An unexpected winner in the midterms: public health

Public health was on the ballot last week — and it won. 

I’m not talking about specific candidates, as important as those races are. I’m talking about the ethos of public health — the principle that health is a fundamental human right and the understanding that we must look out for one another, to think not just about our own well-being, but about the public good. 

That ethos has been in retreat for the past two years, beaten back by the forces proclaiming that individual freedom trumps all. In one of many low points, protestors targeted a breast cancer clinic in Los Angeles for requiring masks to protect their patients, many of whom had weakened immune systems as a result of chemotherapy and were therefore at higher risk from COVID. This failure of empathy has been deeply disheartening. 

Yet as I’ve tracked election results over the past week, I’ve found many reasons for optimism. In blue states and in red states, voters made choices that reflected care and concern for their fellow citizens. Again and again, they voted to protect public health. In an extension of that trend, voters also opted to use the levers of government to extend dignity to individuals in bleak circumstances, such as extreme poverty, crushing debt and imprisonment. 

The most high-profile examples of public health wins are the abortion referendums. Voters in California, Michigan and Vermont endorsed women’s right to choose. In conservative Kentucky and Montana, too, abortion rights supporters scored clear victories on ballot measures. This clean sweep for reproductive freedom in the midterms follows a resounding win for abortion rights supporters in a statewide referendum in Kansas in August. These successes are critically important for public health because restrictions on abortion put women’s lives, health and economic futures at risk, and are particularly dangerous for low-income women and women of color.  

In another major victory for public health, South Dakota voters decisively chose to expand eligibility for Medicaid, using a ballot measure to extend access to health care to the working poor when their legislators refused to do so. The expansion will take effect next summer, providing subsidized insurance to 40,000 low-income adults. Many of these men and women will soon have access to preventive care and treatment for chronic conditions, in some cases for the first time in years. This measure will undeniably save lives. 

In Oregon, meanwhile, voters approved a ballot measure that makes the state the first in the U.S. to guarantee residents access to “cost-effective, clinically appropriate and affordable” health care. This measure effectively establishes health care as a human right — a principle that should not be revolutionary, but that has never been integrated into the fabric of our nation. It’s not yet entirely clear how it will be implemented, but I’m heartened to see the first steps in the U.S. toward recognizing a fundamental right to health care. 

Oregon voters also passed one of the strictest gun safety measures in the U.S. It will require a federal background check and gun safety training for all gun purchases, as well as a police-issued permit, renewable every five years. This, too, will save lives. 

Elsewhere in the midterms, Arizona voters overwhelmingly supported a ballot measure to restructure collection and limit interest rates on medical debt, which has become an enormous burden for far too many families. Alabama, Oregon, Tennessee and Vermont outlawed forced labor for prison inmates, restoring some measure of their dignity and autonomy. And in California, voters overwhelmingly endorsed a ban on all flavored tobacco products in the state — a move designed to protect young people, who gravitate toward flavored vape products. 

To be sure, public health didn’t win everywhere last week. And health and well-being still face grave and urgent threats from the Supreme Court. 

But as I survey these results, I am encouraged. Too often in the past few years, it has seemed as though an every-man-for-himself ethos was ascendant across the country. Yet these midterm results show voters assessing policy through a lens of empathy.  

The outcomes of these ballot measures suggest that a majority of voters, in both red states and blue, believe the government has an obligation to protect the health and well-being of the most vulnerable among us. That is the essence of public health. It also happens to be the only way to build a resilient economy and a successful civil society.  

The task that now falls to all of us is to turn this moment into a movement. A few weeks ago, I wouldn’t have predicted that the midterm election would be the leading edge of a resurgent public health ethos in the U.S. Now, I am optimistic that it may be.  

We can build a future with health, dignity, and justice for all. Voters have shown they have the will. Let’s work together on the way. 

Michelle A. Williams is dean of the faculty of the Harvard T.H. Chan School of Public Health.