Module 1 > The need for systems change

Too often, we wait to act until after disaster strikes. That leaves us with fewer options—we're left picking up the pieces, rather than anticipating, preventing, and addressing traumatic experiences. While repair, reconstruction, and at times relocation are essential elements of disaster response to ensure the immediate safety of community members, we need to identify ways to build community resilience before the storm. This means looking at the systems that shape our community environment such as the education system, food system, transportation system, and many others. The impact of these systems on people’s health and wellbeing is even greater than the impact of the quality of their healthcare. Changing larger systems can help get to the root of factors that contribute to suicide risk. For example, rather than addressing financial loss, a suicide risk factor, one person at a time, policies that focus on economic security can address and prevent suicide and multiple other negative health outcomes.

In some cases, catastrophic events can accelerate systems change. During the COVID-19 pandemic, due to an increased reliance on the internet, some communities were able to address long-standing issues for digital connectivity and increase broadband internet access. 



Systems of Power, Root Causes, and Health Outcomes

Understanding how health inequities have been produced sheds light on the path forward to changing systems and addressing inequities. In this brief, Countering the Production of Health Inequities: Ensuring the Opportunity for Health for All, Prevention Institute analyzes how various sectors such as housing, education, and economic development have contributed to inequities in health but also have important roles to play in advancing an equitable culture of health.

The Center for Health Equity in Louisville, Kentucky 2017 report “Uncovering the Root Causes of our Health,” uses the analogy of a tree. Health outcomes, including asthma, heart disease, and cancer, are represented by the leaves of the tree. The health of the leaves reflects the quality of eleven “root causes”that are the social determinants of health. These root causes are neighborhood development, housing, transportation, criminal justice, early childhood development, education, health and human services, environmental quality, built environment, food systems, and employment and income. The soil that nourishes the roots are the “systems of power,” such as racism and sexism, which define how different people experience root causes.

Reflection Questions

  1. What are some of the key root issues in your community? How might these relate to suicide?

  2. What is the impact of systems of power on these root causes?

  3. What does the course of the COVID-19 pandemic in your community show about the state of the “roots” and the “soil”?

  4. How might hazard mitigation planning shore up the “roots” and the “ground” in your community as a proactive approach to catastrophic events and infrastructure disruptions?

Lack of basic supports such as housing and income stability makes life difficult during “normal” times and can be especially detrimental to wellbeing during infrastructure disruptions. Policymakers should consider policy changes that strengthen these systems as they engage in efforts to be proactive, not just reactive, to catastrophic events and infrastructure disruption. CDC’s Suicide Prevention Technical Package  features evidenced-based systems approaches for decreasing suicide risk, such as strengthening household financial security and housing stabilization policies and assuring coverage of mental health services.

THRIVE (Tool for Health & Resilience In Vulnerable Environments) enables communities to design their own strategies to improve health and safety, and promote health equity. Click on the assessment tool link for a template that can be adapted to engage community members and practitioners in assessing and prioritizing the community determinants of health, safety, and wellbeing, and taking action to change them. We will revisit THRIVE in module 2.

Reflection Questions

Consider how you might begin an assessment in your community.

  1. What information do you already have?
  2. What more do you need to learn?

Complete Module  1