The Public's Health: The Census and Public Health | Public Health Post

The US Constitution mandates that every resident be counted at least every ten years. As the 2020 census approaches, the Trump administration’s decision to meddle with how to perform this head count by adding a question about citizenship to the census has already been criticized by the Census Bureau’s Scientific Advisory committee and has become the target of lawsuits.
What has provoked the Trump administration to add this question appears to be political representation. The new census question appears to be an attempt to depress the 2020 population count in immigrant-rich and predominantly Democratic areas in advance of redistricting in 2021. The Justice Department’s argument that it needs more detailed citizenship data to better enforce the 1965 Voting Rights Act has the same flavor as North Carolina legislators’ recent voter identification bill, which was nominally aimed at voter fraud, but actually targeted African Americans with voting restrictions. In both these cases, tying population data to law enforcement makes some worry that as many as 24 million people will not participate and get counted—those who owe child support or are behind on student loan payments, as well as fugitives, for example—because they fear their names and addresses might be shared with police. Nearly nine million legal US residents live with an undocumented person, and what if they ignore the census or undercount their households?
We do not know the effect of adding a citizenship question. It has never been tested, even in a pilot study. But we do know that these data will influence political representation—seats in Congress, electoral votes—which can influence how and if health disparities get addressed legislatively.
So, as a matter of public health, should our health organizations and public health professional groups and schools actively get involved?
Accurate census data are critical for the public’s health. These data drive, for example, federal grants to states for the Special Supplemental Nutrition Program for women and low-income children at nutritional risk. They determine funding for Medicaid and for school lunch programs. They guide disaster response and disease outbreak planning. The CDC uses census information to locate geographic areas with low education levels and high poverty rates so as to expand screening and outreach programs. These data inform the building of roads, schools, and health centers—what public health cares about. Eight hundred billion dollars of federal funding is allocated based on census data.
Not participating in the census in support of those too afraid to participate seems counterproductive to us. Actively encouraging members of disadvantaged and minority populations to participate in the US census may be a more positive approach as these groups are historically undercounted. All of us leaving the answer to a citizenship question blank also seems reasonable as a means of rendering it meaningless, but debating the options is what public health practitioners should do first. 

Michael Stein & Sandro Galea