Percentage of citizen population aged 18 or older who voted in the 2020 U.S. Presidential election. The 2023 County Health Rankings used data from 2020 & 2016-2020 for this measure.
Voting collectively influences the health of our communities and healthier communities are more likely to vote.1 Studies show that communities with higher voter turnout tend to also have better self-reported general health2-5, fewer chronic health conditions6, a lower overall mortality rate7, and less depression8.
The U.S. Constitution gives states the primary responsibility to regulate elections, which means that each state has different voting practices (e.g., access to early voting, online voter registration). Many states share a history and present reality of exclusionary laws and practices that create structural barriers to voting such as voter registration restrictions, lack of protected time for voting, and disenfranchisement following certain interactions with the justice system. Groups disproportionately impacted by barriers to voting include people of color9-11, people with disabilities12, people with lower income10, people with felony convictions11, young people, and people with limited English proficiency13-14. Low voter turnout may signal that there are systematic barriers that reduce access to voting.
History shows that when previously disenfranchised people vote, policies that benefited all – and health outcomes – have followed.15 The Fourteenth Amendment to the Constitution (1868) granted citizenship to formerly enslaved people but Black Americans continued to be systematically denied voting rights.16 The Voting Rights Act of 1965 enforced rights for African Americans 95 years later, which increased voter turnout to 61%.17 From 1965 through 1971, the gap between Black and white infant mortality narrowed and Black infant mortality declined by 40%, due to desegregation of hospitals as mandated by the Civil Rights Act.18 After women’s suffrage in 1920, infant mortality rates dropped dramatically due to passage of law setting up maternal and child health units in every state health department, expanding birth and death data collection, and supporting home-visiting initiatives.15 Native Americans were not granted the right to vote until 1924, after which 40 years passed before all states allowed Native Americans to vote.19
The Voter Turnout data is reliable because each vote is counted. Voter turnout tends to be highest during presidential elections as compared to congressional, senate, and local elections. These presidential election data provide the best national coverage at the county level. However, the data may overestimate typical levels of local civic participation.
Data and methods
MIT Election Data and Science Lab; American Community Survey, 5-year estimates
The MIT Election Data and Science Lab is a clearinghouse for datasets that can fuel studies on elections, and how they're conducted. The goal of this work is to support advances in election science by collecting, analyzing, and sharing core data and findings.
Citizen Voting Age by Race and Ethnicity (CVAP) special tabulation was originally created from the Census 2000 long form and was originally published in 2002 for use in voting rights analysis. At the request of the Department of Justice, the US Census Bureau began publishing an annual CVAP special tabulation from the American Community Survey (ACS) 5-year estimates. The special tabulation and the subsequent ACS versions are all published down to the block-group level of geography.
Key Measure Methods
Voter Turnout is a percentage
Voter Turnout is the percentage of citizen population aged 18 or older who voted in the 2020 U.S. Presidential election.
Voter Turnout cannot be compared across state lines
Voter turnout at the county level is heavily influenced by state laws which may restrict or support voting access; and should not be considered reflective of willingness or motivation for civic participation.
Voter Turnout should be compared with caution across counties
U.S. citizenship is required to vote at the national, state, and municipal level, although citizens in the U.S. Territories are disenfranchised. As a proxy for civic participation, Voter Turnout does not reflect noncitizen contributions to a community’s civic health. Further, Voter Turnout does not reflect civic participation of people who have lost their voting rights due to certain interactions with the judicial system or because of a mental disability. Voter Turnout is overestimated in places where the voting-eligible population is significantly smaller than the citizen voting age population.
These data will have infrequent updates. Presidential elections occur every four years.
The Voter Turnout measure calculated as the percentage of the citizen voting age population may underestimate voting participation for the voting-eligible population, which excludes people who do not hold citizenship, are mentally incapacitated, or have a felony conviction (depending on state law).
Voter Turnout does not directly measure civic infrastructure, such as no-excuse absentee voting, protected work flexibilities on election day, or available and accessible polling places, which supports voter participation nor the structural barriers, including restrictions relating to voter registration, which hinder voter participation. Voter turnout reflects a combination of a community’s civic participation as well as the privilege, extended through civic infrastructure and barriers constructed to support or hinder that participation.
The numerator is the total number of people who voted in the 2020 U.S. Presidential election.
The denominator is the total number of U.S. citizens ages 18 and older.
Can This Measure Be Used to Track Progress
This measure can be used to track progress with some caveats. The data are generated from presidential elections which occur once every four years, these infrequent data points make trend detection more difficult. Voter Turnout is affected by the laws determining who may vote and how voting occurs. Changes in these laws will impact Voter Turnout values.
Finding More Data
- MIT Election Data and Science Lab: https://electionlab.mit.edu/
- Cost of Voting Index: https://costofvotingindex.com/
- ACLU map of Felony Disenfranchisement Laws: https://www.aclu.org/issues/voting-rights/voter-restoration/felony-disenfranchisement-laws-map
- Healthy People, Healthy Democracy: https://www.healthydemocracyhealthypeople.org/
- Healthy Democracy, Healthy People. (n.d.). “Health & Democracy Index.” Accessed from https://democracyindex.hdhp.us/
- Blakely, T. A., Kennedy, B. P., & Kawachi, I. (2001). Socioeconomic inequality in voting participation and self-rated health. American journal of public health, 91(1), 99.
- Kim, D., & Kawachi, I. (2006). A multilevel analysis of key forms of community-and individual-level social capital as predictors of self-rated health in the United States. Journal of Urban Health, 83, 813-826.
- Ard, K., Colen, C., Becerra, M., & Velez, T. (2016). Two mechanisms: the role of social capital and industrial pollution exposure in explaining racial disparities in self-rated health. International journal of environmental research and public health, 13(10), 1025.
- Ballard, P. J., Hoyt, L. T., & Pachucki, M. C. (2019). Impacts of adolescent and young adult civic engagement on health and socioeconomic status in adulthood. Child development, 90(4), 1138-1154.
- Gollust, S. E., & Rahn, W. M. (2015). The bodies politic: chronic health conditions and voter turnout in the 2008 election. Journal of health politics, policy and law, 40(6), 1115-1155.
- Kawachi, I., & Kennedy, B. P. (1999). Income inequality and health: pathways and mechanisms. Health services research, 34(1 Pt 2), 215.
- Ojeda, C. (2015). Depression and political participation. Social Science Quarterly, 96(5), 1226-1243.
- Leadership Conference on Civil and Human Rights. (2019). Democracy diverted: Polling place closures and the right to vote. Accessed from http://civilrightsdocs.info/pdf/reports/Democracy-Diverted.pdf.
- Pitzer, K., Mcclendon, G. G., & Sherraden, M. (2021). Voting Infrastructure and Process: Another Form of Voter Suppression?. Social Service Review, 95(2), 175-209.
- King, B. A., & Erickson, L. (2016). Disenfranchising the enfranchised: Exploring the relationship between felony disenfranchisement and African American voter turnout. Journal of Black Studies, 47(8), 799-821.
- Shields, T. G., Schriner, K. F., & Schriner, K. (1998). The disability voice in American politics: Political participation of people with disabilities in the 1994 election. Journal of Disability Policy Studies, 9(2), 33-52.
- Ancheta, A. (2006). Language Accommodation and the Voting Rights Act. Legal Studies Research Paper, (06-21).
- Parkin, M., & Zlotnick, F. (2011). English proficiency and Latino participation in US elections. Politics & Policy, 39(4), 515-537.
- Ehlinger EP, Nevarez CR. 2021. Safe and accessible voting: The role of public health. American Journal of Public Health 111(1):45-6.
- African American Pamphlet Collection (Library of Congress). (1900). To the colored men of voting age in the southern states. Accessed from https://www.loc.gov/resource/rbaapc.33200/?st=text&pdfPage=1
- Library of Congress. (n.d.). “Voting Rights for African Americans.” Accessed from https://www.loc.gov/classroom-materials/elections/right-to-vote/voting-rights-for-african-americans/.
- Hahn RA, Truman BI, Williams DR. 2018. Civil rights as determinants of public health and racial and ethnic health equity: Health care, education, employment, and housing in the United States. SSM Population Health 4:17-24.
- Library of Congress. (n.d.). “Voting Rights for Native Americans.” Accessed from https://www.loc.gov/classroom-materials/elections/right-to-vote/voting-rights-for-native-americans/.