Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 180, Issue 12, Pages 1133-1140Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwu263
Keywords
accountability; air pollution; clean air act; health outcomes; particulate matter
Categories
Funding
- Health Effects Institute 4909
- US Environmental Protection Agency (EPA) [RD83479801, 83489401-0]
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The regulatory environment surrounding policies to control air pollution warrants a new type of epidemiologic evidence. Whereas air pollution epidemiology has typically informed policies with estimates of exposure - response relationships between pollution and health outcomes, these estimates alone cannot support current debates surrounding the actual health effects of air quality regulations. We argue that directly evaluating specific control strategies is distinct from estimating exposure - response relationships and that increased emphasis on estimating effects of well - defined regulatory interventions would enhance the evidence that supports policy decisions. Appealing to similar calls for accountability assessment of whether regulatory actions impact health outcomes, we aim to sharpen the analytic distinctions between studies that directly evaluate policies and those that estimate exposure-response relationships, with particular focus on perspectives for causal inference. Our goal is not to review specific methodologies or studies, nor is it to extoll the advantages of causal versus associational evidence. Rather, we argue that potential - outcomes perspectives can elevate current policy debates with more direct evidence of the extent to which complex regulatory interventions affect health. Augmenting the existing body of exposure - response estimates with rigorous evidence of the causal effects of well - defined actions will ensure that the highest - level epidemiologic evidence continues to support regulatory policies.
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