Trump Is Aiming Again at a Familiar First-Term Target. The Consequences Could Be Deadly.

Last week, the Trump administration proposed a regulation that, if not undone by the president taking office in 2029, would end the uninterrupted practice—one almost as old as our nation—of collecting race and ethnicity in the decennial census. This proposal would impair public health and cost numerous Americans their lives.

The most widely reported part of the regulation was the decision not to count noncitizens without green cards, a change that could have radical implications for future elections and billions in federal funding. But the race and ethnicity change is also important and could trigger large implications for public health.

As we have argued in recent academic research , race and ethnicity data are key in understanding population health outcomes. Our article shows that racial health disparities come from both differences in exposure to environmental stressors and different underlying vulnerability stemming from, for instance, genetics or access to healthcare.

The resulting differences can be stark. For instance, Black children are 60 percent more likely than U.S. children overall to have asthma and four and a half times more likely to die from it. Hispanic women have a 40 percent higher incidence of cervical cancer and 20 percent higher death rate from it compared to non-Hispanic white women. And Asian Americans have extremely elevated rates of certain diseases, including tuberculosis and hepatitis B.

For many diseases, it is impossible or impracticable to collect detailed, local-level prevalence data. Government agencies have responded by using race and ethnicity as a proxy or input into models determining the prevalence of these health conditions. Most notably, the U.S. Centers for Disease Control and Prevention combine survey data with census race and ethnicity estimates to model the prevalence of a number of chronic diseases—including asthma, chronic obstructive pulmonary disease, and cancer—at a fine-grained geographic level.

That granular data allows decisionmakers to allocate resources and target outreach to the areas with the highest need. For instance, Michigan has established a pilot program to place mobile health unit vans in at-risk areas. Private health systems also use this type of data frequently, with one medical system using it to concentrate services in four high-risk neighborhoods of New York City.

Without collecting race and ethnicity data in the census, these estimates could not be produced, needlessly wasting resources and endangering lives. And the Trump-proposed rule makes this pernicious move despite centuries of contrary historical practice.

The practice of collecting race and ethnicity data is as old as the census itself. The 1790 census differentiated between “Free White” individuals and all others, and race has appeared in every census since. The White House Office of Management and Budget promulgated the first government-wide standards in 1977, which have been used by every administration during the past five decades.

The Biden administration made long-needed changes to the standards in 2024 , including adding a “Middle Eastern or North African” category.