2015年，芝加哥公共卫生部门确诊了三例侵袭性脑膜炎球菌病，这是一种极度危险的病原体，可在数小时内致死。为判断这些病例是否预示着更大规模的疫情爆发，该部门——当时由我们其中一位、朱莉·莫里塔博士领导——不仅需要掌握病例总数，还需要了解受影响地区的总人口数及人口结构。团队求助于我国公共卫生体系的一大支柱：美国人口普查。
In 2015, Chicago’s public health department identified three cases of invasive meningococcal disease, a highly dangerous pathogen that can kill within 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. The team turned to a pillar of our nation’s public health system: the U.S. Census.
数据显示，在该市黑人群体中，男男性行为者——包括同性恋和双性恋男性——受影响程度不成比例地高。这一发现推动了卫生部门的应对行动，其中包括与社区合作伙伴协作，向芝加哥各社区投放数千剂免费疫苗。疫情最终以芝加哥11例病例、1例死亡告终，避免了更大规模、致死率远高的爆发。
The data showed that men who have sex with men—including gay and bisexual men—among the city’s Black population were disproportionately affected. That finding drove the health department’s response, which included working with community partners to surge thousands of free vaccines into neighborhoods across Chicago. Instead of a larger and far deadlier outbreak, the outbreak ended with 11 cases in Chicago and one death.
人口普查数据贯穿我国公共卫生体系的方方面面。作为地方和联邦卫生机构的前任负责人，我们对此深有体会。遗憾的是，特朗普政府提议对人口普查进行根本性更改，这将使我国变得更不健康、更不安全、更不公正。
Census data informs every aspect of our nation’s public health system. As former leaders of local and federal health agencies, we have seen this firsthand. Unfortunately, the Trump Administration has proposed radical changes to the census that would make our country less healthy, less safe, and less fair.
针对该提议的公众意见征询期将于11月2日截止。卫生界领袖必须迅速行动，反对这些严重错误的变更。我们清楚地认识到，这些变更不仅等同于对我们公共卫生体系的攻击，也是对美国宪法的攻击。
The public comment period on this proposal closes on Nov. 2. Health leaders must move quickly to oppose these deeply misguided 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.
根据宪法规定，联邦政府自1790年起每十年进行一次全国人口普查——历经战争、经济萧条和大流行病。所有居住在我们国家的人都很重要，都应被统计在内。但特朗普政府正提议人口普查应有意排除某些人群。这包括无证居民和非移民签证持有者，例如外国留学生和临时工人，他们的签证可能允许他们在美国居住数年。政府还试图从人口普查问卷中删除与种族、族裔和性取向相关的人口统计问题。
Per the Constitution, the federal government has carried out a national census every decade since 1790—through wars, depressions, and pandemics. Everyone who resides in our country matters and should be counted. But the Trump Administration is suggesting that the census should intentionally exclude 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. The Administration is further attempting to remove demographic questions related to race, ethnicity, and sexual orientation from the census questionnaire.
后果将十分深远。不准确的统计将对国会代表权产生负面影响。认为某些人不值得被统计这一观点，令人不安地呼应了原宪法中那条阴险且后来被废除的“五分之三妥协”条款，该条款规定被奴役者按不足一个完整的人计算。不完整且不可靠的人口统计数据可能扭曲数万亿美元联邦资金在数百个项目（如医疗补助、补充营养援助计划、妇婴营养补充计划和“开端计划”）中的分配。需求最大的社区，尤其是拥有移民或混合身份家庭的社区，可能受冲击最重。
The repercussions would be vast. An inaccurate count would negatively affect congressional 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. 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. Communities with the greatest needs, especially those with immigrant or mixed-status families, would likely be hardest hit.
这些人是我们的邻居、家人和朋友。但必须明确的是：影响将超出这些社区，尤其是公共卫生后果。正如芝加哥脑膜炎球菌疫情所示，卫生官员需要完整的图景，才能保护人们免受疾病和其他威胁。他们必须知道谁生病了、在哪里生病以及发病率如何。如果从方程式中去掉其中任何一项数据，最需要帮助的人获得帮助的可能性就会小得多。
These are our neighbors, families, and friends. But let’s be clear: the impacts would extend beyond those communities, especially the public health consequences. As the Chicago meningococcal outbreak illustrates, health officials need a complete picture to protect people from disease and other threats. They must know who is getting sick, where, and at what 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.
在2009年H1N1流感大流行期间，当时我们之一的理查德·贝塞尔博士担任美国疾病控制与预防中心（CDC）代理局长，人口普查数据在追踪疫情方面发挥了关键作用。CDC依靠这些数据计算各年龄段的感染率，结果显示儿童和青年患病率远高于老年人——这与季节性流感的典型模式形成了显著差异。当疫苗上市后，这些数据直接用于制定优先为儿童和青年接种的建议。
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. 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. When a vaccine became available, these data directly informed recommendations that prioritized children and young adults.
十年后，COVID大流行再次展示了这些数据在大规模上的重要性。疫情初期病例激增时，人口和人口结构数据揭示了谁承担了最大的负担。CDC发现，美国印第安人、阿拉斯加原住民、黑人和西班牙裔人群的住院率最高。随后，CDC利用人口普查的人口估计计算各族裔的疫苗接种率，使卫生官员能够识别疫苗接种的差距。北卡罗来纳州等州成功依靠普查区块数据提升了目标人群的接种率。
A decade later, the COVID pandemic demonstrated the importance of these data on a massive scale. As case counts surged in the initial months of the outbreak, population and demographic data revealed who was shouldering the greatest burdens. CDC found that hospitalization rates were highest for American Indian, Alaska Native, Black, and Hispanic populations. CDC later used census population estimates to calculate vaccination rates by race and ethnicity, allowing health officials to identify disparities in vaccine uptake. States like North Carolina relied successfully on census-tract data to increase vaccination rates among target populations.
这些案例跨越不同地区、疾病和政府层级，却体现了共同的主题：公共卫生官员高度依赖人口普查数据来拯救生命、保护社区，而保护风险最高的社区有助于让全体人民更加安全、健康。
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.
卫生官员使用人口计数研究癌症、心脏病、艾滋病等众多疾病。人口结构数据揭示了原始数字可能掩盖的差距，并显示这些差距是扩大还是缩小。两者结合提供了一张路线图，指引资源流向最能发挥作用的地方。
Health officials use population counts to study cancer, heart disease, HIV/AIDS, and many other diseases. Demographic data expose disparities that raw numbers can obscure and show whether those gaps are growing or shrinking. Together, they offer a roadmap to direct resources where they can do the most good.
下一次人口普查还有几年时间，但我们的领导人现在所做的决定至关重要。一次刻意少算人口、同时提供更少信息的普查，将使我们的国家在未来应对疫情和流行病时准备不足，同时也会使日常卫生挑战更难应对。公共卫生界现在就必须发声，这一点至关重要。
The next census count is still a few years away, but what our leaders decide now matters a great deal. 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. It is essential for the public health community to speak out now.