Participate in the Census, Promote Children’s Health

The 2020 census is in full swing and its results will have a major impact on children’s health efforts in the years to come. The census findings inform the appropriation of billions of dollars in federal funding across states and communities, which directly affects public health, housing, and early education programs. The census also determines the numbers of seats each state receives in the U.S. House of Representatives. An accurate census count helps ensure that all children and families get the resources and representation they deserve to help them reach their optimal health. However, the census has historically undercounted millions of people, many of them children.

What is the census?

The census is meant to count every person who lives in the U.S and is conducted every ten years. It is constitutionally mandated and run by the U.S. Census Bureau, a nonpartisan government agency.

In mid-March, households began to receive invitations to respond to the census questionnaire online, by phone, or by mail. Census results will be delivered to the U.S. President and Congress by December. These results then go on to influence national and state policymaking and planning.

Responding to COVID-19
Typically, census workers go door-to-door to encourage census participation. Due to COVID-19, door-knocking has been delayed. During this rapidly evolving health emergency, the safest way to participate is on your own – either by mailing in a survey, or by participating online at or over the phone. Census participation is vital.

The COVID-19 pandemic has led to new concerns about undercounting, which makes participation and awareness-raising more important now than ever before. This census will impact health outcomes for the next decade. 

“I can’t say enough about the importance of census participation—everyone counts, so everyone should be counted,” says NICHQ Senior Director of Applied Research and Evaluation, Becky Russell, MSPH.

Russell is an epidemiologist and evaluator with two decades of experience leading national public health research and evaluation efforts. Below, she expands on the importance of census data for public health efforts, addresses common concerns that can affect participation, and shares why public health professionals are essential for the census’s success. 

The census’s impact on children’s health

The census has direct implications for the health and well-being of children and families across the country. Hundreds of public programs use census data to determine how to distribute more than $800 billion in funds. These programs included the maternal and child health services block grant, which provides health care and public health services for an estimated 55 million people; the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); the Children’s Health Insurance Program (CHIP) and Medicaid; and Head Start, to name just a few.  

Troublingly, children have been historically undercounted in the census. In fact, estimates suggest that over 2 million children were not counted in 2010. This undercount means that vital children’s health programs are planned based on inaccurate numbers and demographics.  

“So many federal programs that target social determinants of health—from housing to education to health care—depend on census counts and how those counts impact resource allocation for families across the country,” says Russell. “The 2020 census is a vital opportunity to improve health outcomes for the next generation of children, especially those living in underfunded communities, and ultimately promote health equity. Getting an accurate count of our population is the first step in helping the government plan for and provide appropriate resources.”

Along with funding programs, census data also impacts how public health professionals and agencies understand and implement programmatic work. The data help researchers, evaluators, and program planners identify community and population-level indicators associated with poor birth and health outcomes and help illustrate trends related to births, mortality, and disability. Census data also assist programs in determining high-risk areas to target, how to distribute resources accordingly, and are behind important decisions about where to build clinics, hospitals, and schools.

“It’s easy to feel removed from the data—to feel like another number on a list. That’s why it’s so important to realize exactly what the data will do and how it will affect peoples’ daily lives,” says Russell. 

Responding to concerns

Despite the importance of census data, people may feel uncomfortable participating because of concerns about data collection and misuse. “People are more afraid about data privacy than ever before,” says Russell. “My concern with the census this year is that this fear will stop people from participating, so it’s really important to address common concerns about how the data is collected and stored, why it is collected, and what it is being used for. Remember, with the census, your data is safe.”

A Disturbing Legacy
Historically, people of color—adults and children—have been disproportionately undercounted in the census. This legacy can be traced to the earliest census, where each enslaved African was counted as only three fifths of a person—a response to the Three-Fifths Compromise. Today, persistent undercounting impacts federal funding for programs that specifically target underserved populations. Reducing census count disparities is vital for improving health outcomes for everyone. Learn more about the history of undercounting here.

The how: Census data is collected through questionnaires; the answers are entirely confidential and anonymous. In fact, the Census Bureau is bound by law to never release any information that could identify individuals. This means that government agencies and courts can never use census answers against individuals.

The why and what: Individuals may feel more hesitant about responding to certain questions, especially those related to race, ethnicity, housing, and sex. Understanding the purpose of these questions as well as being assured of privacy (see above) can help alleviate concerns about participating. For example, questions about race and ethnicity help federal agencies monitor compliance with anti-discrimination provisions, such as those in the Voting Rights Act and the Civil Rights Act; and questions about home ownership help determine housing programs, planning, and decision-making. You can read about the logic behind each question here.

No citizenship question: In 2019, the White House administration proposed including a citizenship question on the census. This question was blocked by the Supreme Court and will not appear on the census. But, nearly 70 percent of adults think it will be included. Unfortunately, this confusion will likely reduce participation among immigrant families who could most benefit from public programs.

What can maternal and child health professionals do

“There is a big opportunity for health care providers and public health professionals to raise awareness about census participation, especially among underserved communities,” says Russell. “We can alleviate fears and empower people to participate by sharing the facts: what happens to their data and why certain questions are being asked. And importantly, we need to do this in a way that respects concerns stemming from peoples’ lived experiences.”

There are multiple opportunities to connect with families about the census: Pediatricians can ask families if they’ve completed the form during their regular well-child visit, and talk to them about the importance of including all children, even toddlers and babies, on the form; home visitors and other public health professionals can spread information about the census when meeting with families; and everyone can use social media to raise awareness about the importance of participation. The American Academy of Pediatrics and the Census Bureau have all provided resources to support health care providers in spreading the word.

NICHQ has also created a social media toolkit focused on raising awareness about the census’ importance for children’s health specifically. Check it out.