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Public Health. 2017 Oct;151:87-97. doi: 10.1016/j.puhe.2017.05.015. Epub 2017 Jul 29.

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

Author information

Department of Public Health Sciences, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, United States. Electronic address:
Department of Sociology and Criminology, Program in Demography, Pennsylvania State University, State College, PA 16801, United States. Electronic address:
Department of Economics, Carleton University, Ottawa, Ontario K1S 5B6, Canada. Electronic address:
Royal Society for Public Health, John Snow House, 59 Mansell Street, London, E1 8AN, United Kingdom.
Bureau of Epidemiology, Pennsylvania Department of Health, Health and Welfare Building, 625 Forster Street, Harrisburg, PA, 17120, United States. Electronic address:
Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London, WC1X 8SH, United Kingdom. Electronic address:
Department of Medicine, Rutgers New Jersey Medical School, 30 Bergen Street, Suite 1614, Newark, NJ, 07103, United States. Electronic address:
University of Alberta, 11405 87 Ave, Edmonton, Alberta T6G 1C9, Canada; Health Research Institute, University of Canberra, University Drive, Bruce ACT 2617, Australia. Electronic address:


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.


Census; Disease cluster; Disease surveillance; Epidemiology; Population survey; Standardized incidence ratio

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