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Why Policy and Environmental Changes?
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Public health professionals frequently hear objections to work involving policy. "Government should just educate people” or "You've got to teach them while they are young.” The trouble with education-only efforts is they take place in a vacuum. Without the neighborhood, school, and family support, education goes no further than the exit to the classroom. Support could include sidewalks, designated walking or rolling routes to school, bike racks, and physical activity and play time during school hours. Such neighborhood and school efforts require policy (e.g, each child will have 20 minutes of recess each day), environmental (e.g., sidewalk markers designating routes to school), and systems (an emphasis on promoting physical activity for children from before school to after) to reinforce educational messages.

Meanwhile, children are taught to "eat healthily” while in some schools candy is used to illustrate math problems and junk food sales to teach commerce. Substituting non-food items (or dried beans) in math can be a policy change by the school principal as part of an overall systems change of encouraging healthy eating. It's a way of practicing "do as I say AND as I do.”

Adults are bombarded with health claims from the specious to the well-researched but two health ideas that are almost universally accepted are (1) Get physical activity, and (2) Eat fruits and vegetables. Again we know that various modes of education get the message out, but how well does the person's environment support these ideas? Does the workplace have vending machines that offer apples? Do the town's streets have bicycle lanes?

Policy, environmental, and systems changes are designed to make the healthy choice the easy choice. Our modern society wasn't engineered with health in mind, and our collective health is paying the price. No U.S. state has an obesity prevalence of less than 20 percent of the population (United Health Foundation, America's Health Rankings 2011).

Tobacco use prevention professionals have long worked in policy and environmental change. Smoke-free workplaces, parks, and public areas are more effective at reducing tobacco consumption than gathering 15 individuals in a room to teach them how to stop smoking. Importantly, these measures also reduce secondhand smoke exposure, whereas educating people who smoke that their smoke harms others produces limited results.

Health promotion programs have been moving toward policy, systems, and environmental change approaches for many years. These approaches do not replace the need for individually aimed health promotion but they do fill a critical gap. Public health agencies are positioned to see the community-based changes needed to support health and collaborate with private groups to make them happen.

As used in the Systems Change for Health courses offered by DHPE, the term "policy” refers to a range of approaches, actions or interventions that are part of the policy process. The policy process can occur at the local, state, or national levels. Policies include workplace rules, insurance provisions, limitations businesses accept, local ordinances, joint use agreements (such as allowing the use of school facilities for community physical activity programs), changes to built environments (such as traffic calming measures and safer walking routes to schools), school board decisions, agreed upon ways of doing business, and state guidance—in addition to state or federal regulations, and local, state, or federal laws. This series of courses take participants through a broad spectrum from defining and framing problems to evaluating the solutions.

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