In 2015, Chicago’s public health department identified three cases of invasive meningococcal disease, a highly dangerous pathogen that can kill within hours.
asserted
that → identify → hours
To determine whether these cases signaled a larger outbreak, the department—which one of us, Dr. Julie Morita, led at the time—needed to know not just total cases, but the total population and demographics of affected areas.
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one → determine → areas
The team turned to a pillar of our nation’s public health system: the U.S. Census.
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team → turn → system
The data showed that men who have sex with men—including gay and bisexual men—among the city’s Black population were disproportionately affected.
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who → show → population
That finding drove the health department’s response, which included working with community partners to surge thousands of free vaccines into neighborhoods across Chicago.
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which → drive → Chicago
Instead of a larger and far deadlier outbreak, the outbreak ended with 11 cases in Chicago and one death.
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outbreak → end → Chicago
Census data informs every aspect of our nation’s public health system.
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data → inform → system
As former leaders of local and federal health agencies, we have seen this firsthand.
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we → see → this
Unfortunately, the Trump Administration has proposed radical changes to the census that would make our country less healthy, less safe, and less fair.
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country → propose → census
The public comment period on this proposal closes on Nov. 2.
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period → close → Nov.
Health leaders must move quickly to oppose these deeply misguided changes.
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leaders → move → changes
It is clear to us that these changes would amount not only to an assault on our public health system but also on the U.S. Constitution.
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changes → amount → Constitution
Per the Constitution, the federal government has carried out a national census every decade since 1790—through wars, depressions, and pandemics.
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government → carry → wars
Everyone who resides in our country matters and should be counted.
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who → reside → country
But the Trump Administration is suggesting that the census should intentionally exclude people.
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census → suggest → people
This includes undocumented residents and nonimmigrant visa holders, such as foreign national students and temporary workers whose visas may permit them to live in the U.S. for several years.
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visas → include → years
The Administration is further attempting to remove demographic questions related to race, ethnicity, and sexual orientation from the census questionnaire.
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Administration → attempt → questionnaire
An inaccurate count would negatively affect congressional representation.
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count → affect → representation
The idea that some people do not deserve to be counted uncomfortably echoes the “3/5 compromise,” an insidious and later repealed clause in the original Constitution under which enslaved persons were counted as less than full people.
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persons → deserve → people
Incomplete and unreliable demographic data could distort how trillions of federal dollars are distributed across hundreds of programs such as Medicaid, SNAP, WIC, and Head Start.
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trillions → distort → Medicaid
Communities with the greatest needs, especially those with immigrant or mixed-status families, would likely be hardest hit.
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Communities → hit → families
But let’s be clear: the impacts would extend beyond those communities, especially the public health consequences.
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impacts → let → communities
As the Chicago meningococcal outbreak illustrates, health officials need a complete picture to protect people from disease and other threats.
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officials → illustrate → disease
They must know who is getting sick, where, and at what rate.
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who → know → rate
Take any of those data out of the equation, and the people who need the most help are far less likely to get it.
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who → take → it
During the H1N1 influenza pandemic in 2009, when one of us, Dr. Richard Besser, served as acting director of the Centers for Disease Control and Prevention (CDC), census data were instrumental in tracking the outbreak.
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data → serve → outbreak
CDC relied on this data to calculate infection rates by age, which showed that children and young adults were getting sick at far higher rates than older adults—a striking departure from typical patterns observed with seasonal flu.
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children → rely → flu
When a vaccine became available, these data directly informed recommendations that prioritized children and young adults.
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that → become → children
A decade later, the COVID pandemic demonstrated the importance of these data on a massive scale.
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pandemic → demonstrate → scale
As case counts surged in the initial months of the outbreak, population and demographic data revealed who was shouldering the greatest burdens.
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who → surge → burdens
CDC found that hospitalization rates were highest for American Indian, Alaska Native, Black, and Hispanic populations.
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rates → find → populations
CDC later used census population estimates to calculate vaccination rates by race and ethnicity, allowing health officials to identify disparities in vaccine uptake.
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officials → use → uptake
States like North Carolina relied successfully on census-tract data to increase vaccination rates among target populations.
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States → rely → populations
These examples span different locations, diseases, and levels of government, but illustrate common themes: public health officials rely heavily on census data to save lives and protect communities, and protecting communities at greatest risk helps keep us all safer and healthier.
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us → span → risk
Health officials use population counts to study cancer, heart disease, HIV/AIDS, and many other diseases.
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officials → use → cancer
Demographic data expose disparities that raw numbers can obscure and show whether those gaps are growing or shrinking.
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gaps → expose → that
Together, they offer a roadmap to direct resources where they can do the most good.
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they → offer → good
The next census count is still a few years away, but what our leaders decide now matters a great deal.
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decide → decide → what
A census that deliberately counts fewer people while telling us less about them will leave our nation ill-prepared for future outbreaks and pandemics, while making it harder to handle daily health challenges.
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it → count → challenges
It is essential for the public health community to speak out now.
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community → speak → ?
The Aporia