The census, the decennial count of our nation, is important for a variety of reasons. As a vehicle for how our democracy functions, the primary purpose of the census is to determine the number of congressional representatives each state has. The basis of our government is on balance between the three branches of government that (ideally) have equal power to ensure an appropriate level of checks and balances is possible. Ensuring validity in the number of individuals each representative serves is important to ensure equal representation by our elected leaders. Arguably as important as the function of determining the number of representatives each state has is the fact that the count of the census is used to appropriate billions of federal funds.
The appropriation of federal funds and ensuring our democracy is balanced and functioning is why it is so concerning to see the current concerted efforts to undermine the integrity of the census. Earlier this week, the Trump Administration signed an executive order that instructed that undocumented immigrants would be removed from census counts. This has been described as unconstitutional, as traditional interpretation of the constitution mandates the census count of all individuals living in the U.S.
It should matter to all citizens that there is currently an effort to undermine our democracy and constitution, but why is this particularly unsettling for healthcare professionals and pharmacists? It all comes back to the money.
What are census dollars used for?
Federal funds allocated by the census are used for many different purposes to help communities, and it is very important that all persons are counted to ensure appropriate appropriations of funds. As described by the Census Bureau on its website, “Your community benefits the most when the census counts everyone.” These funds are spent on education, critical infrastructure, vital public programs, and healthcare infrastructure and services.
Digging in to how census dollars are used for healthcare services is important to understand why this issue is relevant to patients that pharmacists care for. An accurate census count is used as the foundation of allocating funds for public health and insurance programs, such as Medicaid, Medicare Part B, Children’s Health Insurance Program (CHIP), Supplemental Nutrition Program for Women, Infants, and Children (WIC), and reproductive health programs. Without these programs, many of the patients pharmacists care for would not have access to vital healthcare services.
Census data is also used to identify medically underserved areas in our communities. Recent efforts to pass legislation that would recognize pharmacists as healthcare providers under Medicare Part B are focused on pharmacists providing care to patients in these medically underserved areas. I mean, our bill in the 114th and 115th Congress was even called the Pharmacy and Medically Underserved Areas Enhancement Act! Jeopardizing the integrity of the way that we identify these areas by excluding millions of individuals that live in our country could have dramatic effects on access to healthcare in areas that are already underserved.
In addition to direct issues that a misinformed count could have on representation in our democracy and allocation of federal funds, there are many indirect consequences due to the numerous sectors that use census data. Census data is used to understand population health demographics, supports the decision making of businesses that assist with social determinants of health, and are used for various other public health programs. A misinformed count could further disparities that we are already seeing in our country as a result of systemic racism.
Relevant to our current pandemic, census data is frequently used to respond to public health threats and natural emergencies. In their 2019 article, Cohen et al lays out how census data was vital during an emergence of the Zika virus in New York. While we live in this current pandemic, and fear for future occurrences, we should not be jeopardizing the data we need to appropriately respond.
The integrity of our census is so important for our democracy and the allocation of vital healthcare resources. Access to health insurance programs and healthcare centers funded by federal dollars are vital to millions of patients having access to pharmacist provided care. Hopefully, this executive order will be ruled unconstitutional in the courts, but we should never assume justice will prevail without concerted effort. Pharmacists, students, and professional pharmacy associations cannot stand by as the patients pharmacists care for and their access to healthcare is put in jeopardy. We must act. Reach out to your elected leaders. Talk about this in your communities and on social media. Help our government realize how this will harm and not help.
Resources to read more
Cohen GH, Ross CS, Cozier YC, et al. Census 2020—A Preventable Public Health Catastrophe. Am J Pub Health. 2019;109(8):1077-1078. doi: 10.2105/AJPH.2019.305074.U.S.