KyleYasuda, M.D., FAAP, President, American Academy of Pediatrics
Letter from the President
The U.S. census is a pediatric issue? Absolutely!
The Annie E. Casey Foundation estimates that for the 10 largest federal programs serving
children, $160 billion a year is distributed using census-derived data. In fiscal
year 2015, for example, the government distributed $61 billion for children’s Medicaid
services (not including Medicaid payments to children with disabilities); $29 billion
for food stamps; $4.6 billion in foster care funding; and more than $8 billion for
Yet the 2010 census missed close to 1 million young children — costing over a billion
dollars each year in federal funding for these and other vital social programs. And
the conditions are in place for it to happen again in 2020.
Granted, no count of more than 325 million people can be perfect. But children under
age 5 have a higher net undercount rate than any other age group. Latino children
account for a disproportionate share of undercounted children; the undercount rate
for African-American children is close behind.
Characteristics that compound the risk of being undercounted include poverty and housing
insecurity. In some cases, whole families were missed. In other cases, families who
responded did not include all of their children due to joint custody arrangements,
children being cared for by grandparents or other relatives, or situations where several
families lived together.
Some households did not respond out of fear or mistrust of the government, particularly
in circumstances where a parent is undocumented or a child is living with a grandparent
in an age-restricted housing unit.
In addition, dispersed rural populations and overly dense urban populations in cities
like Newark, N.J.; Cleveland; Detroit; Memphis, Tenn.; Laredo, Texas; and Santa Ana,
Calif., are harder to count and often end up under-represented.
The 2020 census brings two additional challenges:
A new proposed question asking respondents to list their citizenship status may discourage
immigrant families from responding (even though laws safeguard the privacy of responses.)
The AAP is deeply concerned by this proposal and has filed comments with the U.S.
Census Bureau urging it to withdraw the question from the 2020 survey.
With this being the first census conducted primarily online, fears of cybersecurity
may arise and disparities in internet access could hit low-income communities the
Ten years is a long time to live with a mistake, especially if it affects our nation’s
ability to provide equal representation and equal access to important governmental
resources for all children. That’s why we’re working with like-minded national and
local groups to ensure the 2020 census is fair and accurate and prevent the 2010 census
undercount from happening again.
Children are not numbers; they are the patients we care for and about. As we well
know, our patient population has grown increasingly diverse. Children who are foreign-born
or U.S.-born to immigrant parents are a large and growing part of the U.S.
Today, one in four of our nation’s children lives in immigrant families. Nearly one
in five children lives in poverty, and that ratio is greater among children who are
black or Latino.
As trusted messengers, pediatricians must alert our colleagues, communities and patients’
families to the implications of a high undercount among young children and how it
affects them and their communities.
Census Day is April 1, 2020, a little over a year away, and we need to get this right.
Soon, the Academy will begin efforts to ensure all children are represented. Outreach
will include federal advocacy, connecting with like-minded partners and helping pediatricians
educate and motivate their communities and families to respond. We are looking forward
to working with partners in the Federation of Pediatric Organizations who are spearheading
efforts to make sure that all of pediatrics is united and coordinating efforts.
Stay tuned for more on this important work and how you can help make every child count
and be counted.