In 2017 — four years after the start of the Flint water crisis — health department officials found dangerously high levels of lead in the blood of more than 1,600 children under the age of six in Detroit. That’s more than the number of students who attend an average American high school. Lead poisoning causes developmental delays, learning difficulties, weight loss, vomiting, hearing loss, and seizures, among a host of other side effects.

That year, the city applied for a $1.34 million U.S. Centers for Disease Control and Prevention grant that would have allowed the city to hire more health department staff focused on assisting the city’s ongoing efforts in preventing childhood lead poisoning. The grant would have funded city officials to test more young children for lead poisoning and collect better data that would allow them to identify the most at-risk kids.

Just months after applying, the city was denied. But the reason had nothing to do with public health. As the CDC explained, the 2010 U.S. Census counted Detroit’s population at 713,777, which was shy of the grant’s 750,000 minimum population requirement. The CDC said in a statement that it does not advance grant applications that don’t meet eligibility criteria requirements for further review.

The lost opportunity underscores the importance of having an accurate count of all people living in the United States during the constitutionally-mandated decennial Census. The count factors into how billions of federal dollars are distributed throughout the country. The number of people in your city can determine eligibility for resources needed to address lead, fix up roads, or improve schools.

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It is unclear whether Detroit’s 2010 population was undercounted by exactly 36,223 people, the number of residents by which the city fell short of the lead prevention grant’s threshold. But there is a lot of evidence that Detroit’s Census population in 2010 was less than the number of people actually living in the city, and it’s probable that it would have reached 750,000 with a more accurate count. Undercounts are typical for large cities with a large number of hard-to-count populations such as renters or immigrants.

In Detroit, only 64 percent of households responded to the Census, according to Victoria Kovari, the executive director of the city’s 2020 Census campaign. In total, about 220,000 people did not send in the forms. The Census Bureau was able to track down information about some of those households after workers spoke to residents at their doors, as well as landlords, neighbors, or even the mailman.

But, according to the Census Bureau, 26,585 people were never counted, and instead represented an estimated number of people living in uncounted units, which the federal agency calculated based on a formula that includes comparable household sizes for the specific neighborhood. It is likely that the Census Bureau was off on its estimates and that the actual number was higher.

The populations in Detroit that the Census was unable to collect any information for and forced to guess about include people living in gated communities or renters such as young people and small, low-income families living in multifamily apartment buildings, Kovari said.

Kovari said it was too tough to tell whether there was an undercount, but based on the high number of people that the Census Bureau had to make a guess about, the count was likely not accurate. “It’s clear that renters in multi-family housing were not counted,” Kovari said. “I would go as far as to say we did not get an accurate count in those areas.”

For a city like Detroit, which filed for municipal bankruptcy just six years ago, those federal funds that were denied because of a likely undercount could have been critical, said Lyke Thompson, director of Wayne State University’s Center for Urban Studies, who studies lead poisoning in Michigan.

While childhood lead poisoning in Detroit has improved in recent years, its rates still surpass those in nearby Flint. In 2016, city officials found that 8.8 percent of tested kids under the age of six were positive for lead poisoning, compared to 1.8 percent of kids in Genesee County, which encompasses Flint, according to the Detroit News. The elevated levels were higher in the city’s poorer neighborhoods, including one zip code that encompasses the Atkinson Avenue Historic District and Yates Park, in which 22 percent of 686 kids tested positive.

A lot of the city’s childhood lead poisoning problems stem from aging infrastructure that makes the water undrinkable and the city’s aging housing stock, often located in poorer neighborhoods, with lead paint-covered interior and exterior walls. Children in those neighborhoods are exposed to chippings and dust that come from the walls and breathe in exposed lead after nearby homes are demolished without following environmental remediation standards.

“$1.3 million would go a long way for [city officials] to get to the houses, to measure the blood levels in those houses and to provide case management and other services to those families. They simply lose that through this process,” Thompson said. “Detroit has some of the highest percentages of children with lead poisoning of any major city in the country so they really do need the support.”

Other cities likely experienced similar lost opportunities. The U.S. Department of Health and Human Services relies on population data when distributing nearly $3 billion each year in funding and reimbursements of five of its grant programs, including Medicaid, the Children’s Health Insurance Program, a foster care program, an adoption assistance program, and a child care and development fund program, a 2018 report from George Washington University’s Institute of Public Policy found.

Those researchers identified 37 states that may have lost out on millions of dollars in federal funding in fiscal year 2015 if their populations were undercounted by 1 percent during the 2010 Census. This includes Texas by $291.9 million, Pennsylvania by $221.7 million, Florida by $177.8 million, Ohio by $139 million, Illinois by $122.2 million, and Michigan by $94.2 million.

In most cases, it is impossible to tell which communities may have lost out on federal funds because of a Census undercount due to the fact that there are many overlapping programs with different complex funding formulas that take into account statistics beyond population size, such as the age and income of an area, according to another recent report from George Washington University’s Institute of Public Policy.

Many Detroiters had no interest in being counted and the city never worked to convince them otherwise.

– Kurt Metzger

But what is clear is that undercounts do occur throughout the United States, disproportionately impacting the black population.

According to the Census Bureau’s own 2014 analysis, nearly 1 million children — 4.6 percent of all kids under the age of five in the U.S. — were not represented in the 2010 count. Children who are Latinx or black were undercounted at higher rates than white children. Such undercounts are due to children who have complex living situations, such as splitting time living between parents who do not live together, or who come from families that are considered hard-to-count, such as those who live in high-poverty neighborhoods or rental housing, according to the website FiveThirtyEight.

“The undercount of children under age five in the decennial census, and in surveys like the American Community Survey (ACS), is real and growing,” the 2014 Census Bureau report read. “This is not a new problem and has been present in decennial censuses for many decades. The differential undercount of this population across geography and demographics makes this a larger problem for some racial and ethnic groups and some parts of the country.”

It is reasonable to conclude that Detroit’s undercount was larger than the national average. The city’s population of children under five is higher than the national average and, according to research conducted by the City University of New York, several of its neighborhoods are considered among the hardest to count in the country.

In fact, the city’s population meets the very definition of hard-to-count: Areas in which less than 73 percent of its residents responded to the bureau’s first attempt to reach them.

Hard-to-count communities often include young children, racial and ethnic minorities, non-English speakers, low-income people, people who are disabled, people who are experiencing homelessness, and people who do not live in traditional housing, according to Ron Jarmin, deputy director of the U.S. Census Bureau.

Detroit has a poverty rate of 37.9 percent, 85 percent of its population are considered ethnic minorities, more than 10 percent of its population uses a language other than English at home, and 20 percent of its population is disabled, according to Census Bureau data.

To complicate matters, one in five Detroiters is evicted each year, a problem which, according to Pulitzer Prize winning author Matthew Desmond, disproportionately impacts black women, which would also lead to an undercount.

Lastly, the 2008 economic recession, which crashed the city’s economy, may have also played a part, according to Kurt Metzger, a demographer and Michigan mayor who started the local data organization, Data Driven Detroit. In 2010, city leaders, he said, were trying to address Detroit’s high unemployment rate, foreclosure crisis, and plummeting housing values as residents were underwater on mortgages and land contracts, so they were not thinking about the Census.

Metzger expected an undercount, but the end result was much worse than he anticipated, he said.

“While I have no exact undercount in mind, I was floored when I heard the 2010 count. I knew there was going to be a significant pop loss even without an undercount, but was expecting something closer to 775,000,” Metzger said in an email.

“The undercount was the reason for not qualifying for the grant. Many Detroiters had no interest in being counted and the city never worked to convince them otherwise,” he added.

The Trump administration is going to make this bad situation worse. It tried to include a citizenship question in the Census, a move that would have caused an undercount of at least 9 million people, since non-citizens and households or families with non-citizen members would fear retribution from the government if they answered. The Supreme Court ruled that the Trump administration could not include the question unless it changed its justification for adding it, which they claimed was to better enforce the Voting Rights Act.

The Trump administration shortly after dropped the question, but is still providing an inadequate supply of resources needed to ensure an accurate count. The NAACP filed a lawsuit last year against the Census Bureau and the Trump administration, claiming that their lack of preparedness for the 2020 Census violated the U.S. Constitution, since the government is required to conduct a full head count of everyone living in the country.

The civil rights organization claimed the Census Bureau was under-funded and under-prepared, hiring fewer people to knock on doors and count people that did not self-respond, and opening half the number of field offices throughout the country. Those cuts are being made while the Census Bureau rolls out, for the first time, an Internet-based survey response system.

There are widespread cybersecurity concerns related to allowing people to respond to the survey digitally, and such techniques could affect responses from communities with limited Internet access, which are often areas with a high population of people of color who are considered hard-to-count.

The Census Bureau in a statement defended its 2020 count efforts. According to the bureau, the agency is planning the most robust marketing and outreach plan in the agency’s history: It will spend $500 million on marketing, up from $376 million in 2010, advertise in “many different languages,” and is designing a “robust” outreach plan and hiring locally to engage with communities and reach hard-to-count populations.

The bureau also said that households in areas where Internet is unreliable will receive a paper questionnaire on the first mailing and all households that do not respond, regardless of the area, will receive a paper questionnaire on the fourth mailing. It added that people can respond in 12 different languages other than English over the phone or through the Internet, and enumerators will have 59 different non-English language guides among other ways of reaching out to non-English speakers.

But such threats to the accuracy of the count are real, according to Kelly Percival, a counsel at the Brennan Center for Justice’s Democracy Program.

“The 2020 Census is facing a lot of threats. A lot we have seen in past Censuses and a lot is unique for 2020,” said Percival.

“These are having a snowball effect and they could lead to an undercount in certain communities,” Percival added. “This will translate into less political power and less funding for those that need it… I think it’s an attempt to politicize the census which is not what the census is about.”

A relatively small lead prevention grant can go a long way and help a lot of children. According to Detroit officials, the 2017 grant would have enabled the city to increase the number of children under six years old who are tested for lead by 20 percent, allowed the city to collect better data so it could identify higher-risk populations, improved lead exposure outreach and education for those higher-risk populations, and better identified kids who have been exposed so they could be connected with services. It would have also provided new training for public health professionals, the lead prevention workforce, and other stakeholders who are on the front lines of the fight.

Ask the city, though, and losing out on the grant was no big deal. While, “Federal dollars will certainly assist the Department in coordinating lead related activities,” the city is doing just fine addressing the problem without it, according to city spokesperson Tamekia Nixon.

“After we didn’t receive the 2017 grant, the Detroit Health Department pursued other funding streams to allow us to provide the same scope of service intended in the grant, albeit to a somewhat lesser degree. However, at this time we are not able to quantify the exact difference in numbers,” Nixon wrote in a statement.

The 2020 Census is facing a lot of threats.

– Kelly Percival

Last week, the city received a $9.7 million grant from the U.S. Department of Housing and Urban Development to assess 120 housing units and address lead hazards in 450 homes throughout the city for low-income families with young children, among other functions.

However, the primary function of the grant is for lead abatement, not surveillance of lead poisoning, like the CDC grant would have provided, and it will not solve the issue, said Thompson. Federal funds for such prevention efforts is crucial, he said.

“It’s really hard for the Health Department to get to even a fraction of the houses and really work with the families and they lost support to do that,” Thompson said.

Members of Detroit’s Health Department spoke to TalkPoverty on background but referred questions to the city’s communications department before going on the record. The city’s communications department gave TalkPoverty basic information about its lead program after more than a week of requests, but gave vague answers about whether losing out on the CDC funds hurt the city’s lead prevention efforts in any way. At times, Nixon told TalkPoverty to “file a FOIA” (Freedom of Information Act request) for such information.

It is unclear why the city downplayed the importance of missing out on the federal grant. However, after being denied the CDC grant, the city’s former Health Department Executive Director, Joneigh Khaldun, in a July 10, 2017 appeal of the federal agency’s decision, characterized the federal funds as a “severe need.”

“Addressing lead exposure remains a critical need given the history of Detroit as a large industrial community and the subsequent ubiquity and permeation of lead in our neighborhoods,” Khaldun said.

As American cities like Detroit scrap for federal funding to address very important issues facing their communities and their residents, an accurate count in 2020 is crucial.