Counting & Crisis: How the US Census Affects Local Public Health Responses

• In Event: Subnational Variations in Healthcare Infrastructure

Abstract

The federal system of governance in the US places the primary responsibility for the safety and wellbeing of residents on state and local governments. This is especially the case when it comes to physical health. While previous research has focused on finding explanations for the variation in health outcomes at this level, there has been less attention paid to the role the federal government has in determining the ability of state and local governments to respond to public health needs, particularly in times of crisis. I argue that the federal government’s data collection practices can help to explain why the public health responses at the state and local level vary so widely; in particular, I hold that the US decennial census plays a vital role in these dynamics. The total population count, as well as other data that relies on it, are used to allocate federal dollars to state and local governments, to assist local governments in providing services such as healthcare coverage and disaster relief, and to inform public heath responses. This means that inaccuracies in the count can have large effects on local communities, which might be felt most intimately during times of need. As such, I hypothesize that counties with higher net undercounts in the US census are more likely to be severely affected by and have less capacity to handle a public health crisis. I test this claim using data on census accuracy from the 2010 census and county-level public health data on the opioid epidemic and on COVID-19 surges. I find partial support for my claims.

Author

• Ashley Moraguez, University of North Carolina, Asheville