Prioritizing Population Approaches in Cancer Prevention and Control: Results of a Case Study Evaluation of Policy, Systems, and Environmental Change

Abstract

Development and implementation of policy, systems, and environmental (PSE) change is a commonly used public health approach to reduce disease burden. The Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program conducted a demonstration with 13 programs to determine whether and to what extent dedicated resources would enhance the adoption of PSE strategies. This paper describes results of the qualitative portion of a longitudinal, mixed-methods evaluation of this demonstration. Case studies were conducted with a diverse subset of the 13 programs, and 106 in-depth interviews were completed with state/tribal program staff, community partners, and decision makers. Interviews addressed PSE change planning and capacity building, partnerships, local context, and how programs achieved PSE change. Dedicated PSE resources, including a policy analyst, helped increase PSE change capacity, intensify focus on PSE change overall, and accomplish specific PSE changes within individual jurisdictions. Stakeholders described PSE change as a gradual process requiring preparation and prioritization, strategic collaboration, and navigation of local context. Findings suggest that the demonstration program, including PSE-dedicated funds and a policy analyst, was successful in both increasing PSE change capacity and achieving PSE change itself. These results may be useful to other state, tribal, territorial, and public health organizations planning or implementing PSE change strategies.

Healthy Eating and Physical Activity Policy, Systems, and Environmental Strategies: A Content Analysis of Community Health Improvement Plans

“…However, few resources are available to guide communities and local public health systems through the development of comprehensive PSE strategies for inclusion in a CHIP that address additional key activities (21)(22)(23). Community workshops, trainings, and technical assistance have successfully guided communities through the process of multiple key activities to produce PSE-change (30,31). Alternatively, details about the strategies in our sample of CHIPs may be outlined elsewhere.…”

“…Conducting and supporting this activity requires a multidisciplinary coalition of actors (33). Taking steps toward assessing social and political environments may also address local context (e.g., economics, political climate and support), which can influence PSE implementation (31). CHIPs contained more PA-related PSE strategies, which exhibited greater alignment with key activities to facilitate change than HE PSE strategies.…”

Understanding the Neuroscience Underpinnings of Obesity and Depression: Implications for Policy Development and Public Health Practice

“…Although correlates such as neural pathways to food motivation can offer important insights for policy development and intervention design, most obesity prevention efforts in the United States do not apply neuroscience in their implementation, choosing to focus primarily on mitigating structural or environmental barriers to healthy eating ( 46 ). Unfortunately, data on these structural-level interventions have been mixed, suggesting this socio-ecological approach may be insufficient for fully changing individual consumption behaviors.…”

Still Lost in Transition? Perspectives of Ongoing Cancer Survivorship Care Needs from Comprehensive Cancer Control Programs, Survivors, and Health Care Providers

“…This work is informed by and aligns with the health impact pyramid [ 17 ], which depicts public health interventions that have the greatest potential to address social determinants of health and increase population impact on the bottom of the pyramid and interventions that require additional individual-level efforts on the top (see Figure 1 ). While providing individual-level education and implementing clinical interventions are important, public health practitioners also work with partners to implement evidence-based policy, systems, and environmental (PSE) change strategies that address factors such as socioeconomic status and the built environment that have greater population impact [ 18 , 19 ].…”