In the course of creating a policy scan on local and state measures that affect social determinants of health, Build Healthy Places Network and Shift Health Accelerator gathered information on all the statewide ballot measures, measure summaries, and election results that had impacts on racial and health equity. We got our information from the secretary of state website for each state and/or the state ballot database from the National Conference of State Legislatures.

The ballot measures we explored ranged from state constitutional amendments to legislative tweaks; some were put on the ballot by legislators and others by citizens. Communities then voted to pass or reject these policies.

Massive turnout in suburbs and cities, as well as an increase in voter registration in communities of color, point to an America that is diverse, desires an end to systemic oppression, promotes and funds healthy communities, and aims to make strides toward race and health equity. But, evident in the measures that advance equity and the measures that do not, America remains divided on what an “equitable future for all” looks like. The ballot measures highlighted below are in three categories: (1) ballot measures that passed that advance race and health equity, (2) ballot measures that passed that are a detriment to race and health equity, and (3) ballot measures that did not pass but would have advanced race and health equity.

Ballot Measures That Were Passed That Advance Racial and Health Equity

Arizona’s Proposition 208 increases taxes for residents who have a total income exceeding $250,000. It is estimated that this measure will generate more than $827 million in revenue in year one, which will go toward funding education. This is critical because education has been identified as one of the most important modifiable social determinants of health.

California’s Proposition 1 restores voting rights after incarceration and allows those on parole to vote. This proposition will immediately restore the voting rights to 50,000 Californians and eliminate one form of voter suppression and institutional racism. Those categorized as a felon in the United States have their voting rights stripped permanently in 9 states and not restored until after prison, parole, or probation are completed in 19 other states. With Black Americans being imprisoned at nearly six times the rate of white Americans, and Hispanic Americans being imprisoned at double the rate of white Americans, the restoration of voting rights is a social justice issue and would allow these communities to vote on ballot measures that directly affect their communities (e.g., access to medical care).

Colorado’s Proposition 118 establishes a paid family and medical leave insurance program of 12 to 16 weeks. While only 6 percent of low-wage workers in the United States have access to paid family leave, the more workers who can take time off and balance family responsibilities, the healthier the workforce becomes. This is particularly important because nearly 50 percent of low-wage workers are women of color.

Florida’s Amendment 2 raises the minimum wage to $10 per hour effective Sept. 30, 2021 and it will gradually increase to $15 per hour by Sept. 30, 2026. The current federal minimum wage is $7.25 an hour, and advocates have pushed for a $15-an-hour minimum wage for nearly a decade. In 2018, the American Journal of Managed Care stated that at least three mechanisms could link higher wages to a change in health status. Higher wages would make it easier for workers to access medical care, afford homes in safer neighborhoods, and increase job satisfaction. Just one emergency expense of around $500 can plunge an individual or family into an economic downfall. With 100 million people living at or below 200 percent of the federal poverty level (more than 50 percent of whom are people of color), ballot measures to increase wages help Americans reach economic security, which is a key social determinant of health.

Mississippi’s Ballot Measure 2 removes a Jim Crow-era policy that required a gubernatorial or state office candidate to receive both the highest number of votes in a majority of state house districts and the statewide popular vote to win the election. If neither were met by any candidate, the State House of Representatives would choose a winner. The goal of this policy when it was passed was to limit the voice of Black voters.

Mississippi’s Measure 3 approves the state’s new magnolia flag design. This replaces the previous flag, which had a Confederate battle emblem.

Nebraska’s Initiative 428 caps payday lenders’ rates at 36 percent annually. Across the United States the average annual interest rate on a two-week payday loan is 395 percent. Payday lenders are located disproportionately in poor communities of color, while more than 28 percent of all Black and Latinx adults do not have a credit score. Low-interest personal credit is essential to those seeking loans to secure education, opportunities to generate wealth, medical services, housing, or transportation.

Nebraska’s Amendment 1 and Utah’s Amendment C eliminate slavery or involuntary servitude as a punishment for crime.

Nevada’s Question 6 requires all utility providers to acquire 50 percent of their electricity from renewable sources by 2030. With about 85 percent of America’s energy coming from nonrenewable sources, and millions of Black Americans living near oil refineries, this is a major step forward to combat the climate crisis, which disproportionately affects low-income communities and communities of color. According to the NAACP, race is more strongly correlated than income with living near toxic facilities in the United States.

Oregon’s Measure 110 makes the possession of small quantities of all drugs a minor violation. Also, it establishes an addiction treatment program funded by revenue from medical marijuana taxes and the cost savings from imprisoning fewer people for drug crimes. There are ongoing disparities in drug convictions for Black Americans, and convictions instead of treatment mean difficulty in getting housing, employment, and student loans.

Rhode Island’s Question No.1 amends the Rhode Island constitution to remove “Providence Plantations” from the official state name. Though a name change may not seem like a consequential policy, the acknowledgment that “Providence Plantations” is a reminder of one the most grotesque times in American history matters. But superficial changes will not be enough. As America removes monuments, flags, and language that have been either tied to the enslavement of people, the glorification of the Civil War, or the intimidation of those involved in the civil rights movement, as a country we also must make strides that address the root of these issues.

Ballot Measures That Passed That Are Detrimental to the Progress of Racial and Health Equity

California’s Proposition 22 allows companies like Uber Technologies Inc., DoorDash, and Lyft Inc. to continue classifying their drivers as independent contractors instead of employees. Because these workers will not be considered employees, ride-hailing programs are exempt from providing benefits and protections like paid time off, insurance, and vacation.

Florida’s Amendment 1 (and similar measures in Alabama and Colorado) states that only citizens can vote in elections. Though this is already the law, support for this amendment came after other states proposed initiatives to allow permanent residents and immigrants to vote in local elections. The constant vilification of immigrants and falsehoods around widespread voter fraud has caused this knee-jerk reaction. Simple word changes may not seem impactful, but the push for new voter restrictions, and the lapse in reauthorization of the Voting Rights Act of 1965, continues to restrict and disenfranchise millions of voters. The Florida League of Women Voters said that this measure “is cloaked in xenophobia and false patriotism.”

Louisiana’s Amendment 1 adds to the Louisiana Declaration of Rights that the right to an abortion is not protected and that the government is not required to fund abortions. Stefani Bangel, New Orleans Abortion Fund outreach manager, stated that “People in Louisiana suffer when restrictions like these are passed. Women are suffering now.” With amendments like this one, women are being denied access to medical care.

Missouri’s Amendment 3 will undo the Clean Missouri initiative. The Clean Missouri initiative was intended to limit partisan gerrymandering when the state redraws its district map in 2021. The initiative also limited campaign contributions and required that contributions had to be made public. Gerrymandering is disenfranchising millions of voters and especially those in communities of color. Future redistricting must prioritize fair representation for communities of color, who are drastically underrepresented in Congress.

Ballot Measures That Did NOT Pass That Would Have Advanced Racial and Health Equity

California’s Proposition 21 would have allowed the local government to decide on rent control measures and increased protections for renters to prevent discrimination. This would have increased rent affordability, while stopping and preventing evictions among communities of color, LGBTQ+ people, and people with disabilities. As in much of America, high rents and low wages in California are threatening economic security for many communities.

California’s Proposition 209 would have repealed the 1996 policy that banned public colleges and the government from considering race and gender in admissions and government hiring decisions. Prioritizing diversity in college and workplaces improves the opportunities and representation for communities that have been deliberately excluded.

Oklahoma’s Question 805 would have prohibited the use of prior nonviolent felonies to extend prison sentences, which would have advanced criminal justice reform.

Oregon’s Measure 26-218 would have enacted a payroll tax on large employers. The revenue would have funded transit improvements including a rapid bus network, and programs benefiting students and low-income communities (e.g., free bus passes for youth and investing in affordable housing).

Looking Ahead

Though progress is slow, and some measures to advance equity did not pass, optimism should be high. The 2020 election saw the highest voter turnout in more than a century (during a pandemic nonetheless) which sent a booming message that justice will continue to be the focus in local, state, and federal elections. The election results showed that voters are divided, regardless of whether they are in a long-standing blue state (e.g., California), a long-standing red state (e.g., Oklahoma), or a purple state (e.g., Florida). They voted to pass measures of social progress in some places and clung to racist policies in others.

Policymakers working together with cross-sector coalitions and community leaders must seize this moment to center and propose solutions that focus on racial and health equity and advance the social determinants of health. We must be more progressive, even when the environment is less favorable, and speak out on policies that will continue to hurt our low-income communities and communities of color.

Coming soon: Build Healthy Places Network and Shift Health Accelerator’s Healthy Neighborhood Investments Policy Scan and Strategy Menu. It outlines policy actions and strategies, and offers mapping tools for multi-sector coalitions and leaders to make policy changes that value the well-being of everyone living in the U.S. and support redressing the institutional and structural racism pervasive in our political, social, and economic systems.

 A longer version of this post appears on Build Healthy Places Network.


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