Original ResearchHealth impact assessment as an instrument to examine the health implications of education policies
Introduction
Although not always considered health issues, access to quality housing, transportation, jobs, and education improves community health.1 The relationship between educational attainment (e.g. high school graduation and college education) and morbidity and mortality is well documented.2, 3, 4, 5 People with higher levels of educational attainment have lower rates of disease and longer life expectancies. They have greater access to jobs that pay higher wages, provide safer occupational environments, and offer health insurance.4 In addition, they are able to afford healthier food, live in safer communities that support physical activity, and have access to preventive care. People with higher educational attainment are less likely to engage in health-related risk behaviors and are more likely to participate in health-promoting behaviors. All of these factors contribute to lower rates of chronic diseases.5, 6 However, the causal pathways that connect education and health are less well understood and can be difficult to study because they involve multiple, intricate mediators.
Through complex mechanisms, decisions made in education and other seemingly non-health sectors often inadvertently affect health; however, the health impacts across these sectors are rarely considered. A health impact assessment (HIA) provides a systematic method to incorporate health concerns into these sectors and to examine the potential health effects of a policy, plan, program, or project originating outside of the health sector. Such decisions can arise in the education, transportation, housing, urban planning, labor and employment, or other sectors.7 HIA provides a flexible and interdisciplinary tool for analysis, utilizes an array of data sources and analytic methods, and considers input from impacted stakeholders and community members to report ways to maximize potential health benefits while minimizing harms.8
An HIA consists of six major steps:9
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Step 1 – Screening identifies decisions or issues for which an HIA could be useful.
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Step 2 – Scoping determines which health effects and pathways to consider.
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Step 3 – Assessment considers possible health risks and benefits and identifies who may be affected and how.
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Step 4 – Recommendation presents opportunities to promote positive and minimize adverse health effects.
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Step 5 – Reporting presents and communicates HIA results.
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Step 6 – Monitoring and evaluating examines the process, outcome, and impact of the HIA and establishes ways to continue engaging with the issue.9
HIAs have been used extensively internationally, especially in Europe, Australia, and Canada, and are gaining popularity in the United States. Since the 1990s, over 300 known HIAs have been conducted in the US.7 The majority of HIAs have focused on transportation, urban planning, and housing. Few have examined the education-health nexus.10 Education-related HIAs in the US include those assessing the health impacts of policies related to grade retention in Ohio, school discipline in California, and school siting in Texas.10 Because of the education-health nexus, education-related HIAs provide opportunities to ensure that the health impacts of education are being considered and vice versa.2, 3, 4, 5 This article presents a case study of how public health professionals can work with other stakeholders and the community to examine the health impacts of policies originating outside of the health sector.
Section snippets
Methods
The purpose of the HIA was to consider how access to full-day kindergarten (FDK) in Nevada impacts health in the state and to make that information widely available. The core team conducting the HIA comprised four public health faculty members and two students from the University of Nevada, Las Vegas (HIA team). In addition, a Steering Committee (SC) was formed to provide the HIA team guidance and assistance. It consisted of educators, education policy experts, public health professionals, and
Educational attainment and health
The review of existing literature assessed the connection between access to kindergarten and health, directly and through school performance. Findings suggest that there are many complicated and often interacting factors that impact high school graduation rates and lifetime educational attainment. However, FDK may provide an opportunity to bolster school success, especially for some of the most vulnerable students.17 In turn, student success can impact health over the life-course.
In the short
Discussion
This HIA identified several pathways through which access to FDK could have positive community health impacts both in the short term and long term. In the short term, increasing the amount of time that children spend in kindergarten can increase access to school meals and school services as well as physical education and school-based physical activity. In the medium term and long term, expanding the amount of time children spend in kindergarten could improve reading proficiency, especially in
Acknowledgements
The authors would like to thank Amber Lenhart with the Health Impact Project for her guidance on this project and Tatiana Lin and Sheena Smith with the Kansas Health Institute for their technical assistance. They would also like to acknowledge the Steering Committee members and students who helped with this HIA: Nancy E. Brune, Karen Callahan, Victoria Carreon, Lisa Coker, Brian Davie, Salvatore Maranto, Della Scott, Caryne Shea, Denise Tanata, and Deborah Williams.
Ethical approval
The University of Nevada, Las
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