A Citizenship Question on the Census May Be Bad for Your Health

As the Census Bureau finalizes the questions for the 2020 census, key voices in the Trump administration are pressing for surveyors to ask one critical question: Are you a United States citizen?

Advocates of the so-called citizenship question say it is merely clerical, an effort to ascertain how many noncitizens reside in the United States. But the question would have broad ramifications, not only for the politics of redistricting that will emerge from the census but for an issue that goes beyond partisanship: public health.

The fear is that immigrants — even those in the country legally — will not participate in any government-sponsored questionnaire that could expose them, their family members or friends to deportation. But low response rates from any demographic group would undermine the validity of the next decade of health statistics and programs, health experts warn. Scientists use census data to understand the distribution of health conditions across the United States population. In turn, officials use the data to target interventions and distribute federal funding.

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In a December document first reported by ProPublica, the Department of Justice argued that inquiring about citizenship status in the decennial census was critical to enforcing Section 2 of the Voting Rights Act, which protects against racial discrimination in voting. Measuring the total number of citizens of voting age in a region is vital to understanding voting rights violations, the department argued.

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And, they argued, “adding a citizenship question at this late date would fatally undermine the accuracy of the 2020 census, harming the states and our residents.”

The Justice Department is standing by its request.

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Even without the citizenship question, minorities have been undercounted in the national census, with undocumented immigrants and their legal relatives among the least responsive. Amid a fiery immigration debate — including Immigration and Customs Enforcement raids nationwide — the inclusion of a citizenship inquiry could make it worse.

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When census results are released, scientists often measure the impact of a disease by comparing its prevalence to the total population. With skewed census data, public health officials may invest in solving a problem that does not exist — or worse, may overlook one that does.

“This is completely foundational,” said Michael Fraser, the executive director of the Association of State and Territorial Health Officials. “We take for granted that we have a really accurate understanding of who lives in this country: their ages, ethnicities, where they live.”

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Public health officers use demographic data to model neighborhoods before launching preventive programs, like tracking old housing in low-income communities where they expect to find lead-based paint. The same is true for preventing asthma, a condition often correlated with substandard housing. By targeting the right homes for remediation early, officials can prevent disease and save millions of public dollars in treatment down the line.

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“Only U.S. citizens should be represented in Congress,” he said Tuesday. “If we counted only citizens for redistributing seats, California would give up several congressional seats to states that actually honor our Constitution and federal law.”

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