Glasgow et al. (1999) suggests that there is a need to re-frame chronic diseases, such as diabetes, from a clinical disease to a public health issue. This important perspective briefly acknowledges issues of equity and an enhanced patient/community quality of life in the context of the broader factors that influence self-management and patient care, but stops short of a full exploration of the implications for outcome measurement. The population health approach requires an explicit examination of the determinants of health. This requires the measurement of distribution of outcome indicators, such as the incidence of diabetes by such variables as income and education.