An Accurate Census Protects Our Health

— Proposed changes threaten the accuracy of data about our communities

As a physician, I take care of the individual patient in front of me. As a public health leader, communities are my patients. I ask: Who needs care but is not getting it? Where should we focus resources to prevent vaccine-preventable diseases like measles or whooping cough? Who might need help during a natural disaster?

An accurate census helps us answer those questions. It tells us how many people live in our communities and helps set a baseline for understanding and comparing health needs. Yet, proposed changesopens in a new tab or window to the decennial census would make some people invisible and make the picture of communities in our country less complete, therefore making it harder to plan for health needs and prepare for emergencies. Leaving people out of the count does not make their needs or our responsibilities disappear.

The proposed rule would make sweeping changes to who counts in the census and how we are counted. Rather than counting the total population, the proposal would now intentionally exclude many residents from the count used for apportionment (the process of reassigning seats in Congress). While the census has never counted tourists and other temporary visitors, the new rule would exclude long-term residents such as student and work visa-holders, refugees, asylees, and others who don't have permanent residency. The proposal would also dramatically change how we are all counted, relying heavily on tax records that may miss many people.

The public health consequences of these manufactured undercounts and forced errors will be immediate and severe. Hundreds of billions of dollars in federal healthcare resourcesopens in a new tab or window -- including Medicaid, the Children's Health Insurance Program, community health center grants, and emergency preparedness funds -- are distributed using census-derived population formulas. This means the impacts of an inaccurate count will not only be borne by the people who are erased or misplaced; the impacts will affect each and every one of us. For some families, an undercount could mean longer waits for a child's checkup or a harder time finding a doctor close to home. When a hurricane hits, a community could have fewer resources to open shelters.

The proposed rule would also ban certain demographic questions, including questions on race, ethnicity, and sexual orientation. Removing demographic questions strikes at the heart of epidemiological surveillance. These data form the denominators we use for tracking rates of maternal and infant mortality, cancer incidence, chronic disease prevalence, and vaccine coverage that may vary across demographic groups.

Many major public health surveys rely on census data to make sure their results accurately reflect the population. Without demographic data to weigh survey estimates, the quality of those estimates erodes and puts the health of all Americans at risk. The National Health and Nutrition Examination Survey uses Census Bureau population data to take findings from a few thousand participants to develop national estimates of conditions such as high blood pressure. If these estimates become less reliable, health departments won't be able to plan for prevention programs and health systems can't estimate needed patient visits.

Maternal mortalityopens in a new tab or window is a significant issue in our country, especially compared to peer nations. To address differences in maternal mortality across racial and ethnic groups, for example, we need reliable information about those populations to develop more effective responses, such as community-based doulas, "promotorasopens in a new tab or window" who provide health education and outreach, or patient navigators who help people get care. Similarly, American Indian and Alaska Native populations have higher rates of diabetesopens in a new tab or window and are nearly twice as likely to die from diabetes than the U.S. population overall. Without demographic information, it becomes harder to direct programs where they are needed most and to assess if these interventions are working.

The Census Bureau should withdraw these proposed changes and preserve an accurate count and the demographic information communities need to make decisions for health. Before November 2, you can submit a public commentopens in a new tab or window asking the bureau to do exactly that. Share how these changes will impact your patients and other issues you care about: planning care for pediatric patients, supporting mothers, or preparing for the next emergency.

We all want our communities to support our patients' health and well-being, and to be ready when disaster strikes. We should expect transparent, accurate data about our communities and not accept decisions that leave us less prepared.