•Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
An example of such policies are so called TRAP laws, or Targeted Regulation of Abortion Providers. These laws are often introduced under the guise of safety, but frequently have an impact on health. For example, laws/policies are often introduced requiring that abortion facilities meet the standards of an ambulatory surgical center. While this would not typically be considered a health policy, its implications in many parts of country has led to the closure of abortion clinics, leading to affects on access to abortion care.
•Describe why an evaluation of that policy is informative (primarily about the policy, or primarily a test of hypothesized mediators?)
As mentioned above, the implementation of facility requirements for abortion clinics to comply with the standards of ambulatory surgery centers has led to clinic closures, leading decreased abortion access. As these types of restrictions disguised as building policies have no evidence of improved safety, understanding the impact of these type of restrictions are imperative.
•Specify the outcomes and populations you think most affected or least affected by the policy.
This would vary by state studied, but generally reproductive aged women in non-urban areas. As abortion clinics are more likely to be located in the larger metropolitan areas, those in suburban and rural areas are most likely to affected by clinic closures. Outcomes of interest would include distance traveled for abortion, out of pocket expenses, changes in perinatal morbidity and mortality.
•Propose a study design to evaluate the policy
Prior studies have evaluated these types of policies. For example, the Texas Policy Evaluation Project evaluated abortion rates and access immediately prior and immediately after implementation of several targeted abortion restrictions. They assessed abortion rates, distance traveled, out of pocket expenses, etc.
•Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health
The challenge in drawing inferences is that there are other factors that may affect abortion access. It is challenging to separate these from policy implementation.