Columns for The Lufkin News

​An Accurate Census – Our Health Depends on It!

Posted Feb 09, 2020 by Sidney C. Roberts, MD, FACR

When I was a skinny, naïve teenager, I worked the summer of 1980 for the US Census Bureau going door to door, pencil in hand, filling out census forms. Or rather, I went trailer park to trailer park in the outskirts of Odessa, Texas, where I was assigned to work. Do you know how many pit bulls and Doberman pinschers live under the steps of trailer houses in West Texas? I do. Fortunately, that was not one of the census questions.

The US Census counts each resident of the country, where they live on April 1, every ten years ending in zero. The count is mandated by the Constitution to determine how to apportion the House of Representatives among the states.[1] The US has counted its population every ten years since 1790. Households will be able to respond to the 2020 Census online, over the phone, or through a paper questionnaire. Results are anonymous and confidential; answers cannot be used against you by any government agency or court.[2]

My appreciation for the US Census has grown tremendously since my days walking trailer parks. Far beyond being a simple head count, an incredible $1.5 trillion in federal dollars are distributed according to census counts. Myriad local and state governments, businesses, and community groups rely on US Census data to determine needs, guide investments, provide services, and lobby for state and federal funding.[3] If the count isn’t accurate, the distribution of funds isn’t fair. We have one shot every ten years to get it right.[4]

Healthcare in particular has much at stake if the US Census does not get accurate information. As I love to mention, the healthcare sector drives our local economy. The State of Texas cannot ignore the healthcare sector either. Elena Marks, president and CEO of the Episcopal Health Foundation, states, “No sector is as dependent within the state budget in drawing down federal funds than the health sector, and those funds are based on population that's determined by the Census. Health clearly stands the most to gain, and the most to lose if there's an undercount.”[5] In fact, experts estimate that a 1% undercount in the Census could cost Texans about $280 million per year for health programs alone. Current forecasts predict anywhere from a 4%-8% undercount in Texas.[6]

From political representation to federal funding for clinics, Medicaid, the children's health insurance program and much more, a complete and accurate Census count is crucial for community health – especially for low-income and vulnerable populations like many in deep East Texas.[7] The $1.5 trillion in federal money guided by census data helps fund 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), and community health centers funded through the Health Resources and Services Administration Health Center Program.[8] Indivar Dutta-Gupta, co-executive director of the Center on Poverty and Inequality at Georgetown Law, notes that the groups that tend to be undercounted 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.[9]

The Census is also fundamental for population health data, including calculation of death rates, birth rates, and fertility rates.[10] A recent journal article titled Census 2020—A Preventable Public Health Catastrophe[11] points out that population counts provide denominators used to derive disease prevalence and rates. Inaccurate counts limit our ability to understand and track disease over time. If we cannot accurately stratify our populations by social factors such as education and race/ethnicity, we cannot assess their relationships to health.[12] Rural populations with spotty Internet connectivity are also likely to be undercounted.[13] Simply put, if we can’t measure social disparities in health, we are hindered in working to reduce them. Given our history of hurricanes, we need to understand that a flawed Census will compromise efforts to track and effectively manage natural disasters and emergent public health threats (coronavirus?), which require geographically focused provision of food, water, and shelter.[14]

Lately, it seems as if politics gets in the way of everything. We must understand that federal dollars follow people. More people counted equals more funding coming our way. Whether or not we like with the ways those dollars are raised or spent, we should all agree that we deserve our fair share of whatever dollars are distributed. An accurate US Census is something we should all be able to count on and get behind!

[1] https://www.census.gov/program...

[2] https://2020census.gov/en

[3] https://ajph.aphapublications....

[4] https://journalistsresource.or...

[5] https://www.episcopalhealth.or...

[6] https://www.episcopalhealth.or...

[7] https://www.episcopalhealth.or...

[8] https://journalistsresource.or...

[9] https://journalistsresource.or...

[10] https://ajph.aphapublications....

[11] https://www.ncbi.nlm.nih.gov/p...

[12] https://www.ncbi.nlm.nih.gov/p...

[13] https://www.ncbi.nlm.nih.gov/p...

[14] https://www.ncbi.nlm.nih.gov/p...

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