SDOH on the Ballot: Health & Social Referendum Questions in 2020

Elections have the power to focus the nation’s attention on critical issues. While the debates that surround the highest offices drive much of the dialogue, we can also look to the state and local referendum questions to understand what’s on the minds of voters. 

In 2020, healthcare and social services are both very much on the ballot. In this year’s General Election, there are more than 120 statewide ballot measures, and many more local and municipal questions. Many pundits are calling this election a “referendum on race relations”, driven by the convergence of the pandemic, joblessness and police brutality.

In several weeks’ time, we will know the outcomes of these ballot questions, which will tell us exactly how far local voters are willing to go in several key areas related to the social determinants of health.


Explore 2020 ballot measures:

2020 ballot measures about policing and criminal justice

2020 ballot measures about marijuana and psychedelic substances

Oregon’s Measure 110 to decriminalize drug use


2020 ballot measures about policing and criminal justice

Communities in seven states are being asked to reimagine what policing strategies could look like through changes in funding and legislation. 

In California, voters are considering Proposition 25, which proposes to eliminate the cash bail system, and has been called “perhaps the single largest criminal justice reform ever put up for a popular election.” On any given day in the United States, there are nearly a half-million people sitting behind bars who have yet to be convicted of a crime but can’t go home to their families, jobs and communities simply because they don’t have the cash necessary to make bail. Advocates for reform argue that not only does this system punish people simply for being poor, but it also frees people who may pose a legitimate danger to the public or likelihood of skipping court because they’re wealthy.

Across California, there are seven local ballot initiatives that challenge current practices around civilian oversight of police, shift money from criminal justice to social services, and evaluate the size of police departments:

  • Los Angeles County, Measure J reallocates funds for housing, mental health care and programs considered alternatives to incarceration.
  • Oakland, Measure S1 seeks to strengthen civilian oversight of the police department.
  • San Diego, Measure B enhances subpoena and investigation powers for the civilian police oversight commission.
  • San Francisco, Proposition D sets up two new oversight commissions for the Sheriff’s Department.
  • San Francisco, Proposition E removes mandatory police staffing levels.
  • San Jose, Measure G expands the authority of the independent police auditor.
  • Sonoma County, Proposition P calls for several changes to law enforcement oversight.


Outside of the nation’s most populous state, there are a number of local ballot initiatives that seek similar aims in Ohio, Washington, Pennsylvania, and Oregon:

  • Ohio: Voters in Akron and Columbus are deciding on new rules related to police body camera recordings and a Civilian Police Review Board, respectively.
  • Washington: Voters in Seattle and King County will vote to decide if investigations should be mandatory when a member of a law enforcement agency's action, decision, or possible failure to offer appropriate care might have contributed to an individual's death.
  • Pennsylvania: Voters in Philadelphia are weighing multiple questions on victims’ rights, stop and frisk policy, and police oversight.
  • Oregon: Voters in Portland are also weighing a measure on the creation of a new police oversight board.


2020 ballot measures about marijuana and psychedelic substances

The 2020 election is pivotal for the future of marijuana policy reform. In four states – Arizona, Montana, New Jersey and South Dakota – voters will decide whether their state will join 11 others where recreational marijuana is already legal. Polls in October 2020 have indicated that all four ballot measures look likely to pass into law. A medical marijuana initiative is also on the ballot in South Dakota and in Mississippi.

In Washington, DC and Oregon, initiatives are on the ballot that, if passed, would decriminalize the use of psychedelic plants, like ayahuasca and psilocybin mushrooms. Advocates argue that there is "very strong evidence" that psychedelics have anti-addiction effects and can treat depression and anxiety in some patients, as well as PTSD in veterans.


Oregon’s Measure 110 to decriminalize drug use

Getting caught with drugs like cocaine, heroin, or methamphetamine normally leads to arrest, jail time, and a criminal record. But that could change in Oregon, where the passage of Measure 110 would make it the first state in the nation to decriminalize possession of personal amounts of drugs, weighing between a gram or two depending on the substance.  

Instead of being arrested, going to trial and facing possible jail time, the users would have the option of paying $100 fines or attending new, free addiction recovery centers. The initiative would establish the Drug Treatment and Recovery Services Fund that would receive funds from the Oregon Marijuana Account and state savings from reductions in arrests, incarceration, and official supervision. 

The Oregon Health Authority would give grants from the fund to government or community-run organizations to create addiction recovery centers, which will be mandated to be established within each existing coordinated care organization service area by October 1, 2021.

Advocates for Measure 110 argue that the current drug laws have created deep disparities in the justice system, and “arresting people with addictions is a cruel punishment because it slaps them with a lifelong criminal record that can ruin lives.” In October 2020, polls showed tentative support for the measure, which could be under-counted due to a huge influx of new voters during a presidential election year.

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