Description
For this assignment, identify an area of focus in community health within your own community.
Using Gordon’s Functional Health Patterns framework (p. 130 in your e-text), assess the health risks in your community.
In your community assessment paper, include the following:
Identify resources in your community that would enable you to complete a community assessment and submit a summary of your findings (1–2 paragraphs).
Refer to Table 8-3: Examples of Community Strengths and Concerns, and assess the strengths and concerns of your community (2–3 paragraphs).
Identify potential barriers to implementing community health plans in your community and brainstorm ways of addressing these barriers (2–3 paragraphs).
Your paper should be 2–3 pages in length, not including the cover and reference pages. Use APA throughout.
You must include 2–3 sources that are APA cited and referenced in your paper. (Sources may include community resources such as flyers, brochures, interviews, news stories, and local research data from credible sources.)
Review the rubric for further information on how your assignment will be graded.
Unformatted Attachment Preview
COMMUNITY HEALTH
ASSESSMENT AND GROUP
EVALUATION (CHANGE)
CDC’s Healthy Communities Program
Building a Foundation of
Knowledge to Prioritize
Community Needs
COMMUNITY ASSESSMENT
AN ACTION GUIDE
Division of Adult and Community Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
4770 Buford Highway, NE, Mailstop K-93
Atlanta, Georgia 30341
PHONE: 770-488-6452 FAX: 770-488-8488 E-MAIL: [email protected]
www.cdc.gov/HealthyCommunitiesProgram
Suggested Citation
Centers for Disease Control and Prevention. Community Health Assessment aNd Group
Evaluation (CHANGE) Action Guide: Building a Foundation of Knowledge to Prioritize
Community Needs. Atlanta: U.S. Department of Health and Human Services, 2010.
The Centers for Disease Control and Prevention (CDC), an agency of the U.S. Government,
authored this document, the substance of which is a work of the U.S. Government. All
materials appearing in this document, except where noted, are in the public domain and may
be printed or reused without permission.
April 2010
CHANGE TOOL TEAM
The CDC’s Healthy Communities Program recognizes the following individuals for their
dedication and commitment in developing the Community Health Assessment aNd Group
Evaluation (CHANGE) tool and related materials.
Shannon Griffin-Blake, PhD
Team Lead
Program Services and Evaluation Team
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Stella Cory, MD, MPH
Health Scientist
Program Services and Evaluation Team
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Andrae Ivy, MPH
Northrop Grumman
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Ann Ussery-Hall, MPH, CHES
The Ginn Group
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
CHANGE ACTION GUIDE TEAM
The following individuals assisted the CHANGE tool team with step-by-step documentation
and editing of the Community Health Assessment aNd Group Evaluation (CHANGE) Action
Guide: Building a Foundation of Knowledge to Prioritize Community Needs.
Hema Desai, MMedSci
Booz Allen Hamilton
Keisha Edwards, MPH, CHES
Booz Allen Hamilton
CONTRIBUTORS
The CDC’s Healthy Communities Program recognizes the following individuals who
contributed subject matter expertise and editorial guidance to the Community Health
Assessment aNd Group Evaluation (CHANGE) Action Guide: Building a Foundation of
Knowledge to Prioritize Community Needs.
Stacy Adams
Evaluator
Healthy Communities Branch
Alabama Department of Public Health
Selma, AL
Anthony Barbagallo, III MS, MBA
Booz Allen Hamilton
Erica Barrett, MOT, MBA
The Ginn Group
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Alyssa Easton, PhD, MPH
Director
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Wayne Giles, MD, MS
Director
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Kurt Greenlund, PhD
Associate Director for Science
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Heidi Hataway
Director
Healthy Communities Branch
Alabama Department of Public Health
Montgomery, AL
Bruce Hathaway
Healthy Communities Program
Bureau of Community Chronic Disease
Prevention
New York State Department of Health
Albany, NY
Jennie Hefelfinger, MS
Action Communities for Health, Innovation,
and EnVironmental changE Project Manager
National Association of Chronic Disease
Directors
Timothy LaPier, MA
Team Lead
Translation and Dissemination
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Donna Burge Norkoli BS, CHES
Project Coordinator
Strategic Alliance for Health
Sault Tribe Community Health Services
Sault Ste. Marie Tribe of Chippewa Indians, MI
Samuel Perry, MPH
Booz Allen Hamilton
Richard Roman, MS
Associate Director
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Anne Short
Executive Director
Alliance for Health in Cleveland County, Inc.
Cleveland County, NC
Monica Hobbs Vinluan JD
Project Director
Activate America: Healthier Communities
Initiatives
YMCA of the USA
Branalyn Williams, MPH
Health Education Specialist
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
We would like to thank the following organizations within the National Center for Chronic
Disease Prevention and Health Promotion (NCCDPHP) and the National Center for
Environmental Health (NCEH) at the Centers for Disease Control and Prevention for
their collaboration, teamwork, and contribution of subject matter expertise during the
development of the CHANGE tool.
Office of the Director, NCCDPHP
Division of Adolescent and School Health, NCCDPHP
Division of Nutrition, Physical Activity and Obesity, NCCDPHP
Office on Smoking and Health, NCCDPHP
Division for Heart Disease and Stroke Prevention, NCCDPHP
Division of Diabetes Translation, NCCDPHP
Division of Cancer Prevention and Control, NCCDPHP
Division of Emergency and Environmental Health Services, NCEH
Office of the Director, NCEH
In addition, we would like to recognize the following groups for their invaluable input during
the development of the CHANGE tool: ACHIEVE National Partners – National Association of
Chronic Disease Directors, National Association of County and City Health Officials, National
Recreation and Park Association, Society for Public Health Education, and YMCA of the USA,
as well as Steps, Action Communities for Health, Innovation, and EnVironmental changE,
and Strategic Alliance for Health communities. For more information about local, state, and
national partners please visit the CDC’s Healthy Community Program web site at www.cdc.
gov/healthycommunitiesprogram.
TABLE OF CONTENTS
Foreword……………………………………………………………………………………………………………………. i
Legend……………………………………………………………………………………………………………………… ii
About.the.CD.ROM…………………………………………………………………………………………………… ii
Snap.Shot.of.Action.Steps.for.Completing.the.CHANGE.Tool………………………………………….iii
Background.of.the.CHANGE.Tool………………………………………………………………………………… 1
Why the CHANGE Tool? …………………………………………………………………………………………….. 2 �
Community Change Process and the CHANGE Tool ……………………………………………………….. 4 �
Purpose of CHANGE…………………………………………………………………………………………………… 5 �
Purpose.of.the.CHANGE.Action.Guide…………………………………………………………………………. 7
How.to.Complete.the.CHANGE.Tool……………………………………………………………………………. 7
Action Step 1: Assemble The Community Team ………………………………………………………………. 8 �
Action Step 2: Develop Team Strategy ………………………………………………………………………….. 10 �
Action Step 3: Review All Five CHANGE Sectors …………………………………………………………… 10 �
Action Step 4: Gather Data…………………………………………………………………………………………. 13 �
Action Step 5: Review Data Gathered ………………………………………………………………………….. 18 �
Action Step 6: Enter Data …………………………………………………………………………………………… 21 �
Action Step 7. Review Consolidated Data……………………………………………………………………… 31 �
Action Step 8. Build the Community Action Plan ………………………………………………………….. 39 �
Looking.Beyond………………………………………………………………………………………………………. 42
Evaluation.and.Reassessment……………………………………………………………………………………… 43
Appendix.A..Glossary.of.Terms…………………………………………………………………………………… 45
Appendix.B..Sector.Participant.List…………………………………………………………………………….. 59
Appendix.C..Community.Health.Assessment.aNd.Group..
Evaluation.(CHANGE).List.of.Questions…………………………………………………………………….. 65
Appendix.D..Citations………………………………………………………………………………………………. 83
FIGURES
Figure.1..Program.Evaluation.Framework……………………………………………………………………… 2
Figure.2..The.Socio-Ecological.Model……………………………………………………………………………. 3
Figure.3..Community.Change.Process…………………………………………………………………………… 4
Figure.4..Action.Steps.to.Complete.the.CHANGE.Tool……………………………………………………. 8
Figure.5..Possible.Elements.of.a.Community.Team………………………………………………………….. 9
Figure.6..CHANGE.Dialogue.Guide……………………………………………………………………………. 12
Figure.7..Framework.for.Completing.CHANGE……………………………………………………………. 18
Figure.8..Snapshot.of.the.CHANGE.Sector.Excel.File…………………………………………………….. 24
Figure.9..Definitions.of.Terms.in.the.CHANGE.Sector.Excel.File…………………………………….. 25
Figure.10..Definitions.of.Item.Responses…………………………………………………………………….. 26
Figure.11..Item.Responses.and.Accompanying.Comment.Boxes……………………………………… 27
Figure.12..Definitions.of.Key.Terms……………………………………………………………………………. 28
Figure.13..Module.Percentages.and.Tabulated.Ratings…………………………………………………… 29
Figure.14..Module.Score.Summaries……………………………………………………………………………. 30
Figure.15..Example.CHANGE.Summary.Statement.(Community-At-Large.Sector)……………. 32
Figure.16..Designation.of.Assets.and.Needs………………………………………………………………….. 34
Figure.17..Definitions.of.Objectives.in.Community.Action.Plan……………………………………… 41
TABLES
Table.1..Advantages.and.Disadvantages.of.Data.Collection.Methods……………………………….. 14
Table.2..CHANGE.Tool.Policy.and.Environment.Scale.for.Community-At-Large.
Sector.and.Physical.Activity.Module……………………………………………………………………………. 20
Table.3..Example.of.a.Sector.Data.Grid……………………………………………………………………….. 33
Table.4..Community.Health.Improvement.Planning.Template………………………………………… 38
Table.5..Example.of.a.Community.Action.Plan…………………………………………………………….. 40
FOREWORD
Our nation faces a crisis in the burden of chronic disease. Today, 7 of the 10 leading causes of death
in the United States are chronic conditions. Nearly 50% of Americans are living with at least one
chronic disease. The Centers for Disease Control and Prevention (CDC) recognizes that the scope
and impact of chronic disease requires transforming the places and organizations that touch people’s
lives every day – communities and community organizations, work sites, health care organizations,
and schools – to improve the health of the nation. To undertake this work, states and communities
will need to address multiple factors through policy interventions including broad-based policies
such as smoking bans and laws; targeted regulations, such as those promoting breastfeeding; and
community-wide interventions, such as community-and street-scale urban design and land use
policies.
In order to effectively identify, plan, and implement needed policy, systems and environmental
changes, communities need to be able to assess the current policy landscape and monitor changes
over time. The Community Health Assessment aNd Group Evaluation (CHANGE) Action Guide:
Building a Foundation of Knowledge to Prioritize Community Health Needs was designed to meet
this need. Although the CHANGE tool is not intended to promote any specific policy, it serves
as a critical tool to help communities discover the array of approaches being used in the field.
The CHANGE tool also helps communities identify and monitor important policy, systems, and
environmental changes over time.
As the CDC collaborates with communities on the development and implications of policy, systems,
and environmental change strategies, this important CHANGE Action Guide offers communities a
valuable tool in our efforts to promote health and prevent disease.
Ursula E. Bauer, Ph.D., M.P.H.
Director
National Center for Chronic Disease Prevention and Health Promotion
i
LEGEND
Icon
Usage
Boxes marked with this light bulb icon present tips, ideas, and additional
information on implementing an action step and may also provide web
site links to helpful resources.
Boxes marked with this hurdler icon describe possible obstacles that
may occur during implementation and offer suggestions for successfully
overcoming those hurdles.
Boxes marked with this icon indicate additional resources are available
on the CD-ROM.
Boxes marked with this icon indicate questions generated by users of the
CHANGE tool and are included to assist in executing the Action Steps.
ABOUT THE CD-ROM
The CD-ROM included with this Action Guide contains resources to support your
community assessment and evaluation efforts. The resources are:
▪ CHANGE Sector Excel Files (i.e., the CHANGE tool) that provide a list of the items and
definitions for each sector (i.e., Community-At-Large Sector, Community Institution/
Organization Sector, Health Care Sector, School Sector, and Work Site Sector).
▪ Blank versions of the CHANGE Summary Statement, Sector Data Grid, CHANGE Strategy
Worksheets, Community Health Improvement Planning Template, and Community Action Plan
contained in Action Steps 7-8. Print and use these worksheets during strategy and brainstorming
sessions.
▪ A template for a policy brief or one-pager to use as CHANGE activities come to a close and your
team begins to develop products to share success stories with stakeholders.
▪ A Microsoft Office PowerPoint presentation template for town hall meetings, road shows, or site
visits with partners.
▪ A resource list of assessment tools and evaluation guides that have been used and developed by
CDC and its partner organizations.
ii
SNAP SHOT OF ACTION STEPS FOR COMPLETING THE
CHANGE TOOL
The following is a summary of the action steps that are suggested for successfully completing the
CHANGE tool.
ACTION.STEP.1:.Assemble.the.Community.Team
Identify and assemble the community team; diverse representation is preferred. Consider the make-up
of the team to include 10-12 individuals maximum.
ACTION.STEP.2:.Develop.Team.Strategy
Decide whether to complete CHANGE as a whole team or divide into subgroups. Communities tend
to divide the team into subgroups ensuring there are two people collecting and analyzing data and
reporting back to the team to gain consensus.
ACTION.STEP.3:.Review.All.5.CHANGE.Sectors
Review all 5 sectors prior to completing them so the community team understands the total picture
of what is being assessed. These include the Community-At-Large Sector, Community Institution/
Organization (CIO) Sector, Health Care Sector, School Sector, and Work Site Sector.
ACTION.STEP.4:.Gather.Data
Use multiple methods (two or more) to gather data from each site to maximize the data quality.
Methods could include, for example, focus groups, windshield surveys, or questionnaires. Consider
the amount of time needed for each of the methods selected.
ACTION.STEP.5:.Review.Data.Gathered
Gather with the community team to review the data received. Brainstorm, debate and dialogue with
the team to gain consensus on what these data mean in terms of parameters of the CHANGE tool.
Data should be rated based on a comprehensive review of all sources and agreement of everyone
involved.
ACTION.STEP.6:.Enter.Data
Use the CHANGE Sector Excel File to enter data. Within the community team, make sure there is a
designated data manager to input the data. Complete a separate CHANGE Sector Excel File for each
site.
iii
ACTION.STEP.7:.Review.Consolidated.Data
Once ratings have been assigned to each sector, the following steps will need to be completed so the
team can begin to determine areas of improvement to develop a Community Action Plan based on
the community-level data.
ACTION.STEP.7a:.Create.a.CHANGE.Summary.Statement
ACTION.STEP.7b:.Complete.the.Sector.Data.Grid
ACTION.STEP.7c:.Fill.Out.the.CHANGE.Strategy.Worksheets
ACTION.STEP.7d:.Complete.the.Community.Health.Improvement.Planning.Template.
ACTION.STEP.8:.Build.the.Community.Action.Plan
The final step is to build a Community Action Plan. This will be organized by project period and
annual objectives, and reflect the data collected during the CHANGE process.
iv
BACKGROUND OF THE CHANGE TOOL
Community Health Assessment aNd Group Evaluation (CHANGE) is a data-collection tool and
planning resource for community members who want to make their community a healthier one. The
Healthy Communities Program (www.cdc.gov/HealthyCommunitiesProgram) within the Division
of Adult and Community Health, at the National Center for Chronic Disease Prevention and Health
Promotion of the Centers for Disease Control and Prevention (CDC) developed the CHANGE
tool. The CDC’s Healthy Communities Program designed the CHANGE tool for all communities
interested in creating social and built environments that support healthy living.
The purpose of CHANGE is to gather
and organize data on community assets
A Community Action Plan is a
and potential areas for improvement
living document, usually time
prior to deciding on the critical issues
based, that enables a community
to be addressed in a Community Action
to structure its activities around
Plan. Development of the CHANGE tool
a common purpose and to
began in fall 2007, and the first iteration
prioritize needs.
was piloted with a set of CDC-funded
communities. The tool comprises a set of
easy-to-use Microsoft Office Excel spreadsheets for collection of local-level data from schools, work
sites, community organizations, and health care facilities. CHANGE walks you through a community
assessment process and helps define and prioritize improvement areas by providing community-level
data on current policy, systems, and environmental change strategies. With CHANGE data as a guide,
you can map out a course for health improvement in your community with specific, targeted action.
The CHANGE tool improves community health with feedback on actions that should be developed
and implemented to transform communities into those that support healthy living.
CHANGE combines items that have scientific support for policy, systems, and environmental changes
with items that communities are initiating and assessing based on their practical experience but
may lack stronger scientific support. As a result, this tool should not be construed as promoting any
particular policy, systems, and environmental change strategy; it helps communities to assess potential
approaches that are innovative as well as approaches that show strong evidence of effectiveness. For
example, the scientific literature on tobacco use and exposure strongly recommends the use of a
smoke-free indoor policy as a first point of action. Communities have utilized smoke-free indoor
policies to reduce exposure to second-hand smoke as well as begun to utilize smoke-free outdoor
policies, such as smoke-free parks and beaches, and tobacco-free indoor and outdoor policies at work
sites, such as CDC’s tobacco-free campus policy.[1] Ultimately, this demonstrates CHANGE’s dual
benefit of science coupled with community innovation being documented and tracked through the
use of this assessment tool. As an annual process, the tool also allows your community to address
incremental change and track progress against key policy, systems, and environmental change
strategies.
1
CHANGE provides a foundation for utilizing CDC’s Recommended Framework for Program
Evaluation.[2] Program evaluation is important because it permits the community to measure
efforts that can inform decisions. Therefore, start with the end in mind by weaving evaluation into
your work from the very beginning. Formulate evaluation questions when you begin the process.
For example, how well was a program implemented? Did it meet expectations? If so, how can we
capitalize on the success; if not, what areas need improvement?
An accurate evaluation process is stakeholderdriven, and requires clear steps. Figure 1 shows
Assets are the community
how the steps of the evaluation process are
strengths; community areas
interrelated. The process begins with engaging
that have achieved great
stakeholders; that is, connecting with individuals
progress or environmental
and organizations within the community
change strategies.
whose interests and goals are similar (or even in
opposition). The next evaluation steps focus on
design and gathering the data needed to make decisions. Evaluators finalize the process by again
engaging stakeholder groups. CHANGE embraces this stakeholder-driven process by using credible
evidence to support and justify conclusions. CHANGE encourages your community team to share
information with all stakeholders, and to share the information on an annual basis as a projection for
future community action.
Figure 1. Program Evaluation Framework
Engage
Stakeholders
Ensure Use
and Share
Lessons Learned
Justify
Conclusions
STANDARDS
Describe
the Program
Utility
Feasibility
Propriety
Accuracy
Gather
Credible
Evidence
Focus the
Evaluation
Design
Why the CHANGE Tool?
Change can be achieved at many levels—individual, interpersonal, organizational, and community.
The CHANGE tool enables users to consider the factors needed for multi-level impact and multilevel change. By supporting the collection of data from a variety of sources, CHANGE provides a
community snapshot of the policy, systems, and environmental change strategies currently in place
2
and helps to identify areas for improvement. The Socio-Ecological Model, depicted in Figure 2,
provides a useful framework for showing the multiple influences on community health, and barriers
to health improvement. Understanding these factors and barriers aids in developing strong, actionable
strategies for your community. Examples of such strategies include tobacco-free policies at schools
and restaurants, healthy vending machine policies in work sites, safe sidewalks in all neighborhoods,
and stair use promotion in public buildings.
The CHANGE tool development began by analyzing relationships among living conditions, culture,
economics (e.g., community and/or individual wealth, financial stability), social networks, and
lifestyle factors. Community health is affected by more than just individual behavior; multiple
conditions and factors determine individual health decisions. Allowing for external issues, such as
policy, systems, and environmental changes, provides a more comprehensive view of how to impact
change at a community level.
Why is it important to consider community-level change? Community-level changes such as policy
are more sustainable, impact infrastructure, and aid in shifting social norms. For example, an effort
to educate parents on healthy food choices for children is sustainable only if parents have safe,
affordable, and accessible locations to purchase food. Education alone is not as viable a change
strategy because other factors may impede its success. Figure 2 also shows the connections among
public policy, community, and interpersonal aspects such as social networks. None of these factors
can be analyzed alone. The CHANGE tool assists you in conducting assessments, gathering data,
examining the connections, and convening community teams for action. The CHANGE tool provides
community teams with the data needed to strategize for change, identify the policies for change, and
build the partnerships for change.
Figure 2. The Socio-Ecological Model[3]
Public Policy
national, state, local laws and regulations
Community
relationships among organizations
Organizational
organizations, social institutions
Interpersonal
family, friends, social networks
Individual
knowledge, attitudes, skills
3
Community Change Process and the CHANGE Tool
Every community is different, but there are similarities in the process by which communities mobilize
to affect change. The five phases of this process are depicted in Figure 3.
▪ Commitment.
▪ Assessment.
▪ Planning.
▪ Implementation.
▪ Evaluation.
Why is this process important to consider when completing the CHANGE tool? The process to
complete the CHANGE tool mirrors these five phases and has been used as a basis to set up this
Action Guide. Consider that, while there are five phases to the community change process, this
Action Guide focuses specifically on the first three – Commitment, Assessment, and Planning, as they
frame the step-by-step process for completing the CHANGE tool.
COMMUNITY
CHANGE
PROCESS
ASSESS
ME
NT
TION
ENTA
EM
PL
IM
COM
MI
TM
ION
AT
LU
T
EN
EV
A
Figure 3. Community Change Process
PL A N NIN G
1. Commitment involves assembling a team — or coalition — of community members to address key
issues and establish partnerships with other agencies. Coalitions and partnerships give participants
ownership of the process and a ready pool of fiscal and human resources to support policy, systems,
and environmental change strategies.
2. Assessment involves gathering data and input on what the community needs. Assessment also
provides a way for the community’s voice to be heard. Change strategies must reflect the needs of
the community to have the intended impact. As Chang has noted (1994), “a community assessment
process is not just a matter of surveying what people need, but it is a community organizing strategy.
By rigorously and creatively assessing community needs, the process gives real ‘voice’ to individuals
in the community…voices that can significantly influence program design.” [4]
4
3. Planning is the natural progression from assessing community needs. Now that the information
is available, your team takes action to develop the Community Action Plan for change.
4. Implementation is executing the plan you have developed, in collaboration with the community
team, stakeholders, and partners. Implementation requires maintenance of the commitment and
ownership established in the beginning; without this support the plan can fall apart.
5. Evaluation is woven throughout the community change process and provides the basis for
answering key questions: Are you implementing the right strategies? Are you creating the
measurable impact envisioned? Evaluation, whether formal or informal, gathers lessons from
what you are doing and provides recommendations for what can be done in the future.
Evaluation also helps to inform key decision makers. Evaluation is listed as the final component
of this cyclical process, but it should be considered from the beginning and included
throughout all phases.
Purpose of CHANGE
The purpose of the CHANGE tool is to enable local stakeholders and community team members
to survey and identify community strengths and areas for improvement regarding current policy,
systems, and environmental change strategies. The definitions of policy change, systems change, and
environmental change are below. These terms and others used in the CHANGE tool itself are in the
Glossary of Terms (Appendix A).
Policy change:
Laws, regulations, rules, protocols, and procedures, designed to guide or influence behavior. Policies
can be either legislative or organizational in nature. Policies often mandate environmental changes
and increase the likelihood that they will become institutionalized or sustainable. Examples of
legislative policies include taxes on tobacco products, provision of county or city public land for green
spaces or farmers’ markets, regulations governing the National School Lunch Program, and clean
indoor air laws. Examples of organizational policies include schools requiring healthy food options
for all students, a district ban on the sale of less than healthy foods throughout the school day, menu
labeling in restaurants, required quality assurance protocols or practices (e.g., clinical care processes),
or a human resources policy that requires healthy foods to be served at meetings.
Systems change:
Change that impacts all elements, including social norms of an organization, institution, or system;
may include a policy or environmental change strategy. Policies are often the driving force behind
systems change. Examples are implementing the National School Lunch Program across the state
school system or ensuring a hospital system goes tobacco free.
5
Environmental change (Environment):
Physical, social, or economic factors designed to influence people’s practices and behaviors. Examples
of alterations or changes to the environment include:
▪ Physical: Structural changes or the presence of programs or services, including the presence of
healthy food choices in restaurants or cafeterias, improvements in the built environment to
promote walking (e.g., walking paths), the availability of smoking cessation services to patients or
workers, and the presence of comprehensive school health education curricula in schools.
▪ Social: A positive change in attitudes or behavior about policies that promote health or an increase
in supportive attitudes regarding a health practice, including an increase in favorable attitudes
of community decision makers about the importance of nonsmoking policies or an increase in
nonacceptance of exposure to second-hand smoke from the general public.
▪ Economic: The presence of financial disincentives or incentives to encourage a desired behavior,
including charging higher prices for tobacco products to decrease their use or the provision of
nonsmoker health insurance discounts.
The CHANGE tool has four key objectives and three benefits.
Objectives:
▪ Identify community strengths and areas for improvement.
▪ Identify and understand the status of community health needs.
▪ Define improvement areas to guide the community toward implementing and sustaining policy,
systems, and environmental changes around healthy living strategies (e.g., increased physical
activity, improved nutrition, reduced tobacco use and exposure, and chronic disease management).
▪ Assist with prioritizing community needs and consider appropriate allocation of available resources.
Benefits:
▪ Allows local stakeholders to work together in a collaborative process to survey their community.
▪ Offers suggestions and examples of policy, systems, and environmental change strategies.
▪ Provides feedback to communities as they instit
