Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
I believe that many environmental policies are not usually intended to be health policies but have important health implications. One in particular that comes to mind is the Clean Power Plan, which was a policy promoted by the Obama administration to reduce carbon dioxide emissions from electrical power generation by 32 percent by 2030, relative to 2005 levels. The plan focused on reducing emissions from coal-burning power plants, as well as increasing the use of renewable energy, and energy conservation. Reducing carbon dioxide emissions would decrease the pollutants that contribute to smog and soot, can improve health in a number of ways, including decreasing asthma attacks, can save people money in energy bills which allows them to spend money on other things. Carbon dioxide emissions disproportionately affect low-income communities and communities of color, who are more likely to live near power plans compared to national average, which leads to increase risk of disease and death due to toxic particular matter emissions and air pollution. Importantly, reducing carbon dioxide emissions will help reduce global temperature warming; global temperature warming leads to increased drought and increase famine due to decreased water supply and agricultural production. Increased global temperature also broadens the ranges of mosquitoes and ticks and increases rates of vector-borne illnesses. This also would have global impacts: greenhouse gas emissions from developed nations such as the U.S. disproportionately affect developing nations that do not have the infrastructure to combat climate change induced drought, famine and other natural disasters. Unfortunately, this plan was eliminated under the Trump administration. For this exercise, I will consider the hypothetical scenario if it the plan was passed.
Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).
An evaluation of this policy would be informative because it would help determine the economic and health impacts of the policy. It would also lend credence to future environmental interventions to address the growing issue of global warming on our environment and health.
Specify the outcomes and populations you think most affected or least affected by the policy.
Outcomes: Global temperature change; amount of carbon dioxide emissions; hospitalizations/clinic visits for exacerbations of asthma, respiratory illness, emphysema; number of tick and mosquito borne diseases.
Populations: Communities who live close to power plants and coal miners would be most affected. Those who live next to power plants may have less job opportunities if power plants are shut down; however, here would likely be less expenditure on healthcare from being exposed to toxic emissions and worsened pollution. Coal miners would be impacted by potential layoffs in the coal industry, but would likely spend less money on healthcare from side effects of working in a coal mine.
Propose a study design to evaluate the policy.
I would propose a pre-post study design looking at hospitalizations/clinic visits for exacerbations of asthma, emphysema, and other respiratory illness before and after the policy change to reduce carbon dioxide emissions. I would look in communities closest to power plants as well as those further away.
Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
The biggest challenge to implementing and drawing inferences about the impact of this particular policy on health is that there are a lot of confounders and it would be hard to isolate the impact solely of reducing carbon dioxide emissions alone on a particular health outcome. A study by Mark Jacobson using computer modeling showed that for each increase of 1 degree Celsius caused by carbon dioxide, the resulting air pollution would lead annually to about a thousand additional deaths and many more cases of respiratory illness and asthma in the U.S.; worldwide, about 20,000 air-pollution-related deaths per year per degree Celsius may be due to carbon dioxide. As our technology and research techniques improve we may be able to better hone in on the impact of carbon dioxide for a particular health outcome. In addition, the time course of the impact of reducing carbon dioxide emissions is likely over years or decades, and not immediate, so people may not feel quite as invested in this policy.