Written by: Cynthia Feliciano (she/they)
Knowing that day by day challenges, misinformation, and attacks on our work to advance health and racial equity are at risk, it’s a heavy toll as a person and professional at this moment. It is a challenging time for all of us in the fields of public health, science, advocacy, civic engagement, civil rights, and others. We need to hold space to process for ourselves and others how to continue thinking of long-term goals when short-term goals are shifting constantly and need to be addressed. And there’s also fear of retaliation, (re)building trust with one another, and showing up authentically to sustain and maintain long term goals of our work. You know, life is life-ing for real at this moment!
While we acknowledge the container of the present moment and share the transparency of what we are all holding, we can collectively come together to support one another focusing on long-term goals and changes, what we call moving upstream in public health. Historically, our ancestors, leaders in communities and organizers have shown us how to address the current needs while thinking of the future infrastructure, organizing, and community-led needs so that when history repeats itself, we can harvest the lessons learned and continue to build an equitable future for all.
How, with so much uncertainty, do we take steps towards meeting this need while planning for long-term goals? Well, my friends, it all starts with small, slow steps. The first step I took in understanding how to avoid the energy of doom and gloom, (which is tempting, and I have my days that I must feel it!), was to learn about a strategy that can help with lasting change. What I discovered was the Policy, Systems, and Environmental (PSE) change strategies.
The PSE change strategies help you think about what current changes need to happen to address long-term goals for you personally, professionally, and in your community. PSE change is #upstream work. It consists of interventions to reform fundamental social and economic structures that distribute wealth, power, opportunities and decision-making to those impacted the most. Policy change is the passing or changing of laws that involve key components of community engagement, partnerships and health and racial equity. Systems’ change creates fundamental shifts in how problems are solved and how resources and services get distributed. Finally, environmental changes involve the economic, social, or physical surroundings or context that affect health outcomes. 1 These PSE changes address long-term goals and approaches to reform the fundamental social, economic, and physical structures that distribute wealth, power, opportunities, and decision-making. 2 (If you are interested in learning more about PSE Change, view CHTI’s training here.)
Incorporating PSE change is a foundational framework in the design, planning, and implementation of our work, and is essential to address the current needs of the moment. This approach is critical to help bolster confidence individually, as a community member, as a co-worker, and as an incredible human being. PSE change helps to build community power, establish structures of power-sharing, and inspires creativity and multi-sector partnerships during challenging times.
I realized that I have carried the PSE change strategy with me throughout my career without knowing it. I started my career as a caring land steward growing cultural crops such as ají dulce, cilantro, and culantro for homemade sofrito at a small urban garden in Holyoke. I also advocated for cultural investments that includes arts, events, and storytelling. In this new environment (as I grew up in the rural area of Puerto Rico), which I now call my home, I asked questions to neighbors, organizations, and city officials about how to access land, resources, space, and made connections with other residents trying to do the same. We were all trying to find ways to change our physical context to have access to food, and art installations, which were all tied to PSE changes identified in my community.
I have always rooted my work with community engagement, power-sharing, and health and racial equity in the forefront- all key components needed for PSE changes. I would brainstorm policy ideas to advance food access while gardening in a local community garden, come up with artistic ideas of safer infrastructure while walking with friends or family members on sidewalks, or sit near a recently planted tree on a busy corridor with elders enjoying a nice steaming cup of cafecito. These activities are steppingstones of how PSE change can be designed, implemented, and evaluated. Most importantly, it is crucial to use PSE changes to continue to invest in the communities most affected by the current attacks. It is these individuals, community leaders, and organizations who have been planning on how to address the long-term goals while meeting the current needs. Therefore, it is crucial not only to address the need now but to create PSE changes that focus on #Upstreaming.
It brings me back to the most meaningful space of dreaming of power-building, which was with my abuela, peeling las habichuelas and chatting about the news, its impacts, and always ending with the saying “si yo puediera hacer algo, ¡ ‘tacho!…” (if I could do something, “slang word meaning you know what I mean?!”). It is a bit of a challenge to translate this quote from Spanish to English, because it comes with the heavy willingness and eagerness of excitement of community power to make a change for the greater good, but those who understand the slang, get it. From my personal experience to my academic and career journey the PSE change strategy language has become, “a tool in my toolbox” or my preference, “a seed in my garden”.
It is without a doubt an unprecedented, challenging, chaotic and exhausting time, yet it is one that has the upmost potential for creativity, bravery, and community power. It calls for a pivot to appreciate the moments of connections with nature, that makes us take slow steps and breathe to then make us walk the walk and talk the talk through long-term goals of health and racial equity. Now share your story, moments of connection with others and how it helps address the current moment and how #upstreaming the impacts and needs of today can be backed up with storytelling, arts, and science and data driven research. PSE provides examples for all of us to creatively come together and continue the momentum of equitable health for all.