GTE Toolkit

Getting to Equity in Obesity Prevention (GTE) Toolkit

Policy, Systems, and Environmental Changes (PSE): Definitions

Please click over each blue box to view the details.

  1. PSE Approach: A policy, environmental, or systems change intended to facilitate environments that support healthy behaviors.
  2. 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.
  3. System: Comprises a group of different components that are interconnected and interacting, e.g., transportation, manufacturing, financial, health care, and food systems.
  4. Food System: The interrelated functions that encompass food production, processing, and distribution; food access and utilization by individuals, households, communities, and populations.
  5. 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
Examples of PSE Changes


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)


Changing the system: for example, changing infrastructure within a school, park, worksite, health care setting, etc. or how it operates 


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:

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
Equity Lens, Community engaged, People-centered

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.