1) Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
An important policy could be income supplementation for pregnant women with low income or unemployment. This is particularly important because it can help pregnant women buy vitamins that are necessary for a healthy pregnancy (i.e. folate) and pay for transportation to obtain prenatal care.
2) Describe why an evaluation of that policy is informative (primarily about the policy, or primarily a test of hypothesized mediators?)
Women who don’t obtain adequate prenatal care are known to have worse outcomes for the pregnancy and for the baby (i.e. birth weight, prematurity). Similarly, women who don’t take prenatal vitamins are also known to have an increase in fetal anomalies. Thus, it is important to study whether social policies that increase prenatal care or vitamin intake can improve both pregnancy and birth outcomes.
3) Specify the outcomes and populations you think most affected or least affected by the policy.
The population of interest would be pregnant women. In particular, it would focus on pregnant women that are unemployed or of low-income status. The outcomes of interest would be gestational age at delivery, birth weight, and prevalence of fetal anomalies.
4) Propose a study design to evaluate the policy: Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
In this study (broadly speaking), the population of interest would be pregnant women of low-income status. The intervention group would receive an income supplement and the control group would not in a randomized fashion. The primary outcome would then be birth outcomes such as gestational age at birth and birth weight. There would be several challenges to this study. The biggest challenge would be the presence of several confounders that can influence the outcome. This can be partly handled by randomizing the participants to the intervention and control groups. Another potential issue is that this may be an ethical dilemma that certain subjects receive a supplement whereas the control group would not.