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• Background on Environment & Policy Initiatives
• Evidence on Environment & Policy Initiatives
• Example Environment & Policy Initiatives
• Action Steps to Create and Implement Environment & Policy Initiatives
• Tools and Resources for Environment & Policy Initiatives
• Evaluation of Environment & Policy Initiatives

Environment and policy initiatives are designed to create healthy places and practices to support healthy community members. Environmental changes are designed to change structures and physical surroundings in ways that improve individuals’ capacity to prevent or manage diabetes in order to impact their own health or the health of those around them. Policy changes are laws or regulations that are put in place to achieve a goal, including organizational policies or public policies at the local, state or national levels. Policies are an important way to focus on the social, economic, and environmental factors that serve to create and or enable individual prevention or management.

Environment and policy initiatives can support:

• improved diabetes-related behaviors (e.g., glucose monitoring, taking medications, nutrition, physical activity);
• ways to change individuals’ lifestyle patterns by increasing access to resources (e.g., diabetes test kits, diabetes medications, nutritious foods and drinks, facilities for physical activity) and reducing barriers to prevention and management of diabetes (e.g., cost of resources, transportation).

Environment and policy initiatives are attractive because they have the potential to reach all community members and create community changes that last much longer than most other types of interventions. It is believed that changes in environments and policies are critical to creating broad-based changes in diabetes. In order to create policies and environments that support diabetes prevention and management patterns in your organization, you may need to work with management and decision-makers to decide what makes sense for the organization (e.g., changes to vending machines, installing on-site physical activity facilities). Likewise, in the community, you may want to meet with local organizations (e.g., businesses, educational institutions, community organizations) to decide what can be implemented as well as policy- and decision-makers to develop, enforce, and evaluate these policies and changes to the environment.

Environmental changes and policy initiatives to prevent diabetes and improve diabetes management have included: development of diabetes registries and protocols for care, provision of medical supplies, and changes in access to healthy foods and changes in access to places to be physically active. These are summarized below:

Development of diabetes registries and protocols for care: These initiatives have been developed to enhance tracking and monitoring of individuals with diabetes.  In addition, protocols for care can provide cues to action for physicians to check certain individuals at risk and to engage in particular clinical practices (e.g., checking eyes and feet).

Provision of medical supplies: In some instances clinics and individuals may not have the access to medical supplies required for self-management or clinical assessment related to diabetes. Some programs have provided glucose monitors to individuals with diabetes while others have provided medical supplies required to examine eyes.

Changes in access to healthy foods: There are many different ways that people have suggested improving access to healthy foods (see Nutrition environmental and policy changes).  Some programs have focused specifically on diabetes prevention and management and have eliminated all but sugar free beverages from school vending machines. Others have created changes in snacks and meals available at schools or developed community gardens. 

Changes in access to places to be physically active: There are many different ways that people have suggested improving access to healthy foods (see Physical Activity environmental and policy changes) Some initiatives have developed walking trails or new wellness or fitness facilities to increase access to places for youth and adults to be physically active. Others have sought to create policies to increase the amount of time spent in physical education classes in schools. 

In order to create changes to policies and environments, you may need to work with decision-makers at worksites, schools, health care facilities, local government, or other community destinations. In addition, you might consider working with experts in public policy, law, advocacy, law enforcement, community organizing, insurance or other partners to decide what changes can be made to improve the community as well as how these changes can be promoted.

Intervention strategies such as group education sessions and campaigns and promotions are often used in conjunction with environment and policy initiatives. These strategies can be used to provide information to vendors, restaurants, bars, recreation centers, schools, workplaces, or other places on the importance of providing access to healthy choices.