However, regardless of vote choice, there does seem to be a closeconnection between good health and political participation. Numerous studies have found thata range of illnesses lead to depressed likelihood of voting at the individual and aggregate levels,with the magnitude of effects often similar to or greater than that of traditional predictors (

It matters not only that (some) people are able to vote, but also who they vote for, whoseinterests their representatives promote in policy, and whether politicians can in fact achieve theirpolicy goals.

Nationaltrends can be measured by using any of these data sources,state trends can be measured by using NVSS and BRFSS,and county trends can be measured by using NVSS.

“No single measure can capture the health of the nation”(24)

Global nursing is the use of evidence-based nursing processes to promote sustainable planetary health andequity for all people. Global nursing considers social determinants of health, [and] includes individual andpopulation-level care, research, education, leadership, advocacy, and policy initiatives.

Social determinants of health are additional factors that influence the health of populations, families, andindividuals. Social determinants of health are conditions and social factors that affect outcomes and risk related tohealth, functioning, and quality of life. Conditions or factors in hospitals, clinics, workplaces, homes, towns andcities, schools, and beyond influence health outcomes for the population. Economic stability, education access andquality, health care access and quality, neighborhood and built environment, and social and community context arefive domains that shape the social determinants of health (Office of Disease Prevention and Health Promotion,2022). Please see Social Determinants Affecting Health Outcomes for a comprehensive discussion of socialdeterminants of health

Despite these gains, millions of Americans remain uninsured (see figure 2). Some are eligible forsubsidized coverage via Medicaid or the Marketplaces but have yet to enroll, or have lostcoverage. The Marketplaces offer challenges (i.e. a perceived lack of affordable options). 17Despite subsidies, affordability remains a barrier for some, especially those at the higher end ofincome ranges eligible for subsidies. Others are not eligible for subsidies at all, due to having anaffordable offer of employer insurance, or being part of the “family glitch:” if an employer-sponsored plan satisfied the affordability threshold for that year, the entire family becomesineligible for subsidies, even if a family plan through the employer would cost more than theaffordability threshold.

Figure 2. The US Uninsured Population, by Subgroup, 2018

But could health care reform be forever deferred? As long as the ranks of theuninsured continued to grow, the presence of market failure was impossibleto deny, and the door would be left open to calls for universal health care.Furthermore, health care expenditures actually continued to accelerate during the2000s, further weakening the defense of the status quo. As soon became clear,the sort of health care system that neoliberals wanted—a “consumer-driven”system with an abundance of private insurance plans with high out-of-pocketexpenses—wasn’t necessarily mutually exclusive with a system of almost-universal health care.

The “consumer-driven health care” movement emerged directly from the“moral hazard” idea that people had to play with their own money when it cameto health care. As told by Jost in Health Care at Risk, its proponents have wonseveral policy achievements in recent decades, some of which were actuallyfirst championed by neoliberal think tanks.

Much research has shown that individuals without health insurance are less likely to seekpreventive medical care such as medical checkups (especially Pap smears and mammograms for women,and prostate cancer screening for men) and immunizations and are less likely to see a medical providerwhen sick (or they wait until they are very sick when the benefits of early detection are lost). They areless likely to have a regular source of medical care and are more likely to see a different provider on eachvisit.

The lack of personal financial resources to pay for medical care and the lack of health insurance havea profound effect on the health of individuals and families.