· Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
The Every Student Succeeds Act (ESSA), passed in 2015, replaced the No Child Left Behind Act passed in 2002. The ESSA is a reauthorization of the Elementary and Secondary Education Act (1965), which initially established the federal government’s role in public education. The ESSA actually narrows the federal government’s role, and shifts accountability to states, with the goals to ensure success for all students and schools, including disadvantaged and high-needs students. Per the Act, it requires that all students in America be taught to high academic standards to prepare them to succeed in college and careers. States must put together and submit their plans, and students are then tested nationwide on an annual basis from 3rd through 8th grade to create accountability for states and to ensure lower-performing schools are improving.
As described in Vable et al, improvement in education may reduce some health inequities. Therefore, if this policy has been successful to achieve what it was created to achieve, this could potentially improve health outcomes for individuals and communities most positively impacted.
· Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).
As education, employment, and income are all important aspects of socioeconomic status, one of the goal’s of this policy is to improve education for all children with the overall goal of preparing this children for their future, whether that is to pursue additional education or in a career. Through this policy, the federal government narrowed its role in achieving this goal and passed the responsibility to states. Compared to NCLB, ESSA allows for more flexibility to states and allowed for the creation of rigorous state-developed plans designed to “close achievement gaps, increase equity, improve the quality of instruction, and increased outcomes for all students.” As the main measurement of the success of each state’s plan is a standardized test, this still brings into question the utility of what students are learning, and whether or not this is resulting in the promised outcomes. Additionally, because the plans are created by each state, there is likely more variability in the plans and unfortunately more or less success still creating inequity based on geography.
Although it is likely too early to measure outcomes, it will be important to see if targeting higher achievements via standardized test scores by state-developed plans results in 1) improvement in school curriculums, 2) higher scores of students in all geographic locations, particularly in those areas with historically poor-performing schools, 3) number of years students remain in school, 4) graduation rate, 5) college enrollment rate, 6) employment for students in school at time of implementation of policy, and 7) range of income for students graduating high school after implementation of this policy.
Mediators would be schools’ performance prior to policy implementation as measured by prior student scores, prior graduation rate, prior college enrollment and employment rate, geography, students’ demographics, caretaker/parents’ demographics and education level. This is how I would be interested to measure the success of the policy strictly on education outcomes.
For health outcomes, it would be ideal to use a National Longitudinal Survey of Youth of this population, compared to that of the more recent survey (NLSY from 1997). This would allow for a comparison of health outcomes for the two pre- and post-policy populations on a National level.
· Specify the outcomes and populations you think most affected or least affected by the policy.
I would be interested to look at the following outcomes: 1) level of education completed, 2) college attendance, 3) employment status, and 4) income for children in neighborhoods/school districts with poorly performing schools and/or those with a higher proportion of children coming from low SES. I would ideally want to compare these outcomes for this population prior to and after ESSA. Additionally, these outcomes should then be compared to all children at the state level and nationally. How this policy affects SES for children in these districts, compared to the same populations prior to the policy and all children statewide and nationally, would be necessary to determine if the policy is affective in the way desired. Health outcomes that should be measured are the physical component score and mental health component scores described in Vable et al.
· Propose a study design to evaluate the policy.
With use of the National Longitudinal Survey of Youth from 1997 cohort data (most recent), and with the hopes of another NLSY from after the policy change (2017), survey results would be used to measure the outcomes described above. Of course, if another NLSY does not become available, a study could be designed on a smaller scale, either focused on a specific state (ie California), or specific geographic locations across the country, balancing out school districts with low SES children, districts with high SES children, balanced rural and urban neighborhoods, as well as variety of locations with different race/ethnicity composition.
· Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
The biggest challenges are the number of other variables present, the variety of changes to education based on the policy (varies by each state), the challenge in using historical comparison of pre and post implementation of the policy, as well as other major changes to healthcare that occurred around the same time, particularly the passage of the Affordable Care Act.