· Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
California has recently been severely affected by wildfires, which inflict significant damage on properties and communities. In 2001, the California Legislature passed the Public Utilities Code (PU Code) Sections 451 and 399.2(a), which allowed power companies to de-energize power lines in areas at risk for fire. An unintended healthy consequence of this is that it can affect healthcare facilities or homes where life-sustaining medical treatments are used. These often occur in rural areas, therefore this policy may affect economically disadvantaged populations who have limited means to obtain backup equipment or travel to other facilities to receive care (e.g. dialysis centers). This may cause increased the incidence of life-threatening emergencies in these vulnerable populations, which would increase their hospital admission rates.
· Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).
Starting in 2018, new efforts to modify policies that notify the public about these de-energizing events and management of the downstream effects were started and are still pending (e.g. Resolution ESRB-8). This speaks to the importance of evaluating this policy in light of the increase in wildfires California has experienced over recent years. Understanding how this policy affects vulnerable populations is essential in assuring that other appropriate policies are enacted that ensure there is funding and resources for members of the population with specific medical needs (e.g. accommodations for travel to different health care facilities, tax credits for home generators, etc.).
· Specify the outcomes and populations you think most affected or least affected by the policy.
The specific outcomes are death and hospital admissions due to lack of normal power supply. Patient populations include those on supplemental oxygen, home ventilation devices, patients receiving peritoneal dialysis at home or hemodialysis center, and any patient that is taking medication that requires refrigeration. Specific populations that are at highest risk are those in very rural areas and those with the lowest incomes.
· Propose a study design to evaluate the policy.
A study design to evaluate how this policy affects these outcomes would be to select specific hospitals that treat patients in areas that had planned de-energizing events in the last 5 years. A review of emergency room visits in these areas could assess diagnoses patients were admitted for immediately before and after these events could be done and the diagnoses as well as demographic data could be collected. Specific diagnoses could be used to identify events related to emergencies related to loss of power. Using home zip codes, census tract data could be used to assess average income and geography to determine if there is an association between the de-energizing events and higher events in specific geographies and incomes, using pre-de-energizing data as a baseline.
· Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
The biggest challenge will be making inferences about the data because income would not be directly measured. While pre-and post-event rates of diagnoses would be used, it will be challenging to establish what the actual “baseline” rates for these events will be given fluctuations over time.