Integrating Racial/Ethnic Equity Into Policy Assessments To Improve Child Health

Introduction

This article introduces a framework called the Policy Equity Assessment that was designed for policy analysts and researchers to assess a policy’s or program’s ability to reduce inequities. This framework couples policy analysis approaches with rigorous equity-focused research methods. This combination allows for a more comprehensive equity analysis compared to other research methods. This article demonstrates how to apply the assessment, highlights new findings, and provides recommendations for future analyses to fill evidence gaps.

The article focuses on use of this assessment in the context of child health equity. Despite increases in racial and ethnic diversity in the United States, wide inequities persist in social determinants of child health and health care access, which lead to harmful and costly racial/ethnic gaps in child health and developmental outcomes. The authors encourage the use of their framework to develop policies that reduce this disparity. 

Pamela K. Joshi is a Senior Research Scientist and the Associate Director of the Institute on Children, Youth and Families at Brandeis University. Joshi’s work focuses on conducting research and evaluating public policies relating to family and children’s health in diverse populations.

Methods and Findings

The Policy Analysis Framework encompasses three stages and focuses on general policy assessment questions. Each stage addresses a core equity question:

1. “What is the policy designed to do?” 

The Logic Stage evaluates whether the goals of a particular policy recognize and acknowledge unfair differences between different racial and ethnic groups. The main goal of this stage is to determine if services are specifically designed to tackle these differences, and if that equity goal is mentioned directly or indirectly. This requires a detailed examination of legislation and rule changes over time.

2. “Is the policy implementing services and distributing benefits as intended?”

The Capacity Stage examines a policy’s ability to provide sufficient quality and intensity of services to all those who are eligible for and could benefit from the policy. This stage focuses on equitable distribution, determining if a policy can reduce disparities in distribution of benefits among different racial and ethnic groups. For example, by looking at the policy capacity in this stage, the early childhood program Head Start assessed that while its eligibility criteria primarily targets low-income children, it has finite capacity to serve that population because limited funding restricts the number of available program slots.

3. “Is the policy effective for the defined target population?”

The Research Evidence Stage looks at research evidence “to determine what works, for whom, and under what conditions, as well as whether policies reduce racial/ethnic inequities in outcomes.” It can be broken down into three crucial inquiries determining: 1) whether a policy is effective in improving outcomes for specific racial or ethnic groups, 2) whether any analyses have been done to measure the differences in health outcomes between different racial and ethnic groups, and 3) how the delivery of services, the resources available for the program, and the quality of a program might differ depending on the race or ethnicity of the participants. 

The authors demonstrate how the Policy Equity Assessment can be applied by working through key examples in early childhood education, parental employment, and housing—specifically Head Start, the Family and Medical Leave Act, and the Section 8 housing program. Through these examples, the authors illustrate the importance of collecting and reporting information by race and ethnicity, socioeconomic status, and other relevant characteristics.

Conclusions

The Policy Equity Assessment offers practical benefits for policymakers interested in improving racial and ethnic equity. By assessing equity at all stages of a policy, interested stakeholders can  identify areas for equity-focused analysis and advocate for the collection of new data to inform policymaking. Additionally, the framework provides a comprehensive understanding of how program effectiveness and resources can differ by race and ethnicity. By doing so, the framework also helps highlight the unmet needs of specific marginalized subgroups.

Recommendations from the authors to address equity disparities in policymaking include:

• Social programs should systematically collect and report information by race/ethnicity, socioeconomic status, disability, nativity, and other characteristics.
• Organizations should create capacity indicators, such as population eligibility, enrollment, funding, services, and quality by race/ethnicity; the authors advocate that these indicators should be included as measures in program evaluation and impact analyses.
• Federal and state agencies should establish funding streams for programs that demonstrate evidence of reducing inequities in outcomes or services for marginalized  groups.

Overall, the Policy Equity Assessment serves as a valuable tool for enhancing the evaluation and monitoring of policies, aiming to improve outcomes for all children and families, especially those from historically marginalized groups.