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Emergency management --- Health planning

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Taxes --- Hygiene. Public health. Protection --- United States of America

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To provide objective analyses about the effects of prevention and treatment programs on improve child welfare outcomes, RAND researchers built a quantitative model that simulated how children enter and flow through the nation's child welfare system. They then used the model to project how different policy options (preventive services, family preservation treatment efforts, kinship care treatment efforts, and a policy package that combined preventive services and kinship care) would affect a child's pathway through the system, costs, and outcomes in early adulthood. This study is the first attempt to integrate maltreatment risk, detection, pathways through the system, and consequences in a comprehensive quantitative model that can be used to simulate the impact of policy changes. This research suggests that expanding both prevention and treatment is needed to achieve the desired policy objectives: Combining options that intervene at different points in the system and increasing both prevention and treatment generates stronger effects than would any single option. The simulation model identifies ways to increase both targeted prevention and treatment while achieving multiple objectives: reducing maltreatment and the number of children entering the system, improving a child's experience moving through the system, and improving outcomes in young adulthood. These objectives can all be met while also reducing total child welfare system costs. A policy package combining expanded prevention and kinship supports pays for itself: There is a net cost reduction in the range of 3 to 7 percent of total spending (or approximately $5.3 billion to $10.5 billion saved against the current baseline of $155.9 billion) for a cohort of children born over a five-year period.

Child welfare --- United States.

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This study uses within-state variation in taxes over the 1989-1992 time period to test whether maternal smoking and birth outcomes are responsive to higher state cigarette taxes. Data on the outcomes of interest are taken from the Natality Detail files, generating a sample of roughly 10.5 million births. The results indicate that smoking participation declines when excise taxes are increased. The elasticity of demand for cigarettes is estimated to be appro- ximately -0.25. In addition, estimates of two-part models suggest that taxes only alter the probability a mother smokes and not average daily consumption conditional on smoking. Reduced-form models also indicate that higher excise taxes translate into higher birth weights. These two sets of results can be used to form an instrumental variables estimate of the impact of smoking on birth weight. This estimate indicates that maternal smoking reduces average birth weight by 367 grams, which is remarkably close to estimates from random assignment clinical trials. It is important to note that as a policy tool to improve birth outcomes, cigarette taxes are a blunt instrument. Taxes will be imposed on all smokers, but the benefits received and costs imposed extend beyond the targeted population. Under the naive assumption that the only benefits of the tax are received in the form of improved birth outcomes, we find that an increase in the cigarette tax is not as cost effective in preventing low birth weight as other more targeted public policies such as the Medicaid expansions of the late 1980's.

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The Equity-First Vaccination Initiative (EVI) aims to reduce racial disparities in coronavirus disease 2019 (COVID-19) vaccination rates in the United States and, over the longer term, to strengthen the public health system to achieve more-equitable outcomes. To accomplish these goals, The Rockefeller Foundation has committed