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Introducing the Population Approach

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To implement health promotion interventions, population approach is known to be very effective. Then what is it? Take an example of a blood pressure control. In clinical medicine, health professionals tend to take a high-risk approach. And they treat them with medicine and medical consultations. However, population approach tries to target the entire population including those blood pressure is within normal range. It tries to reduce the risk of such a type of operation to avoid hypertension. This is population approach. One of the most successful cases is the CASH strategy taken in the United Kingdom. CASH stands for Consensus Action on Salt and Health. And they try to reduce the salt intake per day from 9.5 to 6.0 grams per day.
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As baseline, when they analyze the source of salt, they found 80% of salt were included in the processed food. In particular, bread. Then they gradually reduce the salt content in the bread over the years. Over ten years, they achieved 20% reduction of salt in the blood. And then what happened? First, as you can see in this figure, mortality reduced caused ischemic heart disease and stroke. And then, the average blood pressure of the population was also reduced. Third, although not shown in the figure, they could save more than 1.5 billion pounds per year. This is the power of population approach, which is a very very successful. Population approach, like CASH, is very successful, but not all the time.
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Scientists have observed some programs have increased inequalities in health. After an intervention, for example, only those who are at lower risk gained its benefit. Let’s see some examples. One of such cases is cervical cancer screening. In Ontario and the United States, when cervical cancer screening was done, rich women were more likely to attend the screening. And similar cases were also found for neonatal intensive care and smoking campaigns. To overcome this problem, we may have to take different approaches, not only on conducting population approach. We should not forget about the vulnerable population. Then what is vulnerable population? Let’s compare the difference between population at risk and vulnerable population.
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The population at risk is defined by a higher measured exposure to a specific risk factor, such as a high blood pressure. But, the vulnerable population and those who are at risk of risks. For example, aboriginal descent or people living in low-income countries, their income is low, education level is limited, and they tend to be exposed to multiple health threats with less access to health programs. They are vulernable.

In this video, we learn about the population approach. Using CASH as an example, Dr Jimba explains how population approach was used to reduce national salt intake in the UK. However, we must keep in mind that population approach is not a one-size-fits-all strategy. Despite the success of CASH, population approach was less beneficial in campaigns promoting cervical cancer screenings in Ontario and the US. Increasing inequality is a potential unwanted effect of the population approach. This brings us to the concept of vulnerable population.

Population approach has its pros and cons. It would be beneficial to read up on other 3 examples provided by Dr Jimba, in which population approach increased inequality between social groups. As you do, try to weigh the achieved health benefits against the disparity caused. Have the benefits outweighed the disparity? If you would like to share your thoughts please leave a comment in the comments section.

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This content is taken from Taipei Medical University online course
Capacity Building: Core Competencies for Health Promotion
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