Understanding Policy,

Systems, and Environmental

Change to Improve Health
Minnesota Department of Health
Allison Faricy, Community Specialist
Allison.Faricy@state.mn.us
 Outline of Presentation
What is policy, systems, and environmental
(PSE) change?
Why is PSE change important?
How is PSE change work different from
public health/health promotion work done
in past?
SHIP timeline
SHIP Menu of Strategies
How can SHIP resources like Guide to
Implementing SHIP 2.0 Strategies help you
in planning and implementing PSE?
 Institute of Medicine Quote
It is unreasonable to expect that people
will change their behavior easily when so
many forces in the social, cultural, and
physical environment conspire against
such change.
-Smedly and Syme (2000)
 What is policy change?
Policy strategies may
be a law, ordinance,
resolution, mandate,
regulation, or rule (both
formal and informal).
Example: Organizational
policies that provide
time off during work
hours for physical
activity.
 What is systems change?
Systems strategies are
changes that impact all
elements of an
organization, institution,
or system.
Types of systems include:
school, transportation,
etc.
 What is environmental
change?
Environmental
strategies involve
physical or material
changes to the
economic, social, or
physical environment.
Example: Incorporating
sidewalks, paths, and
recreation areas into
community design.
Socio-Ecological Model

McLeroy 1988; Livewell Colorado 2007

Spectrum of Prevention
 Moving Upstream - Story
While walking along the banks of
a river, a passerby notices that
someone in the water is drowning.
After pulling the person ashore,
the rescuer notices another
person in the river in need of
help. Before long
 Importance of PSE Change
Health problems are influenced by societal
policies and environments that in some way either
sustain behaviors or fail to foster healthier
choices
Where you live affects how you live
Major health problems will not be solved solely by
individual actions and choices
By moving upstream to address causes and
improving environments where we live, work,
learn, play, and receive health care, we can
prevent many people from becoming chronically
ill
Programs for Individual Behavior
Change vs. PSE Change
Personal choices are made in context of larger
environment
Many health and social problems are related to
conditions outside the individuals control
Recently there is a growing sense of importance of
broader societal trends and policies that affect
behaviors
While programs can lead to behavior changes in
individuals and/or communities during course of
programs, unless scaled up and instituted through
formal and informal PSE changes, programs may not be
sustainable
Events/Programs vs. PSE Change
Characteristics of Characteristics of PSE
Events/Programs Change

One time Ongoing

Additive: often results in Foundational: often
only short-term behavior produces behavior change
Individual level over time
Not part of ongoing plan Policy level
Short term Part of an ongoing plan
Non-sustaining Long term
Sustaining
 Examples from Schools
Programs/Events
Celebrate National Nutrition Month
Host a Family Fitness Night
Participate in Walk to School Day
Provide healthy snacks or breakfast
Participate in Kick Butts Day
Provide health screenings for staff
Policy, Systems, and Environmental
Change
Add fruits & vegetables to a la carte
Make school athletic facilities regularly
available to families
Establish a Safe Routes to School Program
Adopt a Healthy Food & Beverage Policy
Establish a tobacco-free school taskforce
Establish a building-sponsored wellness team
 A Comprehensive Approach
PSE supported by:
Assessment and Evaluation
Community Engagement
Individual and Community Education
Skill building
Programs (as appropriate)
Promotion
Enforcement
 Catalysts for PSE Change
Add-on or extension of previous efforts
Existence of compelling data to support change
Change in environment/attitudes as a result of
another policy
Peer/constituent pressure for change
Seed money/funding available to support
initiative
A group, or organization, and/or committed
individual on a mission to effect a change they
believe strongly in
 What are PSE Changes to Reduce
Obesity?
Physical Activity
Active schools and child
care such (safe routes to
school)
Worksite wellness policies
support physical activity in
workplace
Active living in
communities like
promoting biking and
walking through
community design
(complete streets)
 What are PSE Changes to Reduce
Obesity?
Nutrition
Healthy breakfast, lunch,
and vending in schools and
child care
Healthy vending and
catering policies in
worksites
Access to healthy foods in
communities through
farmers markets,
community gardens, and
fruits and vegetables in
corner stores
Support maternity care
practices in health care
setting
What are Examples of PSE Changes to
Reduce Tobacco Use and Exposure?
Tobacco
Tobacco-Free Post-
Secondary campuses
Smoke-Free Multi-Unit
Housing
SHIP Menu of Strategies for FY12-13
Examples of Successes from first round
of SHIP?
Role of Local Public Health (SHIP
Grantees) in PSE Change
Initiative development/management/
facilitation
Assessment and evaluation
Convening/partnering/collaborating
Technical assistance
Key leadership
Resources
Regulatory language
Education
Information
Marketing and public relations
Traditional and Non-Traditional
Partners
Elected officials
School districts and YOUTH
Other State and National agencies
Other local public health agencies and health care
providers
Other local government agencies
Coalitions, community- and faith-based
organizations, non-profits, etc.
Private interests and/or companies (media!)
Remember SHIP is supposed to touch where you live,
work, learn, play, and receive health care!
 Role of Partners
Participate on SHIP Community Leadership Teams or local
partnership teams
Assist with assessments
Be willing to implement strategies in your setting
(businesses, health care providers, schools, etc.)
Update your general/comprehensive plan to incorporate
non-motorized transportation
Provide financial resources for capital
improvement/construction work to implement plans
Be an advocate! Host forums/hold meetings/provide
information to community leaders
Provide media coverage
Promote benefits (environmental, economic development,
higher achieving youth, etc.) of healthier communities
Importance of Partnership
Can this work be accomplished
without partnerships? No!
Research shows the importance of:
Public-private partnerships for policy change
success.
Embedding targeted policy and environmental
changes in broader community initiatives
whenever possible.
Continually engaging and interacting with
broader community.
 SHIP 2.0 Strategy Guides
Guides were developed for every strategy on
the menu
Intended for CHBs and tribal governments
Includes: background, outcomes, partners,
sites, financial guidance, planning and
assessment steps, implementation steps,
sustainability, resources and references
Available on SHIP website
 SHIP Next Steps for MDH
Continue planning and
implementation with our
partners
Provide technical assistance
to grantees to ensure
successful implementation
Secure future funding to
achieve goals of reducing
obesity and tobacco use and
exposure in Minnesota
Reduce the burden of chronic
disease to generate future
health care-related cost
savings
 QUESTIONS?

SHIP Website:
http://www.health.state.mn.us/health
reform/ship.html

My contact information:
Allison.faricy@state.mn.us
651-201-5416