The Supersetting Approach
Why some community health initiatives change communities and most produce a portfolio of programs.
Good programs, flat results
Most community health initiatives run activities in many places at once. A clinic screens, a school teaches, a workplace offers a wellness program, a congregation hosts a health fair. Each activity can be well designed and well run, and the community can still end up no healthier, because the settings work in isolation and sometimes at cross purposes. What one setting builds, another quietly undoes.
Chronic disease is not produced in any single setting, and it cannot be prevented in one either. Diabetes, hypertension, and obesity grow out of the whole fabric of everyday life, where people learn, work, worship, shop, and live. Prevention has to work the same way.
What a supersetting is
In 2014, Paul Bloch and colleagues at the Steno Diabetes Center Copenhagen named the answer the supersetting approach. A supersetting is not just an initiative that works in multiple settings. It is an initiative where activities across settings are deliberately coordinated so they reinforce each other, producing synergy that no single setting could produce alone.
The approach rests on 5 principles:
Integration. Activities are implemented through coordinated actions across the boundaries of specific settings. Partners plan together, time their work together, and where possible act together.
Participation. The people the initiative serves take ownership of developing and implementing activities, rather than receiving programs designed for them by others.
Empowerment. People acquire the skills and competencies to express and act on their own needs and aspirations, so results outlast any single project.
Context. The everyday life challenges of citizens and professionals are respected and considered when activities are developed, because plans made at a distance from daily life get polite reception and low uptake.
Knowledge. Scientific knowledge is produced from action and used to inform action, so the initiative learns as it works and can show what changed.
Does it work?
The approach has been tested most thoroughly in Denmark. Project SoL applied it on the island of Bornholm from 2012 to 2015 and produced measurable changes in the food and activity practices of families with young children. Since 2015 it has guided Tingbjerg Changing Diabetes, a long-term initiative in one of Copenhagen's most disadvantaged neighborhoods.
In 2026, a register study in BMJ Open reported that type 2 diabetes incidence in Tingbjerg declined after 2015 while rising in Denmark as a whole. The study design cannot prove the interventions caused the decline, and the authors say so plainly. It is nonetheless the first documented reduction of its kind in a non-prescriptive, community-based initiative, and it is consistent with what the approach predicts.
The approach has also drawn recognition beyond Denmark. In 2024 the World Economic Forum and Deloitte featured Tingbjerg and the 5 principles in their guide to place-based health change, a sign that institutions well outside Danish public health now take the model seriously.
The research is equally honest about what makes these initiatives fragile. A 3-year follow-up of Project SoL found that when the coordinator position ended, coordinated action across settings fell apart even though every partner stayed motivated. Coordination is not overhead. It is the mechanism.
My Experience: More than a decade of putting it to work
I have spent over 10 years applying the supersetting approach in American cities, in ongoing collaboration with Paul Bloch and his colleagues.
In 2014 I founded the Houston program of Cities Changing Diabetes, now Cities for Better Health, as the third city in what has grown into a global network of more than 50 cities on 5 continents. Bloch's thinking was the intellectual spine of how we built it. The Houston coalition governance and co-creation model I designed there is now referenced across the network.
Houston also became the first city in the network to engage houses of worship as a strategic health channel. That adaptation, applying supersetting principles to congregations, grew into the Southwest Houston FaithHealth Collaborative and the FaithHealth Leadership Cohort, which today connects congregations, clinics, and community organizations in coordinated work on cardiometabolic health.
From 2018 to 2022 I replicated the model in Philadelphia. Replication is where you learn what is principle and what is local habit. Some parts of the approach travel intact. Others must be rebuilt from local context every time, which is exactly what the context principle predicts.
How I work with this
I help coalitions, health departments, health systems, and funders turn a collection of programs into a supersetting. Depending on where you are, that can mean an honest assessment of your current initiative against the 5 principles, the design of coalition governance and co-creation processes, building the coordination capacity the Danish evidence shows is decisive, or an evaluation approach that produces knowledge from action instead of reports for the shelf.
Every engagement starts the same way, with a clear picture of where your synergy is leaking.
Start with a 8-minute diagnostic
I built a free self-assessment that scores your initiative against the 5 principles, shows your profile, and names your most specific weak points. It takes about 6 minutes, aboslutely nothing is stored, but you can send me your results for an informal conversation if you want one.
About this diagnostic. Developed by Klaus Madsen, Klaus Madsen Strategies, based on the supersetting approach described in Bloch P, Toft U, Reinbach HC, Clausen LT, Mikkelsen BE, Poulsen K, Jensen BB. Revitalizing the setting approach: supersettings for sustainable impact in community health promotion. International Journal of Behavioral Nutrition and Physical Activity 2014, 11:118. The 5 principles are Bloch and colleagues' work. The questions and scoring are Klaus Madsen's operationalization and have not been formally validated. This tool is for reflection and planning, not research measurement.
Research cited in the results. Olesen K, Stougård M, Rønn PF, Bloch P. BMJ Open 2026, 16:e111667. Pedersen AK, Toft U, Bloch P. Health Promotion International 2023, 38(3):daac035. Termansen T, Bloch P, Tørslev MK, Vardinghus-Nielsen H. BMC Public Health 2023, 23:392, and Health and Place 2023, 80:102996. Mikkelsen BE et al. IJERPH 2018, 15:1513. Bloch P et al. Diabetic Medicine 2024, 41:e15160.