Doctor Prescribes Democracy & Healthy Doses of Active Citizenship

Dr. Rishi Manchanda, A97, M05, speaking at the medical school.Dr. Rishi Manchanda, A97, M03, has a vision to unite health care systems and civic engagement.  In 2008 he founded RxDemocracy.org, a national nonpartisan network of health professionals and civic allies.  Last week, Manchanda spoke to dozens of students, staff, and faculty from the medical and dental schools, describing the wider social and political contexts of health and civic participation.

“Civic participation is a determinant of health,” said Manchanda.  “The data there is indisputable, but the mechanics of why that’s so aren’t very well understood yet.  The relationship works the other way too – health is a resource for civic participation.  In 2008, one in five low-income registered voters didn’t vote due to illness.  That’s about three times the rate of the high-income group.   It’s a pretty stark illustration of the saying ‘If you’re not at the table, you’re on the menu.’”

RxDemocracy’s focus has been on voter registration and turnout efforts. Through the the RxVote campaign, the group supports clinics and hospitals in hosting nonpartisan voter registration drives and informing patients of their voting rights.

“In 2008 we registered 26,000 voters – that was proof of concept,” Manchanda explained.  “The approach is common sense, but it’s transformative.  Health care is a civic institution, arguably it’s the largest civic institution, and it’s the one major point of contact that is going to reach the entire population at one time or another.  So we’re looking for ways to unite work in health care with civic engagement, and bring the voiceless into the system.  And what we’re finding is that this improves transparency, equity, and healthcare itself.  By engaging providers, clinics, and hospitals, we add a new dimension to the civic participation movement.”

“Many hospitals are nervous about providing patients the option to register to vote,” said Manchanda.  “They don’t want politics in medicine or entering patient care.  But nonpartisan voter engagement doesn’t interfere, it pays huge dividends in demonstrating commitment to community.  For patients and staff, it demonstrates that the hospital is a leading civic institution that can be trusted.”

“It’s not about changing any laws, either,” Manchanda continued.  “The motor voter law has a section that encourages service providers to offer non-partisan voting registration, including hospitals, Medicare and Medicaid offices, and the like.  The DMV part has been enforced, but these other venues haven’t been utilized.”

This year RxDemocracy has been concentrating on teaching hospitals.

“There’s a natural fit with teaching hospitals,” he said.  “They make up about 22% of all hospitals, but they see about 70% of the ‘charity’ cases, the populations who experience health and civic disparities. So everyone at a teaching hospital, from patients to administrators, clinicians, and students, everyone at a teaching hospital is immediately affected by political decisions about healthcare policy and spending, even more so than in other parts of the system. But without their civic voice or vote, it’s harder for teaching hospitals or their patients to make a dent in health disparities. There are many reasons and many simple ways to help staff and patients in teaching hospitals have a voice in the democratic process.”

A triple Jumbo – he received his B.S. in biology from Tufts, and an MD and Masters of Public Health (MPH) from the medical school – Manchanda credits his time at Tufts for fueling his passion for civic engagement.

“The idea that physicians and clinicians can be active citizens is very dear to me,” he said.  “It has its roots in my time at Tufts, both undergrad and at the med school.  I’ve really been looking forward to coming back for this talk, it’s like coming full circle.”

Before starting medical school, Manchanda worked on health care and community development in India, at what he called “the intersection between grassroots democracy and healthcare.”  The experience propelled him towards medicine.  He completed his residency at UCLA, and worked in south central Los Angeles for four years.  Currently he is the lead physician for homeless primary care at a clinic in the VA Greater Los Angeles Healthcare System.

“I think of active citizenship in the same way I do about health,” Manchanda said.  “Health means different things to different people, and every patient defines it for themselves.  Health is a resource for leading an effective life and upholding values, no other activities can take place without it.  Same with active citizenship.  It’s a resource and mirror of the values we hold dear.”

Audra Williams, M15, introduced Dr. Manchanda.
Audra Williams, M15, introduced Dr. Manchanda.

Manchanda was introduced by Audra Williams, M15, a student in the joint MD/MPH program at the medical school, who has been working with the organization MassVOTE to register voters.

“Dr. Manchanda’s work is an inspiration,” said Williams.  “I hope he’ll get more students motivated to do this work.  We’ve had a lot of success this year partnering students with MassVOTE and setting up outside T stops and at the dental clinic.  On just the day before the deadline to register we enrolled over 100 new voters.”

Following his talk, Manchanda led a lively discussion that touched on voter ID laws, professional ethics, and ways of measuring civic engagement and its effects on health.

“Health care still has a long way to go,” said Manchanda.  “I’m inviting the Tufts community to join us and help lead the way.”

Originally published November 2012