Over the last decade, public health has become increasingly tied to the health of our democracy. Life expectancy has been declining for the first time in nearly a century.

At the same time, many state legislatures have insulated themselves from public accountability through extreme partisan gerrymandering and restrictive election laws. Biased, unrepresentative state legislatures have been less likely to expand access to health care, and health disparities in those states have continued to worsen, especially for communities already under greater social distress.

The United States needs to restore and improve electoral integrity and political equality in state legislatures to address growing inequalities and empower communities to protect themselves.