Critical Components of Using a Systems Approach to Effect Environmental Asthma Policies and Reduce Health Disparities: An Evaluation of the Community Action to Fight Asthma Initiative in California

Purpose: The Community Action to Fight Asthma Initiative, which funds statewide local coalitions and technical assistance providers (now in its fifth year of funding), is employed as an example of using a systems approach to change environmental asthma policies. Critical systems change concepts are presented for communities to use in planning and implementing policies.

The Evaluation included • Outcome measures for policy formulation and implementation, • Policymaker surveys, • Media Usage, • Qualitative and quantitative data. Policy outcomes were categorized into: • Indoor air quality in schools, • Indoor air quality in homes, • Outdoor air quality.

Systems change concepts and examples are discussed for community, regional, and statewide use to affect policy changes. These include: Designing synergistic systems aligning values, activities, and relationships; Developing collaborative planning and consensus building; Creating capacity using education, refining assumptions, and using data; Creating leaders, advocates, and champions; Employing communication strategies to enhance capacity and leadership development; Designing change efforts that are sensitive to community cultural and environmental factors; Instituting and reinforcing appropriate feedback loops; Assessing positive and negative unanticipated consequences; Addressing root causes of problems; Designing changes at appropriate systems levels; Addressing relevant interrelationships; Leveraging resources for sustainable funding; Shifting power among stakeholders.

Conclusion: Employing systems change concepts to evaluate this type of community-oriented environmental policy initiative provides valuable tools and feedback to the participants and the funder (The California Endowment). Using these methods can facilitate effective policies and outcomes.