Springfield, MO

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Opinion: Stand up, be counted: the net benefit of Census 2020

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The census is carried out every 10 years as required by the U.S. Constitution. Most people focus on the political importance of the activity, which is to provide data for legislative reapportionment and districting.

Yet, the census has been directly connected to the health of the people for well over a century. Census tracts – a defined geographic area with a population of 1,200-8,000 people – were first used in 1910. Initially they were called “sanitary districts” because public health departments were instrumental in establishing the boundaries to plan for public health and health services.

Over the next several decades the use of these data to track neighborhood morbidity and mortality became a staple of public health practice. These surveys led to significant advances in health issues from infant mortality to tuberculosis.

Fast forward a hundred years and the census has become a crucial undertaking for the well-being of Missourians and everyone in the U.S. This is why it is essential that we ensure an accurate count in 2020.

So much of our state depends on having a fair census, and this will promote Missouri’s health in three important ways:

1. It ensures high-quality, health-related data. Our health information infrastructure includes the census as a key component. In addition, it is the underlying statistical framework that is essential to a whole family of surveys. The census data provides essential population knowledge about demographics, social determinants of health, public health, insurance, fertility and disability. The 2020 census will be the fundamental information source on our population for a variety of public purposes over the next decade.

2. It serves as a basis for funding allocations of federal health programs. Hundreds of billions of dollars are distributed to states and communities annually based on the census. Among these are health programs such as Medicaid, Medicare Part B, Children’s Health Insurance Program, Supplemental Nutrition Program for Women, Infants, and Children, reproductive health programs, and community health centers. The larger the population counted in Missouri, the greater the share of federal dollars that will come to the state. According to some estimates, every uncounted person in the 2010 census cost Missouri approximately $1,272 in federal funding annually. In 2015, the total federal dollars at stake totaled a massive $11.26 billion.

3. It influences the geography of community-based services. The location of health facilities and health professionals are shaped by data documenting an area’s need. The census provides community-level comparative figures for private and public decisionmakers. This is particularly important for our state because most of Missouri is considered a health professional shortage area.

So, you see why counting everyone in Missouri in the 2020 census is so important for the health of our state. However, I can’t overstate what a huge undertaking it is. Although 2020 may seem far in the future, the education and coordination needed to ensure we have an accurate count means we need to start planning now.

Several issues stand in the way. First is undercounting. In 2010 more than 5 million children under age 5 were not counted, making it imperative in 2020 to make a special effort to count young children. Second, Missouri has not done well in counting all Missourians. One estimate found that Missouri lost more than $150 million in 2015 for Medicaid funding alone due to undercounting, the fourth highest amount of any state. Finally, the 2020 census will be the first to be electronic as well as on paper. The concern is that residents of rural areas, with 21 percent of homes lacking internet access, will be at risk of being undercounted. This could have negative impact on Missouri because of our extensive rural population.

The future health of Missouri is important to all of us, and we must demonstrate that by promoting the importance of the census and making sure everyone is counted.

Healthy communities lead to healthier individuals and a more equitable state.

Bob Hughes is president and CEO of St. Louis-based Missouri Foundation for Health, which aims to improve the health of Missourians through partnership, experience, knowledge and funding. He has a doctorate in behavioral sciences from Johns Hopkins University and regularly blogs on Hughes can be reached at


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