Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
At the height of the 1980s crack-cocaine epidemic in the United States, the federal government passed two policies in regards to sentencing crack and cocaine offences (i.e. the Anti-Drug Abuse Act of 1986). Together these policies created a 100:1 quantity ratio between the amount of crack and powder cocaine needed to trigger specific mandatory minimum sentences for trafficking, and a mandatory minimum penalty for simple possession of crack cocaine. As a result, crack users and sellers received much harsher penalties than users and sellers of powder cocaine. While these policies intended to reduce crime related to drug use, the policies resulted in a surge of adverse birth outcomes including the number of fetal deaths, low birth weight babies, and infants sent to foster care. Moreover, many drug users saw their pre-existing mental health conditions exacerbated due to the mandatory long-term incarceration.
Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).
A critical evaluation of the Anti-Drug Abuse Act of 1986 is informative because it allows us to see how a “color blind” policy had the effect of widening pre-existing racial disparities in rates of incarceration, which in turn also caused notable perinatal health disparities.
Specify the outcomes and populations you think most affected or least affected by the policy.
African-Americans of low socio-economic status living in inner cities were most affected by the policy. They were most likely to be unfairly sentenced due to the policy, and faced an unprecedented scale of militarization of policing, arrests and incarceration. However, very few studies have evaluated the effects of this policy at an inter-generational level, to see how the children born to parents criminalized by the Anti-Drug Abuse Act of 1986 are currently fairing in terms of adverse physical and mental health outcomes.
Propose a study design to evaluate the policy.
A longitudinal approach could be useful to compare the rates of adverse health outcomes among the children of parents incarcerated during the 1980s crack epidemic, and those who did not have parents incarcerated during this period. Stratifying these analyses by race would also be helpful to understand how this policy may have reinforced intersecting oppressions.
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 policy on health would be the “noise” caused by other secular trends in the data. For example, I am not sure how I would disentangle the effects of the 1986 policy from other structurally racist policies that were enacted around the same time. I therefore believe it would be difficult to draw causal inferences about this policy and its’ effect on the health of Americans. Many prison advocacy groups have campaigned for the repealing of the policy to no avail, so I am unsure about how one would effectively implement policy that could remedy the negative impacts of a law that was passed so long ago.