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-Editorial
Ballot measures have become a powerful tool for voters to improve public health, addressing issues such as abortion rights, paid sick leave, minimum wage increases, and access to clean water. Over the past decade, these initiatives have passed critical policies that directly impact public well-being, especially in communities historically underserved by legislative bodies.
Yet, as ballot measures continue to drive progress for equity, efforts to restrict access to them are intensifying. In 2023 alone, 75 bills were introduced across U.S. state legislatures seeking to make the ballot initiative process more difficult. As of 2024, that number has climbed to 103, with even more expected in the coming year.
Avenel Joseph, Interim Executive Vice President of the Robert Wood Johnson Foundation (RWJF), highlighted the crucial connection between ballot measures and health equity. In an impassioned speech, Joseph outlined RWJF’s commitment to advancing health fairness across race, gender, and socioeconomic lines.
“Ballot measures allow voters to enact transformative policies when state legislatures fail to address critical issues,” Joseph explained. “Over 63% of ballot measures between 2014 and 2023 focused on health-related policies, showcasing their vital role in shaping equitable public health outcomes.”
Recent wins in states like Missouri, Nebraska, and Alaska, where voters approved measures for paid sick leave and increased minimum wages, serve as prime examples of the power of ballot initiatives. Abortion rights measures also found success, indicating that ballot measures often reflect the public’s values, regardless of political divides.
However, Joseph warned that these victories are under increasing threat. For instance, in Florida, a 60% threshold requirement for passing ballot measures thwarted an abortion access initiative despite majority support. Joseph called such barriers a roadblock to progress in creating a society where health is seen as a fundamental right for all.
In response to these challenges, RWJF is focusing on four strategic areas: uniting national and state organizations, supporting advocacy efforts, and promoting public education on the importance of preserving the ballot measure process. “Protecting the ballot measure process is about ensuring that communities have a direct say in creating fairer and healthier futures,” Joseph concluded.
Richard Von Glahn, Political Director of Missouri Jobs with Justice, has witnessed firsthand the transformative impact of ballot initiatives in the state. Under his leadership, Missouri passed measures to raise the minimum wage and expand Medicaid, providing healthcare to over 250,000 people.
“The ballot initiative process in Missouri has allowed workers to step in when lawmakers fail,” Von Glahn stated. “Through initiatives like the $15 minimum wage increase and paid sick leave, we’ve helped workers secure economic stability and dignity.”
Von Glahn also emphasized the intersection of economic stability and health, noting that a full-time minimum-wage worker in Missouri earns less than $500 a week before taxes, a figure that is insufficient to meet basic needs. “It’s not just about wages,” he said. “It’s about ensuring people can afford to take a day off when they’re sick without risking their financial stability.”
For Von Glahn, these victories are more than policy wins—they’re about justice and humanity. “Our work isn’t just about surviving; it’s about thriving,” he said.
Chris Melody Fields Figueredo, Executive Director of the Ballot Initiative Strategy Center Foundation (BISC), echoed similar concerns about the future of direct democracy. Fields, who uses she/her pronouns, spoke about the importance of ensuring accessibility and community engagement, particularly for those from marginalized backgrounds.
“We work with grassroots leaders to help them use ballot measures to directly impact their communities,” Fields explained. However, she also warned of increasing legislative efforts to undermine the will of the people, such as raising the voting threshold for ballot measures or imposing burdensome signature requirements.
Fields emphasized that winning at the ballot box is only the first step. Ensuring the implementation of these policies is where the real work lies. “Even after voters approve measures like abortion access in Missouri, there’s significant work needed to make sure those policies are realized,” she said.
Fields called for continued action: “When we empower communities through direct democracy, change is possible. Now, we must defend these victories and ensure their lasting impact.”
