DESIGNING PUBLIC HEALTH LAW EVALUATIONS

Most changes in laws and regulations affecting population health represent natural experiments, where scientists do not control when and where they are implemented, and thus cannot randomly assign the legal “treatments” to some and not to others.

The randomized clinical trial (RCT) research design has transformed medical research and is now accepted as the most reliable method for measuring the effects of drugs and other specific medical interventions. In this monograph the authors describe how randomized trials can be used to evaluate broader issues related to public health laws and policies.

Policy decisions can be informed by information on anticipated costs and expected future benefits of courses of action. The key questions in economic evaluation of a public health law are whether its benefits, as measured by health outcomes or cost savings, exceed its costs; secondarily, there is the question of the distribution of those costs and benefits across stakeholders. Cost savings are concrete and understandable benefits, and they provide a single compact measure that captures wrecked cars, stolen statues, fractured arms, even deaths.