Getting to Equity in Obesity Prevention (GTE) Toolkit
BACKGROUND AND RATIONALE
Policy, Systems, and Environmental Changes (PSE): Definitions
Please click over each blue box to view the details.
- PSE Approach: A policy, environmental, or systems change intended to facilitate environments that support healthy behaviors.
- Policy: A written statement reflecting a plan or course of action of a government, business, community, or institution that is intended to influence and guide decision making.
- System: Comprises a group of different components that are interconnected and interacting, e.g., transportation, manufacturing, financial, health care, and food systems.
- Food System: The interrelated functions that encompass food production, processing, and distribution; food access and utilization by individuals, households, communities, and populations.
- Environments: The external influences on the life of an individual or community through physical, economic, social, policy, or political environments that comprise systems.
Sources: Institute of Medicine, Accelerating Progress in Obesity Prevention, National Academies Press 2012; RWJF 2015; Lee, et al. 2017
Policies
Changing the rules: for example, passing a new law, changing a law, or making new resolutions or guidelines (public or private sector policies at national, state, or local levels)
Systems
Changing the system: for example, changing infrastructure within a school, park, worksite, health care setting, etc. or how it operates
Environments
Changing what is available in an environment or what it costs: for example,
- physical environment – changing physical structures, programs or services
- economic environment – subsidizing healthy behaviors or taxing unhealthy behaviors
- sociocultural environment- changing attitudes about health behaviors
- media environments – restricting what can be advertised to young children on TV or social media
Source: adapted from What is Policy, Systems, and Environmental Change: http://healthtrust.org/wp-content/uploads/2013/11/2012-12-28-Policy_Systems_and_Environmental_Change.pdf
e.g., Food Availability
- Improve availability of mechanisms for purchasing foods from farms
- Increase support for breastfeeding
e.g., Physical Activity
- Increase opportunities for extracurricular physical activity
- Enhance infrastructure supporting bicycling
If you build it, will they come, and will it have the intended effect?
- SNAP Fruit and Veg coupons
- Lactation Rooms
- Classroom Exercise Breaks
- Urban Bicycle Paths
A PSE intervention that works equally well in priority populations compared to other populations may improve health in both populations but leave the disparity intact.
A PSE intervention that works less well in priority compared to other populations conflicts with the principle of “first do no harm”—it worsens disparities by creating a situation that leads to a new basis for inequity.
The equity objective is to identify or create circumstances in which a PSE intervention works better in priority populations compared to others. This “catch-up effect” lessens the disparity.