By Thomas Goldsmith
The 2020 Census could have a distinct effect on the distribution of health services in North Carolina, particularly if the process misses “hard-to-count” populations including Hispanics, older people in long-term care, children and rural residents.
That’s the concern expressed by voices from the Washington, D.C.-based organization The Leadership Conference on Civil and Human Rights, as well as by authors of a recent Triangle-led academic paper, and by Adam Zolotor, a physician and epidemiologist at the University of North Carolina-Chapel Hill and president of the North Carolina Institute of Medicine.
“For sure we use census data to inform a lot of the ways we think about the distribution of resources,” Zolotor said in a phone interview. “If the census is less accurate it will impact our ability how to allocate resources.”
Who are the “hard-to-count”? “Historically, the census has undercounted young children, people of color, rural residents, and low-income households at higher rates than other population groups. Also, groups with low self-response rates in prior censuses or census tests include “linguistically isolated” households; frequent movers; foreign born residents; households below the poverty line; large (i.e. overcrowded) households; low educational attainment households; and single-parent-headed households. “And people who distrust government authorities and/or have been or could be targets of law enforcement or heightened surveillance…” Source: U.S. Census Bureau
Worry about full participation followed a protracted effort by President Donald Trump’s administration to add the citizenship question, beginning with a March 2018 announcement by U.S. Commerce Secretary Wilbur Ross. The U.S. Supreme Court ultimately stopped the effort, rejecting Ross’ claim that the citizenship data was needed to enforce civil rights law.
Bureau: ID data can’t be shared
Zolotor said even the losing effort has led to fears that non-citizens could give themselves away by their answers.
Theautry Green, a North Carolina media partnership specialist for the Census Bureau’s Atlanta region, discounted fears that people’s personal census information would be used against them.
“The Census Bureau cannot release any identifiable information about individuals, households or businesses, even to law enforcement agencies,” Green said in an email. “The law states that information collected can only be used for statistical purposes.”
But Zolotor was skeptical.
“The Supreme Court has made that decision, but there has been a lot of discussion about this in the media, and I’m not sure that individuals keep up with what the Supreme Court is doing,” he said.
Researchers are concerned that a lower response could lead to inadequate data on which to base some state and federal decisions on where to spend health care dollars. Other recent developments could also affect the response rate, including the General Assembly’s passage of a bill that required county sheriffs to turn in non-citizens to ICE.
“If they are uneasy about how welcome they are, that can lead to a reluctance in participating in the census,” Zolotor said.
Health-related uses of 2020 census count Source: U.S. Census Bureau Census 2020 officials tout the ease of taking part in next year’s count through internet and phone connections. But there’s a reverse side to that, Zolotor said. “The other thing that’s kind of interesting about the 2020 census is that it’s going to be mostly online,” he said. “I wonder how that will affect accuracy and the quality of the data.” Health researchers routinely use U.S. Census Bureau results in their work. One example is the calculation of cancer incidence and mortality in every U.S. county between 1967 and 2017. Data the Census Bureau gathers are so vital that any lessening of quality could contribute to increasing inequities in areas such as mental-health care, researchers, including three lead authors at the National Institute of Environmental Health Services at the Research Triangle Institute, wrote in a paper this month. “Undercutting the Census and the American Community Survey, rich data sources that allow representation of all people in the United States, is a step backward in our effort to mitigate the population mental health consequences of disasters,” the authors wrote, citing “threats to the validity” of the upcoming count. “As a result, public health funding could be misallocated, and disaster preparedness and response efforts misinformed; this can also contribute to the worsening of mental health inequities, particularly in the context of disaster,” the paper said. Green said the Census Bureau already has plans to encourage buy-in by undocumented Hispanic residents, a group that may feel skeptical about giving out personal information. “Throughout the country, we have identified areas with heavy Hispanic populations and have hired bilingual staff to assist in those areas where language could pose barriers for those needing to participate in the census,” he said. “This holds true for other populations, too.” The population shifts that Census data captures can also guide the rearranging district lines from the U.S. Congress to local school boards. Kenneth C. Wilkins, a partnership specialist with the U.S. Census Bureau, spoke recently to the North Carolina Coalition on Aging, a statewide nonprofit group. With only a glancing reference to the citizenship question, Wilkins put the operation in its simplest terms. “In its basic sense, the census is only about who’s on our soil,” Wilkins said. “It’s not about anything else. It’s about counting heads. Data from the Census Bureau tallies, such as the characteristics of people in a prescribed geographic area, are used to calculate in North Carolina where about $16 billion should be dispensed annually for health care and emergency response, as well as schools and roads. The numbers are also useful in making sure that funded groups have done what they have pledged to do with the financial support. The national Brennan Center for Justice has projected that North Carolina will add at least one seat in the U.S. House of Representatives after the 2020 census. That’s partly a result of people moving here from other states. A full count, including a push to snare the so-called hard-to-count groups, could mean more for Tar Heel coffers as population remains a major driver of dividing $675 billion in federal grant money to state and local governments. “I’m really excited to be here, because I’m excited about what the census could mean for our state,” Wilkins told the Coalition on Aging, “And certainly for the communities that you come from, the folks that you serve.” In addition to the overall population data, the Census Bureau keeps an eye on health care measures such as the Small Area Health Insurance Estimates, a county-by-county tool that’s been used to gauge the effects of Medicaid expansion in several states. A new batch of major reports on health insurance coverage and poverty is coming in September, the bureau said, courtesy of those estimates. Zolotor noted that most health care funding to the states flows through Medicaid, which is managed by the state and not as likely to be affected by census data. But millions are still parceled out through payments to the states such as the Social Services and Home and Community Care block grants, he said. In the end, the census count is about “money and power,” Wilkins told an audience of more than 40 members of the Coalition on Aging. The group serves as a statewide voice for older people, people with disabilities, LGBTQ people, and others. The 5,600-person census workforce in North Carolina, he said, will pay special attention to hard-to-count populations, including older people and those in long-term care, prisons, military barracks and other locations. “We are working hard to ensure we minimize undercounted populations,” Green said. “For the 2020 Census, it is part of our operational guidelines to count people living in what are called ‘group quarters.’ Nursing homes and assisted living facilities fall under these guidelines. Therefore, anyone living in these facilities on Census Day will be counted.” Attendee Jeff Horton, representing the state’s adult care homes, wanted more information upon hearing that the U.S. missed a million children in the 2010 count. “If a numerator came to the house, or if someone filled out a questionnaire, and there was an infant in the house, they may have thought, ‘Well, I don’t need to count that person,’” Wilkins said. “It could also be that we have children and family that may be at this house one week and that house next week.” The bureau knows roughly how many people are under-counted through data including the American Community Survey, with its detailed questionnaire on family incomes, employment, health information and more. To encourage as many people as possible to respond to the short form, the bureau establishes complete count committees to address specific groups such as older people. The state Department of Administration coordinates efforts by the Complete Count Commission throughout North Carolina. In addition to encouraging locally based volunteers, the census operation is hiring, now and into next year. Connections can be made through the Atlanta office. Wilkins told members they should start expecting a census publicity blitz early next year when the inevitable bad actors will also appear. “Every time we have something like that, there are always folks out there who are thinking about how they can scam somebody, to take something from somebody,” he said. “We will never ask for full Social Security numbers, we will never ask for credit card numbers, pin numbers. “Nothing will come from any political party. Anyone who’s doing that is not working for the Census Bureau.” Republish our articles for free, online or in print, under a Creative Commons license.
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