DEKALB, IL — Plenty of factors predict how healthy people feel, from diet to exercise to age.

Could the ease (or difficulty) of registering and casting a ballot really matter, too?

Turns out, it does.

New interdisciplinary research published in Social Science Quarterly by NIU political science professor Scot Schraufnagel and three co-authors, including NIU political science graduate student Robert Durbin, found that more restrictive state election laws are associated with lower self-reported health. The effect was especially pronounced for Black Americans.

Even after accounting for standard health predictors, the relationship held.

“There are a lot of things that predict health,” said Schraufnagel, who began the research upon being contacted by health practitioners who suggested the finding. “I set out to prove them wrong.”

Yet, the study, titled “Restrictive State Electoral Environments and the Health of Black Americans,” ultimately found that state election laws may have significant implications not just for politics, but for public health.

“When election barriers discourage participation, people can be cut off from the very policies that support their well-being,” Schraufnagel said.

Research has shown that healthier people tend to be more politically involved and civic involvement can, in turn, promote health awareness and prompt better health outcomes, he said.

Americans vote on ballot measures shaping everything from Medicaid expansion to reproductive health and access to broadband. The later influences resident access to relevant healthcare information.

“The research underscores the importance of the public health and healthcare sectors, working in partnership with politicians, to improve civic engagement as a means to advance health, generally,” the study found.

The findings build on Schraufnagel’s earlier work developing the Cost of Voting Index, a widely cited measure that compares the ease of voting in each state. The index examines hurdles such as voter ID requirements, registration deadlines, early voting windows and ballot access.

Over the past several years, public-health organizations, nonprofits and legislative leaders have used the index to understand not just political participation, but broader social consequences tied to civic engagement.

The states of New Hampshire and Louisiana stood out in Schraufnagel’s recent study. New Hampshire makes voting relatively difficult, yet residents report high health scores. Louisiana doesn’t have major voting obstacles yet posted the nation’s worst state health score in 2021.

When examined further, a clear pattern emerged: states with larger Black populations absorbed most of the negative effects, suggesting the health consequences of voting barriers fall disproportionately on Black communities.

While persistent gaps in infant mortality and chronic disease are often chalked up to lifestyle differences, Schraufnagel’s findings suggest structural forces, including how welcoming a state is to voters, play an underappreciated role.

“Everyone wants to assume health disparities are about personal choices,” he said, “but when we control for those choices, the structural explanation remains. If we’re sincere about addressing health inequities or gaps, we should also be sincere about making sure everyone can participate in democracy.”

Media Contact: Jami Kunzer

About NIU

Northern Illinois University is a student-centered, nationally recognized public research university, with expertise that benefits its region and spans the globe in a wide variety of fields, including the sciences, humanities, arts, business, engineering, education, health and law. The Wall Street Journal and CollegeNET recognize NIU as a leading institution for social mobility, or helping its students climb the socioeconomic ladder. Through its main campus in DeKalb, Illinois, and education centers for students and working professionals in Chicago, Naperville and Rockford, NIU offers more than 100 areas of study while serving a diverse and international student body.