Insights from a multidisciplinary team’s review of studies linking law and policy with health and economic outcomes reveal ways to strengthen methods used to conduct health policy research.
“How do laws and policies impact health?” is a familiar question to those who work at the intersection of policy and health. Whether posed by peers, collaborators, partners, representatives, community members, or our own curiosity, the question reflects an interest in better understanding the ways in which upstream policies and laws impact downstream health.
With the growing importance of evidence-informed approaches to public health policymaking and intervention, understanding the methods used to document relationships between policy or legal interventions and health outcomes could increase the quality of health policy research. To understand and assess the existing body of research we brought together a group of CDC staff with backgrounds in public health, data science, law and policy, quantitative methods, psychology, and economics. We sought to not only identify existing research in the field but also to answer questions such as, “What methods are used to test correlations?” or “How is legal data collected?” and “How are established legal research competencies integrated?”
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In seeking answers to these questions, we examined the research methods that have been used in the literature and determined what we could learn about linking policy and law interventions with health outcomes. We sought to identify how established methods such as legal epidemiology have been incorporated into studies examining health and economic outcomes. We also sought to understand the quantitative methods used in those studies. “A Narrative Review of Literature Examining Studies Researching the Impact of Law on Health and Economic Outcomes” is the result, explaining our reasons, methods, and findings from our search.
Together our transdisciplinary team used our diverse skillsets to design and conduct a narrative review of scientific literature linking law with health or economic outcomes. We collected and reviewed studies linking law with health or economic outcomes published between 2009 and 2019. Of the 12,570 studies identified from 8 major literature databases, 177 met criteria for in-depth analyses after abstract and title screening. From these studies, we learned important insights about the sources of health data, methodological approaches, and legal data used in the studies.
KEY INSIGHTS
Looking at research design, methodological, and legal components, we were able to collect descriptive information and identify trends among studies linking legal and policy interventions with health and economic outcomes. We found that:
(1) The studies reflected limited variability in the sources of the health data. Similar data sources were used among the studies, which raises further questions about how the availability, format, and fit of existing health data may influence study design or analysis.
(2) The studies featured limited differences in the methodological approaches used to connect law to health outcomes. Among other descriptive findings, we discovered that most of the studies looked at outcomes over time, and primarily used regression-based models in their methodological analyses. We also found limited use of supplementary and sensitivity analyses to check for robustness of study results.
(3) Studies lacked transparency in the source and quality of the legal data used. If legal data were mentioned, reference to the methodology used to collect legal data lacked the detail needed to assess the quality. Many of the studies failed to reference components of established legal mapping methodology checklists. For example, only a quarter of studies that feature original legal mapping mention using a search string, which is one such checklist component. Where legal data were mentioned, many studies relied on external sources, which may only summarize a law or its status, rather than refer to a law’s original text. Non-observance of established legal mapping methodologies can have a bearing on quality and inference-making.
How we study the relationships linking policy and health outcomes has important implications for how we understand them. The insights gained from this review have the potential to strengthen future research, promoting quality in data collection and analysis used in this type of policy research. The research gaps and suggested practices that the review identifies can help researchers and reviewers alike improve the quality of science supporting policy intervention and implementation.
Greater attention to foundational methods work will allow us to better assess the impacts of policy and legal interventions on health, ultimately strengthening evidence-based actions toward health.
To learn more about the study and its implications, as well as to learn about our findings in detail, read “A Narrative Review of Literature Examining Studies Researching the Impact of Law on Health and Economic Outcomes” in the January/February 2024 volume of the Journal of Public Health Management and Practice.
About the Author
- Lauren Tonti, JD MPH, is a Public Health Analyst with DRT Strategies, Inc. at the Office of Public Health Law Services, National Center for STLT Public Health Infrastructure and Workforce (NCSTLTPHIW), Centers for Disease Control and Prevention.
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