Since it impacts us, every household is encouraged to complete the 2020 Census. The U.S. Congress started taking the U.S. Census in 1790, as noted in the U.S. Constitution. The Constitution also required that the federal government do the census every 10 years. Political power and funding are greatly impacted by the census, which also impacts all the elements that contribute to the social determinants of health. The census is used to allocate congressional seats, electoral votes, funding for government programs, as well as the database of a lot of research.

More than $675 billion federal funding is distributed yearly based on the U.S. Census. Accuracy in the “count,” counting the correct category, clear descriptive verbiage, and engagement are imperative. Relating the importance of completing the census to all stakeholders, and creating an environment where people feel safe in completing the census, especially marginalized populations, is essential. Minorities, children, immigrants, and low-income areas are noted to be difficult to count.

The Count

Accuracy of the count has always been a concern from day one. President Washington and his Secretary of State, Thomas Jefferson, shared concern that the Census of 1790 undercounted the population greatly—and we still have this issue today. According to the U.S. Census Bureau, the first Census consisted of six questions:

the name of the head of the family, free white males at least 16 years old, free white males under 16 years old, free white females, “other free persons,” and slaves. Slaves were counted as three-fifths of a person and Indians were not counted until almost 100 year later.

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The 2020 Census has had a hot debate over including a citizenship question and the negative impact it would have. Although the suppressive citizenship question will not be included, citizenship numbers could be extracted from the yearly American Community Survey (ACS), which falls under the U.S. Census Bureau. We still deal with inaccuracies of the census, concerns of undercounting the population, as well as debates over the questions included on the census. The census has a huge impact on the allocation of funding, research, and political representation.

African Americans and Latinos have been historically undercounted. These groups are even ranked by states in census tracks called HTC (Hard to Count) with New York, Texas, Florida, California, and Georgia in the top five states respectively for African Americans and for Latinos, it is California, Texas, New York, Arizona, and Florida, respectively, according to CensusCounts.org. Children also have a ranking in HTC states. Many elements play a role in why the census does not reflect an accurate count or low survey participation with minorities, low-income, children, and immigrant population. Fear, distrust, inequity, lack of information, privacy, and intent contribute to poor participation.

The 2020 Census adds a new element that for some may be a barrier and/or learning curve, which is technology. For the first time in history, the census will be available online. The addition of media brings about many issues, such as computer literacy and internet access issues. The HTC marginalized population should be targeted for support and resources to get optimal participation in completing the 2020 Census.

Political Representation

The U.S. Census data determines our political representation. Congressional seats for each state are determined by census data. As a result, a state could lose a member in Congress or your city could lose state representation. For example, the House of Representatives divides its 435 memberships or seats among the 50 states based on the total resident population (citizen as non-citizens) using a 1941 calculation methodology; a complex process. Let’s not forget two important political terms: redistricting and gerrymandering. Redistricting is the period where legislative boundaries are redrawn. The data is used to define legislative districts, school district areas, as well as other areas in government. Gerrymandering is a method that officials may use to draw district lines to influence election results, manipulating boundaries and changing voting districts to favor a political group.

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Funding

Census data is used to make decisions on road repair, schools, services, jobs, education, neighborhood improvements, and more. As noted above, more than $675 billion federal funding is distributed yearly based on the U.S. Census. According to the College Board’s annual Trends in Student Aid report, in 2017-2018, there were 7 million Pell grant recipients equaling $28.2 billion. In 2016-2017, 49% of Pell grant recipients were dependent students; 37% of these students came from families with incomes of $20,000 or less, and another 36% came from families with incomes between $20,000 and $40,000. Funding is allocated in one of three ways: selection and/or restriction of recipients, award allocation, and monitoring and assessment of program performance.

Medicaid, for example, is the largest source of health insurance for low-income and disabled persons. It’s a federal and state program where funding and reimbursement level calculations include the state’s population and income levels, which are derived from the U.S. Census.

The Special Supplemental Nutrition Program for Women, Infant, and Children (WIC) serves low-income women, infants, and children at nutritional risk by providing nutritious foods and health care referrals. WIC provides vouchers for crucial foods like baby formula, eggs, milk, and fresh fruits. According to the Food and Nutrition Service, in 2018, WIC served approximately 6.87 million (5.5 million being children and infants served). For the first five months of FY 2019, 6.4 million had been served. WIC uses the Health and Human Services (HHS) guidelines for WIC eligibility. WIC uses the Consumer Price Index, which is derived from the U.S. Census, to see monthly food voucher prices and the ACS (which is also part of the Census Bureau) to allocate funds to each state. By the way, the U.S. Department of Agriculture reported that in 2016, 58.6% of WIC participants were white, 20.8% Black or African American, 10.3% American Indian or Alaskan Native, and 4.4% Asian or Pacific Islander.

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Research

We often look to the Centers for Disease Control and Prevention (CDC) for data collection and research; from tracking diseases and prevention to program evaluations for effectiveness. It is accepted as vetted, accurate information; as well as the guardians of public health while utilizing this data. The National Health Interview Survey (NHIS) is the methodology used for this data and it is based on the decennial census information and updated with every census.

Many sources that track the social determinants of health, such as income and poverty level, use census-derived data. The Current Population Survey (CPS) is one of these sources, collecting data since 1940. CPS, sponsored by the U.S. Census Bureau and U.S. Bureau of Labor Statistics, provides information about our jobs, earning, education, and other studies that note the population’s social well-being, such as volunteerism, child support, and health insurance coverage. A huge impact of CPS is obtaining the number of unemployed population and the demographics. Unemployment data and economic data are used by policymakers to address unemployment and the repercussion of it.

One of the largest, well-known research projects commissioned by the Institute of Medicine was published in Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. The Institute of Medicine used data from the U.S. Census throughout this research. This study concluded, “Evidence of racial and ethnic disparities in healthcare is, with few exceptions, remarkably consistent across a range of illnesses and healthcare services.” This study confirmed what people of color have always known through personal experience, but validation by a scholarly entity through research was priceless. This research has impacted health care delivery and highlighted the realization that care is not equal, and inequities exist which we must address.

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Summary

A complete and accurate count of our population by the U.S. Census is imperative. The U.S. Census data impacts many elements of life, especially funding, representation, and research. Federal funding allocation dictated by the U.S. Census affects our classrooms, jobs, senior services, health care in our communities, and numerous other programs and services. This includes health insurance programs like Medicaid; as well as WIC and Head Start. Hence, the U.S. Census impacts health care disparities and the social determinants of health as well.

Minorities and low-income people are undercounted and noted to be difficult to count for many reasons, yet census data impacts this population greatly. Our political representation and redistricting is based on the census data and being counted dictates the number of representatives. Our elected officials, our representation, advocate for funding and represent us in all issues that impact life, liberty, health, and even our pursuit of happiness. Research drives the allocation of funds, health care delivery and changes, social issues and justice, just to name a few areas in which the US Census Data is used as a resource. Funding dictated by the census impacts our classrooms, jobs, grants, and health care in our communities—especially vulnerable, underserved populations. Since the U.S. Census impacts us all, we must encourage everyone to complete it.

Brenda Robinson, DNP, MSN, BSN, RN
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