Challenges to the census: international trends and a need to consider public health benefits

GeoSES: A socioeconomic index for health and social research in Brazil

The individual’s socioeconomic conditions are the most relevant to predict the quality of someone’s health. However, such information is not usually found in medical records, making studies in the area difficult. Therefore, it is common to use composite indices that characterize a region socioeconomically, such as the Human Development Index (HDI). The main advantage of the HDI is its understanding and adoption on a global scale. However, its applicability is limited for health studies since its longevity dimension presents mathematical redundancy in regression models. Here we introduce the GeoSES, a composite index that summarizes the main dimensions of the Brazilian socioeconomic context for research purposes. We created the index from the 2010 Brazilian Census, whose variables selection was guided by theoretical references for health studies. The proposed index incorporates seven socioeconomic dimensions: education, mobility, poverty, wealth, income, segregation, and deprivation of resources and services. We developed the GeoSES using Principal Component Analysis and evaluated its construct, content, and applicability. GeoSES is defined at three scales: national (GeoSES-BR), Federative Unit (GeoSES-FU), and intra-municipal (GeoSES-IM). GeoSES-BR dimensions showed a good association with HDI-M (correlation above 0.85). The model with the poverty dimension best explained the relative risk of avoidable cause mortality in Brazil. In the intra-municipal scale, the model with GeoSES-IM was the one that best explained the relative risk of mortality from circulatory system diseases. By applying spatial regressions, we demonstrated that GeoSES shows significant explanatory potential in the studied scales, being a compelling complement for future researches in public health.

Potential Impact of 2020 US Decennial Census Data Collection on Disaster Preparedness and Population Mental Health

Increasing in frequency and impact in the United States and worldwide, disasters can lead to serious mental health consequences. Although US census data are essential for disaster preparedness and the identification of community-level risk factors for adverse postdisaster mental health outcomes, the US Census Bureau faces many challenges as we approach 2020 Decennial Census data collection. Despite the utility of the information provided by the Census and American Community Survey (ACS), the 2020 US Census and subsequent ACS data face threats to validity. As a result, public health funding could be misallocated, and disaster preparedness and response efforts misinformed; this can also contribute to the worsening of mental health inequities, particularly in the context of disaster. Undercutting the Census and the ACS, rich data sources that allow representation of all people in the United States, is a step backward in our effort to mitigate the population mental health consequences of disasters.

Inaccuracies in the 2020 Census Enumeration Could Create a Misalignment Between States' Needs

As the most accurate reflection of the United States population, the US decennial census is vital to health policymakers and others at all levels of government. Competing priorities related to cost containment and the introduction of new reforms raise concerns about the resources available to the US Census Bureau to conduct an accurate population enumeration in 2020. We examined the state of the Census Bureau's preparations for the 2020 Census and how inaccuracies in the coming census enumeration could influence public health and health equity in the coming decade. The results of the 2020 Census will be used to allocate trillions of dollars in federal funding to states, including support for programs vital to public health such as Medicaid and the Special Supplemental Nutrition Program for Women, Infants, and Children. Inaccuracies in the census enumeration could create a misalignment between states' needs and allocation of federal resources. Also, a census miscount of the population could create challenges for public health surveillance and research activities that inform public health policies and interventions.