•Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
The National School Lunch Program is a federally assisted meal program operating in public and nonprofit private schools and residential child care institutions. While it might not have been intended to be a health policy, this program has certainly had important health implications.
•Describe why an evaluation of that policy is informative (primarily about the policy, or primarily a test of hypothesized mediators?)
The program was established under the National School Lunch Act, by President Harry Truman in 1946 but has really grown over the years and in the late 2000’s, began to also include snacks for after school programs. Children whose families earn less than 130% of the poverty level quality for free meals, and those between 130%-185%, reduced meals. Children from low-income families might not have adequate access to nutritious, well-balanced meals. This could lead to adopting poor eating habits with downstream consequences of obesity and its related complications. In the short-tem, poor access to nutritious meals could impair cognitive and emotional development in turn affecting a child’s ability to learn. Per the programs website, in 2012 the program provided nutritionally balanced meals for free or at a low-cost to 31million children each school day!
•Specify the outcomes and populations you think most affected or least affected by the policy.
Potential outcomes to consider: Cognitive development, emotional development, growth parameters (weight, height, etc.), Obesity, childhood diabetes, & rates of HTN/DM/HL/CAD, etc. in adulthood.
Populations that would be most affected without this program would be low-income children and those least affected would be high-income children.
•Propose a study design to evaluate the policy. Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
Since its inception, there have been several studies that have evaluated the implications of this policy on many factors, including several health-related ones. One study that might be interesting to evaluate this policy, would be a before and after implementation study comparing BMI and cognitive development in a school where most children are enrolled in the free lunch program to a school where most children were not enrolled in such a program. The biggest challenge to drawing inferences about the impact of this health policy on health in such a program, is that it is difficult to account for the effect of home environments on these outcomes. Some children regardless of income may not have challenges accessing nutritionally balanced meals and at times even if access to meals at home is scarce, children may spend time with grandparents or other caregivers who may provide access to these meals.