15 states and Washington DC currently have school voucher programs. These programs are designed to provide students from low income families the opportunity to attend higher performing schools by providing money through a variety of different means. The programs vary from state to state and the Department of Education has recently proposed a federal voucher program. Disparities in education achievement and the quality of education have both been linked to disparities in health outcomes, however, school voucher programs widen education disparities and likely widen health disparities as well. This is achieved through several means. First, eligibility for the programs varies from state to state and it likely that there are many students who do not qualify for voucher programs, are attending low quality schools, and whose families are unable to provide better educational opportunities for them. Secondly, the programs rely on parents taking on the responsibility for applying for the programs, and low SES families are more likely to have less time available to spend on these types of applications and lower literacy to understand the process. When money is diverted from these schools to other schools, the poorer schools become poorer, leading to lower quality education, fewer resources available for students, and worse infrastructure in the schools that are left.
While the programs may benefit certain students, it is likely that for the students who remain end up disproportionately disadvantaged. The first state school voucher program was instituted in Wisconsin in 1991. Several other states have had programs in place for over a decade. This provides an opportunity to evaluate the health outcomes for the students affected by these programs including those who participated and those who remained at the schools because they either did not qualify or were unable to apply for the programs. These students provide a cohort who could be followed for a multitude of health outcomes. Two outcomes that would be relatively simple to measure would be incidence of metabolic syndrome and of early pregnancy in the students who received vouchers and moved to a new school compared to those who remained in the schools.
The biggest challenge to measuring the effect of policy on health is that there are an incredible number of variables that interact to lead to health outcomes, so attributing the effect of a policy to an outcome is difficult. Additionally, some policies vary significantly from state to state and can change frequently, which can further complicate measuring any particular outcome.