A Rigorous System to Determine the Health Impacts of Policies and Programs

描述（由申请人提供）：大规模的政策和项目，如减少暴力犯罪的倡议和经济发展项目，肯定会对人口健康产生重大影响。值得注意的是，大多数政策和项目对健康的影响仍未得到研究，尤其是那些不是为影响健康而设计的政策和项目。实施健康影响评估有时是为了在一项政策通过之前预测其对健康的影响。然而，令人惊讶的是，对政策实施后的健康影响的实际评估并不多见。在实施后研究健康影响的罕见情况下，设计的选择依赖于广泛的指导方针，并为每次评估动员一项新的研究。因此，迫切需要一个严格和具有成本效益的系统，可以定期用于评估政策和规划对广泛健康结果的影响。所提出的研究的第一个贡献将是建立一个新的系统来确定政策和计划对健康和差距的影响。该系统将包括一个基于网络的模拟生成器，以确定最佳的研究设计和分析，以及一个可用于估计健康影响的10年以上人口健康数据的大型数据库。拟议研究的第二个贡献将是应用该系统来评估加州刑事司法政策和计划的健康和差异影响：特别是在奥克兰实施的暴力计划，以及全州范围内强制执行的刑事司法调整。整个系统的建立将具有重大意义，因为它将彻底改变研究人员以低成本定期和严格评估政策和项目实施后的健康和差异影响的能力。该系统将具有创新性，因为它挑战了“执行前的卫生评价就足够了”的范式，将引入一种新的方法来研究具有成本效益的政策卫生影响，

DESCRIPTION (provided by applicant): Large-scale policies and programs, such as violent crime reduction initiatives and economic development projects, certainly have a substantial influence on population health. Remarkably, the health effects of most policies and programs remain unstudied, particularly those not designed to influence health. Health Impact Assessments (HIAs) are sometimes implemented in an attempt to predict the health effects of a policy before it is adopted. However, actual assessment of the health effects of policies post-implementation is surprisingly uncommon. In the rare circumstance that health effects are studied post-implementation, the choice of design relies on broad guidelines and a new study is mobilized for each assessment. There is thus a critical need for a rigorous and cost efficient system that can be applied regularly to assess the effects of policies and programs on a wide range of health outcomes. The first contribution of the proposed research will be establishment of a new system to determine the health and disparities impacts of policies and programs. The system will comprise a web-based simulation generator to identify the optimal study design and analysis, and a large database of over 10 years of population health data that can be utilized to estimate health effects. The second contribution of the proposed research will be application of this system to assess the health and disparities effects of criminal justice policies and programs in California: specifically a violence program implemented in Oakland, and the criminal justice realignment that was mandated statewide. The establishment of the system overall will be significant because it will revolutionize researchers' ability to regularly and rigorously assess post-implementation health and disparities effects of policies and programs at low cost. The system will be innovative because it challenges the paradigm that pre-implementation HIAs are sufficient, will introduce a new approach to studying policy health effects that is cost efficient, and will incorporate the most rigorous tools from the field of biostatistics (i.e., simulations and causal methods). The web-based simulation generator is significant because it will improve the quality of scientific knowledge on health impacts, and innovative because it moves beyond the current broad guidelines and allows rigorous quantitative assessment of which design and analysis approach is optimal for each program. Preliminary analyses demonstrate the important insight gained by using simulation to optimize study design and analysis decisions. The application of the system is significant because it will provide information about the health and disparities impacts of major changes in criminal justice policies and programs that would otherwise remain unknown. This project overall will have a substantial health impact by improving fundamental understanding of how policies and programs influence health and disparities, reducing the cost while improving the quality of assessments of health effects, and providing the evidence base to inform modification of current policies and design of future policies to protect health and reduce health disparities.