· Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
The Urban Agriculture Incentive Zones Act, passed in California in 2014 allowed owners in urban settings to convert their properties to urban gardens or for agricultural use for a minimum of five years in exchange for property tax breaks. Initially publicized as a means to curb greenhouse emissions by decreasing supply chain transport, a potential income-generating opportunity for low-income communities and a self-generating means to address health food deserts. There are broad potential health benefits for diet-sensitive chronic conditions. Urban farming has the potential to increase access to nutrient-rich foods, curb food insecurity and impact diet behavior through education and engagement. Further, these plots would increase urban green space, which have potential mental health, respiratory and cardiometabolic disease benefits (WHO Urban Greenspace and Health Review, 2016).
· Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).
There are widespread assumptions of the upstream benefits of a tax break targeted towards increasing uptake of urban farming in low-income communities – formal evaluation of identifying the implementation of such a program, including which communities end up transforming plots, the size and reach of urban farming in the communities, sustainability of the projects and most relevant, the health and behavior outcomes of the policy in relations to property transformation.
· Specify the outcomes and populations you think most affected or least affected by the policy.
The greatest potential benefit could be low-income, low-green space communities with poor access (distance, nutritional food diversity, time fluctuations in accessibility) to nutrient-rich foods. Potential harm of transforming previously accessible housing on property in communities with low-income housing needs.
· Propose a study design to evaluate the policy.
First part descriptive of community characteristics by properties participating in the UAIZA. Second part could be a cohort matched (community-level - ~% race/ethnicity/household income/urban score) defined area around property under UAIZA vs control assessing health outcomes over time (BMI, insulin resistance, A1c, pediatric asthma visits)
· Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
Huge number of community-level confounders that would be difficult to control for (measures of food access, pre-policy habits/characteristics, pollution exposure, etc) and the issue of selection bias – where properties transformed to UAIZA are non-random with potential community-resilient factors that promote their uptake. Potential health benefits, although potential broad, are unlikely to be very significant and masked in a large population-level analysis.