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Can government policies correct race and ethnicity disparities in child health?

When Dolores Acevedo-Garcia and Pamela K. Joshi set out to study the racial and ethnic equity of federal policies impacting child health, they didn’t expect it to be terribly difficult. After all, they figured, there are federal mandates that require agencies to collect data on race and ethnicity.

But finding the data that the researchers from Brandeis University wanted to analyze was difficult. It was buried in reports or tied up in semantics.

Health Affairs“We thought this would be a relatively easy project,” Pam Joshi, a senior research scientist at Brandeis’s Heller School for Social Policy and one of the author of the study, said. “And three years later, here we are.”

To study the data, they created the Policy Equity Assessment, which questions how the policy works in relation to race and ethnicity. Their results showed multiple gaping holes — in the data on policy impact and racial/ethnic inequalities in access to benefits.

“It’s hard to put together the picture across ethnic groups and across geographies,” said Dolores Acevedo-Garcia. “Everyone should be on top of this — it shouldn’t be on an individual project to do.”

Joshi explains their primary goals as getting data into the hands of policymakers, using research evidence to help policymakers adopt “reasonable, policy-based decision to reduce gaps,” and to find room for states to work on these issues on their own.

To make the data more accessible, and, hopefully as a result, to lead to more effective policy, they created the website, which they will continue to maintain after the paper is published.

The NewsHour recently spoke with Joshi and Acevedo-Garcia about their study, which was published in Health Affairs’ December issue. The conversation has been edited for length and clarity.

NEWSHOUR: What surprised you about the process or results of the study?

PAMELA K. JOSHI: First, the lack of data was very surprising. The lack of data in terms of gaps and reporting on disparities, considering that it’s a part of the mandate in Healthy People 2020. Ideally, you’d think they would also be reporting on disparities.

For Hispanic kids, we saw lower participation in all programs. So that was really surprising to see the differential access for Hispanic parents and kids in these three landmark policies that address child health.

DOLORES ACEVEDO-GARCIA: There are underlying issues that should be explored further. There is this unequal or differential access. We found that across all the groups, there is limited access to coverage. That’s the first thing we want to emphasize. Secondly, the group that has the least access is Hispanic.

Hispanics are 25 percent of the child population today and the only group which the majority of households today is raising kids in. If we want to invest in children’s health, obviously an important investment is what we do for Hispanic families.

NEWSHOUR: Because of recent events, race is a big national conversation right now. How does your study figure into that?

DOLORES ACEVEDO-GARCIA: Given the climate of a littler more openness to talk about these things, the mission of our project is to put the mission of equality in the [spotlight] of the country and to make sure we are raising kids with equal access to good outcomes. It’s a really stark example of how there are inequalities by race. They start much earlier in life, even if you only see it when they are teenagers or young adults. The mission of our project is when we have the chances to invest: When do we meet these opportunities across life and geography?

Of course, this very important event [in Ferguson] is what we’re talking about, but about 50 percent of the African-American kids in the St. Louis metropolitan area live in neighborhoods that are high-poverty and don’t have quality early childhood education centers. In white neighborhoods, that number is only 8 percent. A lot of investments could be made in early and middle childhood. Some of the issues are injustice in the criminal justice system, but there are preventative measures that could be taken with early childhood education and adult time off. A lot of these inequalities could be corrected if we address some of these underlying issues. We need to be paying a lot of attention to how all kids are going to develop.

NEWSHOUR: Why did you chose to apply the Policy Equity Assessment to Head Start, the Family and Medical Leave Act and Section 8?

PAMELA K. JOSHI: We take social determinants of health perspective on how policies affect child health. We have an ecological approach where we look at different places where children live, where they go to school, what their family is like, where their parents work and the health care system — the environments that kids interact with. From there, we think about politics. For this particular paper, we looked at non-health policies that have health components. That’s how we got Head Start, the Family and Medical Leave Act and Section 8.

NEWSHOUR: Are there parallels between your paper’s recommendations and affirmative action?

PAMELA K. JOSHI: This policy, this website, is really looking at differential access to existing policies. It’s just access to the policy. We don’t consider this at all affirmative action. We do know when programs target vulnerable populations, and the racial and ethnic makeup of those population. There is, for example, a targeting of migrant and seasonal worker parents. We know that these are mainly hispanic kids. It has to do with how we serve migrant kids.

DOLORES ACEVEDO-GARCIA: Some of the potential solutions are well within existing policy tools. It’s moving toward knowledge from a lack of information. It’s not getting preferential treatment. It’s getting a smarter way of reaching these populations.

NEWSHOUR: How people are using the data already?

DOLORES ACEVEDO-GARCIA: One New York advocacy group, the Child Neighborhood Opportunity Index, has been using it. Someone in New York took the data from the website, created their own maps, and are using it to show the disparities children are facing at the neighborhood level. We heard about that just as we heard about the no indictment decision in the New York case

PAMELA K. JOSHI: Another example is state paid leave for families. We work with a group called Family Values at Work who presented at the White House Working Families summit this summer. We asked them, is this data helpful to what you’re doing? That group has been using our data to push change because a lot of the family leave, if it’s unpaid, prices the families out of the market. If you’re trying to help the most disadvantaged workers, this data helps make this case at the state policy level. Our data is meant to be useful to the people who go and do the advocacy work for improving access to coverage.