An Introduction to Policy, Systems, and Environmental (PSE) Change

Photo on Unsplash by Clint Adair

What are Policy, System, and Environmental Change Strategies?

Policy, system, and environmental (PSE) change strategies are approaches to behavior and culture change that aim to create lasting improvements in individual and community health and well-being. PSE change seeks to make healthier choices more practical and accessible to all members of a community. We know that our health and well-being are created in the places we live, work, worship, learn, and play. Our ability to make healthy choices in those places is dictated by the availability, affordability, and accessibility of the Vital Conditions (i.e., humane housing, meaningful work and wealth, transportation) we all need every day to thrive.

Creating policies, systems, and environments by adopting new laws, changing organizational policies, or shaping physical landscapes can positively influence community health and well-being. Actions focused on changing conditions through PSE are more effective than traditional programs alone because they create more supportive environments, reach more people, and lead to more impactful, sustainable change.

The table below illustrates the distinct characteristics of programs versus policy, system, and environmental (PSE) approaches.

What is Policy, Systems, and Environmental Change?

Resource - Fact Sheet

Policy, Systems, and Environment Change

Story - Video

Policy, Systems, and Environmental Change - Rural Health Promotion and Disease Prevention Toolkit

Resource - Website/webpage

Policy, Systems, and Environmental Change (PSE) 101

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Why are Policy, System, and Environmental Changes Important?

Policy, system, and environmental changes are important because they help create healthier, more equitable, and more sustainable communities. By working together to implement these types of changes, we can create better health and equity outcomes for ourselves and future generations through:

Addressing root causes: These changes help address root causes of many health, social, and environmental problems, such as poverty and racism—addressing root causes rather than one-off problems leads to more effective change. By changing policies, systems, and environments, we can create a healthier, safer, and more equitable society.
Prevention: Many health problems are preventable, and PSE changes help prevent them from occurring in the first place. For example, policies that promote healthy eating and physical activity can help prevent high blood pressure, while regulations on tobacco and alcohol use can reduce the incidence of smoking-related diseases and alcohol-related harms.
Improving population health outcomes: PSE changes improve health outcomes for large groups of people across communities. By improving access to healthcare, making healthy behaviors the easier choice, and reducing exposure to environmental hazards, we can positively impact health outcomes for whole populations.
Advancing Equity: PSE changes helps promote equity and reduce health disparities. By addressing the underlying social determinants of health, such as poverty, racism, and discrimination, we can create a more just and equitable society where everyone has the opportunity to live a healthy life.
Sustainability: PSE changes are inherently more sustainable than one-time or intermittent programs and interventions. They often endure over time, changing individual and community behaviors that shift health and well-being cultures that serve current and future generations.

The impacts of PSE changes are strengthened when implemented through collaboration and collective action—in many cases across sectors. Programs help build support for PSE changes and subsequent adoption of new healthy behaviors. For example, bike riding, safety, and repair programs offered in coordination with the expansion of newly opened bike trails and lanes can foster increased use of the trails and lanes.

Below, we’ll unpack each of the PSE levers for change further:

Policy Change

Policies are written statements created and adopted by organizations, agencies, and stakeholders, and are intended to achieve specific health goals. Policy change is a tool used by communities across the country to improve population health by advancing initiatives that can affect the behaviors of entire populations more efficiently than other tools. Importantly, policies to advance well-being are not limited to formal policy passed through (local, state, or federal) legislation. In fact, often policy change is more feasible at the organizational level. Examples include laws that require smoke-free public places, zoning laws that promote walkable neighborhoods, and policies that regulate the marketing and sale of unhealthy foods and beverages. Businesses, neighborhoods, and institutions have the capacity to implement important policies that advance equitable well-being.

What is Policy?

Resource - Guide/handbook

Brought to you by ChangeLab Solutions

Principles for Racially Equitable Policy Platforms

Resource - Guide/handbook

Targeted Universalism

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Brought to you by Othering and Belonging Institute

Systems Change

Systems change involves transforming and redesigning the practices and structures within organizations, institutions, or networks to promote better health outcomes. Systems change addresses problems on a fundamental level and often works hand-in-hand with policy change. An example of a systems change is the creation of a Farm-to-School initiative that creates processes to rebuild healthy food systems in school by serving local produce in the cafeteria and instituting food education opportunities in the classroom.

Leading Together for Systems Change

Resource - Journal Article

Racial Justice and Power Sharing: The Heart of Leading Systems Change

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Community Approaches to Systems Change

Resource - Blog

Brought to you by de Beaumont Foundation Inc.

Fostering Systems Change

Story - Written

Brought to you by SSIR

Environmental Change

Environmental change involves transforming the economic, social, or physical contexts in the lived, physical environments that affect health outcomes. Environmental change strategies are often used in conjunction with other policy and system strategies to improve population health. Examples of environmental change include building bike lanes and sidewalks to promote physical activity, changing organizational procedures to include evening and weekend community health clinic hours, or reducing exposure to environmental toxins and pollution.

Leveraging the Built Environment for Health Equity

Resource - Report

Brought to you by Urban Institute

Intersections: Health and the Built Environment

Resource - Book

Brought to you by Urban Land Institute

The Built Environment and Its Relationship to the Public’s Health: The Legal Framework

Resource - Journal Article

Organizing Around Vital Conditions Moves The Social Determinants Agenda Into Wider Action

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Brought to you by Health Affairs

Learning from Communities Across the Country: Stories of Policy, System, and Environmental Change

Organizational and individual community stewards from across the country are leveraging policy, system, and environmental strategies to advance healthy, equitable, sustainable communities and strengthen Vital Conditions for all. They are doing so by working across differences, identifying solutions that solve more than one problem, and starting with those who are most impacted.