4 ways that census undercounting could impact the health of Pennsylvanians | Opinion
And what we can do about it.
The political impact of the 2020 Census data has already been felt in Pennsylvania with the loss of a seat in the U.S. House of Representatives. Soon, Pennsylvanians may experience the impact of census data on their health.
On March 11, the U.S. Census Bureau reported that Black, Hispanic, and American Indian residents were undercounted, while non-Hispanic white populations were overcounted nationwide. Miscounting estimates have not yet been released for individual states and cities. However, cities with high numbers of Black and Hispanic residents, like Philadelphia, where the Hispanic population has grown by 36% since 2010, may be most vulnerable to the ramifications of undercounting.
In 2018, authors from the Children’s Hospital of Philadelphia’s PolicyLab highlighted the potential health implications of census miscounting nationally. Now, with the census results out, it is important to understand the implications for Pennsylvania.
Loss of federal funding
Undercounting could lead to a loss of federal funding for Pennsylvanians for Medicaid, the Children’s Health Insurance Program, and similar programs that protect the health of the state’s most vulnerable people. This happened after the 2010 Census, when, as reported by the GW Institute of Public Policy, Pennsylvania lost $1,746 per person due to census undercounting, second only to Vermont. Additional losses would be particularly devastating for Pennsylvania, where Medicaid enrollees increased by 13.7% to 3.2 million from February 2020 to February 2021. This would mean less federal funding to support the health of Pennsylvanians at a time when the need for it is sharply rising.
Disrupts vaccine distribution and other public health policies
During the COVID-19 pandemic, for example, masking and vaccine policies have been based, in part, on case counts per 100,000 people. Ensuring adequate vaccine availability has required knowing the number of people and the age makeup of different communities. All of these efforts rely on population measures generated by census data. Miscounting can result in over- and underestimates of disease that lead to potentially misguided health policies.
Exacerbates existing disparities
Census miscounting can exacerbate the long history of health disparities by race and ethnicity that became even more evident early in the COVID pandemic. In 2020, the Philadelphia Health Department reported that death rates in the Black population of Philadelphia due to COVID were 50% higher than in the white population. Communities with the lowest supply of primary care providers in Philadelphia are those with higher proportions of racial and ethnic minorities. Undercounting in communities of color means potentially losing funding and resources in communities that are already underresourced and disproportionately suffer from poor health.
Limits health research
Identifying and addressing health hazards in the community requires correctly characterizing the population. For example, Pennsylvanians experience higher cancer incidence than the national average. However, new cancer cases in an area that is presumed to have a growing elderly population will prompt different investigations and responses from the public health research community than new cases in a seemingly stable, young population. In either case, miscounting detracts from efforts that will most effectively improve the public’s health.
“We can plan ahead now to avoid repeating this problem in the future.”
What can Pennsylvanians do now? First, stay vigilant. Right now we only know about undercounting at a national level. In the coming months, the U.S. Census Bureau will release results of undercounting at the state level. Cities and states can contest these results. It will be important for researchers and policymakers to review these data to fully assess the impact of undercounting in Pennsylvania. Already, the borough of State College is considering challenging the 2020 Census results, as closing college campuses during the pandemic likely resulted in undercounting.
Second, Pennsylvanians should continue to support programs like Philly Counts, an office of the city of Philadelphia that empowered residents of historically undercounted neighborhoods to participate in the 2020 Census. These programs need support to start organizing years in advance to ensure Pennsylvanians are counted in 2030. Look for opportunities to volunteer. For the 2020 Census, Philly Counts trained nearly 6,000 census champions to encourage participation in their home communities.
Every person should participate and be counted in the 2030 Census. Let your local, state, and congressional officials know that you want all Pennsylvania residents counted. Voice support for multipronged efforts that reach people in person, on paper, and online. Ask your officials to build trust by working now with community-based organizations. Advocate against changes to the census, such as the citizenship question proposed in 2019, that may perpetuate community distrust or induce fears that discourage participation.
We can plan ahead now to avoid repeating this problem in the future.
Annemarie Hirsch is an epidemiologist, an associate professor at Geisinger, and a Delaware County resident. Christine Gray is an epidemiologist, an assistant research professor at Duke University, and a former Philadelphia resident.