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Using My Trusted Voice for Kids in the 2020 Census

Published:March 15, 2020DOI:https://doi.org/10.1016/j.acap.2020.03.002

      Abbreviations:

      WIC (Women Infant and Children), ICE (Immigration and Customs Enforcement)
      In an opening during a well-child visit for an 11 years old, I asked the mother “This may seem like an odd question, but do you remember getting something in the mail in 2010 asking you to fill out the Census?” She thought for a moment and then responded while pointing to her son, “Yeah that's when he was one. We were living with a friend back then.” I followed with, “Did the friend filling out the Census include you and your son in their response?” She responded, “No, we weren't on the lease and we weren't trying to cause any trouble.” I nodded and continued the visit.
      On my penultimate clinic day of 2019, I began discussing the importance of the 2020 Census with parents. I fretted about how to fit this topic into short visits when I would already be pressed for time to discuss other important issues. However, I reassured myself that the Census is a once in a decade critical topic that I could meaningfully discuss with parents in a short amount of time. The experience was eye opening for my patients and for me.
      To my surprise, I was able to have a meaningful exchange in two minutes. I discovered ways to work the topic into conversation while gathering the social history, finishing the physical exam, or when providing anticipatory guidance. While some parents met my question with a quizzical look, others were excited to share their positive and negative thoughts about the Census. The well visit with that 11 years old was by far the most memorable encounter of the day.
      While giving final anticipatory guidance about her son's overall health, I thanked the mom for sharing her story and reassured her: “Filling out the Census is safe, and it's actually illegal for someone working for the Census Bureau to share your personal information with anyone. That includes other government departments like state and federal law enforcement, immigration officials like ICE or businesses like landlords.”
      United States Census Bureau
      2020 census - investigating the undercount of young children.
      I expressed the importance of counting everyone who lives in the home to ensure programs that benefit children get the money they need. She nodded and responded—“Now I know that…I wish I had known that then.” I smiled and asked her, “Are you planning to fill out the 2020 Census?” She smiled back and said, “Yes, for sure.” As we ended the visit, I handed her school health forms, her son's asthma action plan and instructions for a follow up asthma visit. In an attempt to lighten the mood, I said jokingly, “I now deputize you to share this information with other people in your community to make sure they fill out the 2020 Census. Count every adult, child and infant living in the home, whether or not they are on the lease.” She let out a big laugh and said, “Okay!”
      Some of my colleagues and I have taken to repeating the phrase “winter is coming” mimicking the protagonist in Game of Thrones when we note the first spike of respiratory illnesses during the Fall months. I will admit, I have never watched an episode of Game of Thrones, but as I learned more about the context of the phrase, I have come to see how the sentiment applies to the Census. The protagonist uttered this phrase to urge his community to be diligent in preparation as the cruel effects of winter hit their region the hardest. Each winter, I brace myself for increased respiratory and viral illnesses which hit my pediatric population hard during that season. As winter ends, I have also been bracing myself for the 2020 Census, being vigilant to prepare my patients and their families. Akin to the Game of Throne's winter, I know the impact of a Census under-count hits our pediatric population the hardest as children under 5 are the largest under-counted population.

      Title 13, U.S. Code - History - U.S. Census Bureau. Available at:https://www.census.gov/history/www/reference/privacy_confidentiality/title_13_us_code.html. Accessed December 30, 2019.

      The exchange with this mother and son put a face to the statistic of the 1 million children not counted in the 2010 Census.

      United States Census Bureau. The Undercount of Young Children. Available at: https://www.census.gov/content/dam/Census/library/working-papers/2014/demo/2014-undercount-children.pdf. Published February 2014. Accessed March 2, 2020.

      It gave me a better sense of what some of my patients’ parents understand about the Census and of their unique concerns. It also reinvigorated how I approach discussing a topic—the Census and its use to allocate billions of dollars in federal funds—which some may view as dull and un-relatable. Thinking about my patient, I realize that for a majority of his childhood, he was invisible and not counted in the planning and allocation of resources for programs such as Medicaid, Women Infant and Children (WIC) and funding for Title I schools for his community. His complex housing situation put him, along with children who live with grandparents or households with low English proficiency, at the greatest risk of being missed in the Census.
      Each day as I turn the corner to enter the clinic, I drive past a Title I school and walk past the co-located WIC center. This daily commute makes the impact of a Census undercount so personal and so close to home because many of my patients attend the school and I refer several families to WIC. These programs benefit from an accurate Census count. As a pediatrician, I am a trusted messenger for children and their families through illness and health. I am choosing to leverage this trusted messenger role to sound the alarm that “the Census is here” and to have the critical one-on-one conversations needed to inform, allay fears, and dispel myths.
      Families have begun receiving mailed invitations to complete the Census. I will keep taking two minutes of a clinical encounter to discuss the 2020 Census with parents and caregivers because I know it can significantly improve the health services that children receive for the next decade, especially within pediatric populations at increased risk of being undercounted. Few other two-minute investments of my time can have such a profound and lasting impact. I will keep sounding the alarm well past Census Day on April 1, and into May and June when census takers will knock on the doors of those who have not responded to the invitations. My message to families is simple: please complete the Census, include all children who live in your home, and know that your responses are safe and secure.
      I hope my patient's mother completes the Census this time around. When they return for a follow-up asthma visit in the upcoming months, I will be sure to ask if she did and if she told anyone in her community the funny story of her child's pediatrician who made a big deal about the Census during his annual checkup.

      Acknowledgments

      Thank you to Dr. Beth A. Tarini and Dr. Paula Magee for reading and providing thoughtful feedback on the manuscript.

      References

        • United States Census Bureau
        2020 census - investigating the undercount of young children.
        Summ Recent Res. 2019; (Available at:) (Published February 14. Accessed January 2, 2020)
      1. Title 13, U.S. Code - History - U.S. Census Bureau. Available at:https://www.census.gov/history/www/reference/privacy_confidentiality/title_13_us_code.html. Accessed December 30, 2019.

      2. United States Census Bureau. The Undercount of Young Children. Available at: https://www.census.gov/content/dam/Census/library/working-papers/2014/demo/2014-undercount-children.pdf. Published February 2014. Accessed March 2, 2020.