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This document is an adaption of the Centers for Disease Control and Prevention’s (CDC) Community Health Assessment aNd Group Evaluation (CHANGE) Action Guide:  Building a Foundation of Knowledge to prioritize Community Needs.  This document shifted the information in the CHANGE Action Guide to provide guidance for tribes, tribal health programs, and tribal organizations in implementing policy, systems, and environmental (PSE) strategies to reduce chronic disease.  Prior to implementing these strategies it is suggested tribal communities convene a Tribal Community Team (TCT).  The team serves to provide guidance, support and insight.  Implementing a culturally-competent and community sensitive strategy is essential to successful PSE change.  Definitions of underlined terms can be found in the section titled “Understanding Terms.”

PSE interventions are intended to:

• Implement Policy change including the passing of laws, ordinances, resolutions, mandates, regulations, or rules.  Examples:  Passing an ordinance allowing residents to plant community gardens in vacant lots, worksites establishing a policy that prohibits sugar-sweetened beverages from being served at meetings and events.
• Create systems change involving change made to the infrastructure, rules, or systems within an organization.  Systems change and policy change often work hand-in-hand.  Examples:  Train nurses, case-managers, and pharmacists in behavioral approaches that can improve patient adherence to diabetes medications.
• Implement environmental change which is a change made to the physical environment.  Examples:  Increasing access to cool drinking water in public places, posting no smoking signs, and creating environments that encourage physical activities such as walking and biking.

This guide intends to:

• Provide the opportunity to strengthen partnerships among tribes, local health departments (LHDs), schools, hospitals, clinical providers, and other community organizations;
• Direct clinics and tribes to additional resources available from the CDC and other public health agencies and tribal health programs;
• Provide PSE strategies for various sectors of the tribal community to address physical activity, nutrition, and chronic diseases.