1. Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
ANSWER: State policies that increase school/educational choices for children (Charter schools or Magnet school programs) or adults (federal/state funding of GED programs or job skills training) may have important health implications particularly for low income children or adults.
Low income children likely live in low income areas where the assigned school district may not perform as well as schools in high income areas. Giving parents the opportunity to choose better performing schools could improve kids education, increase the chance to attend college and overall increase the likelihood of higher income as an adult.
Higher income is itself associated with lower risk of cardiovascular and metabolic diseases.
With adults, state programs that fund GED programs for adults to get their high school diploma or programs that allow young adult to learn a trade skill (plumbing, mechanics, computers, etc) could increase their chances of employment and/or self employment and thus income level.
So a social policy that affects education for kids and adults could in the short term (adults) or long term (kids) affect health outcomes through higher income attainment.
2. Describe why an evaluation of that policy is informative (primarily about the policy, or primarily a test of hypothesized mediators?)
ANSWER: Normally educational policies and their effectiveness are evaluated by standardized test performances and number/percent of students reaching satisfactory test performances.
Doing a longitudinal evaluation of an educational policy that includes health parameters (physical and mental) would provide more information on how “better” and different types of education affects income, employment, and health (directly or indirectly).
3. Specify the outcomes and populations you think most affected or least affected by the policy.
ANSWER: Education policies that increases school choice for children and funds job training for adults would most affect kids/adults with low employment opportunities and low income. Children of parents who have higher income would most likely already have school choice options.
4. Propose a study design to evaluate the policy
ANSWER: Interventional longitudinal study similar to the MTO program sponsored by the US Department of Housing where families are randomly selected to choose for the kids either: a Charter school, a Magnet school program, or staying in their local school. State standardized test performances for each enrolled kid in each group will be tracked and noted. Childhood Health evaluations (physical and mental) would be performed and tracked as recommended by clinical guidelines. Kids would be tracked for 10 years after turning 18 yoa. Surveys collecting information about their employment, income, physical and mental health status would be performed every annually for those 10 years.
5. Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
ANSWER: Biggest challenge to implementing the policy would be consistent state or federal funding. Job training programs, school buses, high performing schools for young adults already exists but convincing state legislators to fund a 5-10 year project that pays for tuition and fees could be challenging.
The biggest challenge to drawing inferences would be controlling for confounders that influence health outcomes like neighborhood (a better school/education may improve income and access to health care in the long run, but learned dietary patterns and a lack of access to healthy foods from childhood may persist and attenuate the positive effects of higher income on health).