Addressing Challenges in Measuring Policy

Monitoring policy effects on child health has not been a national priority. While existing laws require that environmental impact statements be developed when new roads, bridges, or dams are built, there is no such requirement to monitor the effect of labor, health, housing, energy, or transportation policies on children’s health. Yet as noted earlier, such policies can exert important yet unintended and unanticipated effects on children’s health, sometimes positive and sometimes negative. Given strong evidence that children’s health sets the stage for life-long health, assessing the effects of policy on children’s health should be given much more attention.

Existing ongoing data systems have several limitations as a tool for assessing policy effects, including their limited focus on particular diseases, the relative lack of longitudinal data, and the inability to link data across systems. Given the latitude afforded to states to implement policy, there is also a need for better tracking of state-specific policy implementation from one year to the next. Approaches being undertaken in Canada, England, and Australia provide valuable models for the United States. These models should be considered as new approaches to measuring children’s health are developed.

CONCLUSION

Additional well-designed research and evaluation that address the challenges articulated throughout this chapter are needed to fully understand the range of influences and the interactions between them. The conceptual basis of many studies of children’s health would be improved by the simultaneous study of at least one factor from each important category of influences known to be associated with health—an exception is the assessment of social class. In this way, studies can avoid the most egregious biases from failing to include variables that influence health and that interact in powerful ways with variables that have been included. A prototype of such a study is that of Lantz et al. (1998), which included both behavioral as well as social factors in the analysis of a national dataset. This was a study of adults; similar studies are warranted for children.

No single survey collects data on all influences on children’s health in a comprehensive manner; it would be both financially and methodologically onerous to do so. Ensuring that the portfolio of surveys collects at least some data on multiple salient influences and improving the comprehensiveness of individual surveys drawing on the content of existing surveys should be priorities as research continues to elucidate the dynamism of health and its influences. Surveys focused on child outcomes other than health would profit from paying more attention to health outcomes and influences. For example, education-focused datasets often provide rich information on the child’s readiness for literacy, family access to resources, and school quality but lack data on the child’s biomedical markers and



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