The U.S. census is a pediatric issue? Absolutely!
The Annie E. Casey Foundation estimates that for the 10 largest federal programs serving children, $160 billion a year is distributed using census-derived data. In fiscal year 2015, for example, the government distributed $61 billion for children’s Medicaid services (not including Medicaid payments to children with disabilities); $29 billion for food stamps; $4.6 billion in foster care funding; and more than $8 billion for Head Start.
Yet the 2010 census missed close to 1 million young children — costing over a billion dollars each year in federal funding for these and other vital social programs. And the conditions are in place for it to happen again in 2020.
Granted, no count of more than 325 million people can be perfect. But children under age 5 have a higher net undercount rate than any other age group. Latino children account for a disproportionate share of undercounted children; the undercount rate for African-American children is close behind.
Characteristics that compound the risk of being undercounted include poverty and housing insecurity. In some cases, whole families were missed. In other cases, families who responded did not include all of their children due to joint custody arrangements, children being cared for by grandparents or other relatives, or situations where several families lived together.
Some households did not respond out of fear or mistrust of the government, particularly in circumstances where a parent is undocumented or a child is living with a grandparent in an age-restricted housing unit.
In addition, dispersed rural populations and overly dense urban populations in cities like Newark, N.J.; Cleveland; Detroit; Memphis, Tenn.; Laredo, Texas; and Santa Ana, Calif., are harder to count and often end up under-represented.
The 2020 census brings two additional challenges:
- A new proposed question asking respondents to list their citizenship status may discourage immigrant families from responding (even though laws safeguard the privacy of responses.) The AAP is deeply concerned by this proposal and has filed comments with the U.S. Census Bureau urging it to withdraw the question from the 2020 survey.
- With this being the first census conducted primarily online, fears of cybersecurity may arise and disparities in internet access could hit low-income communities the hardest.
Ten years is a long time to live with a mistake, especially if it affects our nation’s ability to provide equal representation and equal access to important governmental resources for all children. That’s why we’re working with like-minded national and local groups to ensure the 2020 census is fair and accurate and prevent the 2010 census undercount from happening again.
Children are not numbers; they are the patients we care for and about. As we well know, our patient population has grown increasingly diverse. Children who are foreign-born or U.S.-born to immigrant parents are a large and growing part of the U.S.
Today, one in four of our nation’s children lives in immigrant families. Nearly one in five children lives in poverty, and that ratio is greater among children who are black or Latino.
As trusted messengers, pediatricians must alert our colleagues, communities and patients’ families to the implications of a high undercount among young children and how it affects them and their communities.
Census Day is April 1, 2020, a little over a year away, and we need to get this right. Soon, the Academy will begin efforts to ensure all children are represented. Outreach will include federal advocacy, connecting with like-minded partners and helping pediatricians educate and motivate their communities and families to respond. We are looking forward to working with partners in the Federation of Pediatric Organizations who are spearheading efforts to make sure that all of pediatrics is united and coordinating efforts.
Stay tuned for more on this important work and how you can help make every child count and be counted.