These resources provide introductions, explanations and/or examples of PSE change:

• Anti-Lobbying Restrictions for CDC Grantees – Released in 2012, this document provides helpful guidelines for Centers for Disease Control and Prevention (CDC) grantees on what they can and cannot participate in related to policy advocacy, lobbying and related activities.
• Healthy Communities, Healthy Behaviors: Using Policy, Systems, and Environmental Change to Combat Chronic Disease – This issue brief from the National Association of County and City Health Officials describes how PSE change can make communities healthier and highlights examples of how local health departments can be involved in PSE change efforts.
• Moving from Programs to Policy, Systems, and Environmental Changes – This YouTube video (1:08:54) by Community Health Training Institute describes the benefits of moving beyond program efforts to sustainable PSE change efforts with broad impact and provides examples from Massachusetts on a range of prevention topics.
• Overview of Policy, Systems and Environmental Change – This YouTube video (16:26) by the American Cancer Society provides a brief introduction to PSE change tailored to Comprehensive Cancer Control programs.
• The Path from Program to Policy, Systems, and Environmental Change: From Conceptual Model to Real Life Application – These slides from Georgia Health Policy Research Center provides an overview of a framework supporting PSE change efforts at the community level. The webinar highlights some PSE examples and discusses their evaluation.
• PSE 101 Webinar – This YouTube video (57:52) from ChangeLab Solutions, partners in the Health in All Policies movement in California, provides basic PSE background and case examples from healthier food initiatives. Their website includes tools and information on a variety of topics from tobacco control to obesity to healthy housing and urban planning.

Complete relevant trainings for in-depth learning on the PSE change process:

• Action for PSE Change: A Training – This training from the GW Cancer Center explores PSE change, from its evidence base to a full-length case study. It provides background information on the 7-step PSE change process, stepwise worksheets, a PSE action plan template, real-world examples from comprehensive cancer control programs, an extensive resource list and theoretical and evaluation approaches to help grow the PSE change evidence base.
• Introduction to Policy Evaluation in Public Health – Designed by the Centers for Disease Control and Prevention (CDC) for public health practitioners, this online course introduces the use of policy evaluation in public health, teaches how to apply evaluation methods throughout a policy process and provides an understanding of how to apply the CDC Evaluation Framework.
• Region V Public Health Training Center –  This training arm of the University of Michigan School of Public Health, funded by the Health Resources and Services Administration Bureau of Health Professions, offers a broad range of archived webinars and other training.

Use these surveillance sources to pinpoint the issue(s) to be addressed by PSE change:

• AARP Livability Index – With the goal of developing policies that enhance individuals’ ability to exercise choice as they age, this web-based tool evaluates numerous areas, including public health and public policy, in developing measures of community livability.
• Behavioral Risk Factor Surveillance System (BRFSS)  – From CDC, this is “the nation’s premier system of health-related telephone surveys that collect state data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services.” CDC’s Youth Risk Behavior Surveillance System (YRBSS) offers leading causes of death and disability among youth.
• Cancer Trends Progress Report – Based on the most recent data available, this series reports on progress against cancer through research and related efforts. Included are measures of progress in the areas of prevention, early detection, diagnosis, treatment, life after cancer and end of life.
• CDC Wonder – This site allows users to access numerous data sets, reference materials, reports and guidelines published by the Centers for Disease Control and Prevention. Available information includes statistics, charts and maps addressing cancer incidence, census data and mortality data, among others.
• County Health Rankings & Roadmaps – Together with the Roadmaps, which provide tools to understand and use the data, the annual County Health Rankings compile county-level information on a wide range of health factors, such as access to healthy foods, obesity, and smoking.
• Dartmouth Atlas Data and Dartmouth Atlas Interactive Apps –
  This data source allows the tracking of Medicare claims data over time and provides access to data sets through interactive graphs and maps.
• DataUSA – This open platform website and visualization engine provides access to public U.S. government data.
• Health Resources & Services Administration (HRSA) Data Warehouse – This online repository combines data from HRSA with data from numerous other sources to present information about health care programs and the populations impacted by the programs.
• Healthy Communities Policy Guide – From the American Planning Association, this guide “identifies policy ideas for local, state, and federally elected officials aimed at improving community health and quality of living through planning.”
• How Do You Measure Up? – An annual report from ACS CAN that reviews each state’s progress on important cancer issues, including several relevant topics on PSE change.
• LawAtlas.org – The goal of this program is to “increase the use of policy surveillance and legal mapping as tools for improving the nation’s health.”
• National Health Care Quality and Disparities Reports – This site provides national and state-specific measures of performance across different areas of health care, as compared to benchmarks (standard of comparison), as well as data queries and national trends.
• National Program of Cancer Registries  – Administered by the CDC, this program collects and makes available data on cancer occurrence (including the type, extent, and location of the cancer), the type of initial treatment and outcomes.
• State Cancer Profiles – This website provides descriptive cancer statistics based on data collected from public health surveillance systems. The site includes a variety of interactive graphics and maps, and focuses on cancer sites that have corresponding evidence-based interventions.
• Surveillance, Epidemiology, and End Results – Managed by the National Cancer Institute (NCI), use this site to access cancer databases, statistical methods, and software tools.
• Toolkit for Communities Using Health Data – This report, from the National Committee on Vital and Health Statistics, explains how to collect, use, protect and share data responsibly.
• Transportation and Health Tool – This tool provides information and data that can be used to consider the health impacts of existing or proposed transportation systems. It was developed by the U.S. Department of Transportation and CDC.
• United States Cancer Statistics (USCS) – Developed by CDC and NCI, this online resource presents the official federal statistics on cancer incidence and cancer mortality for each year and for the most recent 5-year period combined.

Use these resources to make it easier for stakeholders and policymakers to visualize the need for PSE change:

• Centers for Medicare & Medicaid Services Mapping Medicare Disparities Tool  – Focused on health outcomes, utilization and spending, this tool provides data addressing disparities between subgroups of Medicare beneficiaries (e.g., racial and ethnic groups).
• Community Commons Maps and Data Reports – Using health and other statistics, this public access site provides mapping and reporting capabilities, along with connections to peers and training on best practices. It is managed by Institute for People, Place and Possibility, the Center for Applied Research and Environmental Systems and Community Initiatives.
• ESRI Community Analyst  – Incorporating census, health and other data, this web application uses geographic information systems (GIS) to create a variety of reports and interactive maps.
• GIS: A Tool for Local Implementation of Policy, System and Environmental (PSE) Approach – Learn how GIS can be used to further PSE changes in this Center for Disease Control and Prevention webinar that features state-based examples. This article by Parrott et al. also explains how GIS can serve as a useful tool for illustrating data: Using geographic information systems to promote community involvement in comprehensive cancer control.
• Interactive State Health Policy Map – Use this interactive map from the Tobacco Control Network to find state-level tobacco control policies.
• National Equity Atlas – This data and policy tool, the product of PolicyLink and the USC Program for Environmental and Regional Equity, addresses equity at the national, state, regional and city levels, including data on demographic change, racial inclusion, and the economic benefits of equity.
• Policy Map and Policy Map for Community Health – These sites, which offer fee-based and public access resources, allow users to download and map a range of community-level demographic, health and other data.

Use these sites to gain insight into proven cancer control interventions, policies and programs:

• The Community Guide – An independent panel of public health and prevention experts (the Community Preventive Services Task Force) is responsible for collecting these evidence-based interventions to help you select programs to improve health and reduce disease. Search by topic and choose policy development, environmental change or other relevant terms under “strategy.”
• Community Guide in Action – Use this interactive map to see how programs and organizations have used the Community Guide to improve health.
• Community Health Advisor – This interactive site, supported by the Robert Wood Johnson Foundation, incorporates your location to help identify policies and programs that may have the biggest impact on health and medical costs.
• Examining Whether the Health-in-All-Policies Approach Promotes Health Equity – Through public and private sector interviews, the authors of this article found a relationship between the use of health in all policies and the promotion of health equity.
• The Evidence for Policy and Environmental Approaches to Promoting Health – This publication is a supplement to the Society for Public Health Education’s (SOPHE) Health Education & Behavior journal addressing policy and environmental approaches to advance health.
• Health Impact in 5 Years (HI-5) – This CDC initiative “highlights non-clinical, community-wide approaches that have evidence reporting (1) positive health impacts, (2) results within five years, and (3) cost effectiveness and/or cost savings over the lifetime of the population or earlier.”
• Healthy Schools – The CDC’s Healthy School website provides numerous resources for engaging school systems in PSE change.
• National Governor’s Association (NGA) Center for Best Practices – The NGA Center for Best Practices provides resources to assist policymakers in realizing solutions for local challenges, offering best practices related to issues such as environment and health.
• Shaping the Context of Health: A Review of Environmental and Policy Approaches in the Prevention of Chronic Diseases – This article by Brownson, Haire-Joshu and Luke describes lessons learned from the application of 17 different PSE change interventions.
• Top Tier Evidence – This website, originally created by the Coalition for Evidence-Based Policy, provides information on social programs supported by high quality research.
• What Works for Health – “This site provides communities with information to help select and implement evidence-informed policies, programs, and system changes that will improve the variety of factors we know affect health.”

Considerations for PSE change evaluation design:

• The Cancer Control Technical Assistance Portal (TAP) Resource Repository – This site provides general evaluation resources from CDC.
• Evaluating Policy, Systems and Environmental Change interventions: Lessons learned from CDC’s Prevention Research Centers – This paper focuses on evaluations of PSE change programs that use the Centers for Disease Control and Prevention’s (CDC) Framework for Program Evaluation in Public Health, including lessons learned.
• An Evaluation Framework for Obesity Prevention Policy Interventions – This article describes a “framework developed by the CDC-funded Center of Excellence for Training and Research Translation that public health practitioners can use to evaluate policy interventions and identify the practice-based evidence needed to fill the gaps in effective policy approaches to obesity prevention.” Framework can be applied to other cancer and chronic disease PSE evaluations.
• Policy, systems, and environmental change in the Mississippi Delta: Considerations for evaluation design – This article by Kegler et al. describes one approach to evaluation of community PSE change programs and aims to spark discussion around approaches for evaluation of PSE change efforts.

Learn more about a variety of PSE-related topics using these detailed how-to guides:

• Advancing the Field of Patient Navigation: A Toolkit for Comprehensive Cancer Control Professionals – This resource was developed by the GW Cancer Center to guide states in advancing and sustaining the field of patient navigation, including through PSE change.
• Building Community Resilience Policy and Advocacy Guide – This guide can help organizations become effective policy advocates and educators for building community resistance.
• Built Environment Approaches – This selection of materials from the Community Guide is directed toward helping communities implement the Community Preventive Services Task Force (CPSTF) recommendation for using built environment approaches in combination. It includes examples, a summary of CPSTF’s review and findings and a one-page reference document.
• Community Health Assessment and Group Evaluation (CHANGE:) Building a Foundation of Knowledge to Prioritize Community Needs – An Action Guide – “This action guide provides step-by-step instructions for successfully completing the CHANGE tool. CHANGE can be used to gain a picture of the policy, systems, and environmental change strategies currently in place throughout the community; develop a community action plan for improving policies, systems, and the environment to support healthy lifestyles; and assist with prioritizing community needs and allocating available resources.”
• From Start to Finish: How to Permanently Improve Government Through Health in All Policies – This toolkit, developed by ChangeLab Solutions, highlights Health in All Policies—the process of improving health by incorporating health considerations into policymaking. It includes best practices and lessons learned from community leaders.
• Health Equity Guide – Focused on systems change, this site offers strategic principles, case studies and resources designed to advance health equity.
• Health in All Policies: A Guide for State and Local Governments – This resource from the Public Health Institute provides guidance on using collaborative approaches to improve population health by embedding health considerations into decision-making processes across a broad array of sectors.
• Increasing Healthy Nutrition and Physical Activity Across the Cancer Continuum through Policy, Systems, and Environmental Change: A Resource for Comprehensive Cancer Control Coalitions – This guide was written by the American Cancer Society, in collaboration with the Gretchen Swanson Center for Nutrition, to span the entire cancer continuum. The guide provides comprehensive cancer control coalitions with evidence-based PSE approaches, corresponding data, and resources.
  to inform nutrition and physical activity efforts across the cancer continuum.
• Leading through Health System Change Planning Tool – Developed by the Centers for Disease Control and Prevention (CDC), the Georgia Health Policy Center, and the National Network of Public Health Institutes, “this tool has been designed for those working in public health and other sectors to use adaptive thinking as they grapple with the many questions presented by health reform and health system transformation.”
• Partnering4Health® Approaches to Sustaining Healthy Communities: A Toolkit for Supporting Policy, Systems, and Environmental (PSE) Change Initiatives – This toolkit is a companion to an online sustainability course,  Partnering4Health: Approaches to Sustaining Healthy Communities, and is framed around six approaches to sustainability, including developing and implementing PSE change strategies for chronic disease prevention.
• Policy, Systems & Environmental Change: Effectively Engaging your Coalition when Working with the Media – The purpose of this guide, developed by the ACS, on behalf of CCCNP, is to provide coalitions with information and tools they can use to organize their media efforts and maximize their success.
• Policy, Systems & Environmental Change Resource Guide –This guide, developed by the American Cancer Society (ACS), on behalf of the Comprehensive Cancer Control National Partnership (CCCNP), provides models and tools to assist CCC professionals with planning and implementing a PSE change agenda. It includes ways that PSE change can affect community infrastructure and policies through education, advocacy and direct action.
• Policy, Systems & Environmental Change Resource Guide: Strategies for Increased Access to Healthy Foods, Beverages & Physical Activity – This resource, developed in 2015 by the California Department of Public Health’s Nutrition Education and Obesity Prevention Branch, includes examples of evidence-based, practice-based, and emerging tools and resources for PSE change related to obesity prevention.
• Practical Playbook – This guide from CDC, the de Beaumont Foundation, and Duke Family Medicine & Community Health provides practical tips on building multisector partnerships to help improve community health.
• Prevent Cancer Foundation’s Advocacy Toolkit – This toolkit provides introductory information for individuals who want to engage policymakers on cancer prevention.
• Promoting Health and Cost Control: How States Can Improve Community Health and Well-Being Through Policy Change – This new report from Trust for America’s Health provides detailed information on 13 non-health-related policies that can improve the well-being of state residents.
• PSE Playbook – This guide illustrates how health care providers can partner with local health departments to support PSE change.
• Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide –This manual presents 24 CDC recommendations, including PSE change approaches, to help communities support healthy eating and active living in order to combat obesity, as well as a tool to measure their progress.
• Rural Health Information Hub’s Health Promotion and Disease Prevention Toolkit – This toolkit provides strategies for health promotion and disease prevention, resources and best practices for rural communities.
• Seven Steps for Policy, Systems and Environmental Change: Worksheets for Action – This resource contains some background on PSE change as well as all of the worksheets for the 7-step PSE change process.
• Supporting Cancer Survivors through Comprehensive Cancer Control Programs – This guide, from the GW Cancer Center, includes potential benchmarks and activities for systems-level approaches to addressing the needs of post-treatment cancer survivors.
• Tribal Policy, Systems, and Environmental Strategies For Preventing Chronic Disease – Prepared by the California Rural Indian Health Board, Inc., this resource provides guidance for tribes, tribal health programs, and tribal organizations in implementing PSE strategies.

Navigate through the seven steps of PSE change with these worksheets:

• Seven Steps for Policy, Systems and Environmental Change: Worksheets for Action (contains all seven worksheets)
• Step 1: Engage – Build Partnerships and Engage the Community
• Step 2: Scan – Perform Environmental Scans
• Step 3: Assess – Identify Priority Areas
• Step 4: Review – Assess Feasibility of Interventions
• Step 5: Promote – Promote Awareness, Communicate and Educate
• Step 6: Implement – Take Action
  • Plan – Develop Your PSE Agenda
• Step 7: Evaluate – Measure Your Success

• Advocacy for Government Workers (Flowchart) – This flowchart, from Public Health Awakened, is designed to help government workers determine how to engage in advocacy efforts.
• American Cancer Society (ACS) Cancer Action Network (CAN) – This web page provides numerous resources on a wide range of public policy issues related to preventing cancer and improving the health care system for persons with cancer and survivors. Visit the ACS CAN Action Center to learn about current opportunities to take action on a federal level.
• Breast Cancer Online Toolkit – This toolkit from the Association of State and Territorial Health Officials (ASTHO) provides resources designed to reduce disparities in breast cancer mortality.
• The Cancer Control Technical Assistance Portal (TAP) Resource Repository – This site provides additional PSE change resources.
• The Center on Health Equity Action for System Transformation, by Families USA, is dedicated to developing patient-centered health system transformation policies designed to reduce racial, ethnic and geographic disparities.
• Collaborating for Equity and Justice Toolkit – This toolkit was published in conjunction with Collaborating for Equity and Justice: Moving Beyond Collective Impact, a publication of principles designed to promote collaboration for social change in an equitable and just way.
• Community-Based Prevention Marketing for Policy Development: A New Planning Framework for Coalitions – This article describes a framework for adapting community-based prevention marketing to improve capacity for identifying and promoting evidence-based policies.
• The Community Tool Box – Free tips and tools to guide you in taking action toward community change, including information on community assessment, planning, intervention, evaluation and advocacy.
• Cutting Through the Complexity: A Roadmap for Effective Collaboration – This article discusses what it takes for collaborations and networks to actually achieve their ambitious goals.
• Framing Research for State Policymakers Who Place a Priority on Cancer – This article discusses how best to disseminate research information to educate policymakers, including how to frame issues and predictors of use of research in policymaking.
• The Intersector Toolkit – This tool is a guide for successful cross-sector collaboration among business, government and non-profit sectors.
• Practical Playbook – Through this guide from the de Beaumont Foundation, learn how public health and primary care can form partnerships to improve population health.
• Rural Health Policy Brief: Preventing and Treating Cancer in Rural America – This CDC resource provides suggested policy interventions to improve cancer control in rural America.
• State-Based Cancer Advocacy – The National Coalition for Cancer Survivorship provides resources to facilitate advocacy at the state and local level to improve cancer care and outcomes.
• Straight to the Point: Mapping an Advocacy Strategy – Pathfinder International has designed a series of tools to help develop advocacy initiatives.
• Stronger Health Advocates, Greater Health Impacts – Developed by PATH, this 10-part framework supports professionals in developing policy advocacy strategies, with a global focus.
• Tribal Public Health Law Resource Table – Compiled by the Network for Public Health Law, this is a list of organizations with experience in tribal and public health law.