A district plans two strategies against hypertension. Strategy 1 treats individuals whose blood pressure exceeds 160/100 mmHg. Strategy 2 reduces salt intake across the entire population through food labelling reform, shifting the whole blood pressure distribution leftward. According to Geoffrey Rose, the key theoretical advantage of Strategy 2 is that:

• A It produces a large benefit for each high-risk individual treated
• B It avoids any need for behaviour change among motivated individuals
• C A large number of people exposed to a small risk generate more cases than the few exposed to a big risk ✓
• D It targets resources only to those already above the treatment threshold

Explanation

Rose's population strategy rests on the observation that most cases in a community arise among the many people with modestly raised values, not the minority with extreme values, so shifting the whole distribution prevents more events than treating only tail individuals. Options A and D describe the high-risk strategy, which offers strong individual benefit but leaves the majority untouched. Option B is wrong because population strategies require widespread behaviour change and suffer from the prevention paradox.

Reference: Oxford Textbook of Public Health / Park's Textbook of Preventive and Social Medicine, Rose 1992; Park 27th ed.

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