An Introduction to Policy, Systems, and Environmental (PSE) Change
Photo on Unsplash by Clint Adair
We know that well-being is created in the places where we live, work, learn, and play. Our ability to make healthy choices is dictated by the conditions of those places—conditions that persist over generations and that we need to be healthy and well. Policy, Systems, and Environmental (PSE) change can positively influence health by improving community conditions. PSE change has gained momentum in recent years, and many funders are requiring PSE strategies in grant work plans, partially because PSE changes often stretch beyond the benefits of programs to create lasting, population-level impact.
The table below illustrates the distinct characteristics of programs versus Policy, Systems, and Environmental (PSE) approaches.
Source: The Food Trust
Let's unpack Policy, Systems, and Environmental (PSE) 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. For example, a school policy that places restrictions on unhealthy food and beverage marketing in schools reduces exposure and consumption of unhealthy food in school cafeterias. Businesses, neighborhoods, and institutions have capacity to implement important policies that advance equitable well-being.
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.
Environmental change involves transforming the economic, social, or physical contexts in the lived-environment that affect health outcomes. Environmental change strategies are often used in conjunction with other strategies to improve population health. Examples of environmental change include increasing the number of community garden plots on vacant land to grow community engagement and improve food security, and changing organizational procedures to include weekend clinic hours or to provide free wellness courses for the patient population.