ChangeLab Solutions’ story is about how profound change takes hold, not just in the health of individuals but in the health of communities. We work with community organizations, local institutions, and state and local governments to advance equitable laws and policies that help ensure that communities are healthy for all residents — especially in places where healthy options are not the norm.
Our interdisciplinary team of lawyers, planners, policy analysts, and other professionals works in every US state and in many territories and tribal nations, prioritizing communities whose residents are at highest risk for poor health. By analyzing existing policies, we help identify which innovative strategies will yield the most improvement in health and equity. Our collaborative approach, backed by research and evidence, seeks to undo the harms of structural racism and other forms of institutionalized discrimination that encumber underserved communities.
View our history timeline for a journey through our major milestones, and keep reading for a brief account of how we became the equity-focused organization that we are today.
Where We Started: Creating Smoke-Free Spaces
The image of an American office worker smoking at her desk evokes an earlier era; it’s a sight you would never see today. Just a few decades ago, smoking was extremely common in workplaces, restaurants, and homes around the nation. And the number of premature deaths due to smoking reflected that murky reality.
Norms related to smoking began to change in 1986, when Contra Costa County, located east of San Francisco, passed a groundbreaking piece of legislation. This ordinance was the first multi-city policy in the nation to restrict workplace smoking. Suddenly, office air was no longer toxic and workplaces were becoming healthier environments for employees. A key leader of this work was Marice Ashe, who later founded ChangeLab Solutions. After many years of working in local government, Ashe had started thinking about the supports that all communities would need to promote health through legally sound changes in laws and policies. In 1996, she started an organization to establish the groundwork for other communities that wanted to curb tobacco use, particularly among youth.
Since then, ChangeLab Solutions has provided legal assistance, trainings, and model tobacco control policies to every California county and to dozens of localities and states across the country. These policy changes helped Californians save $134 billion in health care costs and contributed to a 25% decrease in tobacco-related deaths. ChangeLab Solutions is proud to have been a major player in shifting social norms on smoking.
Going Nationwide: Addressing the Drivers of Health Inequity
While ChangeLab Solutions was working on tobacco control in California in the early 2000s, the United States was facing another public health issue: epidemic levels of childhood obesity. Building on the effective policy strategies we had honed for tobacco control, our staff began crafting model zoning and licensing laws to help rein in obesity and confront its underlying causes. We helped limit the proliferation of fast-food restaurants and created resources to help localities open new facilities for physical activity, including playgrounds and walking trails.
Because so many law and policy decisions affect community health, our staff branched out from tobacco control, leveraging their legal, policy, and planning expertise in many interrelated areas, including food systems; housing and transportation; schools and child care; the built environment; and family-supportive systems.
We also advocated for health in all policies — an interdisciplinary approach to improving health equity in communities by incorporating health, sustainability, and equity considerations into decision making across government agencies and policy areas. Government agencies collaborate to identify shared goals, maximize resources, align activities, and invest in big solutions that produce multiple benefits and serve community needs.
As the fields of public health, law, and policy began to focus on racial discrimination, poverty, and other social determinants of health as the key factors in poor health outcomes and disparities, we began to redefine our approach. Our organizational strategy is outlined in A Blueprint for Changemakers, which proposes that achieving health equity requires addressing the structural barriers to health, which we call the fundamental drivers of health inequity: structural discrimination and racism; income inequality and poverty; disparities in opportunity; disparities in political power; and governance that limits meaningful participation.
At ChangeLab Solutions, we believe that the most powerful risk factors in health are laws and policies that have perpetuated racism, discrimination, and segregation throughout our nation’s history. Using the tools of law and policy, we can undo the fundamental drivers of inequity and thereby increase health equity.
Where We’re Headed
Under the leadership of Sarah de Guia, who joined us as chief executive officer in 2019, ChangeLab Solutions will continue to learn from the work we’ve done and the partners we work with, breaking new ground to promote health equity and address the five fundamental drivers of health inequity.
We’ve found that solutions at the local level are often best able to address real-life community needs and test policy innovations. The most effective policies incorporate community insights and feedback, influence which behaviors are supported and encouraged, and reduce the health risks that residents are exposed to. Our equity-first approach ensures that community leaders are supported with resources designed to help them make profound changes that confront historical injustices and set a path toward a more equitable future.
Guided by these principles, we will expand our collaborations with communities across the country to increase access to safe, affordable housing; strengthen healthy food systems; advance health-promoting policies in rural areas; and transform the way policymakers think about land use, parental leave, and safe learning environments. Many more developments will unfold as we link health directly to civil rights law; address economic injustices; promote equitable enforcement of the law; and strengthen the authority of health departments to keep the public safe. As new public health challenges emerge, ChangeLab Solutions will continue to meet them, maintaining our steadfast commitment to policy change that counteracts the harms of structural discrimination and creates equitable, thriving communities.