President Obama recently announced his support for preschool education, citing programs in Georgia and Oklahoma. It makes me question my own support of programs such as Head Start. I have not looked into its evaluation and the long term impacts until now. Here is a synopsis of my finding:
- The Abecedarian and Perry demonstration projects provided high-quality child care/preschool for children from disadvantaged backgrounds and showed positive educational and life outcomes at a cost of about $12-19,000 a year per student (Head Start costs a lot less up front but also a lot less effective). Return on investment was about 6.9% according to University of Chicago Economics Professor Charles Heckman. There were 111 participants in the Abecedarian and 128 in the Perry RCT design evaluations with follow up to age 40 in the latter project.
- Head Start is a federal program under DHHS with a budget of about 8 billion in 2012 and serves close to a million children nationwide. The program provides comprehensive services that include preschool education, medical, dental, and mental health care, nutrition services, and parental support. There have been 2 recent reports on the long-term impacts/outcomes of Head Start:
- The Head Start Impact Study released Jan 2010 showed that the advantages children gained in cognitive development and health during their Head Start and age 4 yielded only few statistically significant differences in outcomes at the end of 1st grade for the sample as a whole (disappointing).
- A follow-up report tracking the progress of these same children through third grade was published late in 2012. You guess it, by third grade, the Head Start program had little to no impact on cognitive, social-emotional, health, or parenting practices of participants.
- Apparently, we have 1600 Head Start programs of various qualities. Craig T. Ramey and Sharon Landesman Ramey concluded in their paper: "exemplary Head Start programs should serve as mentors, while failing programs must be transformed or terminated promptly to prevent harm."
- So what's the verdict? "re-invent" Head Start? faciliate competition, expand model programs, support State's initiatives, etc. (just don't increase the deficits hah). Early childhood education and care has become a core issue for the OECD. Its focus is on improving quality of ECEC with data on country policy experiences, toolkits and international comparison. I say they have a head start on us and it's time to get cracking!
One of my previous blogs asked what is the evidence on gun control? The tragedy in Newtown, CT is probably as much about mental illness as about gun violence. The package of 23 executive orders issued by Present Obama includes an important directive aimed at the CDC to research gun violence and its impact on public health and safety lifting a 16 year moratorium on federal funding as a result of aggressive lobbying by the NRA. A Gun Policy Summit took place on Jan 14-15, 2013 and provided a series of policy recommendation. They include (among many others):
- Establishing a universal background check system, which would require a background check for all persons purchasing a firearm
- Persons convicted of 2 or more crimes involving drugs or alcohol within a
three-year period would be prohibited from firearm purchase for a period of 10 years
- Federal restrictions of gun purchase for persons with serious mental illness
should be focused on the dangerousness of the individual (hum?)
- Fully fund federal incentives for states to provide information about disqualifying mental health conditions to the National Instant Check System for gun buyers (huh?)
- Congress should provide financial incentives to states to mandate childproof or personalized guns
- Ban the future sale of assault weapons, incorporating a more carefully crafted definition to reduce the risk—compared with the 1994 ban—that the law can be easily evaded
- Ban the future sale and possession of large capacity (greater than 10 rounds) ammunition magazines
The Johns Hopkins University Press released Reducing Gun
Violence in America: Informing Policy with Evidence and Analysis (cover shown above). This volume provides empirical research and legal
analysis to inform the policy debate by helping lawmakers and opinion leaders identify the policy changes that are most likely to reduce gun violence in the U.S.
As someone who is interested in public health policy and primary determinants of health, this question has perked my curiosity since college years. A recent NYTimes' Commentary by Thomas Edsall "The Hidden Prosperity of the Poor" highlighted the debate over the rising inequality in this country. I would like to summarize my own take of this complex topic.
- a number of studies (Kondo, Elgar, Zheng to name a few recent ones, see bib) have examined the association between income inequality and population health; results are mixed/inconsistent but there seems to be a negative impact of income inequality (as measured by gini coeff) on premature mortality, healthy life expectancy and self-rated health
- it is thought that income inequality results in poor health through loss of social capital, social cohesion, interpersonal trust, psychosocial stress.
- The effects of income inequality are more "apparent" in multilevel, cross-sectional datasets, over time and gender-specific (seen in men), and there is a threshold effect of income inequality on health.
- it is unclear whether public health expenditure could mediate the harmful effect of income inequality on health.
- the question is not laissez faire and the belief in the hidden prosperity of the poor and middle class but which policies in social security, welfare, labour market, immigration, tax reform are necessary to address poverty and income inequality!
"I wish to do something Great and Wonderful, but I must start by doing the little things like they were Great and Wonderful"