Cover: Examining Civic Engagement Links to Health

Examining Civic Engagement Links to Health

Findings from the Literature and Implications for a Culture of Health

Published Sep 18, 2019

by Christopher Nelson, Jennifer Sloan, Anita Chandra


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Research Questions

  1. Is there an empirical relationship between health and/or well-being and civic engagement?
  2. Is health and/or well-being a cause of civic engagement, a consequence of it, or both?
  3. What causal mechanisms link civic engagement with health and/or well-being, and how can understanding the mechanisms influence programming or investment decisions?
  4. Is the nature of the health–civic engagement relationship different across various segments of the population?
  5. Where are the gaps in knowledge that might point to possible investment opportunities in new research?

The Robert Wood Johnson Foundation (RWJF) is leading a pioneering effort to advance a culture of health that "enables all in our diverse society to lead healthier lives, now and for generations to come." The RWJF Culture of Health Action Framework is divided into four Action Areas, and civic engagement (which RWJF defines broadly as participating in activities that advance the public good) is identified as one of the three drivers for the Action Area, Making Health a Shared Value, along with mindset and expectations, and sense of community. Civic engagement can serve as a mechanism for translating changes in a health-related mindset and sense of community into tangible actions that could lead to new health-promoting partnerships, improvements in community health conditions, and the degree of integration among health services and systems for better health outcomes.

The authors of this report seek a closer focus on the causal relationship between civic engagement and health and well-being — that is, whether better health and well-being might promote more civic engagement, whether civic engagement might promote health or well-being, or perhaps both.

In this report, authors conduct a structured review to understand what the scientific literature presents about the empirical relationship between health and civic engagement. The authors specifically examine whether health is a cause of civic engagement, a consequence of it, or both; what causal mechanisms underlie this link; and where there are gaps in knowledge for the field.

Key Findings

The health–civic engagement link applied to various forms of civic engagement

  • Increases in physical and mental health and well-being are related to increases in civic engagement, whether through voting or through such activities as volunteering and membership in civic organizations.

Some studies suggest that health and civic engagement make up a reinforcing feedback loop

  • A few longitudinal studies suggest that poor health earlier in life is associated with lower levels of civic engagement later in life.
  • The effects of poor health seem to work in both directions — e.g., early depression is associated with less engagement later in life; and early civic engagement is associated with less depression later in life.

The nature of the health–civic engagement relationship can be different across various population segments

  • Several studies demonstrate differences among health conditions; e.g., there is evidence that those with cancer are more likely to vote than those with heart disease, a difference that authors attribute to social stigma around heart disease and to stronger political organization around cancer.
  • There is also some evidence that the nature of the health–civic engagement connection might vary by social group.

There are few studies seeking to link civic activism with broader concepts of well-being

  • Aside from voting, which is well defined, there appears to be a lack of clear agreement in terminology and constructs for measuring civic engagement.


  • Support the creation, maintenance, and analysis of thorough, longitudinal data sets to further understand the mechanisms underlying the health–civic engagement link.
  • Support more research that specifically targets the causal mechanisms of the health–civic engagement link, which would be useful in designing interventions.
  • Support research that examines how civic engagement influences structural and systemic barriers to health.
  • Sponsor conferences, forums, and networks to provide venues in which researchers can collaborate (including around shared data sets, as mentioned above) and more actively contribute articles to build the literature base on the health–civic engagement relationship.
  • Support collaborative intervention design within communities of practice to facilitate the process of identifying ways to both promote civic engagement and realize any related health benefits.
  • Support the investigation into how health-related civic engagement relates to efforts to improve community health.

Research conducted by

This research was sponsored by the Robert Wood Johnson Foundation and conducted by the Community Health and Environmental Policy Program within RAND Social and Economic Well-Being.

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