Health Disparities Forum

1. Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.

The recent uptick in immigration enforcement raids (which are said to be enforcing current policies and regulations) will likely have an impact on health in members of the undocumented immigrant population and their children who may be less likely to seek health services, more likely to be refused services, or more likely to receive low-quality/high-cost services from private providers who don’t report to the state.

•Describe why an evaluation of that policy is informative (primarily about the policy, or primarily a test of hypothesized mediators?)

Evaluating the impact of the policy on health is important because it might influence policy makers to change the policy.

•Specify the outcomes and populations you think most affected or least affected by the policy.

See above

•Propose a study design to evaluate the policy

If could assure anonymity for participants, I would compare undocumented immigrants in states with increased ICE raids with those in states without increased raids and also similar immigrant populations in the same two states. I could then use difference-in-difference that I think would be specified as:

Y_i = α + β₁ Documentation + β₂ State + β₃ Documentation * State + ε_i

–Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health

I’m quite sure it would not be possible to do this study, since it would put the effected population at risk to identify them, follow-up and collect data. There would also be limitations as to the amount of data on health available before the policy was implemented. Further, if the populations between states or between documented and undocumented were not similar, the groups wouldn’t be exchangeable.

An interesting policy to evaluate from a health perspective would be universal pre-k. This program ensures that all children have the opportunity to go to a pre-k program before entering kindergarten. There are clear (and documented) educational benefits for the children enrolled, but educational access may lead to additional benefits to their health and the health of their families. Being enrolled in pre-k provides children and their families with access to social programs they may not have been aware of if they are not accessing those systems otherwise. Early intervention programs for those with learning difficulties or developmental delays would be accessible through these pre-k programs and lead to improved performance in elementary school and beyond. Health content is provided in schools so it would be understandable if hand washing or dental health habits improved due to exposure to the topics in school by the children and parents were made aware of it. It would also be interesting to see if the expenditure that is diverted from day-care costs to other costs would be put toward preventing health problems or food insecurity (much like it is hypothesized the EITC does).

There are a number of nature experiments to test the hypothesis that access to universal pre-k improves the health of children because a number of states (~40) have these programs. The National Institute of Early Education Research has done a lot of work in the area of whether these programs impact later learning and how they compare with other programs like subsidies for child care. It would be interesting to understand the connection between universal pre-k and the health outcomes we know are related to education – like smoking and access to healthcare. Racial disparities in these groups are key to understand because of the differences seen in those outcomes by race and SES and the use of a universal pre-k program by race and SES.

I did not find a study looking at these issues during a quick search. But an ideal study design to highlight the effect of universal pre-k on health is use of data from a cohort study already in progress. Students who were enrolled in pre-k could be compared to those who were not enrolled and followed to adulthood to compare health outcomes. It would be interesting to look at lifestyle factors because of the links to heart disease and diabetes, but also access to care, the health of others in the family, and health beliefs. In the case of universal pre-k, there is so much time passing between the intervention and the outcomes of health later in life. This presents a challenge in drawing inferences about its effect and opens any research up to scrutiny because of potential confounders which occur during the child's life.