We use a policies, systems and environmental (PSE) change framework
PSE is a sustainable way to create healthy environments and address whole populations at a time.
Policy change can be laws, regulations, rules, protocols, and procedures designed to guide or influence behavior. They can be legislative or organizational in nature. ESHC focuses on organizational policy change. Creating policy requires an intentional act of placing in writing a new procedure. A written policy tends to be enforced and reviewed annually. When an organization creates policy, it impacts large numbers of individuals. Examples include:
- Schools requiring healthy food options for all students
- A district ban on the sale of less than healthy foods throughout the school day
- Menu labeling in restaurants
- Required quality assurance protocols or practices (e.g., clinical care processes)
- A human resources policy that requires healthy foods to be served at meetings.
System changes impact all elements, including social norms of an organization, institution, or system and may include a policy or environmental change strategy. Policies are often the driving force behind systems change. Making systematic changes can impact large groups of individuals at one time – for example:
- Insuring a health system goes tobacco-free
- Requiring 30 minutes of physical activity for all students within a school system
Environmental change may be physical, social, or economic factors that influence people’s practices and behaviors. Changing environments influences the behavior of large groups of people, encouraging healthy behaviors over unhealthy ones.
- Physical: structural changes or the presence of programs and services, such as improvements in the built environment that promote walking (sidewalks or walking paths), or the presence of healthy food choices in restaurants or cafeterias.
- Social: a positive change in attitudes or behavior about policies that promote health or an increase in supportive attitudes regarding a health practice. For example, an increase in nonacceptance of exposure to second-hand smoke from the general public
- Economic: the presence of financial disincentives or incentives to encourage a desired behavior. Offering discounts for selecting healthy food items in vending machines is an economic incentive. So is the provision of nonsmoker health insurance discounts.