· Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
I think an interesting policy that has come up recently that could have major public health implications in the possible government takeover of PG&E. Currently, PG&E has filed for chapter 11 bankruptcy after it was found responsible for wildfires in the past few years. These wildfires have killed people and burned over 200,000 acres of California. With this bankruptcy the burden of the cost will now be on the residents who are obligated to use PG&E’s services. This increased cost can add financial burden to patients with lower SES. Furthermore, the actual fires themselves, beyond burning and destroying the environment could potentially be responsible for increased asthma and other related respiratory illnesses in patients that live near or around the fire, which in the end would cost or society much more than just the effects of the fire.
· Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).
IF PG&E was nationalized and taken over by the state of California, it would be important to study how a government run utility company would function and its effectiveness. Would it be able to provide better, more reliable power delivery? Would the government be able to maintain and update old and outdated power lines that PG&E has neglected? Finally, the easiest measure would be the rate for gas and electricity compared to pre gov take over. Also, rate and size of wildfires could also be studied. I think these are measures that could potentially be studied.
· Specify the outcomes and populations you think most affected or least affected by the policy.
Utility costs are regressive in many ways. Populations with lower SES and financial resources are at the mercy of the rate and are subject to take a bigger hit to their wallet when they have a higher rate. They are unable to afford solar panels and Tesla batteries when the power has to be shut off for safety reasons to prevent wild fires, which could impact patients that are on powered oxygen machines, or limited grocery budgets and potential food spoiling in their fridge.
In terms of outcomes, I would hypothesize that under a nationalized electric company there would also be less forest fires, which could potentially be a cause of asthma exacerbations. I think incidence of asthma exacerbations could be just one of many health-related outcomes that would come from the take over the electric company.
· Propose a study design to evaluate the policy.
I think a study design to evaluate this specific outcome would be to look at incidence of asthma exacerbation cases pre and post take over, with the takeover acting as the instrumental variable for wild fires and cases of asthma.
· Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
A government takeover of PG&E would have innumerable impacts on the people of California. While it will mainly be felt in the pocketbooks of the users of the utility, I think that the health effects will ripple under it unnoticed. I think this is because it is hard to really quantify these effects. How large of an impact will a family saving 10-15 dollars, or even potentially paying 10-15 dollars more per month on utilities have? It will vary family to family and is incredibly difficult to quantify. Furthermore, but upgrading infrastructure, perhaps mandatory power outages would decrease, what are the health implications of a power outage? Food can spoil, which would affect families with less income and resources to keep power on during these outages, but this again is hard to quantify and study. I think it will be very difficult to draw inferences from the change in policy because a lot of this granularity would be difficult to assess.