Statement from Public Health Institute President and CEO Melissa Stafford Jones Urging Census Bureau to Withdraw Rule that Would Weaken the Nation’s Health Data

FOR IMMEDIATE RELEASE
CONTACT: media@phi.org 

The Public Health Institute (PHI) is urging the U.S. Census Bureau to withdraw a proposed rule that would remove race and ethnicity questions from the census form and tie where people are counted to tax records that miss about a quarter of the U.S. population. The census tells the nation how many people live in each community and who they are. Those counts shape how health problems are tracked, where federal health dollars are invested and how civil rights protections in health care and housing are enforced.  PHI is calling on the Census Bureau to withdraw the proposed rule, “Decennial Census of the Population of Americans; Proposed Residence Criteria and Proposed Regulations for Demographic Questions” (91 FR 57524), before it is finalized.

Disease doesn’t stop at the line between who is counted and who isn’t. Accurate denominators, the population counts behind every health rate, are the backbone of disease surveillance. They let us measure progress toward our shared goals of reducing illness and improving health for all Americans. Get the denominator wrong, and we weaken our ability to detect, respond to and prevent disease across the entire country.

PHI serves as the operational backbone for more than 40 public health programs that provide the full continuum of public health services, from conducting research and advancing science to implementing public health solutions in communities. Census data are the starting point for much of the work of public health. They are used to calculate disease rates, identify which groups face the greatest health risks and measure whether public health interventions are working. PHI supports the Census Bureau’s obligation to conduct an accurate, constitutionally sound count but has serious concerns that this proposed rule narrows who gets counted and removes data used to prevent, detect and address disease. PHI has submitted formal comments to the Census Bureau, raising the following concerns and recommended changes.

• Leaving people out of the count distorts health data for everyone. The rule would exclude from the apportionment count people who are not U.S. citizens or lawful permanent residents, including international students, visa holders and undocumented residents. It does not say whether they would still be counted for other purposes. Public health tracks disease as a rate, the number of cases compared with the number of people who live in a place. Leaving residents out of the population count distorts the data used to calculate disease rates for every neighborhood, county and state. PHI urges the Census Bureau to withdraw this provision and keep the 2020 census approach of counting every person at the place they usually live.
• Removing race and ethnicity questions masks health disparities. The rule would prohibit questions about race and ethnicity on the census form. These data show where health gaps exist and whether efforts to close them are working. Those gaps are costly. A 2023 NIH-funded study in JAMA estimated that racial and ethnic health inequities cost the U.S. economy $421 billion to $451 billion in 2018 alone. PHI urges the Census Bureau to keep the race and ethnicity questions on the census form.
• Tax records could miss children and hard-to-reach communities or count them in the wrong place. The rule is silent on people with no tax record or a conflicting one. The Bureau’s own research shows individual tax returns cover at most 76 percent of the population. Most government records list only adults, and newborns often don’t appear until about a year after birth. Independent researchers also found that the Bureau’s record matching works less well for people of color, immigrants and people with lower incomes. PHI urges the Bureau to keep direct counting as the main basis for where people live and ensure a missing or conflicting tax record never by itself removes anyone from the count.
• A sample survey cannot replace the census. The Census Bureau points to the American Community Survey (ACS) as a continuing source of demographic data. That survey reaches only a sample of households, so its estimates for neighborhoods are often too imprecise to rely on. PHI urges the Census Bureau not to treat the ACS as a substitute for asking every household about race and ethnicity.

We all depend on an accurate count. Health departments, hospitals, researchers and community organizations use census data every day to decide where to focus resources and to measure health improvements or declines. When the census becomes less accurate, every one of those decisions gets harder, and the children, families and communities already facing the greatest health risks pay the price. The Census Bureau should withdraw this rule.

Read PHI’s formal comments submitted for the record.

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The Public Health Institute is a national independent nonprofit that advances the health and wellbeing of all people and communities, particularly those facing the greatest barriers. Rooted in 60 years of public health experience, PHI moves ideas into action through practice, policy, research and community engagement, while serving as the operational backbone for more than 40 programs delivering evidence-based solutions to complex health challenges.