Population approach

The population approach involves multifaceted strategies targeted at all levels of

population regardless of risk. This approach embraces intersectoral collaborative efforts and
thinking beyond the traditional biomedical model of care towards the recognition of the
social model. Entire population prevention includes legislation or regulation, fiscal
incentives, social marketing and provision of health information to an entire population as
well as structural and environmental measures (e.g., new infrastructure for active commuting,
such as cycle lanes). Targeting policy, structural and environmental factors has been
advocated and recommended throughout from major agencies such as the World Health
Organization (WHO) and the Centre for Disease Control and Prevention (CDC) in the US.

There are strong indications that population-based interventions aimed at modifiable

risk factors can reduce incidence of diabetes. While the primary aim has usually not been
T2D prevention specifically, their contributions to this goal are significant and considerable.
In fact, since most noncommunicable diseases share common behavioural risk factors, the
population-based prevention has shown to even lower blood pressure and cardiovascular risk-
factors leading to the advantage of “spill-over” effects. The sugar-sweetened beverage tax
policy in Mexico provides one such example of a population wide strategy. In January 2014,
Mexico implemented a nationwide tax on drinks containing added sugar that increased prices
by over 10% Even tough, drawing far-reaching conclusions about the effectiveness of this
policy is too early, estimates have shown that the 10% increase in price of added-sugar drinks
was associated with an 11.6% decrease in quantity consumed. Furthermore, purchases of
these drinks were decreased by an average of 6% during the first year of implementation and
more prominent reductions were seen in households of lower socioeconomic status. A
similar approach was implemented in the UK in April 2018 and initial analysis have shown a
reduction of sugary drinks consumed of up to 30%.

Another landmark example of a model for chronic disease prevention by the CDC in
America to combat the rise of noncommunicable diseases like T2D was the STEP Program.
This large-scale implementation program was developed back in 2008 when common
realizations concluded that characteristics of a healthy community were interdependent on the
need for altering social and built environments to support healthier living and healthier
behavioural changes. The STEP program implemented a sustainable, practice or evidence-
based policy, systems and environmental changes to prevent and control rising rates of
common NCDs including T2D. The approach was to build environments (eg, sidewalks,
bicycle paths and walking trails to promote physical activity); conduct wide-spread
availability and accessibility of population-based health programs to increase awareness;
(school-based health education policies); increase access to healthy foods (by providing
incentives and vouchers to increase fruit and vegetable consumption, increased number of
farmer markets and restrict number of fast-food joints in localities.) The effectiveness of
STEP Program was recognized in report by Trust for America’s Health to be highly cost-
effective in the long run and lead to the reduction of modifiable risk factors by a significant
amount.