In the PSE context, systems are organizations, institutions or networks ranging from health care delivery systems to tribal organizations to schools to worksites. Organizations can continually adapt and improve to fit the needs and wants of stakeholders who are impacted by these systems.

Making changes in systems involves changing the rules within the organization to encourage healthier choices and promote healthier outcomes. To be successful, these changes cannot occur at a single time point or in a silo, but rather must be fully integrated into the established systems in which we live, work, study, play and pray. Such change does not occur over night; rather, incremental adjustments can lead to broad shifts in attitudes, behaviors, rules and processes.

Examples of systems and systems changes include the following.

  • Health Care Systems: Occurring in an Individual hospital or in the broader health care network, an example of a systems PSE change would be changing organizational procedures to include weekend clinic hours or to provide free wellness courses for the patient population.
  • School Systems: Similarly, school systems may make PSE changes in individual schools or at the district level. Examples include adding produce or healthy options to school lunch programs or eliminating sugar-sweetened beverages in vending machines.
  • Food Systems: Systems changes can take place throughout the food distribution chain by, for example, establishing farmers markets or farm to table programs that link farmers with local retailers in low-income areas.
  • Worksites: Systems changes in this area may take place in any worksite and include implementation of a worksite wellness program to improve employee health.


Truss, M. (2013). Policy, Systems and Environmental Change in Cancer Control. [PowerPoint slides]. Retrieved from