The System exChange
The System exChange provides powerful tips and ideas for transforming your local community.
The last issue of the System exChange introduced the Root Cause Analysis process. Click here to read past issues.

This week's System exChange builds on these ideas and highlights ways to design powerful strategies.
What is a powerful strategy?
Powerful strategies shift the status quo . They are designed to change community system conditions (versus just individual behaviors) in ways that promote local health equity and wellbeing (Carey & Crammond, 2015; Meadows, 2008).

Powerful strategies are able to:
  • Transform the purpose and goals driving organizations, institutions, initiatives, & communities.
  • Create new narratives that shift local assumptions about how to solve community problems
  • Expand boundaries around which settings/stakeholders have power and influence
  • Shift policies, rules, and protocols that drive local behavior and influence how work is done. 
  • Create opportunities for improved living, working, schooling, and playing conditions
  • Promote new roles and relationships across settings, stakeholders, and residents, including who is responsible for health and who is an actor of change.

Powerful Strategy Approach:
Tackle Multiple Outcomes
Change efforts can be a burden to many communities , as residents, staff and leaders struggle to integrate something else into an already packed schedule or stressful situation. Stakeholders can begin to feel that change is not possible just because of the sheer quantity of work ahead.

One way to reduce this tension, and to build more powerful strategies, is to design strategies to simultaneously tackle multiple outcomes , such as multiple social determinants or community system conditions.
Case Example of Tackling Multiple Outcomes

The Delta Health Center in Mound Bayou, Mississippi provides primary medical services while simultaneously addressing multiple local social determinants of health. The table to the right summarizes the center's strategy activities.

Strategy Outcomes :
  • Helped 1,000 families grow vegetables instead of cotton, sharing the harvest and selling the surplus in local markets.
  • Within the first eight years, the center helped 7 physicians, 5 doctors, 2 engineers, 12 registered nurses, and 6 social workers get their degrees.
  • As a result of hiring local residents within the bank branch, racial discrimination in mortgage lending practices decreased, which benefited home ownership.

 Additional Resources
Use this checklist to design powerful strategies to address local problems and inequities.
A BLe Change Manual
Refer to pages 189-300 in your ABLe Manual for more on designing powerful strategies.
If you find this publication useful, forward to your colleagues and encourage them to subscribe!

Want access to more information about community transformation? Check out the Michigan CHIR Learning website !! This website includes information, tools, and resources to help support local collaborative efforts.
February 2020
This ABLe exChange update is distributed to ABLe Change Training participants. It is intended to provide information to support your future efforts. Have an idea for a future update? Email us at:
  • Carey, G., & Crammond, B. (2015). Systems change for the social determinants of health. BMC public health, 15(1), 662.
  • Lounsbury, D. W., & Mitchell, S. G. (2009). Introduction to special issue on social ecological approaches to community health research and action. American Journal of Community Psychology, 44(3-4), 213-220.
  • Meadows, D. (1999). Leverage Points: Places to Intervene in a System. Hartland, Vermont, USA: The Sustainability Institute.
  • Phelan, J. C., Link, B. G., & Tehranifar, P. (2010). Social conditions as fundamental causes of health inequalities: Theory, evidence, and policy implications. Journal of Health and Social Behavior51(1_suppl), S28-S40.
  • Stroh, D. P. (2015). Systems thinking for social change. White River Junction, VT: Chelsea Green Publishing