Systems change is identifying and changing the various layers of our societies, communities, and environments that may intentionally or unintentionally contribute to negative health and social outcomes and disparities across different population groups. These changes can create a different context in which healthy and safe behaviors are the norm. Systems changes can include the creation or improvement of public policies, regulations, and community systems or structures.
Sometimes only one part of a system might need to change but other times, many parts of the system or an entire system itself needs to change. Practitioners should thus assess and create an action plan around the core components of systems change to identify an action plan for mending or changing systems or structures within their communities. Learn more about the core components of systems change.
It is very important that communities tailor their systems change efforts to the needs of their community and identify strategies that are appropriate (their local community buys into the effort) and feasible (there is capacity to do the work). In order to build this capacity and community buy-in, communities should focus on building strong and healthy coalitions. Learn more about building community coalitions to support systems change efforts.
An integral part of systems changes is a focus on policy. These can be broken down into a convenient framework for thinking about large and small policy decisions: Big P and Little P. Big P policies often refer to policy changes that are part of local, state, or national governments and include laws, regulations, or administrative actions that are decided upon by legislative or other authoritative bodies, executive action, or voting by the populace. Learn more about policy change and the connection to public health. Little P policies are typically done within organizations and can address internal practices and priorities, internal and external distribution of resources, and regulations. These types of policy changes can often create quicker “wins” and can often model the way to other organizations, which may lead to larger changes (including Big P changes) over time.
To create public policy (Big P) changes in a community, it is important to walk through the policy process. This provides a systematic way to develop policies locally that are aligned and responsive to community needs. Learn more about the CDC policy process and the five domains that lead communities to implementing a local policy. While state and national policies can be as important as local policies, note that the focus on any policy change within this Menu is at the local level, as communities likely have more opportunities to make an impact within their direct community and environment. This includes changes at the county, city/town, or neighborhood level.
Whether a community is focused on policy changes or changes to other systems/structures more broadly in communities, because of this expansive level, these efforts can affect the entire population within a community. While the subsequent reach of these efforts is admirable, these changes often do not address the true underlying conditions that most harmfully impact those who are part of groups that experience negative health outcomes more than others. Given this, there is a need to focus on deep equity, which involves partnership with those most impacted by health disparities in a community. Learn more about why we should focus on deep equity to reduce health disparities as part of this work.