The Role of Direct Democracy in State Policy Making

A new health study in Health Affairs explores how direct democracy through state ballot initiatives has played a significant role in shaping population health policies across the U.S. Between 2014 and 2023, 63.5% of successful state ballot initiatives were health-related, covering critical areas like health care, public health, and social determinants of health.
Common topics included Medicaid, abortion, marijuana decriminalization, and environmental issues.

 

However, challenges persist: only 26 states allow citizen-initiated measures, and increasing legislative efforts aim to restrict this process. Public health stakeholders must recognize both the potential and obstacles of using ballot initiatives to advance health equity and improve population health outcomes. Read the full health study brief from Health Affairs here.