california dialogue on cancer (cdoc)

Policy, Systems, and Environmental (PSE) Change:

Approaches to Comprehensive Cancer Control & Prevention

Policy, Systems & Environmental Change

What is PSE change?

PSE change is an approach to effectively improve health in a community. It prioritizes creating or changing infrastructure to support healthy behavior across populations. It focuses on modifying the context in which people live through changing policy, systems, and/or the environment to make healthy choices available and easy for everyone. PSE change in cancer control focuses on interventions that impact whole populations instead of individuals and is applicable to all stages of the cancer continuum.

Policy Change

Policy change strategies are changes in policies, procedures, rules, ordinances, laws, and regulations. Policy change can occur at macro levels, like high levels of government. Policy change can also take place at lower levels that we interface with every day, such as healthcare settings, worksites, companies, and organizations. Examples of policy change include: enacting federal regulation of e-cigarettes, banning junk food at schools, increasing age criteria for tanning salons, and menu labeling at restaurants.

Systems Change

Systems change strategies are changes that impact all elements of an organization, institution, or system. Settings for systems change may include: healthcare systems, insurance systems, worksites, schools systems, and transportation systems. These strategies focus on changes to the rules or procedures of an organization that impact a large portion of the people they serve. A systems change may refer to an organizational policy change, or a change in processes or procedures of operation. An example of systems change is modifying the hours of operation of a cancer screening facility, making it more convenient for patients to access and/or utilize screening services.

Environmental Change

Environmental change strategies are changes made to the physical environment to promote healthy behaviors and lifestyles. Settings for environmental change include physical environments such as the location of health clinics and recreational spaces, while the strategies may involve community planning in neighborhoods. An example of environmental change is installing sidewalks, bike lanes, and recreational space in communities to promote physical activity. Another example is making healthy food options available in neighborhoods, worksites, and schools.

PSE Overlap

PSE strategies may overlap across all three categories: policy, systems, and environment. For example, California's smoking ban is a policy change that led to a systems change for workplaces and restaurants. Prohibiting smoking created an environmental change that allowed for a general smoke free environment, making it a social norm. PSE strategies may also overlap across health sectors or programs, such as programs that focus on diabetes prevention, tobacco, heart disease, and nutrition and physical activity.

Resources for PSE Change Approaches

PSE in Comprehensive Cancer Control & Prevention (PDF)
Policy, Systems and Environmental (PSE) Change Resource Guide (PDF)
ChangeLab Solutions webinars:

PSE 101: building healthier communities through PSE change
Strong Communities: improving urban nutrition environments
Strong Rural Communities: improving rural nutrition environments
California Childcare Settings: childcare nutrition and physical activity environments
Farmers' Markets: improving access to farmers' markets in California
After School Environment: improving the food landscape in afterschool settings
Urban Agriculture: urban agriculture plans and policies in California
Healthy Food at Schools: how PSE strategies can improve the food landscape on campus