· Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
The No Child Left Behind Act of 2002 was a U.S. congressional act that reauthorized the Elementary and Secondary Education Act of 1965 originally signed by President Lyndon B. Johnson as part of his "War on Poverty" legislation. No Child Left Behind aimed to close the educational achievement gap by requiring that schools meet state-determined achievement and assessment standards in order to receive federal school funding. This was a very controversial educational policy.
· Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).
No Child Left Behind may have important health implications because childhood educational achievement influences one's ultimate education level (e.g. whether one is able to graduate from high school by age 18), which can contribute significantly to one's socioeconomic level as an adult (e.g. the type of employment that one can obtain), which in turn can significantly affect one's long-term health (e.g. whether one has access to nutritious foods, affordable health insurance, regular primary care, and preventive medicine). The quality of one's childhood education may also contribute to their neuro, cognitive, and emotional development, which are likely to have long-term biological implications for their mental and physical health as well.
· Specify the outcomes and populations you think most affected or least affected by the policy.
The population I think most affected by this policy are children who attend public schools in low-income neighborhoods. The population least affected are children who attend private schools. The outcomes I think most affected by this policy are: high school graduation rate, highest level of education attained, incarceration rate, income as an adult, incidence of learning disability, incidence of mental illness, and incidence of chronic health conditions as an adult e.g. diabetes, hypertension.
· Propose a study design to evaluate the policy.
I would perform a retrospective cohort analysis to compare the outcomes I outlined above among subjects who attended public schools in low-income neighborhoods from 10 years before and up to 10 years after the passage of the No Child Left Behind Act. (The number of years refers to the pool of subjects that I would draw from relative to when the policy was passed; the actual study outcomes may occur over 10 years after the policy passed, such as the measurement of adult diabetes incidence.)
· Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
The biggest challenge to studying the impact of this policy on health, is that there are a myriad of biases or confounders that may also influence the outcomes that I outlined above. For example, public schools in low-income communities may lack resources such as access to school psychologists or early childhood education specialists who can pick up on and properly diagnose a child's learning disability or mental illness that may be impacting their learning. Failure to property diagnose such conditions may lead to an underestimation of incidence of learning disability among children from low-income communities, for instance.