# The relationship between the lifestyle health index and voter turnout during the 2020 United States presidential election in the context of regional cultures

## TL;DR

This study finds a link between poor health behaviors and lower voter turnout in U.S. counties during the 2020 election.

## Contribution

It introduces the Lifestyle Health Index and shows its correlation with voter turnout across different regional cultures.

## Key findings

- Lifestyle Health Index scores strongly correlate with voter turnout (r > 0.63, p < 0.001).
- Counties with the lowest health scores had voter turnout below 60%.
- Health impacts extend beyond personal well-being to civic engagement like voting.

## Abstract

There are numerous population health challenges confronting the United States (U.S.), including the unhealthy lifestyle – chronic disease pandemics. However, the impact of unhealthy lifestyle behaviors and the increased prevalence of chronic diseases that result from them affect many facets of life outside of the health domain, and their scope remains under-appreciated. The current analysis contributes to addressing this knowledge gap by comparing the newly developed Lifestyle Health Index (LHI) to U.S. county-level voter turnout rates in the 2020 presidential election.

Descriptive, cross-sectional, retrospective analysis.

County-level data on the LHI, percent voter turnout, and the American Nations regional cultures model schematic was used in the current analysis.

Pearson correlations between county-level LHI scores and sub scores and Democratic, Republican, and overall voter turnout were all statistically significant and of similar strength (r > 0.63, p < 0.001). All counties in the worst performing LHI quartile had a voter turnout <60 %. Higher LHIs were consistently assocaited with lower voter turnout across the regional cultures, although heterogeneity was evident across the American Nations.

A large percentage of the U.S. population is afflicted with poor health, and unhealthy lifestyle behaviors are a primary driver. Poor health does not occur in a vacuum and impacts many other facets of an individual's life. The current study further demonstrates the potential detrimental impact of poor health on civic engagement, specifically participation in the electoral process (i.e, citizens' health may influence voter turnout). Health care professionals and institutions in the U.S. should uniformly embrace the recent policy brief by the American College of Physicians on participation in the electoral process for patients receiving care. This paradigm shift has the potential to substantially improve voter turnout during U.S. elections.