By Amy Cook
Public health experts know that the social determinants of health—the environments in which we live, work, learn, and play—all have important effects on our health and well-being. As further evidence of this, in October 2018, researchers from Opportunity Insights collaborated with the Census Bureau to unveil the Opportunity Atlas, an interactive tool tracking data from more than 20 million Americans from childhood through their mid-30s, across each of the country’s 70,000 census tracts. The Opportunity Atlas gives us crucial insight into the level of geography that can impact adult outcomes: beyond the state and city, the neighborhood matters, sometimes tremendously.
The Opportunity Atlas provides one set of data—how adult outcomes are shaped by the neighborhood in which you grew up; specifically, estimating opportunity for upward social mobility. LawAtlas, created by the Policy Surveillance Program at the Center for Public Health Law Research, is another. Legal epidemiology can provide an organized method to examine the laws that are present in each of these communities and assess the law’s effect. The goal of legal epidemiology is to more effectively utilize law for health (including social determinants) by rigorously measuring the effects of those laws. Legal epidemiology helps researchers and policymakers understand what the laws are on a given topic, know how they differ across time and jurisdiction, and provide rigorously collected data to evaluate the impact those laws have on health outcomes.
Looking at both sets of data—what outcomes certain areas have, and what laws are enacted in those areas—can allow us to explore how, if at all, laws can expand or narrow the opportunity gap. Like the Opportunity Atlas, legal epidemiology is longitudinal, examining laws and policies across time and jurisdiction, providing for a more robust set of data and a more nuanced understanding. There are many pathways this could take, and many research questions that we could explore using both these sets of data.
Research could look specifically at criminal codes or sentencing requirements to see how juvenile offenders are treated and whether there are marked patterns in their adult life. Legal epidemiologists could also examine whether zoning laws restrict what kind of residential homes can be built in a certain area and what the effect of those restrictions are.
As a more specific example, LawAtlas has a dataset on minimum wage laws implemented by each state. One could overlay data on each state’s minimum wage with the geographical outcomes shown in the Opportunity Atlas, then examine how minimum wage variances across the country correspond to income levels or the gap between the minimum wage and the average hourly wage (another outcome measured by the Opportunity Atlas). Are there any overlaps with neighborhood characteristics, such as median rent or poverty rate?
Alternatively, one could study the educational laws in a given state or community. Studies show that early childhood development has a large impact on later outcomes in life. What kind of laws or policies do communities have in place to support education and child development? Is there a correlation between access to Head Start programs and later adult outcomes? Does the state or local jurisdiction offer vocational training programs in high school? Do states divert budgetary funds away from their state colleges and universities and do those states have smaller percentages of its citizens completing post-secondary education? What impact do these laws and policies have?
Of course, as with any study, there will still be limitations. Legal epidemiology is difficult on the local level simply because there are so many possible variances and some consistency is required to make fair comparisons. But there is value in having this information. The opportunity gap is real. We should use whatever tools we have available to make every opportunity to close it.
Amy Cook, JD, is a Law and Policy Analyst at the Temple University Center for Public Health Law Research.