Policy, Systems, and Environmental (PSE) Changes

Beginning in the early to mid 2000s, there was a shift in thinking about how to effectively improve health in a community. For many years, the focus has been on individual behavior via offering programs education. This was based on the assumption that if we teach people how to be healthy - tell them what to eat/what not to eat - they will find a way to be healthy.


We now know that individual-level interventions alone are not as effective as population-level interventions, which address the larger context in which people live. The Health Impact Pyramid depicted to the right shows the importance of addressing this context to help make healthy choices practical and available to all community members. This is where Policy, Systems, and Environmental (PSE) changes come into play. PSE changes focus on providing a context for West Virginians where making a healthy decision is easier.

Health Impact Pyramid (1).png

What is a Policy change?

What is a systems change?

What is an environmental change?

Changing or implementing laws, regulations, rules, ordinances, or resolutions. Policy changes can be classified as Big Policy Changes (changing policies at the national, state, or local governmental level or within healthcare settings, schools, communities) or Little Policy Changes (internal changes to
organizations or groups).


EX: Clinic policy to check blood pressure on all patients 16 years or older, policy to reduce access to
sugar sweetened beverages in schools.

Changing processes or practices of an organization, institution, or system to address the healthy change
you are trying to make. Examples of organizations, institutions, or systems include communities, worksites, schools, health care systems.


EX: Partnering with new organizations to provide physical activity opportunities, refer patients to
chronic disease self-management programs, form a health promotion committee for a worksite.

Physical, observable changes to the built, economic, and/or social environment. These changes can take
place in stores, schools, worksites, parks, rail trails, health clinics, offices, and communities.


EX: Install bike pumps along rail trails, create an educational community garden, install ADA
compliant playground equipment, install water bottle filling stations, give employees under desk
portable fitness pedal stations.

PSE Change Equation.png