Advancing Policies/Systems Change


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Leading public health organizations have recently emphasized the adoption of new policies to create healthy communities. Much of this is due to mounting evidence about the influence of school, workplace and community environments on health and the knowledge that policy is the primary and most powerful way we influence the nature and performance of those places.

This new emphasis on policy and environmental change has been profoundly productive in communities as public health professionals have learned to collaborate with similarly interested stakeholders promoting walkable, livable communities for environmental, economic and social justice reasons. Policy and environmental change is now a key element of public health’s response to major health challenges, such as obesity and asthma. Healthy community design to “make the healthy choice the easy choice” is a major trend affecting the planning and design of our communities.

This is good news. However, it is too early for the institutions of public health to claim victory.

Policy is only one part of a system of supports needed to embed a culture of health in the way we build our communities. In addition, this system is complex. The process of implementing policy itself usually takes great effort and reveals other related policies, practices and resources that need adjustment to achieve the intended impact.

Whether in school districts, workplaces or the various departments of local government, systemic change is won gradually, one institutional or community context at a time. Before difficult change can occur and take hold at a larger scale, partnerships must test new approaches, integrate learning and increase confidence and constituency involvement.

Beyond good community design and the opportunities it provides for healthy choices, individuals also need encouragement as well as culturally appropriate and reliable social support to adopt and sustain healthy lifestyles. This has long been the challenge of health promotion. Active Living By Design’s Community Action Model of community change integrates the traditional strengths of health promotion with policy and environmental change.

Healthy community partnerships that see their work holistically, and change as the work evolves, are more likely to achieve their larger vision. Here are some core lessons and principles about the evolution of policy and systems change we have gleaned from the community partnerships with whom we have worked.