Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
Examining the growth in mass incarceration, one can investigate changes in legislation initiated in the 1980s during the War on drugs. Since then, the number of people incarcerated for drug offenses in the US have skyrocketed dramatically. Within mass incarceration, there is a gross disparity in sentencing policies with people of color and those from socioeconomically disadvantaged backgrounds being significantly more likely to be arrested, charged with a crime, and receive a harsher sentence than those who are non-Hispanic white. When examining these effects on health, studies have shown impacts on social, educational, and economic opportunities (RWJ Foundation). Furthermore, studies have suggested an inverse relationship between the time spent in prison and reduction in life expectancy. These effects not only impact the immediate generation but has unfavorable effects on the children born to those incarcerated.
Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).
Evaluation of a policy is crucial for quality improvement. Often policies are borne as a reaction to events or problems that have occurred which indicate they are often well intentioned – serving as a treatment. However, policies are often in essence contrived through prediction instead of hard evidence of their functionality and possible downstream effects. For these reasons, it is important policies undergo quality control evaluations to ensure the policy is implemented as it was intended and to investigate possible sequalae from the policy – intended and unintended. For this policy in particular, we’ve seen the persistent disparities in criminalization of drug possession which have had widespread consequences.
Specify the outcomes and populations you think most affected or least affected by the policy.
Outcomes most affected by the policy include – arrests (including initial and repeat offenders), homelessness, single parent homes, number of underrepresented minorities in college, number of underrepresented minorities able/participatory in voting, and median household income among underrepresented minorities. The populations that are typically least affected are the majority – this can be evidence by differences in access to treatment and policies borne from the Crack vs Opioid epidemics.
Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
The greatest challenge in implementing and drawing inferences about the impact of the policy on health is the temporal relationships that are difficult to examine. When a policy is developed whether at a federal or state level, it takes time before this policy is universally implemented. Consequently, there is a ripple effect in essence in terms of the response seen from the implementation of this policy.