The US Census and the People's Health: Public Health Engagement From Enslavement and "Indians Not Taxed" to Census Tracts and Health Equity (1790-2018)

Abstract

Public health professionals have long played a vital-albeit underappreciated-role in shaping, not simply using, US Census data, so as to provide the factual evidence required for good governance and health equity. Since its advent in 1790, the US Census has constituted a key political instrument, given the novel mandate of the US Constitution to allocate political representation via a national decennial census. US Census approaches to categorizing and enumerating people and places have profound implications for every branch and level of government and the resources and representation accorded across and within US states. Using a health equity lens to consider how public health has featured in each generation's political battles waged over and with census data, this essay considers three illustrations of public health's engagement with the enduring ramifications of three foundational elements of the US Census: its treatment of slavery, Indigenous populations, and the politics of place. This history underscores how public health has major stakes in the values and vision for governance that produces and uses census data.

FIGURE 1—

1840 vs 1850 US Census Schedule Showing Transformation From (a) One Line per Household (1840) to (b) One Line per Individual, by Household (1850) Note. The 1850 census was informed by public health expertise and implemented in the wake of the national controversy involving inaccurate 1840 Census data—invoked by proponents of slavery—that erroneously suggested higher insanity rates among free versus enslaved Black Americans. Source. US Census Bureau.

FIGURE 2—

Buffalo Dance—Allan Houser (1914–1994) Source. Census 2000: US Census Marketing Posters.

FIGURE 3—

Counting Everyone Once, Only Once, and in the Right Place Source. US Census Bureau: The 2020 Census at a Glance.

FIGURE 4—

1940 Census Tracts and Economic Gradients in the White Infant Mortality Rate, Cleveland, OH Note. Economic tenths defined in relation to “rent of tenant occupied homes and rent-equivalent of owner-occupied homes.” Source. Green. Reprinted with permission.