A Health Impact Assessment Looks at All-Day Kindergarten in Nevada

Researchers at the University of Nevada, Las Vegas (UNLV) conducted a health impact assessment (HIA) in 2015 to examine the potential health benefits of implementing full-day kindergarten across the state.

The HIA process uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of proposed policies or projects on the health of a population and the distribution of those effects within the population. The Nevada assessment was intended to inform the state Legislature about changes to the availability of full-day kindergarten.

Max Gakh, an assistant professor at UNLV and associate director of the school’s Health Law Program, led the work and answers questions here about the process and its impact.

Q. How did you choose the topic of full-day kindergarten for an HIA?

A. We chose the availability of full-day kindergarten in Nevada for an HIA for a few reasons. First, educational attainment is a critical factor affecting health into adulthood. Second, K-12 education is a really important issue, because overall education outcomes—such as reading and math proficiency and high school graduation rates—are lower here than in most states. For example, the Annie E. Casey Foundation’s Kids Count Data Book has for several years ranked Nevada toward the bottom of the list along education measures, such as preschool attendance, fourth-grade reading proficiency, eighth-grade math proficiency, and on-time high school graduation. Third, at the time of the HIA, some students in Nevada could access publicly funded full-day kindergarten while others could not, and some policymakers and advocates were interested in exploring expanding [the program]. Finally, we knew from careful work done by the Community Preventive Services Task Force that full-day kindergarten had the potential to improve reading and math, which in turn affect health—especially for students from low-income families or who are racial or ethnic minorities.

Q. What connections between health and full-day kindergarten did the HIA uncover?

A. Our HIA focused on the connections between full-day kindergarten and school outcomes, such as reading and math proficiency and high school graduation; access to school-based services such as school meals; and nutrition education and physical activity. We focused on these areas after discussions among our UNLV team, guidance from our steering committee, exploring existing literature, and engaging with stakeholders and community members during community events and through a survey and focus groups. As we completed the HIA, we concluded that full-day kindergarten access could improve test scores, particularly for at-risk students, as well as access to school meals, nutrition education, and physical activity. Finally, we concluded that there were some possible long-term benefits of full-day kindergarten regarding high school graduation, and thereby employment opportunities, and adult health outcomes.

Q. What was the biggest challenge that you and your stakeholders faced during the HIA process, and how did you overcome it?

A. One challenge we faced was obtaining data to figure out the baseline health and education conditions. There was a plethora of state-level, publicly available data and information related to some of the questions posed by our HIA. However, finding granular data about kindergarten enrollment, access to school-based meals and other services, and school-based nutrition education and physical activity was difficult. To overcome this, we worked very closely with our steering committee and partners in the education sector, including school districts, to obtain relevant data. This data, in turn, allowed us to take more context into account when we applied findings from the literature and made projections.

Q. Who were the different stakeholder groups involved in the HIA, and where did they contribute to the process?

A. This HIA was a group effort. The UNLV team led the analysis and was guided by a steering committee at every step. Our steering committee included representatives from southern Nevada’s local health department, a local elementary school with a high percentage of students from lower-income families, two policy-oriented community-based organizations, and an organization of parents committed to improving K-12 educational opportunities in the state. First, and maybe most importantly, its members helped us determine what questions to ask in the HIA. They also helped us collect information on baseline conditions such as enrollment and access to meals and services. They suggested data sources, helped us engage with the community, considered the feasibility of our recommendations, assisted us in disseminating HIA findings, and helped us reflect on the HIA at its conclusion. We really couldn’t have done this work without an engaged and thoughtful steering committee.

Q. What changes have you seen in Nevada as a result of the HIA?

A. I think the HIA helped reveal the connections between education and health issues in Nevada and demonstrate the value of full-day kindergarten, providing suggestions for implementation. I also think the HIA process itself helped strengthen partnerships in our community and the capacity to conduct multidisciplinary work to address health in all sectors. I know that members of our team remain committed to HIA-related work. For example, two of us periodically offer an HIA course where graduate students learn about and conduct real, rapid HIAs. As for an update on kindergarten access in the state: For now, access to voluntary full-day kindergarten has expanded at many public and charter schools with the help of additional state funding. Whether expansion continues remains to be seen.