Health Disparities
2/14/17
Melanie Thomas
•Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
As discussed in the Adler et al. Viewpoint, there are several if not many policies that are not primarily intended to be health policies, but that greatly influence health. One example is education policy, for example early education programs like Head Start are an example of how policies and programs that implement those polices can have a lasting impact on health trajectories. Kindergarten readiness (a focus of early childhood education) is a strong predictor of health and developmental outcomes later in life.
•Describe why an evaluation of that policy is informative (primarily about the policy, or primarily a test of hypothesized mediators?)
Evaluation of policy and programs is always informative. Otherwise, we simply don’t know what is or is not working and what parts of different interventions are salient to the proposed outcomes. Using the early childhood education example above, it would be important to evaluate whether policy designed to improve access to early childhood education actually improves access to intended target populations and whether engagement in the program results in the intended outcome—like Kindergarten readiness. In this example, Kindergarten readiness can be seen as a marker for socioemotional/cognitive development which in turn is a potential mediator for a variety of health behaviors and outcomes.
•Specify the outcomes and populations you think most affected or least affected by the policy.
I addressed this a bit before. I think low income and other marginalized children are most likely to be affected by policy designed to improve early childhood education. Part of this is because those children may not have parents with the resources to provide them with early childhood education apart from subsidies or other governmental programs. Overall, education is a critical marker for a variety of health outcomes and may be one of our best tools for improving other social determinants of health and a wide range of health outcomes.
•Propose a study design to evaluate the policy
I don’t like the idea of randomizing children to early education programs or not, seems pretty unethical, so let’s go with a pre-post evaluation of a policy implementation. One approach would be to examine various markers of kindergarten readiness (a battery of socioemotional and cognitive testing) given to kindergarteners county-wide before implementing early childhood reform and after. This quasi-experimental approach would allow us to evaluate the policy and make recommendations for improvements and next steps.
–Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health
One of the biggest challenges is that policies are often broad and may affect multiple levels of healthcare access, social determinants of health, health behaviors, etc. It can then be difficult to clearly evaluate what is the “active ingredient” of the policy that makes the health impact. Another challenge is in study design as alluded to in the question before—policy changes and implementation don’t lend themselves well to RCTs which is often heralded as our research gold standard.