Voter turnout and health outcomes are interrelated and vary by region, according to latest research from Nationhood Lab collaboration

April 3, 2023

NEWPORT, RI  – Voter participation and health outcomes in the United States are interrelated, according to a new academic paper in the journal The Lancet Regional Health – Americas built on the work of Salve Regina University’s Nationhood Lab.

“Voting is a means by which people can influence policies that affect their own health and the well-being of their communities,” lead author Nicolaas Pronk, president of the Minneapolis-based HealthPartners Institute, wrote in the paper, which appeared online Mar. 29. “To reach people with messages that promote voter participation, communications should recognize the importance of regional cultures…regional norms, values, and belief systems.”

The article was co-authored by the Nationhood Lab director Colin Woodard and outlined how differing norms in the regional cultures identified in his book, American Nations: A History of the Eleven Rival Regional Cultures of North America, effect civic participation and the social determinants of health.

For instance, Puritan New Englanders believed they were a covenanted people tasked with building a more perfect society in the New World, and in the tier of the country they and their descendants colonized there is a relatively strong faith in shared institutions and emphasis on the common good over individual liberty. The opposite is true in Greater Appalachia — a large zone extending from southwestern Pennsylvania to the Texas Hill Country and parts of the lower Great Lakes states – where most colonizers were Scots-Irish from war ravaged parts of the British Isles, “where government institutions were weak and exploitative and one had to protect kith, kin, and herd oneself, creating a culture prioritizing personal sovereignty and individual autonomy and hostile to external authority, including governing institutions.”

“It is no wonder that such profound differences in cultural roots are reflected in the current-day variation in civic engagement that ultimately drives population health and well-being outcomes, Pronk wrote. “The 13 American Nations display a significant degree of variation in economic development, gender wage gaps, personality characteristics, voting behavior, social vulnerability, physical inactivity, obesity, life expectancy, chronic conditions, sleep insufficiency, and firearm violence,” he added, citing a series of previous studies the research team have published over the past ten months.

The study found that, across these regional cultures, “where voter participation lags, health status is lower,” and that the relationship is likely bidirectional. It noted that the federal government’s health targets for 2030 – set forth in the Department of Health and Human Services’ “Healthy People 2030” report – includes a core objective to boost voter participation.

Pronk, Woodard, and co-author Ross Arena, a physiologist at the University of Illinois-Chicago, recommended interventions to improve public health and voter turnout will be more effective if they use tailored messaging that takes into account “local values, norms, beliefs, and traditions [that] resonate within a regional culture.”

The paper is part of an ongoing collaboration between Woodard, Pronk, Arena and other academic health researchers that has published thirteen academic papers using the American Nations regional model to better explain geospatial patterns in various health indices, from obesity and diabetes to gun violence, disability, sleep disturbances and poor diet. Prior papers have appeared in Progress in Cardiovascular Diseases, Current Problems in Cardiology, the American Journal of Medicine, the Journal of Cardiopulmonary Rehabilitation and Prevention and the Journal of Activity, Sedentary and Sleep Behaviors.

The Lancet Regional Health – Americas is one of a suite of open access general medical journals focused on WHO’s six regions of the world and published by The Lancet, the world’s oldest and highest impact medical journal, now owned by Dutch academic publishing giant Elsevier.

Nationhood Lab, based at the Pell Center for International Relations and Public Policy at Salve Regina University, is an interdisciplinary research, writing, testing and dissemination project focused on counteracting the authoritarian threat to American democracy and the centrifugal forces threatening the federation’s stability. The project delivers more effective tools with which to describe and defend the American liberal democratic tradition and better understand the forces undermining it.

[This press release is cross-posted at]