•Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
Housing policies and neighborhood policies such as the Safe and Healthy Homes Act of 2010 are usually intended to be health policies but vary drastically in implementation and exposures considered. They also tend to address only common environmental exposures such as mold. Exposure to neighborhood violence can have a large impact on health and it is not evaluated in these housing policies. Therefore, I consider housing policies to be missing important components that impact health. Those of low socioeconomic status tend to live in impacted neighborhoods with higher rates of exposure to allergens such as dust, mold, and termites, elevated exposure to toxins, and increased experiences of violence. These are all known to cause worse asthma outcomes in children with asthma. Housing code ordinances that are meant to enforce the minimum local, state, or federal standards for safety and sanitation for housing do not include violence as a measure to be reduced and violence tends to segregate into specific neighborhoods, with those living in those areas trending to have worse health outcomes, including higher asthma incidence and morbidity.
•Describe why an evaluation of that policy is informative (primarily about the policy, or primarily a test of hypothesized mediators?)
An evaluation of Housing Code Ordinances would be informative to see how minimum standards of safety within neighborhoods can be strengthened.
•Specify the outcomes and populations you think most affected or least affected by the policy.
As mentioned above, those of lower socioeconomic status will be the most affected by a revision of housing code policies to include violence control. Outcome measured could be asthma morbidity (looking at asthma exacerbations as an example of asthma morbidity).
•Propose a study design to evaluate the policy
–Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health
Baseline measures of SES (as a composite score using multiple measurements), social and environmental exposures (to toxins, allergens etc), experiences of neighborhood violence and some type of asthma morbidity outcome measure like exacerbations or asthma control.
Implementation of the policy could be having security present, brighter streetlights, cleaned up streets for example.
Post-intervention/policy measures of all the previously mentioned measures would be needed and comparing asthma exacerbations before and after the implementation could give an idea how this policy may have impacted the children’s health over time. Measuring violence exposure would be absolutely necessary.
The biggest challenge to this implementation is that it would have to be in place over a long period of time to make a difference in health outcomes. Social interventions such as this of intervening with neighborhood violence can be difficult to implement and even more difficult to maintain over time due to financial and practical difficulties.