Why the 2020 census matters for public health: An explainer

At the American Public Health Association’s annual meeting in Philadelphia last week, researchers and public health leaders spoke on a range of topics affecting public health. In one session, Indivar Dutta-Gupta, co-executive director of the Center on Poverty and Inequality at Georgetown Law, explained the health implications of the 2020 census.

In the lead-up to the decennial population count, the Center is publishing a series of fact sheets, briefs and reports to outline the importance of a fair and accurate census.

Below, we summarize his most compelling points about why the census matters and what it will mean for public health in the United States.

Why the census matters

• It’s the country’s one shot at getting an accurate picture of who lives here, Dutta-Gupta explained. “The decennial census is the only attempt we make to count and collect information about everyone in the country. That’s it,” he said.
• The data gathered is used in a number of high-stakes applications. For example, it’s used to divide the 435 seats in the U.S. House of Representatives among the 50 states. It also guides an estimated $1.5 trillion dollars in federal funding, according to estimates from George Washington University’s Andrew Reamer. Dutta-Gupta continued, “A fair and accurate decennial census is essential to the equitable distribution of federal funding, and political power, and it’s essential for us to make smart decisions about how to solve social problems.”

What it will mean for health

• Shifts in political power, like the one that follows apportionment, can have health policy impacts. Consider, for example, how political shifts determined the fate of policies such as the Affordable Care Act.
• Census data influence a number of measures — the poverty level, for example — that guide the distribution of federal funds, Dutta-Gupta said. “Decennial data feed into other data that then are used to determine if [government] program providers are eligible for funding and which individuals are eligible for programs,” he explained.
• The $1.5 trillion in federal money guided by census data helps fund the following health-related programs:
  • the Children’s Health Insurance Program (CHIP)
  • Medicaid
  • Medicare
  • the Supplemental Nutrition Assistance Program (SNAP)
  • the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
  • community health centers funded through the Health Resources and Services Administration Health Center Program.
• Many national surveys rely on data collected through the decennial census. “One of the things that I’ve learned is that the decennial census really affects everything,” Dutta-Gupta said. “It affects basically every [national] survey that you can think of,” he said, explaining that Census data influences the sampling of subsequent surveys — it helps to establish what a representative population would look like on a smaller scale, and it helps to determine the “weighting,” or conversion between the sample population and general population. Dutta-Gupta cited the following surveys as influenced by census data: the U.S. Census Bureau-run Current Population Survey, the American Community Survey, and Survey of Income and Program Participation. These surveys are conducted at several timepoints throughout the year and measure labor participation, population and housing information, economic well-being, food security and rates of health insurance, among other things. Dutta-Gupta also mentioned that any survey that depends on inflation adjustments is in that way tied to census data. Additionally, the Healthcare Cost and Utilization Project, which also relies on census data, measures health-related factors such as income, educational attainment, housing, age, race, ethnicity, financial well-being, disability, fertility, health insurance coverage and costs, health care utilization and medical expenditures.
• Census data has a large impact on the assessment of certain health programs. Dutta-Gupta explained: “Decision-making, monitoring and assessment of program performance is also dependent on decennial data. For example, the Rural Health Program utilizes decennial census data to define non-urbanized areas and medically underserved community populations. These areas are classified basically entirely based on the counts of the decennial census initiative.”
• Some populations are often undercounted. “The Census Bureau aims to count everyone once, only once and in the right place. This commitment, however, is particularly tested when it comes to groups that we consider hard to count, like young children, people of color, people with low incomes, recent and undocumented immigrants, and people experiencing homelessness,” Dutta-Gupta noted. He later added in a phone interview, “The groups that tend to be omitted at the highest rate, unsurprisingly, are also the ones that would probably most benefit from greater access to and provision of health care and coverage.”
• Census data also can help researchers and government officials understand which communities are most vulnerable to the impacts of climate change. “People of color and low-income communities are some of the communities hit hardest by the climate crisis, and accurate decennial census data are needed to ensure environmental policies, practices and strategies are equitably developed and implemented,” Dutta-Gupta added.

Story ideas

For journalists looking for stories about what the decennial census means for public health, Dutta-Gupta suggested the following ideas:

• Dutta-Gupta explained in a phone interview that health-related coverage of the census rarely goes beyond the funding impacts it might have, and even when it does, this coverage typically is lacking in detail. He recommends asking state officials how state-run programs would be affected by potential funding cuts. For example, which benefits would they cut if they received less government funding?
• Dutta-Gupta also suggests looking at the role health-related institutions, like hospitals and doctors’ offices, might play in encouraging people to participate in the 2020 census. He advises journalists ask various health institutions whether and how they will assist with the count.
• Consider how public health could be affected if bad information about the census is shared with the public, whether intentionally or inadvertently. “We might start seeing tweets and all sorts of misinformation and disinformation around the census — just like we always see around voting,” he said in a phone interview. “I think that [mis- and disinformation] might have direct health implications itself,” such as psychological effects — fear and anxiety — which might in turn lead individuals to avoid using social programs such as Medicaid.