Elsevier

Public Health

Volume 151, October 2017, Pages 87-97
Public Health

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

https://doi.org/10.1016/j.puhe.2017.05.015Get rights and content

Highlights

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    Recent governmental actions in Europe and North America threaten the availability of reliable census information.

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    Census information is critical for effective health improvement and emergency preparedness planning.

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    Threats to the census are threats to evidence-based decision-making.

Abstract

The Canadian government decision to cancel the mandatory long-form census in 2010 (subsequently restored in 2015), along with similar discussions in the United Kingdom (UK) and the United States of America (USA), have brought the purpose and use of census data into focus for epidemiologists and public health professionals. Policy decision-makers should be well-versed in the public health importance of accurate and reliable census data for emergency preparedness planning, controlling disease outbreaks, and for addressing health concerns among vulnerable populations including the elderly, low-income, racial/ethnic minorities, and special residential groups (e.g., nursing homes). Valid census information is critical to ensure that policy makers and public health practitioners have the evidence needed to: (1) establish incidence rates, mortality rates, and prevalence for the full characterization of emerging health issues; (2) address disparities in health care, prevention strategies and health outcomes among vulnerable populations; and (3) plan and effectively respond in times of disaster and emergency. At a time when budget and sample size cuts have been implemented in the UK, a voluntary census is being debated in the US. In Canada, elimination of the mandatory long-form census in 2011 resulted in unreliable population enumeration, as well as a substantial waste of money and resources for taxpayers, businesses and communities. The purpose of this article is to provide a brief overview of recent international trends and to review the foundational role of the census in public health management and planning using historical and current examples of environmental contamination, cancer clusters and emerging infections. Citing a general absence of public health applications of the census in cost-benefit analyses, we call on policy makers to consider its application to emergency preparedness, outbreak response, and chronic disease prevention efforts. At the same time, we call on public health professionals to improve published estimates of monetary benefit (via either cost-benefit or cost-effectiveness analysis) to a given public health intervention.

Section snippets

Public health impact statement

Accurate census data are relied upon by epidemiologists and public health professionals to establish standardized incidence rates, mortality rates, and prevalence for the reliable identification and characterization of population groups for targeted public health intervention. The census is the chief source of information for denominators used for deriving and comparing rates of illness or conditions and contributing to the calculation of social deprivation scores and wider determinants of

Background and purpose

Over the past few years, trends to cut or severely hamper census and public health information have occurred internationally. In Canada, response rates to the long-form census dropped substantially (as low as 25% in a number of communities with some communities providing zero responses) after it was made voluntary in 2011. Canadian census estimates among the poor and under-served are now considered to be unreliable by experts.1

In the United Kingdom (UK), the Office for National Statistics (ONS)

What is a census?

A census is the official enumeration of a population defined according to administrative boundaries which includes enumeration by age, sex, race/ethnicity, and occupation, among other demographics. The term derives from the Latin word cēnsēre meaning ‘to assess’ as governments historically have used the census as a means of taxation. Debates about the census are not new. The census of Quirinius sparked a tax rebellion in Roman Syria and fueled the Zealot movement in the year 6 CE.3

As required

Cost and privacy

In general, threats to the census have come about through a number of concerns surrounding cost and privacy. Issues surrounding cost of the census are not without merit—the Committee on National Statistics of the National Academies of Sciences, Engineering, and Medicine has provided an extensive list of recommendations to substantially increase efficiency and reduce costs in the US.9 While the compulsory nature of the census heightens privacy concerns, census employees in several countries are

Cost-benefit analysis of the census

Cost-benefit analyses of the census are generally confined to the allocation of funding from the central to local governments in the USA and Canada. In the UK, the cost-benefit analysis for the 2011 census assumed six main uses: resource allocation, investment targeting, service planning, policy making and monitoring, research, and as a benchmark for other national statistics.21 In 2007, the benefit of the UK census was projected to be £945 million over a 10 year period (2012/13–2021/22),

Cancer control

The ability to measure disease rates and identify variation between areas as small as neighborhoods is a critical aspect of not only investigating suspected disease clusters, but also to efficiently and effectively address local resident concerns. Surveillance of cancer rates by geographic area are also useful for testing and generating hypotheses about disease occurrence, causes, and outcomes and may be used to target public health programs. Such an example of a current-day application started

Population threats, including threats to public health

Any analysis of vulnerable populations requires information on likely determinants such as incomes, education, ethnicity, labor market experience, and access to services. In Canada, this information could be found in the mandatory LFC, but is no longer reliable from the voluntary NHS.16 The inconsistencies in how the Canadian census has been carried out leads to other problems of linking the data for historical trends. Statistics Canada cautions that such linkages are not feasible because of

Conclusions

Census data are relied upon by epidemiologists and public health professionals to establish standardized incidence rates and prevalence within populations by age, sex, and race/ethnicity; to understand the role of individual and community-context influences (e.g., SES and education) in disease transmission, incidence, stage at diagnosis and prognosis; and to use demographic information in order to assess whether participants in clinical trials are representative of the general population.

Acknowledgments

The authors would like to thank the International Joint Policy Committee of the Societies of Epidemiology (www.ijpc-se.org) for their generous discussion and suggestions for the manuscript.

Ethical approval

None sought. This manuscript reviews publicly-available information.

Funding

None declared.

Competing interests

None declared.

Contributors

All authors have participated in the article preparation. All authors have approved the final article.

Authorship

All authors made substantial contributions to the following: (1) the conception of the manuscript idea; (2)

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