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Census 2020 is a pressing health care issue - Crain's New York Business

For government officials, health care providers, adult children of older parents and just about every other person in the United States, the most pressing concern of the day is the spread of the coronavirus. That’s understandable and appropriate. Yet, ironically enough, that pinpoint focus presents a risk of its own—because there’s another critical health care event taking place right now, and if it’s overlooked, the impact will ripple through the next few decades.

On March 12, the US Census Bureau began mailing invitations to households across the country, asking residents to complete Census 2020. Clinicians should educate every patient they see about the importance of taking part. To do otherwise would be medical malpractice.

That’s because the census determines how much each state gets of the $300 billion in federal aid allotted annually for health care. We’re talking about money that helps fund programs like Medicaid, which provides health coverage to low-income individuals, families and persons with disabilities; the Children’s Health Insurance Program (CHIP), which assists uninsured, low-income children; and health center programs that help assure access to primary health care for vulnerable populations.

Census results also open or close the spigot on funds that less directly—but powerfully—shape the health of our patients and communities. Research shows that the conditions in which people live, work and age shape 80 percent of their health outcomes. These “social determinants of health” include stable housing—after all, it’s hard to take your insulin if you don’t have a refrigerator in which to store it. They include transportation—just try being adherent to medical appointments if you don’t have a car or reliable public transportation. And they include consistent access to adequate amounts of nutritious food.

About $80 billion in federal aid each year goes into the Supplemental Nutrition Assistance Program (SNAP), which helps low-income working families with children, seniors and people with disabilities purchase the food they need to survive and flourish. The effects of SNAP ripple through a lifetime. Children whose families participate in the program are less likely to develop metabolic syndrome 30 years later.

Similarly profound impacts are seen from the Section 8 Housing Choice Vouchers Program, which aids low-income households in obtaining decent, safe and sanitary rental housing. More than $20 billion in federal aid goes toward housing programs across the country.

But New York is on track to leave a lot of that money on the table. Factors like the push to include a citizenship question on the census has made participation less likely among the state’s immigrant population, even though the question has been abandoned. According to a recent report from the Census Bureau, New York City’s all-important initial response rate is projected to be 58 percent—woefully short of the national average of 76 percent. We’re heading for an initial response rate in the city not seen since 1990, when 244,000 people went uncounted, roughly equal to the population of Topeka, Kansas.

If that happens, health care providers may soon be seeing toddlers at well-baby checks who are no longer getting enough healthy food. During flu season, they could be treating elderly patients living in homes without enough heat. Their patients whose asthma is now under control may start wheezing again as mold-control funds evaporate. 

That’s why March 12 should kick off a second initiative in medical offices, clinics and hospitals. Health care providers and staff should pledge to fill out the census and get comfortable explaining why their patients should do the same—organizations like New York Counts 2020 have plenty of information that can help. Waiting rooms should have census hotline numbers prominently displayed. Offices can even provide online access for those who are willing to fill out the census in the waiting rooms. 

If people get encouragement from a trusted messenger, they’ll be more likely to fill out the census. Those in the medical field already play that role for their patients when it comes to the coronavirus and other emergencies, but they must do the same for health issues that play out across decades.. By urging our patients to fill out the census, we are letting them know that they count—and should be counted. After all, it’s good for their health.

Udai Tambar is the vice president for Community Health at Northwell Health. Meeta Anand is the Census 2020 senior fellow at New York Immigration Coalition.

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