Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
One often overlooked policy is Weatherization Assistance Programs provided by the Department of Energy to improve the energy efficiency of homes. These programs provide grants to states to assist low income families with tasks such as window replacement, heating and cooling system inspection and repair, utility cost assistance during the winter, and repair or replacement of low efficiency electrical appliances. There are two potential pathways for Weatherization Assistance Programs to impact health. First, by reducing heating/cooling bills money is freed to pay for medications, food and other necessities that may benefit health. Second, weatherization may provide direct health benefits by reducing rates of home-related health problems which tend to disproportionally impact low-income families: house fires, home accidents, hypothermia, smoke inhalation and potentially even asthma.
•Describe why an evaluation of that policy is informative (primarily about the policy, or primarily a test of hypothesized mediators?)
The majority of research on weatherization assistance programs comes from the Department of Energy and is focused on outcomes which include # homes assisted and $ reduction in energy bills. The potential direct health benefits of weatherization described above have not been studied but if found to be substantial might change the cost-benefit ratio for these programs.
•Specify the outcomes and populations you think most affected or least affected by the policy.
The most affected populations are low income families – particularly those who own their own homes. I would hypothesize that the health impact of weatherization is likely to vary by geographic region. For example, northern areas of the country with cold winters are likely to see benefits related to decreased heating cost, house fires and hypothermia.
•Propose a study design to evaluate the policy
Weatherization funding varies by year and is handed out by the Department of Energy (DOE) through grants – thus an ideal study would be a natural experiment comparing health outcomes in a state or county which received DOE funding the year after funding was dispersed and programs implemented with a neighboring state or county with similar weather, urbanization and SES status.
•Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health
The two biggest challenge to drawing inferences about the impact of weatherization on health are 1) many confounders along the causal pathway and 2) a time lag between intervention and health improvement. Confounders in studying the direct impact of weatherization programs might include changes in winter severity, families moving houses and changes in energy prices. Regarding the timing of anticipated health benefits, some potential health improvements are gradual such as a reduction of asthma in children and would take a decade to study; other outcomes, such as house fires, are rare though devastating and the scarcity of events would make it challenging to demonstrate a significant change without a long study period before and after interventions.