•Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
I think California’s Three Strikes Law (Prop 184, reformed in 2012 by Prop 36) had a significant effect on health through increasing the prison population. Prison crowding has negative health outcomes including increased spread of infections, unsanitary conditions, and decreased mobility. In addition, being incarcerated in the United States also often exacerbates mental health problems through harsh draconian punishments in prisons for minor behavioral infractions, solitary confinement, lack of treatment, and lack of meaningful rehabilitation.
•Describe why an evaluation of that policy is informative (primarily about the policy, or primarily a test of hypothesized mediators?)
I think evaluation of this policy is informative because many states have enacted a variation of California’s Three Strikes Law. I think it is important to study the health effects of this policy to add to the growing body of evidence that this law is harmful and ineffective (legal studies have shown that the law does not reduce violent crime).
•Specify the outcomes and populations you think most affected or least affected by the policy.
The outcomes I would be interested in would be all-cause mortality, and then mortality by category. I think chronic stress related outcomes would also be of interest. I think minority men are most affected by the Three Strikes Law and white women are least affected.
•Propose a study design to evaluate the policy
I would propose doing a retrospective cohort study comparing California incarcerated population to another state’s incarcerated population that has a less crowded prison system to look at the effects of prison overcrowding on health. While this is not a direct study of the Three Strikes Law, it is known that the policy causes prison overcrowding.
•Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health
The biggest challenge is that there are many factors that influence health on a population scale and often it is hard to determine what is cause and effect and what is a spurious association. For a Three Strikes study, one could argue that incarcerated people are less healthy due to risky behavior not related to their imprisonment or that California's prison population is unique and cannot be compared to other prison populations.